Reuven was a frum teenager who tried to follow the halacha correctly. Whenever he recited the Shema, he got nervous that he might not have pronounced every single letter properly. In order to alleviate his concerns, he repeated words numerous times until he felt confident that he pronounced it just right. As time went on, it took longer and longer to complete the Shema, until it reached the point that Reuven could not get through the Shema in less than one hour, and due to his frustration, he stopped reciting the Shema. Reuven then felt very depressed, because he was not fulfilling the mitzva of Shema. Reuven has obsessive-compulsive disorder (OCD). Did Reuven’s religion give him a mental illness?
* * *
Rivka learned in her halacha class that if someone performs a good deed three times it becomes like a neder (a religious vow) and is binding on the person unless he declared bli neder. Rivka became nervous about many things she does that might constitute a neder. If she ate pas Yisrael three times, is that a neder? What if she went to her Monday night shiur for three consecutive weeks? What if she was nice to her little brother three times? She had no idea what is considered a good deed. Just to be safe, she started muttering bli neder under her breath before she did anything. At night, she would be up for hours in bed as she mentally reviewed everything she did that day to make sure that she did not fail to utter bli neder. She later consulted with her Rav who told her that she did not need to say bli neder, but she was nervous that he was not following the strict halacha with her. Rivka has OCD. Is Rivka’s religion to blame for her OCD?
Reuven and Rivka suffer from religious OCD, also known as scrupulosity. Some people will assume that Reuven’s and Rivka’s religious observance caused them to develop OCD. Unfortunately, OCD is a condition that is poorly understood by the general public. With a proper understanding of the condition, we can better understand the underlying causes for Reuven’s and Rivka’s OCD.
What is OCD?
Obsessive-compulsive disorder is usually composed of two components: the obsessions (the “O”) and the compulsions (the “C”). Obsessions are unreasonable and intrusive thoughts or fears, and compulsions are repetitive behaviors that are meant to prevent or reduce the anxiety that is related to the obsession. For example, Rivka’s obsession is the fear of inadvertently making a neder, and her compulsion is the repetitive behavior of saying bli neder.
Everyone has irrational thoughts every now and then, but for people with OCD, the thoughts are intense, frequent, and demanding. Thus, they feel compelled to do something to get the thought out of their head. Almost always, however, the relief provided by the compulsion is very brief, and the intrusive thoughts return, creating a constant cycle of OCD anxiety.
OCD is sometimes called the “doubting disease,” since uncertainty is the cornerstone of OCD. OCD can make someone doubt even the most basic things. It can even have power over high levels of intelligence. (Indeed, some research suggests that people with OCD tend to have above-average intelligence.) The OCD brain can generate thoughts that resemble rational thoughts and therefore trick the person into following them.
Studies also show that the more one tries to fight OCD and suppress his thoughts, the more the thoughts will haunt him, compelling the person to engage in a compulsion. Just to illustrate this point, imagine if you were told that in the next minute, whatever you do, you should not think about a pink elephant. For most people, it would be nearly impossible to drive that thought out of their brain. Since the OCD thought is unwanted and intrusive, the more a person tries to suppress it, the higher the anxiety gets and the more the thought persists. OCD basically gives a person “pathological doubt.”
Most OCD sufferers recognize the irrationality of their obsessions, but the intensity of their thoughts that they do something to calm their anxiety. As someone with OCD once said, “Torture is knowing that something makes no sense and doing it anyway.”
Here are a few examples of OCD. In each case you will be able to see the obsession and the compulsion.
Yaakov has an obsession that the gas on his stove was left on. His compulsion is that he often returns home to check the gas after leaving the house, causing him to be late to work. He will call home frequently during the day to ask his (so far very patient) wife if the gas on the stove is off. His checking is irrational, since he understands that the chances of the gas being on after multiple checks is remote, but his OCD thoughts are compelling him to have doubts.
Leah, a young mother, has intrusive thoughts of harming her baby in a horrific way. (She is not planning to do it; there is just an intrusive thought in her brain that suggests she might do it.) Her compulsion is that she avoids touching any of the knives in her kitchen if her baby is in the house, and she refuses to bathe her baby for fear that she will drown him. Her intrusive thoughts create such intense fear and distress that she is scared that her thoughts may have a basis in reality, even though the mere fact that she is so terrified of her thoughts indicates that she does not fit the profile of someone who would harm her baby.
Chava read an article that studies show that ATM machine keypads and shopping carts have more germs than a toilet seat. (If you have OCD tendencies, please do not search for that study!) Chava became nervous about touching anything in the public domain out of fear of the germs. In the winter, she wears gloves whenever she leaves the house. Otherwise, she touches as few things out of her home as possible. If no one is looking, she will wipe every surface before she touches it. She understands that she is going a little bit overboard; but since her feelings of anxiousness are so overwhelming, she feels compelled to take these thoughts seriously.
What Is Not OCD?
Enjoyable Organization: OCD is an anxiety disorder and is a condition that causes someone a lot of stress. If someone happens to enjoy being very organized, that is not OCD. For example, Penina likes to color-code the books on her shelf following the order of the colors of the rainbow. She finds the pattern to be very beautiful and enjoys the color scheme. Since her organization is an enjoyment for her, and is not an attempt to avoid a disturbing thought, she does not have OCD. You might hear someone say, “Penina is so-o-o OCD!” That person obviously did not read this article! (There are people who are perfectionists in an unhealthy way. It is very possibly not OCD but a different disorder that is beyond the scope of this article.)
Pleasurable Obsessions: Pleasurable obsessions are not OCD. A talmid chacham who loves learning and derives great pleasure from it is obsessed with his learning. But it is not due to anxiety; rather he loves to learn Torah. There are even pleasurable obsessions that are illogical, like fanatically following sports. (Sorry, sports fans!) It might be an irrational and silly obsession, but since it gives the person enormous satisfaction, it is not a mental illness.
Rational Avoidance: If someone has a rational avoidance of something, it is also not OCD. Most people will not eat off a plate that someone else used unless the plate was washed first. That is not OCD, since it is a rational method of germ avoidance. Even if someone is a “clean freak,” as long as the cleanliness is done within social norms, it is not OCD. But if the window must be scrubbed exactly seven times without interruption, or if countertops are cleaned numerous times even though they are already sparkling clean, that already raises the suspicion of OCD.
OCD is Common and Chronic but Manageable
OCD affects men, women, and children of all races and backgrounds equally. In the United States, about 1 in 40 adults and 1 in 100 children have OCD. OCD commonly emerges in childhood, the teen years, or early adulthood (with earlier emergence being more prevalent in boys).
OCD generally persists throughout life, with fluctuations in severity. Researchers believe that there is a genetic component to the condition and that there is an underlying predisposition to develop OCD that is not within our ability to control.
OCD can be successfully managed with therapy and/or medication, but it cannot be cured. A person can live his life while keeping the OCD manageable, provided he retains the skills he learned in therapy and keeps on applying them in his daily life. Stress, illness, or fatigue might cause a person’s guard to be let down, which might trigger a relapse of the OCD.
57 Varieties
Heinz ketchup has 57 varieties, but OCD has a lot more! OCD is as varied as life itself. If there is some room for doubt, there is someone out there who has OCD in that area. OCD behaviors include excessive washing or cleaning, preoccupation with violent or religious thoughts, aversion to particular numbers, rituals involving specific numbers, making sure certain items are in a straight line, repeated checking of locks; and the list goes on and on.
So if OCD has so many varieties, how does the OCD brain “decide” which flavor to choose? One answer is that the OCD brain tends to attack whatever you value the most. If hygiene is important to you, then you can get contamination OCD. If safety is important to you, then the OCD will develop in an area that relates to safety. Additionally, the OCD might change throughout the person’s life. For example, it might be religious OCD as a teenager (since teens tend to not be concerned with safety), and change into a safety-oriented OCD in adulthood.
The Bottom Line
Religious OCD is just one of the flavors of OCD. If someone is predisposed to developing OCD, then his religion makes it possible for his OCD to take on a religious flavor. The bottom line is that Yiddishkeit cannot be blamed for an individual’s OCD; rather, since he is frum, his OCD is also frum. Therapy for religious OCD is somewhat tricky, because the therapy might raise some questions in halacha. Collaboration between the person’s Rav and the therapist is often necessary.
There is an old Jewish saying that there is no joy greater than the resolution of doubt. Unfortunately, clarity is not always attainable. May we all merit achieving clarity in our lives - but since doubt is inevitable, may we all merit not to be plagued by that doubt.
Rabbi Hauptman is Director of Relief of Baltimore, a mental health referral service. Contact him at ahauptman@reliefhelp.org or at 410-448-8356. This article was reviewed for clinical accuracy by Dr. Mordechai Zeiger, Psy.D., who has a subspecialty in anxiety disorders and OCD. Contact him at 443-220-8142.
