Judaism and Obsessive-Compulsive Disorder, Part 1

I expect to offer a shiur on Judaism and Obsessive-Compulsive Disorder on Monday night, and so I've been immersed in reading on the topic for a while. I'm posting my source sheets here, but there is a lot, so I expect to do it in three parts. Some of this won't make sense without the actual shiur, but some of it may help someone.

Here is Part 1:

What is OCD?

1.   Obsessions: Recurrent, persistent thoughts, impulses or images that are experienced as intrusive and inappropriate, causing marked anxiety or distress. They are excessive and unreasonable, not grounded in reality, and a product of one's own mind rather than someone else's conditioning.

2.   Compulsions: Repetitive behaviours that a person feels driven to perform in response to the obsession, to resolve and quiet the worries by preventing some dreaded event or situation, but that are an unrealistic or excessive response to the situation.

3.   Treatment approaches

·         Medication

·         Psychoanalysis

·   Behaviour Therapy – Includes Exposure and Response Prevention, Emotional Habituaiton, Response Repetition

·         Cognitive Therapy – Includes Acceptance and Commitment Therapy, Guided Imagery

·         Cognitive Behaviour Therapy

Linking OCD and Religion – Scrupulosity, Theomania, The Doubting Disease

4.   Obsessions include:

·         Fear that one has sinned, or will sin

·         Fear that one has taken a vow with some thought, to engage in some action

·         Fear of blasphemous or immoral thoughts

·         Fear that Gd is punishing or will punish them or others because of this person's inadequacies.

5.   Compulsions include:

·         Hyper-attention to the words of prayer, and to establishing proper concentration for prayer

·         Hyper-concern about washing one's hands and cleaning other parts of one's body, as in for prayer

·         Hyper-concern about dietary law, but specifically in the area of cleanliness

·         Hyper-concern about questioning Gd's existence and desires

The Relationship between Religion/Judaism and OCD

6.   Joseph W. Ciarrocchi, The Doubting Disease: Help for Scrupulosity and Religious Compulsions, pg. 8

A superficial view may lead an observer to conclude, as do some mental health professionals, that religion is the source of scrupulosity. After all, a scrupulous man obsesses about sinning if he feels attracted to a pretty woman only because he believes this constitutes "committing adultery in his heart." The superficial view fails to distinguish between religion causing the disorder from religion as its background. Religion does not cause scrupulosity any more than teaching someone French history causes him to believe he is Napoleon. All human beings exist in some cultural context… Cultural backgrounds provide the scenery around which emotional problems create the drama…

7.   David Greenberg and Eliezer Witztum, Current Treatments of OCD Chapter 10, pg. 175

It may be suggested, in summary, that obsessions of OCD appear to mirror the prevalent habits and values of a culture. Religious symptoms are common in OCD in cultures in which religious practice and ritual are important. It appears that if a topic is dealt with scrupulously in everyday life, then it is a likely focus for the symptoms of OCD that will emerge in that culture.

8.   David Greenberg and Eliezer Witztum, Current Treatments of OCD Chapter 10, pg. 176

OCD symptoms of a religious nature are not found in all areas of ritual, nor necessarily in the areas of ritual most hallowed by the religion. In our experience with religious Jewish patients, for example, Sabbath observance is a very important feature of religious life associated with many detailed laws but does not appear frequently among the religious obsessions of OCD in our clinic. However, cleaning the perianal region before prayer gets one line in the footnote of a latterday code of Jewish law, but this ritual presents often in patients with OCD in our practice. The presentation of OCD in a religious context is less typically religious than it is classically obsessive-compulsive…

9.   Religion's potential contributory role

·         Legitimizing obsessions – Thought-Action Fusion; Minutia; Punitive Gd; Flawed humanity

·        Complicating diagnosis – Is it religion or OCD?; Blaming bad training

·  Challenging treatment – Accepting secular aid; ERP challenges; Distrust for treatment; Clergy cooperation

10.      OHEL, Totally Engrossed: Extreme Piousness or Obsessive-Compulsive Disorder?

The key question to ask a religious person who is irrationally scrupulous about religious matters, is: "Are your chumros enhancing your religious development or impinging upon it?" Herein lies the answer. A person who davens an exceedingly long Shemoneh Esrei may merit the same heavenly assistance that allowed the Chassidim Harishonim to be involved in davening for nine hours a day while still mastering Torah study (as described in Gemora Berachos). He then is not suffering from any mental dysfunction. A person who is just repeating words over and over again, however, and feels frustrated and depressed by this imprisoning ritual, will not grow in his religious observance and is victim of mental illness, not piety. This person needs treatment. 

11.      Dr. David Greenberg's test (Current Treatments of OCD Chapter 10, pg. 180)

·         Compulsions transcend requirements of religious law

·         Compulsions have a narrow focus on one area of religious experience

·         Compulsions focus on something that is trivial to religious practice, but normal for OCD

·         Compulsions cause the patient to ignore, or to be unable to fulfill, other areas of religious law

·         The patient repeats actions because of doubt, where law would not require it.