27 April 2015

Sure thing

Image courtesy of Stuart Miles/
Obsessive-compulsive disorder makes it difficult to cope with uncertainty and can lead to checks and rituals that are designed to remove doubt, for example with regard to your own or a loved one's wellbeing.

Some of these compulsions have a foundation in common sense, such as locking doors and windows. Others are completely irrational, like tapping objects or performing tasks a certain number of times.

Even if a check begins as sensible, though, OCD will render it irrational, as the condition compels sufferers to repeat it, over and over again, until it feels 'right'. Without that feeling of 'rightness', doubt remains as to whether the associated risk has been eliminated.

Reaction to the Germanwings air crash last month - apparently caused by the co-pilot deliberately flying the plane into a mountainside - reminded me that it's not just OCD sufferers who find it hard to tolerate doubt. 

Within a day or so of the tragedy, a number of airlines and aviation authorities implemented regulations that banned sole occupancy of a cockpit, to prevent one person from locking themselves in and assuming control of a plane.

I immediately wondered how that could provide any kind of guarantee. While it's a wise precaution, it's hardly an infallible one. With a relatively small crew on most aircraft, what's to stop two like-minded individuals collaborating and then biding their time until they find themselves on a flight deck together?

I read numerous comments online in response to the crash, from people vowing never to fly again, in spite of the new security procedures. Perhaps they're right. Never mind the fact that these measures aren't infallible, they might actually lead to a different risk. After all, it only became standard to lock cockpits following the terrorist attacks of 9 September 2001, which is what enabled this latest tragedy.

Yet avoidance of flying isn't going to protect these worried passengers from harm forever; the world holds an infinite number of other, equally unpredictable hazards. We can't mitigate against every possible danger in air travel, but nor can we in any other walk of life.

Daily, the news reminds us that potential disaster lurks everywhere: a landslide engulfs a car, a sink hole opens up under one property, while a gas explosion demolishes another...and so on and so on. The joking reassurance, 'If you think about it too much, you'd never go out', is no reassurance at all - staying in is no safer!

A lot of people struggle to handle uncertainty, especially in relation to their own mortality. We all have to find a way to live with this, though, whether we have OCD or not; we really don't have any other choice.

20 April 2015

Overcoming OCD

Last year, on this blog, I interviewed Janet Singer*, who lives in the USA and whose son, Dan*, suffers from OCD.

Today I am delighted to review Janet's recently released book about her family's experience of the condition.

* * *

Dan Singer's OCD has prevented him from eating for five or six days and he is not only thin, but also dehydrated. His mother, Janet, on a visit from home 1,500 miles away, finds a son who is a shadow of his former self. His condition also often prevents him from moving and she has to coax him, step by agonising step, up the stairs to her motel room. Once inside, the problems continue: Dan proposes to do nothing but sit in the same chair for the next eight hours, before returning to his student accommodation. 

So begins Overcoming OCD: A Journey to Recovery, which describes Dan's often rocky road to a better life - one free of OCD's disabling grip.

 Cover image courtesy of Rowman & Littlefield
For those who might be put off by a book with mental health at its core, don't be; this is no misery memoir. Yes, it's the story of a troubled teenager and his family, but the family is a loving and supportive one, and not the cause of his troubles; his parents, Janet and Gary, want only for their son to be happy. His mother is obviously heartbroken - and uncomprehending - at the transformation of her bright, happy, engaging little boy, who previously loved life, into a thin, twitching, anxiety-ridden young man, who has also resorted to self-harm to alleviate his feelings.

Janet perfectly conveys her desperation, frustration and helplessness in the face both of her son's difficulties, which he first revealed at the age of 17, and the challenges of finding the most appropriate treatment for him. Initially implicitly trusting the experts' opinions, Janet comes to realise that her sometimes conflicting parental insight and instincts - and research - are equally valid considerations.

At times, the story reads almost like a psychological thriller. Will Dan escape the clutches of his obsessions and compulsions? Will his parents be able to extricate him from the care of doctors whose treatment - whether via therapy or medication - is sometimes, it transpires, doing more harm than good? 

It all makes for a pacy, compelling and moving read, which also has dots of dry and dark humour, both from Janet and Dan - even OCD sufferers can, on occasion, see the funny side of their plight! 

The book is co-authored by Seth Gillihan, who provides expert commentary and background information about the condition and its treatment, which is interspersed throughout the book in bite-sized chunks easily digested by the layman.

At the end, I had a lump in my throat, in spite of already knowing the outcome of Dan's journey, both from the book's title and as a follower of Janet's blog. His success in reclaiming his life is inspirational and proves that, no matter how badly affected you are by OCD, you can do the same.

* * *

Overcoming OCD: A Journey to Recovery is available on amazon.com here and on amazon.co.uk here. You can also read more from Janet on her blog, ocdtalk.

*Pseudonyms Janet uses to protect her son's privacy.

13 April 2015

Time bandit

Image courtesy of Aleksa D/FreeDigitalPhotos.net
'I'm late, I'm late, for a very important date. No time to say hello, goodbye, I'm late, I'm late, I'm late.'

So sings the White Rabbit in Disney's version of Alice in Wonderland. He doesn't, however, then compound the problem by stopping to carry out a few compulsions...which is precisely what I do, when I'm running late.

These days, I'm always chasing to get everything done and find it increasingly hard to be punctual. Once I know I'm pushed for time, my stress levels rise, and increased stress leads to an increase in compulsions, which tend to be at their worst when I feel circumstances are out of my control. Running late is, of course, a kind of loss of control - of time - but ordering my belongings allows me to regain at least the illusion of being in charge.

On many an occasion, when hurrying to get ready to go out, I've become sidetracked by obsessing over the angle of the soap, as I put it back on the edge of the bath. Or by making sure that my hair brush, deodorant and face cream are precisely positioned on the shelf. Or that my toothbrush is angled correctly in its holder.

Instead of leaving everything as it is, to make up lost time and get wherever I'm meant to be going, I end up in a vicious cycle of stress (about being late), compulsions, more stress (because now I'm even later), and yet more compulsions. I often berate myself out loud - 'You don't have time for this!' - but it makes no difference.

A friend once arrived so early for a dinner date that I had to let him into my flat, while I finished up in the bathroom, rather than going straight downstairs and meeting him outside. The stress of knowing that he was on the other side of the partition wall - and probably getting unjustifiably impatient - left me unable to position things to my satisfaction: nothing 'felt right'.

In fact, I took so long that he called through to check on my progress, which only exacerbated the situation. His interruption made me doubt my checks and I had to start all over again. Now I was even more on edge, expecting him to interrupt again at any moment, which shattered my concentration and rendered it harder still to be sure of what I was doing. 

Incidentally, this was before anyone knew I had OCD. If something like that were to happen now, I would simply explain what was going on and ask the person to bear with me. In my experience, keeping things secret only adds to my stress levels.

In fact, even when I'm only running late according to my own schedule of 'things to do', the resulting stress leads me to waste yet more time on compulsions. No wonder I usually end up eating 'lunch' at four o'clock on my days off!

6 April 2015

For better, not worse

Over the years, I've come across a number of debates as to whether OCD can be cured or not, and the effect that the answer might have on sufferers. Whether sufferer or expert, opinions differ. To a certain extent, perhaps your viewpoint depends on how you define the word 'cure'. 

I've always thought of a cure as pretty final, meaning that a patient no longer suffers from a particular condition. After all, if you had cancer, you wouldn't describe yourself as cured, if any of the disease remained in your body. Collins English Dictionary seems to support that view with one of its definitions of 'to cure': to get rid of (an ailment, fault, or problem)

It's now generally agreed, however, that OCD is a chronic condition - ie persisting for a long time or constantly recurring - that has to be managed in the same way as chronic physical problems such as back pain, eczema or asthma. It's important to know what the triggers are, to be aware of the first signs of a flare-up, and to have the tools ready to deal with any recurrence. Not something, then, that you can completely get rid of.

I've never applied myself with sufficient vigour or consistency to stop all of my obsessive-compulsive behaviours, which now tend mostly towards the mild end of the spectrum. If I were ever to overcome these entirely, though, I would still be aware that in the right - or, rather, wrong - circumstances, they might creep back into my life. 

In fact, genetic predisposition can play a part in developing the condition, and I believe that this is a contributory factor in my case, so I could never be completely free of this risk without being genetically re-engineered! 

Which brings me back to the cancer analogy. If you had a genetic predisposition towards a particular form, and the first occurrence of it was successfully treated, you wouldn't say that you still had cancer, would you? So maybe the absence, albeit possibly temporary, of obsessions and compulsions would, in fact, constitute a cure? The position is far from clear cut.

Image courtesy of adamr/FreeDigitalPhotos.net
Some claim that without the promise of a cure, OCD sufferers might give up hope and be deterred from seeking help. The drive to 'do things right' and a difficulty in accepting uncertainty are both common to the disorder and can make it hard to settle for anything less than a perfect outcome.

Curable or not, significant improvement is possible for anyone, though, no matter how severely the condition affects them. Perhaps the second Collins' definition of 'to cure' is, therefore, closer to the mark: to restore to health or good condition

With appropriate treatment, any OCD sufferer can reach a point of good condition, where the disorder no longer dominates their life. That, at least, is not a matter of debate.