OCD – The Inside Job

First, what does this intruiging title mean?

I stated a couple of times that OCD might be considered a neurological problem. I meant: it’s located, as an illness, inside of our head. Moreover, thanks to the progress in science, we begin to understand where it is located in our brain.

So: although we do not know where our ‘soul’ is, nor our ‘mind’, our ‘consciousness’, or our ‘spirit’, we know quite well these days where in the mysterious machinery of our brain, there are correlations with certain afflictions.

Hey, and here’s the first obstacle that needs clarifying. I used the word ‘correlations’ not for nothing. Especially where the neurosciences are concerned, it is strikingly difficult to establish causal relationships. True, with modern scanning techniques we can visualize the insides of our head somewhat better with each passing year, due to advances in applied technology when it comes to those scanning apparatuses. We pick a patient, put him/her inside, take a series of pictures, and look for possible abnormalities in the brain.

What does this mean? It means that we can state: this person had OCD (or: depression, or: schizophrenia, or: dipolar disorder, etc.); and simultaneously we can, with any luck, observe things that are not to be seen in healthy persons.

That’s it. No less, no more. Sure, we are tempted to say: hey, there’s a lobe that looks a bit strange, compared to the same lobe in unaffected folks. Or: crikey, there’s much more bloodflow than in healthy subjects. So that lobe, or the blood flow, must be the cause of the disorder.

Which is taking things too far. It’s not allowed, for the skeptic scientist, to draw such a conclusion. He or she can only say: the alteration, and the illness, they go together. In other words: there is a correlation, or: there is an association.

This is really a rule of thumb, this awareness of the limitation of a study, and the use of this awareness in describing observations and making concepts for further study.

Think of the hen/egg problem: which came first? If you care to ponder the problem, you will see it clearly for yourself. In theory, a person may be endowed with a perfect brain, i.e.: a brain that could have been the template for an antomy textbook. Everything in proportion, nothing wrong.

Then that person may develop, for whatever reasons, OCD like thoughts, worries, and behavioural patterns. Life changes for this luckless subject. It is lived more and more indoors, and more and more time is spent on senseless compulsions. Stress rises, and sleep escapes. And eventually, as a result, that surplus of stress and lack of sleep cause physiological and anatomical abnormalities. Some brain parts decrease in size, others get bigger, and local blood flow as well as metabolism changes.

And this is what I am driving at today: differences as seen in the visual recordings of a scanning procedure may still be causal to OCD, but just as well the effect of the disorder.

That is why we speak of correlations and associations. To consciously limit ourselves to what we are allowed to state. Nothing more.


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