In a test version of this blog, I wrote: patients with OCD are normal, abnormally so. You may think: eh, that is a contradiction…? My reply is: no, it isn’t. Allow me to explain.
Let us put important OCD dimensions under the microscope. Take ‘checking’, ‘washing’, ‘hoarding’, and ‘ordering’. Muse a bit on a potential common theme in these expressions of the illness, and remind yourself of the story about our student Iris, who was a compulsive washer.
Are these dimensions symptoms of madness, of having gone berserk, of seeing pink elephants walking on your desk? Of course not. They are: symbols of protective measures. When a healthy person leaves home to go on vacation, he/she controls whether the windows are closed (against potential burglars); whether all devices consuming electricity are off (to save money, and avoid short-circuiting; only the alarm is left on); whether no water is spilled anywhere (save money, and prevent overflow); whether the gas stove and the open hearth are safe (a house on fire isn’t a nice thing); and whether all usual house garbage has been done away with (for maintaining hygiene and to prevent a minor insect plague, or even rats sneaking into the premises). On the other side, the caravan has been stocked with fine food for the holidays, with a case of good beer, with enough clothes for everyone to reduce primitive washing procedures at the camping place, with books, and with a medical emergency kit.
In my example, all of the above OCD dimensions are well represented… in a normal way. Their accompanying actions are carried out up to a point. To be precise, up to a point so that they don’t interfere with normal life itself, and with the joy of going on a holiday.
And here is the transition point, where normal safety measures mutate into illness. Patients carry out the above actions in the extreme. They become so time-consuming, that they are a real threat to all aspects of ordinary everyday life. Moreover, in a patient normal protective measures have become ‘overconscious’, the patient can’t think of anything else. They are nasty intruders in the mind, whereas in healthy persons they are more or less performed spontaneously, with some attention of course, but not with the extreme pressure on awareness that patients experience.
There is an old saying about neurotic disorders, of which OCD is one. It goes: “every neurosis eventually is converted into its opposite”. Washers are a good example of this. Think of Iris. She was obsessed about being clean, and mortally afraid of microbes and dirt. She washed and rubbed her hands so intensely, so long, and with aggressive detergents, that the skin was severely damaged. Because of this, in the end she ran a very high risk of getting infected with even the most simple types of bacteria, that would never stand a chance to harm healthy persons. In short, Iris had reached exactly the opposite of what she intended to achieve with all that washing.
If we see OCD this way, as an very severe exaggeration of protective actions that originally are meant to serve our health and well-being, then the meaning of my dictum will be clear: OCD is normal, abnormally so.
Reduced to normal proportions, the actions carried out in OCD protect the individual, and the species named humankind. Staking off territory for one self and one’s family, maintaining proper hygiene, warding off aggressive intruders, preventing fire, saving money, and collecting essentials for having a nice vacation… all are very much in tune with the theory of evolution. In wider context, religious and sexual obsessions fit in well with this idea (although again, in the disorder they are present in an unhealthy way).
Imagine a bell-like curve, a normal or Gaussian distribution. Imagine all humans in such a distribution, and imagine the X-axis representing ‘prone to protective measures’, ranging from zero (= 100% sloppiness) to infinity (= 100% diligence). Then the majority of folks on our planet will fall into the ‘normal’ area, say the middle 95% of the distribution. At the lowest 2.5%, we have people so utterly sloppy that they certainly are ‘Darwin Award’ material, they won’t grow very old because they simply can’t answer the simplest protective demands. And at the upper 2.5%, we have: OCD. This then is the area where people are represented, who suffer so much from extreme urges to protect, that they are very ill. And they too may pass away before their time (e.g. extreme hoarders can become homeless vagrants, they can’t keep house in any useful manner).