A man who suffered from severe obsessive-compulsive behavior apparently cured himself when he shot a .22-caliber bullet through the front of his brain while attempting suicide, it was reported Monday.
The bullet apparently destroyed the part of the brain that was causing the abnormal behavior in the 19-year-old man without damaging his intellectual capacity, according to a report in Physician's Weekly. The publication wryly referred to the suicide attempt as "successful radical surgery."
The man recovered from the attempt, finished his high school education that had been interrupted by his illness, and is now in his second year of college, said psychiatrist Leslie Solyom of Shaughnessy Hospital in Vancouver, British Columbia.
"The idea that a man could blow out part of his frontal lobe and have his pathological symptoms cured is quite remarkable, but it is not beyond belief," said psychiatrist Thomas Ballantine of Massachusetts General Hospital in Boston.
In fact, experts said, surgery on the frontal lobe is occasionally attempted as a last resort in treating patients with intractable obsessive-compulsive disorders.
Victims of the disorder typically have an unexplainable compulsion to repeat activities over and over. Solyom's patient, whom he identified only as George, had an obsessive fear of germs and would wash his hands literally hundreds of times a day, in addition to taking frequent showers. He was so incapacitated that he could not attend school or hold down a job.
Other victims may be compulsive about maintaining their clothes in perfect order in drawers and closets, performing rituals before leaving the house or arranging tools in a perfect order before beginning work. New research indicates that as much as 3% of the U.S. population may display some obsessive-compulsive behavior, according to psychiatrist Michael Jenike of Harvard University.
Conventional psychotherapy is "useless" in such victims, Jenike said. The disorder is most effectively treated with a combination of antidepressant drugs and behavioral therapy similar to that used to treat victims of phobia.
The patient is gradually exposed to whatever frightens him or her and encouraged not to show the compulsive behavior. More than 90% of patients can be cured or improved with the antidepressants and such therapy, Jenike said.
As a last resort, neurosurgeons will occasionally remove part of the left front lobe of the brain, where the obsessive behavior is thought to originate. The operation is probably performed between 10 and 30 times per year in the United States, Ballantine said, with "mixed" results. The procedure is not as radical as the frontal lobotomies that were used in the past to control extreme mental illness.
George was a straight-A student before he had to drop out of high school because of his illness, Solyom said in a telephone interview.
Solyom had been treating him for more than a year when the suicide attempt occurred.
"George was also very depressed, and told his mother that his life was so wretched that he would rather die," Solyom said.
"Parents of obsessive-compulsives, particularly mothers, often have cruel streaks," he said. "She said, 'So look George, if your life is so wretched, just go and shoot yourself.' So George went to the basement, stuck a .22 rifle in his mouth and pulled the trigger."
The bullet lodged in the left front lobe of the brain. Surgeons removed it, but could not get out all the fragments. "When he was transferred to our hospital three weeks later, he had hardly any compulsions left," Solyom said. "He was still depressed, but we were able to treat that with drugs."
George was able to hold down a job for the first time after leaving the hospital, Solyom said. He eventually completed high school and entered college.
"What made the case so very interesting was that we had measured IQ and done a lot of other tests before the suicide attempt," Solyom said. "Afterward, we compared results and he had not lost anything. We used very sensitive tests to measure brain damage and could find none." Solyom published a report on the case in the British Journal of Psychiatry.
It has now been five years since the suicide attempt, and George still has minor quirks. Solyom said George will, for example, close a window twice to make sure it is really closed, and washes plates particularly thoroughly to make sure they are clean. But those traits are "nothing that would interfere with his life," Solyom said.
He lives alone and visits his family only occasionally. "He's still a lonely person," Solyom said, "but we don't have any way to treat that."