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Monday, August 08, 2005

The House Of Obsessive Compulsives Episode 1: My View

As mentioned, I only managed to catch about ten minutes of last Monday's first episode of The House of Obsessive Compulsives but I rectified that situation yesterday by sitting down to watch my taping of it. So here's my opinion, simply on the basis of being an OCD sufferer treated with the same techniques shown during the show.

I was very pleased to see that my concerns about the show being exploitative, or insensitive, or intrusive, or portraying the sufferers as "mad" were completely unfounded. My firm belief that the Centre would not have agreed to participate in such a show were well founded. I completely agree with Fizzwhizz that the show beautifully demonstrated that those of us with anxiety disorders are not mad, just big time worriers. And anything which helps break down the stigma relating to mental illness has got to be a good thing.

That said, I was a little disappointed to realise I came away feeling that the show hadn't really explained CBT for OCD. I read a review of the show in Metro in which the writer felt the programme had not adequately explained why a participant was being asked to put her hand in a toilet bowl and then eat a sandwich. While I disagreed with some other aspects of the Metro review, I do have some sympathy with this point, and it's one I've seen expressed elsewhere. Putting your hand into a toilet and then eating without washing first is, of course, not "normal" behaviour, and I suspect a lot of viewers will have been asking themselves why someone so completely obsessed with cleanliness was being asked to do this.

I think Fizzwhizz's suggestion that it all seemed a bit easy (a contention with which I again tend to agree) is linked to the same problem. By not showing the work that goes on before Exposure and Response Prevention, the programme left itself open to misunderstanding of the reasons for the behaviours in which the participants were being asked to engage, and did indeed make it seem like an "easy" process.

The fact is that, before any of the three were invited to expose themselves to what they were afraid of, they would have spent a great deal of time talking the problem through with their therapist. I imagine that the participants would have undergone the same assessment interview I did in the first instance to make sure that the treatment was appropriate - this takes upwards of three hours, and involves the completion of many questionnaires, and detailed discussion of symptoms and behaviour. And then, during the first part of treatment, the way in which the problem works would be discussed. The patient would work out the meanings they'd attached to their thoughts, and see how their behaviours were simply reinforcing the problem. Only once this has been worked through, and the patient gained a full understanding of the problem - and, as a result, how to fight it - would they be invited to "experiment" by facing the things of which they were afraid.

To be fair, this sort of area was occasionally touched upon - in interviews with the therapists and, in particular, when Sophie the obsessive washer phones home. She talks with her partner about having talked through how the problem works, and how her - for example - asking for reassurance simply reinforces the problem. And later, when she's talking to Wendy, she also talks about issues such as avoidance and rituals.

But, really, I feel this whole area should have been made much more explicit. That way, viewers could have understood exactly why these participants were being asked to do what they were doing, and how it helps. I think it also would have got rid of the criticism I've read elsewhere that the programme never really explained why these people had become so obsessive. The fact is that CBT does not really focus on this issue - instead (as you identified, Fizzwhizz - gold star!) it focuses on the here and now and dealing with the anxious behaviour. Again, I'm not sure this was made explicit enough.

I have to be cynical about it, and suspect that an hour talking about thought conceptualisations of OCD is less likely to attract viewers than an hour of watching a glitter-phobic spreading the stuff all over her room, or an obsessive cleaner putting her hands down the toilet. I imagine that's why the programme makers put the focus where they did, but I think it's a shame a bit more of a balance couldn't have been struck between the two areas - confronting fears, and showing the framework used to confront such fears.

I still have some hope that tonight's, concluding, show (9pm, Channel 4, everyone) will redress the balance a little, but I suspect it will be pretty much the same - the time at which most of the discussion of how the problem works is at the beginning of therapy and, obviously, these participants are now past that.

I understand that tonight's show involves each of them going home, and it will be interesting to see how that goes. I have to say that after watching the show, I am almost grateful that I lived alone during my worst OCD spells - clearly, partners, friends and relatives of sufferers have a stressful time of it, made far worse if you're living with the sufferer.

It should be noted that the partners of each of the participants were unintentionally reinforcing their OCD-spouses' behaviour. Of course, they were acting with the best of intentions, but reassurance, for example, just feeds right back into the problem.

Be interesting to see how they deal with changing their behaviours in order to best help their OCD-suffering partner. It's tough. Think about it: you see someone who's upset. What do you do? I imagine you try to reassure them. You'll say stuff like: "It'll be OK". It's human nature. We do it automatically, because we think it's the best and most comforting thing to say. Problem is that, often, it's not. Let's say you're worried about giving a speech in public. You tell a buddy this, and your buddy automatically says: "C'mon, it'll be OK". For a while, you'll probably feel better. But then perhaps you get to thinking and worrying again. How can your buddy be sure that it'll be OK? Fact is: your buddy can't be sure. And you can't be sure. You have to go out there, do your best, and take the risk.

But dropping reassurance to an upset person is really, really difficult. Quite often, when someone tells me they're worried about something, I find myself giving reassurance - and that's even knowing that it's not the best thing to do. Try it next time someone comes to you worried about something - bet ya can't do it.

That's why I was interested to hear on the show that American studies have shown good outcomes when OCD patients are treated in a group. On the one hand, I can understand the benefits of the "we're all in the same boat", and can see how patients could spur one another on to greater progress - this certainly seemed to be the case with the three sufferers in the house.

On the other, I can see that this human nature to reassure could be a problem. My Mum told me she was talking to the TV when Wendy was having a bit of a panic, telling the others not to tell her it was going to be OK, because that was reassurance, and would only make the problem worse (how well I've infected my Mum with the CBT bug). The problem is that, I think, a group of sufferers may - with the very best intentions - wind up reinforcing one another's obsessive behaviour. This is certainly why I intensely dislike the forums on the two prominent UK OCD support group sites. There's value in learning that you're not alone, but posters tend to wind up telling one another to continue engaging in obsessive behaviour - believing that this is the right thing to say. It's not.

Perhaps that's less of a problem in The House of Obsessive Compulsives, because they're all undergoing CBT at the same time and, hopefully, all changing their beliefs and behaviours at the same time. Again, it would be easier to judge that had they shown more of the work done with each participant relating to understanding the problem.

Well, that's my two cents' worth, anyway (well, probably closer to twenty two cents' worth, actually). I might have felt there could have been more on the therapy, but there's so much value in a sensitive depiction of OCD and its sufferers - and in a depicition of the dedication, expertise, and kindness of good therapists - that, all in all, I'm happy.

Do tune in again tonight if you can. If only to see whether Wendy's husband gets diagnosed with OCD himself - I loved the way that, when taking her to the house, he said: "OK, here's Number 39. I guess this must be it. We're sure it's 39?" Concrete proof we're all on an OCD continuum.

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