His sister first rang us, and asked to make an appointment. When I asked what problem her brother has, she was a bit unsure whether this is the right place for him. Her brother has some unusual habits, he collects stuff, and not like others who collect toys, stamps, … he collects women’s inner wears.

He is in his 40s, grows up in a family of five siblings being the only son. He is now in his second marriage. His current wife has a 17 years old daughter from her previous marriage. This is where it really tests his self-discipline ability.

He spies others, compulsively. He can’t help it and is very frustrated by his urges  and obsession to do so. It isn’t easy for him to make the decision and have the courage to come to seek help.

More commonly people call them Peeping Tom. Here is the definition of Voyeurism in ICD-10 (International Classification of Diseases).

He also suffers when he started to take medicine, and didn’t understand the reason of taking it. The sister questioned how the medicine can help him and wondered he would ever recover. In fact, voyeurism can just be like any other Obsessive Compulsive Disorder (OCD, see my previous post), some people wash hands compulsively, some spends hours reading, some tell lies compulsively, some spy others… So then it can be treated like OCD!

For me all voyeurism is pathological, but I’m just wondering whether it can be voluntary? So, someone can quit being a voyeur by own will maybe?

He is a very intelligent man, was sent to Canada for studies, till a psychotic breakdown which he had to discontinue his studies and return home.

He became very obsessed with continuing his studies. He wanted his family to send him back there, demanding his father, brother and sister to pay him there again. His psychosis was slowly masked by OCD (obsessive compulsive disorder). It took him a long time to stop thinking about going back to continue his studies, but he developed other obsessions…

One with hygiene. He doesn’t touch things in the public. When he goes to public toilet, he finds way to open the door without touching the handle. When he comes to clinic, no matter how many hours he has to wait, he never takes a seat. He just stands and observes (sometimes you may want to call it “staring”).

One with reading. He spends over 6-8 hours reading his Financial Times. The reason he gave was that he spent money buying the magazine so he has to make sure he finish reading all of it and doesn’t waste it. Sometimes he couldn’t finish his reading and stays up till late night. Though most of the time he doesn’t even understand what he’s reading about.

Recent months he also starts sleep walking. And this freaks him out. He sometimes wakes up in the morning having his room door opened, sometimes the light on, and had completely no memory how these happened. If it was just sleep walking that’s better. But he also has suicidal ideation. He had tried to drink Listerine to kill himself, though it hurt his stomach so much that he had to stop, and was sent into hospital for stomach washout. So being aware of his suicidal ideation and at least one attempt in the past, he became so worried that he may kill himself in his sleep walking. And of course, his worries become so obsessional.

Despite his intelligence and being probably the smartest in the family, he keeps on tricked by his illness. His obsessions are like a protection to him, from his psychotic symptoms. When his OCD symptoms are unmasked, his psychosis will be shown. Yet it isn’t easy to treat his OCD, or should I say, to treat anyone’s OCD. Quite often they think they recover, but they “move” their target of obsession, maybe from washing hands to taking long shower, or to counting items, asking questions, …

He seems a bit secretive, not willing to talk or disclose much about himself, and was consistently looking at his phone (well, this is pretty common nowadays) when he first visited the clinic.

He is at his 30s, was divorced and is now in a new relationship. He started lying since young, and over time it became a habit, he started to lose control, and lies even when he really doesn’t have to, when he and no-one else gets any benefits from the lies. He just has to lie, he can’t help it.

At this point of his life he realised it’s problematic, he’s having frequent rows with his current girl friend (though the end of his first marriage had nothing to do with his pathological lying). The lies he’s telling is definitely affecting many aspects of his life, relationships, works, family, …

Do you think others can help him? Counselling? Psychotherapy? Medicine?

If he can come to seek help, being honest with the clinician and throughout the treatment process, then does he still need treatment? Well, he can behaves and talks honestly, why still come for treatment? If he can’t be honest, then how are we going to help him?

Perhaps for many pathological liars they don’t care about upsetting others due to their lies, but if this carries on in their lives, will they eventually start living in their little worlds, having some levels of delusions about their lives, and become paranoid, delusional, even schizophrenic …?