Fighting Fear

Confronting phobias and other fears

OCD: Trying To Do the Right Thing

The wish to behave ethically taken to an extreme.

Evolution seems to push pack animals (including human beings) in opposite directions. Individuals are rewarded for behaving aggressively and selfishly with a heightened likelihood of success, namely, a greater chance of reproducing and sustaining their descendants.  At the same time, the uncontrolled behavior of such individuals is likely to undermine the success of the group of which they are a part and which competes against other such groups.  The ability of the members of such a group to survive and thrive depends on the success of the group as a whole. To succeed as a competitive group, provision must be made to encourage cooperation among its members, including supporting the weaker and less aggressive.  Therefore, rules have grown up to limit the ability of the very strong and aggressive to dominate, and in such a way, undermine the group. Behaviors reflecting these opposing evolutionary pressures are apparent in all such animals. In human societies they take on the character of ethical rules and, on certain important matters, codified  laws.

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Every person feels impelled to a varying degree to fulfill these biological imperatives: to keep up with and, also surpass, others around him, and, no less real and powerful, to fulfill the altruistic desire to help other people. Both urges are part of the human condition. Everyone has come to believe in the importance of individual striving, but, also, of limits to that behavior. These conflicting urges are sometimes apparent in the political arena.

Sometimes, one or another aspect of human behavior seems to take on an exaggerated form in certain individuals. Such a person may seem to be ill.

Someone who very aggressively pursues his own interests to the detriment of others and with no regard for the feelings or interests of others is said to be a psychopath.

Someone who has an exaggerated concern of injuring others, to the point where that person is caught up endlessly and irrationally with taking precautions against such an injury, is likely to be suffering from obsessive-compulsive disorder.

These are the two extremes of behavior measured by the inclination to fit one’s own desires and interests into the larger interests of a community.

Some examples of obsessive-compulsive disorder (OCD):

  1. A woman tries to avoid leaving her home because when she walks down a street, she finds herself progressing very slowly and painfully. She is driven to examining the sidewalk for cigarette butts. She feels that it is her responsibility to step on them in case one of them may be smoldering and represent a fire hazard.
  2. Another woman pulls over to the curb when she is driving if she hears some noise that sounds like a siren, no matter how distant. Even so, she is haunted by the idea that she may have inadvertently slowed the progress of a fire engine with possibly fatal consequences.
  3. A man has to go back to check if he has driven over a bump in the road to make sure he did not strike a pedestrian. Sometimes he has to go back a second time.
  4. A young man spends an inordinate amount of time each morning picking the clothes he will wear. He thinks that if he picks the “wrong” clothes, something bad will happen to someone in his family. He has no rule to help him decide which clothes are “right” and which are “wrong.”

5     A middle-aged woman has spent the better part of her life cancelling out “bad” thoughts by      saying something “good” to herself. Sometimes she makes her children repeat these meaningless phrases, lest something bad happen to them,

These are specific thoughts about not hurting other people. They have the quality of a superstition; but they are idiosyncratic, that is, they are distinctive and peculiar to that person. They seem to be made up out of whole cloth. These examples could be multiplied endlessly. Food, in particular, may require handling in bizarre ways; otherwise it can be seen to be dangerous.

Commonly, specific fears of hurting someone else generalizes in persons suffering from OCD to a desire to do things the “proper” or “right” way. Even when there is no right way or wrong way of doing something, they contrive to make such a distinction.

  1. A woman studies the sidewalk before walking down the street. She avoids cracks. Another young man purposely steps on the cracks.
  2. A young nun has to repeat her prayers over and over again until she can pronounce them exactly correctly.
  3. Another young woman has to line up her shoes in the closet exactly before going to sleep.

 The fear of hurting other people does not preclude other fears. Patients suffering from OCD are also afraid of inadvertently hurting themselves:

  1. A housewife has to check the front door many times to make sure it is locked, and the stove, and other appliances to make sure they are unplugged lest they start a fire.
  2. Another man is afraid of going into his basement which he thinks mat be contaminated by asbestos, even though the basement has been inspected and found not to have asbestos.
  3. Another man also avoids his basement because he is afraid of radon poisoning which he could die from and which could cause others to die also.
  4. A mother and daughter are both so afraid of germs that they spend hours washing their hands with the result that both have developed fungal infections.
    These fears are innumerable.

The particulars fears an obsessional person has do not define the condition of OCD. It is a complicated illness marked by doubting, repetition, un-doing and avoidance. But it is true that someone who expresses exaggerated and irrational fears of hurting other people is likely to be suffering from that condition. It has seemed to me sometimes that these preoccupations , however unwarranted  and unnecessary they may be, tend to occur in people who are otherwise concerned about others and are—well-- nice people.(c) Fredric Neuman. 2012 Follow Dr. Neuman's blog at fredricneumanmd.com/blog

 

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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