Andy Warhol Was a Hoarder (7 page)

Plenty of people have borrowed the term “OCD” to make fun of the way they feel compelled to alphabetize their spices or wash their tennis shoes. And many of us
do
exhibit OCD-like characteristics every now and then—running back to the front door to make sure it's locked or stepping over cracks in the sidewalk. But more often than not, these behaviors are quirky and short-lived; they don't cause us ongoing distress, significantly impede our lives, or drive our family members
too
crazy. A severe case of clinical obsessive-compulsive disorder, on the other hand, can be as debilitating as the worst case of depression. The constant pattern of repetition may help reduce uncertainty by creating the appearance of warding off trouble and keeping people safe—but it is enormously stressful and a terrible burden to bear. Some people with OCD commit suicide to escape the constant barrage of messages and impulses. “It's horrible,” says Elias. “It's torture from the inside.”

T
HE CHARACTERISTICS OF OBSESSIVE-COMPULSIVE
disorder have been around for as long as humans have been scanning the horizon for danger. Some evolutionary psychologists believe the condition may be an extreme overreaction to the early warning systems that protected us against deadly threats and disease and were vital to survival. A prehistoric human who kept an obsessive lookout for a saber-toothed cat might have noticed the animal coming sooner and escaped faster than his cool-as-a-cucumber cave mates. We're not the only ones who exhibit compulsive behaviors: Birds
overpick at their feathers, pigs chew excessively on chains, cats pace and gnaw on fabric, and dogs lick at their paws and flanks so vigorously they develop ulcers and infections. It's impossible to know if animals actually obsess—but, like humans, their behaviors sometimes develop after stressful experiences, such as injury or loss of a companion.

Numerous historical figures are believed to have struggled with the condition, dating back to Martin Luther, the German monk who led the Protestant Reformation movement in the early 1500s. He is thought to have suffered from a particular form of OCD called scrupulosity, in which obsessions revolve around purity, committing sins, and going to hell. Luther was said to have been so consumed by such transgressions that he held lengthy confessions with his priest, in which he repeated his worries for hours at a time. By the late 19th century, modern conceptions of obsessive-compulsive disorder began to evolve. It was around this time that Nikola Tesla, the Serbian inventor, exhibited some of his famous symptoms: He counted his steps, insisted on having 18 napkins on the dinner table, and became obsessed with germs and the number three.

OCD is often confused with obsessive-compulsive personality disorder, a separate, and distinctly different, diagnosis. People with obsessive-compulsive personality disorder are preoccupied with orderliness and precision and are often rigidly stubborn and inflexible when it comes to rules and morals. They tend to think that they're right and that everyone else should be as persnickety as they are. They are not, however, plagued by the obsessions and compulsions of OCD. Above all, they lack one hallmark characteristic: insight. People with true OCD are painfully aware of how debilitating their thoughts and behaviors are but cannot figure out how to stop them. They are locked in a never ending duel with their brains.

Hughes's brand of OCD ran the gamut from germ phobias to rituals about how his clothes needed to be hung and the order in which his food had to be served. Petrified of germs, he required his assistants to wash their hands and put on white cotton gloves before presenting documents. Newspapers had to be delivered in stacks of three, allowing Hughes to grasp the middle, and presumably cleanest, copy.

As his symptoms intensified, Hughes fluctuated between functional and paranoid. He suffered his first severe psychological breakdown in 1944 in the midst of the Spruce Goose fiasco and another in 1958, when he holed himself up in a private film screening room, watched movies around the clock, and then slept for more than 24 hours straight. Hughes's obsessions revolved around precision and routine. His menu consisted of just a few items served repeatedly: whole milk, Hershey's bars with almonds, pecan nuts, and Poland bottled water. Everything had to be delivered in a brown paper bag rolled back at the outer edges and held at a 45-degree angle from his aide's body. Hughes then used Kleenex to reach into the bag and pull out the goods. None of this served him well. “He deteriorated physically and lost so much weight that his employees thought he would die,” Fowler wrote.

During his seclusions, which also took place in a private bungalow at the Beverly Hills Hotel, Hughes issued an edict that “nobody ever goes into any room, closet, cabinet, drawer, bathroom or any other area used to store any of the things which are for me—either food, equipment, magazines, paper supplies, Kleenex—no matter what. It is equally important to me that nobody ever opens any door or opening to any room, cabinet or closet or anything used to store any of my things, even for one-thousandth of an inch, for one-thousandth of a second. I don't want the possibility of dust or insects or anything of that nature entering.”

Even the smallest tasks required painstaking instructions. Take the three-page directive on opening a can of fruit. One step required that his assistants wash the can with soap first and then scrub it “from a point two inches below the top of the can.” The label was to be soaked and removed and the can cleaned with a sterile brush “over and over until all particles of dust, pieces of paper label, and, in general, all sources of contamination have been removed.” Serving the fruit mandated a new set of rules, requiring the server to always keep his head and upper body at least one foot away from the can and to present it with “absolutely no talking, coughing, clearing of the throat, or any movement whatsoever of the lips.”

Windows and doors were sealed with masking tape. Kleenex became Hughes's defense against the world—he used it incessantly and demanded others do the same. In a memorandum about how to remove his hearing aid cord from the bathroom cabinet (Hughes suffered a moderate case of hearing loss for most of his life), his instructions required that six to eight Kleenexes be used to grasp the doorknob and turn on the water, six to eight more to open the cabinet, and fifteen to twenty additional to turn the faucet off. And then there was this: “The door to the cabinet is to be opened using a minimum of fifteen Kleenexes. (Great care is to be exercised in opening and closing the doors. They are not to be slammed or swung hastily so as to raise any dust, and yet exceeding care is to be exercised against letting insects in.) Nothing inside the cabinet is to be touched—the inside of the doors, the top of the cabinet, the sides—no other objects inside the cabinet are to be touched in any way with the exception of the envelope to be removed.”

Hughes created his own “private mental institution—his very own asylum,” according to Barlett and Steele, where aides accommodated every one of his demands, no matter how preposterous. Each one of Hughes's directives was compiled in a manual for staff
members to follow. When Hughes said he liked a grilled cheese sandwich that came from a certain eatery on Sunset Boulevard, the “Grilled Cheese Sandwiches” report was created with instructions on how to prepare it exactly the same way every time. “The waitress and cook were requested to be certain that any knife or cutting board, anything touching the sandwiches, be free from the odor of onion,” the report read. “To make a grilled cheese sandwich, the grill cook followed this procedure: two pieces of heavily buttered bread were placed separately on the grill, buttered sides down and a slice of cheese was placed on each. Then, after sufficient grilling, the two slices were joined to form one sandwich.”

During this time, Hughes was married to the actress Jean Peters, his second wife, who quickly found herself living under the strange rituals dictated by her husband. The two watched movies together, but Hughes required that they live separately. His wife had her own bungalow at the Beverly Hills Hotel, and was instructed to call “Operations,” the staff who manned Hughes's phone calls, when she wanted to reach him. In one of his directives, Hughes made it clear to his underlings that if his wife were to become sick, she needed his permission to seek treatment. “Under no circumstances should she be allowed to go see a doctor either at an office, a hospital or any place else, until HRH has talked to her first,” he ordered. Somehow, the marriage lasted 13 years until the two were finally divorced in 1971.

Studies have found that obsessive-compulsive disorder runs in families, and it is very possible that Hughes inherited a genetic vulnerability to the condition. His mother's intense phobias about germs and illness likely had some impact, whether handed down through DNA or modeled through behavior. “Allene Hughes exerted an overpowering influence on his development,” write Barlett and Steele. “If she was not worried about his digestion,
feet, teeth, bowels, color, cheeks, weight, or proximity to others with contagious diseases, she was anxious about what she called his ‘supersensitiveness,' nervousness, and inability to make friends with other boys. If Howard had no inherent anxieties in those directions as a small boy, he certainly had them by the time he reached adolescence. His mother helped instill in him lifelong phobias about his physical and mental state.”

Genes are rarely the sole cause of illness, and scientists are on a quest to pinpoint other risk factors as well. Intriguing research has found that some children who suffer from strep infections may go on to develop sudden cases of OCD, possibly because their immune systems overreact to the bacteria and attack the brain. In Hughes's case, another factor may have played a role: plane crashes. Traumatic injuries to the brain have been known to trigger psychiatric disorders, especially depression, and there have been case reports of brain injuries leading to OCD. Hughes's passion for flying was boundless, and he took enormous risks during test flights, which resulted in several serious crashes. His first injury took place in 1928 during the filming of
Hell's Angels
, when he insisted on performing a risky maneuver and hit his head in a crash. In 1943, his plane went down into a lake in Nevada. The worst, by far, was his test flight of the military reconnaissance aircraft in 1946. Because of an oil leak, the plane pitched and lost altitude, crashing in Beverly Hills. Hughes broke ribs and a collarbone, crushed his chest, and suffered third-degree burns. He barely survived. An autopsy report allegedly later revealed that he had cracked his skull at least three times.

Researchers have uncovered some compelling clues about the biological underpinnings of obsessive-compulsive disorder. Neurological studies of people with OCD have found increased activity in several parts of the brain, including areas that are responsible
for detecting errors and making decisions. The message that says “lock the door” keeps going and going until what is normally a vital mental warning system becomes a constant and debilitating intrusion. In people with OCD, this particular region of the brain “doesn't give up,” says McLean Hospital's Elias.

As with other mental health conditions, OCD exists on a continuum, with some people suffering more recurring thoughts and ritualistic behaviors than others. Symptoms often overlap with other conditions. Researchers have discovered a close biological link between OCD and Tourette syndrome, which is characterized by rapid and repetitive movements called tics. Many people with OCD struggle with attention deficit hyperactivity disorder, depression, and anxiety. Serotonin, one of the neurotransmitters implicated in mood disorders, may also play a role in OCD, so treatment often includes antidepressants and anti-anxiety medications.

Behavioral therapy has evolved significantly over the last few decades. Early on, therapists were afraid to confront patients with their worst phobias, concerned that they might upset them more than help them. But today, exposure and response prevention therapy, or ERP—rooted in facing one's fears—is used frequently. Patients are guided to undertake the very actions that worry them most: They must leave the house without checking the door or halt their counting routines, no matter how strongly they believe something bad will happen as a result. The therapy can be exceedingly challenging, especially early on when patients become agitated, fearing they have lost control. But about two-thirds of patients who stick with ERP respond well and learn to tamp down the obsessions and compulsions. “Eventually, the tasks they are assigned can be completed comfortably even in the presence of uncertainty or anxiety,” says Elias. “This restores their confidence and quality of life.”

Dr. Jeffrey Schwartz, the UCLA researcher, believes in an alternative approach that harnesses the significant insight that OCD patients often exhibit, which he uses to retrain their minds. Schwartz's techniques are based in mindfulness, a practice that focuses on living in the present and viewing one's thoughts and feelings with less judgment and reactivity. During treatment, Schwartz encourages patients to talk back to their OCD. Instead of allowing distorted notions to dictate their actions, patients learn to identify their obsessions as a symptom they can control. Rather than give in, the person might say, “That's just a false message, and I don't have to listen to it.” In a series of exercises, patients are trained to understand that their intrusive thoughts are happening because their brains are “stuck in gear,” as Schwartz describes it. They learn to ignore their obsessions, shift away from destructive behaviors, and refocus on more productive and energizing activities. In time, with significant practice, their reactions can become much bolder and more confident: “Go ahead, make my day. Just
try
to make me wash my hands one more time.” Schwartz believes that people have the power to rewire their brains. In experiments he conducted in the 1990s, Schwartz performed PET scans on the brains of his patients and found that the overactivity in their brains declined after mindfulness treatment.