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August 2010 Posts

16/08/2010 12:02:13

The Aviator


The Aviator is a biographical film about the American billionaire, Howard Hughes, that presents an extremely well researched and accurate portrait of the development of his obsessive compulsive disorder (OCD), from its first emerging symptoms, to his struggle with severe symptoms in middle age. It tells the story of his lifetime achievements as a filmmaker, an aviator, a record breaker, a playboy and a successful entrepreneur. These successes were probably aided by his extreme perfectionism and his determination to attend to every small detail in a project, something the film illustrates brilliantly.


The film, directed by Martin Scorsese in 2004, with Leonardo DiCaprio playing Hughes, won 5 Academy Awards.


The Aviator

Scorsese consulted with OCD specialist, Dr Jeffrey M. Schwartz MD, an Associate Research Professor of Psychiatry at the UCLA School of Medicine and a medical advisor to the UK’s national Obsessive Compulsive Disorder charity OCD-UK, on every aspect of DiCaprio’s portrayal throughout the filming.

On the DVD with bonus features, there is a 15-minute film about the condition presented by Dr Schwartz in which several patients recount their own experiences of the illness. Di Caprio reveals, in an interview on the bonus disk, that he spent a significant period of time with a sufferer, before filming, in an attempt to understand what lay beneath the compulsive behaviour of excessive hand washing. DiCaprio also admits that he rediscovered some obsessional behaviour from his own childhood, involving cracks in pavements, when preparing for the part. This resulted in him sometimes taking ten minutes to walk from the studio door to the set.

The Film

Lasting for 163 minutes, this is an epic film but one well worth the investment in viewing it.  It tells the story of the early life of Howard Hughes from the 1920s to the 1940s and records the history of his OCD from the first subtle signs to the full blown incapacitating episodes in which he was almost certainly suffering from depression as well.


The film opens with shots of his mother bathing his naked body as a boy and telling him that he is not safe from disease, giving the viewer clues about a strong family history of OCD (which was in fact also present in other relatives) as well as early parenting influences in the causation of his OCD.

The Aviator beautifully depicts the grand age of the Hollywood studios with all of their glamour and shows the many famous actresses of the day with whom Hughes had sexual relations. However his personal isolation and difficulty in finding intimacy is particularly well enacted, especially in his relationships with Katharine Hepburn and Ava Gardner.  Through their eyes we are given insight into how the early symptoms of his illness become apparent and how OCD can adversely affect the partner in a close relationship.


A significant focus of the film is on Hughes’ contribution to the aeronautical industry and his involvement in the birth of modern aviation as we now know it.  His meticulous attention to detail and extreme perfectionism, coupled with his technical vision, are shown transcending the real limitations imposed by his OCD. This is a film that demonstrates just what can be achieved despite such a serious mental illness.


In contrast, his excessively controlling behaviour, in all of his personal relationships is shown as causing him huge difficulties.  His ability to employ staff to carry out his compulsions, an extraordinary facet of his illness, is an unusual feature of his mental ill-health made possible only by his great wealth.

The most severe episode of his OCD is brilliantly illustrated near the end of the film in the scene showing him living as a naked recluse in his screening studio. His nakedness at this point in the film has powerful echoes of his nakedness as a boy at the beginning of the story, being washed clean of germs by his mother.


Relevance to the field of mental health

For anyone interested in learning more about OCD, this film provides tremendous insight into the thoughts and compulsions that can cause sufferers so much distress.  It also illustrates the fact that depression may arise in association with untreated OCD and can contribute to the burden of illness. The Aviator helps us to imagine how it might feel to be close to someone with OCD who has not yet sought help.


Our understanding of this illness has grown significantly since the decades represented in The Aviator, when frontal lobotomy was the treatment of last resort for the condition. Although the role of early influences is acknowledged, the majority of scientific research now supports the view that in a significant proportion of sufferers it is a brain disorder.  It is also well recognised that stressful events and major life changes can bring on or worsen the symptoms of OCD, something that is well illustrated in the film.


Fortunately cognitive behavioural treatments have been developed in the past two decades that are very effective in treating the symptoms, using either exposure and response prevention (3 out of 4 people are helped significantly) or cognitive therapy (very effective for mild OCD on its own).

Additionally, there are thought to be problems with a neurotransmitter, serotonin, which is deficient in certain brain areas of people with OCD. This explains the use of certain drugs in the SSRI group of antidepressants, which increase available levels of serotonin, in the treatment of moderate to severe OCD, even when depression is not present. People who find relief with medication alone (around 6 out of 10 people) tend to relapse when it is stopped, unless it is combined with cognitive behavioural therapy.

The film portrays clearly that Hughes’ obsessive compulsive symptoms fluctuated significantly in severity in response to the stresses and traumas in his life, especially his near fatal plane crash.  But even during the worst episodes of his earlier life, he was able to suppress the symptoms fairly effectively when totally absorbed in a task.  The complete focus and absorption required to fly a plane seemed to overcome his symptoms and gave Hughes some of the happiest experiences in his life.  This makes sense to us now because effective treatments involving mindfulness in the present moment and distraction into activity are known to help lessen some of the symptoms of OCD.


I believe that this film offers the viewer an opportunity to gain an empathic understanding of the suffering that individuals with severe OCD might experience.  Indeed, one wonders what further achievements Howard Hughes might have made in later years had he been able to access the treatments available today, when he had first developed symptoms.


These issues were examined in a recent prospective, long-term follow up study of children and adolescents, seen at the specialist OCD Clinic for Young People at the Maudsley Hospital, London.  Published in the August 2010 issue of The British Journal of Psychiatry, the authors concluded that “early recognition and treatment of OCD in childhood might prevent chronicity“ and urging “a need for increased recognition at the earliest stages of the disorder” (Long-term outcomes of obsessive-compulsive disorder: follow-up of 142 children and adolescents N. Micali, I. Heyman, M.Perez, K. Hilton et al; The British Journal of Psychiatry (2010) 197, 128-134.).


  • The Royal College has a good leaflet on obsessive compulsive disorder for anyone wanting further information on the symptoms and treatments available.
  • Further information about The Aviator can be found at IMDB, as can a short trailer.
  • The DVD is available to purchase at (either with 2 discs and bonus features or one disc without the extras).

Minds on Film blog is written by Dr J Almeida. 




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About this blog


Minds on Film is a blog that explores psychiatric conditions and mental health issues as portrayed in a selection of readily available films.

Please note that this blog may contain plot spoilers. Any views expressed are purely my own.

Dr Joyce Almeida

Dr Almeida is a consultant
psychiatrist working in the private sector in the UK.


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