The prison of the mind: obsessive compulsive disorder

A primary aspect of how our mind constructs the trap in which it remains imprisoned concerns the fact that, in the process of forming a obsessive-compulsive disorder, certain "regularities" can be observed in the way it is structured; at the same time there are different reasons that trigger the reactions and the vicious circle of the pathology. In the extensive research-intervention conducted on this pathology by the author and his collaborators over the span of over twenty-five years on over twenty thousand cases treated, it was possible to identify five basic types motivation that trigger compulsive thoughts and actions.

La first type is represented by doubt that triggers the need for reassuring answers. It is, for example, the doubt of being infected or of being infected with a disease through contact with an external agent.

This question triggers the need to seek absolute and reassuring answers: I must prevent infection in all ways; or, if this is not possible, I must activate the disinfection mode, to remedy what has happened. The dynamic arises from a doubt that triggers a system of reasonable protections, preventive or restorative, which by exasperation become the obsessive-compulsive prison.

This type of mental trap can also be activated starting from a doubt about what can positively propitiate my life: for example, I gave an exam and it went well, that day I was wearing certain pants and a t-shirt and I made a certain path to to go to university. At the next exam I perform the same ritual and the professor asked me about topics I knew well; it may work, so I'll do the same thing at the next exam.

The repetition of this script can also become an irrepressible compulsion in this case; if I can't execute the script, out of fear the exam will go wrong, demonstrating the completely random association between the ritual and the exam outcome. This first type emerges from a doubt to which I respond by putting into practice a series of actions or thoughts that work in my mind, and for this reason I repeat them until they install themselves as an irrepressible compulsion. The unreasonable becomes totally reasonable.

La second mode It consists in rituality that derives from the excess of ideological rigidity or in respect of a morality or superstitious belief. For example, I fear I have committed a sin, I must pray to atone for the guilt and be forgiven, a reparatory ritual clearly linked to a form of punitive religiosity. Or I force myself to give up something I like to resist the temptation, but being quite difficult I impose a preventive ritual, such as washing with cold water every time I feel the erotic urge to block it; or, on a moral basis, I can activate propitiatory rituals, such as morning prayer rites to ensure that everything goes well during the day; I try to propitiate the benevolence of God so that nothing bad happens to me and my loved ones.

 La third type is represented from the exasperation of rational reasoning processes to make them completely unreasonable. For example, before making a decision I have to analyze all the possibilities, otherwise I risk making a mistake; this is reasonable, but if I apply this logical criterion to extremes, it becomes the inability to make any decision quickly.

When I am faced with situations that require an immediate response, I must first compulsively analyze all the variables. This process leads to a short circuit: the more I try to find security, the less I find it. The attempt to prevent mistakes turns into the inability to act. This is what happens when, before important actions, I put in place correct preventive procedures, which however I exasperate in trying to reassure myself, repeating them or trying to always carry them out in the same way.

This is the frequent case of the surgeon who, as a propitiatory rite, before entering the operating room, implementing the correct washing, sanitizing and dressing procedures, checks to exasperation that everything is done exactly the same way, even going into crisis. for the smallest variation in the ritual. What is reasonable turns into an unreasonable mania that invalidates abilities.

When I am unsure and afraid I have made a mistake, I repeatedly double-check what I have done until I can no longer complete my task. For example, an accountant convinced that he has made a mistake repeatedly checks the documents and repeats the calculations in exasperation until he stops.

La fourth type it is represented by the mechanism by which the pathology is triggered on the basis of acts of healthy prevention carried out to the extreme: prevention turns into phobia.

For example, a mother who is attentive to her baby's health can no longer allow him to expose himself to situations considered dangerous. If on the one hand it is positive, on the other it can turn into a protective glass bubble, for example when no one can approach the child as a possible carrier of infections, when animals are avoided, when there is fear or the slightest change in temperature or the exposure to wind or sun.

Often, in these cases, the house becomes the temple of cleanliness, and whoever has to enter must first be sanitized: prevention turns into phobic mania. Here too there are many preventive, restorative or propitiatory variants. For example, if preventive avoidance has not been possible, exasperated disinfection is used, or products considered almost magical are abused.

La fifth typology of motivation consists of effects of a traumatic experience. To defend against what the trauma has produced, the person develops a series of sedative or immunizing thoughts or behaviors.

It is a frequent case in women who are victims of abuse: after the traumatic event, when they arrive home, they wash themselves in an exasperated way as if they could "wash away" what had happened. Unfortunately, this modality tends to be structured as an irrepressible compulsion every time something occurs in the woman's life that can be associated with the first terrible experience.

The gaze of a man or the feeling of being attracted to a person is enough for the woman to be forced to carry out the purification ritual. What makes the ritual "functional" is that, in its execution, the anxiety and anguish associated with the sense of dirt are relieved by compulsive washing, which however invalidates the subject's personal and relational life. Also in this case the rituals can be of a restorative, preventive or even propitiatory type, to deceptively guarantee what will happen.

Obsessive-compulsive disorder represents, like no other psychic and behavioral pathology, the evolution of a health condition towards apparently more absurd insanity through a compelling but exasperated logic. From a healthy doubt we can reach the pathological ritual, from the natural reaction to a trauma to the compulsion, from a correct morality to inquisitorial torture, from reason to unreasonable mania, from prevention to phobic behaviors.

In other cases, the aim is to prevent or remedy something unwanted or to try to predict one's future. On this basis, the three fundamental types of the disorder are structured, which represent the expression in the compulsive practice of the five motivations described; for each of the possibilities it is possible to have the three expressive variations of the disorder. Such mechanisms are extremely subtle and can deceive anyone, precisely because of their rationale.

Compulsive obsession can creep into the mind in any way and completely devour sane reasonableness. Therefore, the only possible form of prevention is to pay attention to when a behavior or attitude begins to structure itself as inevitable. THEinevitability andunstoppable they are the first conditions of a compulsion; the third is the rituals, that is, when an action or a stereotyped thought reassures us or guarantees us the desired effect. Furthermore, we should observe when our need for control, by preventing or propitiating our reality, or by remedying the negative effects of our actions and thoughts, turns into a constant and uncomfortable presence, which blocks our sensations and prevents us from taking the risk. to make mistakes in order to learn. But all this requires an acrobatic ability in managing oneself, others and the surrounding world.

George Nardone
(co-founder and director of the Strategic Therapy Center)
based on the book Obsessions compulsions manias