Out Damned Spot

When thinking about mental health problems it helps to think of ourselves all on the same spectrum.

So, for instance, you might think of self-harm as ‘really weird’.  Maybe it’s a way of thinking and acting that seems completely alien to you.  But as we’ve talked about before, isn’t ‘I’m an idiot!’ self-talk a kind of self-harm?

And what about Obsessive Compulsive Disorder (OCD)?  Is that just for nut-bars, or might there be a teensy bit of OCD in you too?

I think the gap between ‘normal’ and ‘crazy’ isn’t as wide as we might think. For example, consider some of the rituals we use to oil the cogs of daily life. You and I both know that there’s no such thing as ‘bad luck’. And yet there are many rituals I perform that make me feel just a bit safer.  Maybe some of the following sounds familiar…

double and even triple-checking the doors when going on holiday

finding it hard to complete tasks because you don’t feel they’re good enough

storing up money or things as a kind of insurance policy

sitting in the same chair for mealtimes

saying ‘hello mister magpie, how’s your wife and children?’ and ‘surreptitiously’ turning round three times then touching the ground, when you spot a magpie on its own (Now surely we’ve ALL done this? I blame Granny Black and her Oirish folklore)

finding it difficult to throw things away, e.g. old clothes that don’t fit, or just about anything that doesn’t have any value. (A friend of mine at college used to collect his used toenail clippings in a jar to see if they would grow. Beat that)

using a special cup and going A BIT CRAZY WHEN SOMEONE ELSE TOUCHES IT

finding it hard to delegate to others in case they don’t do things right

loving your lists just a little too much, (you know who you are)

All of these behaviours could be experienced by someone who struggles with OCD. Superstitions and repetitive checking behaviours are commonly experienced in everyday life and certain behaviours (like praying), may be due to cultural or religious differences. However, the difference between ‘normal’ and a diagnosis of OCD is simply one of degree. OCD is diagnosed when these worries and behaviours interfere with your life and cause you significant distress.

So what is OCD?
It can take many forms, but, in general, sufferers experience repetitive, intrusive and unwelcome thoughts, images, impulses and doubts which they can’t ignore. These thoughts form the obsessional part of ‘Obsessive-Compulsive’ and they usually (but not always) cause the person to perform repetitive actions (compulsions) in a vain attempt toget rid of the fear. The obsessions can include fear of contamination or germs, fear of causing harm to yourself or others, upsetting sexual, violent or blasphemous thoughts, the ordering or arrangement of objects and worries about throwing things away. They’ll often begin with the question, ‘What if….I left the cooker on, or the door open?..or whatever ‘it’ is’.

Sufferers try to fight these thoughts with mental or physical rituals, the compulsions, which involve repeatedly performing actions such as washing, cleaning, checking, counting, hoarding or thinking in endless circles. They might decide that a particular number has a special meaning and so decide to do the ritual that number of times. They’ll also doubt they did it ‘properly’, which is why they need to keep repeating it. Often they’ll try to avoid situations that make them feel stressed, e.g, using public toilets if they’re afraid of germs or avoiding the people they are scared of hurting. However, this often makes things worse as the obsession becomes bigger and the worries more intense. Most sufferers know that their thoughts and actions don’t make any sense, but feel they can’t stop them. This affects their confidence and their relationships, careers and lifestyles. In a way it’s like being trapped in your own head and not being able to switch off.

Who gets it?
About two in 100 people are affected by OCD. It’s often diagnosed in young adults, and affects more women than men. About one in 100 children may have OCD.

It’s also common in those struggling with eating disorders, depression or self-harm.

I’ve got strong tendencies in this direction, but had OCD proper when I was about 16 and being treated for anorexia. For me, all the stresses of life and putting on weight transferred to a fear of germs. I knew it didn’t make any sense, but I couldn’t stop it. I couldn’t use public toilets or door handles or pretty much anything that anyone else had touched. To make me feel better I had to scrub my hands and body with soap, over and over, in a particular order. But just a few minutes later, I’d have to start all over again – if I didn’t, I felt that something terrible would happen to me or the people I loved. At my worst my hands were bandaged as they were opening up with weeping sores where I’d washed them in bleach. The worst thing was, I knew it was crazy, but I couldn’t stop. And when the anxiety started building, it was so terrible I’d do anything to stop it. I felt like I was in a private hell, a world that was getting crazier and more complicated day by day. It felt worse than anorexia or depression or anything else, especially because I couldn’t explain it to myself, let alone other people. But if you don’t have ways of coping with stress you’ll develop your own rituals to make your life safe. The way I got over it was by gradually exposing myself to the things I feared, building up my tolerance to anxiety and by asking the Lord to give me extra courage as I did it. Even now, I still form habits very quickly and have a tendency to worry about making the ‘right’ choices. But that’s ok. Right…?!

It helps to know I’m in good company. Charles Darwin suffered from it, as did Florence Nightingale, actor and director Billy Bob Thornton and actress Jessica Alba. Football stars Paul Gascoigne and David Beckham have talked about their battle with the disorder. Cameron Diaz has said she opens doors with her elbows to avoid germs and washes her hands many times a day.

Again, I think many of us have traits in this direction – but hopefully manageable ones that  don’t cause us misery and interfere with life. If you know someone struggling in this way, the best thing you can do is to listen and provide a supportive environment for them to address the issues behind it. Try to be patient with the behaviours and encourage the sufferer to open up about how they feel. It is very, very rare for someone with obsessional thoughts to act upon them and it’s just as distressing for them as it sounds to you. In fact, the reason that they’re so upset is because the thoughts are in such opposition to their personal values.

For more info, check out this radio 4 programme or a site like this. GPs are also a good first port of call.

If this is you, don’t despair. Help is available and the earlier you can get it, the easier it is to address. You’re not crazy and you don’t need to battle on your own.