Family Forum: Not Leaving the House

Concerns about family member’s mental health.

QUESTION:

My friend is very worried about her brother, who is in his late 50s. Even before COVID-19 came along, he was always very clean and tidy. He has for many years spent a lot of time cleaning his house. His family have never been invited to his house and the assumption has been that this is because he is not able cope with dirt, he is very focused on cleanliness. He used to socialise outside of his home and have meals at family members’ homes and at restaurants when invited to family functions. But since COVID he barely leaves his home and finds reasons to decline family events. He has become almost a total hermit. He held a responsible job until about five years ago when he was more or less forced to retire. He seemed to adjust to early retirement, he keeps fit and is not a drinker. He has never married, although was engaged once many years ago. His family thinks that he may have obsessive-compulsive disorder (OCD), although they have never discussed this with him. Is this treatable? How can he get help? What is the best way to approach him?

ANSWER:

As people age, there can be a tendency for them to increasingly struggle with conditions they used to be able to manage more effectively when younger. Strategies that enabled someone to go to work and socialise out of necessity or a sense of family duty may crumble when no longer required. This is also exacerbated by situations such as the COVID-19 pandemic. If a person already has a tendency towards anxiety, depression or social phobia, then this can be magnified by the very real fear of a deadly virus.

Obsessive-compulsive disorder is usually underpinned by high levels of anxiety or fear of an adverse event. It can result in specific rituals or behaviours in order to alleviate those intense feelings.

Treatment can be difficult. Humans have a great capacity to adapt and cope with adversity, and your friend’s brother may not agree that his behaviours are a problem. The first and most important step is to encourage him to recognise and accept that his condition is serious enough to necessitate treatment. Treatment can require a combination of medications and psychological therapies, such as cognitive behaviour therapy (CBT). The next step is to facilitate the acceptance of professional support from experienced clinicians. This usually starts with a visit to, or from, a trusted general practitioner, who can then refer the person for specialist therapeutic treatment.

In your friend’s case, providing a pathway to therapy is the best way to help her brother. Offering to accompany him on a visit to a GP for a check-up may work. The increased use of telehealth, including both video and phone consultations in the home, is also a useful tool in engaging him in the therapeutic process. If her brother refuses to acknowledge that he has a problem, then a straightforward honest expression of concern and offer of support may be all that is possible. At the very least, this may plant the seed for acceptance of treatment in the future.