Governor Cuomo, A Case for OCB?

Over the past 40 years, I treated many people from the financial, television, movie, sports, political and dot-com worlds as a psychiatrist.

Many of these individuals were powerful, driven, successful and they also hurt people. Most of them were summarily thrown into the wastebasket diagnosis, narcissist.

Seeing so many of them as a psychiatrist, I have come to believe that there was something else going on beneath simple narcissistic behavior that I have descriptively called: OCB.

You may have heard of OCD, which stands for Obsessive Compulsive Disorder. OCB stands for Obsessive Compulsive Bipolar. It’s more of a condition than a disorder because OCBs often function quite highly, even though their personal lives are usually a mess.

They differ from pure bipolar (or manic-depressive) people. When bipolar people become manic (especially what is referred to as Bipolar I), they may go off the deep end into psychosis, occasionally breaking the law and frequently ending up in a hospital. Even so, they do it with a smile, because they feel invincible and free when they are manic.

OCBs don’t go to those extremes. Their obsessive-compulsive traits work like emergency brakes, pulling them back just before they go over either edge. People with OCB don’t lose touch with reality, just with common sense.

The rules don’t apply

Generally regarded as exceptional because of their formidable abilities, they come to believe they’re exceptions to the rules that apply to everyone else. They tend to disregard the possible consequences of their behavior. Sometimes they’re even surprised when those consequences are disastrous. Compelled to seek the exhilaration of “controlled” mania, their life becomes like a roller coaster. They don’t get real joy or contentment on the ride, but it is exciting, and they’re not necessarily unhappy, tending more often to become angry when hitting some of the speed bumps from reality.

It’s often their friends, partners (usually female, because OCB men outnumber women four to one) and children who are miserable. It’s they who must live with the OCB’s unpredictability, his inability to give them undivided attention, his lack of emotional understanding and his failure to make good on promises to reform.

One woman compared life with her OCB boyfriend to riding with him in a Porsche, blasting along curvy Mulholland Drive at 60 mph.

“He tells me to just cool it, he’s in complete control as he downshifts and the tires screech,” she said. “He probably does feel more in control, feeling the wheels touching the road while he shifts and accelerates. On the other hand, I don’t feel anything other than scared silly and totally at his mercy. Sometimes I dig my fingernails into the dashboard, and it irritates the hell out of him.”

People with OCB are addicted to excitement and power.

Seductive to Women

Prior to the #metoo movement, some of these men were highly attractive to women, and usually adoring women. That’s because these men’s strength, power and promise to take care of those women could cause some women to feel special plus offer them the appeal of being taken care of by a powerful man to overcome their insecurities (a.k.a. the “sugardaddy” syndrome).

Over time, many of those women can come to realize that these men don’t care about them. What they care about is how the adoration of those women make them feel which may explain how many of these men would turn cold, when any of these women began to look for something that such men are incapable of, which is true emotional intimacy. Upset in such women often escalates greatly if together with that man they have children and observe their children wanting a connection with their dads that he doesn’t (and often doesn’t know how to) give them.

However, with the arrival of #metoo, a Governor Cuomo is not going to get away with behavior that twenty years ago, a President Clinton (almost) got away with.

Seduced by Power

Power is one of the toughest mistresses to compete against.

In fact, the seductive attraction to mistresses is that they make an OCB man feel powerful and even heroic in ways that his wife no longer does. When power and excitement are present, OCB people are sharp, goal-directed, amazingly effective and productive.

When these feelings are missing, they become unfocused, listless and irritable.

Enter Medication

It’s the moodiness and their tendency to over-control that stops working for them that may cause them to seek out a psychiatrist and may prompt psychiatrists to treat them with antidepressants like Prozac, Paxil, Lexipro or Luvox (these drugs,  called SSRIs, are used to treat depression and OCD, to help people “lighten up”).

Frequently this is insufficient, because treating OCB people with only SSRIs is like trying to control boiling water by putting a lid on the pot. The lid won’t help unless you take the pot off the fire. In fact, putting a lid on boiling water only adds to the pressure. Similarly, giving only an anti-depressant to someone who has a concurrent bipolar component can make matters worse by causing him to become more manic.

If there is true bipolar neurochemistry going on, antidepressants can frequently push such people into becoming manic. One of the signs that an antidepressant might actually be making the person worse and triggering their bipolar manic side is that they will report within 24 to 48 hours of taking an antidepressant that they are feeling great. With true non-bipolar depression, such mood elevating results usually take longer to occur.

Medications that help

What may help is a combination of an antidepressant and a mood stabilizer such as lithium, Tegretol, Depakote or Lamictal. These medications for bipolar disorders help turn down the flame. Psychiatrists have been using the combinations for many years for what’s referred to as “treatment resistant depression.” In recent years, medications known as atypical antipsychotics including: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) have been used to treat bipolar depression to avoid the risk of an antidepressant triggering a manic episode. 

As intensity of the OCB lessens, patients discover a feeling of calm and often a new kind of non-frenetic energy. One patient was so relieved he called me in tears: “I’m normal!” he said. “All my life, I thought normal was for everyone else. You know? Success doesn’t make up for feeling like a mental misfit!”

After medications have effectively stopped the Porsche by removing the keys, individual and couples’ therapy can help a patient and partner develop a healthier relationship — now that they have slowed down enough to put some emotion into it.

Once their tendency towards either bipolar mania or depression settles down, insight therapy might also help, since there has often been some childhood abuse, neglect or dysfunction that contributes to (but alone doesn’t cause) OCB. Pretty soon OCB people listen better, are more “present” and see the quality of all their relationships improve.

One treated dad started to cry as he told me about reading his five-year-old year old a bedtime story. For the first time, he was emotionally “there,” not just mouthing the words with his mind miles away.

Finding peace of mind

There are a couple final reasons to get your OCB taken care of sooner rather than later — peace of mind and increasing your chances of preventing a chaotic, roller coaster life that leaves a trail of hurt and injured relationships with people that you actually believe you love, but can’t seem to stop hurting.

Years ago, I made house calls to an entertainment industry giant dying of cancer. He also had OCB, having thought he was above the consequences of alcohol and cigarettes. A few weeks before he died, he talked about something that had been tormenting him. “I don’t think I’ve ever done anything important in life,” he said.

I tried to reassure him that he had brought pleasure to millions of people, created hundreds if not thousands of jobs and had a lot to be proud of. He thought I was trying to manipulate him into a solace he didn’t deserve. “Yeah sure,” he said, “but what about the two wives I ruined and my three loser kids on drugs who’ll never amount to anything?”

Because he was like other people with OCB and never meant to hurt anyone.

Do you know anyone who has OCB?

Powerful, charismatic, larger-than-life AND taking professional and creative risks resulting in a much better than chance record of success (because their exceptional instincts and abilities override professional shortcomings)

• Fiercely competitive but a terrible and often vindictive loser
• Superficially compassionate and empathic in public when it will increase people’s admiration/adoration/compliance, but mercurial and evasive regarding deeper emotional closeness
• Emotionally distant and cold towards spouse, who sees through his self-serving veneer and often views him contemptuously as a opportunistic BSer; non-distant, but mentally preoccupied when with his children (cell phone dad)
• Often married to strong women who keep them grounded early in the relationship, but whom they later resent later for trying to control them
• Surrounds self with sycophants and if they have affairs it is usually with emotionally dependent and needy women who make them feel like a hero (although the women may turn out to have ulterior motives)
• Do not feel they are doing anything wrong if they are not consciously doing anything to hurt anyone
• Long-standing pattern — usually dating, back to college — of driven, controlled and controlling behavior, periodically interrupted by impulsive and reckless behavior
• Many-year history of seeking out exciting and risky situations that provide an adrenaline rush
• Grandiosity usually manifested as reckless behavior with a disregard for consequences and even surprise when negative ones occur
• Depression usually expressed as moodiness, impatience, annoyance, irritability and emotional withdrawal
• Dabbles with cocaine or speed (rarely reaching the need for rehab), which helps them to feel powerful and effective (which causes them to be confused with people who have Attention Deficit Disorder).

If six or more of the above are present over a period of many years, there is a high likelihood of OCB being present.