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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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