Life with deramtillomania is hard, especially during Covid-19.
I woke up this morning to this not-too-helpful article from the BBC. In it, the author, Justin Parkinson, talks about the need now for not touching our face.
Not touching our face, so governments say, can help reduce the spread of Coronavirus.
Even the Behavioural Insights Team don’t appear to have too much grasp on mental health. Whoever these people are, one thing is clear – they have little understanding of how anxiety works.
I want to share an embarrassing fact with you, it’s something that has plagued me for a long time but in light of this development, I feel it needs to be talked about.
I suffer from dermatillomania. When I’m bored or anxious, I rake my fingers through my hair. I can’t help it that much, it’s like adults who suck their thumb or bite their fingernails. It’s a self-soothing, compulsive habit, rather than merely an unconscious one. It’s an action that has a purpose, at least for my anxious mind.
Dermatillomania affects various parts of the body. Some people pick wounds, I pick at my scalp. It’s a compulsive habit, not too different to OCD. Thousands of people suffer from it and no, it’s not pleasant. At its mildest, it is gross and shameful. At its worst, it leaves us with angry, bleeding sores.
Dermatillomania isn’t something that only plagues me, it plagues my mother, too. We talk about it quite openly because it’s a monster we both suffer from. If she has a large, angry-looking sore on her arms, I’ll pull her aside and ask if she’s okay. If she notices my hair is looking particularly ratty, she’ll do the same for me. People with mental health disorders need to be supported and understood, not shamed for their compulsive behaviours.
Why Shouting “Face” Won’t Work
One of the most troubling new pieces of advice in this article is for a family member to shout “face” any time an individual moves to touch their face. I don’t know where the Behavioural Insights Team studied human psychology, but this kind of method lies in sharp contrast to the advice normally distributed by clinical psychologists when it comes to stopping unwanted personal habits. A longstanding approach to handling intrusive thoughts was “thought suppression”, where the sufferer wears an elastic band on their wrist and snaps the band against their skin any time they experience a negative intrusive thought. The idea of it was that the pain served as a punishment to the brain anytime the individual had what they perceived to be a bad thought, but instead, the fear and anticipation of the thought made the problem worse, combined with the sense of helplessness caused by the physical pain. In a very similar way, someone shouting “face” at you is likely to cause a sense of shame and helplessness. It won’t empower, instead, it’s demoralising for our loved ones which is something that nobody needs or wants right now.
When it comes to a condition like dermatillomania, the cause for the touching and picking is entirely different to a lack of self-control. This isn’t merely an unconscious habit, but rather a symptom of an anxiety disorder.
Modern approaches to overcoming compulsive behaviours use mindfulness and cognitive behavioural techniques. Instead of shouting “face”, we can ask our clearly-anxious loved ones about their emotions and help them to become more self-aware in a more positive and supportive manner. Instead of shouting “face”, we can ask how they’re feeling and let them know that it’s okay to feel anxious, confused and scared. After all, right at this time, I think we all are.
Enough With The Shame
In the article, I noted that the author labelled people who ignore advice as “lazy, selfish or ignorant”. I think the word the author is looking for is stubborn, and if he has even an iota of knowledge on the British people, then stubborn is sort of what we are. You can tell the vulnerable British public not to go out, but they will go. You can tell panic-buyers not to panic-buy, but they will still panic-buy. Our human psychology is just too strong and shaming people is highly likely to backfire. A collective effort to try and make sure that those with the most need are protected and looked after is great, but we need to understand that some of those we want to protect simply aren’t willing to listen. Asking people to stay in and stop going out will be challenging enough, we need to allow some flexibility with each other during these hard times. In a country famed for its festivals and boozy social culture, social distancing is hard enough without our government trying to control our personal habits on top.
The “nudge method” can work in some cases and not in others. For example, if you put a depressed person with a few friendly, happy, supportive people, then it has been proven in some cases that it can improve their mood. If enough good neighbours make their presence felt, then it can have a knock-on effect in stopping the anti-social behaviour on any given street. These are examples of the nudge effect working as it should, but it doesn’t work so well when you’re dealing with a compulsive habit. For us, working to make it less often and in better conditions is far better than not at all, at least in the immediate term.
At this point, it all feels like a bit of a dystopian response to handle something that, dare I say it, a vast majority of people appear to recover from at home. I understand that this is a new virus (hence the “novel”), I understand that there is no vaccine and I understand that there is a monumental strain on healthcare professionals on top of annual coughs and colds, especially when it comes to caring for the elderly and the most vulnerable. Pandemics are inevitable, but this one is still only 5% of the carnage that Swine Flu caused and we weren’t shouting “face” at one another back then. If our government isn’t too careful, we will be congregating in large groups once more- right outside our psychotherapist’s door.
How Can We Change What We Do?
Ahh, behaviour modification. It’s a great idea, but it’s an absolute beast to implement off the bat like our government seems to hope. For this, I want to use the chocolate box model. It’s a little crazy, but bear with me.
Imagine that I put a box of luxury chocolates on the table in front of you. Any time you reach into the box and take a chocolate, I let you take one and eat it without a problem. Twenty chocolates in and you’re quite happy, this is an easy task!
Now, I suddenly tell you that the chocolates can make you sick and you need to stop eating the chocolates immediately. Instead, you can only tap the box if you think about taking another chocolate until we know they are safe to eat. How do you feel? Frustrated? Angry? Hopeless?
This is kind of the same thing. Just like thought suppression, immediate behaviour modification for a lifetime habit doesn’t work, at least not without consequence.
So, What Can We Do?
I believe that the only personal habits that we can really practice to reduce our chances of catching Covid-19 are to maintain personal hygiene and practice mindfulness. Instead of shouting “face” at one another, we can all do our part by recognising our behaviours, showering regularly and remembering to wash our hands. Disorders like dermatillomania aren’t something that you can stop overnight, but by becoming more mindful of our actions, we have the power to limit how often we do them. Change won’t happen overnight, but with time, these habits can happen less. Stress is among the biggest contributors to anxiety disorders, and by shaming the people who suffer from them, we only encourage them to happen more.
If you’re concerned by someone’s behaviours, please don’t shout “face” at them. Instead, understand that perhaps they’re feeling anxious and confused and engage them in a fun activity. People are finding great and fun ways to take their minds off of the pandemic, why not encourage them to try some? Please don’t shame your friends with a mental health disorder, let’s work together in these trying times and support each other with a good dose of positivity!
Until next time,
Stay safe & have fun,