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OCD is linked to an imbalance of a chemical in the body and therefore can be chemically addressed. The name of the chemical is serotonin, which regulates nerve impulses as they surge through our system. When there is insufficient secretion of serotonin, it increases the likelihood that a person will give in to repetitive behaviour. • Since circumstances of life — stress, emotional deprivation, an uncontrolled desire to succeed — can exacerbate the disorder, it is best treated with both drug and behavioural therapy. • The most widely used medications for the treatment of the disorder are antidepressant drugs (medically called Selective Seratonin Reuptake Inhibitors or SSRIs). • Behavioural therapy (applied when the action is performed involuntarily, for instance, washing one’s hands too often) and cognitive behavioural therapy (applied when the behaviour is governed by a painful thought and the patient assumes that his repeated action will prevent the thought from haunting him) are often used in conjunction with drug therapy to treat and alleviate some of the symptoms of OCD. • Behavioural therapy often uses the “exposure and response prevention” technique. In this technique, a patient is deliberately and voluntarily exposed to the cause of his obsession, and is then taught ways to avoid performing the activity brought on by that exposure. One patient obsessed with cleanliness, for instance, was asked to place his hands inside mud and count to 100. This technique, supported with medication, cured him of his obsession. Vishnupriya Sengupta

Strange obsessions: Tabu, who plays Nimmi, a character inspired by Lady Macbeth, in the film Maqbool Have you ever caught yourself spending longer hours in the washroom than the rest of your family, believing your hygiene isn’t good enough? Turning switches off and on because you fear that if you don’t, some terrible fate will visit you? Gone over tasks endlessly because you don’t think you’ll ever get them right? Beware, you may be sharing the fate of Rajiv Basu.

Six years ago, 32-year-old Basu joined a multinational company and was posted in the North-east — where the company virtually had no presence — as head of the regional sales division. A bachelor, Basu worked hard at his job. Within a couple of years, the sales shot up by more than 500 per cent. He got a promotion, was told to shift base to Calcutta and take over the reins of the loss-making unit here. In Calcutta, stiff competition and an apathetic bunch of subordinates added to his pressure to perform.

Gradually, he began to doubt his own abilities and competence level, began to check and recheck reports, calculate figures repetitively and ended up as an object of ridicule. Basu, on his part, hardly realised anything was wrong. He was working hard, wasn’t he? If he wasn’t, he’d be fired, wouldn’t he?

It was only when he found himself doing things at home in an equally obsessive fashion — checking over and over again to see if he had locked the door or turned off the bathroom tap — that he decided to seek psychiatric help.

He was diagnosed with obsessive compulsive disorder (OCD) — a condition characterised by recurring thoughts and impulses that invade one’s mind despite attempts to suppress them, and a compulsive need for action which apparently (though only temporarily) relieves a person of the discomfort associated with those thoughts.

“In Basu’s case, the pressure and demands of his work — that is the environmental factors — had triggered off his problem. But on probing further, I realised he had shown mild symptoms of the disorder when he was a teenager,” says psychiatrist Dr Aniruddha Deb, attached with Mon, a psychiatric nursing home in Calcutta.

Deb discovered that the young Basu used to write out entire answers to question papers without ever dotting the ‘i’ or crossing the ‘t’. Later, he would painstakingly use a ruler to cross the ‘t’ and measure to see that the subsequent dots he added were in the same line. But since his near-insane perfectionism had no ill effect on his studies, his family ignored the symptoms of a disorder they didn’t know existed.

“However, under stress, there was a change in the nature of the symptoms and the disorder surfaced acutely,” says Deb. It is common, therefore, for an individual not to be aware he has the disorder till he is effectively pushed over the edge.

What is even more discomfiting to know is that we are, all of us, obsessively compulsive to a degree. “These symptoms are discretely present in every individual,” says Dr Ashim Chatterjee, a consultant psychiatrist in Calcutta, “but within limits of social acceptability. For instance, it is only natural to double-check and see whether the door is locked or the tap turned off. But when it crosses the point of relevance, it enters the zone of morbidity and is manifested as a disease.” Chatterjee attributes this increased rate of manifestation to modern-day stress, the pressures to keep up in the rat race and a dipping tolerance level.

Over the past five years, say psychiatrists in Delhi, Mumbai, Calcutta and Bangalore, the number of those suffering from OCD has increased drastically. “I now treat three to four patients everyday,” says Dr Yusuf Matcheswalla, who runs a clinic at Mumbai’s Masina Hospital. While that does not exactly constitute an epidemic of flu proportions, it is a significant number.

In Bangalore, Dr Ali Khwaja, who runs the Banjara Academy, says, “In 2002, the centre got 15 cases of OCD. Last year, this went up to 120.” At Nimhans in Bangalore, the figures are equally grim: the number of OCD patients in the Out Patient Department has gone up by 30 to 40 per cent, points out Dr Mohan Issac, professor of psychiatry. And at a conference on OCD awareness organised by the Institute of Psychological Health in Thane, Mumbai, last year, of the 100 OCD patients, it was observed that 55 had already undergone treatment.

Only two decades ago, persons with OCD would probably have been called just “weird”. Literature even singled them out to dramatic effect. Agatha Christie’s creation, detective Hercule Poirot — who wouldn’t eat eggs unless they were of the same size — was seen as only a lovable and extremely gifted sleuth.

Another fictional (and earlier) compulsive, Shakespeare’s Lady Macbeth, washed and perfumed her hands repeatedly to rid them of the stain and scent of blood, in the only scene in the play to depict her sympathetically.

But while murder is hardly the history behind all obsessive compulsives, it is a fact that guilt is sometimes the aggravation.

“Today the guilt stems more from an extra-marital affair or not being able to live up to one’s parents’ expectations,” says psychoanalyst and head of the department of pure psychology, University of Calcutta, Dr Nilanjana Sanyal.

Not that people with success stories have been spared, either. Legendary movie producer, aviator and billionaire Howard Hughes was obsessed with avoiding germs. He devised a system of “insulations” of paper towels and tissues for protection and demanded that everything be brought to him wrapped in these materials. He also insisted that doors and windows be sealed to prevent germs from entering his home. Ultimately, Hughes was overwhelmed by his disorder and ended his life in filth and neglect.

That was then. All that has changed over the past decade. Now, those plagued by such inner demons can live a more or less normal life, provided they take their pills and undergo behaviour therapy. For those who, like Jack Nicholson’s character in As Good As It Gets, are obsessed with the locks on their door, or, closer home, like the killer-adultress Urmila on Zee TV’s popular serial Astitva: Ek Prem Kahani, focus on the cleanliness of their feet, there is hope.

“It is true that increased awareness about the disorder has resulted in the rise in the number of people coming in for treatment,” points out Dr Anand Nadkarni, director of the Institute of Psychological Health, Thane.

There are other reasons as well. “In today’s performance-oriented society, we have become far more individualistic,” explains Dr Chatterjee. “No go-getter can compromise on his or her performance level. That is the reason why those in their 20s and 30s seek psychiatric help as the disorder can be treated and hence controlled. Besides, in nuclear families, one can’t afford to be a stickler for excessive neatness or cleanliness. The shuchibayu syndrome (compelling people to wash frequently) which was once a socially acceptable way of life is now considered a menace in a modern household. In fact, there are some people with OCD who insist on roaming around in the nude at home — because they regard clothes as contaminants. Their condition can obviously no longer be tolerated or ignored by families.”

Nor are they consigned to lunatic hell. Compulsives can live normal lives. Elaborating on the profile of such patients, Dr Matcheswalla says, “Usually, such people are intelligent, educated and do well in life except that at times their obsession becomes somewhat irritating.” This is when recognition of the disorder by colleagues and, more especially, by family at home becomes crucial to the cure. “The absence of emotional support or the feeling that one has not excelled in something contributes to the sense of insecurity and can precipitate OCD,” says Dr S. Dutta Ray, a consultant psychiatrist in New Delhi.

Thirty-year-old Harshita Bajoria, a nurse who suffers from OCD, doesn’t look visibly dysfunctional. She discharges her duties efficiently. But whenever she has a problem with her seniors and feels the consequent tension, the OCD symptoms surface. “I start muttering to myself, occasionally frowning, and people naturally find that queer. Unwanted thoughts come to my mind, thoughts which are illogical and which, I realise, are of my own creation. But I can’t help myself. In the past, I used to keep turning on and off the tap for hours on end, believing that I would be rid of the abnormality. But now that I am under medication, things have improved.”

As they did in Preeti Kejriwal’s case. She was studying medicine at a top Karnataka college. Although medicine had not been her career choice, she had enrolled under parental pressure. But Preeti was unable to perform in college. Her scores dipped and she became a recluse.

“She found it difficult to socialise,” says Dr Khwaja. Preeti began to develop OCD symptoms. She could not sit still if anything was out of place in her room. This resulted in squabbles with her roommates in the hostel. Strangely, she also became obsessed with her bindi. She had a constant feeling that it was crooked and she couldn’t resist looking at a mirror to check that it wasn’t. Preeti was referred to the Banjara Academy in Bangalore last year and has since then shown improvement.

An anaesthetist working with Dr Matcheswalla is another case in point. He has a minor OCD problem. He repeatedly checks medical procedures his work demands of him, believing that will help prevent any lapses. Dr Matcheswalla says in his defence, “It can be irritating for others and at times time-consuming, but it doesn’t harm anyone.”

No one, that is, except the person suffering from it. As nurse Harshita emphasises, “This is the loneliest of all disorders. You know what the problem is, are in touch with reality but are helpless. You still believe you can get rid of the disturbing thoughts by repeating a particular action. There is no way you can control your mind. It’s like being possessed by the devil.” And that’s as bad as it gets.