Tormenting Thoughts and Secret Rituals Page 7

  Johnson frequently suffered a nervous tic disorder, not uncommon with OCD sufferers. Sometimes, his compulsions and tics were the object of ridicule. Boswell writes: “Once Johnson collected a laughing mob by his antics; his hands imitating the motions of a jockey riding at full speed and his feet twisting in and out to make the heels and toes touch alternately.”

  THERESE OF LISIEUX

  Patron saint of France, author of a still popular spiritual autobiography, Story of a Soul, Therese of Lisieux (1873–1897) appears to have endured disabling obsessive-compulsive disorder that started at age twelve. Interestingly, her OCD improved when she entered a Carmelite convent at age fifteen. Therese tells in Story of a Soul of that early period in her life:

  It was during the retreat for my second communion that I was assailed by the terrible sickness of scruples. One would have to pass through this martyrdom to understand it well, and for me to express what I suffered for a year and a half would be impossible. All my most simple thoughts and actions became the cause of trouble for me, and I had relief only when I told them to Marie. This cost me dearly, for I believed I was obliged to tell her the absurd thoughts I had even about her. As soon as I laid down my burden, I experienced peace for an instant; but it passed away like a lightning flash.

  While in the midst of an obsessional crisis Therese writes: “If you only knew what frightful thoughts obsess me!… I would like to be able to express what I feel, but alas! I believe this is impossible.… Must one have thoughts like this when one loves God so much?… I undergo them under duress, but while undergoing them I never cease making acts of faith.”

  The obsessions that tormented Therese were primarily excessive fears of committing sins, or “scruples.” That her scruples represented what we now call clinical obsessions is indicated by her strenuous resistance to them, as well as by her full insight into their “absurd” nature. Her compulsions included constant reassurance seeking, as well as, perhaps, “ceaseless acts of faith.” Note that Therese herself tellingly refers to her problem as a “sickness.”

  WINSTON CHURCHILL

  At the funeral of Winston Churchill, the novelist Rebecca West summed up the feelings of those acquainted with the great British statesman: “Really, the world will not come to peace with itself except as it acknowledges that some men are simply superior.” Yet Churchill himself suffered from classic harm obsessions: intrusive impulses to suicide. They did not interfere into his life in a major way, and it is not at all certain that Churchill had diagnosable OCD, but his obsessions were anxiety provoking and a nuisance. Churchill once confided to his personal physician, Charles Moran: “I don’t like standing near the edge of a platform when the express train is passing through. A second’s action would end everything. I like to stand right back, and if possible to get a pillar between me and the train.” Because of similar obsessional impulses to jump to his death, Churchill didn’t like to travel by boat. “I don’t like to look down into the water,” he once told Moran. “A second’s action would end everything. A few drops of desperation.” For the same reason, Churchill didn’t like to sleep in rooms with access to a balcony.

  Yet Churchill was not suicidal. As is always the case with obsessionals, to follow through on his tormenting thoughts was the last thing he wanted. He explained to Moran, “I don’t want to go out of the world at all in such moments. I’ve no desire to quit this world, but thoughts, desperate thoughts, come into my head.”

  MARTIN LUTHER AND IGNATIUS OF LOYOLA

  Lastly, we may consider two great historical figures who, even though they were bitter enemies, had much in common. Both marked turning points in 1521: Luther was condemned by the Catholic Church as a heretic; and Ignatius of Loyola experienced religious conversion. Both men started great movements: Luther, the Reformation; and Ignatius, the Jesuits. Both men, too, suffered obsessions.

  Martin Luther underwent severe mental turmoil with obsessions and depression. In Young Man Luther, the psychiatrist Erik Erikson notes that during his first years in the monastery, Luther’s mental state was so disrupted that “it seems entirely probable that young Luther’s life at times approached what today we might call a borderline psychotic state.” Ignatius endured similar, if not quite so severe, afflictions. W. W. Meisner, M.D., writes in his biography Ignatius of Loyola that Ignatius’s early life was “filled with inner torment” due to “intense, destructive obsessions.”

  Luther and Ignatius both endured tormenting obsessional doubts and, to a lesser degree, other types of obsessions as well. Religious doubts, a form of scruples, were indeed a common problem in past centuries; they qualify as obsessions when they are persistent, tormenting, and recognized as inappropriate. Luther writes in his Commentary on Galatians:

  When I was a monk I thought that I was utterly cast away. If at any time I felt fleshly lust, wrath, hatred, or envy against any brother, I assayed many ways to quiet my conscience, but it would not be; for the lust did always return, so that I could not rest, but was continually vexed with these thoughts: This or that sin thou hast committed: thou art infected with envy, with impatiency, and such other sins.

  Because of these excruciating scruples, Luther could not feel certain that he had confessed all his sins. He would confess for hours and hours, splitting his transgressions smaller and smaller. He would go back to childhood and endlessly enumerate possibly sinful acts. After finishing he would ask for special appointments to correct previous statements. His preceptors, confused by his obsessiveness, threatened to punish him for obstruction of confession. As quoted in The Way of Interior Peace, one of them told Luther: “You have no real sins with which to reproach yourself … give up your nonsensical and ludicrous notions.”

  Ignatius suffered similar battles with confessional scruples. He writes in his autobiography St. Ignatius’ Own Story:

  Even though I had confessed … my scruples returned, each time becoming more minute, so that I became quite upset, and although I knew that these scruples were doing me much harm, and that it would be good to be rid of them, I could not shake them off.… I continued with my seven hours of prayer on my knees, rising faithfully every midnight, and performing all the other exercises. But nothing provided me with a cure for my scruples.

  Luther and Ignatius also suffered violent and blasphemous obsessions. Luther once declared at the dinner table that the sight of a knife conjured up “painful pictures” before him. He writes: “For more than a week I have been thrown back and forth in death and Hell; my whole body feels beaten, my limbs are still trembling. I almost lost Christ completely, driven about on the waves and storms of despair and blasphemy against God.” Ignatius notes: “While these thoughts were tormenting me, I was frequently seized with the temptation to throw myself into an excavation close to my room. But, knowing that it was a sin, I cried again: ‘Lord, I will do nothing to offend you,’ and I frequently repeated these words.”

  Who knows how many other great historical figures suffered obsessions? Charles Darwin, arguably the single most influential scientist who ever lived, suffered frequent attacks of heart palpitations, shortness of breath, fainting, a buzzing noise in his head, stomach pains, and eczema. Most of his recent biographers agree that he had panic disorder. Darwin’s letters and diaries suggest he may have also been plagued by obsessions. Darwin mentions having “much involuntary fear” and sudden “insane feelings of anger.” He reports: “I awake in the night and feel so much afraid, though my reason laughs and tells me there is nothing to fear.… By habit the mind fixes on the same object.” In the 1977 medical biography of Darwin, To Be an Invalid, Ralph Cope, Jr., M.D., concludes that Darwin was “tortured by obsessional thoughts.”

  EXCESSIVE PERSONAL RESPONSIBILITY

  What are the similarities between the personalities of these “great obsessionals”? What are the deep-seated ways of looking at life that make a person vulnerable to OCD?

  A good place to start in looking for an answer is a recent theory advanced by Oxford psychologi
st Paul Salkovskis. The critical factor in the development of obsessions, Salkovskis hypothesizes, is an inflated sense of personal responsibility—a deep-seated, automatic tendency to feel accountable for anything bad that might happen. This tendency can turn unwanted, intrusive thoughts into disabling obsessions. Since Salkovskis first demonstrated this idea in 1985, other investigators have confirmed his finding. A 1992 study, for instance, found that of five factors related to intrusive thoughts, only personal accountability significantly predicted compulsions.

  According to Salkovskis’s 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. 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’d 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. A patient of mine, an articulate, middle-aged mechanic with OCD, described it this way:

  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. 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. Johnson remembered that, fifty years before, he had refused his father’s request that he sell books at a stall. He went to that stall and stood in front of it for an hour in the rain, ignoring the sneers of passers-by. 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.”

  Having an exaggerated sense of personal responsibility is not all bad, of course. It can be a spur to greatness. When the mental mechanisms work together fortuitously, it may find expression in a sense of lofty mission. Churchill felt he was chosen to lead Britain to its finest hour. “This cannot be accident; it must be design,” the prime minister once noted. “I was kept for this job.” Similar sentiments are echoed by Luther, Ignatius, and Bunyan.

  Salkovskis’s idea that a deep-seated, exaggerated sense of personal responsibility lies at the root of obsessions is particularly appealing because it accounts for many of the well-known character traits of OCD patients. As noted by Stanley Rachman, Ph.D., in his 1980 text Obsessions and Compulsions, foremost among those traits are fearfulness, introversion, and a tendency to depression.

  FEARFUL, INTROVERTED, AND DEPRESSIVE

  Jeremy Taylor, a seventeenth-century cleric who wrote a great deal on mental problems, said of OCD sufferers:

  They dare not eat for fear of gluttony; they don’t sleep for fear of sleeping too much. If they are single, they fear their temptations. If they are married they fear doing their duty, then fear that the very fearing of it is a sin. They repent when they have not sinned, and accuse themselves without reason. Their virtues make them tremble, and in their innocence they are afraid.

  People with OCD fear that they will act on impulses of violence, fear that they will be damned for ideas of blasphemy, fear that they will be contaminated by images of germs, and fear generally that they are going insane. Fearfulness is their most commonly described personality trait.

  In fearing their thoughts, unfortunately, they only fuel them, however. Somehow, in the mind, fearing a thought exaggerates the importance of that thought, guaranteeing that it will return again and again. Fearing unacceptable thoughts turns them into obsessions.

  The trait of introversion refers to a tendency to be absorbed in the inner world of the mind rather than in the world outside. This inclination to look inward throws a person repeatedly back into any ongoing battles with obsessions and by doing so escalates the problem.

  It might be argued that since obsessionals are driven to spend hour upon hour analyzing, repeating, correcting, regretting, and fighting their thoughts, it is having obsessions that makes a person introverted, not the other way around. However, studies show that obsessions usually develop after age twenty, when the major personality traits, including introversion, are already in place. Introversion precedes obsessions and almost certainly increases the likelihood of getting OCD. Rachman observes that extroverted obsessionals are quite rare.

  A tendency toward depression also goes hand in hand with severe obsessions. Anyone who works with OCD patients can’t help noticing this relationship. Recent research confirms that depression is the most common complication of OCD and that approximately two-thirds of people with OCD suffer severe depression at some time during their lives.

  Serious bouts of depressions were suffered by all the historical figures discussed above; most of them tended toward chronic melancholy as well. Biographers write that Ignatius had “an
essentially depressive core to his personality.” Luther was “a melancholic.” Churchill had a “depressive temperament,” and was subject to deep depressions, which he himself referred to as his “black dog.” Johnson suffered “constitutional melancholy.”

  It is obvious that the long, demoralizing battles OCD sufferers wage with their thoughts could lead them to depression. It now also appears certain that depression leads vulnerable people to experience more and more obsessions. In 1986, researchers in Australia showed that intrusive thoughts in college students are closely related to mood and speculated that depressed people experience more intrusive thoughts because of an impaired ability to process and get rid of them. This is seen on a clinical level. As depression saps people’s confidence and breaks down normal means of coping, the result is more difficulty dealing with potentially troublesome thoughts. Samuel Johnson recognized this clearly: “If the imagination presents images that are not moral, the mind drives them away. But if a person is melancholic … the images lay hold on the faculties without opposition.”