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 psychologist 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 ate 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 cute 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 fear-fulness, introversion, and a tendency to depression.
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