The first half of the year is nearly over and I am finally feeling like I can catch a break from what has turned out to be a pretty awful six months. I’ve hesitated to write about what’s been going on in our family for a few reasons, the main one being that the girls are old enough to appreciate personal privacy and don’t like me talking about them even though few can put two and two together from this blog to identify them in real life.
I want the girls to take control over who they choose to tell about their struggles, and when and how they do so. However, I also want to tell the story as I have been living it, because it might help other parents out there who are going through the same situation. There is also nothing shameful about all of this, so I’m doing my part to destigmatise mental illness and to tell the world that having something wrong with your brain chemistry is no different from having problems with your insulin, or with your vision.
Late last year, Girl #1 was diagnosed with obsessive compulsive disorder. She had been under psychiatric care for a while because she had several episodes of hyperventilation and also reported hearing voices. I was worried that she might be exhibiting symptoms of early onset schizophrenia, but after several visits to the psychiatrist and psychologist, and in-depth assessments, she was diagnosed with contamination OCD, which is when a person is obsessed with cleanliness or the lack thereof, and manifests this obsession in the form of compulsive tidying, handwashing, or cleaning in general.
Girl #1’s diagnosis was a revelation to us because her contamination OCD showed up mainly when she was in the bathroom. We had never noticed her spending long periods of time in there, and were at first reluctant to believe that she could have OCD because we obviously could not see her scrubbing away while in the bath. But the diagnosis must have been a relief to Girl #1 because she no longer needed to hide her compulsions, and could finally get some help to cope with the symptoms. She started seeing a psychologist regularly for exposure response prevention, which is a type of therapy that teaches people with OCD to control their thoughts such that they do not translate to actions. She also started on an anti-anxiety and antidepressant medication called fluoxetine, which is better known as Prozac.
We went through some terrible times in the early months of the year trying to find the right dose of Prozac that would help her keep her anxieties under control without incapacitating her with its side effects. At one point, the side effects (headache, nausea, dizziness) were so bad that we stopped the Prozac and switched to another drug, Lexapro. That turned out to be a huge mistake as Girl #1 felt that this new medication did nothing for her. Her OCD was exacerbated to the point where she felt that she was so crazy that life was no longer worth living. In early April, she overdosed on paracetamol in school. Thankfully, she did not ingest enough to cause permanent damage or death.
After that incident, Girl #1 went back onto Prozac and we worked through the dose increments and side effects until she got to a dose that the psychiatrist felt was optimal for her. She has been on this dose for several weeks now and her OCD is currently well controlled such that she doesn’t feel the need to see her psychologist for the time being. The side effects have also mostly abated. But because of this tough situation, she missed more than half of the first school term of the year and had to work hard to catch up.
That’s Girl #1.
While all of this was going on, we were also dealing with Girl #2, who was diagnosed with social anxiety disorder early this year. In hindsight, she has probably lived with anxiety for at least the last four years. We just didn’t realise that her worrywart ways are not her personality, but a mental health problem.
Her social anxiety showed itself as extreme reticence. She would not greet or speak to people she has known her whole life. As you can imagine, this prompted comments on her “bad behaviour”. People couldn’t understand that she wasn’t being rude; she was simply too anxious to be able to interact with others outside her immediate family. I lost count of the number of times I had to explain the situation to people and assure them that no, it wasn’t something that they had or hadn’t said or done.
Like Girl #1, Girl #2 went through several psychological assessments before the diagnosis of social anxiety disorder was made. Unlike Girl #1, she was not prescribed medication immediately because of her age. Her psychiatrist felt that we should give Girl #2 a chance with therapy before we considered medication.
Girl #2 started seeing a psychologist who worked with us to identify her “ladder of anxiety” and learn ways to work through her feelings whenever she was in an anxiety-inducing situation. I would force her to do progressive muscle relaxation with me every night, to inculcate self awareness of the difference between being tense and relaxed, and how to use relaxation to cope with anxiety. I went on a supplement buying binge on iHerb and put both Girl #2 and Girl #1 on multivitamins, probiotics, and Omega-3 fish oil. To their dismay, I also bought a magnesium supplement for them to take before bedtime, as magnesium is a relaxing mineral. (These days, I no longer make them take magnesium, but they still get all the other supplements.)
Unfortunately, Girl #2 was not receptive during these sessions with her therapist, and would sit in stony silence. Her mood became increasingly despondent. At one point, she attempted suicide by eating flowers from the school garden, thinking they would be poisonous. She also self-harmed whenever her feelings became too big to bear. I can’t tell you how painful it is to see scars on your young child’s arm, and knowing that there is nothing you can do about them except to apply balm and remind your child that there are safer and more constructive ways to emote. I can’t tell you because my way of coping has been to build a wall around those feelings and focus on finding solutions to the issues at hand.
After discovering several notes in her room about wanting to die, I decided that we could no longer wait to see if therapy would work, and scheduled an emergency appointment with the psychiatrist. I showed him the notes we had found, and he agreed that it was time to start Girl #2 on medication. She now takes the same medication as Girl #1, but in a lower dose appropriate for her age and weight. Thankfully, she hasn’t felt the side effects as keenly as Girl #1, and her mood has improved considerably. She can now converse with relatives and has gained confidence in doing things like buying things at shops. She even spoke during her oral exams at school, which was an immense relief as we thought she would not open her mouth when it was her turn in front of the examiners. Her smile is back, and so is her goofy sweetness.
Anxiety disorders run in families, and anxiety and depression often go hand in hand. While neither the husband nor I have been diagnosed with anxiety or depression, we’re well aware that we exhibit some of the traits associated with these conditions. Unfortunately, there’s nothing we can do about the poor genes we appear to have passed down to our children, so the best we can do is to ensure that they are both fully supported and to keep close tabs on how they are from day to day. We are deeply thankful that both girls’ schools have been very supportive and their teachers actively work with us to ensure that they get the help they need at school.
I am now keenly aware of how society views people with mental health conditions. I never used to find it offensive when people said they were “OCD” in reference to their desire to keep their stuff in order, but I do now. A person living with OCD is tortured constantly with overwhelming thoughts that they cannot control – what they go through is sheer hell. It should never be trivialised and compared to mundane thoughts like the need to spring-clean an overflowing closet. Perhaps it seems fashionable to claim that one is “OCD”. A conversation with an actual OCD sufferer would quickly disabuse you of that notion.
Likewise, a person with social anxiety disorder is not “just shy”, they are actually struggling to breathe at the thought of having to socialise with others. Before she went on medication, Girl #2 would visibly shut down when she was placed in situations with people outside her comfort zone.
I’ve also realised that mental health conditions in children, unless severe from the outset, often escape unnoticed until they boil over and become full blown problems. After I described what the girls had been going through to a friend, she noted that she knew of someone who had a child who seemed to be exhibiting the same behaviour as Girl #2. I asked that friend to gently encourage the child’s mother to consider seeking help.
If you have young children at home, don’t hesitate to see a child psychologist if your child seems worried and anxious all the time, suddenly becomes angry or volatile, or expresses thoughts about wanting to die. Conditions like OCD and anxiety or depression are highly treatable, and the earlier a child is diagnosed and gets the help that is needed, the better their long term prognosis.
Having said that, I’m not thinking too far ahead about the girls’ health and their future. There is some concern about the impact of long-term medication on children’s growing brains, as well as future developments such as pregnancy. But for now it’s more important that my children are stable, happy and safe, than to think about what-ifs that are far off on the horizon.
So there you have it – what’s been going on for the last six months. The husband and I decided to cancel our planned trip to Taiwan at the height of Girl #2’s crisis as I didn’t feel comfortable leaving the girls at home while we travelled. We are now on an even keel (touch wood!) and I hope that the rest of this year will be good to my girls. After all that they have gone through so bravely, they definitely deserve it.