As Melbourne descends into COVID-19 lockdown, Steph Amir sees the lines blurring between mental health and illness.
‘The medical establishment is trolling me,’ my friend Josh says with a groan. It is mid-March 2020 and we are scrolling through Facebook feeds full of articles featuring desperate plea from doctors, epidemiologists and government officials: Wash your hands! Don’t touch surfaces that might be contaminated! Stay home if you’re sick!
Given the rising rates of COVID-19 around the world, it is excellent advice. It was also the exact opposite of what he and I have been told in the preceding months and years. Doctors, psychologists, books, podcasts and online learning modules all had similar messages: stop washing your hands; touch those public bathroom doors with your bare skin; and if you start to worry about a sickly-looking colleague, stay right there next to them.
It’s called Exposure-Response Prevention and is standard practice for the treatment of people with obsessive-compulsive disorder (OCD).
The seminal and arguably most popular guide for managing OCD is a book called ‘Brain Lock’ by American psychiatrist Jeffrey Schwartz. In it, Schwartz explains that rigorous handwashing and other compulsions have no value. Among other things he describes them as false, inappropriate, bizarre, senseless, irrational, abnormal, worthless, foolish and silly.
Other books about OCD treatment make similar claims, with some authors explaining that even the patients themselves usually know that behaviours like frequent and rigorous handwashing make no sense. The bible of psychiatry—the DSM-5—specifies that practitioners should differentiate between OCD patients who have ‘good or fair insight’ and those with ‘absent insight or delusional beliefs’. Presumably for those with an obsession around contamination, a patient in the former category may agree that their determined handwashing is unfounded, while someone in the latter may say that their careful handwashing is perfectly fine, thank you very much.
And yet here we are, being strictly instructed to wash our hands for at least twenty seconds, all the way to our wrists, with warm water and soap. The Premier of Victoria suggests singing the first verse of ‘Dancing Queen’ by ABBA to ourselves to get the timing right.
It makes me wonder: if less than twenty seconds is insufficient, at what point does the washing of hands become inappropriate, bizarre, abnormal or silly? Thirty seconds? Sixty? It’s not a rhetorical question for someone working hard to fight the monster that OCD can become. It’s a very real decision that must be made to balance the risk of physical illness with the risk of increased mental illness symptoms, because once someone with OCD becomes accustomed to a particular ritual, it can be very difficult to stop.
The next week in an office bathroom I watch someone lather their hands into a frenzy, and this sign of crisis unexpectedly makes me feel comforted, knowing that the doors of public bathrooms are a bit less disgusting during the pandemic than they usually are.
It’s an odd experience to transition from being stuck in my own individual world of fear to suddenly being part of a fearful crowd. Pressing buttons for the lifts with my knuckle and for pedestrian lights with my elbow is no longer unusual because everyone else is doing the same. Suddenly others are seeing the world as I do, and avoiding the same things: cash, handshakes, crowded trains. They are horrified to realise that if they use their phone with potentially contaminated hands, then wash their hands carefully, they can’t touch their phone again without getting potentially re-contaminated. Welcome to my world.
When my OCD was at its worst, I’d become angry at all the ways that day-to-day life required people to put themselves at risk. ‘What kind of masochist invented networking functions?!’ I once ranted to my therapist. ‘You’re expected to shake everyone’s hand and then eat canapes! Whyyyyy?!’
This kind of anger sometimes led to fantasies of all the contagion-prevention measures I’d take if social convention allowed, and how clean and safe everything would be. Yet reality is brought into focus as I take my daughter to the library and the swimming pool for the last time before council services close across Melbourne. Both were places that have made me feel fearful in the past as I imagined all the sticky fingers touching the books and sweaty bodies in the pool before me, but faced with the reality of my OCD-dream coming true, I desperately mourn the loss of these places. I make a promise to the atheist gods that when the COVID-19 pandemic passes and public places re-opened, I won’t let my fear overshadow the joy of public libraries and swimming pools ever again.
Most people with OCD work hard to present as ‘normal’, hiding their compulsions and staying silent about their obsessions for fear of judgement or discrimination, so it’s hard not to smile at the irony when people ask if I’ve washed my hands, or express concern that I’m not being cautious enough.
As we enter lockdown, I overhear snippets of conversations as I pass people on my daily walk. They discuss whether it’s necessary to disinfect groceries, how long it’s safe to share a room with someone before they could breathe enough to infect you, agreeing that churches are safer than gyms but what about schools?
The constant assessment of risk is a big part of OCD, as is frantically seeking information in the hope it will provide reassurance that everything will be okay. I think of this as I attend yet another meeting on Zoom with the window slightly minimised so that I can keep pressing ‘refresh’ on The Guardian live updates page to see the daily tally of new cases as soon as it’s published. ‘278’ my colleague says suddenly, looking up from her phone. My screen refreshes to report 278 new cases.
I’m not the only one lying awake at night, my mind reeling. News articles report that anxiety is on the rise, and by July the weight of extended lockdown in Melbourne is driving people to breaking point. A woman I’ve never met calls me about a routine administrative matter then mentions her children and bursts into tears. ‘I’m just so tired, Steph,’ she sobs. ‘It’s too hard having to work and home-school every day. I don’t know how to go on.’
It’s the second time in two weeks that a stranger has cried to me on the phone and it pushes me towards action, checking in more vigilantly on my friends and family. I share resources and stories, and gently guide people with anxiety symptoms towards professional supports. I notice some friends do the same, especially those with experience of mental illness. The chronic fear caused by uncertainty—and the shock at the many ways that it can impact a person’s mind, body, and day-to-day life—is new to many people this year, but not to those who were living with illnesses like anxiety or OCD before COVID-19 emerged. The tricks and tools we’ve learnt and developed turn out to be quite useful in a global pandemic.
I also lie awake and think about all the things I will do when the pandemic is over. I think about going to concerts and hugging my friends and hanging out in other people’s lounge-rooms. This pandemic highlighted to us all the extent to which humans—including myself—crave physical proximity. Most of us need human touch and connection. We want to be part of a roaring crowd. We want to run or sing or dance together.
In September, my partner is horribly sick for weeks so I’m trying to look after her fulltime while juggling two jobs and solo-parenting our three-year-old with limited access to childcare in Stage 4 lockdown. I don’t have to worry much about contamination because we’re barely allowed to leave the house anyway, but the stress and sheer volume of work causes OCD symptoms to manifest in the form of frightening, violent or disgusting images flashing in my mind’s eye (referred to by psychologists as ‘intrusive thoughts’). Meanwhile, friends and family from Sydney and Canberra share idyllic photos of holidays and brunch dates.
The clinically-proven strategy to reduce the impact of intrusive OCD thoughts is to accept them rather than trying to stop them, but I’m too tired to follow the recommended approach, so I ignore the tiger snake slithering through my thoughts and distract myself with work. In my Facebook feed, people across Melbourne make a similar choice, telling interstaters to quit it with their sunny cheerfulness, and then clocking up their twelfth hour of screen-time that day to binge-watch something on Netflix or attend an online event. Self-improvement will have to wait; we’re too busy trying to survive.
Now it’s early October and restrictions in Melbourne are slowly being eased. We can sit in a park, with our masked faces turned towards the sunshine, or a friend 1.5m away. I could go for a swim if my local pool wasn’t booked out completely every day.
Public toilets still have signs about handwashing, installed in March or April, but they now seem archaic. But when we all return to offices, restaurants, cinemas and yoga classes—and when the vaccine arrives and the risk of COVID-19 fades—will everyone return to their former habits, leaving OCD-folk alone in the bathroom to wash their hands for the full twenty seconds, thirty or sixty seconds? Or will some people retain a preference for avoiding cash, handshakes and crowded trains? Are they ‘abnormal’ too, or rationally taking steps to reduce the risk of future illnesses? The answer is of course subjective, variable across time and place, and in a constant state of flux.
We don’t yet know when the pandemic will end, but in the interim I’ll try to keep my handwashing within the normal-for-a-pandemic range. ‘See that girl, watch that scene, digging the dancing queen …’
Steph Amir is a current social scientist and former politician, zoologist and nachos-seller. She has been actively involved in the LGBTIQ community for many years including as a radio presenter and on the Board of Directors at JOY 94.9, Program Manager for Safe Schools Coalition Australia, inaugural Co-Convenor of Queer Greens Victoria, and Chair of the Sex, Sexuality and Gender Diversity community advisory committee at the City of Darebin. Steph’s writing has previously been published in Bent Street, Archer and Melbourne City of Literature.