Psychiatrists, psychologists, and other mental health professionals who
have studied obsessive-compulsive disorder have been keenly
interested in identifying its most fundamental psychological cause.
Freud thought the culprit was repressed unconcious conflicts from
childhood. These conflicts, bottled up and hidden, were released in
adulthood in transmuted forms as obsessions and compulsions. This
theory has been proven wrong.

After Freud, a leading theory held that people with OCD were overly
perfectionistic. The person who washed his hands again and again did
so in order to wash them perfectly. Studies show, however, that while
OCDers are indeed often overly perfectionistic, this trait is even more
common in the sufferers of other mental disorders.

Another commonly held theory is that OCD sufferers have a special
problem with uncertainty. They worry and obsess in order to gain a
measure of certainty that makes them comfortable (and, of course, they
rarely find it). This theory does, in fact, explain a good deal; and the
therapeutic tactic of helping OCDers become more comfortable with
uncertainty is a widely used and valid clinical approach. But again,
research suggests that problems with uncertainy are not specific for

In 1989 psychologist Paul Salkovskis of Oxford, England, proposed a
new theory to explain why OCD occurs. The key, Salkovskis surmised, is
that “intrusive thoughts are mistakenly interpreted as indicating that a
person may be responsible for harm to self or others.”

Obvious, right? Of course obsessive-compulsives check the stove
because they feel responsible for preventing danger—why else would
they do it? Yet Salkovskis’s idea nicely explains a number of common
clinical observations. OCD sufferers, for instance, rarely obsess about
purely chance events, such as being caught in an earthquake or a
hurricane. Why? Because the obsessional patient plays no role in the
occurrence or the prevention of such happenings. Obsessional
individuals do, on the other hand, readily develop symptoms when they
are put into situations where obvious harm may occur as a result of their
actions. A striking example is the frequent onset of obsessions and
compulsions in women after the birth of a first child. Approximately 20
percent of all females with obsessive-compulsive disorder suffer its
onset (almost always related to the safety of their babies) at this time of
unparalleled assumption of personal responsibility.

Several dozen well-designed experimental studies have lent strong
support to Salkovskis’s theory. In one interesting study, for instance,
psychologist Edna Foa of the University of  Pennsylvania, a longtime
leader in research in anxiety disorders, compared the responses of
OCD sufferers, phobics, and a “normal” control group to differing levels
of imagined danger: high risk (“You see that a person sitting alone in a
diner is choking”), medium risk (“You see some nails on a road”), and no
significant risk (“You see a piece of string on the ground”). In the last
two situations, OCD patients felt more responsible for outcome, and
experienced more anxiety and more urges to check that harm would not
occur.At the present time, the weight of scientific data support
Salkovskis’ claim that the unique trait of OCD sufferers is a tendency to
feel overly responsible for ham that may occur to self or others.

One way to look at this, purely speculative, is that humans have
developed a certain center in the brain whose job it is to regulate the
flow of  thoughts of personal responsibility into and out of conscious
awareness. The apparatus “decides,” on an automatic, almost
instantaneous basis, whether a particular fearful idea, image,or urge
should be dismissed from consciousness or kept there for further
processing. Such a module would have survival value, since thoughts of
personal responsibility deserve special consideration—surviving
depends on recognizing and dealing with dangers that can be
prevented, while, on the other hand, there is little point in dwelling on
those that cannot. In obsessive-compulsive disorder, it is this
“responsibility-module”  that breaks down. Thoughts of personal
responsibility for harm are not automatically dismissed from awareness
when they should be. They get stuck there, and then they cause

Transfer of Responsibility

In an experiment performed by researchers at the University of
Vancouver, thirty OCD patients were visited in their homes and asked to
expose themselves to their most frightening obsessional situations. A
woman who feared that a fire would start in her stove, for example, was
asked to turn her stove on and then off, then walk into the next room
without checking it. This was accomplished under two different
experimental conditions. In the first, the experimenter solemnly promised
that if a fire started, she would neither be blamed for it nor charged for
any damages. In the second, the experimenter told her that she had
responsibility for anything bad that might occur. The results were
striking. OCD sufferers who were assigned no responsibility experienced
markedly less discomfort and fewer urges to check.

Dr. Stanley Rachman, generally regarded as the world’s leading OCD
researcher over the last forty years notes, “A person who has been
tormented for years by the need to conduct meticulous, repeated, slow
checks of each use of the gas stove may revert within minutes to
completely normal use of the stove—if he/she agrees to transfer of
responsibility.” Such direct transfer of responsibility, it appears, could be
the most powerful of all therapeutic approaches to obsessive-
compulsive disorder.

Unfortunately, in practical use this technique has serious shortcomings.
For one thing, an individual willing to assume responsibility will not
always be available. For another, he or she may tire of the burden. In
addition,  therapists strive to help their patients be more, not less, self-
reliant. Therefore, the technique of transfer of responsibility is seldom

But what about transfer of responsibility to God? This approach has not
been studied, but three of the greatest Christian religious figures in
history—Martin Luther, John Bunyan, and Saint Therese of Lisieux—did,
in fact, use this technique in order to overcome their own cases of what
we now refer to as OCD.