The little secrets that help people cope

Some people do have rather odd habits. They may just get used to them, feel a bit embarrassed, and perhaps tell their families, perhaps not. As often as not they don’t go to the doctor.

Miss A came to see me because she was embarrassed and her GP (in whom she had confided) was concerned about her health.

Her habit was eating ordinary garden soil. She said she had done it when a teenager, her mother had dissuaded her (or perhaps been more emphatically forceful about stopping her) and then she had started up again a few months ago. The reason was the nice smell of soil, the fresh grass aroma to it.

Alarmed at the risks of ingesting the (probably) dog-fouled grass of public parks, her family helped to obtain packets of soil from garden centres, which they thought would be cleaner. She didn’t have any health problems from this, had managed to cut down from eating a bowl a day to a handful, and her GP had given her some iron tablets, in case anaemia was a cause.

This habit is known as pica, and is sometimes seen in children with learning disabilities. It is also recognised in pregnant women (when odd eating habits abound), and the more technical term is geophagia. There’s usually nothing else wrong with you.

You don’t hallucinate or feel depressed, you just like it. Miss A agreed not to overdo it – say, no more than once a week, as a treat – but how do you treat something that a patient sees as a “treat”?

Another habit disorder is the impulse to pull hair out of your scalp, known as trichotillomania. Usually this comes on when you are tense or anxious, and the effect is one of relief. In that regard it is not unlike the relief that certain patients find when they cut themselves. It is as if the tension is reduced. Some theories say that by doing that kind of thing you stimulate your natural endorphins, producing a biochemical inner calm.

Miss B came to see me because of her trichotillomania. She was wearing a beret, and when she took it off there were two or three little patches where she had taken out lumps of hair. She came more in hope than expectation, having checked the internet (as people do these days) and found nothing much to help her. As it is rather a rare condition, and often not reported by patients, no one has any idea how common it is. It may be related to obsessive compulsive disorder (OCD), and some have suggested using antidepressants, which can help with obsessional thoughts and actions.

We discussed treatments, and she said she would try some medication but she didn’t think it would work. She had previously been given Prozac, when she told her doctor she was “depressed” rather than reveal her funny habit, and it had not worked. She was not in fact disabled by what she did, just rather embarrassed and with a nice range of hats.

So the assessments and the discussions, carried out with the evidence available (essentially zilch), may have been helpful, if only in enhancing Miss A and Miss B’s scepticism about psychiatry. Both were polite and friendly, and didn’t ask for more. Of course, there is always a therapist out there somewhere, whether in Camden or California, who would happily take regular payments (often based on the therapist’s ego rather than their effectiveness). But do these folk need resolution of the inner conflicts that are deemed to cause their habits, or are they just, like you and me, coping with the way they are?

Trevor Turner is a consultant psychiatrist working in east London. Some details have been changed to protect identity. Sophie Harrison is on maternity leave

Copyright The Financial Times Limited 2017. All rights reserved. You may share using our article tools. Please don't cut articles from and redistribute by email or post to the web.