I was watching Pat Kenny’s Late Late Show on Friday, 16th January and wondered what was his purpose of interviewing a woman in her thirties who had a psychiatric diagnosis of ‘obsessive-compulsive disorder?’ I found the interview quite voyeuristic in that it focused on the extremely tormented life of this woman whose obsessive-compulsions revolved around fear of contamination. She described going to extreme lengths to ensure that all threats of contamination were eliminated. The psychologist who attended with her described her condition as a ‘neuro-biological disorder for which there was no cure.’ I found this ‘no cure’ claim disturbing and the purpose of this article is to provide hope for individuals who are afflicted with obsessive compulsive behaviours. The woman in distress would not take medication – for fear of contamination – but the psychologist rightly pointed out that medication is not a cure, but could reduce some of the intensity of the symptoms. Of course, very often the reduction in the symptoms of obsessive thoughts is outweighed by the side-effects of the psychotropic medication – rarely mentioned, but a shocking reality for individuals on such long-term medication. The psychologist also mentioned CBT (cognitive-behavioural therapy) as a possible symptom-reducer, but, definitely not as a means of resolving the tormented life of this young woman.
I believe it would have been helpful if the psychologist had pointed out that the notion of an obsessive-compulsive disorder (OCD) being a neuro-biological condition is a theory and not a fact. Neither is it true that there are no means of resolving such a condition. In over thirty years of clinical practice, I have helped many individuals to understand and resolve their obsessive-compulsive practices. However, a health-care practitioner cannot help a person with their crippling psycho-social symptoms if they do not believe, one, that all human behaviour makes sense, two, that the relationship with the person is critical to the recovery process and, three, that they need to be able to foster hope rather than hopelessness.
In his interview, it was not possible for Pat Kenny to engage in the crucial exploration of the woman’s story and we were left with her very distressing symptoms hanging in mid-air without any means of discovering their meaning. Certainly, medication and cognitive-behaviour therapy will not help individuals manifesting obsessive and compulsive behaviours. What is required is a psychodynamic approach, because it looks at the symbolic nature of the symptoms and searches in the person’s biographical history for meaning.
A particular case may help to clarify the difference in approach between the ‘no cure’ schools of psychiatry and CBT and ‘the resolution’ school of psychodynamic psychotherapy. This was the case of a woman in her thirties, still living at home with her parents, who came for help with an obsessive-compulsive problem of having to check and recheck regulators (light switches, taps, cooker switches) many times before going to bed at night or before leaving the house in the morning. Her main preoccupation was with taps, but the compulsion had generalised to other regulators. The rationale that this woman gave for her ‘irrational’ behaviour was that ‘I’m afraid of flooding the house’. It took her hours to get to bed every night and frequently she would have to get out of bed to recheck again. Similarly, in the mornings she rose early in order to go through her checking rituals and often had to return home when half-way to work. She had no close friends and neither had she had a heterosexual relationship up to that time. What eventually emerged was that she had enormous fear of the expression of any feelings, whether of love or of fear or of anger, as these feelings were not expressed by her parents when she was a child. Neither could her parents receive any such feelings. As a child, she learned that her security rested on repression of all feelings. Her acceptability then depended on her being ‘emotionless’. But feelings arise spontaneously and at thirty years of age she now had a huge flood of repressed feelings within her, needing to be seen and responded to, but which subconsciously were seen as life-threatening. It was not ‘flooding the house’ that accounted for her compulsive behaviour but the ‘flood of emotions’ within her. As she gradually learned to express the different feelings, the obsessive-compulsive behaviours began to extinguish.
It can be seen from the above story that the obsessive-compulsive behaviours were a necessary and wise subconscious creation to ensure that the threat of expressing feelings was kept at bay by the preoccupation of constantly ‘turning off tightly all regulators’. The triple purposes of the checking rituals were one, to keep a tight hold on her repressed feelings, two, to distract from her inner feelings to instrumental regulators and, three, to give some attention to the repressed emotions by the continual attention to ‘turning off the regulators’. Such responses are ingenious creations and not disorders of the brain.
The threat of abandonment is always a greater threat than the anguish of the constant checking behaviours. Indeed, there is no greater threat to any individual than the threats of not receiving and giving love. Alfred Adler, a contemporary of Sigmund Freud, and founder of Adlerian Psychology, puts it accurately when he says that ‘the cause of all human problems is a lack of loving’.
Dr. Tony Humphreys practices as a clinical psychologist and is the author of several books including Whose Life Are You Living?