Clinically OCD is an anxiety disorder, characterized by the inability to restrain obsessive thoughts for sustained periods. In extremis, sufferers obsess identical thoughts for years, in an endlessly exhausting cycle.
Patients also perform compulsive actions, repeatedly washing or endlessly rearranging objects for example. Some recap mental counting processes or repeatedly mutter single words or phrases until “satisfied" that the compulsive problem has been put to rest. Sufferers become intensely frustrated and depressed by their inability to dispel these intruding, life wasting, thoughts and actions.
Melancholia and the Early History of OCD
Since the fourth century BC, obsessional behaviour was explained as “melancholia”, a distinct disease with particular mental and physical symptoms. Melancholia (Greek for black bile) was supposedly caused by an imbalance the four bodily fluids or humours. Hippocrates, in his Aphorisms, characterized “all fears and despondencies, if they last a long time" as being symptomatic of melancholia.
For centuries in Europe, from the early Middle Ages, satanic possession was believed to be the primary cause of blasphemous, sexual, or other obsessive thoughts. This could lead to bizarre, sometimes immoral, compulsive behaviours although generally suffers were not themselves deemed evil. Treatment involved the exorcism of malevolent spirits from the sufferer’s body by priests or those deemed to have special powers.
In 17th century England, the concept of "religious melancholy" became established as the cause of a many mental disorders including those with OCD-like symptoms. Unlike its more ancient precursor, religious melancholy supposedly sprang from overzealous devotion to God.
According to Robert Burton's famous book "Anatomy of Melancholy" (1621) "it more besots and infatuates men than wars, plagues, sicknesses, dearth, famine and all the rest." Burton blamed "priestly superstition" as the prime cause of "religion run wild and frenzied". Mental distress caused by religious melancholy could be cured by “the comfort of cheerful friends and productive work" and the avoidance of "solitariness and idleness".
Psychoanalysis and OCD
Austrian psychiatrist Sigmund Freud (1856-1939) believed obsessive-compulsive behaviour is linked to unconscious conflicts manifested as symptoms of the illness. For example Freud described a case of "touching phobia" initiated when young children have a natural desire to touch and explore objects with their fingers. Later, an "external prohibition", such as the admonition of adults can develop, suppressing this desire to touch and becoming a repressed urge within the unconscious.
Conflict develops between the desires and subsequent actions of the conscious and unconscious minds. OCD sufferers, frequently "compelled" to carry out actions giving only temporary relief from anxiety, still "know" it’s ridiculous or embarrassing to do so. Freud developed psychoanalysis for curing OCD and other mental disorders through extensive dialogue between patient and psychoanalyst.
Neurotransmitters and Serotonin
Modern theories indicate an abnormality in the neurochemistry of OCD patients, linked to a chemical called serotonin. This “neurotransmitter” carries nerve impulses through the brain from neurons to receptor cells. OCD sufferers may have blocked or damaged receptor sites in the brain, preventing serotonin working correctly. Indeed many OCD patients benefit from the use of selective serotonin reuptake inhibitors (SSRIs) - medications increasing serotonin availability.
Neurological abnormalities may be linked to genetic mutations whereas environmental factors can affect how OCD anxieties are expressed. Progress in understanding the causes of OCD, away from superstition and pseudo-medicine mean that the prospects for OCD patients are considerably brighter than in centuries past.
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