HPS788 Case Study: Analyzing Howard Hughes' OCD in 'The Aviator' Film

This case study analyzes Howard Hughes' Obsessive Compulsive Disorder (OCD) as portrayed in the film 'The Aviator'. It explores predisposing, precipitating, perpetuating, and protective factors contributing to Hughes' condition, considering biological, psychological, and social influences. The analysis includes a diagnostic perspective based on DSM-5 criteria, assessing the accuracy of the film's depiction of OCD symptoms. The study also addresses the stigma associated with mental health conditions, examining both positive and negative messages conveyed by the film. Finally, it discusses the prognosis of OCD and potential treatment strategies, integrating insights from various research studies. The case study uses the 4P model to understand the development and maintenance of Hughes’s OCD, and how the film portrays mental health stigma.

Running head: OBSESSIVE COMPULSIVE DISORDER
Healthcare
-Obsessive Compulsive Disorder
Name of the Student
Name of the University
Author Note

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Part 1: Case Formulation
In the film ‘The Aviator’, Howard Hughes got his psychological modeling of a having
a phobia for germs from his mother while he was a child which can be a significant
predisposing psychological factor that increased his risk of developing an OCD. The
psychological predisposition of having a phobia to germs could have also been further
accentuated by a social conditioning while growing up in Huston, Texas during a disease
outbreak which could be a psychological and social predisposing factor. As a result of this
he developed a fear for germs at an early age. Moreover, Hughes’ mother also showed
symptoms of OCD which might point out towards a biological predisposition towards OCD
for Hughes (Shapiro, 2015; Scorsese et al., 2018).
The federal investigation that Hughes had to undergo could be understood as a
psychological precipitating factor that might have caused an emotional stress. The
experience of the stress could have been made worse due to his already existing phobia of
germs and seeing the federal agents handling all his belonging which he believed
contaminated all his belongings with deadly germs (Scorsese et al., 2018). The plane crash
that was experienced by Hughes could be considered as a biological precipitating factor
which might have led to the aggravation of his germ phobia. Moreover, a lack of a stable
personal relation and social isolation could be considered as a social precipitating factor
which could have impacted the severity of his condition (Angelakis et al., 2015).
Isolation of Mr. Hughes from personal relations could be considered as both a
psychological as well a social factor that caused the perpetuation of his mental health
condition and might have even aggravated it with time (Scorsese et al., 2018). Due to
isolation, the worsening mental health condition continue unabated and unchecked as Mr.
Hughes failed to recognize anything wrong with his behavior and instead blamed everyone

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else about how he felt. Moreover, a family history of OCD could be considered as a
biological perpetuating factor for Mr/ Hughes mental health condition (Dorfman et al.,
2018; Wootton, 2016).
Mr Hughes however was a very resilient person and had exceptional ability to handle
stress due to his profession as a pilot, which could have been a psychological protecting
factor as it allowed him to remain calm and composed even under stress. The high economic
status of Mr Hughes could be considered as a social protective factor, as it provided him
access to adequate resources to treat his condition as well as protected him from ridicule from
others (Scorsese et al., 2018). The ability of Mr. Hughes to adapt his body to his changing
and restrictive diet could be considered as a biological protective factor that protected his
body from the adverse effects of his unhealthy behavior for quite some time (De Wit et al.,
2015; Picó‐Pérez et al., 2018).
Two important questions that can be asked from Mr. Hughes can include: 1) Has any
of your relatives been diagnosed of neuroticism (worrying more than others about normal
things)?. This is an important question because neuroticism can increase risks of mental
health conditions like OCD and 2) Do you fear that adverse events might occur if you fail to
be careful?. This question can help to understand elevated perceptions of threat, specially
fears of contamination by germs which is common in OCD. Since the film does not clearly
show such factors, I believe that these two questions can shed important light.
Part 2: Diagnosis
In the film it was shown that the obsessive behavior and thoughts started at an early
age for Mr Hughes. Such as aspect can be verified by the Diagnostic and Statistical Manual
of Mental Disorders-5 (DSM-5), which states that symptoms of OCD in males can start
before the age of 10 years (Krebs et al., 2015; Anderson et al., 2017). Several key symptoms

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of OCD were expressed by Mr. Hughes such as a worrying behavior, repetitive actions and
an irrational fear of dirt and germs. In the final years of shooting for ‘Hells Angel’ he also
faced a financial problem that almost led him to become bankrupt which could have
provoked the OCD. The cleaning rituals exhibited by Mr. Hughes in the film had a close
resemblance to the symptoms of OCD described in DSM-5 which states that compulsive
behavior is mostly performed according to the rules and phobias of the sufferer and is aimed
to avoid anxiety or a feared incident (Stein et al., 2016). In the film. Mr. Hughes is seen to be
repeating a phrase “show me all the blueprints” several times and carrying a soap that was
wrapped carefully in a cloth to prevent contamination which shows a compulsive behavior as
outlined in DSM-5 thereby suggesting accuracy of the depiction of OCD (O'kearney et al.,
2017).
The behavior of Mr. Hughes also provides several good insights into the condition. It
was shown that Mr. Hughes have attempted to suppress his unwanted urges on several
occasions which shows that the understood that his ritualistic behavior and beliefs were not
completely rational and was adversely affecting him, which fits the description of an OCD
patient as explained by the American Psychological Association. The compulsions of Mr.
Hughes was also shown to be consuming a lot of his time and in the film it was shown that
Mr. Highes spent almost three months alone in the screening room to avoid contamination
and also found it repulsive to touch the handle of the toilet door, fearing contamination,
waiting for someone else to wait it (Scorsese et al., 2018). These factors are also supported by
the DSM-5 diagnosis and have significantly affected his social interactions and personal
relations thereby making him more isolated. Several studies have actually shown that the
compulsive, ritualistic and repetitive behavior and excessive fears experienced by OCD
patients are one of the main reasons for their social isolation and thereby shows the
diagnostic accuracy of the film (De Haan et al., 2015; Scorsese et al., 2018).

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Part 3: Stigma
In the film, both negative and positive messages could be found that can be
considered to influence the stigma associated with a mental health condition such as OCD.
One of the strongest positive messages that was shown in the film was that not even a
psychological condition such as OCD cannot stop a motivated and driven individual to
achieve success when he/she puts his/her mind to it. Despite his condition, Mr. Hughes was
able to become a successful person and have a good career (Wellman & Musick, 2016). This
helps to overcome the stigma about mental health conditions that it renders people
incompetent and makes them unsuccessful in their ventures and instead suggest that people
with mental health can also help to overcome a negative self image, provide people suffering
from OCD with the confidence to try their best to overcome their condition. Showing that
Mr. Hughes was successful in his life, despite of having OCD from childhood shows that
mental health can be treated and managed like any other health condition and can allow a
person to live a normal or even a successful life which also helps to overcome stigma on
mental health conditions (Scorsese et al., 2018; Dorfman et al., 2018).
A negative message that was portrayed by the film was that people suffering from
OCD can often engage in bizarre behaviors to help their compulsions (Scorsese et al.,
2018). Moreover, showing people with mental health conditions as awkward, arrogant,
eccentric and even as annoying or harmful individuals to themselves and others have been
seen in several Hollywood films such as ‘A Beautiful Mind’, ‘Shutter Island’, ‘Split’, ‘Girl
Interrupted’, ‘One Flew Over Cuckoo’s Nest’ and ‘Whatever Happened To baby Jane’
(Dunn, 2017; . This portrays people with mental health issues are different and abnormal
which is generally not the case. This can led to a belief that individuals with mental health
condition can be disruptive to society and therefore cause perpetuation of a stigma on these
conditions. Such caricatures can also make individuals suffering from such mental condition

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from seeking medical care, fearing that they might be rebuked by others (McGinty, et al.,
2015). Moreover, in the film, all his behavior was attributed to his OCD and no mention
about his diagnosis of Syphilis was shown, which could have been a reason for his extreme
behavior triggered due to Neuro-Syphillis thereby misrepresenting his condition slightly
(Dorfman et al., 2018).
Part 4: Prognosis
OCD is a chronic condition that can start at a very early age and can persist
throughout the life of the individual. According to Angelakis et al. (2015), the extent of the
symptoms can vary throughout life, changing in the acuteness of its effect. Studies show that
OCD typically has a very low rate of remission and less than 50% of the patient showing
signs of improvement with prolonged therapy. Other studies however suggested that almost
75% of the patients can have improvements in their conditions by follow up treatments that
focused on reducing the symptoms of OCD instead of trying to cure them altogether. Studies
by Wootton (2016) have shown that more than 50% of patients who have been treated with a
Group Cognitive Behavior Therapy and SSRI Fluoxetine have shown a reduction of the OCD
symptoms by 35%. According to Picó‐Pérez et al. (2018), factors such as hospitalizations, co
morbid psychological conditions, trauma and the intensity of the condition are significant risk
factors that can cause the persistence of mental health conditions. Stein et al. (2016) have
pointed out that behavioral problems seen among people with OCD can lead to an increased
risk for them being socially isolated as the behavior can adversely affect the quality of their
personal relations and interactions. O'kearney et al. (2017) pointed out that the problematic
behaviors can be a stressor for several people and they eventually start avoiding people with
OCD. The isolation in turn can lead to aggravation and persistence of mental health condition
as suggested by Shapiro (2015). According to De Haan, et al. (2015), Cognitive Behavior
Therapy can be used to modify those problematic behaviors and thus help to alleviate the

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symptoms. Moreover, it has also been pointed out that CBT can help to reduce the risks of a
relapse, can foster Exposure and response Prevention and also help to modify dysfunctional
beliefs that mainly trigger the compulsive behavior (Angelakis et al., 2015). It has been found
that Selective Serotonin Reuptake Inhibitors (SSRI) can also be used to improve the
outcomes for people with OCD since almost 60% of the patients have been found to react
well to that medication and thus an important aspect of pharmacotherapy for OCD (Issari et
al., 2016). Other studies have suggested that the best strategies tio treat OCD is to use a
combination of behavioral/Psychological approach along with a pharmacological approach
for maximum efficacy (Öst et al., 2015; Krebs et al., 2015; Wootton, 2016).

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References:
Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A.
(2017). American Psychiatric Association.(2013). Diagnostic and statistical manual of
mental disorders . Washington, DC: Author. The Linguistic and Cognitive Effects of
Bilingualism on Children with Autism Spectrum Disorders, 21, 175. URL:
http://digitool.library.mcgill.ca/webclient/StreamGate?
folder_id=0&dvs=1547372011110~865#page=175
Angelakis, I., Gooding, P., Tarrier, N., & Panagioti, M. (2015). Suicidality in obsessive
compulsive disorder (OCD): a systematic review and meta-analysis. Clinical
psychology review, 39, 1-15. DOI: https://doi.org/10.1016/j.cpr.2015.03.002
De Haan, S., Rietveld, E., & Denys, D. (2015). Being free by losing control: What obsessive-
compulsive disorder can tell us about free will. Free will and the brain:
Neuroscientific, philosophical, and legal perspectives on free will, 83-102. URL:
https://books.google.co.in/books?hl=en&lr=&id=-
JlrCgAAQBAJ&oi=fnd&pg=PA83&dq=Obsessive+compulsive+behaviour+supressio
n&ots=ducjwhLadr&sig=kxkcJCPn9oOdDzyEkmr393Gu_o4#v=onepage&q=Obsessi
ve%20compulsive%20behaviour%20supression&f=false
De Wit, S. J., Van der Werf, Y. D., Mataix-Cols, D., Trujillo, J. P., Van Oppen, P., Veltman,
D. J., & van den Heuvel, O. A. (2015). Emotion regulation before and after
transcranial magnetic stimulation in obsessive compulsive disorder. Psychological
Medicine, 45(14), 3059-3073. DOI: https://doi.org/10.1017/S0033291715001026
Dorfman, A., Szechtman, H., & Eilam, D. (2018). Social interaction modulates the intensity
of compulsive checking in a rat model of obsessive-compulsive disorder (OCD).

8OBSESSIVE COMPULSIVE DISORDER
Behavioural brain research, 359, 156-164. DOI:
https://doi.org/10.1016/j.bbr.2018.10.038
Dunn, E. R. (2017). Blue is the New Black: How Popular Culture is Romanticizing Mental
Illness. URL: https://ecommons.txstate.edu/handle/10877/6985
Issari, Y., Jakubovski, E., Bartley, C. A., Pittenger, C., & Bloch, M. H. (2016). Early onset of
response with selective serotonin reuptake inhibitors in obsessive-compulsive
disorder: a meta-analysis. DOI: 10.4088/JCP.14r09758
Krebs, G., Waszczuk, M. A., Zavos, H. M. S., Bolton, D., & Eley, T. C. (2015). Genetic and
environmental influences on obsessive–compulsive behaviour across development: a
longitudinal twin study. Psychological medicine, 45(7), 1539-1549. DOI:
https://doi.org/10.1017/S0033291714002761
McGinty, E. E., Goldman, H. H., Pescosolido, B., & Barry, C. L. (2015). Portraying mental
illness and drug addiction as treatable health conditions: effects of a randomized
experiment on stigma and discrimination. Social Science & Medicine, 126, 73-85.
DOI: https://doi.org/10.1016/j.socscimed.2014.12.010
O'kearney, R. T., Anstey, K., & von Sanden, C. (2017). Behavioural and cognitive
behavioural therapy for obsessive compulsive disorder in children and adolescents.
Cancer. DOI:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004856.pub2/abstract
Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of
obsessive–compulsive disorder. A systematic review and meta-analysis of studies
published 1993–2014. Clinical Psychology Review, 40, 156-169. DOI:
https://doi.org/10.1016/j.cpr.2015.06.003

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Picó‐Pérez, M., Ipser, J., Taylor, P., Alonso, P., López‐Solà, C., Real, E., ... & Soriano‐Mas,
C. (2018). Intrinsic functional and structural connectivity of emotion regulation
networks in obsessive‐compulsive disorder. Depression and anxiety. DOI:
https://doi.org/10.1002/da.22845
Scorsese, M., Shore, H., Logan, J., & Mann, M. (2018). The aviator. Buena Vista Home
Entertainment. URL: https://web.library.yale.edu/sites/default/files/files/Aviator
%20Notes.pdf
Shapiro, L. J. (2015). Understanding OCD: Skills to Control the Conscience and Outsmart
Obsessive Compulsive Disorder: Skills to Control the Conscience and Outsmart
Obsessive Compulsive Disorder. ABC-CLIO. URL: https://books.google.co.in/books?
hl=en&lr=&id=WdcNBwAAQBAJ&oi=fnd&pg=PP1&dq=the+aviator+OCD&ots=O
SArbzVIFy&sig=H5aC9W9XMjwrUXfCNMAT4ZTx1Eg#v=onepage&q=the
%20aviator%20OCD&f=false
Stein, D. J., Kogan, C. S., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Grant, J. E., ... &
Van Den Heuvel, O. A. (2016). The classification of Obsessive–Compulsive and
Related Disorders in the ICD-11. Journal of Affective Disorders, 190, 663-674. DOI:
https://doi.org/10.1016/j.jad.2015.10.061
Wellman, D., & Musick, M. (2016). Boxes: The Secret Life of Howard Hughes. BQB
Publishing. URL: https://books.google.co.in/books?
hl=en&lr=&id=jJPkCgAAQBAJ&oi=fnd&pg=PT15&dq=Howard+Hughes+Aviator
&ots=lK-
7ycX9JX&sig=X4oHfmHvVE79JAufarBwKZKvKgA#v=onepage&q=Howard
%20Hughes%20Aviator&f=false

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Wootton, B. M. (2016). Remote cognitive–behavior therapy for obsessive–compulsive
symptoms: A meta-analysis. Clinical Psychology Review, 43, 103-113. DOI:
https://doi.org/10.1016/j.cpr.2015.10.001