A vast section of the population are victims of a psychological disorder that threatens lives and livelihoods but are rarely taken seriously, reports Saima Bhat
As the night falls, Naseema, 40, waits for her husband, Dr Muhammad Ashraf to fall asleep. Married happily for a decade now, the routine of going to bed at different timings is not that old for the couple.
Living fulfilling lives, the couple is hailed for their ‘compatibility and understanding’ by relatives and friends.
Ashraf discovered recently that his teacher wife waits for him to sleep first. Brushed off as a routine, Ashraf initially did not give it a thought, but once he was conscious, he investigated and found out that Naseema does not sleep.
Her practice is to come out of bed silently, check clothes of her husband and take money out from all his pockets. What she does with the money shocked her doctor husband.
Once taken out, she lands in the washroom and put notes as well as coins in a tub and wash them with a detergent for a long time. Later she spreads them out to dry. By the time they are dry, it was already dawn.
Once caught, Ashraf asked Naseema the reason, she was normal and confident in her response. “These notes are given by various people so they must be dirty. I have to wash them!”
The doctor again mistook it as normal. But the panic button was pushed when her behaviour started impacting her professional life. Her students started complaining about her being irritable all the time.
The signs of depression were visible in Naseema. Finally, when she consulted a doctor and held a number of counselling sessions, she was diagnosed with Obsessive Compulsive Disorder (OCD).
OCD, doctors say, is a type of anxiety disorder. But it is a devastating disease as it makes a patient dysfunctional. According to doctors, OCD patients spend most of their time in cleaning and washing, as a result of which their other works suffer. It traps the sufferers in endless cycles of repetitive thoughts and behaviours. They are plagued by recurring and distressing thoughts, fears, or images (obsessions) they cannot control.
Dr Muzaffer Khan, a senior clinical psychologist says, OCD is the only anxiety disorder in which a patient can get a disability certificate in mental health. No other mental disorder is considered eligible for such certificate because it does not kill a person but only hampers their work. It acts as a handicap to the person and their socio occupancy decreases.
Tasleema, another teacher from Islamabad reported to a clinical psychologist when she started running out of her school with episodes of crying in the middle of her class.
She told her doctor that whenever she sees a white paper, she gets a thought of writing against the Prophet (SAW) and then if she writes, she feels overwhelmed by how people will react to it. It used to give her distressing thoughts to the extent that she used to run out of the school, leaving her students in the middle of the class.
Unlike her, a renowned surgeon, also suffering from OCD, never leaves his patient. His OCD is his ‘perfectionism’. Everything he does should be perfect.
If a particular surgery takes any doctor two hours, he finishes it in six hours. “Once the surgery is over, he ensures all of the stitches are perfectly done. After stitching the body, he removes them and then does it again and again till he feels it is now done perfectly,” says Dr Khan, who believes clinically the prevalence of OCD is very high in Kashmir.
At the centre for mental health services (CMHS), in Srinagar, started by HELP Foundation, Dr Khan and his team of clinical psychologists have diagnosed 145 patients of having OCD who had come for various mental problems between July 2016 and October 2017. (see box)
|Obsessions with need for symmetry||17|
|Cleaning/ washing compulsions||22|
|Ordering/ arranging compulsions||11|
|Hoarding/ collecting compulsions||3|
Dr Khan says OCD is mostly related to dirt, contamination, rechecking and religious thoughts where a patient repeatedly goes for bathing, or washing hands, refusing to shake hands or touch doorknobs, repeatedly checking things, such as locks or electronics, constantly arranging things in a certain way, eating foods in a specific order, being stuck on words, images or thoughts.
But Dr Khan says he receives patients late, usually referred by a psychiatrist when the patient is predominantly a depression patient. It takes a lot of time to build repo with the patients to check if the depression is secondary.
In Kashmir, the main symptom of OCD, cleaning and washing, is mostly taken as a part of religion. But if it goes to the level that it takes a toll on the routine of a person, it can be very damaging.
Wasiya, a university student has stopped eating anything outside her home. Whenever she has to eat, she washes her set of utensils again and again. Her mother, Atiqa, is worried about her daughter’s future.
“In marriage parties, she does not eat anything and prefers not to share even her bed,” a concerned mother says, adding, “Even going to relatives place have been years now for her.”
Wasiya explanation is simple: “I don’t know but I can’t eat with anybody on the same plate. I tried but could not manage this.”
Dr Akeel, a clinical psychologist, who is now a clinical psychologist in London, says that OCD varies from place to place. If the disorder, cleanliness is considered as a part of religion in Kashmir, in West the OCD symptoms are related to technologies.
“Many patients come with blasphemous thoughts, who are religious people, who value their religion, but the distress reports to the level where they say they don’t go to the masjid, or when mauzin calls the faithful for prayers, they plug their ears,” Akeel said. Earlier in Kashmir, most of his patients were from a particular class who married within their relation only.
Supporting Akeel’s argument, Dr Khan says the disorder is more prevalent in such families because their gene pool gets ‘preserved’.“If somebody in a family has OCD it goes down and their children have a 33 percent chance of having OCD because of genetic loading and when they marry in relations the chances get doubled,” Dr Khan added
Even environmental conditions play a role in the families with strict attitude, harsh parenting, discipline towards their children. “Such children are more prone to get OCD or they can have early manifestation if there is a negative episode in their lives that gives them stress,” says Dr Khan.
The children who are brought up in families with distressed relations or single parents are vulnerable to this crisis. Physical or verbal abuse through harsh parenting for scoring fewer marks or emotional abuse like neglecting the child can also create a tense and unsuitable environment, which can give way to mental disorders like OCD and depression.
“Culturally, we still suppress our children and don’t give them a chance to speak. We emphasize more on academics, forgetting about their mental wellbeing till it is way too late to take action. Another important thing to be mentioned is that our attitude towards female children is harsher. There are still many families, mostly in rural Kashmir, who discriminate between their sons and daughters on a daily basis,” adds Khan. The people discriminating do not realise how adversely it affects their daughters, giving way to feelings of inferiority and dejection.
Offering an instance of his close relative, Dr Khan said that in Kashmir, many elderly females suggest a kid, especially a girl child, should be awakened in the middle of the night and taken to the washroom to pass urine when they are six months old. “If a kid is not able to control his toilet during the night up to four years is normal. But they want to have it in the first year only and it can make them vulnerable to OCD. “Bedwetting is a huge issue in Kashmir, especially in rural areas,” he added.
(All the names of the patients have been changed)