Sunday, 6 November 2016

I’m not an arsonist, I just have a burning obsession

Last night was Bonfire night. At my Bolton home, the 6 houses on my lane have a shared apple orchard that has a small wooded area running around it. For over 20 years that I can recall, we have made a clearing, built a bonfire, and got the children to make a Guy. Friends and families have gathered around for an evening of shared food, drink and good conversation. We occasionally have one or two fireworks, but mainly it’s about relaxing company, a good fire and a chance to catch up. And so it was last night, although I may have enjoyed a beer of two more than I should have. Whilst celebrating around the bonfire each year is probably not a ritual as such, for most of us it definitely has a ritualistic flavour.

Rituals serve a very functional purpose, which is why they are so often found in religious ceremonies. Ritual is both a mnemonic device and a trigger. As a mnemonic device rituals serve to mark an event as being important or significant. So while I sometimes struggle to remember what I was doing last month, I can clearly remember the last bonfire, a year ago, and bonfires before that. As a trigger, preparing the bonfire, and food, buying the drink and eventually lighting the fire sets the stage for what is about to happen.

Throughout our lives most of us will come into contact with rituals at different life stages - births, bar mitzvahs, coronations, graduations, marriages and funerals and so on. However, for some people ritual becomes a part of their everyday life. For example, those with a obsessive compulsive disorder (OCD). This is a common anxiety disorder. In fact about 1 in 50 people, males and females equally, will experience a OCD at some point in their lives. In the UK that is just over 1 million people. A number of familiar and famous people have lived with an OCD, including: David Beckham, Justin Timberlake, Cameron Diaz, Charles Darwin and Florence Nightingale.   

Donald Trump describes himself as being 'borderline OCD' (whatever that might mean) but apart from possibly being obsessive about becoming President of the US he does not have an OCD. He reportedly won’t shake hands with people, particularly teachers who he believes have '17,000 germs per square inch on their desks' but this is a phobia and not a sign of OCD.  OCD involves people experiencing distressing and/or frightening repetitive thoughts, which however irrational they may seem, keep coming into their mind. They do so despite whatever the person does to resist or ignore them. Compulsions are actions that people believe they must repeat to feel less anxious or in order to stop these obsessive thoughts.

Compulsions commonly include excessive checking, cleaning, counting, and other ritualised behaviours, which whilst sometimes providing temporary relief from anxiety often get repeated in order to 'get it right'. However, unlike the compulsive and obsessional behaviours associated with drug and alcohol use or gambling, or even those that run every day – all behaviours that are usually pleasurable - the signature of OCD is that the compulsive behaviour never gives pleasure, and the behaviours are always experienced as an unpleasant demand or a burden. 

OCD is a much misunderstood condition. It is the distortion of the familiar - (counting, checking, cleaning) - things most of us do, that can be the most difficult aspect of the disorder to understand. Most of us will have checked for the 10th time that our passport is in the inside pocket just as it was 5 minutes before. Such temporary states of compulsion and obsession are ameliorated once we are on the plane or whatever. For those living with OCD, the situation can be very different. 

However, these days there is a wide range of help and successful treatments available for those with an OCD. While mental health services continue to be under-funded and there can be problems in accessing care, these are generally peripheral elements in why people don't always seek help for their OCD. Often the reason for people not seeking help is that they don't want others to know they need help. So it can take a long time before people with an OCD seek support from mental health services. Some will go to great lengths to hide their ritualistic behaviour, and many will experience overwhelming shame because they are unable to stop such behaviours.

As with all mental health problems, and OCD is no different, the more we can talk about it, the sooner we can reduce the stigma surrounding the experience of mental health problems and the easier it will become to reach out and help people. And thankfully, we don't need to always light a bonfire to get people together and start talking...

...although bonfires are fun!