I finally talked to a psychiatrist about it.
Image: Tertia Van Rensburg
After work one day, I was particularly tired and not at all in the mood to exercise, but I knew I couldn't skip another workout. As I went into my building's mailroom to check my mailbox, I happened upon a flyer advertising a yoga class at 7 pm that night. A happy compromise.
And yet, I was in dire need of a shower. It had been a full week, at least, since I last took one… or had it been longer? I honestly had no idea. But to skip exercising? Irresponsible.
I struggle with showering. But before I attempt to explain why, allow me to complete the picture of a day in my life.
Eager to exercise that evening, I put on a clean shirt and grabbed my pink yoga mat—rife with sweat stains, mind you. (It doesn't usually matter because I use my mat mostly at home). I plodded downstairs to my building's community room, eager to start the yoga. But already I felt an uncomfortable film on my skin. To avoid embarrassment, I set myself way up front in the left corner of the room, as far away as I could get from the other women. I didn't want them to smell me. Thankfully, our yoga instructor was merely a Gaiam DVD.
As we began, I started to regret my decision to work out in public. That film on my skin was immediately activated, and my neck and brow became covered in salty sweat. My freshly-cleaned shirt now clung to my torso. During the entire video, my mind was not filled with any sort of yogic calm. Instead, I was afraid that I was smelly and offensive to the others in the room.
When the video finished, I made a mad dash back to my apartment and ran the tap for a shower. I applied some organic liquid soap to my natural-fiber brush, bit my lip and began to scrub. And as I scrubbed off that stubborn film, I whimpered audibly.
Those bristles hurt. A lot. For all the days that I skipped showering, I now paid back in spades. That brush had to get off all the sweat and dirt that had accumulated over the past week. My skin was tender, because it is not used to being scrubbed. And then there's the feeling of water on me. Sure, the temperature was pleasantly warm, but I don't like being wet. It is physically uncomfortable for me, especially when I towel off. I get chilled, and I feel like freezing in place instead of moving—but I had to get off that damn film.
My hair was a mess, too. It's curly and long, so it always ends up becoming a tangled ball of frizz, which I marginally manage by using hair product. To wash my hair, I applied shampoo and scrubbed my scalp with my nails. Then a second application. And then a third. And then conditioner. I hadn't had a haircut in a while either, so the ends were particularly tangled and stubborn. Clumps of hair filled my brush.
My hygiene habits have been this way for as long as I can remember. Why can't I get myself to bathe regularly? For one thing, I was diagnosed with schizoaffective disorder, bipolar type. Schizoaffective disorder is a mental illness diagnosis—a combination of schizophrenia, which includes hallucinations, delusions, and paranoia, and a mood disorder, which for me is bipolar. This includes periods of mania and depression. I've also dealt with general anxiety, which includes panic attacks and periods of extreme fretting.
Mental illness has profoundly affected my life. I was diagnosed with clinical depression at age ten, and started medications at fourteen. While in college studying for a master's degree in viola performance, psychosis crept up on me. One insidious aspect of my schizophrenia is that I sometimes don't even realize I have it. My delusions and tactile hallucinations are as vivid as reality, and so they become such, without question.
Three years ago, I was hospitalized for three months and put on an antipsychotic medication called Clozapine, which has rehabilitated me profoundly. I can now live a so-called "normal" life. I have a job, and I can even pay my student loans on time. (This is actually a source of joy.)
And yet, my poor hygiene remains. That episode with the yoga class happened just recently. Why?
"There are what we call 'positive symptoms' [of schizophrenia], which are the psychotic symptoms, delusions, or hallucinations, or magical thoughts, and there are 'negative symptoms,' which are flat affect, not being very expressive, losing motivation," says Gail Saltz, a psychiatrist at New York Presbyterian Hospital and professor of psychiatry Weill-Cornell School of Medicine. "Together, those negative symptoms conspire to make it very typical that somebody with a schizophreniform disorder will have trouble with personal grooming."
Saltz's explanation of positive and negative symptoms reminds me of what I learned in a group I attended while in an outpatient psychiatric rehabilitation program. I remember learning about how positive symptoms are not necessarily "positive" in terms of "happy," but rather additive to a person's experience. Delusions are an example of this, as Saltz says. Likewise, negative symptoms detract from a person's experience. It is a lack of showering that I am struggling with—a negative symptom.
"While medication for anything in the schizophreniform arena is definitely important, it mostly treats positive symptoms, so it controls delusions and hallucinations and so on," Saltz explains. "It doesn't do very much for negative symptoms. What does help with negative symptoms is usually psychotherapy or a sort of rehabilitation program that has to do with training."
I've never specifically had therapy to "untrain" myself from my habit of poor hygiene. It never has crossed my mind, honestly, because I've had more pressing symptoms that needed attention.
I further explain to Saltz my situation with my grandmother, who had a fear of water. Specifically, I spent a lot of time with her as a child. She only bathed me once a week, and never instructed me to use a sponge to scrub myself. Instead, she was more concerned with not having any splashes of water go beyond the tub. When I made a little spill of water, whether during bath time or at the dinner table, she cleaned it up as if she were putting out a fire.
"It wouldn't be surprising for that message to be passed on, and for the child to feel like, 'I don't want to be in water," Saltz says. "'It seems dangerous, the adult has told me so.' But also, phobias and OCD have a genetic component. Sometimes, there's a biology to the passing on of the idea that it's not a good idea to be in water, if that happens to be the phobia. Actually, it's interesting, because phobias not only have a genetic component, but it's also the exact fear or phobia that the offspring develop."
Given that I only first interacted with Saltz during the interview, she was not able to give me a full diagnosis, or an answer to the reason of why I struggle with showering. Is it due to my schizophrenia, or childhood conditioning? Her verdict:
"There's no way to know which has the bigger impact, except to say this: Loss of ability to do personal grooming in schizophrenia is extremely common."
No matter how dirty I am, and no matter how disoriented I become from reality, none of it defines who I am. It is simply the illness manifesting in my life. Those conditions do not define me.
Of course, I'd like to challenge my habit of poor hygiene someday. Doing so will help me reach further towards "normalcy." But do I even want to be that normal? I already have a full-time job and a career. I already can pay my bills. I already have a sense of purpose and happiness in my life. Do I also have to be a clean showered person? Sometimes I want to hold on to the eccentricities I have left.