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OCB: Obsessive
Compulsive Bipolar |
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Dear EXCEPTION,
Here’s your choice. You’re either immoral or you’re sick. Pick your poison. But if you’re really a bad person, I doubt you would have written.
Over the past ten years, I’ve treated many people from the television, movie and dot-com worlds with problems painfully similar to yours. All those people were powerful, driven and successful. They also hurt people without really meaning to. There have been so many of them lately that I came up with a name for the condition: OCB.
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You may have heard of OCD, which stands for Obsessive Compulsive Disorder. OCB stands for Obsessive Compulsive Bipolar. It’s more of a condition than a disorder because OCBs often function quite highly, even though their personal lives are usually a mess.
They differ from pure bipolar (or manic-depressive) people. When bipolar people become manic, they go off the deep end into psychosis, occasionally breaking the law and frequently ending up in a hospital. Even so, they do it with a smile, because they feel invincible and free when they are manic.
OCBs don’t go to those extremes. Their obsessive-compulsive traits work like emergency brakes, pulling them back just before they go over either edge. People with OCB don’t lose touch with reality, just with common sense.
Generally regarded as exceptional because of their formidable abilities, they come to believe they’re exceptions to the rules that apply to everyone else. They tend to disregard the possible consequences of their behavior. Sometimes they’re even surprised when those consequences are disastrous.
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Compelled to seek the exhilaration of "controlled" mania, their life becomes like a roller coaster. They don’t get real joy or contentment on the ride, but it is exciting and they’re not necessarily unhappy.
It’s their friends, partners (usually female, because OCB men outnumber women four to one) and children who are miserable. It’s they who must live with the OCB’s unpredictability, his inability to give them undivided attention, his lack of emotional understanding and his failure to make good on promises to reform.
One woman compared life with her OCB boyfriend to riding with him in a Porsche, blasting along curvy Mulholland Drive at sixty miles per hour. "He tells me to just cool it — he’s in complete control as he downshifts and the tires screech," she said. "He probably does feel more in control, feeling the wheels touching the road while he shifts and accelerates. On the other hand, I don’t feel anything other than scared silly and totally at his mercy. Sometimes I dig my fingernails into the dashboard, and it irritates the hell out of him."
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People with OCB are addicted to excitement and power. Power is the toughest mistress to compete against. In fact the seductive attraction of mistresses is that they make an OCB man feel powerful and even heroic in ways that his wife or girlfriend no longer does.
When power and excitement are present, OCB people are sharp, goal-directed, amazingly effective and productive. When these feelings are missing, they become unfocused, listless and irritable. It’s the moodiness and their tendency to over-control that prompts psychiatrists to treat them with antidepressants like Prozac, Paxil or Luvox (these drugs, called SSRIs, are used to treat depression and OCD, to help people "lighten up").
Frequently this is insufficient, because treating OCB people with only SSRIs is like trying to control boiling water by putting a lid on the pot. The lid won’t help unless you take the pot off the fire. In fact, putting a lid on boiling water only adds to the pressure. Similarly, giving only an anti-depressant to someone who has a concurrent bipolar component can make matters worse by causing him to become more manic.
What does seem to help is a combination of an SSRI and a mood stabilizer such as lithium, Tegretol or Depakote. These medications for bipolar disorders help turn down the flame. Psychiatrists have been using the combinations for many years for what’s referred to as "treatment resistant depression."
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As the intensity of the OCB lessens, patients find calm and often a new kind of non-frenetic energy. One patient was so relieved, he called me in tears. "I’m normal!" he said. "All my life, I thought normal was for everyone else. You know? Success doesn’t make up for feeling like a mental misfit!"
After medications have effectively stopped the Porsche by removing the keys, individual and couples therapy can help a patient and partner develop a healthier relationship — now that they have slowed down enough to put some emotion into it. Insight therapy might also help, since there’s usually some childhood abuse, neglect or dysfunction that contributes to (but alone doesn’t cause) OCB.
Pretty soon OCB people listen better, are more "present" and see the quality of all their relationships improve. One treated dad started to cry as he told me about reading his five-year-old a bedtime story. For the first time, he was emotionally "there," not just mouthing the words with his mind miles away.
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There are a couple final reasons to get your OCB taken care of sooner rather than later — peace of mind and increasing your chances of getting into heaven. Years ago I made house calls to an entertainment industry giant dying of cancer. He also had OCB, having thought he was above the consequences of alcohol and cigarettes. A few weeks before he died, he talked about something that had been tormenting him. "I don’t think I’ve ever done anything important in life," he said. I tried to reassure him that he had brought pleasure to millions of people, created hundreds if not thousands of jobs and had a lot to be proud of. He thought I was trying to manipulate him into a solace he didn’t deserve. "Yeah sure," he said, "but what about the two wives I ruined and my three loser kids on drugs who’ll never amount to anything?"
Because he was like other people with OCB and never meant to hurt anyone, I’m sure he made it into heaven. But it probably wasn’t a slam-dunk. |
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