Stepping in

This morning I was walking to a nearby hospital with my wife. I was there to offer her support, because she was nervous about having a routine test done.

We had our dog with us. The plan was that I would continue to walk the dog in the park beside the hospital, while my wife underwent the brief test.

As we neared the hospital, we heard an unusual, loud noise. It sounded like the call of a howler monkey. My wife and I both reflexively looked up into the branches of the nearby trees, then laughed because we knew we had both thought the same illogical thing. We began to wonder aloud what had made the noise. Then I noticed.

Near a low hospital building a young woman was being held by the wrists by a young man. Then she started to scream, “Get off me! Get off me! Leave me alone!”

I decided to intervene and I asked my wife to stay back and phone hospital security.

As I approached the couple, I noticed that there was quite a lot of blood on them both, but mostly on the young woman. My instant reaction, I’m embarrassed to say, because of my OCD was, “Ugh, blood! A source of human contamination!”. Thankfully, common sense thinking immediately replaced the kneejerk intrusive thought. At least one of them was injured. One or both of them could have a weapon.

They were both visibly distressed. My approach didn’t stop the young man from holding the young woman firmly by the arms. With both hands. No weapon in his hands.

I started to talk to the guy in a calm, measured tone. “I don’t know what’s happening here fella, but the lady looks upset at being held, so maybe back off a couple of feet”

“It’s not what it looks like sir. It’s not what it looks like”

“Sir” seemed an odd and unthreatening way to address me. Even so, I remained alert and cautious.

“OK, but I still want you to back off to let things calm down”

He let go of her and took a couple of steps back.

“You don’t understand. It’s not what it looks like. You don’t understand sir”

I then managed a first proper glance at the woman, while remaining vigilant near the young man. Most of the blood was on the young woman’s arms and jacket front. The blood was coming from very recent cuts on her arms. Not deep cuts, so no immediate danger of fatal blood loss. No evidence of stab wounds. Any blood on her face & jacket was transferred or spattered from her arms. I noticed extensive scarring further up the young woman’s arms. I then understood what was happening.

“Please sir, let me help her. You don’t understand, I’m trying to help her”.

The young man was very upset. Covered in blood spatter and his own tears. I scanned him for injury. He looked unharmed. Injury to him? Why would I check that? Because I had been in his situation many times with my first wife. Whenever she was self harming with a knife, she would try and slash me as I tried to take the knife off her.

Oh shit! I had my back to the woman as I remembered this. I hadn’t checked her hands for weapons! Stupid stupid bastard! I was so busy worrying about the man being the armed one. I instinctively took a step backwards into a defensive posture and scanned the young woman. No weapon, but she was very agitated and distressed.

“Are you OK?”, I asked her.

“You don’t understand man. I’ve lost my phone. I need to find my phone. I am so fucked up and anxious man. I don’t have my meds with me. I need my meds. Where’s my phone…”

She turned her back to me and started to pick through the contents of a hospital dumpster. The distraught young man, overcome with the stress of the situation, had slumped, sobbing against a low wall.

“I can’t find my phone. I need to find my phone…”

The woman was scrabbling through the discarded paper waste. She may have been looking for her phone, but I suspected that she was also looking for a sharp object to cut herself with. I didn’t touch her. I couldn’t touch her, not with so much blood on her, though I would have done so if she had tried to self harm again. I tried to start a conversation.

“So, how come you guys are so upset?”

She stopped searching and turned towards me. “You wouldn’t understand man, nobody understands”

“I think I understand”

“WHAT WOULD YOU KNOW ABOUT BEING MENTAL?” – loudly, aggressively.

I stood my ground, despite the blood spatter coming from agitated hands”

Quietly: “I do understand. I have OCD & PTSD. I’m under the care of the community mental health team. I’ve tried to die by suicide before. I understand your difficulties.”

“Oh… Oh right…” Her stance became less confrontational. Her shoulders dropped and relaxed a little. She started to talk to me in a flood. I won’t detail what she said, because it might reveal her identity. She is entitled to her anonymity. She was engaging with me; I was listening. She was still very agitated, but starting to calm down. I eventually replied.

“I understand. You are very upset. You need help…”

“WHERE CAN I GET HELP?! NOBODY WILL HELP ME!”

“We’re close to the accident and emergency department of the hospital. If I go with you, I can help you to ask for help from the crisis team. I’ve done it for myself. They’re good people. They helped me, they can help you too”

She was considering the idea. She was calming down. I glanced across at her male friend who was continuing to sit on the ground, sobbing uncontrollably. He gave me a thumbs-up sign.

At this point a police car pulled up and two young police officers, one male, one female got out. The male officer helped the young man to his feet, started to talk to him and checked if he was injured. The young woman immediately tensed again as the female officer approached. I reassured her and she relaxed a little. The policewoman was fantastic and straight away put the young woman at ease. I was no longer needed or useful.

I walked over to the young man and the male officer. The man was explaining the situation. He was still visibly upset. He was doing his very best to help his friend, to prevent her from harming herself more seriously. I felt so sorry for the guy. I gave him a hug, despite the blood all over him. I explained to the policeman that I was just a passer-by, a random guy, who had stepped in to help the young woman in distress. I recounted some of the details of what I had witnessed and suggested to the policeman that the young woman was genuinely in need of immediate crisis team intervention. I wished the young man good luck and left in order to walk my wife to her appointment.

I cried a little as I walked the dog round the park. It’s tough to see other people in distress, but I’m glad I was able to step in and in some small way help two other human beings who needed it. I was glad to see some early crocuses in flower in the sunshine. It cheered me up.

I met my wife when she finished her appointment and we started to walk back home. In the distance, the two police officers were walking with the young couple towards A&E. I wished them all a thought of good fortune.

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The third letter

Damaging

Destructive

Disruptive

Demanding

Debilitating

Disastrous

Deadly

Draining

Depressing

Demoralising

Deafening

Disruptive

Domineering

Dominating

Deceptive

Dreadful

Disorder

The “many shades of OCD” myth

There are few aspects of Obsessive Compulsive Disorder more contentious than the misuse of the term “spectrum” to describe a broad range of severity of the condition. The phrase “I’m a little OCD” will generally enrage the average person with actual diagnosed OCD, because there is no such thing as “a little OCD”. 

Mental health professionals use the term “OCD spectrum disorder” specifically to mean a medical condition, such as body dysmorphic disorder (BDD) and trichotillomania, which can be related to OCD and which can be comorbidly present with OCD. They don’t use “spectrum” to mean a continuous range of severity of OCD from very mild to debilitating. To avoid any confusion, I will use the term “range of severity” in this post. 

But some experts in OCD are starting to seriously consider the possible existence of an OCD range of severity. To be clear, it is already generally accepted that there is a narrow variation, ranging from moderate to severe. 

In my personal experience I’ve only met or talked online with people with actual OCD which falls into this range. The severity of an individual sufferer’s OCD can vary. Sometimes it can be moderate. Other times it can be more severe. For some sufferers, the severity of their OCD can vary by time of day or time of year. When first learning about other people’s OCD, this was a revelation to me. My own OCD, prior to undergoing therapy, was unwaveringly severe every waking second, unless I retreated into nature, for a brief respite. I had thought that everybody’s OCD would be exactly like mine was. 100% on, full blast, all the time. 

So I admit that I have a history of having preconceptions about what is or isn’t OCD. I am therefore treading a little more carefully towards the subject of a broader range of diagnosed severity. My gut reaction is to shout, “NO YOU ARE NOT A LITTLE BIT OCD! THERE’S NO SUCH THING!” But… what if there is a broader range of OCD suffering?

The thing which makes OCD what it is isn’t the intrusive thoughts, everybody has intrusive thoughts. It’s how a person reacts to those intrusive thoughts. A “normal” person will just think “well of course I’m not going to push somebody in front of a train”, then they move on to thinking about what to cook for dinner. A person with OCD may hold onto the thought and start to obsess that they are a potential murderer. This horrifies them, so they avoid train stations for fear that the thought will come true. It won’t come true, but that’s not what the OCD constantly whispers. 

So there already exists a dividing line between what is considered “normal” and what is considered “disordered”. Some people are suggesting that we move that dividing line to the left a bit. The diagnosis is partially achieved and quantified by completion of a questionnaire. Depending upon how highly you score, you are rated “normal” to subclinical, not requiring treatment or moderate to severe, requiring treatment. 

So what’s wrong with potentially having a broader scale of diagnosable OCD severity? Essentially it’s the problems of popular cultural misconception and subjectivity, compared to medical reality. 

There are three bits to OCD, not two. What bits? What bits am I talking about?

I’m talking about the Obsessive bit, the Compulsive bit and the Disordered bit. This is the basic distinction that the media stubbornly refuse to understand. 

Put in very basic terms, you can experience the “O” bit and the “C” bit, but without the “D” bit, it’s simply not OCD. But how can that be? Surely if you are obsessed and compelled, it must be OCD?

Not necessarily. The crucial factor isn’t what is thought or what action is done, but how that thought is reacted to, why the action is done and how much the thoughts, reactions and actions interfere with living a normal life. How much suffering is there? 

Take, for example, the media’s favourite portrayal of OCD, the cleaning compulsion. The common misconception is, “I spent a whole hour tidying the house. I’m so OCD, but a tidy house satisfies me so much”. The person has thought, “My house is untidy and is annoying me. I need to tidy it” and they then tidy it. Their house becomes tidy, they are no longer annoyed and they feel positive for having completed a dull chore. They might be obsessive about tidiness. They might be compelled to keep their house tidy. But what about the “D” bit? 

A person with OCD would typically think, “My house is untidy. I am a bad person because my house is now a hazard to people’s health, harbouring germs and risking injury through accidents. Someone could die because of my untidy house. If someone dies because my house is untidy, it will be my fault. I will have caused that person’s unnecessary death. I must tidy my house completely right now, before someone dies”. And then they tidy the house. And again. And again. And again, because they fear that even the tiniest bit of overlooked untidiness could cause death”. 

This sounds incredibly extreme to a “normal” person. People normally react to such an example with, “Wow, that must be at the really severe end of the scale”, but sadly it’s not. That is an absolutely typical example of the intrusive thought – reaction – compulsion process for an average OCD sufferer. The main variations between moderate and severe OCD are the extent to which the condition consumes a sufferer’s time, energy and focus, resulting in suffering.  
This is the “D” bit. How disordered is your life as a result of having the condition? Is the condition all consuming, exhausting, terrifying, guilt inducing, shameful, soul destroying, debilitating? It’s not called a disorder for nothing. 

There is no grey area. There is no broad range of tones of severity. If OCD is a light, it’s either on or off; there’s no infinitely adjustable dimmer switch. It is a harsh and glaring spotlight. Either your mind is in turmoil because you have the disorder or it’s not, because you don’t. There is no “little bit OCD”. No subtle mood lighting for a satisfyingly tidied house. 

What happens if the normal/disordered cutoff gets moved to the left a bit? The fear of many OCD sufferers is that it will legitimise the “little bit OCD” myth, further underplaying the true severity of the condition for most sufferers. It is already viewed popularly as a joke condition. Not a proper mental illness, but just being a bit of a fruitcake like Monica out of Friends. 

If some people are diagnosed as sufferers of an apparently less severe form of OCD, will that trivialise the condition further? Will these people be given access to treatment – medication or therapy – that they are currently denied? Will more mental health resources be made available for OCD treatment or will an already threadbare single duvet have to stretch across a now double bed? I could have a pretty good guess at the answer to that last question. 

I would hope that any professional expansion of the concept of an OCD range of severity would be as a result of earlier diagnosis of the condition after onset, to take into account the smaller amount of time that a person has been thinking and acting in an abnormally conditioned manner. Earlier diagnosis is a fantastic thing. It reduces the amount of time that a person is alone in suffering & it reduces the extent of the mental scarring inflicted by OCD. 

If the earlier stages of the transition over the threshold into the “D” bit can be diagnosed and treated sooner for more people, then I am happy to see an expansion of the severity range concept. 

A Prescription For Murder

Wow! What a title! Sounds like an Agatha Christie novel or a cheap horror movie. It’s actually the title of a BBC Panorama documentary which hypothesises a link between SSRI antidepressant medication and an increased propensity to commit violent acts. 

Is there a link? Statistically yes maybe. A very tiny percentage of people taking SSRIs experience psychosis as a side effect, but statistically more people are killed as a result of trying to put on a pair of trousers. So why is there not a documentary about trouser deaths called Leg Ends Of The Fall? I believe it is because of the manner of the respective causes of death. 

Accidental deaths caused by embarrassing wardrobe malfunctions would be uncomfortable, voyeuristic subject matter. You don’t kick a man when he’s down through no fault of his own. So what’s the difference between that and someone who’s mentally ill through no fault of their own?

It’s because violent mentally ill people are juicy subject matter. A ratings winner. The subject retains a ghoulish car crash fascination. The notion that mental illness equates to violent, dangerous derangement is deeply embedded in the public’s psyche. Why else were lunatics locked in mental asylums, strapped in straitjackets, if not to prevent them from being a danger to others?

There are many variations of the escaped mental patient urban myth, with invariably innocents being slaughtered by the rampaging, almost supernatural human monster. The thing cannot be reasoned with; it is beyond reason. It is animalistic, bloodthirsty, evil. Something to be hunted and killed on sight. 

The factual reality is that mentally ill people are more likely to be a victim of violence than the general population. Only 3% of mentally ill people ever commit a criminal act of aggression. That means that 97% never commit an act of aggression. The person a mentally ill person is most likely to harm or kill is themselves. Suicide is the biggest cause of death in men aged 20-49 in the U.K. and the biggest cause of death of teenage girls worldwide. 

What then is the basis for a 21st century documentary about mentally ill killers, that lingers over gory details? According to Shelley Jofre, the BBC reporter who made the documentary, it is a public interest story. I see that it’s a story the public will be interested in, but is it in the public interest?

The Panorama programme claims that the incredibly rare side effect of SSRI medication causing psychosis, potentially leading to aggression and violence, needs to be more widely known to both the general public and to people taking SSRIs. The problem with this argument is that family doctors and prescribing psychiatrists already weigh up potential side effect risks and discuss them with patients before prescribing. And there are many possible side effects from taking SSRI medications, the most common of which include weight gain, sedation, fatigue and loss of sex drive. The average person taking an SSRI has been informed by their doctor of likely side effects, thoroughly read the leaflet that comes with the medication, probably read up some more about the risks on Wikipedia and discussed the risks with other people taking the same medication. The vast majority of mentally ill people are already very well aware of the potential and actual side effects of taking SSRI medications. 

What about the wider population? Don’t they deserve to know the danger too? If the 40,000,000 prescriptions for SSRI medications in the U.K. every year are going to trigger a nationwide bloodbath, don’t the public have a right to be warned? Therein lies the central weakness in the programme’s premise. 40,000,000 SSRI prescriptions per year already in the U.K., no mental patient slasher movie apocalypse as a result. 

I don’t deny that there are records of isolated cases where an SSRI may have contributed to a tragic incident. But is the potential danger both proven and statistically significant enough to warrant making an hour long documentary about it? What about the much more prevalent side effect of an increased risk of death by suicide among teenagers when they first start taking some, but not all, SSRI medications? That kills more people. Surely that’s more newsworthy?

The unpalatable reality is that few care about mentally ill teenagers killing themselves. It’s dull TV, compared to bloodsoaked rampaging mental patients. Real Hannibal Lecters lurking in our midst. 

This perpetuates the myth that mentally ill people are inherently violent and a well behaved one is just one waiting to explode in a killing frenzy at any moment. Drugs are supposed to suppress this huge danger, not enhance it. A dribbling, sedated, locked up mental patient is the only safe one. 

This is of course total nonsense. One in four of us will suffer a mental illness in our lifetime. The vast majority of people will be treated with a combination of medication and therapy. Out in society. Not locked up. Normal, but unwell people, not dangerous in any way. 

What are the likely outcomes of the documentary being aired?

There is a small possibility that a handful of people who are taking SSRIs and experiencing psychosis as a side effect will realise what has been wrong and seek help and advice from their doctor. This is a good thing. 

Something which is much more likely is that some mentally ill people currently benefitting from taking SSRI medications will stop taking them, to avoid the remote possibility of becoming violent. The benefits of that medication will then stop. Clinically depressed people will slide back into the abyss. People with anxiety disorders will retreat back into tormented Hell. Some of these people may well take their own lives as a result. The documentary could possibly cause more deaths, not fewer. 

Then there is the stigma issue. Some think that the term “mental health stigma” is overused. In the face of the ongoing tide of derision, fear, mistrust and demonisation of mentally ill people, I can assure you that the term could be used much more indeed. Just like black people and gay people have had to stand up and say enough is enough, mentally ill people are now standing up to be counted. 

My name is Patrick. I suffer from clinical depression, severe OCD and PTSD. I am a mentally ill person, a loving husband, a good father. I take a high dose of Prozac, an SSRI medication. It helps me to function normally. I’m not an unquestioning fanboy of Prozac. I have side effects from taking it, but I’m zero danger to anyone. Enough is enough. The unwarranted stigma against all the ordinary people just like me has to stop. This documentary will perpetuate stigma and prejudice. That is harmful and dangerous. Much more dangerous than a rare medication side effect. 

A temporary vegetarian

My wife is a dietitian. Starting yesterday, she and the team of dietitians she leads are trying out some of the clinical and controlled diets that their patients experience. So, for a week, my wife has chosen to be a temporary vegetarian. 

Two of my daughters are already vegetarian; the other is a devout carnivore. But, for this week, the whole family is having a go at the vegetarian thing, in solidarity with my wife. 

We’re into our second day and it’s going OK so far. We bought a lot of vegetables and vegetarian food at the supermarket yesterday. We didn’t buy any fish or shellfish – we’re not doing the ‘pescetarian’ cop out, but we’re also not trying the full vegan thing either. I will struggle enough with just a vegetarian diet. 

One thing I insisted upon was trying some of the facsimile products, like Quorn ‘chicken’ nuggets. We will make some meals from scratch, but I wanted to try some of the foods which are considered as ‘cheating’ by some proper, permanent vegetarians. If one likes meat, but for whatever reason chooses to be vegetarian, then why not have some things which are meatlike in taste and texture?

We have been trying to have one or two meatfree evening meals a week, so we’ve already tried some products. I find the Quorn Mince an unconvincing texture, so we just use it to bulk out a smaller amount than normal of proper beef mince. This week, we’ll have only Quorn mince, so I’ve decided that chilli sin carne would be the best way to disguise it, with kidney beans, peppers & onions adding some bite and texture. 

As well as trying the food, I will also be attempting to cook some of the meals. Normally, I struggle with contamination OCD intrusive thoughts so much that it renders me incapable of handling raw meat products. The decontamination rituals make preparing a meal distressing, prolonged and impractical. So I’m seeing how I deal with veggie cookery. I will still have to face handling things like eggs, so there are some pretty big triggers remaining. It’s still going to be a challenge. I will do my best. 

I’m keen to try a couple of Indian and North African recipes. I’d like the experiment to be a balance between cooking from scratch and lazy convenience foods. 

My wife will be taking professional nutritional, qualitative, cost and environmental impact notes throughout the week, in order to present her findings & experiences to her team. I think that the added data of the whole family participating will make the experiment much more useful. Since it’s only day two, I haven’t yet started to crave bacon sandwiches, but I expect to. From past experience, vegetarian ‘bacon’ is both weird and disappointing. I do intend to try doing a veggie fry-up though, with veggie sausages, which are OK. 

Do I expect to go permanently vegetarian by the end of the experiment? Not a chance. I will always be carnivorous, but it would be good to broaden the repertoire of vegetarian food which could be interspersed among the usual non-stop meat frenzy. 

The experiment ends

It was an interesting week. We set out with a few objectives and achieved some, but not all of them. We had some of our preconceptions challenged and confirmed other things we expected to be true. 

• We all stuck with the experiment without lapse for the full week
• We ate more processed products than we intended to, cooking fewer things than planned completely from scratch
• My vegetarian daughter who still lives at home ate a more varied diet with fewer processed products than usual during the experiment 
• The range, quality & texture of processed products has improved greatly since I last paid attention to them
• The texture issue is still variable. Fake chicken nuggets and chicken burgers were convincingly like cheap chicken products, but without the gristle. We’d get them again. Fake meat pies were sub-football-ground quality. We wouldn’t get these again
• The quality of food based upon price wasn’t consistently equivalent to the meat based version. Processed vegetarian foods aren’t always great value for money
• Both me and my youngest daughter regularly felt hungry and unfulfilled throughout the week. I tried increasing carbohydrate intake to compensate, but this didn’t help
• The nicest meal of the week was a chunky veg chilli prepared from scratch
• The other really enjoyable meal was a barbecue, the highlight being satay kebabs made of peppers, onion, courgette and haloumi. These will be a part of all future barbecues
• The issue of farting wasn’t as bad as anticipated. I expected a remake of the Blazing Saddles campfire scene
• I did however find that the instant I woke up in the morning, I had to dash to the bathroom for a “long sit”. The sudden increase in vegetable and fibre intake had a noticeable effect in this respect
• The flavour of the processed products was often quite strong. It felt over the top at times. Was this to disguise a bland base product? Maybe. 

So, will we repeat the experiment? No, I don’t reckon we will. Will we eat fewer meat based dishes, more vegetarian dishes and more vegetables? Definitely. We will also be trying a more varied diet, with more seafood and less red meat, which is a positive outcome. I’m glad that we joined in with my wife’s experiment. It was educational.