28 December 2015

A testing time

Every December I enter appointments for the upcoming year in my new hard copy diary. As I filled these in for 2016, one made my heart sink.

Based on your own experience, which of the following do you think it was?:

1. The doctor, to discuss an embarrassing problem.
2. The dentist, to have a filling.
3. The optician, to undergo a routine eye test.

I'd lay odds on most of you answering 1 or 2, but it's actually 3 - I find my biennial visit to the optician by far the most stressful of these events.

I've never been at all concerned about what I bring up with the doctor, or about having intimate examinations or tests. This probably harks back to my health anxiety: I'm happy to talk about anything, and endure any number of unpleasant procedures, in order to identify and address what's wrong with me. I much prefer knowledge and action to avoidance.

As for fillings, I don't understand why people say these are painful - unless, perhaps, they're using the dentist from Marathon Man? The injection only hurts for a few seconds and after that, for me, it's a case of 'lie back and think of England'.

No, it's the optician that really makes me nervous.

A contributory factor is that I had glasses from an early age and was the only one in my class who did. In the 1970s, there was just one kind of NHS frame for children and the only choice was the colour, ie blue or pink. The photo below shows a replica of mine. I hated them and used to stand books up on my desk to hide behind.

Museum image reproduced with 
permission of The College of Optometrists
More than that, though, I hated failing at the eye test. I was a perfectionist even then and wanted to do everything well, even when it was physically impossible.

And I really, really hated the optician's questions, because I could never be sure I was answering them correctly - a need for certainty is characteristic of OCD.

First he'd clamp on the heavy, metal test frames - they were like an instrument of torture, digging painfully into the bridge of my nose and the tops of my ears. Then he'd slot in a combination of lenses and tweak them again and again, asking in a monotone, 'Is this better? Or this?'. 

I was always anxious about giving the wrong answer. Was I contradicting what I'd just said? Would I end up with ineffective glasses because I hadn't directed him properly?

Now, at least, those metal frames have been replaced by a machine that swivels into place in front of your face. That may have eradicated the physical discomfort, but not the agonies of indecision. My eyes often water and blur with the effort, making it even harder to decide which lens provides a sharper image.

I begin every visit gibbering my apologies for my nerves at the optician; he must think I'm an absolute idiot. Dentists might be prepared with sedatives for nervous patients, but I doubt opticians are...

Mine tells me that, in recent years, children have been faking poor eyesight, in the hope of being prescribed glasses and emulating Harry Potter! Hopefully his popularity - and the great range of frames now available - means youngsters these days are less likely to end up with my strange hang-up, even if they aren't blessed with 20/20 vision.

 * * *

This is an interesting page about NHS glasses, from The College of Optometrists - the first and third-from-last paragraphs sum up my experience!

21 December 2015


Christmas can be a particularly stressful time for those with mental health problems, but they're not the only ones who struggle. The song may claim 'Tis the season to be jolly', but more often than not this so-called holiday means a lot of extra work and pressure.

Our increasingly materialistic society has somehow ended up dedicating an inordinate proportion of the year to preparing for a single day. I try to avoid thinking about it until December, but that still means more than three weeks of intense activity - and rising panic - as I plough through my festive 'to do' list.

It doesn't help that advertisers start their promotions at least a month earlier. If you don't get on board then, you can feel as if you're playing chicken with time - how long can you resist without crashing, unprepared, into The Big Day?

For the first time last year, I opted to cut back on some of the more time-consuming elements: making a charitable donation rather than sending cards, putting up minimal decorations, and replacing the usual expansive dinner with a more simple meal.

We also reduced the number of presents exchanged within my family, giving gifts only to my young nephews and our respective partners. This year, I managed to do all of my shopping online, which seemed far too easy. I felt guilty for getting off so lightly - clearly I'm indoctrinated into believing the whole experience should be as challenging as possible.

I'm not the only one. On Saturday, the BBC news channel interviewed a number of people at a shopping centre. One middle-aged man's response was 'It's misery, complete and utter misery. But, hey, it's Christmas.' In other words, misery is only to be expected.

All of this effort is in pursuit of an idea of Christmas as sold to us by the media - no, not the trauma-filled Eastenders' version, but the kind depicted in all those feel-good films and supermarket ads. Airbrushed models might make us feel unattractive, but airbrushed Christmases can make us feel equally inadequate. If ours doesn't measure up to one of these perfect visions, it can feel as if we have failed somehow.

And it's hard not to follow the crowd, especially if friends and family aren't on the same page: people sometimes take offence if you want to do things differently. Fortunately, mine are supportive of my choices.

Image courtesy of Apolonia/FreeDigitalPhotos.net
Which is just as well, as this year I'm volunteering at a Christmas Day lunch for old folk who would otherwise spend it alone. A couple of friends have commented on how 'good' I am to do this. Not a bit of it. This is by no means a wholly altruistic gesture (is there any such thing?); I'm in it for myself, too, as I hope that the event will re-ignite my fading festive spirit.

Because, when all's said and done, there is joy to be had. Whether from a rousing carol service, or good food and drink, or time spent with family and friends...even if you do have to eat sprouts and you feel like strangling someone by the end of it!

Wishing you the most joyful possible of Christmases, however you choose to spend it.

* * *

If you are struggling over the holidays there's help available - check out mental health charity Mind's website.

14 December 2015

Crosses to bear

This week, I'd like to share with you my interview with Rodger Hoefel, of Like-Minded Magazine, which you can read here.

Rodger set up this online magazine to take an in-depth look at a variety of mental health conditions, with the aim of increasing understanding - something I can very much relate to! 

'Like-Minded Magazine was established to...demonstrate that individual potential can still be reached despite not leading a "normal" life, and offer insight and inspiration with an emphasis on honesty and connection.'

Image courtesy of Rodger Hoefel
Rodger is a 34-year-old Australian living in Amsterdam, and working as an art director, who battles with OCD, social anxiety, tinnitus and the ongoing effects of injuries he suffered in a serious car accident as a teenager.

His interviewees come from around the world and conditions covered so far include borderline personality disorder, post-traumatic stress disorder, anxiety and depression.

A list of all interviews is on Like-Minded Magazine's home page and you can also follow this publication on Facebook.

7 December 2015

Good twin, bad twin

It can be very hard when you have OCD to know what constitutes normal behaviour, ie how most people behave in a given situation. Often obsessions and compulsions have become so ingrained that sufferers can't remember life before them.

In Overcoming Obsessive Compulsive Disorder, David Veale and Rob Willson introduce the 'as if' principle as a strategy to help tackle the disorder: trying to think and act 'as if' you didn't have it. A case of fake it till you make it.

Image courtesy of radnatt/
One of the associated techniques is to imagine that you have an OCD-free twin - who is identical to you in every other way - and then imagine how they would act and follow suit.

Of course, this isn't as simple as it sounds. 

Since the start of my 'f**k you' rebellion in response to the terrorist attacks in Paris, it's been a lot easier to resist my compulsions. Every time I've gone to place an item carefully, I've reminded myself 'If you do this, you're letting the terrorists win.'

Not only does this provide a solid reason for modifying my behaviour, but it also means that I'm no longer battling myself: it's now me against them, instead of me against me. 

I've heard of sufferers anthropomorphising their OCD as a means of fighting back, treating it as a real-life bully and sometimes even giving it a name, but I've never tried that trick myself. Directing my resistance at the terrorists - an actual third party - seems to have had the same effect.

Nevertheless, I'm still sometimes stumped as to the right way to do things. 

In my bathroom, for example, I started plonking toiletries on the shelf without arranging them, initially choosing not to look at what I'd done - or, rather, not done - but just walk away.

I began to worry, though, that I was simply avoiding the 'mess' rather than facing it and dealing with the resulting anxiety, which is the tenet of exposure and response prevention, the recommended treatment for OCD. 

So I decided to continue putting things down without any thought, but then deliberately look at them. However, I quickly realised that this wasn't the correct approach either, when considered in the context of my OCD-free twin. Would anybody who didn't have the condition stand looking at something after they'd put it down? Of course not!

Besides, it's impossible to place items with millimetre precision by accident, so even if I don't look, I know that I'm leaving things in what I would consider disarray. While I might not know exactly how bad that disarray is, I can visualise it and that alone causes me discomfort.

My twin is still silent in some situations, and that's where Veale and Willson recommend the 'survey' technique: asking your family and friends what they do. So, if I suddenly start quizzing you about how you put your socks away, please don't be perturbed, it's all in a good cause!

30 November 2015

Medical matters

My intermittent health anxiety reared its ugly head again this summer when anti-inflammatories that I was taking for a bad back triggered excruciating indigestion. 

Initially I had no idea what was going on, having somehow never suffered from this very common complaint, and I immediately assumed the worst. Google provided some reassurance, in that every source I reviewed gave the same answer. My doctor confirmed my self-diagnosis and the problem resolved after a couple of days of his recommended treatment.

Unfortunately, the symptoms reappeared, and escalated, a month later. The constant gnawing, empty feeling left me unsure whether I was hungry or not, I could have won an Olympic medal for burping, and my stomach gurgled day and night, which kept me awake, just to add to my woes. My biggest concern, though, was that I could now feel food going down when I swallowed. 

I tried every treatment I'd read about - antacids, herbal remedies, eating earlier in the evening, avoiding trigger foods, elevating my sleeping position - yet nothing effected a complete cure. While my online research confirmed that the new symptoms could all be attributed to any number of relatively minor conditions, I was convinced I had something more serious. The fact that these symptoms came and went, and some days hardly troubled me at all, was irrelevant!

A few weeks on, a particularly bad flare-up on holiday finally forced me to abandon Dr Google in favour of going back to my doctor, who confirmed continuing indigestion. Even using its medical term, dyspepsia, there's no getting away from the fact that it's not serious - and I'm much better after a month or so of medication and severely restricting my diet.

Although I felt silly for letting a trivial medical matter concern me so much, perhaps it's reasonable to be scared by unfamiliar symptoms. Those people who conjure up completely non-existent illnesses undoubtedly have a much bigger problem. 

Image courtesy of jk1991/
A friend's brother, who is badly affected by health anxiety, became convinced that he had been exposed to asbestos through his work - there was a very slight, but unproven risk - and that he had developed a lung condition as a result. He had no symptoms, but underwent a private scan, which gave him the all-clear. Sadly, this still didn't put his mind at rest.

I've sometimes wondered about doing the same, to check for any lumps, bumps or other anomalies. The upside would be that if a scan did identify any problems, treatment could be carried out promptly and, therefore, more effectively. 

The downside - other than the cost - is that things can obviously still go wrong between these examinations. Any test is, after all, only proof of your medical status on the day that it's done.

For someone like my friend's brother, even a daily scan would be insufficient to quash their health fears. Only cognitive behaviour therapy, and developing a whole new way of thinking, can slay that particular dragon.

23 November 2015

Sign your name

Image courtesy of fantasista/
Earlier this month, a major campaign was launched to try to persuade the government to increase investment in mental health services.

The Equality for Mental Health campaign is being led by MP Norman Lamb, whose son was diagnosed with OCD at the age of 15, and has the support of hundreds of high profile figures from all walks of life.

It's great to see mental health hitting the headlines again and also to see the growing momentum in the work being done to achieve 'parity of esteem' between mental and physical healthcare.

The campaign, described as 'cross-party and cross-society', highlights 10 of its concerns on its website. This list features some truly scandalous facts; the standout ones for me were:

  • Only 15% of people who might benefit from talking therapy actually get this.
  • Three-quarters of children and young people with mental health problems receive no treatment at all.
  • Children are sometimes admitted to adult hospital wards, due to a shortage of beds.
  • Until April this year, there was no maximum waiting time for treatment for mental ill health - this is now 18 weeks.

Just imagine applying any of the above to physical health problems. Suppose only 15% of people who needed heart surgery had it. Or those with kidney disease received no treatment whatsoever. Or children recovering from an operation had to share a ward with adults. Such situations would simply never be countenanced.

As Ruby Wax, comedian and mental health advocate, said: 'They [the government] don't comprehend that mental illness is a physical problem - it just happens to be your brain, which is another organ.'

The knock-on effect of not addressing mental health problems is significant, both on the individuals concerned and society as a whole, not least the impact on the NHS and employment figures. One of the most shocking points raised by this campaign is that people with long-term mental health conditions live on average 20 years less than the general population - suicide is presumably a contributory factor.

Following the list of key concerns is this plea: 'We urge the government to seize the opportunity to end this historic injustice and commit the investment that will lead to an economically and socially stronger Britain.'

If you're a UK resident, please sign the petition to lend your support ahead of the announcement of the 2015 Comprehensive Spending Review, on Wednesday. No doubt this particular battle will go on into the future and this petition is a chance for you to make your voice heard.

With 1 in 4 people suffering from a mental health condition, we all know somebody who is affected, and who might benefit from better investment in services. And you never know when you might become one of the 1 in 4 yourself.

16 November 2015

No surrender

When news broke on Friday evening about the terrorist attacks in Paris, the scale of these was so shocking that it seemed unreal: the number of deaths at that stage was around 40. I went to bed upset, but determined to push it to the back of my mind - I had a big day ahead of me, with my first talk at a local library, and needed a good night's sleep.

However, when I turned on the radio first thing Saturday and heard that nearly 130 people had died, my stomach flipped and my heart began to race. As the day wore on, and I continued to monitor the news, my distress grew, along with my need to perform compulsions.

My OCD is exacerbated not only by bad news close to home, but also by upsetting events further afield that don't directly affect me. The more crazy and out of control the world becomes, the stronger the urge to order my environment: exerting even a little control eases my anxiety.

Over the years, all kinds of horrific incidents have triggered the same response, including the attack on the Charlie Hebdo offices in Paris earlier this year. Although natural disasters usually cause more deaths, it's the instances of human evil that disturb me the most.

I'd already had a difficult couple of weeks, with the sudden death of a friend's wife and a burglary at my boyfriend's flat. Factor in my rising anxiety about performing in public and I was in a pretty wobbly state. The Paris attacks were the final ingredient in a perfect storm of mental distress.

By early afternoon, when I had to leave for my talk, my compulsions were as bad as when my OCD was at its worst, 20 years ago: I was unable to leave my flat until everything was exactly where it should be. These days, I usually only find myself in that position when I'm going away for a prolonged period, not for an absence of a few hours.

On the news yesterday, countless people were saying we shouldn't be frightened and should go about our business as usual, or the terrorists would have won. I couldn't help being frightened, though, and as for carrying on as normal... 

Only days earlier, I'd been thinking of treating myself to a trip on the Eurostar to Paris. Now I was suddenly scared even to go into central London - into any big city. I just wanted to curl up in a ball in my flat, where I may not be immune to all harm, but would most likely be safe from terrorists.

Then it suddenly came to me: I could fight back, in spite of my fear, by reining in my now rampant compulsive behaviours. The terrorists may have wormed their way into my mind, but I wasn't going to let them take it over.

I began to work on reducing my compulsions to their usual mild level, but soon found myself taking this further, using exposure exercises (ie deliberately leaving things out of place) to tackle my most entrenched - and 'accepted' - habits.

Image courtesy of 9comeback/FreeDigitalPhotos.net
All day, I put stuff down without positioning it, thinking 'F**k you, terrorists': you may have frightened me, you may have temporarily terrorised me off this city's streets, but you will NOT terrorise me in my home. In my own small way, je suis Paris.

RIP to all the victims.

9 November 2015

I spy

I began this blog with the intention of focussing on my experience of living with OCD, perfectionism and anxiety. Writing about these conditions has, however, prompted me to reflect on other of my behaviours and I've discovered a great deal about myself as a result.

In the process, I've also acquired yet more labels, including obsessive-compulsive personality disorder, spartanism, compulsive skin picking and misophonia*. Fortunately, I tend towards the milder end of the spectrum of symptoms for each of these.

While I sometimes wonder about the merit of labels, I do think it can help to know that a particular behaviour is attributable to a condition, that you're not the only one affected by it, and that treatment is available. So this week I'm appealing for help in naming a problem that the usually trusty Internet has so far failed to shed any definitive light on. 

The issue I struggle with is that I'm easily distracted by things in my peripheral vision, whether stationary or moving. I already know that I'm not alone in this, as a friend has described the same problem, but I hope that by talking about it here, somebody might be able to provide an explanation.

Image courtesy of Carlos Porto/
At work last week, for example, a colleague sitting some distance away was zipping about between documents on screen and I was forced to adjust my seating position to block my view of this activity. Meanwhile, the friend I mentioned has created a wall of folders and large plants around the edge of his desk, so that he can't see colleagues moving about.

The situation is no easier elsewhere. When my boyfriend and I settle down to watch a film at his flat, I first have to check our surroundings for anything that might divert my attention. This could be the light on his iPod, a remote control on the coffee table or a greetings card standing on the floor beneath the television. While his living room is crammed with stuff, it's only certain items that catch my eye and have to be moved.

In my own flat, it's mainly the traffic that troubles me. My street has become increasingly busy and the flash, flash, flash of cars going past is unbearable. If I'm reading, writing or watching television in the living room, I have to draw the curtains - the nets have proved an inadequate shield.

And don't get me started on the ubiquitous phone screens that have, for me, ruined everything from going to the cinema to watching a fireworks' display...

The problem is exacerbated when the task I'm engaged in is difficult or requires particular concentration. I suspect, therefore, that it's more likely to be a psychological issue than a physiological one.

I'd love to hear from you if you've experienced this, too...especially if you know what it is and, more importantly, what I can do about it!

*You can use the 'Search this blog' facility (see right) to find related posts on each of these subjects.

* * *

I do hope that some of my more local readers will be able to join me for my talk at Friern Barnet Community Library, this Saturday 14 November - full details here.

2 November 2015


Image courtesy of David Castillo Dominici/
Two scenes that I witnessed recently set me thinking about how I might have fared if I'd ever become a mother, in light of my OCD.

The first took place late at night in the waiting room of a railway station in Bristol. Amongst the other passengers were a couple of young mums whose two boys, aged about three, were happily playing together. 

Their game of choice was to lie down on the floor, roll across it, pick themselves up and do it all over again...and again and again. I shuddered at the sight. Whilst my contamination issues are secondary to my ordering compulsions, this was more than I could bear. I felt as if I could actually see them getting dirtier with every roll, turning themselves into walking, talking biological weapons. It made me feel dirty, too.

Less than a week later, I was in another waiting room, at my doctor's surgery, when I found my attention drawn by a man's voice repeatedly saying 'Don't do that; it's dirty.'

I looked up from my newspaper to see a man addressing a small boy standing in front of one of the fabric-covered chairs. The boy was bent at the waist, with his cheek touching the seat, which was evidently the cause of the man's concern; although he seemed calm, he was insistent that the boy stop doing this. 

Strangely, this child's action didn't make me uncomfortable, perhaps because people don't tend to stand on chairs with dirty shoes - although I'm sure the one he was leaning on was far from clean, given its location.

I imagine many parents would cringe if their child rolled on the floor in a public place and, equally, many would dismiss the idea of a chair being a hazard. I'm pretty sure that if I'd had children, I'd have been at the unduly protective end of the scale, as a result of both my OCD and my generalised anxiety. Incidentally, it wasn't these conditions that put me off parenthood; I just never felt the biological urge!

Of course, most parents want to shield their children from harm, but that natural instinct can escalate and trigger compulsions in people previously unaffected by them. And it's easy to see why: when you find yourself responsible for something more precious to you than life itself, the world must suddenly seem a very dangerous place.

Whether a person already has OCD, or only develops it when they become a parent, it's important not to drag children into the condition's miserable orbit. It's hard for anyone to resist complying with a sufferer's demands, but even more so for children, and their emotional wellbeing is likely to be at risk if, for example, they're forced to adhere to a parent's strict cleaning rituals. Such rituals may be designed to protect, but ultimately do more harm than good.

Whatever your particular situation, help is available from both OCD Action and OCD UK. This page, about pre and postnatal OCD, is especially useful, as is this leaflet about perinatal OCD, from the Royal College of Psychiatrists.

26 October 2015

Feel the fear

My boyfriend, Pete, and I often take self-catering holidays in the UK, which is the only significant time we spend together under one roof, and his presence always encourages me to suppress the worst of my ordering compulsions.

Not only would I be self-conscious about him witnessing my most extreme behaviours, but it would be unreasonable to arrange his belongings, meaning some elements of my environment are out of my control, unlike when I'm at home. 

So I might, for example, place my books and magazines in a tidy pile, but I won't line up the corners. A small behavioural shift, yet a significant one, in light of the recognised treatment for OCD, ie exposure and response prevention (ERP). For ordering compulsions, ERP means leaving items out of position, and even just a fraction of an inch can prove effective.

My holiday cottage
Photos: Helen Barbour
This year, we've been unable to take a break due to work and, by last month, I was desperate to get out of London, so made a last-minute booking at a cottage on Mersea Island, off the Essex coast. Although Pete was able to join me for one night, I'd be alone for much of the six days. Nevertheless, I resolved to try to adopt the same more 'relaxed' approach as when we travel together. 

Initially I was excited at the thought of some much-needed downtime, but I began to worry about anything and everything as the date of departure drew near. Would I get lost on the way and miss the one-hour window for key collection? Would I be able to get my heavy bag up the tiny spiral staircase? Would I manage to figure out how all the appliances worked? Most importantly, would I feel safe at night?

View from the east end of West Mersea
- spot the power station
Although I arrived on time, my anxiety levels remained high. I was tired from the journey and carting luggage about, dismayed by the unexpected view of a nuclear power station across the estuary, and downhearted at exploring a cold and echoing house on my own.

By the time I came to unpack, I'd given up any hope of resisting my ordering compulsions - I needed them more than ever, to help reduce my stress.

As for my other fears...I almost fell down the stairs hauling my bag up them, and the promised central heating transpired to be storage heaters, which took three days to master. I did, however, feel very secure in the small community of West Mersea.

Then, a couple of days in, I suffered a flare-up of some recent digestive problems, which left me feeling quite unwell. Being unsure what exactly was wrong served to stoke my anxiety - and my compulsive behaviours. 

Seal close to the jetty in West Mersea
On the penultimate evening, I was in such discomfort that I toyed with the idea of going home a day early. The prospect of being in a familiar environment, with friends nearby, was very tempting. In the end, I stuck it out, which perhaps qualifies as some kind of achievement, even if I didn't reduce my compulsions as planned. 

And, in spite of everything, I somehow had a great week! Once I'd settled in, the house became a cosy and comfortable base, I met some lovely people, and saw some amazing scenery and wildlife. As the saying goes, 'feel the fear and do it anyway'.

19 October 2015

That sinking feeling

My family has adopted the habit of prefacing non-emergency phone calls made out of the blue with comments along the lines of 'There's nothing to worry about...'. Often, however, such reassurance is followed by a 'but', which roughly translates as 'Something bad has happened, but we're all still alive.' 

On a day off a few weeks ago, I received a mid-morning call at home from my parents' number. A surge of adrenaline immediately set my heart racing and Dad's opening words didn't help: 'There's no problem now, but...'

He went on to explain that he'd had to call an ambulance at 4am, after my mum woke up with severe and unexplained back pain. The paramedic could find no serious underlying cause and the pain had, in fact, subsequently eased. A follow-up visit to their GP confirmed that this had been a muscular problem. Sighs of relief all round.

Late afternoon on the same day, I received a text from my boyfriend, Pete, which began 'Don't panic, but...' As he's a keen cyclist, this introduction usually means he's had a crash. This time, though, the 'crash' had been in his back garden; he'd tripped and fallen face first onto the concrete path, breaking two front teeth and suffering nasty grazes. By the time he contacted me, he'd already been to the dentist for emergency repairs.

Dad and Pete both did the right thing in only telling me what had happened once the initial crisis was over. There was, after all, nothing I could do to assist in either situation and I'd just have spent hours helplessly worrying.
Image courtesy of Mister GC/

Receiving two calls of this kind in one day unsettled me, though. They reminded me that, as I potter about my mundane, day-to-day business, something terrible might be happening to my nearest and dearest. At any moment, a genuinely bad news bomb might explode into my life and change it forever.

I know full well that dwelling on what ifs is pointless and saps the joy from existence, however, pushing such thoughts away is a struggle for those of us of an anxious disposition. 

Actually, I sometimes wonder how anybody manages not to worry - as it says in the theme song* of the television show Monk (about a police detective with OCD), 'People say I'm crazy, 'cause I worry all the time. If you paid attention, you'd be worried, too.' The reality is, life is busy priming bad news bombs for all of us.

Sinkholes are the epitome of this. Earlier this month, a hole more than 30ft deep opened up in a road in St Albans, which is about 20 miles north of where I live. The 60ft wide crater also swallowed part of a drive and front garden, but luckily nobody was injured.

To me, this incident is a metaphor for life: a succession of 'sinkholes' that we can't anticipate - it's best just to make the most of the firm ground while you still have it beneath your feet!

*It's a jungle out there by Randy Newman - you can view the opening credits to Monk, including this very catchy song, here.

12 October 2015

Open season

I've been candid about having OCD for many years, so I'm prepared for a variety of responses when I discuss this with somebody for the first time. Most people are interested to discover what the condition really entails, as it's often misrepresented in the media. Most, equally, are sympathetic about the difficulties that it causes me. 

The odd person, however, reacts in a less helpful way. One former colleague - for context, female and senior to me - initially seemed understanding, but then began to make highly inappropriate references to my mental health status.

One day, I was emptying a cupboard in my boss's office ahead of his move to another part of the building. As I shoved pile after pile of documents into confidential waste bags, my colleague suddenly called, from the open-plan office outside, 'Oh look, Helen's having one of her OCD clearouts!' The observation was made in front of numerous other staff and delivered with a laugh. 

Through gritted teeth, I responded, 'Actually, I've been asked to do this. I wouldn't be wasting my time with it otherwise.' Guessing that any elaboration would fall on deaf ears, I chose not to explain that, in fact, my OCD only applies to my own environment - my desk, my car, my home. I have no desire to arrange anybody else's belongings and can happily exist alongside others' mess, providing I'm able to preserve my own oasis of order.

Image courtesy of aopsan/
It struck me as strange that an intelligent woman, who claimed to have a therapy qualification of some sort, would come out with such a comment. After all, if you were aware of a colleague's physical ailment, would you draw attention to a flare-up? Imagine shouting across a room, 'Oh look, Helen's having an eczema outbreak!' - and laughing about it.

Even if I had, in fact, become caught up in a compulsion, I can't imagine why anybody would feel it necessary to point that out. For some reason, those with mental health issues seem to be fair game for ridicule.

No doubt it is partly due to fear of the unknown. Some might see a person who looks different, or who behaves differently, to them, and be unable to handle the discomfort this causes. Sadly, there are far too many reports of those who are disabled, or disfigured, being abused by complete strangers - essentially for something they can't help, and which isn't doing anybody else any harm.

Or perhaps it's the abusers' low self-esteem that drives them to such unkind, pointless and incomprehensible attacks, which can sometimes even become physical. In order to feel better about themselves, they have to point out others' 'faults'.

Explanations of OCD can't prepare the layman for the reality of the condition, and observing compulsive behaviours can certainly be an uncomfortable experience. Rest assured, however, that it will never be as distressing to witness compulsions as it is to be caught in their grip.

5 October 2015

Material world

I'm often surprised at which of my posts generate the most interest and comment: frequently it's those that are about something I'd thought to be a 'niche' area of mental health.

A prime example is 'Less is more', a post about obsessive-compulsive spartanism (OCS) that appeared in February 2014, and which is by far the most frequently viewed on my blog.

Spartanism is the opposite of hoarding, in that sufferers can't bear any clutter and continually seek to dispose of their possessions, often including items they actually need. This can be detrimental both to them and their families.

Having stumbled across an article on the condition, and recognised mild spartanistic tendencies in myself, I decided to investigate further. This was all new to me and so I didn't expected the flood of feedback that followed publication of my own piece on the subject.

Some readers described vividly how they felt when they had too many things around them:

'I get a physical sensation as though I'm being crushed.' 

'It literally feels like gears grinding in my head.'

Others talked about the losses they'd suffered: 'I've even left stuff behind when I've moved - on purpose. I've lost some good things that way.'

Image courtesy of  Matt Banks/FreeDigitalPhotos.net
One spoke of the battle between her minimalism and her husband's hoarding, and another of the devastating impact of her husband's spartanism: 'He recently gave away the last few sentimental items I had left. I don't know how to move forward since they're not replaceable. I understand his mind and empathise with him, however, it feels like basic trust is gone.'

Yet another expressed a sentiment common to many with mental health disorders: 'It's comforting to know that others do similar things.' In fact, from this anecdotal evidence - from an international readership - it seems that a lot of people are affected by this condition.

This set me wondering whether this kind of behaviour is on the increase as a natural, and inevitable, reaction to the rampant consumerism and materialism of most first-world countries. Perhaps 'stuff is the new stress' for many of us? As one reader commented: 'I find that it's just too much for me to keep up with and take care of.'

A Canadian journalist recently asked me to contribute to a feature on OCS. It seems that, across the pond, decluttering has become a massive phenomenon. The gist of her piece was that, as a result, those with spartanism often find it difficult to make others understand that this is a real problem. 

The UK frequently adopts US trends, so I'm sure it's only a matter of time before we follow suit with decluttering. I for one would welcome that societal shift, as I feel much the same as one of my blog readers, who wrote: 'Clearing the physical space has created some much needed mental space and clarity...I didn't feel that I needed the possessions to be happy and the idea of a simpler life was so attractive and liberating.'

We'll have to find a balance between materialism and spartanism, though, or we'll only end up exchanging one problem for another!

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News page now updated! - check out all the latest here.

28 September 2015

Domino effect

The day-to-day difficulties that I face are, by and large, insignificant in the grand scheme of things and I often berate myself for fretting over trivia. However, giving myself a pep talk about retaining a sense of perspective doesn't necessarily keep anxiety at bay. And a succession of minor woes can, in fact, have the same negative effect - cumulatively - as a single, much larger one. 

Last month, my woes began when I took my car in for its MOT. In spite of a low mileage and a solid engine, I always expect some repairs to be needed; it is, after all, 18-years-old. What I didn't expect was that it would take seven trips to the garage to effect them.

The mechanic had to work through a number of possible fixes that took days to complete, so, every morning, I left the car with him and waited with bated breath for The Call. Would today be the day he'd finally resolve the issue, or would it take yet more work that might prove too costly to warrant keeping the car? 

The stress mounted, as I waited to find out whether I'd end the month with or without four wheels. A catalogue of mishaps and errors contrived to drag out the process: a critical piece of garage equipment broke; the supplier forgot to order a part; then, when the part finally arrived, it was damaged.

On visit No. 4, I decided to wait while he carried out the work. An hour and a half later, I'd put my back out from sitting in an awkward position to work at a table in the garage's reception. Within 48 hours, the pain was so bad that I could hardly move from kneeling to standing.

I began taking the strongest possible painkillers...which, within a further 48 hours, had triggered stomach problems. My back was so bad that I couldn't turn over in bed, and concern about my car vied with gnawing indigestion to keep me awake - the resulting insomnia didn't help the situation.

Eventually, two weeks of garage visits - and £500 - later, my car was patched up and back on the road, and my own 'repairs' were also well under way. 

Image courtesy of Ohmega1982/
None of this was either life-threatening, or even permanently life-altering, and I'm certainly fortunate compared to many. Sometimes, though, reminding yourself that others are in a worse predicament is of no help. 

Katie Piper, who was the victim of an acid attack and who spoke at a conference I attended a few years ago, talked about this. Apparently people frequently preface conversations with her by saying 'Of course, my problems are nothing compared to what happened to you...' She always tells them that they shouldn't play down their own feelings and experiences, and she pointed out to us that there were plenty of people worse off than her.

There are times when life can get even the most optimistic person down: perhaps we just need to acknowledge that and be a bit kinder to ourselves when it happens.

21 September 2015

Crisis point

While I'm no fan of the new Labour Party leader, Jeremy Corbyn, I was pleased to hear him raise the question of failing mental health services at his first Prime Minister's Questions (PMQs) last week. 

Mr Corbyn had taken the unusual step of inviting members of the public to tell him which issues they wanted him to bring up and more than 1,000 people raised concerns about mental health care. This seems to be an existing area of interest to Mr Corbyn, who attended an NHS mental health trust fundraiser on his first full day as Leader and appointed a Minister for Mental Health to his Shadow Cabinet.

One respondent apparently described the services in her area as being 'on their knees', echoing many of the participants in the BBC's recent mental health debate.

During this debate, a young woman who had suffered from anorexia nervosa told how she had contacted both her GP and local hospital when she weighed just 4 stone (25kg). However, she had been advised that her Body Mass Index* - weight-to-height ratio - needed to be lower before they could help her, ie she would have to lose yet more weight! By the time she finally secured treatment, she was just 3.5 stone (22kg). 

Another participant in the show had received the same 'advice', and recent research by the eating disorder charity, Beat, indicates that these are not isolated incidents. It's absolutely mind-boggling that this sort of thing happens at all. 

Imagine applying the same approach to physical ailments. If eczema covered 25% of a patient's body, would they be turned away until the proportion was 50%? Would medical staff allow conditions such as anaemia or an over-active thyroid to get wildly out of control before treating them?

People are often less sympathetic towards those with a mental, rather than physical, illness. No wonder, when the same disparity even appears to exist within the medical profession - or, at least, within its treatment protocols.

At PMQs, Prime Minister David Cameron admitted there were problems with some mental health services and agreed the Government could do more. However, he went on to say, 'We will not have a strong NHS unless we have a strong economy.' 

A key way to boost the economy is, of course, to get more people back into work - including those with mental health problems. For many, however, that won't happen without proper treatment.

Image courtesy of cbenjasuwan/FreeDigitalPhotos.net
One comment during the BBC debate was that mental health care is in danger of becoming a 'crisis-only' service. For the sake not only of the individuals concerned, but also the country and its economy, the government must reverse this decline as a matter of urgency. 

We may be in a catch-22 situation, but surely we'll never be able to fix anything, until we fix the state of the nation's health?

*An index used to ascertain whether someone is under- or overweight, calculated by dividing their weight in kilograms by the square of their height in metres.

14 September 2015

Loop the loop

While the exact cause of OCD has yet to be identified, studies by neuroscientists indicate that it may have a biological basis. The BBC's Horizon programme 'OCD: A Monster in my Mind' took a look at some recent research and I found one experiment particularly interesting.

Electrodes were placed on the hands of people both with and without the condition and mild electric shocks administered if they provided the incorrect response to images presented to them: one picture correlated to their left hand and the other their right, and they had to tap a panel with the corresponding foot.

After a while, the electrode was removed from one hand. Although participants were aware that they no longer needed to tap the matching foot to avoid a shock, those with OCD continued to do so. The explanations each of them gave later as to why they had carried on tapping were always along the lines of 'Just in case' and 'Because it seemed better to.' A clear parallel, therefore, with the 'reasoning' behind compulsions. 

Scans conducted during this experiment showed that, in those with the disorder, there was a higher level of activity in the region of the brain known as the basal ganglia. In this area, messages are sent backwards and forwards in a series of 'closed loops' and the hyperactivity noted in some of these is what makes it hard for sufferers to filter out certain thoughts.

Image courtesy of renjith krishnan/
These loops are part of an evolutionary safety mechanism, related to looking for hidden dangers, but in OCD sufferers, there seems to be no natural stop to this. However, the programme introduced viewers to a technique called Deep Brain Stimulation (DBS), which it is claimed can provide some control.

We met a Dutch woman, Nanda, who was housebound by her obsessions and compulsions, even after 14 years of cognitive behaviour therapy (CBT), which is the recognised treatment for the condition. Such extreme cases, where all else has failed, are candidates for DBS in the Netherlands - the procedure is not available in the UK - where it has apparently brought relief to 60% of the 50 patients treated, with some going into complete remission.

This procedure involves implanting an electrode in the brain, which is hooked up to a battery pack stitched into the patient's chest. The pack allows the electrode to be 'tuned' to reduce the hyperactivity in the basal ganglia. Nanda felt an immediate reduction in her anxiety levels, although, at the close of the documentary, fine-tuning was still required to address her symptoms completely.

While her doctor hopes that this treatment could assist with other mental health conditions, at present the electrical stimulation affects a relatively large area of the brain and work is ongoing to find a way to target specific neurons.

Expert feedback to the show, on social media, indicated a high level of scepticism as to the efficacy of this very invasive, and potentially risky, treatment and commentators reiterated the fact that CBT delivers a successful outcome for most. The programme did acknowledge that the mind can change the way that the brain functions, without the need for extreme surgical intervention.

For me, the lasting image was of those never-ending brain loops. It seems some of us really are just wired differently!

7 September 2015

Pros(e) and cons

Being a perfectionist renders decision-making extremely difficult and that was never more true than when I was working towards publication of my novel. 

Finalising the content was the first major dilemma. My writing group had raised many issues: from simple continuity errors to more subtle questions, such as whether a particular character should show more emotion.

Although I'd made a lot of revisions, I'd chosen to add some points to the 'I'm not sure about this' list that I'd begun following initial feedback from agents and other writing professionals. 

Ahead of every redraft, I reviewed this list and ummed and ahhed about which of the advice to adopt. Input from others can leave any writer confused; given my personality type, I felt as if I was drowning in a sea of uncertainty.

Submitting the final manuscript to the publishers wasn't the end of my tribulations. I still had to draft acknowledgements, an author biography and back cover 'blurb', and agree the cover design. I sought guidance from friends and fellow writers, which only led to more confusion, as conflicting advice streamed into my inbox.

Now that my novel is in print, of course, all of the decisions I made along the way - whether right or wrong - are irreversible. My problems still aren't over, however, as new challenges have emerged. 

Over the last few months, I've focussed on promoting my book and have quickly discovered that putting yourself out there means giving up a degree of control.

While I was gratified that one newspaper had run my press release word for word, I was dismayed to see that an advertisement had obliterated the last line of each column of the article; the flaw niggled at me for days.

Another piece was based on an interview and included some joky comments I'd made in passing that I thought made me sound silly. I realised that while you may not be able to influence how other people present you, you can - and should - monitor what you say in the first place.

Even participating in written author interviews has brought problems, in spite of the fact that I've had complete control over these. OCD sufferers tend to mull over, and worry, about things they've said, wondering, for example, whether they might have upset anybody.

And so I've agonised over my responses, especially to questions such as 'What advice would you give to new writers?' It feels as if I'm suddenly in a position of, if not power, at least responsibility, and I fear giving the wrong answer. In reality, there's no such thing - my writing experience is unique and personal to me. 

None of the publicity has been bad, however, and I'm grateful for all of it. Fortunately, it's early days in my media career and what I've learned so far is that I still have a lot to learn!

And my efforts are paying off, with 178 books sold via retailers in the first two weeks after release and 61 sold face to face to date - thank you to everyone who has supported me. Now that my novel has a readership, it makes all the struggles worthwhile.

You can read the feature here and the article - without the missing lines! - here.