A question about obsessive-compulsive disorder (OCD) that remains under study and often provokes animated discussions is the role trauma may or may not play in people with OCD. Trauma, as it is understood within medical parlance, is emotional shock that follows a stressful event or a physical injury. It also may be defined as a deeply distressing or disturbing experience. Regardless of its definition, when associated with OCD, the working assumption seems to be that the trauma is one experience and the OCD is a possible reaction that the trauma triggers. It sounds logical enough and seems to make sense, but what if this assumption is incorrect?
How would the understanding of the relationship between trauma and OCD change if the assumption about the relationship between trauma and OCD was redefined? What would be the result, for example, if the trauma is determined to be the intrusive thought? Under this hypothesis, the thought is so horrific to the OCD sufferer that it is traumatizing. Shock and stress follow, quickly morphing into OCD behavior masquerading as an effective response to the trauma.
While I cannot speak with any authority about OCD as a whole, I have some expertise with OCD that primarily manifests as religious scrupulosity. As such, and based on my pastoral experience, I believe the intrusive thought is the trauma and often the root cause and effect of scrupulosity. People with scrupulosity often interpret intrusive thoughts as so horrendous and horrifying that they trigger stress and anxiety. In my view, OCD is the response to the anxiety.
Other experiences of potential stress and anxiety—including family-of-origin issues and perceptions about God, heaven, hell, sin, and more—quickly rush in with the traumatic intrusive thought. Plus, previous traumas and experiences related to the content of the traumatic thought quickly contribute meaning. The OCD that manifests itself and forms seems to make perfect sense to the sufferer. At first, the traumatic thought may even feel like an effective way to calm the anxiety and make sense of the traumatic feelings. But the thought does not have a long-lasting calming effect.
In addition to being medical and psychological anomalies, traumatic thoughts wound scrupulous sufferers spiritually. An intrusive, traumatic thought masquerades as a freely chosen religious and spiritual choice that inflicts a terrible wound upon the soul of the person. Here, soul is seen as the essential animating energy and life source of the human person that is touched by divinity. A traumatic thought can rupture the connection between humanity and divinity, or so it seems to the person who is traumatized. The experience is like the decision that led to the Fall in the Garden of Eden. The serpent deceived Eve with what she saw as a reasonable choice.
Once wounded by the harmful combination of an intrusive thought and anxiety, the OCD takes root and begins to construct an alternate reality that is nonetheless convincing and real to the person who is suffering and afflicted. The religious constructs of dogma, doctrines, pious practices, devotions, and all manner of things deemed somehow sacred provide the materials for the OCD to construct the alternate reality that is recognized as the condition of scrupulosity.
The traditions in Catholicism—a caretaker of 2,000 years of organized religious thoughts, disciplines, and practices—provide a fertile playing field with treasures that can be discovered at every turn. To the unpracticed eye, all the treasures seem to be of equal value and worth accumulating, effectively mixing everything into one massive pile of “shiny things” that should repel but somehow attract. Trying to sort out all that has been accumulated and assigning each one its proper value is beyond the ability of most people, even though many seem willing to try and tackle the challenge in the false belief that, once sorted and organized, everything will make sense. It will not. The effort is a colossal waste of time. The whole construct must be set aside, temporarily and in some cases permanently, if there is any hope for real healing and spiritual growth.
For the scrupulous, therapeutic and medical help are highly important in the healing process, but something else that is essential is required. Compassion and empathy are needed to effectively enable the healing of the trauma that scrupulous people experience so they can gain or return to spiritual health. The healing touch of grace needs to be applied the moment the intrusive thought sparks the trauma. The sufferers must be engaged as people who have been inflicted with a terrible spiritual wound not of their own making, but they should not be engaged as clients or patients.
I recognize that my proposed perspective is atypical. Nevertheless, I believe it can offer valuable insight and direction for the management of the disorder of scrupulosity. I believe my point of view properly situates the traumatic thought into the context that makes the most sense. Once the context is understood, a path for healing and wholeness can be engaged.
Fr. Thomas M. Santa, CSsR