Germaphobia and the Pandemic

Not everything will kill you.

Posted Oct 02, 2020

Nilses/Wikimedia
Coronavirus
Source: Nilses/Wikimedia

“I think I’ve become a germaphobe,” said my patient Derek. “I’ve been wearing gloves when it’s 90 degrees outside.”

Even before the pandemic, Derek showed signs of obsessiveness — he never stopped checking up on manuscripts once they were submitted to journals (“Did you receive it?” “Is it in the queue?” “Have reviewers been assigned?”) and he kept rearranging mice in their lab cages so they wouldn’t get bored with their cage-mates (“You can’t take the mouse-mind for granted,” he’d muse). Derek was a scientist at a local university, specializing in behavioral research. But increasingly, he’d become concerned about his own behavior. He kept worrying about germs everywhere.

The pandemic has sharpened a lot of our worries. If we were financially stressed, we’re now more taxed, even some petrified. If the rent seemed confiscatory, many tenants now dread eviction. In the case of ever-present germs (justifiably menacing if we take the subway), we now feel their nasty receptors binding onto us to death. COVID-19 has only heightened our awareness of microscopic trouble-makers.

In Derek’s case, the cause for alarm hasn’t stopped with the new coronavirus. Now he worries over every germ he might meet. The other night, for example, when he took some chicken out of the freezer, he first checked the FDA website to find out if bacteria are killed when food is stored at 00. When he found out that they were only deactivated, and could reproduce again once the food was thawed, he panicked. “I cooked that chicken until it was like concrete,” he said. He’s stopped eating salads (“you’ve heard about that spinach scare . . . and then there was the lettuce!”), and he thought about washing fruit in Clorox.  

You wouldn’t know about Derek’s germaphobia just watching him resist COVID-19. He’s sensible about the virus and wears a mask wherever he goes. His university has partially opened up and mandates masks on campus. It urges frequent hand washing and, for personnel who work in labs, it requires weekly tests (“they don’t want us killing off the postdocs — bad for business,” he jokes).  

But what has started Derek worrying is how his obsessions, which we’ve been working on for years, now seems to have burgeoned into looming hysteria. He’s tried to keep what he calls his “germ-craze” from other lab-members by getting in early to clean, but it’s begun interfering with ongoing experiments. “I threw out an open beaker of nutrient,” he said, “because it could have been contaminated. The person who was using it spent hours getting the titer just right again.”  

So, the question became: How do you deal with excessive obsessions when, in principle, the motivation is reasonable but the person has begun taking it to an extreme? When symptoms such as obsessions interfere with functioning, they rise to the level of a disorder. So obsessive traits burgeon into Obsessive-Compulsive Disorder (OCD).

Derek became a successful scientist by paying attention to detail, and checking and rechecking his work for error. He’s trained a generation of postdocs to be scrupulous, and working in his lab is considered a smart career move. It’s just that now, what by-the-book has become noticeably nuts.

Over the past several years, Derek and I have spoken about his father’s inability to hold a job. One year, his father worked as an office manager in an electronics company, making sure that orders were processed. But he was fired when there were missed deliveries. Then he worked at a gym, putting out towels and re-shelving equipment. That went bust too, and he ended up in construction until he was hit by falling sheetrock and fell backward — hurting his back.

He retired on disability, and Derek’s mother had to go out to work. She resented having to work and take care of the family, and Derek thought she cut corners. Once, when Derek’s sister was selling Girl Scout cookies, Derek’s mother handed in all the order slips without counting who had ordered what. When seventy-six boxes of Chocolate Mint arrived, and half the people had wanted to Shortbread, that did it for Derek. “I swore that I’d never be like them.”

It’s common for children, who find fault in their parents, to want to be different. So, Derek became a stickler. Everything had to be just right. He’d sometimes arrange the food on his plate so that the vegetables didn’t touch the meat. He liked order and predictability. He hated anything messy . . . which may account for why he still lives alone. He has a girlfriend, but he’s never been able to find a place together with her. The issue is her casual housekeeping. “I actually think it’s disgusting,” he says, “but around here I just complain about the dust.”

Except now. The relationship has taken a dramatic turn. Before the pandemic and Derek’s germaphobia, they’d have sex maybe twice a week. Derek would stay over and then leave for work early the next morning. Now Derek is reluctant to have sex unless his girlfriend has changed the sheets in the morning. He insists that they both scrub up before they get into bed, and then he jumps into the shower as soon as they’re finished. “I know that’s not exactly romantic,” he said, “but I just can’t stop worrying about germs.” His girlfriend thinks he sees her as dirty. He won’t even share breakfast with her anymore (“she has no dishwasher”) and he’s afraid that she’ll get sick—or at least of him. 

The psychological effects of COVID-19 can splay off in extreme directions. Derek is not afraid that his girlfriend will infect him with it, so much as that she might have something else that is lurking in the biome. The same is true for all his other contacts. For the first time in ages, he said, he feels like that kid in his parents’ house, afraid that trouble is everywhere. “You don’t know when to expect something, so you have to be vigilant.” His girlfriend resents being lumped in with everyone else.

OCD can be deeply embedded in a person’s behavior. Sometimes they don’t even notice. Derek — a behavioral specialist in rodents — is aware enough, at least, to notice the outcroppings of his condition. He recognizes that a stressor like COVID-19 can kick his condition into overdrive. So, we’ve talked about how he can deal with this latest manifestation. Even though ultimately, we want to work through the fundamental causes of why he reacts so obsessively, I recently suggested starting a serotonergic reuptake inhibitor (SSRI) like Prozac, which can help with symptomatic relief. 

We also further discussed other approaches that touch on exposure therapy. Like the next time Derek visits his girlfriend, he should try being more relaxed and maybe stay for breakfast. If he remains healthy (as I was sure he will), then he can relax a little more. He could try getting into the lab a little later, permitting the postdocs to clean up their own spaces as they see fit. I teased, “If there is no contamination, and the experiments work out, then maybe you’ve found a new protocol!”

The way to address OCD is to allow the person some exposure to what stimulates their undesired reaction, and then let them realize that they’ve survived. Then they can move on, exposing themselves a little more until the obsessive reaction is manageable.  

Of course, COVID-19 is no joke. We can’t become complacent. But neither can we permit it to become a universal stressor that aggravates every corner of our complex mental environment. We have to stay sane, despite it. Or perhaps, more affirmatively, like the German philosopher, Friedrich Nietzsche said, ”What doesn’t kill me makes me stronger.”