Stark Reality

Dissolved in the waters,

Dispersed in air,

Your beloved presence,

Though everywhere,

Is now nowhere.

Obsessive-Compulsive Disorder---The Enemy Within

It is easy to fight an external enemy but difficult to fight against one's own mind or slay the demons which it puts forth.This is exactly what happens when one is tormented by Obsessive Thoughts.They constitute one part of the Anxiety Disorder known as Obsessive-Compulsive Disorder. The other part is compulsive behavior,which may,or may not follow obsessive thoughts.

Obsessive Thoughts
These are persistently recurring inappropriate thoughts,images,impulses or memories which the person recognises as improper but cannot control.They could be violent,sexual,incestuous or blasphemous in nature.Naturally he is alarmed,shameful and miserable on account of these thoughts and begins to doubt his own worth.Actually they are manifestations of a deep seated anxiety but their occurrence worsens his condition by generating uneasiness,apprehension,fear,worry,guilt and more anxiety.
Compulsive Behavior
This refers to meaningless acts which the person indulges in, to counteract disturbing thoughts.They become a ritual for that person.They could take the shape of excessive washing or cleaning,counting,repeating routine functions like locking doors or checking them,stepping on cracks or alternate tiles on a pathway, or silently chanting a 'mantra', for example.
He convinces himself that if he carries out a certain ritual he will be fine or a tragedy will be averted.If circumstances prevent him from performing that ritual to his satisfaction he falls prey to more fears that something terrible is in store for him.Pressing anxiety goads him to carry out the compulsive acts.His tension decreases for the time being but it surfaces soon enough and again that ritual is carried out;so that it becomes a permanent fixture of his personality.
Gradually these activities take up more & more of his waking hours so that he can do scant justice to the roles assigned to him.He becomes a recluse so that he can perform those rituals--which could be overt as well as covert.A person who fears dirt could shut himself in a room,spend hours bathing, and have no connect with anyone else.In this way OCD  takes over his whole life.This has disastrous consequences not only for the patient, but also for his family.There is a lot of ridicule,blame,bitterness and acrimony.The relationships go haywire and the patient is generally ostracized.
Causes of OCD
These could be :--
Psychological-- Like a mental trauma or depression.
Physical--A grave disease.
Biological--Imbalance in brain chemicals.
Genetic Propensity
Environmental--Imbibing it from an afflicted family member.
Treatment
Curing OCD is not easy.The first reason is that patients try their utmost to hide their problem because of the shame or stigma involved.Even when it comes to light they may fight hard to justify their habits.The compulsive personality is usually a perfectionist,conscientious person of high intelligence.He is rigid,meticulous,inhibited,unemotional and preoccupied with existential or health issues.He is not amenable to others' advice and thinks he knows best.All this bars him from admitting that his behavior deviates from normal, and seeking help.By the time he finally goes to a mental health professional his symptoms have taken firm roots.This is a major obstacle on the road to recovery.

Talking of treatment,the earlier it starts the better is the prognosis.

In the initial stages self help guided by CBT is the best bet.

Medication alone is not of much use unless it is supplanted by counselling.

Meditation helps to soothe ruffled emotions.A sufferer told me that she had cured herself with the help of self help and meditation.

OCD causes a lot of tension not only in the mind,but also in the body--making him high-strung and nervy.Relaxation Techniques bring taut muscles back to normal. 

OCD is highly debilitating-take a healthy diet and proper sleep and rest.Pamper your body--it has been misused and overused long enough.

Family therapy is employed to awaken the family members to the patient's needs and explain them about his disease.

How it is done
Countering obsessive thoughts is easier than controlling compulsive behavior although both require enormous will power.Obsessive thoughts spew certain emotions which disturb the person because he does not approve of those thoughts.Yet they invade his mind--despite his disapproval.Naturally his peace of mind is ravaged.The stimulus and the thought create certain pathways in the brain's neurons which become entrenched with each repetition.In order to kill this connection he needs to create new pathways.Like if you have blasphemous thoughts when you see an idol,go and see it and then tell yourself 'this God is kind,he will take care of me';or any other phrase which clicks with you.The aim is to create new associations in your mind.As these associations take root the old ones will vanish-trust me.You have to give it time and patience.Don't avoid the stimulus;give it new associations. 

It is natural to feel worthless in the face of such thoughts.Suppose you have this blasphemous thought invading your mind.Tell yourself--This is not me.I am not like this.It is not from my volition and hence i am not responsible for it.It must be the work of some quirky cells in my brain.Shoo from here.

The first time you try to supplant an inappropriate thought with a permissible one pause to appraise your state of mind.Do you feel a tad better?The thought will return,but with lesser force each time after it has been snubbed.Your sense of well being after each such episode will be motivation enough for you to keep at it until you are totally free of this pest.

Whenever you are troubled by an obsessive thought shift your focus to something you enjoy doing.

Some people write down that thought and throw it in a dust bin.They say it works.

Observe your behavior to understand what starts you off on the obsessive path--beware of those triggers so that you can control your response.

Compulsive actions are harder to overcome.The best course of action here is exposure followed by response prevention.Opt for gradual exposure if you dread touching door handles at public places like Cameron Diaz and must wash your hands fifty times after that.Go to a public place,grasp the door handle with a tissue paper and throw it away.When you go home and feel like washing your hands tell yourself--i did not touch the handle,i do not need to wash my hands.There will be a lot of uneasiness in the beginning but control this urge if you really want to get better.After you have desisted from giving in to your urge for fifteen minutes introspect and you will feel that the anxiety is slightly less than it was before.

Once you have adapted to opening doors with a tissue do it with a kerchief this time and throw it for washing.The discomfort will be great but your determination every time has to be a notch higher than the compulsion.Gradually you can go on to opening doors with your hands.

There is no doubt that OCD is a terrible condition to be afflicted with but it need not rule out a productive life.If total remission does not happen,the symptoms can be reduced by 60-80 %--this probably refers to those  patients who refuse to go ahead with CBT.One out of four patients belong to this category.It is just a disease like any other and one should not be ashamed of it.Many celebrities suffer from this disorder but they are living a normal life.But it is best to contact a Mental Health Professional as soon as one feels that things have gone beyond his/her control.

Images courtesy google.

# Fears and Phobias

Fear is an instinctive reaction to potential danger.It saves us from mishaps by stimulating us to either fight the danger or flee from there.When a child is born it has only two fears-that of loud noises and another of being dropped.But as we grow up we face precarious situations or painful experiences which instill in our minds,fears related to those episodes.These are normal,rational fears which are helpful to some extent and can easily be sidelined or overcome.
Origin of Fears
Faulty upbringing gives a very bad start to a child.If it is subjected to abuse,cruelty,hostility or neglect, it could grow up to be timid and fearful of the elements associated with it's negative experiences.Like,if it was confined to closed rooms as a form of punishment,it could develop a fear of enclosed spaces.

Some fears are learned by copying others.Children are quick to catch on to what their elders do.For example if a child sees his parent or any close relative afraid of road traffic,he too may imbibe this fear & dread crossing roads or driving a vehicle as he grows up.

Social conditioning is responsible for the fears which we as a group entertain--like the breaking of glass,spilling salt or a black cat crossing out path as being unlucky.A chance misfortune following such an incident accentuates that fear.

Low self esteem too,exposes a person to many fears.Any activity which he thinks is dangerous for him,beyond his capability,or which will project him in poor light;becomes an object to be feared-like public speaking for example,or participating in competitions,or confronting anyone.

Sometimes a trauma or one negative experience is enough to instill a lifelong fear of that particular stimulus-like a dog bite,an accident or a rough flight.

If someone has been through a lot of stress,life-threatening situations or painful events in a short span of time;he could lose control of his emotions--becoming weak & vulnerable.Clinging to rational as well as irrational fears is a possible outcome.He may believe that if he avoids certain objects or situations he will be safe.
Take the case of Mohan.He had a terrible accident with a truck on a highway on a Saturday.It resulted in him fearing highways,trucks,Saturdays and even the purpose for which he was going on that on road---labeling it as ominous.

Phobias
Most people have an odd fear tucked into their minds which is rational and easy to ignore.But Phobias belong to a different category.They are illogical,intense and persistent.They generate severe anxiety and interfere with normal functioning of life.Many people who suffer from them are forced to make drastic changes in their lives because they cannot tolerate the anxiety generated by these fears.They realize that their fears are irrational and disproportionate to the stimulus but are unable to overcome them.

They avoid the phobic object,this gives relief,and any hint of that same stimulus in future is followed by abrupt withdrawal.Thus this behavior is reinforced.What's more,the fear generalizes to encompass many other stimuli. As they go on capitulating to these fears they become more & more entrenched.This sequence of exposure>fear>withdrawal establishes a kind of circuit in the brain and the whole process becomes automatic.That is why it becomes difficult to relinquish phobias as time goes by.

The diagnostic criteria for Phobia are available at this site.

Now for the good news.Anyone who wants to get rid of his phobias can take heart from the fact that since this is learned behavior,it can easily (well not so easily) be unlearned.

Breaking Free

*Understand your Phobias

First and foremost,phobias are common and treatable.Many people suffer from them but they don't let it show.Think back to the origin of your fear and why you succumbed to it. Aren't you maximizing the danger and minimizing your powers?

*Believe in Yourself

Being afraid of something does not make you weak or crazy.You can get rid of it through self help-which should be your first option.The only condition is you will have to be brave and committed.

*Gradual Safe Exposure
Facing a phobia is not easy,it has to be done gradually.Break it into smaller parts and tackle the easiest,the least scary segment first.

Going back to Mohan,he could start with the Saturdays.He should recall how many Saturdays he has lived safely through.Then recollect the good things which happened on a Saturday.If he has been confining himself to his room on this day then he could venture out and attempt ordinary tasks initially to convince himself that Saturdays are not so ominous after all. 

The highway next.He can sit at a safe place beside a highway and watch trucks whizzing past,without crashing into anyone.By and by,he will feel more comfortable watching them going on the road.
When he is convinced that all trucks are not devils on wheels and what happened to him was a rare chance,he can go on to the next step.

Perhaps he is still fearful of driving a vehicle.He can ask a trusted friend to drive him down a deserted road.When he is fully comfortable riding pillion,he can himself drive a vehicle accompanied by his friend if he likes.Slowly he should graduate to solo driving and increased traffic.

The scariest part--that of driving on a highway,should be attempted only when he feels equal to it.The important thing is-there should be no coercion.Each new step should be taken only when he is fully confident that he can do it.

Of course this is not easy--there will be tension,palpitations and sweating.But think of the good that is going to come out of it.

*Relaxation Techniques

Because this whole process is stressful,one needs to practice relaxation techniques alongside the steps delineated above. Meditation and Pranayam are excellent for soothing the nerves and stilling the mind.They endow peace and positivity.

There is nothing like shavasana for giving rest to a tired body and relaxing tense muscles.Try it.

Initially all these efforts will look like an uphill task but once the pattern of reacting to a phobic situation is broken and the brain has adjusted accordingly,there will be no more fears.You will be much happier than you have been ever since the phobia got you in it's clutches.Remember:---

Image courtesy google.