SINGAPORE: Judith Rapoport, who has died aged 92, was a leading psychiatrist who rejected Freudian theories based on the workings of the “unconscious mind” to focus on the brain’s biology and its role in mental illness.
She was best known for her 1989 book The Boy Who Couldn’t Stop Washing, a bestseller that raised public awareness of obsessive-compulsive disorder, or OCD, an anxiety-driven mental health condition involving uncontrollable, obsessive thoughts and repetitive, often ritualistic, behaviour.
Famous sufferers from OCD include the reclusive tycoon Howard Hughes, who would walk around with his feet wrapped in plastic to prevent “contamination”; Samuel Johnson, who would make ritualistic hand gestures before leaping through doorways; and Frank Sinatra, who, according to the producer Irving Mansfield, “was always washing his hands, constantly washing, washing, washing”.
There is, as Judith Rapoport acknowledged, a little bit of OCD in most people. Who has not gone back into their house twice to check that the gas is off or all the windows are locked? In extreme cases, however, such behaviour becomes so obsessive that it interferes with normal life – a sufferer will not check the gas or locks once or twice, she observed, but “10, 20 or 100 times”.
Judith Rapoport’s patients included the talented 17-year old who overnight found himself unable to stop washing, so obsessed with the idea that he was dirty that he dropped out of school; the man who felt so sure that he had hit someone with his car that he would continually drive up and down the road looking for the body; and the woman who went to confession five times a day to ask forgiveness for the “terrible sin” of coughing during a public lecture.
Sufferers, she found, are often aware that their actions are ridiculous, but are beset by such powerful anxieties that they are unable to stop.
Judith Rapoport’s research revealed a number of facts about OCD that were not generally known, even among psychiatrists. She found that when sufferers sought her out for treatment, their refrain was almost always the same: “I thought I was the only one in the world with these crazy symptoms, and I didn’t want anybody to know about them.” As a result they became expert at concealment – so much so that OCD was widely assumed to be an uncommon disorder.
In fact, she revealed, about 3 million adults and 1 million children in the US were locked into some form of repetitious behaviour. In Britain it is estimated that around a million people suffer from OCD, while between one and four per cent of the population may experience symptoms at some point in their lives.
As a trainee psychiatrist Judith Rapoport had been taught that even before the onset of their illness sufferers invariably had “obsessional personalities” – often blamed on over-strict parenting in childhood.
While the exact causes of OCD are still not fully understood, and treatment for the condition mostly involves cognitive behavioural therapy, she demonstrated that there was a strong neurological component. In 1989 she directed a clinical trial that showed how the antidepressant clomipramine could effectively treat the condition in children, leading to its approval by the US Food and Drug Administration.
She was born Judith Helen Livant in Manhattan on July 12 1933, the daughter of a school teacher and a businessman. From the private Walden School in New York, she read experimental psychology at Swarthmore College, Pennsylvania, taking a postgraduate degree in medicine at Harvard, where she met Stanley Rapoport, a fellow student, whom she married in 1961.
Graduating in 1959, she embarked on psychiatric training that took her eventually to Sweden – to Uppsala University, then to the Karolinska Institute in Stockholm, where she led research into women travelling from the US seeking abortions abroad.
Back in the US, after stints at Georgetown University and the Washington Psychoanalytic Institute, in 1976 she joined the US National Institute of Mental Health in Bethesda, Maryland, where she served as head of child psychiatry from 1984 to 2017.
Judith Rapoport’s research encompassed ADHD and childhood-onset schizophrenia, and in 1999 she led an important study that laid the groundwork for a reappraisal of the adolescent brain, suggesting that there might be a neurological explanation for teenage angst and stroppy behaviour.
From MRI scans carried out over 10 years on children from the age of four to adults as old as 25 she found that the brain matures in a gradual wave of development, travelling from the back of the head to the front, with the last parts to develop fully being the frontal lobes, which are involved in reasoning and problem-solving.
“One could speculate that some of the more immature aspects of adolescent behaviour may be due to the lack of maturity of some parts of the frontal lobes of the brain,” she concluded.
Judith Rapoport is survived by her husband and two sons.