Christians sometimes have a problem employing exposure and response prevention for OCD: How do I do it without sinning? We know that ERP is a very effective form of therapy. The problem is that it sometimes seems to involve activities that are in opposition to biblical precepts.
Marissa, a graduate student in English, came to me with such a problem. She had suffered the acute onset of OCD about a year before, at a time when she was holed up in her apartment studying and writing. Her trusty companion then, as now, was “Iris,” her cat. One evening, while chopping up some food for dinner, an obsessional thought flew into her mind that took her breath away. Since OCD usually involves the worst thought a person can have, you can probably guess what it was: Chop up Iris. “It just came out of nowhere,” she remembered. “I could take the knife and stab Iris.” At first she was able to put the terrifying thought away, but gradually it became stronger. After a while she was suffering vivid images of losing control and violently killing her cat. Panic set in when she began to have obsessional urges to act out. Soon she couldn’t keep sharp objects in her apartment, and she was spending hours a day trying to talk herself out of the thoughts.
The situation improved when she saw a therapist and learned she was suffering from OCD. The therapist, naturally, prescribed ERP exercises. She suggested such tasks as holding a knife close to the cat, and writing “I want to kill my cat.” Marissa understood the therapeutic value of such exercises. It made sense to her that we need to habituate to obsessional fears. Basically, she wanted to do the exercises. Yet, she could not bring herself to enact them. She explained to me:
“It just feels wrong to me. We’re not supposed to go around purposefully making ourselves think about killing people. I can’t help thinking I’m an evil person if I do that. I have a very literal view of what the Bible says. I believe it is God’s word, and his truth. Scripture tells us to think honorable and good thoughts [Phil 4:8]. So, my therapist and I are at an impasse. I won’t do the ERP. I don’t know what to do, now.
Marissa needed another way of conceptualizing ERP. During our first session she had volunteered the observation, “You know, sometimes OCD feels an awfully lot a spiritual battle, like I’m fighting off the enemy.” I suggested we go with that assumption. Indeed, OCD is very appropriately viewed as a spiritual battle. The word obsession, in fact, comes from the Latin obsidere, meaning to besiege, as an army would attack a city for the purpose of forcing surrender. In psychiatric terms, obsessions are defined “egodystonic,” meaning that they seem to come from outside of us, alien to our sense of self. The OCD sufferer is on a battlefield and being attacked by thoughts coming from outside. For the Christian, obsessions are darts from the enemy.
OCD is a peculiar sort of battle. We can’t win it ourselves. Fighting the darts, or trying to reason about them, doesn’t work. Here, God has something else in mind. He wants to teach us a special lesson: It is that he can be trusted, that things will work out. Unfortunately, in order to learn that, we must stop relying on ourselves, and that is the hard part. We need to stay on the battlefield, absorb the painful blows, and do nothing except wait for God to win the battle for us. Marissa got it, and worked with ERP in this context. “You know,” she later said, “I trusted the Lord with my family and that I’m going to be in heaven some day, but I didn’t trust him with my OCD. The biggest thing that helped me, the piece I was missing, was staying on the battlefield and waiting for faith to come.”