Analysis Of Obsessive-Compulsive Disorder In Howard Hughes From The Film Aviator

The film Aviator, set in the 1920s-1940s, depicts the public and private life of director and aviator Howard Hughes, a heterosexual man likely in his 40s. In the opening scenes of the movie, we learn about how during Howard’s childhood, his mother had an obsessional fear of contracting an infectious disease. She persistently instilled her fear by exclaiming “You’re not safe,” and asking questions, such as “Do you know what germs can do to you?” (02:10). She modeled coping with her obsessions by excessively bathing her son, teaching him to wash his hands repeatedly, and frequently spelling out words like “quarantine”. Howard’s mother’s cognitive distortions during his formative years psychologically and socially shaped his future obsessions and compulsions. Later in his adulthood, Howard had a successful occupation, lived in a luxurious home, and was engaged in two separate relationships that both terminated due to the consequences of his persistent obsessions and compulsions. During the production of his movie, Hell’s Angels, Howard dealt with financial stressors as the media and audience fervently criticized his large spending on the film given the recent stock market crash and the death of three pilots. Symptom Presentation and Diagnosis The first DSM-V criterion for obsessive-compulsive disorder (OCD) is the presence of obsessions and/or compulsions. Howard Hughes struggled through distressing obsessions and compulsions that centered around the theme of cleanliness.

For instance, when discussing about his airplanes, Howard would repeat the statement “She’s got to be clean” (30:40), and would explain that he absolutely must avoid “crap on people’s hands” for the cellophane of the plane’s steering wheel (37:50). These obsessions would be very distressing to Howard that he often felt like he was losing his mind and was paranoiac about contamination (89:35, 114:20). In response to the persistent anxiety-inducing intrusive obsessions, Howard performed compulsions. For example, he would wash his hands rigorously – often for up to 50 minutes – to the point where his hands would contain cuts and bleed (56:00). As well, he consistently ate ice cream strictly out of a jar due to fear of contamination from the container (21: 50), rigidly separated vegetables from meat on his plate and refused to consume food if it was disturbed on the plate (35:42), frequently repeated phrases involving the word “quarantine” (130:50), strictly opened doors with tissues (138:15), reported feeling anxiety when noticing fingerprints on his glass (120:35), and showed a large degree of distress at individuals touching his belongings (117:07). These ritualistic behaviours would cause tremendous discomfort for Howard, to the point of taking control of his entire life. The media would comment on Howard’s inability to complete his movie, Hell’s Angels (54:22), and his colleagues would question his inability to build his airplanes according to schedule (23:00). Often, the viewer would perceive Howard’s distress through zoomed in shots of his frowned and despondent face (31:00). The obsessions and compulsions progressively took control over Howard’s occupational, social, and personal life. Both of Howard’s partners would leave him due to the overwhelming nature of his obsessions and compulsions. The nature of the obsessive-compulsive cycle would become so severe towards the end of the movie that Howard ended up unable to continue his profession as an aviator and airplane designer, ultimately ending up isolated in his room. The distressing life-consuming nature of Hughes’ symptoms satisfies the second DSM-V criteria for OCD: obsessions and/or compulsions must be present for at least one hour a day and must cause significant distress and/or impairment in social, occupational, or interpersonal domains of life.

Conclusion and Treatment

Plan Because Howard Hughes did not seem to abuse any psychoactive substances and did not report any somatic illnesses, combined with the time-consuming and impairing nature of his obsessions and compulsions, I believe Howard satisfies all DSM-V criteria for obsessive-compulsive disorder. Given that the symptoms have progressively rendered Mr. Hughes unable to function in society, I would immediately schedule him for an intensive outpatient program of exposure and response prevention (ERP). This form of cognitive behavioural therapy has been shown to be effective for many patients suffering from OCD. If the ERP program significantly improves Howard’s symptoms and allows him to resume his daily activities with manageable distress, I would make sure that Howard returns for subsequent doses of ERP, as needed. In addition to psychotherapy, I would urge Mr. Hughes to exercise 30-40 minutes a day, three or more times a week, to maintain a healthy diet supplemented with evidence-based micronutrient therapy, such as HardyNutritionals Daily Essential Nutrients, and to practice 20 minutes of mindfulness-based meditation daily. However, if Howard does not respond clinically significantly to this natural treatment plan, I would recommend treatment with Clomipramine, a tricyclic anti-depressant, which is the usual frontline pharmaceutical treatment for OCD.