If you find yourself checking and re-checking whether the front door is locked, sweeping and re-sweeping an already clean floor or if you have a strong urge to perform certain rituals repeatedly, then your obsession might be out of control.

Obsession out of hand

Take the case of Raju, a software engineer from Bangalore. He is scrupulous about hygiene. To make sure that his environment is clean, he uses a cleansing swipe each time he touches the elevator button, cleans his keyboard by rubbing alcohol and a micro-fibre cloth every hour, washes his hands every 30 minutes with antiseptic soap and vacuums his seat four times a day. He gets his car washed twice a day with an extra-deep cleaning wash on the weekends at the local car care centre. His parents tried in vain to talk him out of his fixation for hygiene. They thought marriage would change him and so got him married. His wife was shocked on their wedding night when he asked her to bathe thrice in hot water with antiseptic soap. He forced his wife to do the household chores with unrealistic hygiene standards. Predictably, four months into marriage she packed her bags and left.

On the professional front, one unfortunate day he ran out of swipes. In a fit of rage he flung his laptop out of his office window. Regrettably, Raju refuses to get help.

Types of OCD

Do you know someone like Raju? If so, this person might have an anxiety-based disorder called Obsessive Compulsive Disorder [OCD]. People suffering from OCD are preoccupied with a topic, an idea or even a person. ‘Obsessions’ are recurrent and persist in the form of thoughts, impulse, or images at various time intervals. These are triggered by inappropriate stimuli that cause heightened distress. These recurring thoughts, impulses or images are not simply excessive worries about real-life problems, and they will not just go away; besides, they are severe enough to debilitate someone. The person even recognises that these thoughts, impulses or images are a figment of their mind.

OCD can manifest at any age. It usually appears between the ages of eight to 12 or during late teens and early adulthood. The exact cause for OCD is not known.

The most common types of obsessions are:

• Fear of contamination: The worry is that something which is contaminated may cause illness and ultimately death to oneself or a loved one. Such people could brush their teeth excessively due to fear of leaving a minuscule amount of germs and therefore getting mouth disease; or they might clean their kitchen and bathroom repeatedly due to the fear of germs being spread to family.
• Fear of causing harm: The anxiety in this case is of carrying out violent acts against loved ones or others. Obsessive thoughts include violently harming children or loved ones using sharp objects like knives or causing self-harm by jumping in front of a train or a fast-moving bus. While these people might not display ritualistic behaviour, they repeatedly go through the day’s events to check if they have done something to cause harm.
• Excessive concern with symmetry: People with this obsessive fear do anything to ensure everything feels ‘just right’ to prevent discomfort. They have everything neat and in place at all times. For instance, they might have their canned food facing forward or have their clothes hanging in order of colour.
• Unwanted thoughts related to religious beliefs: These people believe that their sins will never be forgiven by God and they will go to hell. To avoid this, they touch or kiss religious objects repeatedly. They also fear becoming a paedophile or a homosexual.
• Excessive accumulation of generic things: Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They might, for example, collect woollen clothes and cartons.

How to treat OCD

Despite the perils of a disorder like obsession, help is available. With treatment and a good support system, you can break free of the unwanted thoughts and irrational urges and take back control of life. The following strategies can be used:

• Psychological intervention or psychotherapy
  Behaviour therapy has a lot to offer to individuals with this disorder. Systematic desensitisation techniques involve gradually exposing the patient to ever-increasing anxiety-provoking stimuli.
  Cognitive-behavioural therapy, which may have some effectiveness for people who suffer from OCD include saturation and thought-stopping. Through saturation, the patient is directed to do nothing but think of one obsessive thought, which worries them. After concentrating on this one thought for a number of days, the obsession can lose some of its strength. Through thought-stopping, the individual learns how to halt obsessive thoughts by identifying the thoughts and then averting it by doing an opposite, incompatible response.
• Medications
  Certain medication has proven to be effective in combating this disorder. However precaution must be taken to prevent an overdose.
• Social support
  Active participation by friends or family in the recovery of an OCD patient is essential. Family members and friends can help by ensuring that medication is taken at the appropriate time, attending follow-up sessions with the patient’s therapist to monitor progress and providing constant motivation at each stage.

Overcoming OCD

In another true story, Radha, a 35-year-old entrepreneur, married with seven-year-old twins was diagnosed with OCD. Prior to being diagnosed, she ran a thriving chain of designer boutiques. Unfortunately her personal and professional life was hanging by a thread.

Radha was obsessed with perfection. She wanted all the clothes in her boutique to be crease free and arranged symmetrically at all times. Employees had to be impeccably dressed and cash in the registers had to arranged denomination-wise. The display lights, carpets and windows had to be cleaned till they shone. She would fire employees instantly if they didn’t comply with her norms. At home, her kids were petrified of her. She would beat them up mercilessly if they left their toys strewn on the floor. She expected them to arrange their school books according to colour or height. She would even hit her husband if he didn’t place his shoes, laptop, clothes and other items in their allocated places.

As things started to get worse, her husband, with the help of her parents, arranged for her to visit a clinical psychologist. But with a lot of support from her family, she met a psychiatrist and a psychologist. Her psychiatrist started her on medication. Her family asked her employees to monitor whether she was taking her medications on time and also requested them to act normal and not to treat her as an ill person. Her siblings made sure she went for her psychotherapy sessions. Her friends would speak to her every week to motivate her on her progress. In a couple of months she began to change; the change was gradual but positive.

Today, Radha is back to being the loving wife, doting mother, happy employer and OCD-free person that she used to be.

All of us have a few harmless obsessions. It’s only when these spin beyond our control and get into endless loops of behaviours that it can be labelled as OCD. Anyone can get OCD irrespective of age, gender, education or socio-economic status.

People who have OCD are suffering and need to be encouraged to seek professional help so that their obsession can be brought under control.

This was first published in the March 2015 issue of Complete Wellbeing.

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Multiple sclerosis [MS] is an autoimmune disease in which the body’s immune system attacks the central nervous system. While there is no known medical cure for MS, there are several treatments that can relieve symptoms and slow down the progression of this disease.

Causes and prevalence

Since the discovery of MS in the 19^th century, medical science has come a long way in terms of understanding why the disease occurs, its diagnosis and most importantly, its treatment.

The nerve cells in our brain send messages to the rest of our body. Each of these nerve cells has a protective cover called the myelin sheath. In MS, the body’s immune system attacks this protective covering. This disrupts the communication between the brain and the rest of the body resulting in a wide range of physical, mental, and even psychiatric symptoms.

Until a few decades ago, Indians were thought to be protected from this disorder as compared to their western counterparts. However, as the number and reach of neurologists have increased and with the aid of widespread MRI availability, more and more people with this disorder are now being diagnosed. This has raised the prevalence, especially in the cities, to around 3 – 5 cases per/lakh population. Surprisingly, this is still lower than the prevalence in some areas of northern Europe where almost 100/lakh suffer from this disease.

What is the reason for this selective affliction? This has been a topic of much scientific debate and the focus of several studies. It is now known that the disease is more common in countries farther from the equator. Certain other genetic factors that are beyond the realm of routine clinical testing may also be contributory. Also, MS is known to be more common in women, perhaps because they are more susceptible to autoimmune conditions in general.

Symptoms and diagnosis

The onset of this disease is usually gradual, cryptic and can mimic a host of other ailments, sometimes delaying the diagnosis for years together. Nonspecific symptoms like tiredness, tingling numbness, blurring of vision, giddiness can be challenging to interpret, but more specific symptoms such as the sudden inability to see with one eye, sudden imbalance to one side, paralysis of one side of body, sudden weakness in both legs or urinary bladder symptoms, especially in the age group between 15 – 25 years alerts the neurologist to suspect multiple sclerosis.

Just as with other neurological problems, there is no single ‘test’ to confirm multiple sclerosis; however, with the help of a combination of patient history, clinical exam, MRI imaging and spinal fluid testing, a diagnosis of MS can be reasonably made. Of these tests, MRI is especially important and indispensable to diagnose and quantify MS. Sometimes other eye tests like a VEP [visual evoked potential] study are also required.

After the diagnosis

A diagnosis of MS can be a bolt from the blue for the patient as usually the individual is in the prime of his life and the disease can have immense social, psychological and financial implications. MS doesn’t just affect the individual; it also affects their entire family. A patient usually goes through various stages of denial, anger, depression; but with family support, counselling by the doctor and self resolve, acceptance is possible.

Treatment options and costs

The basic treatment of MS is to prevent relapses or attacks, which if not prevented, can lead to permanent disability over a period of 15 to 20 years and can make the individual wheelchair bound with the need for assistance for day-to-day activities.

The treatment for MS is three pronged: disease modifying treatment, acute attack treatment and supportive treatment. Among these, the most important are medicines known as disease modifying therapies, which are small insulin-like injections taken on a weekly or daily basis for at least a year or two. These injections are patented medicines and the average cost per month is  INR 30,000 – 40,000. The neurologist helps the patient to decide which medicine to choose depending on the side effects, which are usually manageable with simple oral medicines.

In the last decade or so, stronger and apparently more effective disease modifying therapies have been invented, which are reserved for second-line treatment as they are more expensive [approximately INR 80,000 per month] and have potentially more side effects.

Smoking, lack of exercise, vitamin D deficiency and exposure to hot environments is known to increase the risk of a relapse. As the disease affects all the spheres of one’s life—profession, family, even sexual health—depression is common. It is for these unrecognised outcomes of the disease that doctors usually enlist the help of family, friends and self-help groups in maintaining a positive outlook towards the disease.

With the help of the right treatment, regular aerobic exercises, a positive outlook and supportive treatment, the battle against MS can be won and a person with the ailment can lead as normal a life as anybody.

This was first published in the February 2015 issue of Complete Wellbeing.

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The placebo effect is a phenomenon where your symptoms can be reduced or got rid of, by an otherwise ineffective treatment, because you believe or expect that the treatment will work. Placebos are usually inert substances [like sugar or chalk] which by themselves have no medicinal action on the human body. But if your doctor tells you that these are real and effective medicines, which can cure you of your disease, and if you truly believe this, then they may actually work for you. This phenomenon cannot be explained on scientific terms, because the substance being administered is chemically inert and incapable of producing any effects. Such a substance, when given to others, does not produce the same effect, unlike a medicine such as aspirin or paracetamol, which will uniformly reduce fever and pain in anyone it is given to.

It has been postulated that when a person believes strongly that he will be healed by something, his own subconscious mind comes into action and cures him of the disease. Another explanation frequently given for a placebo effect is that the patient’s symptoms were psychological to start with, that the patient did not have any real disease as such, and hence when the patient was satisfied that he was getting treatment, he improved.

The commonest example for the nocebo effect is when a person bitten by a non-poisonous snake dies, because he believed the snake was poisonous

A nocebo, on the other hand, is again an inactive substance, which is not supposed to produce any effects or side effects. But again, due to the patients’ mindset or belief, even this inert substance when administered causes a lot of unwanted side effects. This effect too cannot be explained scientifically or duplicated. But because the patient is under the false belief that the substance being administered is some harmful chemical, his subconscious mind is activated and forces the body systems to react and produce symptoms. The commonest example for the nocebo effect is when a person bitten by a non-poisonous snake dies, because he believed the snake was poisonous. Technically, the snake has no venom and the bitten person should not die, but due to his belief in general that snake bites are poisonous and lethal, his body goes into a severe shock like response and he dies.

A remedy for anxious patients

The placebo effect is a handy tool for a doctor, when dealing with a hypochondriac patient. Every once in a while, doctors encounter patients who are attention seeking and though they do not have any real sickness, they imagine themselves to be sick. Such individuals often hop from one clinic to another, and do not accept the diagnosis that there nothing is wrong with them. They even go to the extent of subjecting themselves to expensive and extensive medical tests, and are often unhappy when told by the doctors that all their reports are normal. In such cases, many experienced doctors resort to giving such patients some harmless pills, usually sugar pills, and tell them that they will be fine when they finish the course. The patients are happy that their illness has been acknowledged. They willingly take the medicine, and since they believe that they are sick, they also equally willingly believe that they will be cured. And surprisingly, their symptoms do disappear with a placebo treatment.

Both placebos and nocebos ultimately produce their desirable or undesirable effects solely because the patient believes that they will. For instance, many have a mindset that allopathic drugs, mainly antibiotics, are harmful and that they must be avoided at all costs. If, by chance, such a person was forced to take these medicines for an illness, it is likely that due to his strong beliefs and conditioning, he will react with many side effects. If any patient is exhibiting side effects which are not normally known with a drug, a doctor could suspect a nocebo effect and must have a detailed discussion with the patient on his belief systems.

Spontaneous cures

Many magical healings and cures are reported to occur all over the world, either due to faith in a deity or due to a person who is a healer. In all these cases, it is likely that the healing happened because the person believed that he will be cured. The brain is connected to each and every cell and organ of the body with nerves and hormones. Once a particular belief or faith becomes imprinted on the mind, it can act through these nerves and hormones and produce the necessary effects. Placebos and nocebos work in the same way. Since placebos and nocebos work because of complete belief and faith, once the person being administered these substances knows that these are inert things, it is highly unlikely that they will produce any effect. The value of a placebo remains only as long as the patient does not know what it is, and actually believes the doctor and the substance to be true and powerful enough to cure him. The biggest advantage of the placebo in medicine is that, since they are inert substances, and are usually inexpensive and harmless, they can be used to cure a whole lot of diseases which originate in a person’s psyche. If the doctor is experienced and if the patient has 100 per cent faith in the doctor, this relationship can be positively exploited by the doctor to cure the patient using placebos.

Every doctor who has been practising for a few years will have a story to tell about the placebo and nocebo effect

There are many interesting examples of both the placebo and the nocebo effect in the history of medicine. Every doctor who has been practising for a few years will have a story to tell. When it was first discovered that germs are the cause of infections, many doctors did not believe this theory. It is reported that at a scientific gathering early in the nineteenth century, where it was being proposed that germs caused infections, the speaker had brought with him a glass of water contaminated with cholera germs. One doctor, who did not believe that germs existed, drank the entire glass of water. As a result of his strong belief, he never got cholera, although the water was filled with the germs. In another instance, a person was diagnosed with lung cancer. It was at an early stage, and with proper chemotherapy, he was cured. His doctors told him that he was lucky and that he need not worry, as his disease had been eradicated. But he did not believe them, as he always knew that cancer is a fatal disease. He continued with the belief that the disease would spread and eventually kill him. Six months later, he died. When the doctors did an autopsy of his body, they did not find a single cancerous cell, or any other disease that could account for his death. He had died because he believed he would die. These examples give a clear idea how placebos and nocebos work in human beings.

Experts who practise mind-body medicine firmly believe that all diseases start in the mind. When the mind is in disorder, with the help of the nervous and endocrine system, it transfers this disorder to the cells and tissues of the body, thereby producing disease. All mind body healing works like a placebo, by changing our beliefs and by raising our faith in ourselves and in the ability of our subconscious mind to cure itself and the body. If you believe something will benefit you, it will. If you believe something will harm you, it will and it does.

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