It’s #TimetoTalk about OCD, peeps. Why? Well, for a start, Time to Talk Day took place earlier this month: a day of awareness-raising coordinated by Time to Change – an anti-stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness. The aim is to get as many people as possible across England talking about mental health. Hot on the heels of this year’s Time to Talk Day came the current In The Mind season of programmes across the BBC, which started on 15th February. So I’m technically late with my post on the subject, but deliberately so, as anytime is a Good Time to Talk. I’ve honed in on OCD in particular as I believe it’s one of the most misunderstood mental health conditions.
So thanks for clicking this far. Sorry about the title; I don’t mean to sound grumpy but, well, this is something that in turn can baffle and exasperate me. But first of all – a quick recap: what is OCD?
- OCD is characterised by the presence of either obsessions or compulsions, but commonly both.
- The symptoms can cause significant functional impairment and/or distress to sufferers.
- An obsession is defined as an unwanted intrusive thought, image or urge that repeatedly enters the person’s mind.
- Compulsions are repetitive behaviours or mental acts that the person feels driven to perform.
- They may experience anxiety that does not diminish until the behaviour is completed.
- A compulsion can either be overt and observable by others, such as checking that a door is locked, or a covert mental act that cannot be observed, such as repeating a certain phrase in one’s mind (definition courtesy of the National Institute for Health).
Current estimates say that 12 in every 1000 people in the UK suffer from the disorder, equating to around 750,000 people. That’s a lot of people shouting at the TV every time Obsessive Compulsive Cleaners comes on. Take a look at OCD-UK’s website to read the charity’s response when this programme was first broadcast in 2013. Prompting comments such as the following on social media is not exactly helpful, in their opinion and mine: “I’d like to have OCD; it would give me the kick up the ass to tidy up my house when I get up.“
I’m not on a one-woman crusade against this programme in particular, nor Channel 4. I just genuinely struggle to understand how a potentially devastating illness can be seemingly easily reduced to a maddeningly false stereotype. The comment above lays bare a fundamental misunderstanding of the very nature of the disorder, painting the effects of its symptoms as helpful, when in reality they can be devastating. Any actual cleaning completed as part of someone’s compulsive ritual is a side effect of actions the sufferer gains no pleasure from performing; the crucial difference being that if the activity were indeed pleasurable, and performed voluntarily, a diagnosis of OCD would be highly unlikely. These are erroneous beliefs that a simple Google search could easily remedy.
Or maybe I can understand how this happens. Unfortunately, one of the key features of the disorder is Knowing Damn Well that it is silly or even dangerous; it’s a horrible, shaming, brutal self-awareness that compels you to engage in compulsive rituals as a means of dispelling unwanted intrusive thoughts whilst remaining perfectly aware that they probably won’t quell your anxiety. But it’s incredibly difficult to stop. Pitching yourself against the awesome power of your own brain feels like a losing battle. Because what if something awful happened, and it was all your fault? That ‘what if’ can circle the anxious mind like an all-too-familiar predator.
The obsessions and compulsions can vary hugely between individuals. One Ethiopian schoolgirl felt compelled to eat the mud bricks making up a wall of her house. However, it is true that compulsive washing is common, so I can understand how this has become a fairly well known trait of the disorder. Perceived ‘cleanliness’ is an important part of understanding OCD; plain horror in the face of unwanted and persistent intrusive thoughts can fuel an all-encompassing desire to ‘clean’ oneself, which can lead to elaborate rituals. It might help at this point to spare a thought for Lady Macbeth.
Doctor: What is it she does now? Look, how she rubs her hands.
Gentlewoman: It is an accustomed action with her, to seem thus washing her hands: I have known her continue in this a quarter of an hour.
Ever spent fifteen minutes washing your hands? That’s going well beyond a dedication to hygiene; that’s a broken, repetitive loop. Evidenced by the observers’ reactions.
Lady Macbeth: Here’s the smell of the blood still: all the perfumes of Arabia will not sweeten this little hand.
Nobody piped up at this point with the observation that perhaps if we all engaged in some brutal murdering, our hands would ‘sweeten’ up nicely. In fact, they’d likely be red raw, and references in modern day culture highlight the unusual nature of the character’s behaviour, not to mention her eventual fate of being driven to madness and suicide. Which definitely isn’t funny. Right?
It’s easier to focus on extensive cleaning because the initial impulse is understandable. The missing link in people’s understanding of the illness is the compulsion to keep washing, because the usual confirmation that ‘ok, you’re probably clean now’ doesn’t come easily. (See earlier reference to the unfortunate Lady Macbeth.) And this faulty ‘off switch’ can apply to whatever you’re doing, e.g. checking a light switch, making sure you’ve turned the gas off, even down to the way you walk down the street (avoiding cracks in the pavement, or repeating certain numbers, words or phrases in your head as you go).
Applying the description ‘a little bit OCD’ to a person who simply likes cleaning is misleading. To be honest, the additional time it can take someone engaged in compulsive rituals to actually clean something means you’re far more likely to see one shiny mug buffed to perfection than you are a spotless kitchen in the home of an OCD sufferer. And sometimes, hearing references to being ‘a bit OCD’ in everyday life can be extremely jarring to a full-time sufferer, acting as a reminder that they can’t flip that off switch, no matter how much they long to.
So let’s at the very least readjust our perspective on the phrase ‘a little bit OCD’. I hope that taking a little time to understand what’s involved for sufferers will help. I don’t believe that people mean to offend, but sometimes they do.
I think it’s worth noting that The Guardian newspaper’s style guide now specifically bans using ‘schizophrenia’ in anything other than a medical context:
schizophrenia, schizophrenic should be used only in a medical context, never to mean in two minds, contradictory, or erratic, which is wrong, as well as offensive to people diagnosed with this illness; schizophrenic is an adjective, not a noun. After many years we have largely eradicated misuse of this term, although as recently as 2010 a columnist contrived to accuse the Conservatives of “untreatable ideological schizophrenia”.
One day I hope that the severity of OCD will be understood and defended in the same way.
The mental health charity Mind have a range of resources on OCD freely available on their website, including possible causes and how you can access treatment and support. There are tips for helping yourself, and guidance for friends and family.
If you think you might have OCD, or you’ve already been diagnosed and want to check in on your symptoms, try answering these questions to rate yourself on the Yale-Brown Obsessive Compulsive Scale.
I can highly recommend The Man Who Couldn’t Stop by David Adam. Having suffered from OCD for twenty years, this book is a fusion of science, history and personal memoir in which he explores the weird thoughts that exist within every mind, and how they drive millions of us towards obsessions and compulsions. It’s a fascinating read for anyone interested in the disorder.