OCD: Dr. Janike

Fearing for the Future

Dr. Phil says that obsessive-compulsive disorder is a fairly common disorder characterized by recurrent, unwanted thoughts and/or repetitive behaviors, like hand washing or constant cleaning. Studies say that OCD can begin anywhere from early childhood to adulthood, usually up to age 40.

He introduces Dr. Michael Jenike, professor of psychiatry at Harvard Medical School, and the founder and medical director of the Massachusetts General Hospital Obssessive-Disorder Compulsive Institute at McLean Hospital. Dr. Jenike is also co-author of the book Life in Rewind, in collaboration with Terry Murphy and Edward Zine.

"What's your assessment based on what you're hearing so far?" Dr. Phil asks.

"My assessment is that her illness is quite severe, and it's pretty much taken over her life in major ways. It's particularly worrisome that it's having this effect on her children," Dr. Jenike replies. [AD]

"Where does this come from? Why does this happen in some people and not others?" Dr. Phil probes.

"It looks like there's a genetic component in many people," he replies. "There are subtle differences in the brains of people with OCD. They have more gray matter on the surface of the brain. They have a little less white matter, which are the connection fibers. What all of this means for a patient, we don't really know yet. It's going to take us another decade or two to put it all together. But the bottom line is, that we're way ahead, in terms of treatment, than we are in terms of understanding what causes the disorder."

Before the show, Dr. Phil asked Lisa to describe the 10 defining moments, seven critical choices and five pivotal people in her life. "The first think you listed in your 10 defining moments was in elementary school, you threw up on another kid. Now you have a real obsession with stomach flu," he reminds her.

Turning to Dr. Jenike, Dr. Phil says, "Is there a possible tie in there?"

"I think it would be impossible to deny that there's some kind of tie in, since that's so prominent in her symptomology," Dr. Jenike replies. "I would conceptualize that she has a tendency toward OCD, or a genetic vulnerability, and this happened to be the thing that set it off. Unfortunately, that doesn't help us in terms of treatment." [AD]

"There are treatments available, correct?" Dr. Phil asks.

"Absolutely. Lisa will do great. The washing symptoms that she has, even though they're so strong, are often some of the easiest to treat," he answers. "It's going to be hard for her. There's going to be a lot of anxiety, and she's going to have to do things that she doesn't want, but I think with a motivation of helping her children break free of her prison, I think that will keep her going."

On videotape, Lisa gives an example of her kids imitating her behavior. "Bella has a little green mat on her floor, and her sister kind of crumpled the corner of it with her foot. Bella instantly had to drop to the floor, ‘Oh, no. My carpet,'" she recounts. "My cleaning definitely gets in the way of them being homeschooled."

"When I tell Lisa that I think the kids need to be in school, she gets very upset. I do not have any say in the matter. It makes me feel like I'm not really allowed to be the kids' parent," Khristian says. "I don't think that [our son] Reno is getting a proper education. The only thing that he's learning is what Lisa decides to teach him, which, in my opinion is pretty much the bare minimum." [AD]

Khristian worries that his children are missing out on life. "My biggest fear is that when the kids grow up, they're going to be complete shut ins, completely afraid of the world, because that's the way they're being taught," he says.

"It really bothers me, because I want to be the mom to protect them and help them through whatever they need help through," Lisa says, wiping away tears.

"Talk to me about the children," Dr. Phil says to Lisa when the videotape ends.

"I just feel bad," she replies. "I know they're going to end up just how I am, because that's what I'm teaching them."

"Khristian, why is this OK with you?" Dr. Phil asks.

"It's not OK with me," Khristian answers, voice tremulous. "It bothers me that this is the behavior that I'm seeing."

 [AD]"Based on results, it is," Dr. Phil counters. "You are the husband in this household, you are the father of these children, and you are allowing them to be subjected to what you're allowing them to be subjected to. You're allowing yourself to be intimidated by this disease and by your wife. You're the only thing that stands between those children and the toxic nature of this disorder, and you're caving."

"I do my best to make sure that Lisa is not upset or uncomfortable, so the kids always have a mother. Even if she never gets better, I don't want to do anything that's going to push Lisa away or separate either of us from the children," Khristian says.

"I don't want you to be guilt motivated here," Dr. Phil warns Khristian. "I want your reaction to be resolve. Basically, what you're saying is you are becoming in league with this disorder. You are saying, ‘I don't want to upset her. The only way to not upset her is to let her practice OCD.'"

Dr. Jenike adds his thoughts. "It does bother me a lot about the effect on the children. I used to think the kids could just outgrow this when they get out, but now I see the grownups. I've been around long enough to see the grownups where their mothers controlled them and kept them locked in."

He directs his response to Lisa. "Some of the kids will do fine. I'm really worried about your 3-year-old daughter. I think she's heading in a bad direction, and it might get worse, year by year, if things don't get under control."

Dr. Phil says that Khristian needs to step up. "There is no divided loyalty here. If it comes down between protecting your children or sustaining your wife's disorder, that should not be a close call," he cautions. "I would hate for her to leave, I would hate for the children to go through that, but it is better than what they are living now." [AD]

Dr. Phil tells Lisa that homeschooling her kids isn't in their best interest. "They're not getting the proper education, which means they are falling behind day to day to day, correct?"

"Yes," she replies.

"What you're going to wind up with is unsocialized, uneducated children who are then going to be thrust into the world in some way when they're ill equipped to do it," he warns. "That has to stop."

Dr. Phil introduces Dr. Frank Lawlis, chairman of the Dr. Phil Advisory Board. "Talk to me a little bit about things that can happen with Lisa, whether inpatient or outpatient, whatever it might be," Dr. Phil says.

"Through cognitive therapy, we can begin to create some behavioral structure around that so it's not taking away her relief, but it is limiting it so that she can begin to start doing other things in her life," Dr. Lawlis explains. "She's building up a lot of anxiety, specifically around germs, and she's becoming fearful. This is a fear response. What happens is, ‘If I clean off my world, I'll be OK.'"

Addressing Lisa, Dr. Phil says, "If you had other skills to lessen that anxiety, to give you that relief, besides this dysfunctional behavior, can you see yourself embracing those things?"

"Definitely," she answers.

[AD]Dr. Jenike discusses possible treatment strategies for Lisa. "We know there are some drugs that are quite helpful, and Lisa might get a significant amount of relief," he explains. "Medication, to me, is the second best treatment. The most effective treatment is the cognitive behavioral therapy."

"This is severe enough that you really need to consider calling a time-out, and taking yourself out of the situation and really focusing on this for whatever period of time is necessary," Dr. Phil tells Lisa, who nods.

"I will support anything that will help, regardless of what it is," Khristian says.