Repost from the old site.
OCD (Obsessive-Compulsive Disorder) is a very strange illness. Although it is lumped in with the anxiety disorders, some have observed that it has qualities about it that imply that maybe it should be moved elsewhere. On tests, OCD’ers have showed similarities with schizophrenics on certain variables. The suggestion was made by the researchers that OCD may be related to schizophrenia.
Nevertheless, OCD generally does not lead to schizophrenia, nor do anxiety disorders lead to psychosis. That is old psychoanalytic stuff. According to psychoanalysis, as the person “regressed”, they moved first into neurotic “defenses” (the anxiety disorders) and later into psychotic “defenses” as the decompensation progressed. This early thinking has been largely rejected in recent days. But some still rings true.
An old Abnormal Psych book from the 1950′s, big on the decompensation stuff above, said that when a person recovered from a mental illness, they generally went back to a the personality they had previously. That sounds about right?
Anyway, most people afflicted with an anxiety disorder would have a hard time believing that they are utilizing some sort of a defense, because they are so horribly miserable all the time. I feel the same way about a psychosis. Whatever is going on, it cannot be any kind of defense mechanism. Defenses are designed to help us cope, not to make us go nuts!
Since OCD is so terribly misunderstood and the general public has such an ignorant attitude about mental illness, I want to delve into the topic of bizarre obsessions. I will list some bizarre obsessions that I have read about and heard about from sufferers:
1. A man is afflicted with thoughts that he is a fish. He checks himself in the mirror for tiny gills and reads dictionary definitions of fish and wonders if he has gills. He feels terrified whenever he sees pictures of fish. He tries to stop the thought every time it comes into his head and describes it as crazy.
2. A man is terrified that the Night Stalker is going to kill him. No reassurance can stop these fears. The problem? The Night Stalker is safely locked away in a maximum security prison and cannot possibly get at the man.
3. A man is worried that he may possibly be the Devil. This would account for continuous thoughts of committing serial murder, torturing victims, pedophilia and cannibalizing victims.
4. A man has thoughts “Aliens are sending me messages”. The thoughts come in “red neon Technicolor like the signs in Las Vegas” in his mind. He spends all his time resisting the thought and describes it as crazy.
5. A boy has thoughts that he “has to kill his grandmother”.
6. A young woman has thoughts that “wolves follow her everywhere she goes” and that every time she walks anyway, she feels compelled to “walk north”.
7. A man has the thought that there are tiny razorblades on his fingernails, although he admits that he can’t actually see or feel them. Hence he is afraid to touch people.
8. A woman is afraid to walk past garbage of any kind, especially trash cans, because she is afraid she might “lose a little bit of her essence” every time she is goes past. So she avoids garbage cans.
9. A man fears that his overwhelming sexual guilt comes out of his fingertips and goes onto any printed paper, or any surface that can be written on. The sexual guilt will flow out of his fingertips onto newspapers, magazines, etc, and his sexual guilt will be available for everyone to see. Hence he licks his fingers all the time to prevent sexual guilt from flowing out of them.
10. A man fears that the ghost of the dead Jeffrey Dahmer is coming into his body and possessing him, and is causing him to have terrible thoughts about murder.
11. A man gets the thought, “They are poisoning me” sometimes when he sits down to eat. He goes ahead and eats the food anyway.
12. A lawyer throws away his coffee several times a day because he fears someone may have poisoned it.
13. A 29 yr old woman obsessively reads the paper to see if she has committed any murders. She constantly worries that she may have murdered someone.
14. A man worries that he may actually be a woman. Not a woman in a man’s body as in a transsexual, but that he actually is a woman. He spends hours studying his body in front of the mirror trying to figure out if he is a woman or not.
15. A man worries if his dog is really his dog. Perhaps it really belongs to someone else? As he continues these worries, he begins to worry that his dog may actually not even be a dog. Perhaps it is some other species?
16. A man constantly worries that he is hearing voices and hallucinating. Upon questioning, it seems that he is just hearing everyday noises and worrying that maybe they are voices or hallucinations.
At first glance, the overwhelming majority of people looking at these symptoms would say that these people are psychotic and that these thoughts are delusions. Unfortunately, many clinicians will also diagnose these people as psychotic and say they suffer from delusions. The problem is that not one of the people above is psychotic and there are no delusions in the series above.
It’s simply OCD and the thoughts are obsessions, not delusions. The difference between obsessions and delusions is a difference that continues to elude some clinical psychologists and psychiatrists.
The way most people immediately said Seung-Hui Cho, the VT shooter, was psychotic shows that most people associate any kind of strange thinking and behavior with “psychosis”. Most clinicians also said Cho was psychotic. I continue to argue that we lack clear evidence of psychosis in Cho’s thinking and behavior.
Psychotic people have enough problems as it is; although I’ve never experienced it, it’s clearly not adaptive, and in many cases its very painful. They don’t need to be lumped in every deranged homicidal maniac who comes along.
Likewise, folks with OCD have plenty of problems as it is without being called “psychotic”, “schizophrenic”, etc.
Sigmund Freud was wrong about OCD in some ways, but he was limited by his era. Nowadays, Freud would surely be a biological psychiatrist. He has some interesting things to say about OCD. First of all, he said: “This is certainly a crazy illness!” On the other hand, he also said, “They are not psychotic.” He also hinted that the illness may be biological in nature.
For schizophrenia, Freud felt that there was something wrong with their brains. He suggested that in the future, we might be able to find something wrong with their brains. He also said that talk therapy was of no use to schizophrenics.
As you can see, for all the derision heaped on him, Freud was right-on in some very crucial observations about common mental illnesses, observations that continue to hold up in our biological era today.