I can vividly recall the dank November afternoon in the mid-Eighties when, on a sodden school football field, I realised I had mental issues. The epiphany was prompted, aptly enough, by a blow to the head. Oblivious to the game being played around me, I was pacing up and down the pitch, mentally weaving endless mathematical sequences and praying that my family would still be alive when I got home that afternoon, despite my having invited a curse by treading on the chalk of the halfway line. Suddenly, the ball ricocheted off my skull and into touch.
As the metallic taste of blood spread over my tongue, incredulous groans and chortles of derision wafted through the drizzle and freezing mist. “Wake up Scott, you silly!” Something clearly wasn’t right. Yes, the belief that my family would die because I’d stepped on a chalk line sounds like stark, raving insanity. And left to its own devices, it becomes exactly that. But obsessive-compulsive disorder (OCD) – the anxiety condition that sees victims trapped in a pattern of repetitive rituals, fears and behaviours, prompted by involuntary, intrusive thoughts – is a far more common condition than you may think.
“Before the Nineties, every medical source would tell you that OCD is very rare,” says Dr Yousuf Abu Allaban, Medical Director and Consultant Psychiatrist at the American Centre for Psychiatry and Neurology, Dubai. “That was just because people used to suffer without knowing it could be treated, or would be ashamed to come forward and talk about it. The statistics suggest that people were waiting an average of 15 years before they sought help.”
Dr Abu Allaban says there are no official statistics for how many people suffer from Obsessive Compulsive Disorder in the UAE today, but the ballpark figure in the US is about 2.3 per cent of the population, and just under 2 per cent in the UK. These figures refer to a level of disorder that impairs sufferers’ ability to function socially or vocationally. But what about those of us who regularly get mild pangs of obsessional anxiety but take them in our stride?
“Well, then the figure goes up to 100 per cent of society,” says Paul Salkovskis, Professor of Clinical Psychology and Applied Science at Kings College, London. “The only difference is, most of us dismiss these thoughts readily. We don’t get fixated. OCD is simply the everyday intrusive thoughts and images that ordinary people get, but magnified.”
The condition doesn’t discriminate according to gender, class or intellect – although some experts believe it is more prevalent among those with creative or altruistic personalities. There also seems to be a spike amongst the adolescent-to early-twenties age group. There’s no broad consensus among the white coats when it comes to what causes it, although Dr Abu Allaban says that progress is being made. “We now know there is a disturbance in certain neurotransmitters, and that certain regions of the brain are overactive in sufferers,”
‘The madness of doubting’
What is certain is that OCD is nothing new. As early as 1837, the French clinician Jean-Étienne Dominique Esquirol coined the term folie du doute (the madness of doubting), while Sigmund Freud referred to “obsessional neurosis” in 1894. Clearly, though, OCD goes back a lot further than this. “The most famous example in literature is Lady Macbeth’s repetitive hand-washing,” says Paul.
“The ancient Greeks also described it in their literature. History tells us it is culturally embedded. Martin Luther suffered from scrupulosity – he was obsessively concerned with the main invisible threat of the day, which was eternal damnation of the soul. Later, once Louis Pasteur came along, it was all about germs. In the 1950s, a lot of OCD people worried about radiation. More recently it’s bee CJD – and so on.”
“It also changes its form in different parts of the world,” adds Simon Darnley, a cognitive behavioural therapist at the South London And Maudsley Anxiety Disorders Residential Unit. “In India and Africa, it’s very much centred on the supernatural and witches.” Simon’s UK patients, in recent decades, have been preoccupied with issues like E. coli, GM foods and mobile phone radiation. So what’s the fear du jour these days? “In the west you have a lot of people who are obsessive about recycling – to a minute degree,” he says.
Dr Abu Allaban says that the most common OCD behaviour he sees is a preoccupation with cleanliness, and that the obsessions can sometimes grow into outright delusions. “I’ve had patients who think that if they touch a computer, the CIA may be able to trace and monitor their thoughts, and will come and arrest them,” he says. If cultural forces shape OCD, is there perhaps even a synergy between the two? Feng Shui, stress balls and even advertisements for anti-bacterial wipes aimed at guilt-stricken mothers are, arguably, all examples of obsessive compulsion manifesting itself in everyday life.
Alarmingly, left to its own devices, OCD can escalate to the point where sufferers think that the most minor thought, action or act of negligence may cause mayhem to themselves or others. This, in turn, induces ritualistic behaviour. “One person I treated was getting up at two in the morning to do all the cleaning rituals before packing up his car with his TV, iron, microwave – anything that plugged in – so he knew it wasn’t left on at home, then driving to work several times in order to finally get there around 9am,” says Simon.
“The ‘Is the cat in the fridge?’ issue alone took half an hour to deal with.” The condition is even more likely to escalate, says Simon, if the sufferer lives alone, wrapped up in their own belief system, quarantined from outside influence.
Seemingly effective rituals
Simon illustrates the illness’s deceptive nature with what he calls The Crocodile Whistle Story. “There’s a guy who goes into a café in Paris, every day at six o’clock, and blows a whistle. He’s been doing it for years. One day, a customer in there says to him, ‘What on earth are you blowing that for?’ He says, ‘To keep the crocodiles away.’ ‘But this is Paris – there are no crocs here!’ ‘Yes, but that’s only because I come here and blow this whistle every day…’ And that’s exactly what happens in OCD. Because the fears are irrational, they don’t come true – which makes the rituals seem effective.”
Perversely enough, sufferers know that the impulses, intrusive thoughts and rituals hounding them are irrational and absurd, as famous victim Woody Allen can attest. He was obsessed with slicing his banana a certain way for fear that something would happen to his family.
“I understand that there could be no correlation, but, the guilt would be too much for me to bear – so it’s easier for me to cut the stupid banana.” Allen, incidentally, isn’t alone as a high-profile sufferer: Cameron Diaz was once unable to open doors with anything but her elbows, and David Beckham has admitted to throwing away cans of soft drink to ensure there’s always an even number in his fridge.
The treatment most commonly administered to the newly diagnosed OCD sufferer is cognitive behavioural therapy. “We try and separate the OCD from the individual,” explains Simon. “We get people to see their OCD as an abusive partner, effectively, which is ruling their lives and telling them what to do.”
Hence, Simon and his colleagues spend therapy sessions gently coaxing patients to actively disobey the very impulses that are troubling them. “I’ve got someone coming in to smash a huge mirror later,” he says. “We’re going to show him that his mum won’t die because of it.”
Some medicines, especially serotonin uptake antidepressants, are a proven aid to such therapy, although Simon is keen to point out that this is not because OCD is down to a chemical imbalance. “The drugs can take the edge off the anxiety,” he says, “but that doesn’t mean that patients are lacking in serotonin – any more than headache sufferers are lacking in aspirin.”
As for my own childhood experiences of acute OCD, I – with the help of anti-depressants and dogged determination – very gradually became more willing and able to tackle the intrusive thoughts. Now aged 39, OCD is but an easily ignored nag in a distant cranny of my psyche. So I’m fine. Aren’t I?
“You’ve gone for the non-OCD way: to not do the rituals but still have the thoughts,” says Simon. “That’s OK, but not ideal. The best option is the anti-OCD way.” Let me get this right: you want me to taunt those meddlesome voices with wilful perversity? “Yes.
We want to chuck that crocodile whistle in the nearest pond, leave the doors of that café wide open with a big bit of meat hanging in the doorway and nail up a vast sign saying, ‘Crocodiles served here’. You have to keep up the fight: otherwise, if you have a major life event and get depressed, it’ll come and bite you. Blitz it. Now.”
OCD: Are you an acute sufferer?
The average person is likely to answer “yes” to at least a few of the following questions. You should only think about professional help if any of the habits cause you distress, or make you engage in ritualistic behaviour – checking a tap 20 times, for example – or seriously interfere with your day-to-day life.
A) Do you ever find yourself preoccupied with hygiene, cleanliness or the threat of illness?
B) Do you get concerned over keeping everyday items – clothes, tools, food, furniture – in a certain order?
C) Do you get regular intrusive thoughts involving death or catastrophe?
D) Do you fear causing harm – directly or via your thoughts – to yourself or your
E) Do you check taps, gas hobs and appliances aren’t left on several times before leaving your home, or perhaps the handbrake when leaving your car?
F) Do you find it difficult to throw stuff away, or feel the need to inspect rubbish before it is taken?
G) Do you repeat actions – rising from a chair, turning off a light-switch, opening a car door – until it inexplicably feels ‘right’?
H) Do you suffer from hypochondria?
I) Do you have an irrational fear of certain letters, colours or numbers?
J) Do you suffer from superstitious fears, such as treading on cracks on pavements?
K) Do you feel an impulse to confess to things?