Patients with obsessive-compulsive disorder often suffer in silence
Fearful of being exposed, many sufferers keep it a secret
A year ago, Nicky's life was very different. Scared, he would stay in bed all day with a blanket over his head, leaving only to wash his hands or take a shower, which could last for more than an hour. "I'd cover myself with blankets and spend the day in bed. It felt safe," he says.
"I could spend two hours in the shower - I felt so bad about it, that I contemplated suicide."
The 24-year-old Hongkonger agreed to be interviewed on condition his last name was not used because of the stigma attached to people with mental health problems. Last year, he was diagnosed with obsessive-compulsive disorder (OCD).
Obsessive-compulsive disorder is a type of anxiety disorder where patients obsess over certain thoughts. Sufferers perform rituals such as washing their hands over and over again, even if they know their behaviour is irrational.
There's no definitive explanation for what causes obsessive-compulsive disorder, although research connects it to abnormal activity in some areas of the brain, says Lee Wing-king, a psychiatrist and consultant for Kwai Chung Hospital in the New Territories.
There are no statistics on the prevalence of OCD in Hong Kong. In a February 2009 monthly digest, the Census and Statistics Department estimated that 1.3 per cent of the total population, around 86,000 people, suffer from a mood disorder or mental illness.
Lee says obsessive-compulsive disorder is widespread, although not as common as depression. The Hong Kong government has yet to formally asses how many people suffer from the various kinds of mental illness.
The Food and Health Bureau has commissioned the first city-wide mental health study, the Hong Kong Mental Morbidity Survey 2010-13, but the full results have yet to be released.
Obsessive-compulsive disorder can have a huge impact on a person's life, says Tsang Fan-kwong, a private psychiatrist and former senior medical officer at Castle Peak Hospital, a psychiatric hospital in Tuen Mun.
"It can be a very debilitating illness," Tsang says. "I remember one patient, a middle-aged lady, who suffered from severe obsessive compulsive disorder. She liked to make a 4pm appointment to come to see me, but she usually arrived at 7pm.
"She had to check whether the tap was properly turned off, the electricity was properly turned off, and the kitchen stove was properly turned off. Everything was repeated five to seven times."
Nicky had similar problems.
"I was afraid of rubbish bins and whenever I walked past one I'd be afraid the dirt would get stuck on my hand. I would hold my breath when I was taking out the trash, and then I'd have to wash my mouth and brush my teeth afterwards," he says.
"It affected my schoolwork. For example, when I went to a self-study room to study, I'd go to a toilet and it would take me ages to wash my hands. By the time I came out my trousers would be all wet. Only then did I feel clean."
Nicky would also check locks at least five times before he left the house. Despite these habits, he says he kept it a secret from most of his friends and acquaintances.
"I was good at keeping it under wraps, to seem normal to other people," he says. "When I washed my hands, I'd wait until everyone had left so no one knew how much time I'd spent doing it."
Patients such as Nicky keep their condition hidden because those with mental health disorders can be stigmatised.
Nicky has opted for treatment from a private psychiatrist, even though it costs more than the government clinics, because he's afraid that having obsessive-compulsive disorder on his record will affect his chances of joining the police force, his preferred career path.
Psychologist and counsellor Dina Chamberlain says some of her patients even keep their condition a secret from loved ones. "One patient doesn't even want a receipt from me. They don't claim back the expenses from medical insurance because it will immediately show that they are seeing a therapist, and that involves too much of a stigma," she says.
This reticence is partly because those with obsessive-compulsive disorder can appear to be insane, says Vivian Yeung In-wai, a clinical psychologist with the United Centre of Emotional Health and Positive Living.
I'd cover myself with blankets and spend the day in bed. It felt safe
"I saw a case where the patient had to avoid all the cracks on the street. If he touched any of them, he had to go back and start again," Yeung says.
"In cases like this, the patients spend a few hours walking back and forth on the same street. So people who don't know anything about obsessive-compulsive disorder might very well write these patients off as being crazy."
But patients can be helped with medication and psychotherapy. Psychiatrist Lee Wing-king says two-thirds of patients respond very well to treatment, and can at least manage their symptoms.
It worked for Nicky. As well as taking medication, he went through cognitive behavioural therapy, which involves questioning the obsessive thoughts with guidance from a psychiatrist, as well as confronting the behaviour that causes the anxiety head-on. "At first, I had to go to a toilet and touch the floor, toilet seat cover, the sides, the walls, the cover for the toilet tank, the wet floor and places like that," Nicky says.
"I had to touch these surfaces with my belongings, because that's what I'm afraid of - getting my things dirty. I started with my wallet, then my phone. The very first time, I had to just grit my teeth and do it."
Sometimes treatment can take a long time. Psychiatrist Tsang Fan-kwong is treating a patient who has been receiving counselling for more than 20 years; she is now happily married with several children. Another patient of 15 years is a father of two and the chief executive of a listed company.
Doctors have worked out how to treat obsessive-compulsive disorder, but getting treatment in Hong Kong can still be a problem. Amy, a patient of clinical psychologist Vivian Yeung, was stuck on the government's waiting list for a year before she could see a psychiatrist.
Li Yuen-chau, a social worker who's been following Nicky's case, says a year-long wait is common, although it can be expedited for potentially dangerous patients.
"With a case like Nicky's, if you go to a government psychiatrist, the waiting time will be a year, at the very least," Li says.
"In some cases, when a patient really can't wait, the patient will go to a private doctor first. When the wait for government services is over, the patient will go back to the government clinic."
A spokesman for the Hospital Authority says that, as of this June, the median waiting time for a new psychiatric patient is 10 weeks.
Tsang says public mental health services are underfunded, although the situation has improved in recent years.
"The territory-wide service is still underfunded, and there are not enough doctors to take care of patients. Because of this, people have to wait a long time to get treatment. They might have to wait for two years for a first appointment, although the average is a few months, I think," Tsang says.
"Due to a shortage of psychiatrists, most don't bother to do psychotherapy for the patient. As for giving medication, for follow ups, patients only spend four to five minutes with the psychiatrists. But for psychotherapy, you need to spend a whole hour with them. So it is a luxury for most of the psychiatrists working in the public sector."
