THE CASE OF A JUNIOR MEDICAL DOCTOR WHO COMMITTED SUICIDE

While I was scrolling down and trying to keep abreast of the latest newsfeed on social media, I accidentally came across reading one intriguing article which literally piqued my interest and it sort of evoked my instant recollections of the two prominent musicians (Chris Cornell of Audioslave & Chester Bennington of Linkin Park) who had a prolonged history of struggling with chronic depression throughout their lives. It was about the ongoing case of a junior medical doctor who worked at the Queen Elizabeth Hospital in Birmingham (England) named "Dr. Vaishnavi Kumar" where she was reported to have committed suicide in June 2022 due to the severe effect of toxicity at her workplace, and her father has been relentlessly demanding an utter justice for her daughter’s untimely death since then.

To certain people out there, addressing the so-called "Mental Health Disorder" may still appear to be something taboo and inconvenient to be discussed openly, yet, many of us often times possess a tendency to underestimate or even dismiss the crucial impact of the role that mental health plays in our lives, especially from the aspects of dealing with our day-to-day routines. Besides, one of the most contributing factors which tend to escalate such a high degree of employee turnover in any industries is associated with the amount of conduciveness inflicted by a work environment. In other words, the more toxic the cultivation of corporate culture manifested in an organization, the more frequent the replacement of hiring new recruits will take place in a matter of days.

To begin with, the aforementioned case of a young medical doctor’s sudden death and its aftermath was among a series of solemn issues subject to the six-week rapid review led by Professor Mike Bewick following a perpetual sequence of damning allegations which was aired on BBC Newsnight in June 2022. According to one particular source of information retrieved, it was stated that the female Indian doctor decided to take her own life after feeling "belittled" at her workplace, which was perceived as the type of bullying case for us to be concerned with since it could trigger a never-ending episode of mental health struggles to the point where the victim would end up committing suicide. In reference to the additional details of her impromptu demise, it was further revealed that when she felt overwhelmingly distressed by the unpleasant work ambiance at a hospital she worked, a lethal cocktail of medication was identified to be the primary cause which was something she consumed and eventually, a group of ambulance team failed to rescue her as she took her last breath at City Hospital on June 22^nd 2022.

Obviously, the above incident pertaining to a mental health problem could immediately prompt our eye brows to start questioning how such an impact of toxic workplace in the most extreme case can inflict a profound severity on a person’s mental health condition; resulting in an innocent soul to be in a dire state of suffering from suicidal thoughts. Nevertheless, following the audacity of decision to end her life in June 2022, the junior medical doctor was also found to have left pieces of final words on a note she wrote, in which she went saying that "she was sorry to her dearest beloved mother, and she could blame the whole thing on the Queen Elizabeth Hospital, Birmingham" (an exact location where her dead body was discovered following her drug prescriptions with an excessive amount of alcohol consumed as the ultimate consequence of her mental health struggle, which stemmed from the adverse effect of her workplace toxicity).

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GENERAL OVERVIEW OF OCD (CHAPTER 1)

EXAMPLE OF CASE STUDY 1: "Tom worried about being responsible for bad things that could happen. He worried about leaving the stove on which could cause a fire, or hitting someone with his car. He spent all day repeatedly checking every action he did just to ensure that he hadn‘t done something wrong or harmful. Besides, he would circle back in his car to check if he had hit someone and rechecked his locks over and over again at home to make him feel a sense of reassurance that the doors were locked. Eventually, he decided to avoid using his oven fearing that he might forget to turn it off".

EXAMPLE OF CASE STUDY 2: "Gigi had an obsession of causing harm to others through some unintentional act. She worried that she might end up hurting someone with her sloppy or offensive words and would cause the person (him or her) to feel solemnly upset. Or, she was anxious that she might have forgotten to put off a cigarette that would burn her entire house which could wipe out the whole of her neighbourhood. As a result, this had caused her to check things more than once before she left her house and most likely would return to her house again to make sure everything was fine".

Okay, you have seen those two different case studies illustrated. So, what do you think it is? I mean what exactly the kind of mental health issue that those two people had in common? In case if you have never heard of this mental disease so-called "OCD", this is something that those two individuals possessed in common. Yes, it is the type of intrusive thoughts and repetitive behaviours which relentlessly loomed over their mind; causing them to feel an extreme degree of anxiety to redo the actions over and over.

To kick start with the above subject, "OCD – Obsessive Compulsive Disorder" is an anxiety disorder characterised by repeated unwanted thoughts (obsessions) and repetitive behaviours (compulsions) which are difficult to control. As you probably notice, there are two key words contained in the sickness name – Obsessive and Compulsive. So, the key features lies within OCD are obsessions (being obsessive) and compulsions (being compulsive). Perhaps, most people can have both, yet, for some others, it may not be the case as in they probably have only one or the other.

Obsessive compulsive disorder (OCD) is a common anxiety disorder where up to 750 000 people (12 out of every 1000) in the UK are impacted regardless of age, gender, or cultural background. What’s more, it is believed that up to 25% of cases remain undiagnosed by the age of 30. Obsessive-compulsive disorder (OCD) is a severe and debilitating mental illness which affects roughly around two per cent of population. As this mental illness does exist across the world and it even affects women at a slightly higher rate than men in adulthood, its symptoms normally begin in a gradual state and about a quarter of people with OCD start to develop the disorder in their early adolescence.

Furthermore, OCD is not a personality quirk or character trait. The fact that everyone has their own intrusive thoughts, some studies have shown that there is no difference between OCD suffers and other people in the types of random thoughts they possess, nor is there any difference in the frequency for which these random intrusions tend to occur in the first place. However, there is a fundamental difference in the way that OCD sufferers respond to their thinking and misinterpret their intrusions, and it is exactly this pattern of misunderstanding that inevitably leads to the thoughts of becoming stuck and very disturbing.

Obsessions are thoughts, images, or urges. They can feel intrusive, repetitive, and distressing while Compulsions on the other hand are "repetitive behaviours" which a person does to relieve the distress they feel because of the obsessions. When a person is preoccupied with these thoughts and is unable to control the thoughts, get rid of them or even ignore them, they may be regarded as obsessions. For the record, obsessions are usually unrealistic and do not make any sense. As they often do not fit with one’s personality, they can be unacceptable or can be felt disgusted to the person who has them.

Last but not least, obsessions in general cause distress, and they are usually in the form of anxiety. People with obsessive thoughts, in some cases, will often try to reduce the amount of their distress by acting out certain behaviours, known as "rituals" or the so-called compulsions. While most people have preferred ways of doing certain things (e.g. a morning coffee routine, arranging items on a desk), people with OCD feel the sense of urgency that they "must" perform their compulsions (behaviours) and find it nearly impossible to cease. Sometimes, people with OCD are fully aware of the fact that their compulsion is senseless. However, he or she feels helpless to stop doing it and may need to repeat the compulsion over and over again which is why it is described as a ritual.

Some common examples of the so-called rituals (compulsions) include excessive washing and checking things, or counting, repeating certain words, praying, etc. While compulsions often help relieve distress in the short-term, however, they do not seem to be handful in the long- term. As a person with OCD gets used to doing the same thing over and over, the rituals become less helpful at reducing his or her anxiety. And, in order to make them more effective, the person may perform the rituals more frequently or even for a longer period of time. Hence, this is the reason why people with OCD can appear to be "stuck" doing the same thing excessively. In any case, those who struggle with OCD may find themselves feeling isolated and misunderstood as if they are trapped somewhere in a sand dune.

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TRIGGERING FACTORS AND COMMON SYMPTOMS OF OCD (CHAPTER 2)

Before delving into discussing what are the common symptoms and triggering factors of OCD, let’s have a look at the diagram below in order to better identify how OCD can persistently manifest in people who suffer from it.

As you can see from the above diagram, obsessions often take the repetitive form, persistent ideas, thoughts, images, or impulses that are experienced as distressing. Generally, people attempt to resist thinking of the obsession and get rid of the thoughts. However, as people strive to resist, the intrusion persists. Compulsions, on the other hand, are repeated patterns of behaviours or actions used to reduce anxiety and prevent an outcome following a strong urge or pressure to do so (they are sometimes known as neutralising). This is because people with OCD, in general, often feel deceived into believing that compulsive behaviours can affect or "fix" the issues. Although they are rarely related to outcomes and have no impact, however, the risk of merely not performing them is too great. In short, OCD is a mental health adversity in which intrusive thoughts are misrepresented as warning signals and such misrepresentation can cause anxiety to a person who may try to avoid or neutralise them by engaging themselves in their obsessive behaviours.

TRIGGERING FACTORS OF OCD

Obviously, there are a number of different ideas which may all have some contribution to make in understanding the problems of OCD. Despite considerable research into the possible causes of OCD, however, no clear answer has emerged. As with most psychiatric conditions, different factors may be involved. Whatever it is, the most we can say at present is that OCD appears to be caused by a combination of psychological and biological factors.

1. Genetic Factors

Sadly, OCD often seems to run in families. In fact, almost half of all cases show a familial pattern. Research studies on families of people with OCD, as well as data from national health registries indicate that first-, second-, and third-degree relatives of people with OCD possess a greater chance of developing the illness compared to someone with no family history of the disorder. Additionally, when a medical disorder runs in families, it can be due either to genes that are passed on (hereditary) or to shared environment (taught by one family member to another). In the case of people with OCD, for instance, it is believed that genetic factors play a key role in the tendency to cultivate obsessions and compulsions. The evidence for this belief derives from twin studies, which show that if one twin has OCD, the other twin is far more likely to develop the disorder if they are 100% identical twins than if they are fraternal twins who share about 50 per cent of genetics.

2. Behavioural Theory

The behavioural theory suggests that people with OCD associate themselves certain objects or situations with fear, and learn to avoid the things that they are afraid of to perform rituals which may help reduce the fear. This pattern of fear and avoidance or ritual, in fact, may begin when people are under periods of high emotional stress, such as starting a new job or ending a relationship. At such times, we are more vulnerable to fear and anxiety.

Often, when things are regarded as "neutral", people may begin to bring on their feelings of fear. For example, a person who has always been able to use public toilets may, when they are under stress, make a connection between the toilet seat and a fear of catching an illness. Needless to say, once a connection between an object and the feeling of fear becomes established, people with OCD avoid the things they fear, rather than confronting or tolerating the fear.

So, that is one example to illustrate the behavioural theory. Another example could be of a person who fears catching an illness from public toilets will avoid using them. When forced to use a public toilet, he or she will perform elaborate cleaning rituals, such as cleaning the toilet seat, cleaning the door handles or following a detailed washing procedure. Because these actions temporarily reduce the level of fear, something that the person is afraid of will never be challenged and dealt with, and the behaviour is ultimately reinforced. In any case, the association of their so-called "fear" may spread to other objects, such as public sinks and showers.

3. Biochemical Factors

In the biochemical factors, the theories assume that there is some chemical imbalance or other irregularity in the brain of OCD sufferers that is associated with their disorder. Research in this area is relatively new and still has a long way to go before anything certain can be concluded. However, there is a more consistent body of evidence which has identified a particular brain chemical called Serotonin, which may be related to OCD problems.

There is also evidence which argues that there could be an abnormality in the transmission of information via some serotonin neuronal pathways. The precise nature of this problem is unclear. However, some patients with OCD respond to medication that increases the Serotonin available within the brain. There are many people with obsessional problems identify a relationship between their mood and their obsessions. Feeling stressed, low or exhausted can often be associated with a worsening of symptoms. For example, women often find their OCD problems are worse just before menstruation and they may report an increased difficulty at resisting their compulsive behaviours.

Meanwhile, some research proposes that there is a direct association between swings in mood and the development of obsessions. This theory suggests that whenever our mood changes dramatically, we become more susceptible to developing obsessional problems. Perhaps, a good example of this is the behaviour of some students at examination time. The usual response to exams is a change in mood towards becoming more anxious. This is similar to the situation in which we can develop unusual behaviours, such as becoming more particular about our routines or the things that we eat, or we desire to have a lucky charm with us during the examination, etc. Although these behaviours in most of us do not amount to clinical problems, however, they do suggest that mood may have an essential part to play in developing and maintaining OCD which is closely linked to the brain functioning.

4. Cognitive Theory

The cognitive theory focuses on how people with ocd misinterpret their thoughts. Most people have intrusive or uninvited thoughts similar to those reported by people with OCD. For example, parents under stress from caring for an infant may have an intrusive thought of harming the infant. While most people would be able to shrug off such a disturbing thought, individuals who are prone to developing OCD might exaggerate the importance of their thoughts and respond as if they represent an actual threat.

Moreover, people who come to fear their own thoughts usually attempt to neutralize feelings that arise from their thoughts. One way they do this is by avoiding situations that might spark such thoughts. In the cognitive theory, it is suggested that as long as people interpret intrusive thoughts as catastrophic, and as long as they continue to believe that such thinking holds the truth, they will continue to feel distressed and practise avoidance or ritual behaviours. What’s more, people who attach exaggerated danger to their thoughts are very much inclined to do so because of the false beliefs learned earlier in their life. At this point, researchers perceive the following beliefs may appear to be important in the development and maintenance of such obsessions as "exaggerated responsibility" or the belief that one is responsible for preventing misfortune or harm to others.

COMMON SYMPTOMS OF OCD

People with OCD often experience feelings of intense shame about their need to carry out these compulsions. These feelings of shame, in fact, can exacerbate the problem further. Shame and the consequent secrecy associated with OCD, often times, lead to a delay in diagnosis and treatment. Besides, it can also result in social disability (e.g. children failing to attend school or adults becoming housebound). That being said, a person may have OCD if he or she:

1. Has recurrent, persistent and unwanted thoughts, impulses or images (obsessions) that cause distress, as these are not just excessive worries about daily life.

2. Performs repetitive, often seemingly purposeful, ritualistic behaviours (compulsions) in order to reduce distress or neutralise the thoughts.

Additionally, obsessions whether they are thoughts, ideas or images and compulsions share the following features:

a. Repetitive and unpleasant with at least one obsession or compulsion recognised as excessive or unreasonable.

b. Persisting symptoms for at least one hour a day or significantly interfering with normal functioning.

c. Although the person tries to resist them, however, at least one obsession or compulsion is not resisted.

d. The obsessions or compulsions cause distress or interfere with the person’s day-to-day functioning (e.g. work, social life, school, and so forth).

e. The person considers that the obsessions and compulsions do not occur exclusively within an episode of depression.

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OCD AND CLINICAL DEPRESSION (CHAPTER 3)

The fact that most people go through periods of distress at certain times is inevitable. For example, when you are depressed, you feel persistently upset for weeks or even months rather than just for a couple of days. Perhaps, some people tend to view depression as something trivial and not a genuine health condition that they take for granted. This is actually wrong because first of all, it is a real illness with real symptoms which is clearly not a sign of weakness or something you can snap out by pulling yourself together.

Second of all, depression affects people in many different ways and can cause a wide variety of symptoms. What’s more, there can be physical symptoms too such as feeling constantly tired, bad sleeping pattern, having no appetite or desire, and various ache and pain. The symptoms of depression range from mild to severe. At its mildest, you may feel relentlessly demotivated or less energetic. While at its severe condition (clinical depression), it can make you feel overwhelmingly devastated and cause you to have suicidal thoughts perceiving or thinking that life is no longer worth living.

To begin with, most people experience feelings of stress, anxiety, or low mood during difficult times. Obsessive-compulsive disorder (OCD) is not merely one of the most common psychological disorders, but it is also among the most personally distressing and debilitating. OCD, in addition, can be devastating to interpersonal relationships, leisure activities, school or work life, and to self-satisfaction. And not surprisingly, OCD is commonly associated with depression. Bottom line, OCD is a depressing problem and it might be easy to understand how one could develop clinical depression when your daily life consists of intrusive thoughts and urges to engage in senseless and excessive pattern of behaviours (rituals).

Next, people often have OCD and depression at the same time. Both OCD and major depressive disorder including clinical depression are classified as common mental health disorders which affect millions of Americans each year. For example, people who have OCD are more likely to develop other forms of mental illness and depression is no exception. According to International OCD Foundation (IOCDF), it is estimated that around 25% to 50% of people with OCD in United States meet the diagnostic criteria for a major depressive episode.

Most people experience the symptoms of OCD first. However, for a small percentage, the two conditions may begin at the same time. OCD is not necessarily part of depression since it is rare for depression symptoms to precede OCD. Because depression often begins after OCD symptoms develop, many researchers conclude that the difficulties of living with OCD can lead to depression symptoms. For this reason, the very nature of repetitive, unwanted, and upsetting thoughts is more than sufficient to inflict the amount of shock, fear, and eventually depression.

Meanwhile, people with depression often ruminate about past mistakes and perceived failures. In 2018 studies, for example, ruminating (thinking the same worrisome, depressing, or negative thoughts over and over) is the key contributor to depression and OCD. Similarly, in a 2017 study, researchers found that having anxious and depressing thoughts was common in people with these two disorders.

OCD and depression can adversely impact your ability to function in a healthy manner. For instance, obsessions affect your state of mind while compulsions can interfere with your schedules. When your relationships, social life, and job performance in school or workplace are affected, you may begin to experience symptoms of depression which can be undoubtedly overwhelming and difficult to manage. After all, the more severe obsessions and compulsions are, the more they impact your daily functioning significantly which can deteriorate the level of your productivity and worsen your depression symptoms.

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SURROUNDING MYTHS OF OCD (CHAPTER 4)

In theory, Obsessive-Compulsive Disorder (OCD) is the name given to a recognised condition that causes someone to become stuck in a cycle of distressing obsessions and compulsions. It is a very debilitating and often misunderstood condition, so much so that many people with OCD hide it for years or decades. Although it is estimated roughly around 1 or 2% of the population suffer from the illness, however, the good news is that OCD is a treatable condition both with therapy and medication available, which can ultimately help people who suffer from the disease through a series of recovery process.

FACTS VS MYTHS

#1 – LIFE TRAGEDY

a. Myth: Poor parenting or difficult childhood experiences such as a divorce or bullying cause OCD/anxiety.

b. Fact: People with OCD, their families and their loved ones do no cause OCD. Although a specific event or set of circumstances might have contributed to how and when the OCD symptoms started, however, they are not bound to the fact that they did. In fact, the most important thing loved ones can do is not to worry about whether they are the reasons to blame, but rather than to support the person with where they are in their journey to better understanding and recovery.

#2 – CHILDREN ARE NOT PRONE TO THE ILLNESS

a. Myth: OCD is rare in children and therefore are not required to be diagnosed.

b. Fact: OCD can affect all groups of ages. According to the NICE guidelines, it is reported that at least half of adults who receive help for OCD having it since they were little. In most of these cases, they did not have the courage to tell anyone because they were ashamed of it, or they already asked for help but did not receive it.

#3 – A SENSE OF INDULGEMENT

a. Myth: People with OCD enjoy their own rules and compulsions.

b. Fact: Obsessions revolve around intrusive thoughts which go against their values, desires, and beliefs. And the psychological terminology for this is "ego-dystonic". As we know, the OCD cycle is driven by anxieties and doubts, and could not work as they do even if intrusive thoughts were looming over one’s mind.

#4 – OCD IS A TRIVIAL MENTAL DISORDER

a. Myth: For many people, OCD is perceived as something insignificant and is not a big deal to worry about it too much.

b. Fact: Having OCD is not simply an overreaction to the stresses of life. While stressful situations can make things worse, they do not cause OCD. Often, people with OCD confront their severe and debilitating anxiety over any number of things, called "obsessions". As a result, this level of extreme worry and fear can be so overwhelming that it gets in the way of their ability to function. In order to try to overcome the amount of severe anxiety, people with OCD use "compulsions" or rituals, which are specific repetitive actions or behaviours. Bottom line, OCD is not a disease which can be sorted by using logic. It is about an extreme degree of anxiety and trying to get relief for that amount of anxiety.

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TYPES OF PREVENTIVE MEASURES FOR OCD (CHAPTER 5)

Treatments for OCD can give people the tools to make substantial changes in their lives. Changing the way we react to fearful situations can help us make wiser and healthier choices. However, OCD is not like an infection that completely goes away with a course of antibiotics. It is more like diabetes. When someone has an illness like diabetes, we know that it is treatable, and that person can live a full and satisfying life. The same is true with a diagnosis of OCD. There are some preventive measures or effective treatments, and you can expect that your life can be full and satisfying. Similar to diabetes. Taking a good care of yourself will be an important part of ensuring the amount of satisfaction and fullness which you can expect from.

1. Psychological Therapy - Cognitive Behaviour Therapy (CBT)

Cognitive-behavioural therapy (CBT) refers to two distinct treatments: cognitive therapy and behavioural therapy. It is the most commonly used therapy for people with OCD and can be conducted in group sessions, yet, the treatment of OCD is usually delivered individually. Besides, cognitive behaviour therapists work closely with people to develop a shared understanding of thinking and behavioural difficulties. In this case, therapists can assist people to uncover unhelpful and unrealistic ways of thinking aside from helping a person to move closer to more helpful and realistic ways of thinking. In addition, cognitive behaviour therapists also possess techniques which can be accommodating or helpful to minimize the distress level associated with obsessions. By minimizing the distress level associated with the obsession, the thought pattern is broken down and occurs less frequently.

Next, another effective part of CBT is "Psycho Education". This relates to education regarding the symptoms of anxiety and why they occur. For example, people tend to be less fearful of symptoms if they are informed about the human physiological response to fear. People react to the threat of imminent danger with a chronic acute stress response, commonly known as the fight-or-flight response during or in which the brain releases hormones such as adrenaline that prepares the body for action. Understanding this process may assist the person in understanding the importance of breathing and relaxation techniques, as well as the benefits of aerobic exercise. After all, breathing and relaxation strategies are often taught to minimize physical symptoms of anxiety and manage stress in general.

2. Medication

If left untreated, OCD can be a disabling and chronic illness. In addition to cognitive-behavioural therapy, drug therapy can help to reduce symptoms of OCD. The main medications that do this are known as serotonin reuptake inhibitors (SRI). They are the most commonly prescribed drugs in the treatment of COD, and are also used to treat depression. For the record, SRI belongs to a class of drugs called antidepressants, and most doctors treating OCD with medication will prescribe an SRI.

Furthermore, the consumption of SRI by far has been proven to help reduce the symptoms of OCD for a majority of the patients. For those who do not benefit from taking SRI drugs, other drug treatments may provide relief which can be prescribed  to address specific symptoms and taken in addition to SRI. Often, people who take SRI may experience side-effects. For some, the side-effects are mild; an easy trade-off for the benefits of the medication. To others, the side-effects, on the contrary, may be more troubling.

People often experience the side-effects of SRI before they experience the benefits. In general, the side-effects of SRI diminish over time; allowing people to tolerate these medications quite well in the long term. Some side-effects, in reference to the SRI, may be reduced by adjusting the dose or by taking the dose at a different time of day. The side-effects of SRI have no permanent effect and will disappear completely when the medication is discontinued. When taking SRI or any other drug prescriptions, it is important to discuss any side-effects that are troubling you with your doctor.

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LIST OF ALTERNATIVE TREATMENTS FOR OCD PATIENTS (CHAPTER 6)

1. Vitamin D

Vitamin D has important functions in immunity, inflammatory response and antioxidant processes. It is also essential for normal brain development and functioning, as it plays several key roles in the nervous system processes such as neurotransmission, neuroprotection, proliferation and differentiation. For example, some previous studies have demonstrated that vitamin D deficiency is associated with numerous neuropsychiatric diseases which include autism, major depressive disorder (clinical depression), schizophrenia and OCD. There are several possible relationships between vitamin D and OCD pathophysiology, in which of these is the association between the active form of vitamin D3 (1,25-dihydroxy-vitamin D3), and tryptophan hydroxylase. While tyrosine hydroxylase is the rate-limiting enzyme in dopamine, epinephrine and norepinephrine synthesis, tryptophan hydroxylase is the rate-limiting enzyme in serotonin synthesis where the levels of these two enzymes are regulated by 1,25-dihydroxy-vitamin D. Hence, it can be concluded that vitamin D deficiency may contribute to OCD aetiology by affecting the pathway of serotonin and catecholamines synthesis.

Finally, there is also another relationship between vitamin D and OCD has to do with the neuroprotective effect of vitamin D. In some studies, for instance, the role of free radicals or an increased level of nitric oxide in particular is manifested in OCD. Vitamin D has antioxidant effects and possesses an ability to deter an essential enzyme (inducible nitric oxide synthase) for nitric oxide synthesis. With that being, vitamin D deficiency may play a role in OCD by causing the deterioration of neuroprotection.

2. Herbal Treatments

Certain herbs may have some benefit in reducing symptoms of OCD. Unfortunately, the consequent degree of their effectiveness has not yet been tested. As with all types of medications, herbal treatments can have unwanted side-effects and may interact with prescription or over-the-counter medications and other botanicals. For this reason, people who wish to explore alternative treatments should consult with a knowledgeable doctor prior to the above treatments.

The sedating effects of some herbal medicines, in addition, are believed to reduce symptoms of anxiety. These plants include German chamomile, hops, kava, lemon balm, passion flower, skullcap, valerian and gota cola. Unlike the other herbs such as Ginkgo biloba and evening primrose oil which have been suggested as an alternative treatment of OCD with little evidence for their effectiveness, the compounds in these traditional German herbs are known to act on systems in the brain in a similar way to the benzodiazepine class of medications. Regardless of the fact that these plants appear to be safe, however, they should be consumed with caution too since they can potentially elevate the sedating effects of other medications, as well as alcohol.

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POST RECOVERY STAGE OF OCD (CHAPTER 7)

Obviously, one of the first stages in OCD recovery is to believe that you can heal yourself. However, recovery is very much on an individual basis and is considered as a lifestyle. The process of recovery from OCD similar to the onset of the common illness, is gradual and ongoing. For some, recovery is an ongoing journey. For others, recovery is a specific destination. OCD affects every part of a person’s life. It may disrupt your ability to function at work, in social situations and in the family. OCD recovery does not just come to you over a night. Like being in warfare, you need an attacking offence and the support of your armies who are your close friends, relatives, family which can help make your recovery happened.

In addition, OCD recovery does require patience, commitment, courage, resilience, and most importantly "self-compassion". A lengthy illness, for instance, can lower a person’s self-confidence; making him or her feel insecure and vulnerable in situations that were once familiar and comfortable. Such a prolonged mental disorder as OCD can cause people to become quite dependent on those around them. They are often surprised at how frightened they are at the prospect of being independent and resuming their responsibilities. As these reactions are a normal part of the recovery phase of OCD, what is clear is that recovery is a process and not an isolated event.

EFFECTIVE RELAPSE PREVENTION

OCD, like any other physical illnesses (e.g. diabetes, hypertension, and allergy), is also a chronic condition. Although the symptoms can be reduced and controlled with both medication and therapy, however, you need to take precautions to prevent the symptoms from reoccurring. It is important to be aware of how you are feeling. Anxiety, stress, fatigue and feeling out of control can trigger a sudden relapse. For some people, certain situations or conditions can inflict symptoms. After all, one of the most common causes of OCD relapse is when people stop their medication too soon or too fast.

1. Become knowledgeable about OCD

Try to expand your knowledge enrichment. Read as much references or literatures as you can about the OCD and its treatments. The power of internet, for example, makes it easy for people with OCD to seek the best form of cure through myriads of free information available across websites.

2. Learn and use healthy strategies for coping with stress and fears

Once the symptoms of ocd have improved, maintaining these gains requires commitment and determination. Ineffective strategies for coping with stress and fears must be replaced with healthy ones. Try to resist the urge to perform your compulsions. Using skills learned in therapy, continue to work to eliminate the obsessive patterns of your thoughts and rituals. Do not be satisfied with only partial improvement of symptoms since this will leave you prone to relapse from the sickness.

3. Have your support system to get involved in your recovery

If you allow yourself to become isolated and keep your inner world a secret, you will create an ideal breeding ground for symptoms of OCD. When family and friends are aware and involved in your struggle, they can help in a number of ways. For example, they can assist you to control your compulsive urges, help you guard against the recurrence of your symptoms, provide all the necessary support and encouragement. However, who you will tell about your illness is a very personal choice. As a buffer against your OCD relapse, have at least one or two trustworthy people among your social circle that you can rely on.

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MILITARY PSYCHOLOGY AND ITS ESSENCE

In theory, military psychology is basically the research, design and application of psychological approaches, as well as data experimentation towards understanding, predicting, and countering behaviours either in a friendly or a hostile manner in the civilian population, which can be undesirable, intimidating, or even potentially harmful to the conduct of military operations. It is applied towards counselling and treatment of stress and fatigue of military personnel, military families, as well as treatment of psychological trauma suffered as a result of intense field operations. The goals and missions of current military psychologists have been well preserved over the years varying with the focus and strength of research intensity put forth into each sector. Because of this, the need for mental health care is now an expected part of high-stress military environments.

Historically, psychological stress and disorders have always been an inherent part of military life, especially during and after wartime. However, the mental health section of military psychology has not always experienced the awareness as it does now. Even in today’s present, there is much more research and awareness needed and concerned with in this area. And, one of the first institutions established to care for military psychiatric patients was St. Elizabeth Hospital in Washington D.C. (formerly known as the United States Government Hospital for the Insane), which was founded by Congress in 1855 and is currently in a state of despair even though some foreseeable operational plans to revitalize the building was scheduled to begin in 2010.

OPERATIONAL PSYCHOLOGY

By function, operational psychology from the military viewpoint is the use of psychological principles and skills to improve a military commander’s decision-making as it pertains to conducting combat and/or other related operations. Well, this is a relatively new sub-discipline categorization which has been employed largely by psychologists and behavioural scientists in military, intelligence, and law enforcement arenas. While psychology has been utilized in non-related health fields for many decades, recent years have witnessed an increasing focus on its national security applications. The examples of such applications incorporated can be the development of counterinsurgency strategy through human profiling, interrogation, and detention support, information-psychological operations, and the selection of personnel for special mission units.

INTELLIGENCE TESTING IN THE UNITED STATES ARMY

Lewis M. Terman, a professor at Stanford University, revised the Binet-Simon Scale in 1916 and renamed it as the Stanford-Binet Revision. This test was the beginning of the “Intelligence Testing Movement”, and was given to over 170,000 American soldiers during World War 1. In short, Professor Yerkes published and documented the results of these tests in 1912 and that became known as the Army Report.

Essentially, there were two tests which initially made up the intelligence tests for the military; Army Alpha and Army Beta. These two tests were developed to evaluate the vast numbers of military recruits that were both literate (Army Alpha Tests) and illiterate (Army Beta Tests). While the Army Beta Tests were designed to measure “native intellectual capacity” as it also helped to test non-English speaking service members, the standardized intelligence and entrance tests which have been used for each military outlet in the United States has transformed significantly over the years.

For example, In 1974 when the US Department of Defence decided that all Services should utilize the ASVAB for both screening enlistees (future military personnel) and assigning them to carry out military occupations, classification testing made the entire testing process more efficient through the combining selection of screening procedures. As a result, this specific testing system used in the US military went fully into effect in 1976 shortly after.

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