Tuesday, April 14, 2009

Cleanliness Is Not Next to Godliness

As a doctor and waiting-woman eavesdrop on Lady Macbeth, they have the following whispered conversation followed by Lady Macbeth's immortal words.

What is it she does now? Look how she rubs her hands.

It is an accustom’d action with her, to seem thus washing her hands. I have known her continue in this a quarter of an hour.

Lady Macbeth:
Yet here’s a spot.

Hark, she speaks. I will set down what comes from her, to satisfy my remembrance the more strongly.

Lady Macbeth:
Out, damn’d spot! out, I say!—One; two: why, then ‘tis time to do’t.—Hell is murky.—Fie, my lord, fie, a soldier, and afeard? What need we fear who knows it, when none can call our pow’r to accompt?—Yet who would have thought the old man to have had so much blood in him?

Macbeth Act 5, scene 1, 26–40

Today, we call it mysophobia — an irrational fear of contamination. Lady Macbeth had developed an obsessive-compulsive disorder (OCD). It is a common after someone who has experienced or witnessed a traumatic event. Although there was a time delay for her, she was the one who convinced her husband, Macbeth to murder King Duncan of Scotland. By so doing, she became Queen of Scotland. Eventually, the awareness of what she had done began take its toll on her. The excerpt above is from the famous scene (Act 5 of Shakespeare's play Macbeth) and typifies the agony of living with OCD.

I still remember when my new client walked into my office many years ago. Moving slowly so that she would not brush against anything, she carefully wiped off a place on the couch with a tissue she kept in her purse. During the interview she admitted that she used up two large spray cans of Lysol in her house every week.

She was deathly afraid of germs contaminating her body, Like Lady Macbeth, she never really saw what she desperately tried so hard to clean. Education had no effect on her compulsive behavior. She was an intelligent person who understood that her body contained about 100 trillion cells. She also knew that ninety percent of these cells belonged to bacteria (germs) living in and on her body. When she recounted these facts, she curled up in a ball, closed her eyes and looked like she was attempting to hide from the germs.

As a nation we now have people who, although they don’t have mysophobia or OCD, have gone overboard on cleanliness. As the twentieth century progressed, Americans became more consciously aware and afraid of uncleanliness. Maybe it all started with deodorant and mouthwash. Although originally cosmetic, their effectiveness had to do with being able to kill "germs." Most people had never heard of anti-bacterial soap ten years ago. If they did, it was because of its use in medical facilities.

Gradually this product made its way to the average consumer. Now these products can be found in any drug store or grocery store. The big jump in usage came in 2005. People spent more than sixty-five million dollars on sanitizers which was a jump of more than fifty-four percent from only the year before.

Microbiologists have become concerned about our obsession with killing germs because our bodies need bacteria for a variety of reasons. These good germs and bugs help us digest and use the nutrition in the foods we eat. They also protect us from bad bugs that get into our bodies. Microbiologists have determined that if you could become totally germ-free, you would be dead within two weeks.

We need to begin to have a balance in our lives regarding cleanliness. Appropriate hygiene is important but knowing where to draw the line is equally important. Dr. Anne Maczulak, a microbiologist, has written a book entitled The Five-Second Rule and Other Myths About Germs.
Some of her gems (not germs) are startling. One of the big questions many people think about is related to the use of public toilet seats. She says it is extremely difficult to catch a disease from toilet seats. Studies have shown that there are about fifty microbes per square inch of surface on a public toilet seat. Your average office has about 21,000 microbes per square inch of surface. Scary.

She also says it is important what you do with your hands. After using the bathroom you are advised to wash your hands with soap and warm water for about twenty seconds. This will kill about eighty percent of any dangerous germs. On the other hand (no pun intended) try to keep your hands away from your face until after you have washed your hands. Why? Because these are the openings in your face — eyes, nose and mouth — that the germs use to get inside your body.

You’ve probably read by now that your kitchen cutting board is a breeding ground for the bad guys. After using a cutting board, she suggests you wash it with hot, soapy water, rinse it well, then pat it with a paper towel and let it air dry. Why go to so much trouble? She points to studies that have shown the average cutting board has two hundred times more fecal bacteria than your toilet seat. More scary.

For many people in our society, the old saying that "cleanliness is next to Godliness" has now been converted to "cleanliness is next to perfection." Basically, Dr. Maczulak tries to convince us that perfect cleanliness is not only impossible but is harmful.

Back to OCD and mysophobia. What is this all about? The condition is generally maintained by an attempt to control anxiety and discomfort. If a person feels uncomfortable in the presence of dirt or invisible germs, he might feel better after cleaning. Once this happens, it can escalate. When the anxiety returns, the person believes that if he doesn’t clean, then the anxiety will get worse and last forever. Unfortunately, it is like taking drugs to feel better. The effectiveness eventually wears off and more cleaning is needed to get the same sense of relief.

How do psychologists treat this problem when it has evolved into OCD/mysophobia? Our current treatments are quite effective. Unfortunately, there are people who try to sell treatments that are unproven and may not be any more effective than a placebo. Some of the more common examples of unproven therapies include hypnotherapy, neuro-linguistic programming, and so-called "energy therapies."

Cognitive-behavior therapy and exposure therapy have proven track records and have helped millions of people lead more normal lives. Sometimes these two are used by themselves; other times they are used in conjunction with each other. These treatments are extremely effective and, if properly administered, work after just a few months.

Some people have been helped with SSRI antidepressant medications used along side of psychological therapy. However, you must understand that few people get a permanent cure using these drugs by themselves. There is also the problem of unwanted side effects.

So, if you know of someone suffering from mysophobia or OCD related to germs and dirt, contact an experienced cognitive behavior psychologist who has had experience with this problem.

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