Psychological Issue Was More Serious Than Initially Suspected

How do you confront a close family member when you suddenly realize he has a serious psychological issue? I first noticed his extremely red, dry, and chapped hands ...Must be from the dry air, I reasoned....Then, I noticed the frequency he washed his hands...4 to 5 times in 60 minutes. Hmmm, that seems a little excessive, right? It's not like he was doing yard work or handling food. Why was he constantly washing his hands? Something is going on here.


I had a sneaky suspicion that the frequent hand-washing may point to OCD (obsessive compulsive disorder). But, I tried to rationalize the issue and wondered if perhaps the constant hand-washing was caused by some transient anxiety about an upcoming project at work. Everyone reacts differently to stress. I started asking questions. He insisted everything was was very busy, but good. However, while he was talking, I could actually tell by his body language this didn't appear to be the case.

He continued talking and said something about being bothered by new housing construction in his neighborhood. He said he read on the internet that certain building materials may contain asbestos or cause cancer. He also expressed uneasiness about the dust being stirred up. I reassured him that asbestos was no longer allowed to be used in new housing construction. I suggested he request an MSDS (material safety data sheets) or PSDS (product safety data sheet) from the construction manager to confirm this information and set his mind at ease. I could tell he wasn't really hearing what I was saying as he continued to re-hash these concerns over and over again... I realized his psychological issue was much more serious than originally suspected.

As time progressed, I observed additional behaviors and rituals. He insisted on a "no shoes in the house" rule. A lot of people don't like to have shoes in their house, at first that didn't seem to be a big deal, I figured. But then, there came a number of other rules / rituals / behaviors. Purses or bags were not allowed to be placed on the ground, table or counter. They had to be hung on the back of a chair. Any other item that had previously touched the ground couldn't be brought into the house unless that item was enclosed in some sort of bag (plastic or paper). Then the outer bag had to be discarded or left outside before that inner item could be brought into the house.

I then started noticing when he sat in a chair, he would lean slightly forward, holding both hands up in the air, perpendicular to the ground. The way my surgeons hold their hands up in the air to keep the contaminants / micro-organisms off their hands following their surgical hand-scrub prior to surgery as they make their way into the surgical suite into the OR in my department. He wouldn't even shake people's hands and had a particular manner regarding how he touched objects. One time, his wife asked him to bring some food items in from their car for a BBQ for a family reunion. I watched in silence and agony as he awkwardly strained to open the car door to get the items of food / bags from the car only using his pinky finger or forearms, rather than his entire hand...I realized then that his OCD problem was very, very serious, whether HE wanted to admit it to himself or not. I had a bad feeling this was going to be a major up-hill battle, and knew these issues needed to be addressed asap.

I wrestled with knowing exactly how to approach this situation as confrontation is never easy. This is especially true with males as males are standardly less likely to even admit they have a medical issue, let alone a psychological one. However, this was a very, very close family member whom I dearly loved. This was someone who had always been there for me, and I for him....when we both were little and I didn't have any friends, he was my best friend... when he couldn't tie his shoe, I showed him how to tie them...when I was bullied by other children in school because of a slight learning disability and speech impediment, as we walked home from school, he would tell me jokes to stop me from crying. He would tell me "they don't know what they're talking're not stupid, you just learn different"..and "you sound fine to me"....and, when the older boys would shove him and steal his school lunch, I always helped him up and gave him half of my lunch so he wouldn't go hungry. We both would do anything for each other as children, and...I know he feels the same even today.

So why would the approach to this issue be any different? Knowing this individual clearly had a serious psychological issue that appeared to be getting worse, I was not going to let him suffer without trying to do everything possible to help him. Although this individual usually took my advice regarding many, many things, confronting him regarding his OCD was the most difficult thing I've ever done as I wasn't exactly sure how he was going to react.

I set up a time to talk with him alone and presented my observations in a gentle, caring manner. He, of course, initially denied he had an issue. Some people may initially deny they have a mental health issue because they not only have a hard time accepting they have a mental health issue, but they may also feel there is a "stigma" attached to being diagnosed with a psychological problem as well as seeing a psychiatrist or psychologist. Some males may also have difficulty accepting that they need help as it may also make them feel that "needing help" makes them appear "weak". Although it took a lot of convincing, in the end, he finally broke down and agreed that he actually did need help. He stated he actually couldn't "stop the thoughts in his head" regarding the hand washing and all the other behaviors. He said the thoughts were like a broken record that kept going around and around, and just didn't stop playing in his head. He finally saw a psychiatrist and was diagnosed with severe OCD. He was successfully treated. OCD is a lifelong illness. Although this issue was treated and his symptoms went into remission, this is an issue that he, and many others, will continue to struggle with the rest of their lives.

Thought for the day: Intuition / insight can provide the opportunity to make great improvements in lives and health of others by remembering to address the absolute (physical, emotional and mental) needs of the individual.....


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Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

142 Articles; 9,981 Posts

Specializes in LTC, assisted living, med-surg, psych. Has 26 years experience.

Your family member is lucky to have you. :yes: And he is also wise to accept the truth and deal with it.

It takes a great deal of intestinal fortitude to acknowledge the fact that one has mental illness. Even in our supposedly enlightened age, there is definitely a stigma attached to psychiatric issues, and seeking help is probably one of the most courageous acts anyone can do. Taking meds and continuing with therapy also takes a lot of self-discipline, especially when one is feeling better and it's so easy to think "Oh, I don't need this anymore, I am cured!"

This was a well-written and compassionate article. Bless you for being such a good advocate for your loved one.