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.

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

Gentlewoman:
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.

Doctor:
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.

Procrastination

Have you ever procrastinated? Put something off for another time that you really needed to do right now? How did you feel about putting something off? Many people feel mixed emotions when they procrastinate: a sense of relief that they don’t have to do what needs to be done and guilt because they really should be doing that thing right now.

What do people procrastinate about? Anything! We can put off that phone call, pay bills late enough to get a penalty, delay cleaning out that closet until it is unuseable, forget to change the oil in our car, and the list goes on. Technology has contributed positively to many areas of our lives but it can also make procrastination worse. Cruising the Internet and checking email has become an all-too-common distraction for the procrastinator. It has become so common that we now have the expression "the procrastination superhighway."

There are very few people who have not procrastinated at one time or other. About twenty percent of the population chronically procrastinates. In other words, their entire lives are ruled by putting things off. These numbers tend to be higher in the college population. Estimates for student procrastination run as high as seventy percent.

Society often looks upon procrastination as an annoyance, something trivial. Research has shown that it can be much more than that. Psychologist Timothy Pychyl, Associate Professor of Psychology at Carleton University in Canada, has found that procrastination can be "associated with depression, guilt, low exam grades, anxiety, neuroticism, irrational thinking, cheating and low self-esteem.... and be an extremely disabling psychological condition."

Although some people think that procrastination is merely a result of laziness, psychologists don’t agree. We see procrastination as a learned behavior. This is good news because if it has been learned it can be unlearned. How is procrastination learned? It is learned by a process called "negative reinforcement." When we avoid something that results in a reduction discomfort, we are more likely to avoid it again. After that, each time it is avoided the habit of avoidance becomes stronger. Continual avoidance keeps a person from learning skills to eliminate procrastination.

There is a ton of information about coping with garden variety procrastination in books and blogs. If the procrastination is severe, cognitive behavior therapy (CBT) has been quite effective in helping people. One method Dr. Pychyl and his colleagues tried was to have people forgive themselves after they had procrastinated. The technique decreased procrastination for females but not for males.

If you are familiar with the Domino Effect, you know that there are basically three areas that need to be addressed to change the behavior (domino four) of procrastination. One area that needs to be identified is which emotions are associated with procrastination. Strong emotions can contribute to putting something off. If people feel guilty for delaying a project, they will probably punish themselves and what better way to be punished than to not finish the project. Depression is another emotion that may also play a part. The behavior associated with depression is lifelessness. Not having enough energy can be a precipitating event for putting something off.

Physical sensations can also be a contributor. If you feel anxious about starting a task, you can get rid of the discomfort of anxiety by simply doing something else. Other physical discomforts can also make procrastination more likely.

Self talk is probably the most significant factor in procrastination. It is often associated with perfection. A perfectionist is someone who needs to have perfect outcomes. Procrastination may be the end result of being convinced that starting a task will not lead to a perfect result.
Psychologist Joseph Ferrari, Ph.D. Is a Distinguished Professor of Psychology at De Paul University in Chicago. He is another person who has researched and studied procrastination. He and his colleagues have found that five cognitive distortions are shared by many procrastinators.

1. They estimate how much time they have left to accomplish the task. "I have plenty of time to do this task so I don’t need to start immediately."


2. They underestimate how long it will take to finish the task. "This is an easy one and I’ll be able to finish it quickly."


3. They overestimate how motivated they will be to do it later. "I’ll feel much more interested in doing this later."


4. They don’t believe working on the task will make them feel better. "I’m really feeling stressed right now so working on this task will only make me feel worse."


5. They believe that a poor mood makes working on a task too difficult. "I’m don’t really feel in the mood for doing this right now. I’ll wait till I feel better."

How does CBT help people overcome these unhealthy thoughts that are contributory to procrastination? The standard approach would treat these thoughts – and others – as myths to be challenged. For example, "I have plenty of time to do this task so I don't need to start immediately," would be challenged by looking at the facts. How much time is really available? How much time did it take last time? How much time would someone else estimate for the task? The goal is to convert the procrastination myth to facts.

In The Worry Free Life, I teach people a CBT technique called Voice Training. The "Voice" is merely your worry that has been externalized. Putting the worry outside of yourself makes it easier to change your destructive thoughts into constructive thoughts. There are five steps in Voice Training:

• Voice Awareness: What is the Voice saying to you?


• Voice Interrogation: What are the core beliefs that are underneath the Voice messages?


• Voice Analysis: What is the relationship between Voice messages and my emotions?


• Voice Fighting: Using a 5-step procedure for changing lies (Voice messages) to truth (reality).


• Voice Maintenance: Using strategies to manage relapse.

You can get more information on procrastination from these references.

Books:
The Cognitive Behavioral Workbook for Depression: A Step-by-step Program by William Knaus
Procrastination: Why You Do It, What To Do About It by Jane Burka & Lenora Yuen
Counseling the Procrastinator in Academic Settings by Clarry H. Lay and colleagues

Blogs:
Don’t Delay by Dr. Pychyl
Social Science Statistics Blog by Institute for Quantitative Social Science

Websites:
Procrastination Research Group by Dr. Pychyl, Psychologist
Structured Procrastination by Dr. John Perry, Philospher
Procrastination by Cambridge University

Humor:
Procrastination Flowchart (click on flowchart to enlarge) by Project Sidewalk
Two Monitors for Procrastination by ProcrastinationBlog
Procrastination Blog by Late Larry

The Domino Effect

As we mentioned in our previous article on happiness, everybody wants to be happy. The pursuit of happiness is a right guaranteed in the constitution. But most people don't realize that there are two kinds of happiness: Happiness (with a capital H) and happiness (with a small h).

Happiness (big H) is something that runs very deep and is quite profound and long lasting; much more than its cousin, happiness (little h). Real Happiness goes by many names: tranquility, inner peace, serenity. Many other words also come to mind: calm, placidity, quiet, stillness, composure, poise, equanimity, repose, harmony, and peacefulness.

Unfortunately, people keep fooling themselves into thinking that happiness is merely feeling good. Not that feeling good is wrong or bad. It just don't happen to be the same thing as the big H. Little h happiness occurs when we can get rid of pain and suffering. Big H happiness is not the absence of conflict or pain, but rather the ability to cope with both.

B-E-S-T
Happiness is not a goal in life but is rather a by-product of something else. That something else is self control. Perhaps a good way to understand self control is in the sense of self management. Rather than let your life run you, you need to learn the skills to manage (control) your life so that you can experience it the way you want it. By controlling four specific components of your life, you can find your pathway to Happiness. These four parts are what comprise human nature. The more you can control each of these elements, the closer you are to the big H.

This is different from New Age beliefs that promise you the ability to "feel good" no matter what is happening to you. Happiness (with the big "H") doesn't rule out suffering, pain and emotional distress. What it does give you is the ability to cope during such times. It gives you the self confidence that no matter what happens, you will eventually make it through and be a stronger person for it.

These four keys to Happiness are not independent of one another. They constantly interact with and affect each other. The chain reaction that is seen with dominoes is a good way to understand your life. Imagine a set of 5 dominoes where each one represents an important aspect of control. The diagram to the left shows what this might look like.

The first domino represents everything outside of you that triggers off the second domino. This could include weather, people, health, work and any other event that you encounter in your life.

The second domino stands for your thought life. Feelings (emotions and sensations) are the third domino and the fourth is your behavior domino.

The last domino stands for any consequences that happen in the outside world as the result of your behavior. You need to know that these dominoes never change position.

The Big H type happiness occurs when all the dominoes are standing. This is difficult because the first domino, life, has a tendency to keep falling on you (did you notice the round bottom?). So many things can go wrong in life. Yet, we try to keep the dominoes standing by attempting to control the first domino. This is not possible because you have no control over life events.

No matter how hard you try to keep the life domino from falling, it will eventually fall. Every time you set the first domino up it falls again. Then all the other dominoes fall. The trick is to spend less time trying to straighten out life.

You can have the Big H when you have learned to make the second domino immovable. You want to learn how to mentally superglue the second domino to the tabletop. When you can do this by changing your thought life, then you will have Happiness because the rest of the dominoes will remain standing.

In addition to managing your thought life, you also want to learn how to manage your emotions, sensations and behavior. In The Worry Free Life, we show you, step by step how to learn these new skills and apply them to your life.

Cognitive therapy has been one of the most exciting developments in mental health in this century. By discovering that emotions are produced by thinking, psychologists have given the human race a means of finally doing something about such crippling infirmities as depression and guilt.

If you would like to begin a dialogue on the dominoes feel free to click on the comments link below.

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