The Obsessive-Compulsive Disorder

Pastoral Care for the Road to Change

Robert Collie, Harold G Koenig

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317826309
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Gain scientific and theological insight into OCD!The Obsessive-Compulsive Disorder: Pastoral Care for the Road to Change delivers a provocative and stimulating discussion that is meant to inspire new areas of inquiry on this subject. As an OCD sufferer, pastoral counselor, mental health student, or professional, you will reach a new understanding of a complex condition that can destroy the day-to-day lives of its victims.The Obsessive-Compulsive Disorder explores the connection between religion and OCD from many different perspectives. You will explore case studies of OCD with religious connections through interviews, diagnosed symptoms, and discussion of the history of religious figures who suffered with OCD. The book also provides a reference list of organizations that focus on OCD, as well as Web sites and Internet addresses devoted to assisting caretakers and helping sufferers.The Obsessive-Compulsive Disorder will increase your knowledge of:

• the evolution of humans and animals in relation to personality development and the obsessive-compulsive disorder
• church leaders with the obsessive-compulsive disorder
• brain development and biology and their links to the obsessive-compulsive disorder
• quality of life issues for sufferers, pastors, and caregivers
• group therapy for OCD sufferers, including personal stories of OCD in connection with faith and religion
• neurobiological perspectives on theological issuesThe Obsessive-Compulsive Disorder brings you insightful new research into this complex mental illness, and will assist you in understanding and helping people who suffer from OCD.

Chapter 1

Take the “On Ramp”

In the book of Genesis, you will remember, the Tower of Babel was being built by an arrogant humankind who spoke one language and were cooperatively erecting a tower all the way to the sky. God became concerned, pulled a site visit, and then “confounded” them so they could not understand one another. I have a theory for how it was done. That night, God gave a formal dinner and awarded everyone a PhD. By the next morning, they were all so specialized, they could not talk to one another. Having blown it on the World's Highest Tower project, there was nothing to do but split to the five corners of the earth and become consultants. I am a descendant.

In 1972, when as a pastoral counselor I first experienced the puzzlement of a case of OCD, I never thought it would be the beginning of pulling together a lifetime of reading and experience twenty-five years later. Ten years ago, I had not even started to recognize that OCD is what we normally think and experience only magnified in some individuals ten, a hundred, a thousand times. Five years ago, I was just beginning to put the puzzle together, coming to the conclusion I share with you: OCD is humanity writ large. In it, streams of evolution, neurobiology, personality development, and religion begin to converge. The implications of this convergence are important not only for counselors (i.e., pastors and pastoral counselors working with persons having OCD), but also for those who suffer from the disorder. Clearly there are also larger religious and clinical implications as well.

We have all suffered from a narrowed perspective; it is the curse of our somewhat educational schooling. One of the great “light-bulb” occasions for Annelie and me was when we invited our veterinarian and his wife over for dinner to discuss OCD. If I were to identify the central learning I have gotten from OCD, however, it is not that it is partially the story of our animalness, it is that OCD helps us understand the Human Saga.

Referring again to the Tower of Babel, what is being told is not merely a story of why different groups have different languages; what is being taught is that a fundamental part of the human problem is that we cannot understand one another. In The Acts of the Apostles, the Good News—the Gospel—is demonstrated on the Day of Pentecost when persons from all the world hear that good news in each one's own language so that everyone understands what is being preached. It would be good news indeed if we could quit talking past one another and start talking with one another. I would like to have OCD sufferers discuss OCD with veterinarians, who would listen to paleontologists and who would dialogue with church historians, who would get to know those suffering from OCD. The discussion should include geneticists and psychologists, who would pass on their work to psychotherapists and pastors. It would be marvelous if church leaders would listen and comment and pastoral counselors would hear and reflect on what this means as we enter a new millennium. What is being done here is to write a text for a survey course: not OCD 101, but 201, building on what we know so we can move from learning about to learning from.

If that sounds complex, you might ask, “What do you get when you cross a pastor with a counselor?” An interdisciplinarian: a person with a professional bias for looking at a problem from a number of different perspectives. The tradition of the American Association of Pastoral Counselors is that, for training purposes, no case conference is creditable without representation from three different professional disciplines. The intention is to give the counse-lee the maximum benefit of diverse points of view and teach the counselor respect for other perspectives.

For a word as big and gross as neurobiology, the insights from OCD offer exceptional interest. If it is puzzling why references are made to support group experience more often than to a professional practice experience, all you need is a truly fine group. It is a magnificent advantage to be able to listen and wonder rather than hear and respond. As the professional consultant to a support group in earlier years, some evenings it is as if I could watch in imagination some little band of Not Yets/Will Be “people” on the veldt of Africa trying to stand taller so they could check, check, check. At times I could almost watch the firelight illumine the walls of the cave as a storyteller recounts How the People Came to Be or hear reflected the attempt of the shaman to heal what could not be understood. More recently, I have found myself listening to the theological implications of stories shared in the group, but that really deserves a book by itself.

In the meantime, the present chapters provide for the swing of the pendulum to extend to exploring some of the religious implications of neurobiology. I hope that sufferers with little theological background may be better able to talk about their religious feelings, that mental health workers who have left the religious beliefs of their childhood may newly reconsider these in the light of the experiences of their practice, and that pastors may better understand the religious implications of what is being learned from neurobiology. It would be a great compliment if a group of seminarians might gather to discuss the theological implications of these issues, for a church school class and support group members to meet and explore the meaning of suffering and faith, or if a behaviorist feels more confident in raising religious issues with a client who has OCD.

When I was growing up in West Texas we loved to go hiking. About the middle of the afternoon, if we were feeling a mite confused about the best way to supper, it was a good idea to climb a windmill. The country was so flat you could see from Friday to Tuesday.

In order to get the “lay of the land,” I propose climbing the windmill of religion, since the obsessive-compulsive disorder is highly charged with religious symptoms such as scrupulosity. It is a needed perspective, as one of the seminar leaders remarked at a national OCD convention in San Jose, that no one has really explored that topic in any breadth. Excellent work has been done on scrupulosity and also on the lives of saints: parts are known, the whole is yet to be mapped in its outlines.

THE MAKING OF THE MAP

I had done my time as an executive director of a pastoral counseling center and so I looked around for a limited practice, one that was intellectually stimulating and congruent to a lifelong religious commitment. I decided to look closely at the obsessive-compulsive disorder, having worked with a number of sufferers. If you want to be in private practice, it is a good idea to identify a group of responsible people (they pay their bills!). Combine this with a number of reliable medications and effective treatment techniques and it adds up to a pretty weighty option for how a therapist might enjoy spending his or her time.

When my wife and I went to the very first OCD national convention in Minneapolis, what impressed us was that half the group were professionals in health care and half were sufferers of OCD. There seemed to be no second-class citizens; lay or professional, all were accorded respect and everyone freely contributed. I thought to myself, “This pastoral counselor has found a professional home,” and I have written this book in that spirit. Whether you have a PhD or GED, are a psychiatrist or social worker, or family participant in a support group, all are welcome to a seat at this roundtable. The conventions continue to be a feast of shared learning. My purpose in writing is to continue to broaden this. Sharing and enlightenment are fraternal twins.

We were on our way home from the first national OCD convention when Annelie exclaimed, “Heide!” If OCD ever has a registered trademark, it ought to be for such moments when a lightbulb is shown over a cartoon character's head. Heide was a dear friend who had cared for Felix on weekends when Annelie was doing continuing education as a chaplain. As so often happens with those learning about OCD, the enlightenment is retrospective, as little was recognized about the disorder at that time. Annelie's first exclamation was followed by “straightener.” Every time Heide came she reorganized the kitchen. I came up with my own realization, “cleaner,” when I recalled how Heide kept her apartment perfectly immaculate.

But what if we had been able to give it a name back then? So little was understood about OCD we probably would have been embarrassed to discuss it with Heide because, back then, she might have thought that having it was shameful. Even if all three of us had the wisdom and maturity to explore it, there was no treatment back then. Heide, it was so long ago and we have gone our separate ways, but if some miracle of grace should occur and you should read these lines, all of us remember you with great affection.

It just keeps on and on. We were walking our yellow Labrador, Frances, yesterday when Annelie asked me, “Do you know the name of that saint who would lead his horse through the forest trying not to step on ants?” The subject had been a vacation in the Black Forest with her mother when she was ten. She had heard the story in religion class at school and was so impressed she tried it. She said her brush with scrupulosity ended abruptly when an ant bit her. We never could be sure, but we decided it must be the medieval St. Martin, as he is always shown with his horse. I hope you have seen El Greco's magnificent painting of him. St. Martin is pictured on his horse cutting his cloak in two with his sword in order to share it with a beggar. OCD seems seldom to draw back from goodness—perhaps because of its torment of badness, perhaps because it outlines the progress of goodness.

I hope you saw the movie As Good As It Gets in the theater and observed that only half the show was on the screen; the other half was the audience. They mostly sat in couples, and every five minutes heads would jerk forty-five degrees toward each other; you could not overhear the whispers, but if you could read lips, they must have been saying, “Just like my mother,” “Uncle Roy does that!” As Good As It Gets got the wrong Oscar; it should have received an award for Greatest Audience Participation Show-and-Tell Hollywood Ever Produced. The movie was great, of course, not because it was about OCD, but because it revealed aspects of the human story with which we all identify.

I had expected my move toward greater specialization would take the usual route of learning more and more about less and less, until you cannot describe what you are doing or thinking to anyone except a similar specialist. What I discovered was that the OCD knowledge explosion vitally affected the work of pastors and pastoral counselors, so I invited them to the feast. The first literary fruit of my specialization was “The Obsessive-Compulsive Disorder: The Pastoral Knowledge Explosion” in The Journal of Pastoral Care.¹ What I discovered was that the less and less I had been expecting became the more and more as streams of learning flowed together. What emerges now is what you see: an invitation to feast on what we can learn from OCD, a feast that resembles an interdisciplinary and ecumenical church dinner where everyone brings a favorite dish to share and in which a layperson feels equally accepted in commenting.

Scripture says “God is love”; as a longtime admirer, I think the subtext should add, “and a practical joker”: the poor in spirit are blessed, the mighty are fallen, those wise in their own eyes look foolish—and it is the meek who inherit the earth. One of those innumerable jokes occurred while I was doing research on the incidence of OCD in a clergy group. I had counseled with about eleven or twelve hundred clergy and their families, so I had a good idea the percentage of OCD would be high: it was, about half again as much as in the general population. I also had another idea: if ministry was attractive to some with OCD, the highly practical joke was that it probably affected the problem significantly in a positive fashion. It did. Based on the level at which the general population apparently experiences OCD, the clergy rate in the study is almost 50 percent less.² A group having more, suffered less. The question was and still is, “What is there about the attitudes, beliefs, and practices of ministry that lessens the impact of OCD?”

You may question, however, why any author would rush into the area of OCD and religion, for it is rightly an area where many a therapist dreads to tread. You can quickly disrupt a support group when some participants get on the subject of religion. It is at the core of what brought them to the group. I have come to the conclusion, nevertheless, that you cannot understand OCD without coming to grips with religion, any more than you can understand human beings without an interest in religion. It is all so intertwined.

I think any psychotherapist or pastor who went to an OCD national conference would find it the best use of time and money ever spent on continuing education. I am not doing them a favor, either, however, in suggesting this. I know what it is to squirm over a pastoral or client relationship and realize what was missed. I did not recognize what they were telling me, but they were not exactly being completely forthcoming, either, about what they feared was their craziness.

CLEARING THE MIND: NOTA BAD JOKE

Readers probably already know a lot about OCD; some may be wishing fervently they did not. An older mental health supervisor, with a supervisee as a Bright Young Thing who storms book lists, also might have several fervent wishes as to knowing. Pastors, if asked about “scrupulosity” and admitting more ignorance than piety for the moment, are certainly not to be accused, in that they know a great deal about hoarding and cleaning and straightening from pastoral calling in homes and equally about hypochondriasis from making sick calls.³ Most people could easily make quite a list of what they know about OCD, even if it was only from seeing the movie As Good As It Gets. Thinking about it and the ability to make quite a list becomes part of the problem: we know a lot about OCD, but until now the field has not sufficiently matured so that we learn from it.

The longer the list and the more you study it, the more it resembles the proverbial story of the six blind men grabbing different parts of an elephant and trying to explain it to one another. We know a lot, but the whole escapes us.

Consider the human appendix. Not only is it useless, it can get you into a fix in which the doctor is having a talk with your family, not unlike OCD. Fortunately, we know a lot about the appendix and we know how to manage it when that becomes necessary, not unlike OCD. Would it not be wonderful, however, if we understood the appendix? What a marvel to our minds if we could just learn from it. Its tale would unfold back to the beginnings when it must have been useful: Mother Nature does not fool around with the unnecessary. If we just understood what the DNA, the genes, and the chromosomes could tell us; if we just could read the developmental sequence; if only we could unravel the effects of stress and the dying and rebirth of cells: why, understanding all, we probably would even grasp the intricacies of our humanness more adequately, not unlike OCD.

Partially, the problem with most of us is that we do not know what we do not know. Good writing and good research are going on, but mostly we are ignorant of just how ignorant we are because we know so much more. Not too long ago, if you had OCD, you had no idea what it was. The media have done a pretty good job on that one, although you can still hear a few, “Oh, good griefs!” after some magazine article comes out. The fact that you are reading this and can make a list of “knowing about” is quite remarkable, just not entirely helpful. If you are one of those who suffer—or suffer along with—you may have knowledge of … but have lost all sense of wonder and consequently the potentiality of wisdom from it.

To get at that, I propose we do what we did as kids in second grade. When the chalkboard got too chalky, the teacher picked out a favored student who got to take a rag down to the washroom, get it wet, and wash the board, to the envy of the rest of us. I propose we do the same. There is a beauty about a chalkboard when it has been cleaned and is freshly ready to do its thing. Wipe your mind clean of what you know—even though as a sufferer you may not free yourself of what you feel—and appreciate the wonder of what we are yet to know. With that openness, all of us have a better opportunity to manage an awkward condition.

BUT…...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Author
• Table of Contents
• Acknowledgments
• Chapter 1. Take the “On Ramp”
• Chapter 2. The Disorder of Paradox
• Chapter 3. OCD: Hunting for the Disorder of the Thinking Animal
• Chapter 4. OCD and Homo Religiosus—Religious Man
• Chapter 5. Now It Is Our Turn
• Chapter 6. Homo Sapiens Sapiens: We Have Found the Enemy and It Is Us
• Chapter 7. Theory Made Practical
• Chapter 8. Learning from Effecting Change
• Chapter 9. OCD and the Quality of Life
• Chapter 10. Theologizing in a Neurobiological Age
• Appendix: Available Resources
• Notes
• Index