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Compulsive Behaviors

Earworms: A Suggestion for Treatment

Getting rid of that annoying mental music.

An earworm is a short musical phrase that catches hold somehow to your imagination and repeats endlessly in your mind. It is common and similar to an obsession, which is an annoying and intrusive thought or phrase. It differs from a true obsession in that it has no meaning or content. True obsessions are usually the worst thoughts that an individual can imagine. Most common are thoughts of engaging in violent acts, although obsessions can also center on other forbidden thoughts. These may be homosexual, or even sacrilegious in character. Earworms are not as upsetting as true obsessions, but they are annoying anyway.

I have to admit right off that I have not made a study of earworms. I have not separated a large number of people with earworms of exactly the same character into different treatment programs and compared them statistically. (I think some such studies have been done.) My advice comes out of a different tradition in medicine, namely attempting to deal in a trial and error manner with medical matters of no great import.

For example, when I worked in an emergency room, I used to see kids who came in with a blackened fingernail from having their finger caught in a door or hammered on in some other way. Left untreated, the nail was destined to fall off. The nail would not be lost if it were possible to remove the blood that separated the nail from the nail bed. The proper way to do this is to heat the end of a paper clip until it is red hot and push it up against and through the nail, making a hole through which the blood could exit. This requires a delicate touch which, frankly, was beyond me; and I do not recommend that anybody else try it. But some of the nursing staff and other medical staff were really good at puncturing fingernails.

Another unusual—but not that unusual—medical problem was the very upset young child who came to the emergency room with a small cockroach in its ear canal. Apparently, the cockroach does not have the ability to back up, and so it tries to burrow its way through the eardrum. Poking at the cockroach with tweezers inclines the cockroach to redouble its efforts. As anyone can imagine, young children cannot tolerate such a mishap with equanimity. By the time they get to the emergency room, they are bouncing off the walls. The right way to extract a bug from the ear canal is to render it unconscious by dropping ether into the canal, anesthetizing the creature so that it can be extracted without its making more of a fuss.

I know of no scientific studies of the best way of evacuating blood from under a fingernail or the best way of removing insects from the ear canal. Somebody, somewhere along the way, figured it out. It is in this modest tradition that I offer a suggestion for getting rid of a musical earworm. The song has to be completed purposely, or changed into another key and played out mentally until its end. This suggestion is not entirely arbitrary. It derives from a treatment technique applied to compulsive behavior. When a person cannot simply stop doing a senseless, repetitive act, such as checking the front door over and over again, a recommendation is often made to change that behavior subtly—to check the door very slowly. When a compulsive behavior cannot be resisted by the affected person, it is sometimes possible to alter it so that it is less compelling. Rather than stopping thinking an upsetting thought by an effort of will, the individual is instructed to think of it in a different way. I recommend that obsessional patients write down their obsessional thoughts in detail with a colored pencil. When the thought becomes ridiculous by changing its context, it can more readily be resisted.

Anyway, when I get a tune stuck in my head, I play it out to the end. That works for me. (c) Fredric Neuman Author of "Worried Sick" Follow Dr. Neuman's blog at or ask advice at

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