Rumination disorder

Looking back, it must all have started at the age of 14 while I was at boarding school. I know this because I stopped writing my diary. The thoughts I was having were too painful or embarrassing to put down on paper, even in private.

Nearly 20 years later, I've reached another watershed. I've finally received a diagnosis of obsessive compulsive disorder (OCD) and have just started taking drugs for it.

Mostly it has been obsessional: unwanted thoughts--mainly rumination--and imagery, but I have also had some compulsive behaviour. A lot of it has centred on ideas of losing control of myself and the consequences of this to others and myself.

The years as a teenager were definitely the worst. One type of thought would last around a year before being replaced by another. I told no one and consequently had the feeling of being the only person in the world with the problem. At school I seemed happy and gregarious and I performed well in most areas of life. People often remarked to me what a well balanced youth I was and in many ways this was, and remains, true. At one stage I clearly remember thinking that I would pursue a career in psychiatry to try and find out what all this was about. The type of mental isolation I experienced then is common among sufferers of OCD and is probably more painful than the thoughts themselves.

At medical school things went on as usual. The thoughts continued but I started to develop some coping strategies. The big breakthrough was telling another person. I was amazed that they seemed not to be at all shocked by the thoughts that I had thought of as being unbearably embarrassing. Because of the demands of medical school life, I had less time for thoughts but they often filled many of the gaps. They appeared (and still do) at the worst possible times: about to go on stage to sing, just before letting the bowling ball go, in between squash points, and during sex, especially at orgasm. Often, they were at their worst in the anticipation of events rather than the events themselves--I rarely got them right in the middle of exams. They also appeared completely out of the blue and apparently not in relation to anything. The thoughts leave me with so many emotions--powerlessness, frustration, hopelessness, and anger. Interestingly, anger was, and still remains, the most useful of all those emotions. I was angry with myself for not being able to control my thoughts and angry at the thoughts themselves.

The next watershed was counselling. Several years down the road and with a career in psychiatry firmly established, I sought help for the first time. The irony of this was that the very thing I fantasised in my youth would make it easier to understand myself--a career in psychiatry--became the biggest stumbling block. I knew most of the people who might be able to help and was afraid that if I admitted my problems my career prospects would be damaged. I found a friendly psychologist in a private clinic and attended once a week for two years. The process did not lead to much greater insight into the causes of the illness. I still do not know what these are. But it did help me to find better ways of dealing with myself. I told several people--three close friends and my partner. At times it was difficult to tell her about all my thoughts, partly because I did not think that she should have the burden of all of them but also because some of my behaviours involved compulsions to confess thoughts or fears to her in order to receive reassurance. I also learnt to try and separate the form of the obsessions from their content, which usually had little relevance. Now I just say I am having obsessional thoughts; what they are about does not really matter.

The thoughts still remained. I spent a year doing full time research, which was particularly painful. I had lots of spare time for thinking. A return to clinical work was a blessed relief as it involved reacting to others' clinical problems instead of thinking about my own.

I put off getting medical help until I secured my first consultant job. The consultant, a specialist in OGD, was kind and straightforward and confirmed the diagnosis to me and prescribed treatment, paroxetine.

For the first few days after the appointment I was in turmoil. Until that moment, my obsessions had centred around finding answers to a variety of questions. As soon as an answer was found another doubt would surface. Now I had the answer to the ultimate question. The answer was that this state of mind was the result of a mental illness. I decided to take a week to get my head round this concept before changing my mental state again with medication.

The first tablet was the most difficult. I felt it was a symbolic moment, to do with accepting myself as a person with a mental illness. I have definitely experienced side effects, even at low doses. I am more tired and my orgasm feels less intense. But even at this early stage I think that there has been a change. I am spending more time worrying about normal things and less time thinking about crazy ones.

I am still unsure about the future. What degree of benefit will the medication bring? Will it affect my ability to work? Should I tell my general practitioner? How long should I take the medication for? The best thing to be said about these questions is that at least they pertain to the real world and they are questions that are capable of being answered in time. I face the future with hope.

COPYRIGHT 1998 British Medical Association
COPYRIGHT 2000 Gale Group