Rewiring the Brain to Treat OCD

A groundbreaking therapy, relying on mindfulness meditation to treat obsessive compulsive disorder, suggests even adult brains have neuroplasticity.

Dr. Jeffrey Schwartz got a phone call at 3 p.m., a script before 5 p.m. and the next afternoon he was there, sitting with Leonardo DiCaprio, exploring the intricacies of one of the most debilitating mental illnesses in medicine. 

DiCaprio was tackling the role of Howard Hughes in The Aviator, a part requiring him to arc — as Hughes did — from genius billionaire to shaggy recluse, caught in the grip of obsessive-compulsive disorder. Schwartz’s books, Brain Lock and The Mind and the Brain, had established him as one of the world’s foremost authorities on the underlying mechanisms and treatment of obsessive-compulsive disorder, a condition that plagues sufferers with unreasonable thoughts and fears, which in turn compel repetitive behavior. He would not teach DiCaprio the mannerisms of people with OCD, Schwartz announced on day one. Instead, he would show him “how to become a person with OCD,” so his brain was “like the brain of a person who has the disease.”

The message was ominous, but DiCaprio proved game to try. He quickly pointed Schwartz to a particular segment of the script. “Right here, for three pages, I only have one line,” he said. Show me the blueprints, repeated 46 times, with minor variations.

Schwartz explained that people afflicted with OCD engage in a wide variety of problematic behaviors — compulsive hand washing, door opening, repetitive checking of ovens and doors, even repeating the same word, phrase or sentence. The cause, at a neurological level, is hyperconnectivity between two brain regions, the orbitofrontal cortex and the caudate nucleus, creating a tidal wave of unfounded mortal fear and triggering habitual response as the only way to attain calm. But the worst part is that, despite recognition that all these thoughts and behaviors are irrational, the OCD sufferer feels driven to obey them, nonetheless.

Schwartz walked DiCaprio through the underlying neurology to help him understand that, for Hughes, those four words — show me the blueprints — held a magical power, offering him an escape from his fear. “Those words, he’s repeating them like his life depends on them,” Schwartz advised. “But he also understands that this doesn’t make any sense.”

In the 2004 film that eventually emerged, this scene is perhaps the most painful to watch. DiCaprio, as Hughes, twists the sentence in new directions with each rephrasing, emphasizing different words and employing different cadences. Sometimes he races through the sentence almost under his breath. Other times, he slows down, seeking the right combination of sounds, the right rhythm, to free himself from the fear roiling in his gut. All the while, his face betrays a tortured self-revulsion. 

DiCaprio left The Aviator with an Oscar-nominated performance and perhaps a mild case of the disease. It reportedly took him about a year to get back to normal. And today, his willful descent into the illness and subsequent recovery represents one of the most dramatic public examples in our popular culture of neuroplasticity — the ability of the brain to change in shape, function, configuration or size. 

But Schwartz says mainstream science has yet to come to grips with an experience like DiCaprio’s, based on what Schwartz calls “self-directed neuroplasticity,” the ability to rewire your brain with your thoughts. This kind of power doesn’t only rescue his patients, he says. It rescues free will. 

The notion that we have free will flies in the face of much modern neuroscientific research, which suggests an ever-increasing number of our “choices” are somehow hardwired into us — from which candidate we vote for to which flavor of ice cream tops our cone. In fact, neuroscientists like David Eagleman and Sam Harris have released best-selling books offering that we are, at bottom, high-functioning, delusional robots. 

And so, at a time when free will is on the run, few of our culture’s most prominent thinkers agree with Jeffrey Schwartz — a scientist, as it happens, who is entirely comfortable with being disagreeable.