Monday, December 12, 2011

OCD: Life & Art

From a doctor friend:

The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.

My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice paid off.

Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.

Objectively, a reader outside of the UK would find some chapters in the book intriguing because a lot of space was devoted to explaining the jargons (statementing, section, grammar schools) and the NHS administrative systems. Of course, your need to clarify the peculiar UK background of your clinical practice is understandable.

Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang

In psychiatry, sometimes patients do not want any help. Often they positively refuse help and family members collude. At other times the “help” may not be all that good.

As a result many children grow up in very “unusual” environments. Yet we sometimes get very “unusual” outcomes as some individuals can turn such an experience into something ……well, something quite extraordinary.

Obsessional Compulsive Disorder (OCD) is one such condition that many families prefer to cope with secretly and often for many many years.

In a chapter in The Cockroach Catcher called: Who Is The Real Patient?
Wayne is a teenage boy I had been seeing because he could not face school:
“……After nine months, Wayne finally opened up to me.
Mother never threw away anything. Nothing at all!
Except wet waste, which was a relief. 

This was a serious case of OCD (Obsessional Compulsive Disorder). It was still a great shock to have the full extent of the things that were kept detailed to you. Even a five bedroom house soon ran out of space.

Wayne told me that as far as he knew, mother had always been reluctant to throw away anything but it seemed to get out of control about five years ago when she discovered that father kept a woman in a port in the Far East. She moved out of the master bed-room and the rubbish moved in. Everything was neatly put in big rubbish bags and properly tied up. Some were in apple or other supermarket boxes. Even vacuum cleaner bags were kept.

Mother did a good job of it so that there was no bad smell at all, Wayne would reassure me. Just no space.

All these months, I had been thinking that the bullying was the cause of Wayne’s problem. Did I get it wrong? All the time I spent trying to improve his self esteem, was it time wasted? Was there something I could have done earlier? Why did he take nine months?

Perhaps he needed that time to find out if I was going to send his mother to an asylum. Perhaps he needed all that time to trust me enough to talk about the sickest person in the family. Perhaps he never had any plan but the secret just came out.

Perhaps these were all valid explanations, but what could we as a clinic do?”
                                                                     Chapter 19 The Cockroach Catcher

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang
Recently, I visited The Museum Of Modern Art ( MOMA) in New York and saw something that reminded me of my patient’s mother.
Mr. Song Dong is the artist and his mother is called Ms. Zhao.
Here is a write up in The New York Times:
“Mr. Song was born in Beijing in 1966, on the very eve of the Cultural Revolution, a period of ideological danger and economic want. His mother came from a wealthy family that lost everything after one of its members was jailed as an anti-Communist spy. His father, trained as an engineer, spent seven years in forced labor after being accused of counterrevolutionary activity.
“When Mr. Song’s father died, in 2002, his mother was inconsolable. She continued to live in the jammed Beijing house, throwing nothing away and obsessively bringing more stuff into it, as if continuing to feather a nest for a now-absent family. And despite the threatened destruction of the surrounding area, she would make no move that entailed parting with her possessions.
“Finally, in 2005, Mr. Song proposed that they turn the accumulated junk into an art project. In this way, he argued, nothing would be discarded and lost; everything would be meaningfully recycled and preserved. His mother agreed to this and together, with the help of Ms. Yin and Mr. Song’s sister, Song Hui, they emptied the premises.

Waste Not: Projects 90 MOMA /©2009 Am Ang Zhang
“Seen in the museum’s immaculate surroundings…….it is disturbing to imagine anyone growing up, as Mr. Song did, in so smothering a physical environment. Finally, it is deeply moving to see the span of one person’s life — his mother’s — summed up, monument style, in a work of art that is every bit as much about loss as it is about muchness.
“And five years after the piece was conceived……..mother agreed to collaborate with her son, empty her home and effectively let go of her past, she moved into the more manageable setting of a Beijing apartment near a park, where she died last winter after falling from a step ladder while trying to rescue a wounded bird in a tree.”
Life could be cruel.
Waste Not: Projects 90: Song Dong
June 24, 2009–September 7, 2009
The Donald B. and Catherine C. Marron Atrium

The book is free too.
NHS: The Way We Were! Free!
FREE eBook: Just drop me a line with your email.

Email: cockroachcatcher (at) gmail (dot) com.

The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

Dr Zhang had a common sense approach to the children in his care, intuitively finding the answer to their problems, cases ranging from sleep and toileting problems to those of anorexia, autism and psychosis - although towards the end of his career, red tape and ‘guidelines’ were to impact on his practice.

His book also gives insight as to how we as parents may influence the mental health of our children and how childhood is being medicalised when behaviours are due to lack of parental authority and/or guidance and are not psychiatric illness at all.

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