“Big Mouth” on Netflix Animates OCD Rituals

Source: Netflix/Kroll, Goldberg, Levin, Flackett

Recently, many Netflix users discovered their binge-watch recommendations had been invaded by whimsical yet viscerally-disgusting animated creatures: giant insects, leering satyrs, and most disturbing of all, a group of middle-school kids tormented by the horrors of puberty. December 2020 brought us the fourth season of Big Mouth, the gloriously profane coming-of-age animation created by Andrew Goldberg, Nick Kroll, Mark Levin, and Jennifer Flackett.

I previously examined an episode from the show’s first season that depicted sexual intrusive thoughts—like those caused by OCD—in a manner that was simultaneously informative, compassionate, and shockingly frank (Netflix’s "Big Mouth" Animates Sexual Intrusive Thoughts). Since then, the show has tackled other issues related to adolescence and mental health—but I was interested to see Season 4 explicitly return to Obsessive-Compulsive Disorder.

Big Mouth examines puberty through a sort of locker-room magical realism, personifying unwanted impulses and unconscious drives as figures of fantasy: the Hormone Monster, the Shame Wizard, and the truly disturbing Depression Kitty, who coos soothingly as she crushes you to death. In Season 4, Big Mouth adds a new specimen to its Pokédex of pathos: every kid’s favorite, Tito the Anxiety Mosquito, voiced by stand-up comic and real-life OCD sufferer Maria Bamford. The whine of a mosquito is a perfect (if slightly obvious) metaphor for the constant voice of chronic anxiety. And by the end of the season, Tito succeeds in driving John Mulaney’s character Andrew Globerman to a full-on OCD breakdown.

Andrew’s OCD symptoms are all related to his anxieties around sex. That may sound lurid, or exaggerated for laughs, but sex and sexual identity are common triggers for OCD, especially for young adults. In Season 1, Andrew was bombarded by unwanted sexual intrusive thoughts and obsessively tried to suppress them. In Season 4, Andrew’s symptoms return as repetitive OCD rituals: a complicated series of steps that Andrew needs to perform whenever he (as he so delicately puts it) tries to be "personally intimate with myself."

For the sake of time and common decency, I’m not going to review all 17 steps of "the Globerman Method," but a few of these are clear manifestations of his OCD. For example, Andrew explains he needs to check the lock on his door…not once, but three times. In Freedom from Obsessive-Compulsive Disorder, John Grayson explains that "checking refers to rituals that are direct attempts to affect the environment or to perceive the environment correctly. This would include making sure a stove was off by repeatedly turning it on and off... Within these constraints, checking rituals can be used to neutralize almost any obsession."

Similarly, Andrew covers up the framed photo of his parents on his bedstand; with this action, he is unwittingly acting out a ritual to protect himself from the pathology of shame. As explained by Gershen Kaufman in The Psychology of Shame: Theory and Treatment of Shame-Based Syndromes: "Phenomenologically, to feel shame is to feel seen in a painfully diminished sense. Shame reveals the inner self, exposing it to view." Furthermore, "[s]exual functioning is disrupted by the slightest onset of shame, along with other negative effects, and sexual identity itself becomes both molded and distorted by shame... Shame instills doubt, a voice whispering despair."

Some steps of Andrew's rituals—such as when he pulls out exactly four pieces of tissue paper, no more and no less—may seem totally random and irrelevant. But Obsessive-Compulsive anxieties and rituals don't have to be rational or coherent. In The Imp of the Mind, Lee Baer describes a patient exhibiting such symptoms: "During the previous school year, she had begun to obsess about harm coming to her family and felt the need to protect them with numerous rituals involving movement and symmetry. Every time she went through a doorway, she felt she had to touch the left and right sides of the doorway to protect her family. She would continue to do this until it 'felt right'.”

The truth is that any behavior can become an OCD ritual, thanks to a fundamental ability of human intelligence called "arbitrary relational framing." As described by Niklas Törneke in Learning RFT: "Early in life, humans learn a generalized operant: arbitrarily applicable relational responding. This responding is governed by contextual cues that specify the relation so that the relational response can be brought to bear on any stimuli, regardless of their formal, physical properties. This relating will, in turn, govern which stimulus functions are cued in a given moment.”

In other words, the human mind is programmed to derive cause-and-effect relationships between events—and when it does this incorrectly, the consequences can be traumatizing, especially for OCD sufferers. Andrew's chain of obsessive reasoning is both deeply irrational and potentially devastating: he imagines that if he screws up his ritual he might startle a flock of birds, who then fly into a jet engine, which crashes into a carnival and sends the ferris wheel rolling like a giant wheel of death. "I'm not obsessive," Andrew insists, "I just know that if I ever deviate from my very precise method, even a smidge, something terrible will happen." And, unfortunately for Andrew, his irrational fears are seemingly confirmed when he learns his grandfather has dropped dead of a heart attack.

OCD Essential Reads

Is Relationship OCD Real?

Germaphobia: An Infected Mind

Andrew confesses his guilt to his mother and father, who patiently explains that his grandfather's death wasn't his fault, but then take the lecture just a few steps too far: "Death is completely random and uncontrollable and it lurks around every corner," his mother assures him, "every time you close your eyes there's a chance you won't wake up again." "A good chance!" his father adds, "you have bad genes!" Soon, Andrew is seeing visions of his own demise around every corner: trapped in a burning building, an allergic reaction to a bee sting, a high-speed motorcycle chase with Yakuza gangsters, farting so hard his body deflates. And then, finally, Andrew imagines himself in a coffin, buried alive.

But the quiet and isolation of this last scenario finally give Andrew a chance to take stock and challenge his obsessive thinking. "Okay. No matter what I do, eventually, I'm gonna die. I can't fight it. All I can do is breathe." Andrew is right: After all, we will all die eventually and nothing we do can change this. But if we can accept this fact, suddenly we have the freedom to make choices and live meaningful lives, right now, in the moment. This is the sort of insight that helps OCD sufferers overcome their symptoms, and this is what finally liberates Andrew from his vicious spiral of imagined deaths.

If I have a complaint with Big Mouth's Season 4, it’s that the show backs down from explicitly identifying Andrew’s OCD. Andrew is obviously “coded” as having OCD—repetitive checking is a stereotypical symptom commonly used in media as shorthand to signal Obsessive-Compulsive behavior to a general audience. That’s not a problem in and of itself, as long as the show has something more to say about it, and Big Mouth’s portrayal is sympathetic, informed, and ultimately hopeful. I just wish the show had the conviction to tackle Andrew's OCD head-on.

Exposure-Response Prevention therapy seems like obvious material for Big Mouth’s brand of uncomfortably personal humor—and watching Andrew struggle and ultimately persevere through his treatment could help a lot of sufferers.

With Big Mouth, Netflix demonstrates digital media has vastly expanded opportunities for honest, educational, and compassionate depictions of mental illness—and as long as that trend continues, I’m happy to keep watching.

Copyright, Fletcher Wortmann, 2021

You may be interested in two other posts: "Girls" Gets OCD and Why "Monk" Stunk