At the end of the day, Pandurangan’s staff pull down the shutters of his shop. One of the staff then secures them with two locks. And then, he checks them thrice. But Pandurangan tugs at the locks once again to make sure they are indeed locked. He repeats this process three times over for each lock. And he still looks uncertain. So he asks another one of his employees to check them again.
The shopkeepers in the area are familiar with Pandurangan’s strange ritual. His daughter, Pavithra, refuses to visit the shop in the evenings. “It is so embarrassing to see him at war with locks in front of spectators,” she says. The perplexing thing is that Pandurangan knows that the locks are secure. But he is plagued by a repeated doubt that they may not be so. He is aware that it is a silly thought and tries to control it — but without success.
Compulsive checking can be a sign of obsessive compulsive disorder (OCD). An ‘obsession’ is a repetitive thought, doubt, urge or image that intrudes one’s mind, in spite of resistance, a ‘compulsion’ is a repetitive action done in response to a recurrent doubt or a thought. And these obsessions can interfere considerably with a person’s personal and professional life.
When the obsession is about dirt or contamination, the person may wash himself repeatedly. Sekar, for instance, brushes his teeth for 45 minutes, followed by a three-hour-long bath. He begins by washing the tap, the bucket, the mug, the floor and the tiled walls of the bathroom. Then he starts pouring water in a particular methodical way. He soaps himself in a fixed order, starting from his left little finger. Any digression from the order, or a doubt, and he starts the entire process from the beginning. As a result, he reaches his office by noon.
Nithya had an obsessive doubt about whether she had counted her money correctly. Being a cashier in a bank, this considerably interfered with her work. A doctor had an obsessive doubt about whether he had written his prescription right. Just as his patients got up from his desk, he would stop them and ask for the prescription to check it. He did this again as the patient reached the door. “I know what kind of impression I must be making. The patient must be seriously concerned about whether he got the right prescription or not. But I am not able to control it.”
Obsessions can be of any kind. The common ones are about dirt and contamination, sex, blasphemy, safety or accuracy.
Some people have compulsions about arranging things. Aarthy spends a considerable amount of time arranging her table before she begins her tasks. The edges of the books have to be parallel to the tabletop. Pens, pencils and mobile phones should either be parallel or perpendicular to other things on the table. If they are not, she feels that something is not right and cannot concentrate on her work.
OCD occurs in about 3-4 per cent of the population. Though the symptoms are minor (compared to major psychiatric illnesses), the distress suffered is immense. Some persons with OCD develop severe secondary depression or anxiety.
The deficiency of a neurotransmitter called serotonin in the synapses of certain tracks of the brain has been found to be responsible for OCD symptoms. (A synapse is a junction between two neurons.) This can happen due to certain stressors or, in a majority of people, without any known reason.
Since the late 1980s, effective medicines for OCD have been developed. They are called SSRIs (Selective Serotonin Reuptake Inhibitors) and they increase the concentration of serotonin in the synapses. In addition, specific behaviour therapies are effective. And together, they can enhance the quality of life of those who suffer from OCD, and their families.
(Some names have been changed.)
S. Mohan Raj is a Chennai-based consultant psychiatrist.