As far I can remember, I’ve always had OCD.
My mom’s penchant for cleanliness came to the fore when she had her children. Back then, my mother’s fear for her brood falling prey to germs unseen took hold of her. She kept the house clean and, when we went out, she made sure that we had baths immediately upon our return home as though we had to undergo decontamination from traipsing around in a wasteland.
There were small things that stuck with me—the militant enforcement of making sure that shoes do not enter the household. That goes the same for suitcases or umbrellas; items that made contact with the outside ground. Groceries had to be carried with no respite in placing the heavy bagged items on the floor of the bus or the train. A backpack takes up space next to us or, if we encounter a withering stare from another passenger wanting to sit, takes occupancy on our lap.
Wet wipes, tissues and hand sanitisers were standard issues; we were used to the ever-present lemon fresh scent; dust was a distant stranger to this realm my mother ruled over.
Obsessive-compulsive disorder (OCD) wasn’t something that entered our daily vernacular. In fact, my mother wasn’t even diagnosed. It’s only years later that I read about it, a fleeting dalliance with an article that I skimmed through, but I picked up on key words that described my mother’s preoccupation with cleanliness.
OCD, I said to her, that’s what you have.
I’d expected some display of relief. Here I was, giving this unknown malediction a name, a face, and all that she could muster was a non-committal, “oh”.
The discovery of OCD is illuminating to me though. I’ve started to notice mannerisms that I’ve inherited from my mother. I’ve an aversion to dirt, I’m aware of things that touch the ground outside. I have OCD, I thought to myself, I am my mother’s son.
That belief that I have OCD was bolstered by movies and TV shows like As Good As It Gets, Matchstick Men and Monk. Now my worldview on the condition has included not walking on cracks on the sidewalk, facial tics and wriggling one’s fingers to solve crimes. Oh, and these characters possess asshole characteristics, a feature that I have in spades.
To wit, I haven’t been diagnosed with OCD but I am confident that I have it. Maybe it’s not as drastic as the stories that I’ve heard of people with OCD (anxiety and shame from seeing people in revealing clothes, intrusive thoughts of hitting people), but I figured I was on the lower end of the scale.
It was while I was doing my research for this article that I was instructed to take the Yale-Brown Obsessive Compulsive Scale. This was designed by an American psychiatrist, Wayne K Goodman, and his associates to rate the severity of OCD symptoms. There are 10 questions, with the first half dealing with obsessive thoughts and the rest with a compulsion to perform. The Yale-Brown scale is acknowledged as the gold standard in the measurement of OCD symptoms.
The test took less than five minutes and out of a maximum score of 40, I tallied a six.
I didn’t have OCD.
There are moments in history where discovery is accompanied by elation. Archimedes comes to mind when he let out an ebullient ‘eureka’ after he chanced upon water displacement. After a successful cowpox inoculation on James Phipps, Edward Jenner penned a letter to his friend, proclaiming its success.
Happiness was brief when I got the result. And then, almost perceptibly, it’s followed by, oh shit what have I done to my mom?
Dr Oliver Sündermann tells me a cupcake story.
His parents were in Singapore recently and they decide to try the breakfast buffet at the Shangri-La Hotel. The spread included the pastry section and its cupcakes with the hues of a rainbow and liberal application of sprinkles. The back of your teeth hurt when you look at them.
Above the cupcakes was a sign, handwritten in caps: OCD (Obsessive Cupcake Disorder).
While some of the guests found it funny, the opposite was true for the doctor.
“It was kind of minimising for a person with OCD,” Dr Sündermann says. “It’s a disorder that is severe, disabling and can lead to suicide. It’s really not funny.”
He would know. Dr Sündermann is a clinical psychologist and manager of the Clinical and Health Psychology Centre at the National University of Singapore. His office is situated in the basement, near the back of the building, as though demonstrating how covert mental illnesses like OCD are still perceived—hidden.
“We don’t know why OCD is higher in Singapore than the rest of the world but we do know that is the case. I can’t really tell you why it is higher. We could speculate but we need to conduct a good study on it. We need to do some research.”
There are possible hypotheses to the uptick of OCD cases in Singapore. Some allude to our competitive environment or maybe people are better at recognising the symptoms of OCD and are coming forward more readily.
Stigma nips at the acceptance of mental illnesses. It is pervasive, still present all these years like a bad penny. “Compared to the west,” Dr Sündermann says, “Singapore isn’t so different in terms of stigma and shame.”
He pulls out a fact sheet and points to a chart. “If you look at the figures from the latest IMH survey, you’ll see that, worldwide, OCD is at number four but in Singapore, it’s the third most common mental health problem, with around 3.6 per cent of the population suffering from OCD. The average onset is 19 years of age, though it can start earlier. In fact, lots of children have OCD.”
There’s a slight rise in his voice as he gestures to another portion of the data. “Treatment delays have actually gone from nine years in 2010 to 11 years in 2016.”
While the rates for depression and alcohol abuse climbed between 2010 and 2016, the treatment delays dipped, but when it comes to OCD, treatment delays extended by two years. The reason for this could be attributed to more help in dealing with depression and alcohol abuse. It’s also possible that the waiting list for treatment for OCD is too long or that there aren’t enough treatment centres for OCD in Singapore.
One of the few that exist is The Lion Mind. Situated at Peace Centre, The Lion Mind is a non-profit organisation that promotes mental wellness and positive psychology through education. The place is small with two rooms. One of them is set up to look like a classroom, with rows of yellow chairs lined neatly and a private room where the decor— yellow sofas, orange wall, cushions that look like fruit slices— evokes a sense of lightness. There, James Chong, co-founder and counsellor of The Lion Mind, lays out the double standard on the perception of mental health and physical health. “With a cold, you go to the doctor for medication and are given an MC (medical certificate) to recuperate. But when you have panic attacks or feel depressed, people don’t usually see a mental health provider.”
Evidence points to the lack of awareness about the disorder. Earlier in the year, the Institute of Mental Health and the NUS Department of Psychology, Faculty of Arts and Social Sciences conducted a public forum on OCD. Attended by 650 participants that included members of the public, mental health professionals as well as NUS students and staff, the forum aimed to raise awareness of the disorder. “Unfortunately,” Dr Sündermann says, “we didn’t have any media coverage for the event. It was a success but the whole point of the forum is to right any misconceptions about OCD.”
Which circles back to myself. What I am is particular. I’m particular about people walking into my home with their shoes on. I’m particular about people chewing with their mouths open. I’m particular about certain sounds. But unless this peculiarity disrupts my life, that’s all it is, just an aberration. Something to spice up your personality on your Tinder profile.
If you can’t sleep because the following word, ‘color’, doesn’t have a ‘u’ or if you can’t operate normally if you didn’t check to see if your front door is locked (and you’ve already checked it five times before), that’s cause for concern. It’s the frequent, intrusive external changes. That should hoist that red flag high.
Thinking that I have OCD doesn’t mean that I’m going to seek help as my mannerism is seen as manageable. The same is true for language; while OCD is used often—being almost on the same branding platform as Coke or Xerox or at a display for cupcakes— the disorder is often downplayed or even misdiagnosed. Clickbait links like, “Twenty-five cleaning tips for the OCD in you” does not further the cause.
“Other than documentaries, local TV drama series aren’t depicting mental illness correctly,” Chong says, “and I understand there’s a need for the dramatic but it’s not helpful.”
“I think for any portrayals of OCD in the movies, there need to be consultants,” Dr Sündermann adds. “It’s good to get advice from people in that field. But government campaigns are helpful in raising awareness. NCSS (National Council of Social Service) did a campaign called Beyond the Label, where they address the stigmas faced by people with mental health conditions.
“We need to educate doctors because they are the first point of contact and because there would be people who go in to seek help but they are often not diagnosed correctly. Like elderly people— they would frequently come in with somatic problems. They may feel anxious but they say they have a tummyache or if they feel panicked, they feel a tightness in their chest.” To know thyself, that’s always the first step towards recovery. It’s the recognition that will pave the way to the second step: treatment.
When it comes to the treatment of OCD, Dr Sündermann avers that the whole health system is too focused on the medical model [in psychology].
Simply stated, the medical model treats mental disorders like physical ailments whereby medication is often used as the only method in treatment. “Usually, OCD is seen as a chemical imbalance,” Dr Sündermann says, “or that there’s a problem with your brain so you need medication.
“I’m not saying that the medical model is wrong. The brain is the basis of all experience, yes but that’s too simplistic to try and explain all mental health problems with neuro-chemistry or abnormalities in the brain. The psychological model is an equally valid way to conceptualise a person’s problem, and should be used in conjunction with the medical model.”
Exposure and Response Prevention (ERP) is the psychological treatment of choice for people with OCD. Under the guidance of a therapist, ERP ‘exposes’ the person to the object or situation that makes them feel anxious, disgusted, or uncomfortable. They the therapist helps the person to disengage from compulsive behaviours, so that he or she can experience that their concerns don’t come true thereby helping them to overcome their OCD.
For example: imagine a patient with excessive contamination fears. He sees his toilet as a breeding ground for diseases that will kill him. Given this fear, it’s understandable that he cleans the toilet obsessively. There’ll be a brief respite from the intrusive thoughts but it wears off and the cycle of compulsions starts again.
So, the therapist nudges the patient into facing his fear: the patient will forgo washing the toilet, maybe he’ll even sit on it. When he notices that he’s not dead from the contact, the therapist has the patient repeat the process.
The initial phase is very difficult to pull off; it could take years for the patient to be willing to take that first step but when it’s pulled off, it works wonders.
It’s a slow erosion against the mountain of misinformation but the wears can be seen. Dr Sündermann says there are plans for more regular events for the public to raise awareness for OCD and improve access to treatments. Institutions like the IMH OCD team, The Lion Mind and the like, continue to educate the masses about OCD. And for the rest of us? Well, we can normalise the disorder without trivialising it. With International OCD Awareness Week coming up (every second week of October), interested parties can go to iocdf.org to see how to help. Or, on a personal level, stop appropriating OCD as a casual term. Or call for a better depiction of OCD in our local programmes. Or call one’s mother to update her on her peculiarities…
For more information or help with obsessive-compulsive disorder, make an appointment with a doctor at the Institute of Mental Health at 6389 2200 or with a counsellor at The Lion Mind at 9677 6878.
