Copyright The Washington Post Company Nov 12, 2002

Retrieved from ProQuest on Oct. 16, 2006

The air in Martha Miner's one-bedroom apartment is thick with Lysol. The chemicals catch in the back of the throat as you step into the living room, past the plastic bags filled with her clothing, laundry and trash.

Boxes and bags in the dining area overflow with legal papers, junk mail, old newspapers and her deceased mother's possessions. A table against the wall is covered with magazines in neat stacks. Miner says she is unable to put them away, or even go through them to throw some out.

The 47-year-old Fairfax City resident is afflicted with obsessive- compulsive disorder, or OCD, a mental illness that she says keeps her from holding a job and now has her on the verge of eviction.

Hers is a world wrapped in anxiety. She fears coming into contact with germs and being in crowded places. She obsesses over getting rid of something she might need and feels compelled to perform certain rituals before leaving home.

"Sometimes I can't even open the door to go out," said Miner, a slight woman with reddish-brown hair and round glasses. "I don't know why. Maybe it's the fear of going out into the open."

Now she faces a new struggle as she tries to get help. She was fired from her job as a legal secretary recently because of problems related to her condition. As a result, she lost her health insurance. Locally, community mental health programs are being cut back sharply, have long waiting lists and lack specialized help for OCD patients anyway, advocates say. Miner is applying for federal disability benefits, but she fears being turned down because of a lack of understanding about her illness.

"I'm worried that the people making the decisions are not really educated about OCD," she said.

Her disorder is one of the most common mental illnesses -- afflicting up to 3 percent of the U.S. population -- and one of the least recognized. According to the Obsessive-Compulsive Foundation, a nonprofit group based in Connecticut, people with the disorder on average see three to four doctors and spend at least nine years seeking treatment before they receive a correct diagnosis. It takes an average of 17 years to obtain appropriate treatment, the foundation says.

"Many people have obsessive-compulsive behaviors that don't interfere with their lives and might even help them in their work," said Richard C. Baither, a psychologist who treats OCD patients in Fairfax. Such people can be exceptionally well organized and meticulous. But others, he said, are so restricted by the disorder that they are "pretty much house-bound," requiring two to 12 hours a day to complete all their rituals. This "certainly can make people nonfunctional."

One of the worst cases he has seen was that of a man who collected 10 years' worth of his stools in jars in his Fairfax house because he feared that flushing them would contaminate other people.

Fear of harming others is a common obsession among people known as "checkers," OCD sufferers who, for example, repeatedly drive around the block or stop and check under their cars to make sure they haven't run over someone. Others with the disorder include "hoarders," who collect things compulsively; "orderers," who might spend hours arranging their belongings; "counters," who are obsessed with certain numbers or with counting everything; and "washers," who endlessly wash and rinse their hands.

OCD is believed to be caused by a chemical imbalance that short- circuits information processing in the brain and has been described as a case of "mental hiccups" that won't go away. The condition, which may be hereditary, is related to "tic disorders" such as Tourette's syndrome, but is distinct from psychotic illnesses such as schizophrenia.

Unlike those with delusional mental illnesses, people with OCD are generally aware of their condition, although they may be unable to do anything about it. Antidepressant drugs can mitigate some obsessive-compulsive behaviors but usually do not eliminate them.

Even if Miner could get into a local mental health program, "it's very hard to find therapy that's specific to that disorder," said Diane Yolton, secretary of the Northern Virginia Mental Health Consumers Association.

In addition to her fear of germs and her compulsive hand- washing, Miner is plagued by an obsessive need to arrange her belongings before leaving home, which made her chronically late for work. Since losing her job as a legal secretary at a Fairfax law firm in September, she has been struggling to make ends meet.

Medication she began taking in April "takes the edge off" some of her symptoms, but it makes her sleepy, contributing to her problems at work, she said.

At home, simple tasks are an ordeal. She could put some of her belongings in a storage area in her apartment complex, she said, but doesn't feel the area is clean enough. She has to clean the building's washing machines and spray them with disinfectant before using them. She relies on a friend to take out the trash.

Her various fears are "all connected," Miner said. "It's an invisible, powerful thing."

The disorder contributed to the breakup of her marriage in 1988, leaving her alone to raise a son who is now 23. But her toughest setback came in 1994 when she lost custody of a daughter by another relationship. She had put the girl in foster care during a particularly difficult bout with her disorder. A court battle ensued when Miner tried to get her daughter back, and a Fairfax judge ended up terminating her parental rights.

"She turned 10 in September of this year," Miner said of her daughter. "I think she has been adopted."

The loss is a source of endless sorrow -- but one that Miner chooses not to forget. On the door of her refrigerator, whose contents she arranges obsessively so that nothing touches, is a picture of the girl when she was about 2.

In Miner's bedroom, a few feet from her bed, stands an empty white crib.