Obsessive-Compulsive Disorder

A Guide for Family, Friends, and Pastors

Robert Collie

• Editorial: Routledge
• Año: 2014
• ISBN:
  9781317825166
• Edición: 1
• Categoría: Psicologia
• Categoría: Psicologia anormale

Examine the fourth largest mental health problem in America—OCD—and how YOU can help! Since obsessive-compulsive disorder affects 2.5% of the world population, someone you know is likely to have this disorder. Obsessive-Compulsive Disorder: A Guide for Family, Friends, and Pastors is a handy "physician's assistant" that not only provides a fresh overview of OCD but also focuses on the issue of scrupulosity—obsessive-compulsive anxiety over scruples in self and others—as a religious issue. Written by a pastoral counselor who is also a clinical social worker, this book will help you gain insight into the psychological and neurological dimensions of the disorder, the problems of those suffering from OCD, and the development of support groups. Written with extensive knowledge and deep compassion, Obsessive-Compulsive Disorder: A Guide for Family, Friends, and Pastors presents the latest information available on OCD and its effects upon sufferers and their personal relationships. The information is discussed in both pastoral as well as therapeutic aspects, explaining OCD in the brain, then continuing with ways to help a sufferer manage the conflict. Special attention is paid to the issue of scrupulosity—"seeing sin where there is no sin"—which is especially symptomatic for many Roman Catholics, Orthodox Jews, and Orthodox Muslims. Filled with insightful case studies and a useful bibliography, this book helps you understand OCD from all sides while giving effective strategies for individual and group therapy. In Obsessive-Compulsive Disorder: A Guide for Family, Friends, and Pastors you will find:

• answers to the most frequently asked questions
  
• detailed explanations of terms
  
• insightful information on pastoral caring
  
• an in-depth exploration of scrupulosity
  
• helpful information on trichotillomania (hair pulling), kleptomania (stealing), Tourette's syndrome, body dysmorphoric disorder (hatred of a particular body part), and hypochondriasis
  
• case studies highlighting personal and relationship issues
  
• resources for developing support groups
  
• resources for further information on OCD
  

A Guide for Family, Friends, and Pastors is for pastors, pastoral counselors, chaplains, lay ministries, social workers, psychiatric nurses, marriage counselors, and for anyone who cares about someone with OCD.

1 A Walk Around the Perimeter of OCD

DOI: 10.4324/9781315821207-4

The Need for Both Psychological Insight And Spiritual Discernment

One of the elder statesmen of our support group is fond of saying, "Your God is too small." Perhaps it marks being one of the formerly scrupulous: he stole his saying right out of a book title by J. B. Phillips and isn't a bit sorry. In the course of confronting obsessive-compulsive disorder (OCD), one may or may not discover that a person's understanding of God is too small. It is a certainty, however, that a person's unexamined religious assumptions will be called into question.

Nice woman: she was kind and gentle, reared in a deeply pietistic way. She loved her bright red muscle car; she had always dreamed of having one. When she drove her other car into the garage, she parked it three feet away to keep from scratching it. She suspected the neighbors chuckled seeing her do it. Actually they must have scratched their heads wondering why she never drove it. She was terrified that if she did, her treasure would get dirt on it. So she just polished and polished. She confided to the support group that she wondered why, when she prayed about the problem, her prayer seemed to then get mixed up with the problem.

He loved his church, made every service when he wasn't working, and was a deeply dedicated tither. He confided his problem to the group at his first meeting: sometimes he would spend all night cleaning his kitchen floor. It was only after a long time that he admitted that he loved to play an instrument and had always wanted to buy a really good one, but he had never felt worthy.

For those who feel called to the ministry of caring pastorally, there is a need to be especially astute in our understanding of this condition we call obsessive-compulsive disorder. We begin to realize that the more we understand about it, the more we understand about ourselves as humans. In exploring the reality of the anxiety it reveals, we discover our need to accept the biological realities of our existence and our need to both set limits and challenge inhibitions. Although it is true that we are engaged in a study focused on the interplay of science, psychotherapy/psychology, and religion, the stage is set for us to discover the wonder in the opening line of Genesis: "In the beginning …"

Every faith group struggles with these realities. From my perspective, all caregivers will find their understanding greatly deepened and expanded by recalling the Apostle Paul's quest for freedom from the Law through faith in Christ—without neglecting the Apostle James' balancing of purity and good works. This is the perspective of the book, but many perspectives are brought to this world-spanning disorder. One of our group occasionally quotes from the Book of Mormon and neither attendees of Mass nor the most fundamental of Protestants are strangers there—and the "couldn't careless about religion" are always welcome. Let the dialogue begin: in community we sit around a big table.

We Draw from Both the Old And the New

Those in pastoral care may draw on old teachings, of course. In the Gospel According to Matthew (Ch. 23), Jesus pointed out how religious legalists could tithe even down to the most trifling garden herbs, all the while forgetting justice and mercy and neglecting the poor. This subdivision of OCD, called scrupulosity, is of especial interest to us.

If a person has OCD, it raises some interesting questions for pastoral care. According to the translators, Jesus said (but nowhere except Matthew 5:48), "You must be perfect, as your heavenly Father is perfect." Since those suffering from OCD are characteristically tormented perfectionists, how then is OCD a "disorder"? Recognizing the problems associated with trying to be "perfect," anyone knowing OCD can appreciate how Jesus reacted to one of his questioners. The man began, "Good Master …" Jesus scarcely let him finish, "Why do you call me 'good'? There is none good but God" (Mark 10:17 and Luke 18:18).

In our quest for understanding, it is wise to keep in mind that we are walking on a long—and broad—avenue of church history. Ignatius of Loyola, who founded the Society of Jesus (the Jesuits), feared to step on straws fallen in the shape of a cross on the roadway but out of his struggles rose to write an early pastoral manual. A young monk, Martin Luther, entertained the vain hope that he could relieve his waves of guilt by being allowed to confess and receive the sacraments several times a day, but he finally affirmed "the just shall live by faith alone." John Bunyan, as a youth, feared the steeple of the church would fall on him for his manifold sins as a child and was tortured by "the doubting disease" as soon as he began to believe he was saved, but went on to author Pilgrim's Progress. C. S. Lewis, author of The Screwtape Letters, fought with sadistic thoughts.

As we explore this "disorder," doubtless many readers will exclaim, "Oh, that reminds me of…" In the pages that follow, we are fortunate to have friends willing to share their experiences, and it is as much neighborliness as courage for them to do this, for we are all pilgrims here.

Jim's OCD first blatantly exhibited itself when he was stressed out as a freshman in college. When Jim went to the women's dorm to pick up his date, he would panic as he stood in the lobby; soon the rituals began. First it was checking and then it was counting. The doubting disease had broken out, and with it came scrupulosity, in Jim's case—at age nineteen—the notion of going to hell at the whiff of something sexual. A wise priest helped with this sense of "seeing sin where there is no sin." In case of doubt, he assured Jim that the priest took the sin upon himself if there was any. This reassurance helped for a time. The next part of the story was six years later and included seeing a psychiatrist. The doctor silently smoked a pipe and stared at his notepad; his soon self-terminated patient suffered for the next forty years without being able to give a name to what tormented him. In spite of needing to check and recheck, he continued to work, and worked well. He may have repeatedly feared he had hit someone with his car, but he never missed driving to an appointment: "I had a family to feed."

Now, as an experienced member of our support group, Jim often shares such stories with newcomers, adding, "and now I live a pretty normal life. Exposure and responsive blocking does it: bite the bullet."

This is not a particularly unusual story for an older sufferer; until recently it took an average of seventeen years for someone with OCD to get a clinically valid diagnosis. Now the average is dropping; hopefully a year from now, thanks to readers of books such as this, it will have dropped even further.

In part, why we—and the general public—have not recognized more persons as having OCD is that most information comes from television. On the one hand, each program has done the public an enormous service in publicizing this disorder; the problem is, of course, that every program has to compete for ratings, each trying to outdo the others. Two years after our group started, one of the members had an opportunity to go on a national television talk show. It would have been a brave coming out, for she had successfully hidden her compulsions. There was a long telephone interview; she never made it. Her suspicion was that she was no longer strange enough; once she had been but had gotten much better. She was disappointed in not being able to witness the before and after of effective treatment; had they known, there would have been a lot of viewers disappointed, too.

Retooling Our Thinking

It takes "eyes that see and ears that hear" to recognize when and how a person is suffering from OCD; it was that way for a counselee one day. He came in, sat down, and started to laugh. On the way to the office he passed a man who had pulled over and was walking around his car, peering underneath. The counselee said, "I know what he was doing!" Maybe it takes one to know one, for he, too, had often feared the sound of hitting a pothole was really a body jolting his wheels.

When I was a young pastor, one family (very, very large) was there literally every time the church door opened. It was nice—although strange—how scrupulous they were about being in church, although I did not know the term then. The parents were always friendly but did not want me to visit. Once I insisted: I got only quick glimpses at the one room in which we sat. It was bare beyond starkness. I assumed they were poor—rightly—and might be embarrassed at the revelation of their poverty if the pastor came to call. I suspect now, after having been in some homes of those with OCD, that the room's bleak look signified that a cleaner and straightener was in charge; I simply did not know at the time what I was seeing. I also remember once being in the beautiful parsonage of a remarkably talented pastor and his remarkably at-herprettiest wife; the home had a surgical look, it was so spotless. I thought it peculiar. I also recall once being in the study of a master of the pulpit; it was stacked with pile after pile of books, newspapers, magazines, and I-know-not-what in every chair but his. I had no idea what I was seeing; I supposed it was collected for his sermons. Only now would I have realized he suffered from hoarding.

Thus, working with OCD is one way for a person in a ministry of pastoral caring to sharpen his or her thinking. Take, for instance, a phrase used by a modern theologian to describe the Church: the Responsible Society. Sufferers from OCD are responsible, overly responsible being a characteristic of the disorder. The differentiation is helpful; someone with OCD may assume a fantastic responsibility for the welfare of another—whether the other wants it or not. It may be done to prevent harm from befalling a loved one, but tapping one's fingers in a rhythmic pattern is an annoying way of expressing care. In contrast, a member of the Responsible Society is apt to create a support group for those suffering from over responsibility—and also to help sufferers stop magical thinking. Since OCD sufferers tend to be religious, it is important to challenge overt interplays of superstition and religion; in fact, a seemingly secular ritual such as counting often points to background religious issues.

For those in pastoral care, fascinating questions arise: For the mother who revealed her fear that she was going to cause the death of her baby, what is "badness"? For the parents who always had the entire tribe sitting straight and lined up in the pew, what is "goodness"? As we explore OCD, the valuing of "good" and "bad" persists, and is to be cherished rather than avoided. Frequently OCD is trapped in black-and-white thinking in a way that challenges our psychological insights. To be in pastoral care has an additional challenge: to learn spiritual discernment so that we may especially confront the superstitions that are so well camouflaged within run-of-the-mill religious thinking.

Because many sufferers with OCD have obsessions with violence (like the young mother), they always have an audit going on in their heads; those in pastoral care need to be competent in helping them resolve the dilemmas of columns of emotional figures that really don't add up. Central to this challenge is to know when to call in the psychiatrist as a matter of legal accountability and how to take advantage of the pastoral skills of "a physician of the soul." Most often it will require the particular abilities of many, for we are exploring a psychic black hole that sucks energy into it—one not in outer space but in the brain; a black hole sucking in both certitude and self-confidence that so disrupts the best efforts of pastor and parent, physician and priest.

It may be something of a puzzle that this disorder is preeminent among mental disorders in being expressed in religious guise. Even when the thought of having committed "the unforgivable sin" is a psychotic symptom, it is nevertheless an obsession. We will begin clarifying this in a later chapter as we explore the circuits of the brain in relationship to OCD.

There is another explanation to explore as well: obsessions often appear as unconsciously self-designated—actually explicitly contradicting the person's most precious values (such as a loving young mother, notable for her kindness and gentleness, who after the outbreak of OCD may obsess that she will harm her newborn). Probably nearly everyone has occasional mental belches we could characterize as "blasphemous"—ordinarily something verbal such as taking the Lord's name in vain rather than the behavioral variety more common in OCD—but only a genuinely religious person is upset by blasphemy. The secularist shrugs it off. Only the believer can curse—the unbeliever can do no better than get mad and cuss.

If obsessions ordinarily contradict the sufferer's most precious values, it would explain why persons with OCD so seldom strike others as neurotic—unless that disorder is combined with other mental conditions. There is not only an authenticity about their feelings but also a genuineness about their values, however biology has turned them upside down, from which no amount of psychoanalysis has been able to filter out a transference.

Scrupulosity is A Special Concern in Religion

The issue of scrupulosity raises an interesting challenge to us in pastoral care. We rightly pursue those with a deficient conscience—"What does it matter if I take home this or that belonging to the company? They won't miss it"—but we neglect the overwrought conscience that trembles through a long night, reconsidering over and over if he or she misspoke a word and devastated someone's emotional life. Functional pastoral care confronts us with developing a balance of caring—to the tender hearted equally with the hard hearted—that has been neglected to the detriment of the whole community. It also raises issues of social concern.

One evening in Wiesbaden, we were having dinner in our hotel when a young couple came in. They must have just come from the airport. He was in his thirties, dressed in an expensive suit, as if the price of a Mideastern barrel of oil had gone up. Her swanky tennis shoes were the only nonscrupulous thing about the darkly garbed woman humbly walking the culturally prescribed two steps behind. As they ate, even her fluttery hand gestures were submissive. The next morning at breakfast, he was sitting with a gorgeous woman in a thousand-dollar outfit and they were looking into the soulful regions of each other's eyes. Her hands fluttered, but they did not strike us as submissive. Scrupulosity raises many issues, for the socially concerned; scrupulosity often carries a religious sanction.

Another factor to consider is that sensations of guilt are so frequent that having OCD is similar to having your own live-in IRS agent; many would agree that some moral or ethical audit goes on much of the time. Most persons in pastoral care can sympathize with such an ongoing audit. Fortunate indeed that they can testify that the feeling of such an audit moderates as a person matures in grace. What makes OCD especially fascinating, however, is that it is a partial audit: we will see how the perfectionist will strain to catch moral "minnows," while too frequently swallowing ethical "whales." On one hand, the audit is painstaking to the point of being beyond fussy, yet on the other hand, there is a continuum in which it can escalate into self-righteousness and then on into highly inappropriate aggressiveness.

These dynamics are in peoples, climes, and conditions. As a part of a travel group, we once made stops in Israel. Most of the group was Jewish, taking an opportunity to vacation and also to stop for a brief visit with friends and family. It was the Sabbath when we were in Jerusalem. We went to the Temple Wall and began to take pictures. An older man in highly Orthodox garb rushed up, yelling and grabbing at our cameras; it was an aggressive expression of scrupulosity. Photographing on the Sabbath violated his scruples; to the several people doing the photographing, it frustrated what would have been a precious religious memory. ...