Rudolf Virchow, a renowned German sociologist of the nineteenth century, was the first to observe that just as epidemics of infectious disease spring up with massive social and cultural changes (e.g., the Black Plague brought to Europe as a result of burgeoning international trade in the Renaissance), so epidemics of mental illnesses can spring up in critical  junctures of history that are characterized by political and intellectual revolution.

Contemporary leaders in the field of mental health have tended to ignore this cultural dimension of mental illness. One exception, however, is Harvard anthropologist Arthur Kleinman. In a series of convincing articles and books, Kleinman has demonstrated marked differences in the occurrences of various mood Eastern and Western societies. Other researchers have looked at cultural factors that affect the onset of schizophrenia and anorexia nervosa.

Obsessive-compulsive disorder has been largely overlooked in this regard, even though there is tantalizing evidence to suggest that the onset of the disorder is very much culture-related. As far as can be told, for instance, obsessive-compulsive disorder was never a major problem until the Renaissance. At that time, an epidemic of religious obsessions struck. The reason is that Christians in Western Europe felt no burden to please God before the teachings of the Fourth Lateran Council of the Christian Church in 1215. As long as they were members of the church in good standing, they could rest in a reasonable belief that their eternal salvation was assured. That Lateran Council, however, radically altered the personal responsibility that each Christian shouldered for salvation. The fundamental assumption became that each Christian could know and weigh his own sins and could determine for himself his own eternal destiny. The ruling that each Christian had to regularly confess his sins, along with the soon-to-follow declaration that thoughts themselves could represent mortal sins, dramatically changed the lives of all who were prone to obsessions. It exponentially multiplied the role of personal responsibility. Suddenly, Renaissance Europe became a hothouse for the development of obsessive-compulsive disorder.

Personal responsibility increased in all areas of life as individualism and self-determination flourished. In this day, people shoulder a weight of personal responsibility for their well-being that was unheard-of a millennium ago. Thus, the epidemic of obsessive-compulsive disorder continues, even though in secular societies the main topics of obsessions have changed. While obsessions about loss of salvation were most common centuries ago, fears of contamination are most common now.