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. 


The “coming out” thing

Fear can hold you prisoner; hope can set you free. – Stephen King, The Shawshank Redemption. 

Since being diagnosed with OCD, I have learned a lot about the condition. I have suffered from OCD my whole life, but I was only officially diagnosed nine years ago, aged 37. 

I was pretty sure for a long time before that I was an OCD sufferer, but self stigma and shame had prevented me from seeking help. Even before knowing it was called OCD, I had known from a very young age (two years old) that I was somehow “different”. Damaged goods, impregnated with an evil that I had to keep secret. I had badness in me that was trying to leech out. If anyone found out, I would be locked up. My mother reinforced these cast iron beliefs almost every day, when she beat me and I bled or bruised. “That’s the badness coming out of you. When they find out, they’re going to lock you up in The Home”. 

So it took 37 years for me to summon the courage to seek help. By then, it was simply a case of either die by suicide or risk being sectioned and locked up to protect the World from me. I had feigned an outwardly normal life until then. In many respects I was “normal” and successful. But the whole time, I carried this burden of latent evil around with me. I knew I was essentially a good person, but my mind told me I was capable of doing bad things and of not doing good things properly, which would result in evil, catastrophic consequences, which would be my fault. 

I first began to suspect that my “differentness” was partially something called OCD in my mid teens, when I watched two documentaries about people with OCD, one about people living with it day to day, the other about inpatient treatment of severe, treatment resistant OCD. That was a frightening realisation. I was an undiscovered mental patient, like the mental patients on TV. Mental patients were dangerous and needed to be locked up. Everybody knew that. I needed to work harder on seeming normal, in case I was discovered and locked up too. 

With the benefit of hindsight, I remember that the documentaries both concentrated on the compulsions of the sufferers they featured. I recognised similarities to my own compulsions. Up to that point, my primary compulsions were checking compulsions. I don’t recall much mention in the documentaries of the mechanisms of OCD or the intrusive thoughts which fuelled the OCD cycle. So for me at that time, OCD equated to Obsessively Checking things Disorder. 

I didn’t realise then that the physical tics I had, the hair pulling, the skin picking, the ripping off of my fingernails and toenails, which had all happened throughout childhood, were also all indicative of OCD and the anxiety it created. 

So I quietly knew for about 22 years that at least part of my “differentness” was OCD, yet didn’t seek help. Stupid, eh? So many wasted years. Utterly daft. Yet that whole time it seemed perfectly rational. The OCD parasite is cunning. It convinces its host that it is both friend and protector. That the host will be vulnerable, weaker without its presence. So it seemed logical to allow the OCD to remain in control of me. I needed it there to keep me safe, to keep others safe. I couldn’t live with myself if harm came to anyone if I abdicated my burden of responsibility. And so the OCD parasite continued to feed off my anxiety, propagating it with horrific mental images, fear, guilt and paranoia.  

So eventually, in terminal desperation, I went to my family doctor aged 37 to get help for OCD. In order to realise that we need help and then to seek help, many OCD sufferers necessarily self diagnose. Some people go to their doctor knowing just that something is mentally wrong. Some have an inkling that it might be OCD. I was more organised and thorough. In my typical manner, to confirm my self diagnosis, I had looked up OCD on Wikipedia, as well as looking at the OCD-UK, OCD Action and IOCDF websites. My education had begun in earnest. I listed my “OCD things”, three printed pages of a bullet-point list and showed them to the doctor. He agreed with the self diagnosis. He put me onto medication to help control my anxiety. 

Looking back at that list, there were also a few things like “straightening picture frames” that I now know are misconceptions about OCD. Crooked picture frames annoyed me; I never thought anyone would come to serious harm if I didn’t straighten the picture frames. But I can forgive myself now for the commonly held misconceptions. It was early in my education about OCD. That’s what many think OCD is – being mildly annoyed at crooked picture frames. So very far from the horrible truth. 

Perhaps I should be more forgiving of other people’s misconceptions of OCD. They mostly only have media misrepresentations, online memes and jokes to go on. The fact that we OCD sufferers conceal our suffering so well has also helped to perpetuate misconceptions and misunderstanding of the actual condition. I have beaten myself up mentally for concealing my OCD and perpetuating the myths. I’m learning to cut myself and others some slack about that now. We were and are hostages to the parasite in our minds. You don’t shout for help when there’s a gun muzzle pressed to your forehead. 

So I was diagnosed. What changed? Initially, not a lot. The huge burden of self responsibility lifted slightly from my shoulders. The medication reduced my anxiety slightly, but also made me gain weight and feel drowsy. I didn’t magically get well. I bounced along the bottom of the abyss for several more years. 

But then I began to read more about OCD. I began to interact on an online OCD-UK forum. I read a lot about other people’s experiences of OCD. So much of it was like reading someone else’s description of me, but interestingly, a fair chunk of what I read surprised me. I have a bad habit of assuming that my experience of a thing is absolutely typical and indicative of that thing. I’m not good at golf. Therefore I don’t enjoy playing golf. How can anybody enjoy this stupid pastime that I loathe? Only an idiot could enjoy golf. You see? Just like that. 

I had assumed that everybody’s OCD would be exactly like mine: Always present, at maximum volume, every waking second of every single day. Primarily focussed (in adulthood) on contamination, with consistent minor themes such as checking. I was wrong. I discovered that whilst there is a core mechanism to OCD, there can be big personal variations. 

I discovered that some people’s OCD can be less severe. I envied them. I discovered that a few people’s OCD was more severe. I pitied their suffering. I learned that some people’s OCD could fluctuate in severity, depending on the time of day, week or year. This was a revelation!

I also started to learn about the different main themes of obsessional focus: contamination, checking, fear of harming others – accidentally or deliberately, fear of sexually harming others, sexual identity fears, magical thinking, fear of harm from others, religious obsessions, moral obsessions, relationship obsessions, rumination or hoarding. I recognised that I had experienced more of the themes than I had realised and was surprised that I hadn’t encountered others. Given that I was sexually abused for the first 11 years of my life, I’m still amazed that OCD has never latched onto suggesting the possibility of the phenomenon of abused becoming abuser. I simply know unequivocally that I would never repeat the actions of my mother on anyone and the OCD has never tried to suggest otherwise. A good example of the random, unpredictable nature of what OCD does or doesn’t torment its host with. 

Sometimes, when I read or hear of someone else’s experiences of OCD, I consider myself lucky not to have experienced their variation of the torment. Oddly, several of those people have said the same thing in reverse when I have described some of my experiences. We are typically empathetic people. Other people’s suffering seems worse than our own. We are also stoical and determined. We quietly endure years of suffering alone – typically 12 years from onset to diagnosis. It’s hideous mental torture, yet we consider ourselves lucky in comparison when we hear of the horrors in other people’s minds. We are all victims of the same torturer – OCD, which uses the same torture techniques on us. It merely varies the subject matter of what it tortures us with. 

It is good to have now heard and read the experiences of so many other OCD sufferers. It makes me realise that we have a common enemy, which behaves in consistent, predictable ways. That enemy is weak. We are strong. That is why it parasitises us, because it can feed off and drain our strength, but as soon as we learn to control the anxiety triggered by the intrusive thoughts it latches onto, we begin to deprive it of its source of nourishment. 

The thing which had the biggest positive impact for me was attending an OCD sufferers’ support group. I had spent the years since formal diagnosis continuing to endure the OCD parasite, but in a medicated state. I had previously improved my knowledge of OCD, but I hadn’t done anything else, other than attend a one-to-one talking therapy course, which was only briefly beneficial. The support group increased my knowledge of OCD exponentially. It made me challenge my self stigma and see that my shame as a sufferer was unwarranted. It made me start to feel better about myself as a person. 

The most practical things to come from starting to attend the support group were learning about the benefits of CBT (Cognitive Behavioural Therapy) in overcoming OCD and gathering the courage and motivation to ask my family doctor to refer me for CBT treatment. 

Other OCD sufferers gave me support at one of the lowest ebbs of my life and indirectly helped to save me from death by suicide. OCD sufferers are more empathetic and supportive than the general population. It’s in our nature. It’s one reason why we fall prey to OCD. It makes us doubt the innate good in ourselves and feeds off the resultant anxiety. I have been very glad of the support of other sufferers and it is a privilege to return that support in kind. 

Coming out as an OCD sufferer is difficult, frightening, daunting. It is a big thing to do. But it is liberating. For me it was like being reborn and learning to be a proper human being for the first time. I’m still learning: about OCD, about what “normal” is, about self care, about how to be free and untortured. But it’s good. It’s a new adventure. It’s good to feel the rain on my face. 

If you believe that you might be suffering from OCD, these blog posts can help you to seek support and treatment:

• How to first get help if you have OCD – click here 

• Going to an OCD support group – click here

You are not alone. You are not a freak. You are not a bad person. You can recover. You too can break free. 

Try to imagine a monster

I want you to try an experiment. An horrific experiment. Man or woman, it doesn’t matter who you are. Do you have the courage?

Try to imagine looking in the mirror and from this moment onwards you see Jimmy Savile staring back at you. I really want you to do this. Every time you look in the mirror from now on, think “I look like Jimmy Savile… I look like Jimmy Savile…”. 

Jimmy Savile – A now dead British TV personality who used his position and fame to sexually abuse children, coma patients in hospitals and the dead in morgues over decades. A prolific and horrific monster.

Just imagine that evil, cocky, unrepentant grin staring back at you from the mirror. Horrified, you feel your face and hair. They feel like your face and hair, but the mirror shows Savile touching his face and hair, just as you’re doing. You might be forgiven for checking that it really is a mirror and not a TV screen, as part of some sick, tasteless prank on you. No, it’s definitely a mirror. “Oh my God! Has somebody slipped some LSD into my coffee?” You look again. Still that evil, dead, child molester’s smirk where your frightened expression should be. You move to the side and back again a few times. Savile moves in unison with you. Did you just hear the jangle of his tacky, chunky gold jewellery too?

At this point, you might either want to lie down or get someone to describe how you look. When you look down at yourself, it’s your shoes, your jeans, your t-shirt. You must be you. You ask a friend to describe what you look like and they look at you quizzically. You say, “No really, describe how I look. Do I look any different? …like somebody else maybe?” Your friend describes you. Your non Savile chin. Your non Savile eyes. Your non Savile hair. Oh thank God! You must have had a funny turn. Maybe bumped your head without realising. Concussion, that must be it. Or maybe it’s food poisoning. 

So you go home, have dinner, watch some TV to distract yourself and eventually go to bed feeling uneasy. You avoid looking in the mirror in the hallway, just in case. A restless night’s sleep later and you wake up wondering if it was just a nightmare. You go into the bathroom, start to pee and there is Savile leering back at you from the bathroom cabinet mirror. You stop peeing, reflexively, as the old creep watches. You decide to brush your teeth defiantly. You’re brushing Savile’s teeth! URGHHH!!!! You retch at the sight. 

“This is serious! THIS IS BLOODY SERIOUS!!! Am I going mad?! How can an old dead nonce be my reflection? That is utterly creepy and insane. It’s just not possible.”

You run, but there he is, reflected in your neighbour’s car window as you emerge panicking into the street. You look behind you. There’s only you. It’s you. Jimmy Savile is you. 

You don’t tell anybody. They’d think you’d gone mad. How could you be Jimmy Savile? You’re you; he’s dead. Is this your subconscious trying to tell you that you’re secretly a wannabe child molester? You shudder and retch at the thought. You’d rather kill yourself than harm a child in any way. It’s not that… it couldn’t be that… but Savile still grins his sickening grin back at you, from every mirror, every window, every puddle. He’s there, but only you can see him, only in reflections. Has he returned from Hell and possessed you? A demon sent to turn a decent soul bad? There’s no possible rational explanation for what you’re seeing. The freakish, irrational explanation, no matter how impossible, must be the truth. The awful awful truth. 

So you start to take precautions. You alter your route to work to avoid schools, you keep away from your own kids, afraid to hug them. You give up coaching the under 12s football team. It’s completely nonsensical, you know that, but you can’t risk Savile’s demon taking over, doing something horrible that you can’t prevent. He only appears in the mirror, only to you, but if he can do that, then surely anything’s now possible? You never even believed in God, but now this. Your eyes don’t lie. That’s Savile looking back. You must be possessed, or criminally insane or a subsonsciously repressed child molester who’s never actually ever harmed a child in your life. Yet. You must be one of these. What the Hell else could it be? Surely nobody normal could think like this? You’re a vessel for a monster waiting to happen. You must protect the World from what you might become. 

Imagine if something like this bizarre, sick nightmare could happen. Imagine yourself, a normal, decent person, who would never harm anyone, but who’s afraid to go outside, in case you might suddenly become a danger to children. That would be a living Hell. Unable to ask for help for fear of being locked up forever, not because you’re dangerous, but believe you could become so at any moment. 

Incredibly, this is the day-to-day reality of some of the ordinary people who suffer from Obsessive Compulsive Disorder. OCD?! That quirky, “likes to clean, arranging M&Ms by colour” thing? What has that remotely got to do with irrationally believing you could harm children?

An obsessional fear of harming others is a common form of dysfunctional OCD thinking. Sufferers obsessively fear becoming the very last thing in the World they would want to be. It can take a variety of forms: some people constantly fear that they have knocked down a pedestrian with their car without realising, some people fear that they will harm their family with a kitchen knife as they prepare dinner, I fear the knife becoming possessed and me not being able to prevent it harming my family, some people fear that they could harm children in some way.

There is no basis in fact for these fears. The fears are totally irrational. These are considerate attentive drivers, loving family members, caring parents. Normal, ordinary people, just like everybody else. No actual danger to anyone at all. But the OCD makes them believe the unbelievable, that despite being decent people, who’ve never harmed anyone and never will, they somehow have the latent capability to change the behaviours of a lifetime. Amazingly, the OCD sufferer is aware of the irrational nature of these thoughts, but there is always that doubt being whispered by the OCD, “What if… what if a brain tumour is making you behave uncharacteristically? What if you are possessed by an evil spirit? What if you’ve been denying your true evil nature all your life? What if you’re just a careless, heartless bastard? What if… what if… what if?”

Thousands upon thousands of harmless people, tormented by a parasite called OCD, which whispers bizarre, toxic lies constantly into their minds. Many are unable to seek the help they truly need, because they are fearful, ashamed, guilty for no factual, justifiable reason. They’ve done nothing wrong; will do nothing wrong. Something is making them see a monster that isn’t there when they look at themselves in the mirror of their mind. They are just ordinary people, with horrible, repulsive, unwanted thoughts torturing their minds endlessly. The only monster is the torturer called OCD. 

Go now and look in an actual mirror. Look at the ordinary person staring back. Be thankful there’s no torturer in your mind, making you envisage a monster who isn’t really there. Every minute. Every day. Be very very thankful. 

Claiming to have OCD…

…because you’re merely organised, motivated or like to clean, is like…

Claiming to have skin cancer because you have a wart,

Claiming to have an amputated foot, because you cut your toenails too short,

Claiming to have tuberculosis when you have a slight cold,

Claiming you’re having a heart attack, when you have indigestion,

Claiming you have septicaemia because your fingernail has gone septic,

Claiming that shivering with the cold is mild epilepsy,

Claiming that mild sunburn is 80% third degree burns,

Claiming that a grazed knee is a compound fracture of the leg,

Claiming that an eyelash in your eye is profound blindness,

Claiming that a slight headache is a brain tumour,

Claiming that dandruff is leprosy, 

Claiming that a bad hangover is decapitation. 

Nobody does these things. Only an idiot would. Why claim to have OCD if you don’t? It’s just as daft a thing to do. 

The geography of #OCD stigma

It would be rather sad if half of all the harmful stigma tweeted worldwide using the #OCD and #OCDproblems hashtags was tweeted from one country. It would be astonishing if half of all the harmful stigma tweeted worldwide using the two hashtags was tweeted from a single region of one country. 

It is. The State Of Texas in the USA. 

Surely not?! Texas?! Really?! 

Yes, really. It emanates from throughout the state. Cities like Houston, San Antonio, Austin, Galveston and Dallas / Fort Worth. Smaller places too like Cactus, Langtry, Round Top and Clarksville. 

Some, but not all, of the other Southern U.S. states make a gallant effort to contribute their own backward mental health stigma to the hashtags, but the combined efforts of Florida, Arkansas, Georgia, Arizona, Kentucky, California, Oklahoma, Alabama and Louisiana pale into insignificance compared to Texas. 

It’s bizarre, but sadly true. 

There are often common characteristics about the tweeters. They frequently have a reference to either their sign of the zodiac, their strong Christian faith, a motivational, life-affirming quote or a combination of all three in their Twitter bio. Some make reference to having a relative on the autistic spectrum. They regularly describe themselves as quirky, sassy, opinionated or sarcastic. Their follower counts vary from 5 to 10,000, but mostly number several hundred per account. The majority are white, then African American. There are more women than men (about 60/40). Don’t believe me? Here are a few sample screen snapshots from the many many bios of stigma-tweeting Texans. I have cropped out the account names and other identifying details, where possible. 


So that’s Texas and some other Southern U.S. states, accounting for a combined average of 65-70% of the harmful stigma posted by the entire planet using the #OCD and #OCDproblems hashtags. Wow!

Ignorance of mental health issues in the Southern United States is by no means endemic, but it is far too consistent and prevalent to be happenstance or coincidence. Is it lack of education? A cultural throwback? Southern plain speaking, engaging mouth before brain? I have no idea. I have Twitter friends from South Carolina, North Carolina, California, Louisiana and Georgia. They’re well versed in mental health issues, articulate and considerate in their use of words. 

What about the rest of the World? 

There is a wide geographical spread of stigma tweets, but there are notable hotspots, with their own characteristics. 

People from Mumbai, The Philippines, Dubai, Singapore, Belgium, The Netherlands and Malaysia who are trying to appear cosmopolitan, witty and urbane like to make wry, knowing (but sadly not knowing at all) OCD jokes and witticisms. So “sophisticated”, in a pathetically parochial, naive kind of way. 

White South Africans and people from Melbourne and Brisbane don’t even attempt sophistication if joking about OCD sufferers. They just wade in with both feet. 

By far the country using “OCD” without a hashtag most is Japan, but it is short for Old Codex, who is either a comic book artist or some sort of pop star. He has a lot of fans. 

There is also a rap group in America called something like Only Chasin’ Dollaz, who also get quite a few “OCD” mentions. Pity they hadn’t gone with Chasin’ An’ Nailin’ Cash Every Record. Probably would have been less well received. 

There are distinct areas where practically no English language based #OCD stigma and little other-language based stigma are tweeted. Most of the continent of Africa. Much of the Middle East. Scandinavia. Most of India, with the exception of Mumbai. The greater part of Australasia. Southern America. Eastern Europe. 

I have noted these common characteristics over roughly a year of randomly observing the OCD hashtags on Twitter. I’ve found it intriguing and fascinating from an anthropological point of view. It’s not a scientific study, but it is thorough and accurate. The relative percentages by country and region have remained pretty consistent, but I’m glad to say that the ratio of stigmatising tweets compared to genuine tweets about real OCD is falling. In truth, there are much fewer stigmatising tweets these days, which is fantastic, but every one that gets tweeted is still one too many. 

I have no doubt that the many decent people in the State Of Texas will be appalled to learn of their state’s rather shameful claim to fame; the source of 50% (52%, but I generously rounded it down) of the entire World’s discriminatory references to OCD on Twitter. Texas is a beautiful place, with many wonderful people but, as an OCD sufferer, I’m glad I don’t live there.