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Matters of the mind - getting back in control
Page created 27/06/10
Written by Harriet Kelly—September 2009
Frantically moving around the house checking doors have been locked and lights switched off, not once or twice - but over and over. Hours later still holding my hands under a running tap, scrubbing and scrubbing until red raw. Life had spiralled into a debilitating state of endless checking, counting and cleaning – a head full of thoughts out of control. It was as if my entire being had been taken over by these compulsions - at one point I believe I had reached a point where I had simply ceased to be a functioning human being.
The human mind – so complex and intricate, it is little wonder it leaves us prone to the occasional ‘glitch’ in the works. Obsessions, phobias and habits are one such vulnerability; some might say a ‘trade off’ for the intelligence with which we have been blessed. But how can we learn to live with these visitors to the human mind and what is the best way to manage these behaviours which can seem largely beyond our control?
Julie Leitch was only eight years old when she noticed the first signs of her ‘Obsessive Compulsive Disorder’ (OCD) – fuelled by an overwhelming fear that her family would be harmed, thoughts began to enter her head that the only way to keep them safe was to maintain a life of order and perfection. “At school if I made a mistake with my work I would have to tear out the page and start again. If I read something incorrectly I began to believe that someone in my family might die,” she explains.
By the age of sixteen Julie’s condition had become much worse and she began the ritual behaviour of endless ‘washing and checking’. “I would wash my hands over and over and became obsessed with checking that all the doors and windows had been locked. I would pack and re-pack my bag so many times before going to school that I was exhausted before I had even left the house.”
The rituals and thoughts that any mistake in her school work would cost her families life had become too overwhelming and Julie found herself unable to finish her final year of school. Julie explained the sense of isolation and confusion she felt at the time. “I truly believed I was the only person doing these things and never told anyone about them.”
Years later as a married woman with the responsibility of running her own business and own house. “This is when the obsessive compulsive thoughts really took control of my mind and my life,” she reflects. “I started writing lists of all the things I needed to check and lock – there was now more checking, washing, cleaning and counting than ever before. I would spend over an hour in the shower washing my hair over and over. My morning checks of the house were taking so long that I now had difficulty getting anywhere on time.”
Julie’s condition continued to worsen until eventually she was unable to shower or dress herself without assistance. “My life was spiralling out of control – I couldn’t even eat without feeling like I had to ask for permission.”
Unable to be assisted by the many doctors she had seen over the years, it was reading a story in a magazine about OCD where she recognised her own condition – this would be the breakthrough she needed to finally receive the proper treatment she so desperately required. “I commenced a daily behavioural therapy program which involved exposing myself to the things I feared- starting from the least anxiety provoking situations.” For Julie this was confronting the concept of death – she would start by being asked to buy a sympathy card. “So there I was on my first day purchasing this card, I thought that was going to be the worst thing I would be asked to do – how wrong can a person be?” she exclaims. Once achieved, this step was quickly followed by a walk in front of a funeral parlour and eventually even visiting a morgue. Coupled with therapy to control the endless washing and checking – Julie began to take control of her symptoms in a matter of weeks. “I was now getting control over my OCD instead of it being in control of me,” she expresses with delight.
University of Western Sydney Senior Lecturer in Clinical Psychology Dr Rocco Crino has specialised in the treatment of OCD and has seen many patients suffer for years without receiving the treatment they really need.” The most fundamental treatment for OCD is cognitive behavioural therapy where the patient is placed on a graded and structured program which involves exposing themselves to situations which provoke their fears,” he says. “It also involves teaching them to deal with their intrusive thoughts by changing the meaning they attach to them.” Many patients also require medication such as serotonin re-uptake inhibitors to assist this process explains Crino.
It was important that Julie continue treatment for several years following her initial diagnosis and therapy. “I feel very much back in control and back into life. I really had forgotten what it was like to feel well again and to be at peace with myself.”
Julie currently works as an Information Officer for the Mental Health Association of NSW providing support to others suffering anxiety disorders. [Mental Health Association of NSW Ph: 1300 794 992]
“If someone had told me 20 years ago that this would be my life now, I simply wouldn’t have believed them.” Says Melbourne woman Anna Kouloubos who has fought a 20 years battle with Agoraphobia (fear of leaving the house), a poorly understood condition which is often mistaken for excessive shyness or social inability.
Anna’s phobia started soon after the break up of a tumultuous and violent relationship when she was in her mid 20’s. The emotional and physical toll of these events appear to have been the catalyst for a series of panic attacks. “I didn’t know what they were at first”, says Kouloubos. “I would be on a tram and suddenly feel hot and shaky – my heart would start racing and I felt like I was going to die”.It would be the onset of these attacks that left Kouloubos with no confidence to face the outside world. “I was constantly worried about ‘losing it’ in public, especially since my attacks also meant I could have a bathroom accident at the same time,” she says with a sense of despair.
Although there is a sense of sadness and weariness in her voice – Kouloubos’s fighting spirit is abundantly clear. “Some people think that Agoraphobia is someone who simply can’t cope with life”, says Kouloubos. “But it’s not that at all, it is the fear of being ‘out of control’ in public and anyone who has ever had a panic attack would understand how awful and frightening they can be.”
Crino agrees that Agoraphobia can indeed be mistaken for shyness or an inability to socialise. “It is a very different phobia to all the others,” he states emphatically. “Typically commencing with unexpected panic attacks the person, always vigilant for such episodes, may simply withdraw from a whole range of life activities in order to avoid a panic attack in situations where escape is difficult or help may not be available in case they ‘lose control’.
By her mid 30’s Kouloubos was unable to continue work, and had moved back in with her parents. “I believed I had hit an all time low,” she says with anguish. “I had reached a point where I was simply unable to leave the house for anything – I couldn’t shop, couldn’t visit friends,” worst of all she states. “I just couldn’t find the help I needed.”
A breakthrough came however with a referral to a new Psychologist who commenced a behaviour therapy program. “The important thing here,” she explains, “is to start with ‘baby steps’ - some small outings with someone else by your side to give you support.”
Crino suggests that cognitive behavioural therapy (CBT) is again the best and most effective means to treat this condition. “You need to get the person to change the interpretation of their physical symptoms and to overcome the fear of fear itself. That is, a structured and supportive program to reduce the fear they associate with having a panic attack,” he says.
For a short while Kouloubos seemed to be winning the battle. “I had commenced a support group for Agoraphobia and other anxiety disorders and was even facilitating groups from a local community house,” she says with pride. “My mistake was taking a break from running these groups which meant I gradually lost the confidence to leave the house again.” Such is the persistent and virulent nature of this condition.
It has been many years since Kouloubos has ventured out again, “I will get back and get the help I need,” she insists. “My support group, now called the Anxiety Disorder Association of Victoria ‘ADAVIC’ has grown and grown and cares for many thousands of people each year,” she says with a sense of satisfaction. As if fate had a part in bringing her to this point, Kouloubos laments. “Of course I have missed out on a lot, but look at all the things I have achieved – and all from my own little apartment,” she says with a chuckle.
There’s a new player on the psychological landscape, ‘video game addiction’ - a growing phenomenon in Australia and one which is now moving up the list of the most treated psychological problems in the developed world.
For Jeremy Ray, the co-host of ABC’s ‘Good Game’ the addictive qualities of what the virtual world had to offer was all too apparent. “I had always been into ‘gaming’ from an early age, but it was when I found myself out for work for a while that I became seriously addicted,” he says.
For Ray, this amounted to over 16 hours a day fighting virtual monsters, building virtual weaponry and taking on ‘quests’ that would see him rise in the ranks of his on-line world. “Most of my waking life had become devoted to one particular video game,” he explains. “For a while there I was ‘stuffed’ socially and really lost any interest in finding a job.”
This growing trend has been of keen interest to Dr Andrew Campbell from the University of Sydney who has specialised in the science of ‘Cyber Psychology’ – researching and treating those with obsessional tendencies for video games. According to Campbell there are very stark indications of when someone’s ‘gaming’ interests have moved into serious ‘over drive’. “A very clear sign of someone becoming an obsessional ‘gamer’ is when they loose interest in activities or friends not associated with their on-line playing,” he says. Campbell also explains that those whose ‘gaming’ goes beyond the healthy range may also show signs of self neglect. “These people can loose all regard for their personal well-being; eating well, getting enough sleep, even work and family all become secondary to the game.”
Ironically for Ray, it was research into the psychology of some of the games he would present on his up-coming show that provided him with insights into the ‘tricks’ and ‘gimmicks’ being used by some gaming manufacturers to keep their customers hooked. “Their use of sporadic rewards, the way they manipulated your mind so you grow in social status the more you play - it really took me in especially with my competitive nature.” But there was never any sense of closure explains Ray, “it was just like a continuous carrot on a stick.”
The ability of some games to give players a sense of social status and belonging is of particular concern to Campbell. “A proportion of excessive gamers are people who have not achieved a sense of belonging in their personal lives,” he says. While ‘gaming’ does offer a source of social connection with other like minded individuals. “It is these people who are particularly vulnerable towards becoming totally immersed in a virtual world and end up removing themselves even further from their real lives,” he fears.
Leaving his obsession behind came easy to Ray. “I just walked away from the game, I saw it for what it was and felt what they were doing was unethical.” He says with a strong sense of self determination and the closure he had been looking for.
While going ‘cold turkey’ worked well in this instance, Campbell suggests a more tapered approach for those whose on-line habits have got away from them. “I don’t usually recommend going ‘cold turkey’, he explains. “For the truly obsessional gamer this can actually cause real social problems. They just need to introduce some strategies to better control their on-line time.” Campbell explains that this might mean using ‘computer time’ only as a reward and when certain tasks have been completed. “Perhaps for two hours after you’ve done your homework.” Campbell stresses that one of the most important strategies to restoring balance is keeping your non on-line friends. “These people are really important in getting you to think and talk about things not related to video games.”
In a strange twist, Ray’s experience as an obsessive ‘gamer’ has provided him with insights he can now share with other on-line enthusiasts through his TV series. “I love my video games and working on ‘Good Game’, but I am also aware of the traps you can fall into, so we’ve made sure to cover the serious issue of gaming addition in the series.” All things considered, it would be hard to find anyone in a better position to do just that.
Written by Harriet Kelly—September 2009
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