Deal or No Deal viewers know that host Howie Mandel doesn't shake hands with guests—he does a fist bump. But they may not know that it's not for effect; it's because the actor-comedian has an overwhelming fear of germs. The fist bump is one manifestation of Mandel's obsessive-compulsive disorder; he has attention deficit disorder as well. Mandel's new autobiography, Here's the Deal: Don't Touch Me, and a 20/20 story that will air Friday night shine light on these poorly understood mental illnesses, which touch the lives of millions of Americans. "It's more scary than fun" letting the world peer at him, Mandel said in a far-ranging interview. Edited excerpts:
When were you diagnosed with OCD and ADD? Do you feel like you had these problems in your childhood?
I was diagnosed as an adult, but I don't remember a time when I didn't have them. Growing up in the '60s, I wouldn't have gone to the doctor. There still is—and was even more so when I was a kid—a stigma involved when it comes to mental-health issues. So I think at best I was thought of as quirky, you know, and different. My family embraced all this quirkiness and the fact that I was different.
Did you ever receive any other mental-health diagnoses before OCD? Had you perhaps been misdiagnosed?
No. I wouldn't go to a therapist or psychiatrist.
Were you afraid of being being labeled crazy?
Yeah. In Middle America and corporate America, if in the course of a day you said, "I need Thursday afternoon off to go to the dentist," nobody would even flinch. But if you said, "You know what, I need an hour off because I'm going to run to the psychiatrist," your coworkers may not flinch outwardly, but you might see some ramifications later on. And even with nothing seemingly wrong, you go twice a year to your dentist to see if everything's OK and get a cleaning, but God forbid you should just go and speak to somebody and say, "Is this normal that I'm reacting this way or I feel this kind of pressure or anxiety, or my relationship is a little tough right now, or I feel this kind of pressure at work?" just to make sure that you have the coping skills. And that's whether you've got a label or you don't have a label, whether it be OCD, depression, or you're just anxious about something, or a family member has been diagnosed with something, or you lose somebody, or you're feeling pressure at work.
It sounds like it took you a while to understand that's what you needed to do. For a while, you bought into the rest of society's idea that we need to avoid mental-health professionals. But you finally decided to get help?
Well, I needed it. There's a difference between me and people who come up to me from time to time and say, "I've got a little bit of germophobia." You don't have a "little bit" of OCD. It is sometimes incredibly paralyzing, and it's hard to function at times. It's not just that I'm scared of germs. Everything that I'm saying outwardly sounds intellectually correct, but for the most part my thought process makes no sense. When I shake somebody's hand and I feel like I've got something on my hand, there's nothing wrong with going to wash my hand. There is something wrong with being totally consumed that you didn't get everything off your hand, that there's things crawling, so you wash it again, and you're so consumed that you wash it again, and you wash it again and you wash it again and you wash it again. When you can't get past that, that's obsessive-compulsive disorder. It's not that you're afraid of germs, it's that you obsess about that thought and have to do things like hand washing to relieve the worry. I always have intrusive thoughts and rituals, and my ADD is such that it's hard for me to focus and concentrate and carry on a fruitful, elongated conversation even with my own child when I'm incredibly interested. I have to be reminded, "Dad! Dad! Dad!" and then I'm back.
Do you take medications and do psychotherapy?
I do, but I won't tell you specifically what I do for fear that people will read this and think, "Well, that works for Howie, I'm gonna take that."
What types of psychotherapy do you do?
I've done everything from traditional psychoanalysis to cognitive therapy. That's the thing about mental health, there's not one answer for one person. It's a lifetime commitment. I try various things; it's not like one thing works for me and then it's over. Certain things that worked for me a few years back are not working for me today, so now I do different things. But I feel blessed that I'm doing fine, you know, I'm functioning. I'm out there and I have a great career and a great family—not necessarily in that order! I'm fine.
You avoid handshakes as part of your OCD and instead do fist bumps. Has President Obama's adoption of the fist bump made it easier for you?
Yes, but I didn't come up with the fist bump. It was there long before I ever did it on television. It was there in sports. I'd seen it before, and that's why I started doing it because I thought, "What a great way to avoid a possible trigger." It's been helpful to me, and people have been somewhat accommodating. Up until I made my OCD public, they would take umbrage over the fist bump. They would take it very personally: "What, do you think I'm dirty, or you're too good to shake my hand?" The truth is that I really, truly believe that now, given this season of flu and H1N1, that there's no reason to shake someone's hand.
It's no secret that psychiatric disorders run together. People who have OCD or attention deficit hyperactivity disorder are more likely to be depressed or to have problems with substance abuse. How about you?
Depression, yes. Not substance abuse, because I'm neurotic about losing control. I don't drink, I don't take drugs. But yes, depression is an issue.
A game show is a fairly structured filming environment, and perhaps there's some repetition involved. Do you feel like it's something that works especially well for you?
Deal or No Deal fits my personality. Some people tell me that OCD and ADHD are a gift and I've used it to my benefit. If it is a gift, it's a gift I'd love to return. I would trade anything to not have this gift. Do I think it serves me? I think I'd be far better off without it. Deal or No Deal is lucky for me because I don't rehearse, I just show up, and I can stand anyplace. I'm not stuck behind a pedestal reading trivia questions—I wander around, and each person is different. The game serves me better than I serve the game. It's a very comfortable place for me to be. I just show up and meet the contestants. Deal or No Deal allows me to live in the now. It's like my standup act. It's hard for me to sit down and focus on a script and do long-form projects. I can do it—I did St. Elsewhere—but it's hard.
Sometimes my colleagues say, "You need a little bit of OCD to be a good doctor," or joke in other ways about the condition. Do you think this demeans people who really have the disease?
There's nothing wrong with having a little anxiety—to be somewhat fearful or anxious about something probably focuses you more, right? You're a little worried or you're trying harder. I wish I had that. My anxiety, and I can't speak for other patients, is sometimes paralyzing. I can't think of one time where my OCD or depression has been triggered that it has enhanced what I was doing.
At the request of U.S. News, Mandel took a test during the interview to gauge the degree of his OCD. The Yale-Brown obsessive-compulsive scale is a series of questions related to an individual's behavior—whether certain ritualistic acts are part of a daily routine, for example. The test is widely cited in professional journals and studies. Mandel scored 21 out of 40, putting him in the "moderate" range. A score higher than 8 suggests OCD that can be clinically diagnosed and treated. The test also showed Mandel is about twice as obsessive as he is compulsive. It can be difficult to understand the way in which someone with OCD experiences daily life. Mandel's readable and funny book should raise public awareness.