My unmarried sister in law, age 39 has OCD. A primary school teacher, she obsesses over cleanliness, she won’t use certain utensils as they are 'dirty', or touch anything that is 'dirty'. She won’t eat food unless its cooked on a particular gas burner. Someone passed faeces outside their house years back, now anyone who walks through that spot is 'dirty'. As a family they are overly argumentative and most conversations end as argument some minor some not!
When my wife was pregnant about 9 years ago, both my mother in law and sister in law got into arguments with my wife who had just delivered. Probably hormones could be to blame as well. The parents are desperate but she refuses to see professionals. Instead she finds fault with them, argues, and locks herself in her room. Some days she hardly eats and drinks some glucose or something to get energy. I need advice on how to manage the situation and ensure that she gets the help she needs.
Expert advice –
First of all, I would like to appreciate you for taking a step to help you sister-in-law. It seems that your sister-in-law has an inability to tolerate dirty things. OCD generally suggests that the person feels obsession for perfection. This could have come from her career because a teacher specifically in Indian culture, one is trained to check for right and wrong behaviors. We appreciate right behavior and punish the wrong one. In such situation, she has been in a place of authority, where she can use her own idea of judgement. This could be one of the major reasons for her rigid beliefs of what is ‘pure’ and what is ‘impure’.She may not have learnt to take someone else’s views. Also there could be various other reasons that could have supported to develop her OCD over cleanliness like past childhood experiences, strict parenting.
As you mentioned that the family is overly argumentative in most of the cases. Here it is clear that there is less supportive environment for her. But in her case, one needs to understand her ideas and experience of cleanliness and impurity. You also wrote that she is not willing to take professional help. If this is the case, you can negotiate. Ask her to write a long list (or essay) on unclean things related to human that would make herself clear on her own definition of “What does unclean/ impurity mean to her?” She needs to be made aware that what is that actually fear of having her house dirty?
Discuss with her along with your own opinion in this topic. Perhaps her close friend whom she trusts can help her for this assignment. Once she gets that idea and be clear to herself she might get the idea that her rigid belief is making her life difficult. She needs to understand different perspective and once she feels that her rigidity is hampering her daily functioning and seriously impacting the life of other members in her family. When she feels comfortable to have open discussion in this issue, she could be ready to seek help.
I also see that with all these arguments going on, she might be stressed out. Thus I would also like to say that practicing some relaxation exercises and listening to soothing and peaceful music before starting her day would help her remain calm. It would also help her to get distracted from her compulsive thoughts of cleanliness. One thing for sure is that she needs to break the routine of cleaning. For that to begin she can do the activities she enjoys for example listening to music could be one that shifts her focus towards herself rather than cleaning.
She also needs to understand the fact that her fear on contamination hasn’t reduced despite her intense cleanliness. Most of the time the person with OCD feels that fear of contamination doesnot decrease even after intense cleaning. Thus she could realize that her efforts are not rational.
In her case, the family has to be extra patient around her and try to help her view the larger picture of every argument. Once she has the realization of rational and irrational thoughts and behavior, she could help herself.
- Tara Adhikari