OCD: When care turns pathological

by
04 October 2019

The co-founder of OCD-UK, Steve Sharpe, writes about a condition that has afflicted heroes of Christian faith

ALAMY

A statue at St Alphonsus Mary Liguori Parish Church, Magallanes, in the Philippines. St Alphonsus Ligouri, the founder of the Redemptorists (1696–1787), suffered from scrupulosity

A statue at St Alphonsus Mary Liguori Parish Church, Magallanes, in the Philippines. St Alphonsus Ligouri, the founder of the Redemptorists (1696&ndas...

WHEN I was a child aged ten(ish), it somehow dawned on me that if I were to follow certain rituals it could alter outcomes. I vividly remember applying this concept to the West Ham v. Fulham FA Cup Final.

I was a West Ham supporter, and I was convinced that, if I could maintain a round of tennis-ball volleys against the wall on the side of my house (I forget now how many now), my team would win.

It is this insignificant act — or, more importantly my belief, about the act — that I can pinpoint as the first demonstrable evidence of what was to become obsessive compulsive disorder (OCD).

By the way, West Ham won, as I recall, which means that it worked!

All jolly harmless, one might think, and I guess that would be true if that was where it stopped. It is only now, looking back, that I can see that such rituals were an unconscious attempt to suppress feelings of anxiety. This became more evident when I started applying the rituals to things of deeper concern.

My earliest recollection of this is applying the tennis-ball ritual before a family road trip. Not yet a teenager, I was worried that there was a chance that, by undertaking a long road-trip, we might have a car accident. I can trace this to a Play for Today on BBC1, in which I had watched a happy family driving in a car listening to “I can see clearly now the rain has gone” crashing headlong into an oncoming vehicle.

It was entirely logical, therefore, that I should do everything in my power to prevent such a thing happening to my family, and the obvious means immediately at my disposal was the tennis-ball ritual.

My mum, dad, and sisters were involved with the local church, and I tagged along sometimes. It dawned on me that, rather than the tennis-ball ritual, prayer could be the means of ensuring the safety of my family.

To a Christian not suffering from OCD, this might seem perfectly normal — praying for loved ones is a regular practice for most Christians. My OCD twist, however, was to pray a certain number of times as a repeated mantra, and my number was five. I’m not sure, now, where five came from, but it remains with me as my significant number to this day.

 

AT SOME point during my childhood, the ritualistic praying stopped being just a positive “added extra” and started to take on compulsory characteristics. My thought-process went like this: I want my family to be safe and well; it is my responsibility to do what I can to ensure this, i.e. perform the rituals; if I don’t do the rituals, and something bad happens, it will be my fault because I didn’t do the rituals, i.e. I hadn’t made the effort to ensure their safety and well-being. Even now, this has an inescapable logic to me.

In my teenage years, I took it all to another level. I was not interested in going to church for regular services, but I was still using the prayer ritual as my safety net. My brainwave was to visit the locked-up church every Sunday night, when it was dark, and stand just outside in the shadows to do my five-times prayer ritual. This would variously apply to different topics, depending on prevailing circumstances: family being safe during an upcoming trip; girlfriend not being accidentally pregnant, etc. I have to admit to being very nervous as I write this, for fear of a of a spiritual backlash against the breaking of a sacred bond.

This was a ritual that I kept up for years, often supplemented with daytime visits (not when services were on, of course) to churches in the City of London, where I worked. When asked by a work colleague about my frequent City church visits, my cover story was that I was trying to visit all of the churches in the Square Mile out of historical interest.

Inexplicably, my anxiety and rituals petered out after I got married and moved to the United States for a few years. They resurfaced with a vengeance, however, on the birth of my first child and subsequent return to the UK.

My concerns began to centre on cleanliness. Leaving the house for work in the morning became a struggle, and, even at work, I would arm myself with disinfectant wipes. For a period, I even started wearing white cotton gloves. The fear of contamination took over my life. Importantly, my OCD rituals were entirely constructed around the possibility of my “contaminating” anyone else rather than the other way around.

Somehow, the added responsibility of having a child had triggered an illogical but deep-seated belief that I was a bad person, and that the things that I did — or did not — do could adversely affect other people. The transition from childhood/teenage rituals that were designed to avert catastrophic events or ensure positive outcomes, to adult rituals designed to prevent “contamination”, can, in my opinion, largely be ascribed to the AIDS awareness campaign run by the BBC in the late 1980s. The slogan “Don’t die of ignorance” stoked the fires of OCD.

It was at this point that my life descended into nothing short of managed chaos. I discovered that alcohol was a pretty effective way of buying myself temporary relief from my OCD. I would wake in the morning in sheer terror, and, 12 teetotal years later, it is the memory of that that keeps me sober and my OCD at a manageable level, so that it does not really interfere with my everyday life too much.

 

IN RECENT years, my reflections on OCD had taken on a new, theological dimension. After being baptised at the age of 53, I became a Reader, and I am currently pursuing a divinity degree.

It is not only the strict ritualistic practices set out in Leviticus which have provoked these reflections, but the whole concept of prayer itself, which seems to have a strong correlation to the “magical thinking” of OCD: i.e., my thinking about a loved one (praying) might have a positive impact on the circumstances of that person.

The difference is the insinuation of a third party: God. This should remove the direct personal accountability associated with the magical thinking. But, for those of us with OCD tendencies, nagging doubt starts to creep in: perhaps I didn’t pray enough, or in the right way.

Historical accounts suggest that this anxiety about the sufficiency of one’s religious practice — and resulting compulsive behaviour — has afflicted some of the heroes of the Christian faith. The concept of “scrupulosity” was alluded to in the 16th century by the founder of the Jesuits, St Ignatius of Loyola, who wrote: “After I have trodden upon a cross formed by two straws . . . there comes to me from without a thought that I have sinned . . . this is probably a scruple and temptation suggested by the enemy.”

In Wikipedia, scrupulosity is characterised by pathological guilt about moral or religious issues. It is personally distressing, objectively dysfunctional, and often accompanied by significant impairment in social functioning. It is typically conceptualised as a moral or religious form of obsessive compulsive disorder.

Among the prominent religious figures said to have suffered from it are Martin Luther and John Bunyan; and, in the 17th century, an Anglican Bishop, John Moore, gave one of the first public presentations of the condition, describing how “religious melancholy” made people “fear, that what they do, is so defective and unfit to be presented unto God, that he will not accept it”.

Buoyed by this public recognition, religious authorities and figures attempted to develop solutions and coping mechanisms. Indeed, this went so far as members of the Liguori Mission (associated with the Redemptorist Order) publishing the monthly newsletter Scrupulous Anonymous.
 

SO, HOW do we discern between healthy religious practice and the pathological? Consider four lines of thought: 

  1. I pray that God ensures the safety of my family.
  2. I must pray that God ensures the safety of my family.
  3. The manner in which I pray must be sufficient for God to ensure the safety of my family.
  4. The only way that I can be accepted by God is to pray and perform rituals in a certain way.

My interpretation is as follows: 

1. Represents normal faith-based behaviour.
2. and 3. are potentially manifestations of OCD.
4. is a clear manifestation of scrupulosity.

The question whether scrupulosity is a separate condition from OCD (rather than a form of OCD), is an interesting one, as it implicitly leads a sufferer to seek different sources of “treatment”: religious guidance or psychological guidance.

If I am concerned that my praying has become a manifestation of scrupulosity, I am likely to seek reassurance from my vicar that it doesn’t really matter how I pray, etc. This act of seeking of “reassurance” is, however, a classic symptom of OCD, and is likely to draw the sufferer into a pervasive cycle of “reassurance-seeking”.

If, like most OCD sufferers, I am troubled by intrusive thoughts, the last place that I will want to seek help is from my vicar. Divulging these thoughts to anyone other than a trained psychologist — and particularly a vicar — is as anxiety-provoking as the thoughts themselves. So, I confide in my therapist, feeling momentarily cleansed and reassured that these thoughts are of no importance, and that I should learn to acknowledge, reprocess, and discard them.

Yet God knows that I had the thoughts, and so I must be a bad person. This is where the two paths of scrupulosity and OCD converge. For a sufferer of this condition, assistance is likely to fall between the two stools.

My solution lies in the concept of “handing it over to God”. This technique has been successfully used by Alcoholics Anonymous for many years, and is, of course, explicitly addressed in the Lord’s Prayer: “Thy will be done.”

It has been helpful to me to see it as an act of faith, when faced with difficult situations, and I have a well-rehearsed mental conversation along the following lines: “So you claim to be a Christian? Well, let’s see just how strong your faith is by [doing or resisting] the particular action or compulsion.”

I can testify that a combination of cognitive behavioural therapy and medication helped me to transition, in fairly short order, from serious debilitation to being fully and happily functioning in both my personal and work life. First diagnosed with OCD in 2002, when it was a little-known condition, it was my realisation that the power of OCD lies in its shame-driven secrecy which led me to co-found the charity OCD-UK to raise awareness of the condition.

www.ocduk.org

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