OCD – is it a bit weird or are we all ‘a bit OCD’?

In the article ‘Finding the D in the OCD’, I spoke of how the disordered component in OCD is the compulsive interpretation and reaction to intrusive thoughts.  This is what keeps the illness going, and although if feels as if the intrusive thought is what is wrong and what is hurting, it is actually this reaction.  It is this reaction that CBT targets, but it’s not an easy thing to challenge.  Do not underestimate how strong the disordered compulsion is.  Just think about the word: compulsion.  Something that you are compelled to do, that you have to do.  In her book ‘Am I Normal Yet?’ Holly Bourne equates it to the physical urge to urinate.  It is a deep and irresistible urge, which takes over and can’t just be ignored.  It is not something that you choose to do, mistakenly, for the best.  It is not a habitual peculiarity that becomes irritating and difficult to break.  It was no irritating peculiarity which influenced a couple of (admittedly half-arsed, but nonetheless despairingly intentioned) suicide attempts in my early twenties.

It is not easy to explain how much these disordered interpretations and reactions feel a part of you; how undeniable the unsettled, distorted state of mind and self-perception feels, as most people have probably never experienced anything like it.  Hmm, apart from… most people probably have experienced something like it.

As I also mentioned before, everybody has thousands of thoughts passing through their minds a day, and some of those thoughts will be weird or unpleasant, incongruent and unwanted.  Let’s just pluck a few examples out the air:

You’re waiting for a train and among myriad thoughts passing through the background scenery of your mind, this one pops up: ‘what if I jump in front of the train?’

You’re eating your tea/dinner/supper (all regional interpretations catered for here) and for no good reason as you stab your fork into some carrots you have the mental image of a rabbit, doing a poo, on your plate.  Eurgh!

You are walking past a playground when you find a dropped hat.  You pick it up, thinking maybe to hand it in somewhere, then out of nowhere think – ‘what if the child who dropped this has been kidnapped and murdered?!  What if everyone thinks I’ve done that?   I’ve got the hat!!’

Think, just for a moment.  These are just a few examples I’ve made up, out of near infinite possibilities of potential thoughts.  Just think – you’ll find your own examples that all of you will have at some time experienced.  Many of which, you shall have forgotten.

Likewise, everybody experiences unpleasant emotional reactions to thoughts or external events.  Everybody gets trapped in worry-loops about something in particular, sometimes rational, but unaided by the worry, sometimes thoroughly irrational.  In relation to thee examples of unwanted thoughts above, consider these reactions:

While you may think a surprised ‘blimey’ on the train station platform, and take a step back, you may also inspect the thought – ‘why did I think that?  Can I control urges to jump?  I’m not suicidal – am I?’

Where one person may well laugh at the idea of a rabbit doing a poo (each to their own), another may feel sickened, disgusted.  Put off their tea, or even for a while put off carrots.

You may shrug at the thought of being accused of kidnap and murder (unlikely), and carry on; or you may drop the hat, then worry for the next twenty minutes that your DNA is on it.  Or that if you told someone about the thought, they’d wonder why you were hanging around playgrounds.

Also everybody sometimes employs some personal set of rules to manage how comfortable they feel about something.  You knock one had as you walking through the shop, you feel like knocking the other one, to balance it out.  You have in your kitchen a hand towel (for drying hands only), a tea-towel (for drying dishes only) and a dish cloth (for wiping down the work surface only).  And you do not mix them up!!  You get fidgety and irritated when someone visits and uses the wrong one for the wrong thing.

Again, look through your own life, and you’ll find some of your own examples, at some point, somewhere.

So… does this mean that OCD actually affects everybody?  Aha, thanks for asking: No!  Absolutely not.  The often casually banded phrases of ‘I’m a little bit OCD’, and ‘everybody’s a bit OCD aren’t they?’ are part of the harmful myths to which I’ve referred before, which perpetuate a misunderstanding and belittling of a very serious illness, that affects between 1%-2% of the population of the UK and USA (OCDUK.org figures).

You may be thinking ‘OK Baz, fair enough mate, but, um, you do appear to have just slightly contradicted yourself by saying everyone experiences these thoughts and reactions, but it’s wrong to say everyone is a bit OCD…’  Yeah, don’t worry, there’s no contradiction.

What I’ve intended to demonstrate here is that these odd, unwanted thoughts, these anxious interpretations of things, weirdly disproportionate emotional reactions, ways of maintaining our own mental comfort or order are totally normal.  It is all part of normal human cognition, emotion and behaviour, and very valuable it is too, even when sometimes confusing or worrying.  But just as everybody sneezes and coughs, it doesn’t mean that they have a cold.  Just as when people have colds, it doesn’t mean they have pneumonia; or it doesn’t mean they have a serious, chronic and potentially terminal health condition.

What I am getting at here is that OCD, however it may appear, is not weird.  There is a disordered severity to what otherwise could be a normal reaction, to a thought, resulting in attention assigning wrongly significant interpretations to thoughts and behaviours.  In themselves, the processes involved are normal.  Not everyone has it, but as with all mental illness, OCD is normal human thoughts and behaviours becoming unhealthily detrimental.

Realising this is very important to understanding, accepting, and dealing with mental health.  And it is important for everyone.  Because, just as with physical health, while not everyone has a mental illness, everyone has mental health.  This health is on a spectrum, not fixed in one place.  Mental health can move up and down this spectrum, changing to more or less well, for everybody.  So understanding it, is important for us all.

Thanks for reading.  The next article shall be about an important feminist issue in film and culture – and a social campaign that I am going to attempt to start!  I shall return to the continuing narrative regarding OCD and mental health in the article after that.







Beyond the OCD Myth

There is a myth about OCD, and it is a harmful myth.  This myth forms a common public perception: cleanliness, organisation, order, symmetry, doing things in threes, having quirky rules about how you set out life.  Being the love-child of Monica in Friends and Sheldon in Big Bang Theory basically.  What about this is a myth?  And what is harmful about it?

Well, for a start if it really was all a highly sensitive concern about or distaste of germs, dirt and disorder, involved habitual, unnecessary hand-washing, then I, of anyone, should be a textbook example.  I have very good reason why such things should worry me.

Let me digress for a moment, with a short story about me.

Almost five years ago my life changed, to a certain degree, when I was admitted into London’s Royal Free Hospital with a mystery illness.  I had hepatitis, my spleen was distended, and I was – to paraphrase some of the best medical minds at one of the worlds’ top research hospitals – properly buggered.  To cut a very long story (which is still ongoing) short, I have a very rare autoimmune disease, which at first attacked my joints and liver, but given the opportunity would adopt a scorched earth policy throughout my entire body.  At this stage all I can say about my immune system is: ungrateful little bastard.

I was off work for the whole of 2012.  I take a pretty large amount of medication, most of which is, quite frankly, not very good for me.  I take two sets of medication that suppresses my immune system.  This comes with the obvious risk that I am highly susceptible to infection, and when infection occurs I cannot fight it.  As an extra exciting bonus, my liver is no longer very capable of dealing with infection when it does occur – so I’m left on a bit of a knife edge.  I have been readmitted to hospital a number of times since with infection problems.  My illness is still under investigation, as it is so complex, but what has been made clear to me is that it will not go away – and there are a number of ways in which it is likely to go south at any given moment.  Upon my most recent hospitalisation, this past summer, I enjoyed a bone marrow biopsy, and am currently under the care of three sets of consultants, two at the Royal Free, one at the Macmillan Cancer Centre, University College Hospital.

Now, I’ not looking for sympathy or awards for dealing with this (I will accept amazon vouchers – or just cold hard cash – if you really insist).  While I am pretty annoyed at some of the impact on my social life (no beer, for heaven sake!) I do deal with it pretty well.  It’s serious, but you’ve got to laugh, eh!  I tell this story though so that you know I have good rational cause to be fearful of germs.  The very serious consequences of infection are drummed into me, so I should take measures to avoid it which could very easily become excessive… and yet… I’m really not that bothered.  I don’t worry about it and have to admit sailing pretty close to the wind sometimes regarding precautionary measures.  I don’t wallow in filth or anything, I shower each day, my room is (relatively…mostly) tidy enough… but sometimes it’s a chaotic mess, and I spare it very little thought.  None of it really worries me at all.

So how can that be Baz?  You’ve got OCD man!  You’re supposed to be fussy about germs and cleanliness at the best of times…  Oh, yes, right – that’s the myth!  So where does this myth come from then?

Well, for some people OCD commonly can express as an irrational fear of infection, or an extreme discomfort about certain physical features of their environment.  This overwhelming upset is in response to an invasive, obsessive, thought, trapped in the sufferers mind.  The resultant washing or carrying out of specific behaviours to alleviate this fear or discomfort, and remove the obsessive thought, is a compulsive behavioural response.  Such responses become excessive, as they never can alleviate the fear or discomfort, and actually reinforce it (more about this another time), so have to be done more and more.  And to take washing as an example there is nothing ‘fussy’ about this behaviour.  There is a very real need, a seemingly irresistible urge.  Think of that word: compulsion.  You are compelled, you have to do it.  I recently met someone who prior to hospitalisation was trapped in her shower for 9 hours a day, and suffered a great deal of damage to her skin.  OCD victims becoming housebound prisoners, using bleach on their bodies… these really happen.

But my OCD involves nothing to do with germs, washing etc.  The illness expresses in many, many different forms – impossible to list here.   The invasive, intrusive thoughts can be anything, and the compulsive responses demanded as protective measures, can be anything – either external behaviours, or internal patterns of thought.

A number of things make the myth harmful.  If people believe only the myth, then they are misunderstanding and underestimating a serious mental illness that this year was added to the list of ten most debilitating illnesses by the World Health Organisation.  It is demeaning to, and dismissive of, the anguish and despair that those suffering the illness experience.  Would it be acceptable to be so dismissive and demeaning towards the symptoms of cancer?  No.  Given the seriousness of my physical health condition (while I’ve been flippant about it and am doing ok at the moment, the consultants make very clear how serious it is), I feel that I am qualified in making the comparison.  No matter how serious it is, I feel far more affected by my mental health situation.  If I could be free of one of the two, there’s no hesitation: I would get clear of OCD and take my chances with the physical disease.  Being dismissive about it makes sufferers ashamed and not seek help.  It also means that for all those suffering OCD which in no way resembles or has reference to cleanliness/washing etc., they either don’t know what is wrong with them, or people they turn to for help do not know what is wrong, and they suffer on without help.

Great, now we know what OCD isn’t, what it doesn’t involve.  So, if that is the OCD myth, what is the OCD fact?  What is it all about?  How does it work, and what makes is so bad? Even if I can’t list all the possible ways it expresses, I can at least tell you what has happened to me, right?  First hand insight?  Ah, yes… I’d rather worried it was going to have to come to that.  I guess I has better make a start on relating some of my experiences, next time.