Hygiene and Mental Health

mental health hygiene
Today’s guest blog post was written by Kathleen Corcoran.

Mental health and cognitive decline can have a serious impact on a person’s ability to maintain regular hygiene and grooming routines. At the same time, changes or lack of regular hygiene and grooming routines can seriously impact a person’s mental health. Today is World Mental Health Day, a good day to consider how hygiene and mental health are woven together.

You’ve probably heard the saying “cleanliness is next to godliness” at some point. Many people subconsciously apply this moral judgement to the personal hygiene of those around them. As society’s standards of hygiene and grooming have changed over the centuries, so have the judgements on those who do not meet those standards.

This can have deleterious impacts on people already struggling with mental health or cognitive ability. Social stigma can deter people from reaching out for help, whether to mention their struggle to a therapist or ask for physical assistance. Self-consciousness about grooming standards may then contribute to isolation and loneliness.

“Unfortunately, at both ends of the spectrum, a lack of personal hygiene or an obsession with personal hygiene create additional stress and anxiety for the sufferer,” says Carla Manly, PhD, a clinical psychologist and author.

mental health hygiene
When mental health issues get in the way of regular showering or bathing, many people turn to alternative methods of maintaining hygiene.

Depression

Maybe chicken flavored toothpaste makes oral hygiene easier?

The fatigue and lack of motivation that often characterize depression make otherwise routine tasks monumentally impossible. Executive dysfunction can be paralyzing in the face of all the minor steps needed to shower or bathe.

Additionally, depression sometimes causes sensory issues that make bathing physically painful. The temperature changes, scents, or lights can be overwhelming for someone with severe depression.

Instead of traditional bathing practices, those with mental health challenges might turn to alternative methods of hygiene. Dry shampoo, mouthwash, and wipes can enable someone with depression to stay clean when everything is difficult.

Alzheimers and Dementia

People with cognitive decline issues, such as Alzheimer’s and dementia, often have trouble maintaining regular bathing and grooming routines. They may bathe repeatedly, forgetting that they have already done so. Or they may forget to bathe entirely. Alternatively, they may have physical issues that prevent them from bathing. Issues with regular bathing can lead to health complications, such as skin infections or gum disease.

People who can live alone may be able to address this by setting alarms or writing reminders. Maintaining a routine for daily grooming and hygiene can help it become automatic rather than something to remember. Adjustments like hose attachments and rubber mats can remove some of the physical impediments to routine bathing.

mental health hygiene
People in advanced stages of dementia may require help from caregivers to perform regular bathing and grooming.

Nurses, caregivers, and health aides can help patients who need more assistance with bathing. Keeping up habits established over the course of a lifetime can make assisted bathing easier. Bathing at the same time, using the same products or scents, might make a patient less agitated. Focusing on hygiene rather than grooming can help eliminate stress.

Ablutophobia

mental health hygiene
Humans with ablutophobia are not alone in the animal kingdom.

Many young children fear taking a bath or shower, but they generally grow out of it as they become more familiar with the routine or associate the bath with pleasant sensations. However, some people develop ablutophobia, an extreme fear of bathing or washing. This may be due to a sensory processing disorder, a traumatic experience, changes in brain function, or an underlying anxiety disorder.

When people with ablutophobia try to perform routine hygiene or grooming rituals, they may experience the symptoms of a panic attack or dissociation.

In the short term, people with ablutophobia can use alternative forms of cleaning, such as wipes or dry shampoo. However, treating ablutophobia will ultimately require psychotherapy or medication, which may allow a patient to uncover and address an underlying cause.

PTSD and Anxiety Disorders

Both post traumatic stress disorder (PTSD) and anxiety disorders can cause difficulties with regular standards of cleanliness. These mental health challenges can cause people to go to either extreme of hygiene and grooming. Sometimes people avoid bathing entirely because it triggers traumatic memories or causes a spike in anxiety. At other times, people fixate on removing dirt, performing ritualized grooming behaviors, controlling elements of their environment, or perfecting their outward appearance.

At either extreme, a person will likely feel an increased sense of social stigma and isolation, compounding the pain from mental illness.

Some people may prefer to take dust baths rather than water baths.

Short-term solutions may include changing the method of bathing, such as cleaning body parts individually to limit vulnerability, or switching from baths to showers. Changes to the bathing environment may also help, such as removing or installing locks on doors, turning down the temperature of the water heater in the home, or removing harsh scrubbers.

“The ultimate goals with such behaviors are to reduce a sense of being violated and ‘dirty’ and to increase a sense of safety,” says Carla Manly.

Schizophrenia

People struggling with schizophrenia often have difficulty maintaining regular routines and lose interest in daily activities. This includes habits like showering, brushing teeth, or changing into clean clothes.

Additionally, many medications to treat schizophrenia have side effects that contribute to problems with hygiene or grooming. Antipsychotic drugs often cause dry mouth, which can lead to gum disease, cavities, and halitosis. These medicines may also cause incontinence, which makes maintaining hygiene very difficult.

Some people find written reminders or alarms helpful to encourage regular hygiene or grooming rituals. Adjusting medications or dosages may help with side effects. Chewing gum and drinking lots of water can help with dry mouth, improving oral hygiene.

Bottom Line: Hygiene and grooming serve two different functions in our lives. When mental health issues make everything more difficult, focus on hygiene rather than grooming.

HOW CLEAN IS CLEAN ENOUGH?

Balneological custom depends on when you live, where you live, how long you live, what you do for a living, and the seasons!

When You Live(d)

The Kumbh Mela is a Hindu festival that includes ritual river bathing.

If you lived in ancient India, you likely engaged in elaborate practices for personal hygiene with three daily baths and washing. These are recorded in the grihya sutras, covering domestic rituals and are still in practice today in some communities.

If you lived in China during the Chou Dynasty, you likely bathed outside, weather permitting. However, if you lived in a Chinese city during the Song Dynasty, you were likely to wash your hands and face before eating and to visit a public bathhouse several times a week.

Infant Buddha bathing
From Gandhara (circa 2nd century)

If you were a Buddhist monk in ancient Vietnam or Laos, you would have bathed frequently, sometimes daily, for religious reasons. However, if you were a Benedictine monk at Westminster Abbey, you would have been required to bathe only four times a year: on Easter, at the end of June, at the end of September, and on Christmas, according to monastic rules (though the Abbey employed a bath attendant year-round).

A German knight bathing
From the Manesse Codex, circa 1300

If you lived in Europe during the early part of the Middle Ages, you likely would have used a public bathhouse to spend quality time with your family, have a nice meal, meet your neighbors, and possibly even petition local officials. And if you lived during the 1340s-1350s and worried that open pores could allow illness to enter your body, you would likely have believed that dirt all over your skin would block disease. You would actually think bathing bad for your health because it opened pores, which led to sickness.

The Catholic Church has gone back and forth on bathing, sometimes linking physical and spiritual cleanliness and sometimes linking nudity and hellfire.

If you lived in Europe shortly after the Crusades, you are more likely to have engaged in a variation of the Turkish hammam and used soaps and perfumes brought back from Jerusalem.

“Don’t throw out the baby with the bath water!”
Narrenbeschwörung (Appeal to Fools) by Thomas Murner, 1512

The ancient Irish bathed daily, sometimes multiple times a day. With the spread of Christianity in Ireland in the 5th and 6th centuries, societal norms shifted to match the current Church customs in Rome: bathing only a few times a year.

It wasn’t until the time of the American Civil War, and the acceptance of germ theory of disease, that bathing became associated with health in Western medicine. 

In the early 1900’s, a typical Saturday night ritual involved American family members hauling loads of water into the kitchen, heating it, then filling a bath. Usually, the oldest/father of the family bathed first, followed by the mother, then the children in birth order, with the youngest last. Maybe this practice gave rise to “Don’t throw out the baby with the bath water.”

Where You Live

A sweat bath: illumination from Peter of EboliDe Balneis Puteolanis (“The Baths of Pozzuoli“)

“Daily showering is a more cultural phenomenon than medical necessity,” Joshua Zeichner, MD, Mount Sinai Hospital. 

If you believe YaHoo! Life, “Americans have long had a reputation for a “squeaky clean” devotion to hygiene that fuels a $3.1 billion body soap industry, yet recent studies show that Americans are actually quite average when compared to how often people shower worldwide.”

Among people who shower every day, Mexicans and Australians led, followed by Americans and the French. Brits, Russians, Swedes and Germans averaged less, with Chinese the least frequent.

Takaragawa Onsen

If you live in an area where the geography lends itself to hot springs, geothermal vents, and readily available water and fuel for heating water, you are more likely to bathe frequently. Japan’s natural hot springs (onsen, more than 27,000 by some estimates) are used for nearly daily bathing, with some research indicating a link between frequent soaking and longevity. Dense forests provide fuel to heat Finnish saunas and Iroquois sweat lodges, both used for physical and mental health as well as bathing.

Himba woman wearing a paste of hematite, sap, and butter

If you live in an area where water is scarce, you are likely to employ “dry” methods of bathing. Smoke baths, in which a blanket or tent is positioned above a fire of Commiphora wood to trap smoke around the bather’s skin, are effective means of killing bacteria and any bugs on the body or clothing. Oil or fat smeared on and scraped off the skin removes dirt and bacteria as well as protecting the skin from the elements. Pastes made with antibacterial herbs, clay, bark, and scented ingredients serve two purposes: they protect skin from sun, wind, or cold when applied and remove dirt when wiped off after drying.

If you live in an area crowded with other people, you are more likely to bathe frequently and often communally. Turkish hammam, Swiss health spas, Roman thermae, even medieval European bathhouses took advantage of shared resources (such as heat from baking ovens used to heat water) and were visited by groups of friends or neighbors. On the whole, bathing is less frequent in more sparsely populated areas.

Societies with a tradition of communal bathing tend to view a visit to the bathhouse as necessary for social and mental health in addition to physical hygiene. Russian banyas and Turkish hammam are places for meeting neighbors. Swedish and Japanese onsen are used for mental health and relaxation as much as removing dirt from the skin. Taiwanese hot springs and Mexican temazcal serve medicinal roles and are often staffed by medical professionals. The Finnish House of Parliament has a sauna where elected representatives can discuss legislation and issues of the day.

How Long You Live

Children
“Eskimo children bathing in Bering Sea”
c1905 FH Nowell

Bathing recommendations from the Cleveland Clinic depend on your child’s age. Dr. Tamburro suggests these general guidelines:

  • Babies, toddlers and little kids should spend some quality time in the tub two to three times per week. Their delicate skin doesn’t need daily cleansing, but it’s OK to get out the bath toys more often if your child gets dirty or has a messy diaper situation.
    • Speaking of tub toys, make sure they’re non-toxic and don’t have the potential to harbor, mold, fungus, and bacteria.
  • Older kids ages 6-11 should hit the bath two or three times per week, at a minimum. More showers are in order when they get muddy, sweaty or stinky.
  • Tweens and teens should shower daily. (Their newly stinky pits will probably clue you in when it’s time to step up their hygiene game.) They should also wash their face twice a day.  In addition, many teenagers are physically active, and showers are a good idea after strenuous sports events or practices, including swimming, working out, and other physical activities.
Older People/Seniors
  • To avoid any skin conditions or infections, a senior should bathe at least once or twice a week. 
  • Some elderly people may suffer from dementia, and they may have more toilet mishaps. Obviously, this means more frequent baths and showers to avoid infections.
Adults in General 

It may sound counterproductive, but a shower every day could be bad for your skin. Some dermatologists only recommend a shower every other day, or two to three times a week.  If you shower too much it can lead to discomfort, and you may experience:

After the Bath
c1898 by WB Davidson
  • Itching
  • Dry, flaky skin
  • Flare-ups of skin conditions like eczema and psoriasis
  • Dry, brittle hair

Although fewer showers may improve skin health, you should still keep your personal hygiene in mind.  If you go too long between showers you may experience

  • Increased body odor
  • Acne
  • Flare-ups of skin conditions like eczema, psoriasis, and dermatitis
  • Skin infections
  • Areas of dark or discolored skin
  • in extreme cases, dermatitis neglecta, thick patches of scaly skin

What You Do for a Living

Hydropathic applications according to Claridge’s Hydropathy book

People who work at desk jobs and spend most of their time indoors have the same bathing needs as adults in general. However, those who work with dangerous substances, animals, or in any jobs that people consider to be unhygienic may feel the need to bathe more often.

  • Janitor
  • Exterminator
  • Miner
  • Garbage collector
  • Butcher
  • People who work with corrosive materials, dangerous chemicals, disease agents, and radioactive materials need to shower at the end of each of their shifts.
  • Horticulturalists, arborists, amateur gardeners, and anyone who spends a significant amount of time outdoors around a variety of plants can reduce their risk of rashes and other skin injuries by showering as soon as they come indoors. on.
  • Athletes—anyone—whose job requires intense physical exertion.

Seasons and Weather

Home Bathing
by Kusakabe Kimbei

Guidance for better bathing during seasonal differences and changing weather are included in other categories and won’t be repeated here.

Health Line offers tips to bathe correctly and protect your skin.

  • Only take one shower a day (every other day, if possible). On days that you don’t shower, give yourself a sponge bath. Wash your face, armpits, and groin with a washcloth.
  • Don’t shower in hot water. Use warm water, instead.
  • Limit showers to 5 to 10 minutes.
  • Use a gentle soap or cleanser, and thoroughly rinse off soap before exiting the shower.
  • Don’t rub your skin with a towel. Blot skin dry to retain moisture.
  • Avoid cleansers and soaps with fragrances or deodorants. These products can irritate your skin.
  • Apply moisturizer to your skin after each shower or bath

Related Matters

Turkish hammam
  • Sweat doesn’t have an odor. It’s the interaction of sweat with bacteria on the skin that creates the stink.
  • Even with “good” smells, too much is never a good thing, particularly in close quarters. For example, the Richmond Symphony and Chorus ban perfume, aftershave, deodorant, etc.
  • According to the Cleveland Clinic, you probably don’t need to wash your hair every time you shower. Typically, shampooing two or three times a week will help keep your scalp healthy and hair happy.
  • Dutch study found that individuals who ended their showers with at least a 30-second blast of cold water were absent from work 29 percent less of the time than people who did not do so.
Washing before prayer (wudu) at Badshahi Mosque
Lahore, Pakistan

Bottom Line:  According to medicalnewstoday.com,  “Although showering offers physical, mental, and emotional benefits, the daily shower that many people in the U.S. are in the habit of taking is probably more than most people need. Showering dries out the skin and hair, uses natural resources, and creates an additional source of water pollution.”

For a more detailed exploration of how social norms around bathing vary throughout history and around the world, check out Clean: A History of Personal Hygiene and Purity by Virginia Smith.