OCD and Christianity


OCD researcher Paul Salkovskis noted in 1985 that the critical factor in the development of obsessions is an inflated sense of personal responsibility–a deep-seated, automatic, tendency to be accountable for anything bad that might happen. This tendency can turn unwanted, intrusive thoughts into disabling obsessions. Since Salkovskis first demonstrated this idea, other investigators have confirmed his finding. (For a sampling of studies supporting the finding click here).

According to this theory, a potentially upsetting thought causes no emotional reaction when it first comes into the mind.  Indeed, if a person regards it as simply a piece of mental flotsam–as an idea of little or no importance–then the thought will just drift on by without a ripple.  But what happens with OCD sufferers is that they appraise the thought–a split second evaluation that is not in full awareness–and conclude, as Salkovskis puts it, “that they might be responsible for harm to themselves or others unless they take action to prevent it.”  All of a sudden an alarm sounds: “I better pay attention to that thought!”  Now the thought will not float by.  It must be dealt with. This exaggerated sense of personal responsibility is demonstrated most dramatically by people with checking compulsions.  An articulate, middle-aged mechanic offered to me a memorable description of this trait.

“My compulsions are caused by fears of hurting someone through my negligence.  It’s always the same mental rigmarole.  Making sure the doors are latched and the gas jets are off.  Making sure I switch off the light with just the right amount of pressure, so I don’t cause an electrical problem.  Making sure I shift the car’s gears cleanly, so I don’t damage the machinery. I went to a sale at Tru Value hardware Saturday, and bought a Weed Eater marked down from $34.99 to $26.88.  After I checked out, I got to wondering if it was really on sale.  The sales slip said it was, but I still wondered if I had cheated the guy, if maybe his computer wasn’t up to date.  So I went back in and, pretending I was looking at something else, made sure the sale price was under the item I had bought.  It was, but after leaving the store I was still afraid I got sale prices I didn’t deserve.  I wanted to go back in again, but since I’d already spent a long time in there, people would have noticed me.  I stood in the parking lot trying to decide what to do.  Finally I drove away, but I was troubled all day long.  I fantasize about finding an island in the South Pacific and living alone.  That would take the pressure off; if I would harm anyone it would just be me.  Yet even if I were alone, I’d still have my worries, because even insects can be a problem.  Sometimes when I take the garbage out, I’m afraid that I’ve stepped on an ant.  I stare down to see if there is an ant kicking and writhing in agony.  I took a walk last week by a pond, but I couldn’t enjoy it because I remembered it was spawning season, and I worried that I might be stepping on the eggs of bass or bluegill. I realize that other people don’t do these things.  Mainly, it’s that I don’t want to go through the guilt of having hurt anything.  It’s selfish in that sense.  I don’t care about them as much as I do about not feeling the guilt.”

When the exaggerated sense of personal responsibility is violated, the result is guilt–a major driving force in the lives of all obsessionals.  The great 18th century literary figure Samuel Johnson suffered from what we now call OCD, and his biographers have often honed in on his acute sense of guilt. In Young Sam Johnson, James Clifford writes: “Johnson was the kind of man who magnified his sins, and instead of forgetting them brooded over and stressed past offenses… He had a deep-seated sense of guilt.”  Boswell tells the story of Samuel Johnson’s visiting his hometown of Lichfield.  Johnson remembered that, fifty years before, he had refused his father’s request that he sell books at a stall in a nearby town.  He went to that stall and stood in front of it for an hour in the rain, ignoring the sneers of passersby.  Johnson explained that he did this “To do away with my sin of this disobedience…and to propitiate Heaven for my only instance, I believe, of contumacy to my father.” Johnson himself observed the close tie between guilt and obsessions.  “No disease of the imagination,” Johnson wrote, “is so difficult to cure as that which is complicated with the dread of guilt: fancy and conscience then act interchangeably upon us, and so often shift their places, that the illusions of one are not distinguished from the dictates of the other.”

Guilt and obsessions sometimes feed on each other leading to a frenzied state in which an OCD sufferer may even confess to crimes he knows he didn’t commit.  I had a patient who, on the basis of violent obsessions, turned himself in as a murderer.  Yet, in fact, the OCD sufferer who has thoughts to harm others is the least likely person of all to commit a violent act.  The obsessional’s personality is the antithesis to that of the hard-core criminal, or antisocial.  Thomas Insel, M.D., specialist in OCD at the  National Institutes of Mental Health, summarizes this contrariety: “Antisocials are severely aggressive and never feel any guilt, while obsessionals do nothing aggressive and feel guilty all the time.”