CN: OCD, COVID
This is probably the most personal blog post I’ve ever written.
I had a test for COVID on Wednesday. I was experiencing a pretty scary lack of taste, and there were test slots free that afternoon, so I thought I’d book one. I thought the results would come back pretty quickly (the stats I’d seen suggested over 97% of people got them the next day), and I was fairly certain I didn’t have anything, for reasons I’ll go into later. So I was planning for today’s post to be a light-hearted look at what it was like to visit a test centre, to encourage people to go and get tests if they have symptoms.
I’m not really feeling like writing a light-hearted post at the moment. Maybe I’ll do that one someday, perhaps even next week if the mood takes me. But the situation I’m in at the moment is that my test appears to have got lost, or at least heavily delayed, and it seems the results have vanished into the ether. So I’m self-isolating for ten days, as required. And this has affected my mental health more than I thought it would.
So I wanted to talk a bit about how COVID-19 and the restrictions around it interact with OCD. The usual disclaimers when talking about mental health apply: this is my experience, and not anyone else’s. But I suspect this particular aspect isn’t unique to me, and yet it’s the sort that doesn’t get reported in the media, even when talking about OCD during a pandemic.
Let’s start at the beginning, with the question of what OCD is. Because when your average person without the condition says “I’m a bit OCD”, they usually mean they like things to be neat and tidy. If this were what OCD was, it would be safe to say that I didn’t have it—the look of horror on my mum’s face after my first term at uni, upon seeing my room and specifically how much rubbish was on the floor, is something that is permanently etched into my memory. (Of course, this kind of OCD also doesn’t have very much to do with a viral disease, unless sufferers were upset that the vision’s protein spikes weren’t perfectly symmetrical.)
More clued-in people (I’m thinking of that meme with the expanding brain here) understand that OCD is often about germs, or cleanliness, and fear of infection, as well as maybe the tidiness thing too. They think of hand-washing as a typical compulsion associated with the disorder. So we’re allowing a broader spectrum of possible anxieties here, and we can now see how disease anxiety can relate to OCD. This, indeed, is how the media reporting I’ve seen about OCD recently has characterised it: the fact that, for many people, the increased hand-washing we’ve been asked to do is exactly what they’ve been trying not to do for years, and how this can be hard for people to manage.
But this still isn’t a full picture. Let’s go back to the name: “obsessive-compulsive disorder”. The name, really, tells you what OCD is: it’s a disorder characterised by obsessions and compulsions. The obsessions are typically intrusive thoughts that the patient with OCD latches onto, and thinks about (and there really isn’t a better word) obsessively. Their response to this is to carry out one or more compulsive behaviours, which are “traditionally” physical behaviours, which may or may not have a particular connection to the obsessive thought. Mine tend to be prima facie reasonable behaviours that are blown out of proportion—for instance, as OCD presented when I was 16, the behaviour was washing my hands too often and for too long in response to having touched a perceived contaminant. For other people, the compulsions can seem unrelated to an outside observer—for instance, to quote the example played for laughs in Friends, “I need to flip the light switch on and off 17 times before I leave a room or my family will die”.
Sometimes, I should say, the compulsions are mental behaviours—just as going back to your house to check that you didn’t leave the iron on (to use the equally “humorous” example from The Catherine Tate Show) is an example of a compulsion, so would be mentally reviewing events to “make sure” the iron was off. This form is sometimes known as “Pure O”, but it takes essentially the same form. (The musician George Ezra—the one who sings about Budapest in a really deep voice—recently spoke to the BBC about it.) In all cases, the compulsions are behaviours that provide short-term relief from the obsession, but also serve to justify that the obsession really was something worth worrying about, thus making it stronger the next time the intrusive thought pops into the sufferer’s head.
The typical treatment for OCD is something called “exposure and response prevention”, or ERP. Again, it’s fairly self-explanatory—one creates a situation which causes the intrusive thought (or one waits for one to occur naturally), and then doesn’t carry out the compulsion. This causes short-term anxiety, of course, but that eventually fades, and this trains the brain not to over-react to the initial intrusive thought. At least, that’s the theory.
Some things, however, are harder to perform the RP bit of ERP on than others, which leads me on to the aspect of COVID and OCD that I think is under-appreciated. See, the other thing COVID brings, along with risk of infection, is a set of complex government-imposed rules that we are all supposed to follow. And, boy, does the OCD part of my brain like rules. (And I’m not saying this doesn’t have its positives—while we’re talking about the dark side of it here, the light side is that I’m fairly good at writing watertight regulations when the occasion calls for it. That is to say, I can cast my writing of student society constitutions as an act not unlike the heroism of Luke Skywalker.)
Let’s take a non-COVID example for a second, to illustrate the point, and discuss what one would do in more normal times. A little-known fact is that, until 2014, it was illegal in the UK to rip CDs to iTunes or similar, even if you owned the CD and didn’t distribute it anywhere—and, in fact, this was actually outlawed again in 2015 by the High Court, something which the Government has presumably been too busy since then to fix. Anyway, apart from the fact that nobody owns CDs any more, this is a law that is ignored by almost everybody, without consequence—and yet, until it was legalised, I refused to partake in the practice, because I didn’t want to break the law. Most people would, I think, agree that this is an OCD-type behaviour, and that the ERP treatment for it would simply be to rip a CD and watch as nothing whatsoever happened. Possibly extremely stressful for the sufferer, but still an obvious and effective solution.
Back to the problem of right now. As I mentioned, I don’t think I have COVID. Shortly after my test, I realised that the lack of taste was probably caused by the mouth ulcer cream I’d been using (Iglu, by the way, which I highly recommend); and indeed the sense had come back by the time we got home from the test site, whereas most people with lack of taste as a coronavirus have it last for days, if not months. In addition, I hadn’t had any social contact with anyone for weeks—except that I did the day before the test, as it happens. But then my own symptom would have developed in under 24 hours, which is less time than even lower bounds on the incubation period of the virus. This is all to say: if I’d waited an hour or two before booking a test, I might have just concluded that it wasn’t a spontaneous lack of taste, but one with an identifiable cause, and gone on my merry way. I suspect this would have been many people’s behaviour.
But the rules, of course, say that however mild your symptoms are, you should book a test, so I did. And now, of course, I have to self-isolate, because I have no test result. Again, in some people’s case, if they realised after the test was that they hadn’t really had COVID symptoms, they might decide that any positive result from a test would be a false positive one, especially if they’d hardly interacted with anyone—so they’d just go back to life as (new) normal. But my brain won’t let me do that, at least not without a lot of anguish.
See, what OCD does is distort my sense of how socially acceptable it is to bend rules, and also my judgement about how many other people are doing just that. When I’ve written “many people’s behaviour” and “for some people” above, what exactly does that mean? From conversations I’ve had, I’m pretty sure most people aren’t following all the COVID rules strictly or the letter. But I don’t know anyone who’s been in my exact situation. How do I know what most of them would do, without asking them all? And if I ask them all, how do I know that’s not a biased sample of the population?
To put this back into the schema of obsessions and compulsions, the obsessive thought here is “if I don’t follow these rules strictly, people might die”. And the compulsions are to follow the rules strictly, and before even that to look up the rules to make sure that I am following them strictly, and so on. In the ERP method, as with the CD ripping above, the “response prevention” is simple: do something that’s not strictly allowed under the rules. And here we have the problem.
Because, from a societal point of view, the problem is that not enough people are following the rules strictly enough, which is causing the sorts of outbreaks we’ve seen in the north-west, in Aberdeen, and doubtless in more places too. And, indeed, if I tell people that I’ve decided to self-isolate for ten days because I had a test that got lost, I often get applauded for being sensible and civic-minded. Maybe that’s what you thought when you read this. But of course this tells the OCD that I’m doing the right thing. And it can lead to escalations into not doing things that are clearly legal, just in case. For instance, during the full national lockdown, I wondered if it was technically legal to take our rubbish to the communal bins, given that that involved leaving the house without one of the listed “reasonable excuses”. Of course, that would be silly, but it didn’t stop me not wanting to be to the one to take the bins out.
As I said, I don’t think this aspect has been reported much. It’s understandable why: the rules are complex enough as it is, and getting people to follow them is hard enough, without muddying the waters with essays like this one about how, for some people, the problem is that they’re trying too hard to follow them. I trust my readers, especially those without OCD, not to read this and take it as an excuse to stop following the rules. COVID control matters. But so, of course, does mental health, and writing this has been cathartic—so if someone does take it as an excuse to start licking people’s eyeballs, I hope you’ll forgive me.
And I don’t have any solutions here. Partly, this post was just a chance to vent, as well as maybe to educate a little—and perhaps if someone reading this identifies with it, that would be a good outcome too. If anyone does have anything to add, feel free to add it in the comments. But maybe don’t tell me how good I’m being at stopping the spread by self-isolating: my brain is telling me that enough already.
PS If you’re wondering what on earth the header image has to do with this post, I can explain—sort of. As with all the posts I do where I haven’t taken any photos of a place, I got the picture from my favourite free stock photo website, Pixabay, which I’ve blogged about before. When I typed in “ocd” to the search box, it was one of three results, tagged with “head has ocd”. Go figure.
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