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When the brain doesn't know when to stop

Obsessions control patients' lives

By Elizabeth Cohen
CNN

Editor's note: In our Behind the Scenes series, CNN correspondents share their experiences in covering news. CNN medical correspondent Elizabeth Cohen relates her experience with patients being treated for Obsessive-Compulsive Disorder.

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Shannon Fleishmann, left, tells CNN's Elizabeth Cohen about living with Obsessive-Compulsive Disorder.

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BELMONT, Massachusetts (CNN) -- Shannon Fleishman sat in her room at McLean Hospital, eyes shut tight, hands clenched together until her knuckles were white. She was shaking. I watched her and thought, "If I didn't know the truth, I'd think she was a cocaine addict who just ran out of drugs."

But that wasn't it. Shannon Fleishman was trying to fold a shirt.

Dr. Carol Hevia, Shannon's therapist, told Shannon to stop smoothing out every tiny wrinkle, to stop lining up edges of the shirt just right. After what seemed like an eternity, the shirt was folded.

It looked fine to me. But that's the crux of Shannon's disease: What looks fine to others is a mess to her. It took every ounce of Shannon's willpower to just leave the shirt alone, to stop trying to make it look perfect.

Shannon's Obsessive-Compulsive Disorder is particularly severe, requiring three months of inpatient treatment at McLean, just outside of Boston. MRIs of the brain of people with OCD show that areas responsible for simple decisions -- like whether a shirt is folded right or not -- are hyperactive.

There are various forms of OCD, and Shannon's centers around perfection. Other patients have other issues, as I was soon to learn at McLean.

When I asked to use the restroom, a staff member said, "Well, there's that one there, but let's get you another one, because this one doesn't have soap." When I asked why not, he said many of the patients had hand-washing compulsions, and if they just let them into a bathroom with soap, they would be there for literally hours, scrubbing and scrubbing. Patients were therefore given just a tiny cup with soap, and two paper towels, and their visits to the bathroom were timed.

Shannon's OCD was different. Hers was all about how things looked.

Just before her admission to McLean, Shannon had gotten to the point where she would just give up. Folding one shirt would take hours. She could go grocery shopping just fine, but in the end the food would sit out on the counter, because she couldn't line the cans up exactly right in the cupboard, and she'd give up.

She would rise at 7 a.m. to get ready for work, which started at 5 p.m. It took her that long to shower and get her clothes ready.

I asked Shannon what her worst day was. It didn't take her long to remember her 8-hour bath.

What's strange about OCD is that many people seem perfectly fine outside their one area of obsession.

Sitting and chatting with Shannon, she seemed like a friend. We chatted about her art (she's very gifted) and her plans to run a marathon, and her experience pitching softball at her Division I college.

Shannon Fleishman is only 24. She has another six weeks left at McLean. When I said goodbye, I hoped that this therapy would work, that someday soon her brain would know when to stop folding a shirt.

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