Cover your face, scrub your hands, repeat. The pandemic has heightened anxieties of infection, even more so for people with obsessive compulsive disorder
Once in every 20 minutes, like clockwork, Sivakumar Bharati* washes his hands and checks if the window are shut. “I have not ‘relaxed’ in three months aside from my REM sleep,” he says. “There is the prevalent fear of germs and contamination which is why the pandemic has been particularly stressful.”
This is the reality of OCD or obsessive compulsive disorder.
“You don’t really take notice of it until someone else points it out — and a lot of people did,” says 59-year-old retiree Sivakumar . “And back in the 70s, mental health was not taken seriously. People back then just thought I was militant about being neat, some poked fun at it.”
Sivakumar’s home in Hyderabad is evident of his obsessive compulsive disorder: to want everything symmetrical, no clutter, even the presence of muted tones. There are moments of anger and frustration where if things are not lined up, there would be a meltdown, curable only by the correct positioning and considerable time to cool off.
Chennai-based Professor Dr Gauthamadas Udipi, specialist in neuro-behavioural medicine, who has worked with people with OCD for almost many years explains, “OCD may only be the behavioural marker of a more extensive systemic disorder. “After all, the mind is only an expression of the functioning of the brain, and the brain is only a part of the body. At one end of the OC spectrum is ‘normal’ obsessive thinking and ordered behaviour in daily life, which does not interfere significantly with daily functioning. At the other end is severe obsessive rumination and compulsive behaviour that does not allow daily function.”
Essentially, the underlying pathology is in the Salience Network (SalNet) or ‘worry-loop’ of the brain, which sees a person having uncontrollable, reoccurring thoughts and/or behaviours that they feel the urge to repeat over and over; it can be especially harrowing now, owing to the COVID-19 pandemic which invites uncertainty, rising tensions and innumerable risk factors. Often caused by severe psychological stresses, OCD manifests in different forms, from ritualistic obsessions to suicidal compulsions. Sivakumar is on the lower end of this spectrum, and it took a long time for him to realise what he had.
‘I’m OCD about that’
Sivakumar, during the late 2010s, was finally formally diagnosed by a neurologist in South Africa, who stated that OCD is a legitimate condition — and not one about which to be ashamed. “I remember him mentioning how popular culture had not even normalised but trivialised OCD. The parameters of what was ‘deemed’ OCD had shifted in a big way; people thought being tidy was OCD,” recalls Sivakumar.
And things have not been easy as the pandemic trudges on.
Dr Udipi affirms that the pandemic can be a heightener, explaining, it could “result in triggering underlying OC spectrum disorders in a genetically prone person, tilt the balance from ‘normal’ obsessions to a pathological OC pattern, or worsen an already existing OC disorder.”
The International OCD Foundation, Boston, sees the unique challenges for the OCD-afflicted and has offered numerous online resources, which are free-to-use and which help people run through their OCD anxiety with some ease while maintaining physical distancing. These options include WHO-approved tips on how to deal with contamination fears, video teletherapy, which helps those with OCD find a licensed teletherapy provider while retaining physical distancing, and printable coping cards. These cards, not a replacement for help from a medical professional, are written reminders and questions for the self to be mindful, breathe easy, take back control and understand that progress is better than perfection.
Dr Udipi adds that empathy from close friends and family is helpful. “[They] must understand that this is a disorder originating in brain circuits over which the person has little control, and advising the person that ‘it is all in the mind’, and ‘learn to control it’ is of no use, and that yoga, meditation, and other ‘self-therapies’ will not work in the case of a ‘pure obsessive thinking’ (which occurs in a very small percentage of people with SalNet disorder), as the person cannot bring the mind to focus on them due to pure circuit overdrive.” He emphasises that early identification and proper treatment by a qualified psychiatrist and team is the key.
Sivakumar agrees, concluding, “There are times you may not feel worthy because you feel like you are adding stress to home life or work life. But when you start humanising yourself with the help of a mindful and informed healthcare professional, it helps tremendously. It also helped that my family and I could find common ground with patience. But for other OCD folks out there, you have to want to accept it as a condition and not as an extension of the self. It’s emotionally taxing to go through it because your mind is telling you that this obsessive order of things is paramount.”
* Name changed to protect identity
Frequent reminders: As the lockdown ends, we are going back to our jobs and businesses. So we are now bound to spend more time outside our house, working, commuting, etc. As the activities become regular and part of our daily routine, complacency may set in leading to carelessness in following the health guidelines in all seriousness. We may no longer wash our hands as frequently as before or may overlook wearing mask or observing personal distancing while talking to our co-worker. This could increase our chances of exposure to the virus. Therefore, what we need is constant reminders. Placing sticky notes on your computer at work-place for reminding you of staying safe by wearing face-mask, gloves, or using sanitizer, can be of great help in this regard. Make sure that these reminders are conspicuous enough to grab your attention.
A new normal: Post-lockdown, you are going to enter a world of new normal where you have to greet your colleagues and seniors at work-place from a distance and without a handshake; you have to stop touching your face to avoid infection; and you have to limit socializing with your family and friends. All of these are easier said than done because these are habits that we have acquired over a long period of time and making a change in them requires a constant effort. However, until there is any cure for corona, we have no other way but to accustom ourselves to this new normal. During this phase, we might also have to add an activity or two, to our daily routine, such as taking a second bath as we come back home from office, before joining our family members. Remember all this will take time to become part of our daily repertoire, so a few slip-ups are bound to happen, which could add embarrassment to the self or bring quick judgement from others. Don’t let it affect you and cause anxiety. Remember! a habit takes on an average two months to form. So don’t let a few goof-ups derail you or demoralize you.
Don’t neglect: As we fight this deadly pandemic, we might be neglecting some other health conditions that warrant our equal attention. Psychological impact of COVID 19 alone requires a great deal of attention and need to be addressed as soon as possible. Anxiety, panic attacks, depression, risk of self-harm, and even post-traumatic stress disorder (PTSD) are some of the common outcomes of any natural disaster, COVID-19 being no exception. Some of you might have postponed your regular visit to your physician at the cost of your physical well-being. Whatever may be the case, it is imperative that you seek professional help to deal with your psychological or physical issues in order to ensure that your mental and physical health doesn’t suffer amid this COVID -19 crisis.
Since we all are under lockdown, we are spending a lot of time with our spouse. This can be a welcome change for some but for some it can be quite stressful too. There are plenty of data to suggest that divorce rates increase during natural disasters. On the other hand, these may also be times when a much stronger bond can be formed between a couple. Here are a few tips that can help you maintain a healthy relationship, especially during lockdown, and form an even stronger bond with your partner:
Break the monotony: The lockdown has already put a halt on a lot of our usual activities. We all are confined to our houses, so it is natural to experience monotony in our day-to-day activities. It, therefore, becomes even more important that we do not let monotony set in. If you are spending a lot of time on Netflix or Facebook and still not feeling entertained much, or feeling rather bored, it’s time to take a break and do something else—read a book, take a walk indoor, talk with your kids or partner. You can also break the monotony by simply changing your bed-sheets, trying some new dishes, going through old family album, redecorating your house, or by organizing your forever messy wardrobe. Who said there’s a rule where you can’t dress up for home or you have to use your finest crockery only for guests. Arrange a candle light dinner for your partner or family members, dress up, use your finest crockery and have a restaurant like feel at home. You might have to compromise on food, but who cares. The point is to create memories and moments that you can cherish when the pandemic is over.
Be gentle with yourself: Don’t forget to be kind and gentle with yourself as well. Remember, this is something which none of us has ever experienced before, so you must not blame yourselves for not being prepared enough. If you are not able to learn a new skill or cook fancy dinners for your family, or if you are not as productive as your usual self, there’s no need to be harsh on yourself. If you don’t feel like doing anything, that is fine too. Relax, take rest. Remember, the lockdown could also be a chance to refresh or take a break from the normal hustle and bustle of life. If you come out of this lockdown as more energized and refreshed, consider it a success and achievement. Also, stop comparing yourself with others. Every individual is different and will be responding to the situation differently, there’s no point comparing yourself with others. Spend more time with your family. If you feel anxious or depressed there’s no harm in reaching out for help. There must be some online counseling services provided in your community, reach out to them.
HeartyPsych 