Obsessive-Compulsive Disorder and Charles Regan Smith’s Triumph Over It Obsessive-Compulsive Disorder is characterized by the combination of obsession and compulsion, the former includes persistent intrusive thoughts that are uncontrollable, and the latter is defined by repetitive behavioral designed to neutralize obsessions. The themes of obsession are often consistent across culture, which is true in Regan’s case as well. His first obsession began at age 5 regarding fear of contracting disease, which fits the pattern since the age onset of OCD typically begins during early childhood or adolescence.
In 3rd grade, Reagan began spitting to avoid bacteria in his mouth. This compulsion was rather mild and he gave up on this idea after receiving comforts from his mother. In 7th grade, Reagan gained a new obsession with symmetry and he had sleep troubles due to his internal struggle with this obsession. He knew this obsession was egodystonic and inconsistent with his belief; however, he could not ignore the thoughts. Obsessive-Compulsive Disorder is often chronic with gradual onset and have symptoms waxing and waning; for Reagan, he experienced a full blown OCD symptoms in junior year of high school.
He adopted a ritual of removing dirt from shoes before feeding the pigs, and it would take hours to complete since he had rigid rules regarding exactly how the ritual should be performed. He believed if he did not perform the ritual then some dreaded event would happen. Reagan became intentionally absent-minded in daily life to avoid triggering OCD and his mind was filled with fixated details as OCD symptoms worsen. Without a specific reason, his OCD symptoms waned off in senior year of high school and did not come back until junior year of college.
As a college junior, Reagan acquired an obsession with handwriting and he could not control his compulsion to correct each letter until the handwriting was perfect, which was why he failed his finals. Later, his failed marriage with Debbie added stress and triggered more symptoms such as phobia against orange color, which support the statistic of OCD is frequently comorbid with other disorders. Reagan also experienced three panic attacks in his life, which he believed was trigger by the same anxiet OCD. After divorce, he began to receive treatments from Dr. Neely and his symptoms was better after taking Valium.
However, his relationship struggle with his girlfriend Marsha triggered his first attempted suicide. A year later, Reagan found his phobias worsen and he had irrational fear toward orange, f, m, and 13. After being fired from the sugar mill, Reagan turned to alcohol to alleviate OCD, but it only caused anger management issues. His AA group solved the alcohol issue, but his new job’s stressful working environment agitated more OCD symptoms. Reagan quitted his job and move into Marsha parents’ apartment and then to his own parent’s house after an argument broke out in Marsha’s place.
He then move on to be a grade school teacher, which worked well until his third year teaching. He started to question whether God exists while his OCD made him fixated on it and he became concern as to whether he was possessed by devil. He met with Dr. Johnson and Dr. McCallum but none of them was helpful, so he selfadmitted to a hospital for three weeks. Over the years, certain words became anxiety provoking for Reagan and he had to perform mental ritual to cancel out these words. The stress from work caused him to become severely depressed and he had to quit his job and graduate school.
The Trilafon and Elavil from Dr Collier helped Reagan to slowly overcome his symptoms. He then went on to be a great teacher in another high school and his OCD became much less intense. The dominant behavioral model of etiology for obsessive compulsive disorder is derived from Mowrer’s two-process theory of avoidance learning. This model is composed of two parts, classical conditioning and operant conditioning, and behaviorists believes all types of abnormal fear are learned through conditioning.
In classical conditioning, the subject learned to associates neutral stimuli with an unconditioned stimuli, so the presence of only neutral stimuli would have elicit a response due to association. In operant conditioning, an individual learned to associates between a distinct behavior and a particular consequence, and the action of the person is either weakened or strengthen by the presence of reinforcements and the consequences of that particular behavior. To apply this learning model in obsessive-compulsive disorder, we must know what happens in each step.
First in classical conditioning, the patient would have associated a neutral stimuli in the environment with an aversive stimuli, and this enabled neutral stimuli to evoke fear, which contributed to the patient’s obsession. After this learned fear in classical conditioning, the patient would perform action in order to eliminate these stimuli and causes fear reduction, hence developing a compulsion through operant conditioning. Since performing compulsion reduces the obsession anxiety, the compulsion is then reinforced and it is more likely to occur again in the future.
Therefore, Mowrer’s two-process theory of avoidance learning explains why avoidance responses are extremely resistant to extinction. These maladaptive behaviors are hard to extinct due to learned association and consequence reinforcement in the conditioning process. To give a more concrete example, Reagan associated the word blue with devil because he saw the ads of Duke’s Blue Devil team. Since he came from a Christian background, the word devil and the meaning behind it made him very uncomfortable and the color blue now also contributed to his discomfort.
Therefore, blue became one of his obsession through classical conditioning, since he associated the neutral stimuli of blue with aversive stimuli of devil. To ease the discomfort, Reagan actively avoided blue color items and would perform mental actions such as saying positive words to himself in order to cancel out the bad word blue. Since his avoidance behavior reduced his anxiety, these behaviors were reinforced through operant conditioning and became compulsion.
Since his anxiety decrease rapidly after engaging in the compulsive ritual immediately after the provocation, it reinforced the compulsive ritual as Reagan performed these rituals Therefore, the act of repeating compulsive behavior to reduce the anxiety from obsession made obsessive-compulsive disorder a learned process. According to this model, the most effective treatment of behavioral therapy for obsessive-compulsive disorder would be force patient to expose to feared objects and prevent him to perform the ritual, thus enable the person to see that the anxiety will subside naturally in time without compulsive behaviors.
However, this treatment did not work in Reagan’s case. When he tried to control his obsession and to not perform compulsive behaviors, he would become so preoccupied with troubling thoughts that he would lie awake all night with numerous obsessive compulsive preoccupations swirling through his brain and it would prevent him to move on to another activity. Therefore, his anxiety level did not decrease with time and did not fit into this behavior model.
Although this treatment model did not work, Mowrer’s two-process theory of avoidance learning still provides insight to the factors in maintaining obsessive-compulsive behavior. Although Mowrer’s two-process theory of avoidance learning seems to explain obsessive-compulsive disorder’s symptom and its course, there are still questions left unanswered by this etiology model. It did not explain why obsessive-compulsive disorder patients develop obsessions in the first place and why some people never develop compulsive behaviors.
For Reagan, although his obsessive-compulsive behaviors with color blue ould be explained with this model, he also displayed obsessivecompulsive disorder symptom that could not be explained by the two-process theory. For example, his obsession with perfect handwriting seemed to come from nowhere, so he did not gain this fear from classical conditioning. Therefore, Mowrer’s twoprocess theory of avoidance learning alone is not sufficient to fully explain obsessive-compulsive disorder. In order to understand obsessive-compulsive disorder, we should consider multiple etiology models such as c e etiology models such as cognitive, environmental, and personality.
In summary, Reagan’s book really broadened my perspective about human behavior and psychopathology, especially on why obsessive-compulsive disorder is often comorbid with other anxiety-related disorders. Given Reagan’s experience and the chronic and debilitating nature of this disorder, I now understand why many obsessive-compulsive disorder patients also developed depression. I am also grateful for the development of miracle medicine to alleviate obsessivecompulsive disorder; just like Reagan, I believe it is possible to conquer obsessive-compulsive disorder.
