Thursday, June 26, 2003

BY KATHLEEN O'BRIEN

Nicknamed "the defective detective," the hero of the television show "Monk" wouldn't be expected to win points for authenticity among those who share his obsessive-compulsive disorder.

Yet people with OCD, as it is called, are finding themselves charmed by the sympathetic portrayal of the character by actor Tony Shalhoub. In that, they are pleasantly surprised.

"I have to give him credit for that. He's cute and sweet," said Jeanne Yarrow, of the board of directors of the New Jersey affiliate of the Obsessive Compulsive Foundation. (www.njocf.org). The Hunterdon County woman was diagnosed with OCD more than 20 years ago.

"It's good in that it creates a poster boy for the disorder -- and he's a likable one," said Allen Weg, a Milltown psychologist who specializes in treating OCD.

The most famous fictional OCD character until now has been Jack Nicholson's crabby bachelor in "As Good As It Gets."

"In that, you weren't seeing OCD, you were seeing Jack Nicholson with OCD," Weg said.

The USA Network series features Shalhoub as Adrian Monk, a police detective whose obsessive-compulsive disorder flared up after his wife's murder. He is temporarily on disability, but is often tapped as a consultant on difficult cases because of his uncanny ability to solve the crime.

Yet even as he brilliantly notices obscure clues, he must stop to count streetlight poles or clean his hands with alcohol wipes -- all while whimsical pizzicato music signals his quirks are being played for laughs. In the opening credits, he is shown storing his clean socks in plastic zip bags.

The series doesn't shy away from depicting the sadness and difficulty his compulsions create, however. In an early episode, for instance, the villain scampers past him on a fire escape because Monk's fear of heights roots him to one spot, humiliated.

Although Monk's constellation of triggers -- germs, crowds, disorder, heights -- is fairly typical, his inability to control his reactions isn't, said Weg. Citing one incident in which Monk could not stop from picking lint off a stranger's lapel, Weg said real-life OCD people would never do that. They would want to do it, but would realize its inappropriateness and would restrain themselves.

"It's like an itch. You can postpone scratching an itch," he said.

People with obsessive-compulsive disorder suffer from recurrent unwanted thoughts or rituals that they feel they cannot control. Hand-washing, counting, checking or cleaning are performed over and over again in hopes of controlling those unwanted thoughts. Recent research points to a biological origin within abnormal brain circuitry.

The illness strikes males and females equally, according to the National Institute of Mental Health fact sheet (www.nimh.nih/gov/anxiety/ocdfacts.cfr). At any given time, an estimated 2.3 percent of the U.S. population ages 18 to 54 has obsessive-compulsive disorder.

One aspect of the show that rang false with Yarrow was the detective's ability to put his anxious episodes behind him quickly, without being tormented by remorse. "He's so comfortable with himself, a well-adjusted, calm person. But if you really had all his triggers, you'd be filled with anxiety to the point where you'd get exasperated. Yet it doesn't appear to overwhelm him," she said.

"He's so lovable, and he seems to handle things easily, yet having a devastating illness like OCD destroys your self-confidence," she said.

Yarrow was also concerned that viewers might get the wrong message from Monk's ability to function at such a high level in daily life. "They might think, 'It's not that bad to have OCD. Look, he manages,'" she said.

"They're using OCD to make him cute, and the last thing you feel when you have OCD is cute," she said.

In the premiere of the second season, broadcast last week, the detective takes a job as a substitute teacher to uncover a murderer at a private high school. His time in the classroom is excruciating, with high-schoolers giggling while he laboriously tries to write "Mr. Monk" on the board in chalk -- with every letter the exact same size.

Michael, a 50-year-old OCD sufferer from Brooklyn, said he felt the show was accurate in its handling of the disease, with one exception: "Monk sometimes seems unaware of his compulsions, such as when he's writing his name for the English class, or wiping his lunch tray. However, OCD people are painfully embarrassed by their rituals and compulsions and try their best to conceal them," he said. (He didn't want his last name used.)

Monk is being treated by a psychiatrist for his condition, but there is no mention of either medication or cognitive behavior therapy, key components of modern treatment. So-called exposure and response therapy trains sufferers to endure exposure to their trigger agents while resisting an immediate response. Both Yarrow and Michael called the gaps in his treatment a serious omission.

Monk's abbreviated treatment also includes the day-to-day help of Sharona Fleming, a nurse, who ends up as his sidekick.

"She's a great character, but of course she serves as an enabler by allowing him to not confront his illness," said Weg. "She's really not helping him cope with his OCD."

When Monk has to shake a stranger's hand, for example, Sharona quickly hands him a baby wipe with which he can immediately wash his hands. While that might be compassionate and protective, it doesn't help Monk get better. A better technique, Weg said, would be for her to ask Monk to try to postpone his hand-washing for 10 minutes.

"She's not helping him get better," he said. "But she isn't going to do that, of course, because if he got better, there'd be no show."