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Obessive Compulsive Disorder


            This is another very common psychological problem in India and mostly begins in adolescence. This is more disabling than any other psychological problem

COMPULSIVE BEHAVIOR:

             Because of our culture which is rich in rituals, and traditions, superstitions and Magical Thinking, some people get excessive fear of falling foul of these strictly prescribed ritualistic practices. After performing the rituals, they develop doubt whether it has been done properly or not and keep repeating the acts to achieve self satisfying perfection. These acts become repetitive like rituals of washing, touching some articles etc. Excessive cleanliness may become a problem with some patients. This excessive cleanliness in itself looks good. Initially, it is appreciated by a husband who is not very tidy. Meticulousness, tidiness, methodicity, scrupulousness, straightforwardness, exactness, orderliness, and extreme rigid punctuality are seen as a very good influence on the family or on followers or subordinates.

But the trouble starts when he or she notices that along with these qualities there is an element of rigidity and lack of flexibility. He finds that the obsessional partner is incapable of rigidity and lack of flexibility. He also notices that she is extremely nagging and has her way through anger and stubbornness and soon the atmosphere in the house becomes tension ridden. Young children react very badly so much to such an atmosphere and very often show neurotic traits in themselves, like becoming very fussy about food, nail biting and bed-wetting, beyond reasonable age. This shows anxiety in their home life. Unfortunately, if the wife is an obsessional, the husband has to bear the brunt like excessive washing the hands and feet many times before the meals, ban on relatives visiting her house and hostile to friends who may criticize or make fun of their peculiar behavior.

            Some people have their own fixed numbers of performing tasks, always busy wiping, washing, sweeping and if the husband forgets to keep the shoes in its usual place or few inches away from the allotted space, then she gets very angry and she cannot tolerate any deviation. Besides repetitive behavior, they indulge in checking and re-checking whatever they do or other do, even in routine matters like locking, counting the money, switching off the stove etc., some get terribly pre occupied with dirt and contamination.

OBSESSIVE THOUGHTS:

             Some suffer less from acts and more from uncontrollable thought like fear of coming in contacts with lepers and such fears get dragged on to ridiculous lengths and they see nothing but dirt around them and go in search for this with microscopic eyes. Such unnecessary precautions are capable of causing immense annoyance to others. They to go extreme lengths to ward off possible contamination like wearing gloves in the house and washing the change returned by the auto-rickshaw man lest it may have been touched by the hands of a leper or sick person. Some people look for filth on the streets and walk very carefully and when they return home a ritualistic scrubbing goes on. A patient was using a cake of soap a day. Another would just stand staring at the Sun for hours together before going for bath. Another would not open her mouth, with the fear that flies or insects might get in and so she was virtually starving. Another feels paralyzed at the sight of lizard.

Their life becomes really miserable for them and the other family members. This is truly a crippling disease and however much the relatives re-assure them, they understand but cannot themselves out of this vicious circle of fears and methods to clean themselves whether with water for physical dirt of excessive prayers for spiritual cleanliness. Requirement of running water annoys other family users and neighbors -- overhead tanks get emptied in no time.

            The most important aspect of their excessive indulgence in any act of cleanliness or worship or repeated touching etc. is their personal satisfaction. If they are prevented from completing their own laid down ritualistic procedures, they become extremely annoyed and re-start the process all over again. They know that they should not do this and try to resist but against their own weak resistance, there is an inner stronger compulsion. This leads to guilt feeling later on and subsequent depression. They would continue the act till fear of exhaustion they prefer not to do anything and remain filthy or unwashed for days together. They know that all these doubts are irrational and they are intelligent enough to know the nature of their problems but there is a compulsion from inside to indulge in checking and re-checking. They consistently fail to dismiss a doubt.

They entertain lots of doubts in their minds about their daily chores and their day to day life is a misery and full of anxieties, doubts, fears, guilt, remorse and repentance. Some have feared that if they do not do certain actions in a proper manner or if they do not conduct their prayers in a particular manner, then they would invite the wrath of God and their family would suffer because of their mistakes. They get pre-occupied with the fear of possible harm coming to their family members. The whole day, they remain tense imagining baseless fears and remotest possible accidents like if the husband goes out that he may meet with an accident. To ward off their imaginary evil effects on the family they indulge in more and more prayers and all sort of religious activities like excessive charities, visiting temples and darghas etc., to appease the gods.

COMPULSIVE PERSONALITY:

            These are very conscientious people and have a very strange sense of honesty, dignity and pride. They always striving for perfection and this they do to run away from possible fear of failure or criticism. They are extremely indecisive and can never make up their minds, easily, and they are forever in some dilemma whether to do or not to do. Very often they choose to redo a job done by others because they are not satisfied. Such people rarely keep servants for long. They cannot stand ambiguity. They want everything clear cut. They believe only in black and white and there is no such thing as a grey shade in their mind. About health too they desire 100 percent perfect health and slight head-ache they imaging a serious illness. Any chest discomfort is feared to become a heart attack. They cannot restrain themselves from criticizing others but cannot stand any criticism of theirs.

Every action of theirs should be thorough and they expect others also to be so, when they find them wanting, they get into a rage and so their interpersonal relations are always strained. They lose their friends; get estranged from relatives and subordinates. They become unpopular and lonely people. One constant conflict is punctuality and defaulters are severely punished and punctuality is not an Indian virtue. With this back ground if they become pre-occupied with some illness, they break down and need psychiatric evaluation and management.

The family initially does not notice this as an illness and try to co operate with the person by accommodating his/her demands. The demands may be ridiculous like observing various rules and regulations in the house, where things should be kept and what time the children should do certain things etc., They are very thrifty in money matters and they have very restricted capacity to give warmth and affection. They tend to ruminate over trivial matters most of the time. Children brought up in such a strict, disciplined and rigid family environment, feels psychologically suffocated and their mental makeup develops abnormally. In early childhood they suffer from bed-wetting and in adolescents they develop conduct disorders, in adult life they may end up as drug addicts. Because of lack of warmth in the family, they grow to become incapable of giving love and affection and may even turn sadistic, particularly to their spouses. Worst of all they may also turn obsessional which will perpetuate the malady.

Most of the members of the family tolerate this odd behavior because it is easier to fall in line than to take up arms against them. These people do not think they are ill. They think that they are better than others and have no insight into the misery they cause around them. Some crises may bring them to a Psychiatrist and modern treatment is very successful in such problems.