Recently I was listening to NPR on the car radio. The program was about so-called obsessive compulsive disorder, and a woman was describing her difficulty in this area. I didn’t record her actual words, but it went something like this:
I have all these checks and rituals that I have to do each day. And it’s beginning to put a strain on my marriage. Sometimes my husband wants to go somewhere but I can’t go until I finish my checks.
I was immediately struck by the possibility that either this woman doesn’t want to go out, or doesn’t want to go out with her husband. These avenues certainly warrant exploration, but within the present mental health system, all she is likely to get is a “diagnosis” and a prescription. (“You have an illness, takes these pills.”) It would be very rare nowadays for anybody to take the time to explore what payoffs might be involved in the pursuit of the rituals.
The psychodynamics of rituals are self-evident. Most rituals are simply repetitive actions that we can do without effort, and in which we can almost always be completely successful. And we all have them. We get out of bed in the morning; comb our hair (those of us who have any left); shave (those who care to); wash; brush teeth, etc.. And so on at various points of the day.
In my experience, the people who get into rituals to a disturbing degree fall into two groups.
Firstly, people who are very anxious/fearful. The rituals have a calming effect. They’re not the best way to deal with anxieties, but they work after a fashion. I have dealt with more effective ways to cope with anxieties elsewhere in this blog.
Secondly, people who are not feeling generally successful in their everyday lives. This is truly the modern malaise. So many people are stuck in jobs from which they derive no feelings of accomplishment. In my view we all need daily doses of feelings of success. The subject area doesn’t matter. Raking the lawn; building a fence; writing a letter; cooking a meal; teaching a child to ride a bike; painting a door; fixing the car; etc., etc.. Many people manage to get feelings of success through their jobs – this is great. But those who don’t need to organize their leisure time in such a way as to ensure a steady flow of these kinds of feelings. There just isn’t time for rituals when you’re teaching your daughter how to change the oil in the car or helping a neighbor fix his porch or whatever. And everyone can find something that they can do and do well.
Obsessions and compulsions do not constitute an illness. Rather they are ways in which people deal with sub-optimal circumstances. They can be replaced by more effective activities through the normal methods of behavioral change.
There are no mental illnesses.