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The Boy Who Couldn't Stop Washing.

For the millions of people who suffer in silence, bewildered by a disorder that shackles them in misery and pain, Judith Rapoport's book will bring revelation and the bright light of possible relief. She has written the definitive work on obsessive-compulsive disorder.

Until recently, victims of the disorder had little choice but to resign themselves to a torturous existence. Psychotherapy promised little help, medications were useless, aggravated self-doubt only contributed to futility. In her position as chief of the child psychiatry branch of the National Institute of Mental Health, Dr. Rapoport has utilized her talents and unique access to produce a book that brings an age-old problem into the 1990s with an urgency that has behind it the resources of the nation's most important mental-health agency.

With scientific detachment she describes the enigma of obsessive-compulsive disorder. With deep compassion and a talent for recognizing the importance of minute detail, she reports a wide range of case histories that, even without commentary, dramatize the almost unbearable plight in which so many sufferers languish for want of aid. Many become recluses, others wrench themselves from their compulsive routines to go into the world concealing their pain and inexorable rituals.

"Families often don't know they have a sick child," Dr. Rapoport writes. "Many of my obsessive-compulsive adult patients tell me that they kept their disorder secret as children, suffering for months or years because they were too humiliated or did not want to be considered crazy.

"As chief of a federally funded research clinic in child psychiatry, I was able to study this hidden disease before an effective treatment was established, and before we realized that it was a common problem."

She describes the surprises that were in store for her research group:

"At the National Institute of Mental Health, I began the study thinking that it would take 10 years to see enough patients to get an idea of the typical symptom patterns, the age at which they began and what treatments worked. But just as our project was getting started, new facts exploded. First, surveys showed that obsessive-compulsive disorder is not at all rare -- it is indeed common. Then it quickly became clear that there were new treatments that worked. We began to see many, many patients."

The sparse publicity that Dr. Rapoport's work evoked at the time brought forth inquiries and offers to accept experimental treatment beyond the agency's expectations. From an initial interest in OCD among children, the project extended into the universe of adult patients. It is upon this unique enterprise that Dr. Rapoport has drawn to codify the vast spectrum of OCD behavior. Her ventures into the use of the drug Clomipramine (Anafranil) and behavior therapy encouraged the research team to recruit patients throughout the country, accumulating invaluable data.

Dr. Rapoport realized that Anafranil wasn't a perfect treatment, nor did it alleviate the problem for all patients. But it did serve to confirm a supposition that geneticists pondered: that the so-called neurosis-like manic depressive illness or epilepsy -- might be another disease with a biological basis.

With the prestige and authority of the National Institute of Mental Health asserting that the condition is genetically based, progress in broadening the scope of an ongoing government-sponsored project to chart human gene structure holds much hope for an imminent cure for diseases such as OCD.

Rapoport's researchers quickly recognized that serotonin, the chemical responsible for carrying messages between brain cells, affected obsessive-compulsive disorder; the clue opened vistas for them in the brain-chemistry mystery.

Unlike many books on the subject that have been heavy on case histories and frustratingly short on practical information, The Boy Who Couldn't Stop Washing is an almost perfect summation of what OCD is, how it affects the victim and family, and what can be done to alleviate the feelings of hopelesness that the condition engenders.

Dr. Rapoport is not an overwhelming advocate of drug treatment. She declares unequivocally: "For patients willing and able to use its precepts, behavioral treatment should be the first approach.

"Each time I give a drug," she adds, "I actually conduct a mini-experiment. Most of our patients have tried other drugs that hadn't worked and other treatments that hadn't worked. Through using Anafranil, I became convinced that getting rid of these symptoms as quickly as possible is the only rational treatment for my patients."
COPYRIGHT 1991 Vegetus Publications
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes related article on biological and psychological basis of obsessive-compulsive disorder
Publication:Nutrition Health Review
Article Type:Book Review
Date:Jan 1, 1991
Previous Article:Treatment for obsessive-compulsive disorder.
Next Article:Diagnosis criteria for OCD.

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