OCD (Obsessive Compulsive Disorder) is no laughing matter. It is a devastating mental disorder that can easily turn one’s life into a living hell. But that does not mean we cannot use a little bit of humor to cope with this terrifying disorder. While OCD itself is far from being funny, the situations that can […]OCD & Humor – Is Life A Tragedy..Or A Comedy? — Overcoming OCD
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
The real culprit of OCD may not be what you originally thought.
It is not uncommon to hear an OCD sufferer make a comment such as “OCD thoughts are ruining my life,” or “I have to get rid of these thoughts!” This refrain is echoed by many of my clients who lament their unwanted, intrusive thoughts and the seemingly endless struggle to suppress, neutralize, and explain away their thoughts.
The common belief, whether explicit or implicit, is that the presence and content of the thoughts are the problem, and getting rid of them will restore hope, confidence, and happiness.
But OCD is not a thought problem — it’s a feeling problem. In other words, if the thought did not have the accompanying painful feeling, you would ignore the thought, call it “weird,” and simply move on without compulsions or a second thought.
Allow me to unpack this as it may seem like what I’m saying is controversial or missing some important point about OCD.
Obsessive Compulsive Disorder is a condition marked by a pattern of unwanted, intrusive thoughts, feelings, images, sensations, or urges that take the form of a Feared Story. This story tells the sufferer of a potential, and as of yet fictional, outcome or truth about their actions, intentions, character, or future. This story, being completely unwanted, makes the sufferer feel an overwhelming sense of anxiety.
To deal with this anxiety and to get back to a sense of normalcy, confidence, and comfort, the OCD sufferer will then engage in overt or covert compulsive behaviors as an anxiety management strategy. Compulsions can include avoidance, reassurance seeking, mental review, rituals, and other repetitive acts. Once done, the sufferer gets a false sense of security that unfortunately reinforces the anxiety cycle.
OCD’s deception is that you have to struggle with and resolve the content of the thought. You have to clarify, rectify, and examine the thoughts to determine whether they are true or false. For example, the contamination OCD sufferer believes he must be sure that his hands are fully clean, or at least clean enough, before they can interact with anyone.
In the brief overview of the OCD cycle above, you likely noticed that I mentioned thoughts and feelings. Wouldn’t this suggest that OCD is both a thought and a feeling issue? Yes, but in practice not really. People with OCD often get wrapped up in three potential issues; the trigger, the feared story, and the feeling. Ultimately, freedom from OCD requires you to face down the feeling, because OCD is a feeling problem.
OCD can be triggered by almost anything, including things we see, random thoughts we have, sensations we experience, and objects we encounter. Everything that you and I will ever encounter, think, feel, or experience is neutral until we place some value upon it. Meaning it is neither good nor bad, right nor wrong. Is a knife good or bad? It can be used to open to letter, but it can also be used to open a person. How about therapy? It is both good and bad. It can bring about profound positive life transformation, but it can also be emotionally draining, time-consuming, and costly.
Likewise, triggers to one’s fears are also neutral. Yet those with OCD and anxiety disorders exaggerate the meaning and importance of triggering thoughts or images as they relate to the Feared Story.
Each fear has any number of neutral associations. Remember the knife example? It doesn’t have just one meaning or significance. A knife can conjure thoughts of cooking shows. It can cause someone to think of their dad’s fishing knife or Julius Caesar. The thought of a knife can also spark thoughts of suicide, harm, or crime.
If you blame the trigger (i.e. the feared thought or object) and label it as the problem, you are being misdirected. OCD, and the history of repeated compulsions, exaggerate the importance of a select number of mental associations. Over time, the other neutral or positive associations are downplayed or ignored leaving the feared associations as seemingly the only associations for these thoughts or experiences.
When you scapegoat the trigger as the problem, you believe minimizing your contact with it will make the obsession about it go away. Unfortunately, avoiding the trigger leads to isolation and reinforces the false notion that the trigger is the problem, resulting in greater fear of the trigger and the feared story it spawns.
The Feared Story
Our brain tells us stories all day. Some we like. Some we don’t. OCD tells us stories too, and they are catastrophic, threatening, and at odds with who we are. These Feared Stories are a combination of distorted thoughts and mental images about the result of actions, one’s character, or an inevitable future that concludes in something terrible.
Some people blame the Feared Story as the problem within OCD. They think that if they were to simply get rid of the thoughts, think the opposite of the thought, prove that the thought is wrong, or simply “just think right” that their OCD would evaporate. They believe OCD is a thought problem.
To their point, treatment for OCD and anxiety disorders commonly begins by challenging the feared story using rational thought to develop a broader, reality-based view of the fear. This exercise helps the sufferer develop confidence that their intrusive thoughts are likely irrational, overvalued, and not deserving of excessive and exhausting compulsive responses.
When I challenge the Feared Story in session, my clients are quick to point out how their Feared Story is wrong. They usually say, “I know this doesn’t make sense,” then proceed to point out all the reasons why it doesn’t make sense, and they are right!
For example, a client with Pedophile OCD (POCD) might say, “I’m not a pedophile because I’ve never been attracted to a child in the past. I’ve never wanted to do anything sexual with a child. Whenever I have the thought about molesting a child, I always get anxious and have never felt feelings consistent with my typical feelings of attraction when I think about adults.”
Here is the actual problem of OCD. The feeling. More specifically, it is the feeling that makes you engage in compulsive behavior, which subsequently reinforces the OCD cycle. Chasing down and embracing that feeling with a welcoming and accepting posture desensitizes you to the feeling over time. Conversely, if you are unwilling to feel the feeling, but instead rely on compulsions and avoidances, desensitization cannot happen.
Remember, we are able to acknowledge that the trigger is neutral, and has a number of alternative associations. Additionally, we are very capable of telling ourselves why the Feared Story is irrational and wrong. However, we are unable to convince ourselves to not feel something because feelings are largely out of our control.
While not bad or wrong, feeling anxiety in an OCD moment is unwanted. Typically speaking, we say anxiety feels bad, but it by itself is not “bad.” It is an unwanted feeling state at the moment you’re feeling it. When we ride a roller coaster or see a horror movie, we expect to feel butterflies in our stomach, feel our heart racing, and feel jumpy. You know, anxiety feelings. But in this context, we paid good money for the experience! So, the feeling itself is not bad, just unwanted at that moment and inconsistent with the level of actual risk.
Generally speaking, people with OCD are capable of combating their feared thoughts with rational alternatives. However, compulsions exist because a feared thought comes with, or takes the form of, an uncomfortable and unwanted feeling that overwhelms the sufferer.
Despite developing a list of rational observations and objections to the Feared Story, it does nothing long term because the issue has never been a matter of “right thinking,” but of an intolerance of the feeling brought on by the Feared Story.
Similarly, when it comes to OCD, sometimes the feeling isn’t just anxiety, but sadness, loneliness, anger, apathy, or emptiness.
The goal of Exposure and Response Prevention treatment is to intentionally feel this feeling, acknowledge this inconsistent emotional response, and let it remain without compulsive behaviors until it passes. Remember, it will always pass.
Counterintuitively, your job in Exposure and Response Prevention is to engage the feeling. It’s the enemy and the problem. The solution is to show that you’re stronger than it by calling its bluff that the feeling is heralding in something terrible and that you are not strong enough to shoulder the uncomfortable experience. You are strong enough, and the terrible outcome probably is not coming. Stand firm and let the storm pass.
Feel the Pain, See the Results
If you are not ready to do this, you are going to have a hard time overcoming your anxiety. But you can start small, and progressively work up. If you are consistent and keep pushing yourself, you will eventually find more mental and emotional strength and freedom.
Diogenes syndrome, also known as senile squalor syndrome, is a behavioral disorder that affects older adults. It is characterized by extreme self-neglect, poor personal hygiene, severe domestic squalor, excessive hoarding of trash, and social withdrawal. It occurs in both men and women.
The syndrome is named after Diogenes, the ancient Greek philosopher who showed ‘contempt for social organization’ and ‘lack of shame.’ People with this syndrome also show a lack of shame. They are often unaware that anything is wrong with the conditions they are living in and remain unconscious of their self-neglecting behavior. They usually live alone and may also displays symptoms of catatonia.
Diogenes syndrome is often linked to mental illnesses, such as dementia, schizophrenia, obsessive-compulsive disorder (OCD), depression, and addiction. Research suggests that it is most common among people with average intelligence, who are over 60 years, and are living alone.
Anxiety is one of the most common yet most debilitating mental health conditions that can range from worry to full-blown anxiety disorders. There would rarely be anyone who has never worried about anything in his or her life and therefore, occasional worry or fear is rather a part of normal life. We often worry about the wellbeing of our loved ones or we may fear for our own safety too. Sometimes we worry about our financial situations or our work while at other times we are just concerned about our future. These occasional worries are not always bad; in fact, they are somewhat good for our survival. They help us prepare ourselves to deal with life’s challenges. However, worries can sometimes take acute form and become unbearable, excessive, irrational, or even uncontrollable and are accompanied with physical symptoms such as increased palpitation of heart, sweating, and trembling. If you too are experiencing these symptoms, you might be suffering from full blown anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) recognizes seven primary types of anxiety disorders: phobic disorders of the “specific” or of the “social” type, panic disorder with or without agoraphobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). GAD is the most common of these anxiety disorders and is characterized by chronic excessive worry about a number of events or activities. The subjective experience of excessive worry in GAD is accompanied by following symptoms:
- Restlessness or feelings of being keyed up or on edge
- a sense of being easily fatigued
- difficulty concentrating or mind going blank
- muscle tension
- sleep disturbance
However, an individual who worries a lot does not necessarily suffer from anxiety disorders. Sometimes having an unhealthy lifestyle can make you feel anxious. Following are some self-help techniques that can help you keep anxiety in check and manage symptoms of anxiety, though these must not be considered a substitute for professional help or treatment:
Exercise/Running: Performing regular exercise and going for jogging or brisk walk has been scientifically proven to help allay anxiety symptoms. Exercise releases chemicals, i.e., endorphins in the brain that can counter symptoms of anxiety and improves mood. It also helps in lowering stress hormone cortisol that is secreted when we are anxious. Several studies have shown overall benefits of exercise on mind and body. Exercising for half an hour four times a week has been recommended for those suffering from anxiety.
Socialize: Meet people you trust and share your thoughts and feelings with them. Isolation and loneliness has been shown to increase the symptoms of anxiety. You can also talk to your trusted friends over phone and share your worries with them. Since anxiety is often based on irrational thoughts, talking to others can bring sense to our unwarranted thoughts. Suppressing and keeping your thoughts to yourself, on the other hand, can make them overwhelming and difficult to deal with. You can join some support group also, where other anxiety patients like you share their thoughts, feelings, progress, etc. Make socializing a part of your daily routine no matter how difficult it sometimes may feel.
Muscular relaxation technique: Try Jacobson’s progressive muscle relaxation technique. Since individuals who experience anxiety symptoms tend to have high arousal, progressive muscle relaxation technique can help release physical tension.
Sleep: Lack of good sleep can aggravate the symptoms. So in order to keep your anxiety symptoms under check, get qualitative 7 – 8 hours of sleep a night.
Deep breathing: Breathing from your gut has been scientifically proven to lower the arousal level of body. Hence, deep breathing exercise can help calm your body and mind. Use deep breathing to relieve immediate symptoms of anxiety like hyperventilation or shortness of breath.
Stay in the present: Anxiety disorders are often future-based, which means, you tend to worry about the things that you feel are going to happen. So in such instances, try to focus on the present. Ask yourself about what is happening at the moment. Mindfulness can help you stay in the moment. Mindfulness is a technique where we are made aware of what is going on around us through our five senses. What do we see, hear, smell, feel, and taste. A regular practice in mindfulness can help you ease anxiety symptoms.
Train your mind: Anxiety is often based on thoughts; therefore, in order to deal with it, one has to work on one’s thoughts. Be accepting to the fact that you cannot actually control everything. Try to do your best instead of striving for perfection. Research studies provide evidence regarding link between perfectionism and mental health disorders like anxiety and depression. Replace negative thoughts with positive ones and try to maintain positive attitude about life.
Challenge your thoughts: Most of the worries and fears in anxiety are irrational and without any base. Identify your apprehensions and challenge each and every single thought that comes to your mind.
Eating healthy: Avoid consuming alcohol and caffeine and focus on eating a well-balanced diet. Eating healthy food helps maintain healthy mind and body. Stay hydrated. It may seem like too simple a remedy but staying hydrated can go a long way in managing anxiety. Whenever you experience anxiety symptoms, drink water as it helps lower the arousal.
Use art as mode of expression: Art therapy has also been found to help relieve anxiety symptoms. Use dance or painting as a mode of giving outlet to your thoughts and feelings. It can also help you take your mind off your worries.
Professional help: If you feel that your anxiety symptoms are interfering with your daily functioning, don’t hesitate to take professional help from a psychiatrist or psychologists or other healthcare provider in your community. Professional treatment mostly includes medications for severe symptoms, along with cognitive behavioral therapy.
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