Monthly Archives: January 2018

OCD – A Devised Theater Piece

Tap. One two three four five six seven eight nine ten.
Tap. One two three four five six seven eight nine ten.
Goodnight Papa. Papa goodnight. Papa goodnight. Goodnight Papa.
Papa goodnight. Goodnight Papa. Goodnight Papa. Papa goodnight.

No, no, no. Not right! Mama is going to die. Mama is going to die.
Again, Again, Again. From the start.

I went to see a performance on OCD last night. It was great, filled with tears and laughter, anxiety and tension, very much. I can’t help thinking about many OCD clients I have seen in my clinical work, especially those that I’m still seeing this week, and some earlier on. They are living in this every, single, day, and, night.

The actors have done very well, sharply and vividly demonstrated the intense emotion felt by OCD sufferers. I highly recommend anyone who doesn’t really understand OCD to see it, especially those who think “I’m just a bit OCD” to see it. Check if the tickets are available here.

Before I went, I even thought about inviting my clients to see it. Now I’m really wondering for those who have been suffering from it for more than 5-6 years, how they would feel when they see this…

A few things that I want to point out regarding OCD, which are nicely and clearly presented in this performance…

  • It is always about “making sure”. They can’t tolerate uncertainty. Yet in this world, there is no such thing as 100% sure.
  • It’s always about “feeling right”. The comfortable, right feeling is what they are seeking. They can’t tolerate discomfort, that leads to anxiety and fear, so much anxiety and fear that are unbearable.
  • Quite often the sufferers find their own thought (obsession) and behaviour (compulsion) are ridiculous too, but they still can’t help it. It’s not about reasoning on an intellectual level, but it’s the psychological and emotion impacts on them.
  • It can be highly disrupting to the sufferer’s life, and more, to their immediate family.

Things that I want to add…

  • The best psychological intervention is “Exposure Response Prevention” (it’s a very straightforward treatment, refer here)
  • But before the treatment begins, a lot of preparation has to be done, being motivated enough to tolerate the discomfort when one is not allowed to perform the rituals.
  • Seek help as soon as you can. Many patients that we see, came to us around 3-5 years after some initial signs showed. By the time they were here, the disorder is rather aggressive and disabling, and surely, difficult to treat.
  • If you can overcome your longstanding OCD, you can overcome anything. This is what I think. And I sincerely believe it.

Positive Symptoms of Schizophrenia: A Patient’s View

She was referred to me by a consultant psychiatrist, diagnosed as schizophrenia, and taking some medication for the past few years. She is compliant with the medication, even though the medication makes her struggle to wake up every morning. She has a job. She completed a degree few years ago, and has been able to hold her job most of the years despite her illness.

I remember during our first session we talked quite a lot about the symptoms of schizophrenia. She used to have paranoid delusion (suspecting that a fellow friend from the uni is following her and trying to do her harm etc), but now has only auditory hallucination (hearing voices of the ex-coursemate).

The consultant psychiatrist and I always thought that she had good insights into her symptoms and illness. Until it was the 4th session, she disclosed that she never thought she had any illness. Why was she taking the medicine? Because it helps her emotionally, feel calmer. I suddenly realised that it was true in her case, because her antipsychotic drugs have never reduced/ceased her voices.

Sometimes it seems that the voice is like a friend to her. We have discussed that if there is no way to remove the voices right now, how she can live with the voices, and she seems ok with it (sometimes). But after more discussion, I realised that her problems with this voice is because the voice broadcasts her thoughts. She always thinks that others can read her mind, and it’s due to this voice. She can live with this voice if there is no way to get rid of it, but she can’t live with this voice telling everyone else her thoughts…… (she gave quite some good examples of others knowing her thoughts and responding accordingly, and she thinks all these were too much a coincidence).

She believes that the voice in the mind is machinery operated, and this machine is controlled by the ex-coursemate. Once during a breakdown, she even went to confront the person, and the person denied having done that to her. Now when she’s relatively well, she thinks there is no point to confront the person, because the ex-coursemate would surely deny (and she wouldn’t believe that).

From the Psychology’s perspective, both delusion and hallucination are common positive symptoms of schizophrenia. They also tend to happen together.

From the client’s perspective, it’s more complicated than that. Because she doesn’t think they are two separate symptoms of an illness. They are one thing, the voice (hallucination) broadcast her thought (mind being read – delusion).

I surely didn’t attempt to argue with or convince her that it was just her illness. I’m not being irresponsible or denying my job and role as her therapist (I can and will still help her in many other ways), but consider this carefully, is there any point at all to do that in her case? (especially that she’s almost fully functional and is taking her medicine regularly and attending therapy session monthly). After all, who knows she might be right and I might be wrong? Who says everything I learnt in my degrees must be right when the so-call anti-psychotics are not ceasing/reducing her positive symptoms? Who is the expert in one’s illness?

 

Additional knowledge:

Positive symptoms of schizophrenia: Delusion, Hallucination, Racing thoughts

Negative symptoms of schizophrenia: apathy, lack of emotion, poor or non-existent social functioning

Cognitive symptoms of schizophrenia: disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems

Peeping Tom on social medias

No matter how much we study, learn, read, practice (see clients), we barely feel what we learnt is enough. As the world advances, as new technology becomes common, new psychological problems appear too.

They were married last year after being in courtship for 5 years. It all seems fine, their marriage, their relationships, their marriage, their families, their sex lives. Until half a year ago, she realised that her husband was peeping the lady living next door, a married woman with two children. The husband would use every opportunity to peek at her, apparently after understanding her routine, like when she’d be hanging clothes at the balcony, when she’d leave home for work etc. Sometimes they are having meals, the husband notices the timing that the neighbour is coming home, he’d go upstairs to peek. This is his current status.

Previously he has been peeping her on social medias. He searched for her and followed her online, few times a day, he would visit her page just to look at her posts and activities. She is not the only target, according to the wife, he also peeks at a few other women, all beautiful ladies, including the wife’s colleague, a lady that works in the same building with him, . He doesn’t chat with them, but only “watching” them online, few times a day.

Initially he denied it when the wife confronted him. But when all the evidence is showing up, he admitted that he has always had this fetish, for a long time, before they even met each other. But he said he loves her, he only peek at them, he doesn’t and wouldn’t do anything else. He promised to change, but was soon caught by wife to be doing it again, and again.

The wife is confused. What problem does he have? Personality problems? A hidden bad habit? Psychological disorders? OCD? Sexual disorder? She searched through the internet trying to figure it out. But there laid no answer.

Indeed, it surely is an unhealthy behaviour peeping into other’s lives (through social medias) few times a day, every day. So undeniably it’s a psychology disorder, one that’s appearing following technology advancement, as when facebook wasn’t available we can’t peep into one’s life the way we do now on facebook, instagram, twitter etc, right?

The closest I can get to, is Obsessive Compulsive Disorder (OCD). There is certainly compulsive behaviour that he does, though we don’t know the obsessive thought underlying these behaviour/rituals based on the wife’s description. It also does seem that, like many other OCDs, that the problem is worsening.

How does this differ from “traditional” peeping tom / voyeurism? Are they under the same category? Does doing it digitally or online make it less severe and obstructive? Should the treatment differ? How about digital or porn addiction? Aren’t they similar in some ways too?