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Chapter 17

Chapter 17: Treatment of Mental Disorders

Critical Thinking Activities

Treating Mental Illness

In the previous chapter's activity you met Lana, a 25-year-old woman who has been diagnosed with obsessive-compulsive disorder (OCD). In this chapter's activity you will learn about the history of her disorder and the treatment options for OCD.

Lana has experienced obsessive thoughts and the need to perform ritualistic behaviors for as long as she can remember. Her condition was misdiagnosed for several years, a fact that leaves her frustrated and a bit angry. Before being diagnosed with OCD, she was bewildered by her own behavior: "I knew it was irrational," she explains, "and I thought I was crazy."

When Lana begins to obsess about a given thought, it dominates her mind to the exclusion of all other thoughts. For example, if her boss is unfriendly, Lana will expend enormous mental effort considering the possible cause and remedy. An obsessive thought may also intrude without an obvious trigger; at such times, the thought usually centers around one of several painful events in her life, which she will then replay continually: "I am doing great, maybe just writing a term paper, and—BAM—thoughts come back into my mind and I can't get rid of them." To cope with these obsessive thoughts, Lana sometimes performs ritualistic behaviors, such as cleaning or vacuuming, which offer some degree of relief.

With help from her therapist, Lana recognizes that her symptoms become more pronounced when she is under stress or having a busy day. She also explains that simply refusing to perform a compulsive behavior offers no relief: "If I don't do it, the thoughts just keep bugging me. I am absolutely miserable until I do it."

Lana explains that her compulsive behaviors are motivated by a "little voice" that puts doubt in her mind, driving her to perform and repeat some act a fixed number of times. For example, she may need to check that she has locked the front door three, six, or nine times. Furthermore, giving in to one compulsion may trigger a series of additional compulsions—checking that the windows are locked, that the iron is unplugged, that the cat has food—rituals which themselves must be repeated a fixed number of times. It is not unusual for a series of compulsive rituals to occupy more than an hour and a half of her time. "Sometimes," she explains, "it can be very hard just to get out of a room."

Lana learned recently that several of her relatives also show symptoms of OCD. Her aunt becomes fixated on new events in her life, and her grandfather worries obsessively about lunch meats. Both of them also perform behavioral rituals.

Lana meets regularly with a psychiatrist, and she is now taking the medication Luvox. Lana says that the medication has changed her life in important ways: "My whole life is different," she explains, "everything is more clear. Numbers are still important to me, but I feel less obligated to count. Even my relationship with my boyfriend is different. I still do my compulsive behaviors, but I am able to resist a lot more. And I care less about what other people will think." Finally, Lana notes that the reduction in her symptoms has provided her with a lot more free time during her day: "I am amazed at how much time I was losing every day."



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Transcript:
It's not that I don't still do some of this stuff—some of it I'm like "I'm not going to do it! I'm really not going to do it." When I get to the door I usually think that I had better go back and check everything . . . that I haven't left anything, but I don't do that near as much now. I just get in my car and I go to work. I don't worry about, well, "Did I forget to do that? Did I forget . . ." the whole way to work.

I never realized how much time I've lost, and how much I've gained now. I mean, there are so many more things, even with my studies. Everything's so much more . . . I don't want to say organized, because I'm a very organized person, but it's clear. Everything's clear.


In spite of the challenges of living with this disorder, Lana is motivated to be professionally and personally successful, and she describes herself as a highly organized person. She is currently finishing her third year of college, and she is engaged to be married. She hopes that, with the help of medication and therapy, she will be able to achieve her goals.
1. How does cognitive-behavioral therapy work? In your answer, briefly describe the interaction between therapist and patient, and explain in general terms how such therapy can produce lasting changes in brain function. Use your textbook and the links below to research your answers.

Mental Health Net: www.mentalhelp.net/
National Institutes of Mental Health: www.nimh.nih.gov/index.shtml
2. Effective treatments often cross the levels of analysis. Imagine for a moment that you rejected this idea, and tried to treat OCD from either a wholly pharmacological or a wholly behavioral position. Would a patient such as Lana be well served by such approaches? Explain your answer.
3. Luvox is one of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Using your text and information from the sites provided below, explain why SSRIs are often effective in treating the symptoms of anxiety disorders.

RX List: http://www.rxlist.com/luvox-drug.htm
4. Do drugs such as Luvox provide a lasting cure for the underlying disorder?

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