In the 1997 film As Good As It Gets, Jack Nicholson gives an Academy Award-winning performance as Melvin Udall. Udall is a misanthropic romance writer who works at home as a best-selling novelist in New York City. He suffers from obsessive-compulsive disorder (OCD) which, paired with his misanthropy, puts off the neighbors in his Manhattan apartment building and nearly everyone else with whom he comes into contact.
Melvin is middle-aged, probably in his late forties. He is a white male who is unmarried and most likely doesn't have a very active love life outside of the fictitious tales of love that he weaves when he writes his best-selling novels. His profession of being a best-selling novelist has made him rather wealthy, allowing him to afford a nice apartment in New York's Greenwich Village. But that doesn't mean that he's out partying with the elite of New York. Rather, he prefers the confines of his apartment. Although he has an acid tongue and is unabashedly blunt with his opinions, he is very introverted and prefers solace in his apartment, spending hours on his writing.
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Melvin Udall does many things that seem odd. He writes poetically about a love he's never known. He's a bully who delights in heaping abuse on everyone unfortunate enough to encounter him yet is impressed when someone has the guts to push back. He avoids touching other people but deliberately obstructs his favorite waitress so that she has to touch him to pass. He speaks rudely and crudely to people but whispers sweet nothings to a dog: "Don't be like me, don't you be like me. You stay just the way you are because you are a perfect man." He's afraid of many things but mostly afraid of others seeing his fear. He rejects first so that he won't have to suffer rejection. He lives the life of a recluse. He is misogynistic. He is homophobic, as exhibited by his disdain and intolerance for Simon Bishop's homosexuality. He is anti-Semetic. He is racist, as exhibited by his inconsiderate behavior toward Frank Sachs. He feels as if he has to eat lunch at the same table each day, and he always brings his own plastic utensils. He is brutally insensitive to others. He has a ritual to locking his door, turning to the top lock three times and the middle lock 5 times. He turns the lights in his house on and off 5 times to turn them on or off. He washes his hands with several brand new bars of soap and then discards them after having used them for only a few seconds. He walks around cracks. He eats breakfast at the same table in the same restaurant every day using disposable plastic utensils he brings with him due to his pathological germophobia. Melvin is even driven so far as to unknowingly to a good deed for the only waitress he allows to wait on him, Carol Connelly. Melvin hires his editor's husband, a skilled pediatrician, to give personal visits and checkups to her ill son, Spencer, at top dollar. Melvin does this for no reason other than he wants Carol, who left work to take care of her ailing son, to come back to work and wait on him so that he can continue to follow his compulsive routine. This exhibits how people with OCD literally cannot stray from the path of their routine and will go to great lengths to avoid doing so.
Other symptoms generally exhibited by people with OCD include checking rituals, such as returning often to check a door lock, even though each time the person finds it locked. Some people with OCD have violent thoughts. They may fear that they or someone they love will die in a horrible accident or that they will harm someone. One example is drivers who fear that they have run down someone, so they return to the spot to check or give up driving.
As is stated in the DSM-IV-TR, people with OCD suffer from recurrent obsessions and/or compulsions.
Obsessions are persistent and repeated ideas, thoughts, and impulses or images that are experienced as intrusive and/or inappropriate. They also incite marked anxiety or distress. These experiences are difficult to dismiss, despite their disturbing nature. They are more intrusive that worries about real-life problems, and, what's worse, they're usually not even related to real-life problems.
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Melvin Udall has repetitive thoughts about germs and diseases and tries to neutralize his intrusive thoughts with compulsive actions. It is also made crystal clear throughout As Good As It Gets that Melvin fills with anxiety when his routine is violated. His anxiety skyrockets when he walks down the street, fearing he might step on a crack.
Obsessive thoughts can push aside more important things that the person needs to do and make the person feel compelled to take action. For example, people may follow the same route to school even if it takes them miles out of their way or makes them late for class. Or they may let their doubts about touching the tree cause them to go out and touch it again, only to doubt again whether they took the action. Such people may follow their compulsions because they hope to ease the anxietyÂ *Â they feel about their obsessions.
Melvin sends his editor's husband, a pediatrician, to make personal visits to Carol's son, Spencer, at top dollar, just so Carol will come in to work and wait on Melvin's table. Clearly this action looks extremely magnanimous, but in context, he is really focused on himself and his needs. Clearly it is ridiculous to pay a fortune for a continuing pediatrician for someone's son, just so they can go back to their job and serve you, but Melvin's daily routine rules him because of his obsessive compulsive disorder.
Compulsions are repetitive behaviors that those with OCD perform to try to suppress the anxiety associated with their obsessions. For example, people might have repeated, unnecessary doubts about whether they have performed an important task, such as locking the door. Or they might think that if they do not walk the same route to school every day, something awful will happen to them or to someone they love. Compulsions can also include excessive or unreasonable cleaning, checking a stove, hand washing, requesting assurances, or mental acts, such as repeating certain words silently, counting, or praying excessively. These behaviors either serve as coping mechanisms to reduce the discomfort with the anxiety or distress caused by the obsessive thoughts temporarily, or - unrelated to an obsession - they are performed according to rules that must be applied rigidly. In the majority of cases these actions are designed to prevent some dreaded event or situation. Such people may follow their compulsions because they hope to ease the anxietyÂ *Â they feel about their obsessions. However, in other cases there is no obvious logical connection between the two.
Melvin Udall avoids stepping on cracks in the sidewalk because that may bring bad luck. A causal connection also exists when he engages in avoidance and ritualistic behaviors as a consequence of his obsessive thoughts about contamination. The character avoids touching people to avoid germs. He brings his own utensils to his diner, so he does not have to risk contamination from unclean silverware. He lays out his plastic-ware in a ritualistic fashion, because this helps him feel less anxious since the world is now more orderly and proper.
After having experienced OCD for a period of time, some subjects recognize that they are a product of their own mind. They can also recognize that their obsessions and/or compulsions are excessive or unreasonable. They experience their thoughts and actions as disagreeable to their own sense of self. These thoughts and behaviors take up a significant amount of time (more than one hour per day) and cause considerable distress. Because they displace useful and satisfying behavior, these thoughts and behaviors can be highly disruptive to a person's normal routine, occupational or academic functioning, or usual social activities or relationship with others.
Melvin is aware that his obsessional thoughts are a product of his own mind because he reflects on them in a conversation with Carol. Melvin knows that his compulsions are unreasonable. He tells Carol that he sees a psychiatrist and started to take medicine in order to deal with his problem. Even though obsessive intrusions can be distracting, and frequently result in inefficient performance of cognitive tasks that require concentration, Melvin Udall is portrayed as a successful author. Sometimes he complains that his neighbors distract him from his work, while his character's functioning as an author seems to remain mostly intact. But whenever anything disrupts his well-established routine, he becomes anxious and belligerent with people. Melvin gradually overcomes his isolation of affect. He learns to recognize his feelings as well as the impact of his behavior on others.
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Although it is made explicitly clear that Melvin suffers from OCD and, in the context of As Good As It Gets, OCD alone, Melvin exhibits some symptoms of other disorders, namely social phobia, paranoid personality, and slight antisocial disorder. Melvin demonstrates symptoms of social phobia. He prefers to stay in his room and work, isolated from his apartment neighbors. Melvin's desire to do so is amplified when he berates his neighbor Simon Bishop and tells him that he should never come and knock on his door, "not even if [Simon] hears the sound of a thud from [Melvin's] home and one week later there's a smell coming from there that can only be a decaying human body and [Simon] has to hold a hanky to [his] face because the stench is so think that [he] thinks [he's] going to faint." Clearly he has a general disdain for his fellow man, which might lead one to believe he has antisocial personality disorder, but Melvin informs Carol in the latter half of the movie that he is simply afraid of social interaction because he himself is aware of the things he might say to people. He recognizes that his personality is not compatible with many peoples', so he comes to the conclusion that, "none should be subject to me." Also considered for Melvin was an avoidant personality disorder, but Melvin doesn't at all demonstrate the symptom of being extremely sensitive to negative evaluation. For as much as he dishes out in the movie, he receives close if not all of it back. He takes it surprisingly well. One symptom of antisocial personality disorder that he demonstrates is his lack at remorse for the devastating things he says to some people. For instance, the girl who approaches him at the elevator is bubbling with enthusiasm to ask him, "how he writes women so well" when he writes his romance novels. Melvin, frustrated, cuts her down by responding, "I think of a man, then I take away reason and accountability," with no remorse. With regards to antisocial personality disorder, Melvin also demonstrates deceitfulness, impulsivity, irritability, and aggressiveness. Finally, Melvin shows slight signs in the movie of having a paranoid personality, but his mistrust for others and his being vigilant of his environment are not generalized, and so he couldn't be diagnosed with that disorder.
With regards to Axis I in the DSM, Melvin certainly suffers under a certain level of anxiety, which skyrockets when he deals with any one of his many obsessions. This anxiety makes it moderately difficult for Melvin to function up to the standards of society. As a result, Melvin has few friends and other intrapersonal conflicts involving his interactions with others.
Considering Melvin's OCD is an Axis II personality disorder, he should show higher levels of dysfunction here. He has moderately difficult problems with functioning due to his personality disorder. He is so indebted to his routine, like his going to the same restaurant each day, sitting in the same seat, ordering the same food, and getting the same waitress, that he is only tolerable, barely tolerable, when he follows his routine. The anxiety would overwhelm him if some confounding factor caused him to stray from the path. In the As Good As It Gets, Melvin acts very impulsively when his routine is interrupted. When Carol doesn't come in to work to wait on him, he runs to her house and demands that she come in to work. This is a humorous scene in the movie, but it is also evidence of how people with OCD can bring themselves to violate social norms and expectations, sometimes without recognizing that they are doing it. When Melvin learns that Carol has gone home to take care of her sick son, Spencer, he quickly formulates a plan to get Carol back into work. He hires the pediatrician to make personal visits to Spencer at Carol's home, so that Carol doesn't have to worry and can come back into work. This is at great financial cost to Melvin, who is lucky to have the wealth, from his successful romance novels, to be able to afford that. This was obviously not a good decision however, and was another quick decision made on impulse by a man whose obsessions were getting the best of him. His impulsivity is an impairment in functioning that causes him to have his intrapersonal interaction issues. This results in him having no friends.
I'm prepared to give Melvin a "nothing notable" rating on both Axis III and Axis IV. I only do this because nothing of Melvin Udall's medical history or present medical problems is discussed, other than the fact that he is encouraged to take pills for his OCD by his psychotherapist. With regards to Axis IV, he has no psychosocial problems other than a general and a social anxiety due to his obsessions. Environmentally, Melvin is not terribly affected, besides that fact that he lives next to Simon Bishop who, by proximity, is the subject of much of Melvin's scorn.
I would give Melvin an overall Axis V rating of 60-65. I wouldn't go as far as to say that Melvin's symptoms are "serious." Though he demonstrates highly-developed obsessions, compulsions, and other symptoms of OCD, they effect his overall level of functioning only on a moderate level in my opinion. He certainly has few friends, with only Simon, and his waitress Carol carrying any evidence of friendship with Melvin. He has an immense difficulty relating to people or controlling his blunt personality, which presents with many social conflicts. However, even when he strays from his routine by going on the trip with Simon and Carol to see Simon's parents, he is still doesn't present any true breakdown in functioning.
Doctors are not sure what causes OCD. However, they suspect that the cause involves neurotransmittersÂ in the brain that are not sending signals correctly. Udall talks about how, hesitant at first, he finally starts taking the pills to help with his OCD. This demonstrates that biologically, OCD can be helped with medicine that affects a part of the body, the brain.
Even though the portrayal of OCD seems realistic in most parts of this As Good As It Gets, it would be unlikely for clients to handle a dog when they have an obsession about cleanliness as severe as this character. It's also incredibly hard to believe that Melvin is totally comfortable leaving his home city and literally his routine. It is implied and understood that Melvin eats at Café 24, Carol's restaurant, every day as a compulsion, and suddenly Melvin is separated from that routine, yet he seems perfectly fine about it.
Melvin Udall's past or childhood is not discussed at all in As Good As It Gets. The movie focuses on Melvin's present. I would suspect however, that Melvin developed his obsessions as a much younger man, and worked over time to develop compulsions for them. Unfortunately, because the compulsions are a form of negative reinforcement for the anxiety, he would become more and more dependent on the compulsions over time, meaning that most likely he is probably very indebted to them at the present in the movie.
In the movie As Good as it Gets, Melvin's psychotherapist suggests that he take pills for his OCD, pills that will probably effect his serotonin levels. However, this is not the only means to which OCD can be suppressed.
Exposure and response prevention is behavioral technique has been found successful in treating compulsions. For example, clients like Melvin Udall try to avoid germs in excessive ways. They are exposed to a surface that they believe is contaminated, such as a doorknob, and asked not to wash their hands (response prevention). Exposure techniques include systematic desensitization, paradoxical intervention, flooding, and satiation either in vivo or in imagination.
The cognitive-behavioral therapy approach aims for cognitive restructuring by identifying and challenging the cognitive distortions. Patients like Melvin could be subjected to exercises that help them postpone compulsion over an obsession or to pay attention to their obsessive thoughts and noticing how it makes them feel in an attempt to drown out the anxiety. Another creative technique is to have clients record their obsessive thoughts on an audio tape and play it back to themselves until their distress decreases.
Sometimes relaxation or body-focused methods are used. Clients who suffer from OCD are frequently very intelligent, much like Melvin, and tend to spend a lot of time ruminating in their heads, at the expense of being centered and relaxed in their body. They are sensitized to their thoughts and impulses, but are often out of touch with their bodies. Therefore, body-focused therapies are recommended.
Clients like Melvin who suffer from OCD have poor social skills because they are wrapped up in their obsessions and compulsions, and therefore are oblivious to normal courtesies, to social context, and to other's perception of them. This point is verified over and over again in the movie as Melvin humorously stumbles through his intrapersonal interaction. Using interpersonal psychotherapy, the therapist first highlights the ways in which the clients' current functioning, social relationships and expectations within these relationships may have been causal in their problems and subsequently helps them explore problem relationships and consider options available to resolve them.