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Home
and Family
Don't Step on the Cracks
by A. Ross
He was on his way to work in the morning. First he made sure
the lights were out, locked the front door, got into his car
and drove for about ten minutes. Suddenly he turned the car
and drove back home, because he thought he had forgotten to
lock the front door. The door was locked, so he got back into
the car and drove to work. However, he went back three more
times to check on the door, before he actually arrived at his
office. In the evening he would drive back to the office
several times to make sure that he had switched the light
off.
The pretty young woman made the children's cheese sandwiches,
and sent them off to school. Then she washed her hands. Not a
short cursory rinse: she washed for a full ten minutes. She
started making the beds but felt that her hands were still
not clean, so she began the ritual of washing again. It was
when it was time to prepare a meaty meal that she really
began to wash, and wash, and wash again.
These stories are not in the least exaggerated, I know the
two people personally. Surprisingly, hardly anyone else knows
about these compulsions. The sufferers know that their
behavior is bizarre, and keep the rituals a deadly secret.
Obsessive-Compulsive Disorder (O.C.D.) is far more widespread
than is generally known. Even the closest family members do
not realize that these compulsions are not just a quirk, but
that the person is sick. Nearly all babies and little
children have obsessive behavoirs which they outgrow. These
include bedtime rituals which vary in each family, or times
of meals, or routines in the day. Woe betide the mother who
decides to reverse the order of a child's morning routine, if
he happens to be an obsessive child.
Most adults have some obsessive behaviors, which are not
compulsive and which they sometimes drop for other behaviors.
Some are very particular about switching off lights which are
not in use. Some close all available doors, while others
purposely leave all doors, including their bedroom doors at
night, open. Some hum the same tune under their breath, day
after day and week after week, although they themselves would
prefer a change of tune. There are those who tweak leaves off
bushes as they pass and count flagstones as they walk (taking
care not to walk on the cracks!). Counting steps from one
lamp post to the next, or knocking the same number of times
on a door before gaining admittance to a house, is a common
compulsion among 'normal' people. Strict adherence to
neatness is also a compulsion which can easily become
obsessive!
All in the above-mentioned list could be called habits. It
would be an interesting piece of research to ask maybe five
hundred people of what their particular habit consists
— even if it is only inserting the same word more
frequently than others into our conversation until someone
makes us aware of it and we will begin using a different
word. (Perhaps readers would write in about their own
particular 'obsession.') It only becomes a compulsion when it
is impossible to stop. When a ritual does not disturb the
person's life, it is of no importance. It takes on a greater
significance if it disturbs the spouse. Normally it is just a
meshuggas, and everybody (except I, myself, of
course,) has some!
In O.C.D. the ritual of counting takes on a different
dimension, in which case it is called 'arithromania'. Perhaps
the sufferer will count up to a hundred before cleaning his
teeth, and another hundred at the conclusion. He may count up
to fifty before entering any door. The permutations are
endless and the rituals may take hours. Trichtillomania
(compulsive pulling out of hair), bulimia (compulsive eating)
and other compulsions are considered by some to be forms of
O.C.D., and are treated with the same drugs e.g.
clomipramine, paroxetine amongst others, which have been
shown to be successful.
With new effective drugs coming out every year, and with
skilled behavior therapy, many sufferers can be helped, as
long as they break their self-imposed silence and secrecy. An
unsuspecting boy married a girl who had suffered from O.C.D.
since early childhood. It was never diagnosed as such, but
the young husband soon grasped that this girl was sick.
Scrupulous adherence to each minute detail of mitzvos
is laudable: if only each one of us were as conscientious.
Yet when a person checks and re-checks each detail, it might
take a whole day to perform one particular mitzva.
Even after all the checking, the girl felt guilty that she
was not doing things correctly; she even imagined that she
had committed divers sins for which she would be punished.
The young couple consulted a psychiatrist, who prescribed
medication, and monitored her progress till she had the right
dosage. She is still on medication, but has had several
children and the family lives in harmony.
I was told by a psychiatrist that when the compulsion takes
the form of religion, it is very difficult to cure, because
the sufferer denies that he has a problem. Unlike other
sufferers of O.C.D., he parades his compulsion. For instance,
in some obligatory prayers, the sufferer will repeat any
single word up to ten times or more, in public, feeling that
he has not concentrated on it well enough. In fact, some
people reading this article might accuse me of heresy for not
approving of this piety which the sufferer practices for
hours every day. This devout man (usually a man) will
articulate brochos in the same way, stammering over
the initial word till he feels he has achieved the correct
mental sanctity to praise our Creator.
The Chazon Ish was once asked why he did not say Shema
with such intense concentration, and he replied that he did
not check the lock on his door either, once he had locked it.
Once again, if the person has the time, and it does not
disturb his lifestyle, he can please himself on how long he
takes over his religious obligations: but is he pleasing
himself?
Psychotherapy, part of which is an acceptance of the person's
difficulties, and trying to explain the nature and source of
the problem with suggestions for alternative ways of dealing
with it, does not usually work with O.C.D. There is an old
joke about a man who was convinced that he was dead. The
psychiatrist, using psychotherapy, made the man say
repeatedly, that dead men do not bleed. Then he stuck a pin
into him. The patient exclaimed "See, dead men DO bleed".
O.C.D. has been with us for centuries, but formerly, this man
would have been called demented, or crazy. This was in the
days before behavior therapy was a skilled art.
Unfortunately, the disease may hit several members of a
family, and as people usually hide the fact, parents or other
sufferers will be the first to become aware of the child's
misery. A combination of drug and behavior therapy (exposure
therapy in this case) often helps. The person is exposed to
the situations or people which trigger obsessions, rituals or
discomfort. For example, if a young child exhibits symptoms
of constant washing, and shuns finger paints, sand castles or
mud pies, if he can be coaxed to get his hands dirty, and not
wash them for a while, he may not get a full blown case of
O.C.D. The adult who washes constantly may, after much
preparation, be asked to go to a simcha and shake
hands with as many people as possible, without once leaving
the room to wash his hands.
If someone's habits do not disrupt their work or their
personal lives, and if they do not disturb the spouses
unduly, they do not have O.C.D. If you have a child, friend
or loved one who is perfectly normal but behaves in such a
way that his work, social live, or private life are severely
disrupted, do try to convince him to get help. If hoarding
and collecting become fanatical, if packing and arranging
become obsessive, for example, that shoe laces of unworn
shoes have to be exactly in line in the wardrobe, if children
need to ask the same questions over and over again, those
closest to the sufferer should not just ignore the
problem.
It is much more of a stigma to be called 'funny' or crazy,
than to have a consultation with a psychiatrist. Parents can,
and do, deal with different childhood problems before running
to a psychiatrist. There is no harm in telling your child,
"You have asked me this eight times already. Yes, I
will try to fetch you from school today, but you don't
need to ask again." It is when the problem becomes more
widespread and persistent, and the child is in his late
teens, that you will have to consider drug therapy;
especially as O.C.D. is frequently accompanied by
depression.
The dictionary definition for "obsession" is "a morbid
persistence of an idea in the mind, against one's will, a
fixed idea." Compulsion is defined as a strong irrational
impulse. We discussed children and adults, but did not
mention senior citizens. It is a fact that any traits you
have as an adult, increase in old age, to such an extent that
they turn into obsessions. This is probably because the older
person has less responsibility, therefore, less to distract
him from his own little world. Those foibles should be
humored.. ..why not? We may want someone to humor us one
day!
All the above has just touched the tip of the iceberg as far
as O.C.D. is concerned. Sufferers will know far more about
the subject than the writer, who has only met a few, and
spoken to a few therapists. We must remember that sufferers
are not crazy, are often in professions and frequently very
talented, and come from all walks of life. They just need a
doctor's help.
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