The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder

by Judith L. Rapoport

One boy spends six hours a day washing himself—and still can't believe he will ever be clean. Another sufferer must check her stove hundreds of times daily to make sure she has turned it off. And one woman, in an effort to ensure that her eyebrows are symmetrical, finally plucks out every hair. All of these people are suffering from Obsessive-Compulsive Disorder (OCD), an emotionally debilitating sickness that afflicts up to six million Americans. Cleaning, counting, washing, avoiding, checking—these are some of the pointless rituals that sufferers are powerless to stop. Now a distinguished psychiatrist and expert on OCD reveals exciting breakthroughs in diagnosis, successful new behaviorist therapies and drug treatments, as well as lists of resources and references. Drawing on the extraordinary experiences of her patients, Dr. Judith Rapoport unravels the mysteries surrounding this irrational disorder . . . and provides prescriptions for action that promise hope and help.

Genres: Psychology, Nonfiction, Mental Health, Science, Self Help, Mental Illness, Health

304 pages, Mass Market Paperback

First published January 1, 1989

Reviews

[Rand]

Found this one while compulsively checking the books left in a neighbor's blue recycling bin.

It's Crazy, But I Can't Help Myself.

Read most of it; was off-put by the heavy reliance on anecdotes and the repeated assurance that Anafranil is the answer for an individual's mastery of their mind. Rapoport does discuss some behavioral therapies but those methods are depicted as being 1) secondary to pharmaceuticals and 2) wholly dependent upon the specifics of an individual's case. Which, in my heavily biased view, is highly unfortunate.

Some of the stories in this book are humorous, such as the boy who was haunted by the thought that the LSD he ingested once (over two years prior to his treatment with the author) had radically altered his mind. After switching to regular doses of Anafranil + therapy, that young man is now on the fast track to success!

The appendix on the religious perspective of OCD was VERY interesting, despite its exclusive focus on the Judeo-Christian tradition. Brief mention is made of the Hindu rituals used to treat OCD but no particulars are given. You can read the appendix for yourself here, which is well worth doing if you are interested in how Judeo-Christian thought has become more and more psychologically-oriented over time (the chart which compares the definitions of OCD and "scrupulosity" is particularly interesting.) On the Jewish side of the Western tradition, there is Hatarat Nedarim, the formula for annulment of vows. An anecdote is provided of a Rabbi with a degree in psych who treats a young man troubled by conflicting vows taken as part of his faith.

There are many useful things about religion and belief but being a net for OCD is something else. Not exactly useful but not exactly useless either. Just a thing. Entire libraries have been written on how external verification of the sanctity of belief legitimatizes blind rituals. ( Some described ritual as a form of collective obsession, and others saw obsession as a private religious ritual. )

Personally, I know two people who have plucked out all of their eyebrows, in the vain attempt to "make them both appear even". Apparently this was done in Ancient Egypt as a mourning practice, but I digress. Are digressions a compulsion also?

Does my spell-check also dew gramma?

Was not going to write about this but the damn book has been occupying valuable space on my nightstand and I have read enough of it to know that I do not wish to finish it but, still, I was prompted to revisit this particular briar patch upon seeing The Mindfulness Workbook for OCD A Guide to Overcoming Obsessions and Compulsions Using Mindfulness and Cognitive Behavioral Therapy listed in the Goodreads giveaway listings, which I compulsively check every few days. Even so, I need to discard Rapoport's pop-psych pap to make room for other stuff and things in ye olde brain/vat, because

Part of me cannot stop pricking this book up and flipping through its flipping pages every few flipping hours.

Rapoport does not raise nearly as many questions as other books on this subject do, though to give her credit, she was something of a vanguard in explaining this diagnosis to the unwashed masses. She does hint at the emergence of a biological cause for OCD but neuroscience in the 1980s was not what it is now, obviously, as several lines of evidence suggest that abnormal glutamate neurotransmission may contribute to the pathogenesis of OCD.

And no, Rapoport does not make the self-other connection with regards to the obsessive cataloguing of mental deviance which she and others in her profession undertake. Nor does she make the connection as to how internal thoughts can manifest an external reality. Because, you know, that's some Eastern panpsychic hogwash right there, buddy.

I'm gonna go smoke a cigarette now.

[CMT-Michigan · Rating 3 out of 5]

If you ask around, many people would probably say they are "a little obsessive-compulsive." It's one of those phrases I find myself cringing at the overusage of. Another one would be "I'm so depressed" or "he's totally insane." These are medical terms for actual diagnosed disorders, and I feel it takes something away from those that suffer from the actual diseases.

Obsessive-complusiveness disorder usually exhibits itself in a person who has obsessive thoughts they cannot control. To "rid themselves" of these thoughts, they have a compulsive ritual they do. It interferes with their life, and they try very hard to change it, but it's nearly impossible.

For example, a person may obsess over having their hands being dirty. Even though everyone says they are clean, the person can almost feel the dirt, and will wash their hands for what amounts to hours a day. This will cause their hands to chap and bleed, but they cannot stop. They are NOT crazy, but this is obviously a problem.

The book discusses some of the brain activity of these disorders and possible psychologial causes, as well. It also discusses treatment and has a test to see if a person might actually have OCD. But it mostly focuses on patients in their specific study and how they reacted to a specific drug they had created to help with the disorder. OCD is still something we are learning about, and many new developments in the disorder have occured since this book's publication.

I realized I was reading a book about one specific clinic/company, but I was still a bit disappointed that the book focused so much on this supposed "wonderdrug" to "cure" OCD. I did find the cases to be very interesting, however. Next time I will stick with a more unbiased book that gets more in depth with possible causes and various types of cures.

[nicole · Rating 3 out of 5]

Reading this was as helpful and hurtful as my other OCD related reads. I appreciate knowing that my brother is not alone and finding the similarities between his case and others. It was scary to notice that I have some of these attributes as well, although not to the rehabilitating extent that my brother does.

But there were also tremendously frustrating things about this look, such as the noticeable absence of citing loss as a trigger. Over and over again, these stories all seem to start with a patience experiencing an unexpected death to someone very close to them, with the resulting habits forming to help with sense-making of the world in the wake of that tragedy. Yet, not a word was spent on making this connection. The whole work also felt like a giant ad for Anafranil, which isn’t what my brother is taking (and if it’s so good then why not) and wasn’t available in the US at the time of the book’s initial printing, and it’s 13 years later anyway, so where is an updated copy with more correct information? It’s a bit past due if this is still being cited as one of the top picks for understanding the disease. It is really hard to find a book that explains this, and more needs to be explained, and done for this issue.

There were some remarks about marriage and divorce statistics for those with OCD made it hard for me to recommend this to my brother. I will always have hope that he will have a bright and happy future, once he established the routines, tools, and support that he needs for his ongoing struggle. But he’s started to seek cognitive behavior therapy, and that is a step in the right direction.

[Jill · Rating 3 out of 5]

A basic intro to OCD through a series of case studies. The work is quite dated in terms of recommendation of Tricyclic medication as a cure, as well as some of the language. Since the author was such a big proponent of Anafranil, I had to wonder if the manufacturer funded her research. Also very little to no mention of therapeutic intervention apart from meds, but this was written by a psychiatrist. I'd be interested in seeing how this book could be updated.

[Kellie · Rating 5 out of 5]

Wow. This really helps people understand the difference between obsessive actions, compulsions, and every day quirks. Sad stories. Again,I was psych major for 3 years and so this stuff appeals to me, but I still think most people would find the book interesting.

[Aurélien Thomas · Rating 3 out of 5]

Everybody knows (or think they know) about OCD, this 'strange and fascinating illness of rituals and doubts run wild.' OCD is, indeed, fascinating, and very weird to say the least! As the author points:

'A major feature, and a strange one, of Obsessive-Compulsive-Disorder is the inability to be reassured by the senses. Obsessives have lost their ability to 'know' certain simple things that we all take for granted, things that we all constantly check for by some mechanism of which we are unaware, except when it doesn't work.'.

Sufferers perfectly know that their fears and obsessions are irrational. They know their rituals to be unnecessary. And, yet, they can't but burry themselves into their anxieties and debilitating rituals to such a point that they completely loose control of their lives. How people can enslave themselves to their own mind gone wild is baffling! So what is behind OCD?

Dr Judith Rapoport is a child psychiatrist trying here to make sense of what she sees in patients coming through her door. Before taking the floor to offer her insights as a scientist, though, she lets patients tell their stories first. These personal stories of people from all different backgrounds are moving. They make it easier to get the draining impact of such a condition (coming in all different guises) in someone's and their relatives lives - the anxieties, embrassement, pain, lack of control, debilitating consequences... More moving and harrowing is that such testimonies also involve children, having their childhood ripped apart by their OCD (the title of the book refers to one of them, a fourteen years old boy obsessed with washing).

Beyond the personal, the author then moves on to offer her own part of the story as a clinician. She obviously discusses various treatments available - from the history of various therapies to different medications (clomipramine, fluoxetine...). She, above all, uses ethology and neuro-ethology to try and shed light on such baffling comportments; seeing in the spectrum of OCD-related behaviours (grooming, ritualising, collecting/ hoarding...) links to our evolutionary past.

'the parallel between OCD and animal behaviours is compelling. The built-in patterns document some stored knowledge that serves an ancient purpose. Cleaning, avoiding, checking, and repeating relate to the most basic preoccupations of cleanliness, safety, aggression and sex. When they are carried out out of context, they make no sense.'

More than a century ago, von Economo already had pointed to neurological illness producing obsessions and compulsions (so, no, OCD is not the product of a 'poor upbringing'; it's all in the brain indeed!). But delving into the human brain from such a neuro-ethological perspective she reveals deeper and fascinating insights, taking our understanding even further!

Here's a compelling book. Sure, it was first published in 1990, and, we know have a better grip of what OCD is all about. Yet, this book remains a classic, and it's not difficult to fathom why: an engaging read, its fascinating and still relevant outlook, backed up by moving stories, still is a key in understanding OCD. Impressive.

[Janette Townend · Rating 5 out of 5]

I would recommend this book to those who are interested in finding out more about OCD and those who may have to deal with this often debilitating disorder. OCD has been described as a pervasive pattern of preoccupation with interpersonal control at the expense of flexibility, openness and efficiency. It most often begins in childhood and early adolescence and presents in many different ways. Statistics suggest that one in 50 people in living the UK today are likely to be affected in some way and it is sometimes mistakenly diagnosed as other medical and mental health conditions such as: asthma, eczema and schizophrenia etc.

Dr Rappaport writes about what she has learned from her patients by just listening and watching, and from the remarkable coincidences she has found in her research, on the frequency of the disease, on the new treatments, and on abnormalities of the brain in OCD, that came together while she was doing this. She uses case studies to illustrate how treatments such as behaviour therapy and chemical, e,g,Clomipromine have often been successful in relieve the symptoms. My copy of this book was published in 1990 and I am sure things will have moved on but the ground breaking research described in this book is still very relevant today I think.

[Louis · Rating 3 out of 5]

“Each time I swallowed I had to do something. For a while I had to touch my shoulders to my chin. I don’t know why. I had no reason. I was afraid. It was just so unpleasant if I didn’t. So I was late for school a lot.”

“Can telling jokes be a compulsion?
Murray, it turned out, was a compulsive joke teller. But he, or rather his problem, wasn’t funny, and had a lot of people fooled.
“I’ll be sitting in class, paying attention, and know the answers. Then, the thought ‘joke’ comes into my mind, and I have to start. You see,” he said in a rush, hardly able to talk fast enough, “it just hits. I raise my hand, start to giggle, and have to tell the jokes. It’s a kind of an attack or something. I know there is no discussion allowed in class, and the teacher will get mad, but I still can’t help it. So I say, ‘I have a joke to tell.’ The teacher says, ‘not now, Murray,’ but by then, I’ve already started.”

“Sometimes the pain dissipates through an escape into sleep. Sometimes.”

“What are they, these rituals? Sometimes I fantasize that they're like a virus, a foreign invader that simply needs to be expunged. Occasionally, more bemusedly than sadly, I would imagine myself being the controlled pawn of observers from outer space.”

“Genetics. Predisposition. Activate the right buttons. Anxiety. Order. Ritualize. Twitch, twitch. The rituals must be comprehensive. They must be strong. To be strong means they tend to be complicated, tedious, taxing. The more serious the danger, the greater the required salutary efforts. No one said this was going to be easy. Be strong. Fight. It is a huge responsibility you've got. Such power! Brook no weakness. If you're weak, the forces of evil will triumph. Resist. Fight. Survive. Power. My magic is powerful. It must be powerful. Look at what it's up against. I must be careful. Always so. But why?”

“The secrecy inherent in this disorder is the first and sometimes greatest enemy to overcome. The apparent normalcy of even the most severe and unusual compulsions creates a unique situation that permits the patient to suffer secretly.”

[Connie · Rating 4 out of 5]

In-depth look at the intricate behaviors and thought processes of those with obsessive-compulsive disorder told from the perspective of the patients themselves as well as the clinicians who specialize in treating them. Endlessly fascinating and often heartbreaking, this book provides a rare window into a little understood illness. The author's use of case studies reads like a novel. No heavy lifting of scientific jargon is required.

[Lee Rowan · Rating 5 out of 5]

Very good general-access info for people who hear about OCD but don't really know what it means or how bad it is for people who have it. Another reviewer called it "dated" but I think that's irrelevant; it is a good, solid exposition of what OCD means.

[Rhonda D. · Rating 3 out of 5]

This book really helped me understand the disorder. The case study style was easy to read. I wished there was an updated version with more current interventions.

[Alice Wardle · Rating 5 out of 5]

This was one of the best books I have read concerning the subjective experiences of people with obsessive-compulsive disorder. I cannot recommend this book enough for anyone interested in the condition.

OCD is characterised by obsessions and compulsions. For example, a common theme in the disorder is cleaning. Some people with the condition obsess over germs, and so they clean to get rid of the thoughts about potential disease. Another theme involves checking; checking they did not accidentally leave the oven on, they locked the door, they switched the light switch off in the other room. Though most people without the condition might do these things, people with OCD will dedicate hours of their day dedicated to rituals.

The book is clearly a bit outdated (first published in 1989), as so much research has occurred since then. What's particularly interesting is how different people's obsessions and compulsions can be, yet, they all involve the same neural mechanisms going awry.

In more recent times, we see how OCD can change in the way it presents itself depending on social culture. For example, Anorexia Nervosa has been associated with OCD, and this theme has become prevalent mostly in females in the past decade in particular. This is an incredibly dangerous form of OCD, as it instantly puts lives at risk. Now more than ever before, it is essential for people's experiences to be heard and for people to know they are not alone in this. This book was an early first step in doing this.

[Mollie · Rating 3 out of 5]

It is probably unfair for me to rate this book since it was written 30 yeas ago and we know so much more now about OCD and possible treatments. The "experimental" drugs in the book are now readily available and frequently used and some references have been updated. We now know that some of the cases that she only suspected were OCD actually ARE OCD according to the most recent DSM.

Despite its being dated, I still liked reading this book. As someone with OCD, it is always a nice relief to hear from people who can accurately describe the way the obsessions and compulsions actually feel. I also commend the author for looking at this disorder differently than so many other in the past and trying to find new ways to treat it. I think this book is still relevant at the very least for the stories of the people Judith Rapoport has treated.

[Arliegh Kovacs · Rating 4 out of 5]

Judith Rapoport did some of the first studies on OCD. This was written/published in 1989 so, while it doesn't have the latest information on the subject, it is an excellent book to read on the beginning of understanding what it is like to have, or to live with someone with this condition. It also makes clear the differences between those who are primarily driven by compulsions and those who cannot help obsessive. The case studies and sections in the patients' own words make this an especially valuable book to read.

[Abigail G · Rating 4 out of 5]

A clear view into the early years of discovering the extensiveness of OCD. It was interesting to learn the exact classifications and requirement to be diagnosed as having OCD. That the author mixed together the stories and the medical information made reading the book easy. It is interesting to realize that while their have been advancements in this field since this book was written the facts in this book still apply to the foundational aspects of the disorder, especially since the author willing stated that it is in progress and each year more and more will be discovered.

[Stefania · Rating 4 out of 5]

Great book. I really wish there was an updated version...since this one was written over 30 years ago. So much has changed in how mental disorders are seen and can be treated with therapy and newer drugs. Can provide comfort to people with OCD and families with loved ones who suffer from it.

[engelisse · Rating 3 out of 5]

Very informative to be honest, would’ve never know that OCD can manifest mays as shown and the book. Talking about cases and trying to be to remove the stigma around it is always great — could’ve been 100 pages shorter though

[Amie Olsen · Rating 5 out of 5]

This is a great book for people who don’t have ocd but want to understand it better! It gave me a lot of insight on a family illness that I don’t suffer from personally.

[Kathryn · Rating 5 out of 5]

I read this in college and I was hooked on psych theory. The stories were fascinating. I read this again and again.

[Vicki Gooding · Rating 4 out of 5]

Fascinating and informative. A story of a young man and repetitive, frustrating behaviors of an OCD

[Kathy Krieg · Rating 5 out of 5]

Very helpful, helped me understand obsessive-compulsive disorder much better.

[Dana Palmieri · Rating 4 out of 5]

Excellent story. I loved it. I couldn't put it down.

[Jan Stewart · Rating 5 out of 5]

I consider this the best foundational book on OCD, even though it is quite old and some of the info is dated. I have re-read it many times. It really gives the reader a great feel for OCD.

[Tate Hopson · Rating 3 out of 5]

had to read for ap psychology and it was entertaining enough but i went from reading 2-3 books a week to not finishing a single one all summer bc of this book

[Fiona McLaughlin · Rating 4 out of 5]

Super interest read, I felt I couldn’t put it down. Each story was fascinating.

[Hannah · Rating 5 out of 5]

Amazing

[Rose · Rating 5 out of 5]

Surprisingly compeling. More interesting that many other books I've read. Written in a story-telling style, rather than as a clinical dissertation. Not only informative but actually fascinating. Enjoyable and engaging. Definitely worth a read.

[Esther · Rating 3 out of 5]

This is book that I had to get for my psychology class. I did not finish reading it, but I did read a couple of parts of it. It is a book that has many different stories so for the purposes of my review, I am going to focus on one. I will say that this book is outdated so there is some language that is used that can be offensive to some people, but it wasn't offensive when they wrote it. The entire book include different case studies/stories of people who have an obsessive compulsive disorder. It is not just trying to keep things neat and clean, but something that is severe enough to disrupt daily life. The case study I read was The Auto Accident that Never Was. It is about a psychologist who has an obsessive compulsive disorder and how it affects his life. An anecdote from his young days shows him talking about how once, when he was going to take a test, he thought he had hit someone while driving. His disorder made him turn back not only once, but three times and then checks again after his exam. The disorder would not let him go without checking causing him physical pain and loads of anxiety. It goes on to talk about how he dealt with his disorder and how he sees signs of it in his son.
Because it is a anecdote type of case study, voice and the art of specificity is ready noted. It takes the reader into the lives of the person living with OCD and shows you the reality of how severe it can be. There are some words that may be unrecognizable, but I feel like the writer does a good job explaining it.
This book would be a good source book to refer to about OCD, but not for cures. It is outdated so the cures that they discuss in the book are also outdated. I do not know what the child with OCD would look like like in class, but I feel reading this book helps me understand someone with the disability better. It is an informative text.

[Staci · Rating 3 out of 5]

A helpful and sad look at what it is like for some folks to discover and live with OCD. I cringe when people who are very neat or like things a certain way said "I am OCD" because I think it is dismissive of a very painful, life-sucking illness that can get in the way of relationships, studies. I wish people would understand how difficult and objectionable and helpless people are when they live with OCD and not throw the term around for fun.

Only 3 stars because it is so outdated now. 15 years ago I'd give it a 5.

[Colleen · Rating 3 out of 5]

Overall an entertaining and interesting read. The case studies were my favorite part. Some of the chapters or parts were kind of boring so i skipped over those. But the patient stories were interesting. There really are ppl who have genuine OCD like this. This is not something that every person has like ppl seem to claim to have just bc they like their house neat or things arranged a certain way. This is way beyond that. Obsessive thoughts should of been looked at more in this book though. These seemed to be mostly compulsions IMO.