So, here I am.

Two times I tried to start a new blog on OCD, with the intent to make that more structured, hierarchical, more accessible.

It did not work out.

First thing is: you have to re-write so many things you already talked about, and that is boring. I re-read numerous entries with the benefit of a perspective from  huge distance in time. And hey! I could well live with what I wrote. People with OCD tend to be afraid of the unknown (in many walks of life). I thought beforehand: hm, what bloopers will I encounter?

I was pleasantly surprised. So I think it’s more fruitful to diligently work my way forward. And I want to construct a handy search/index function to help readers get immediate access to a topic of special interest.

There have been fine new discoveries in the scientific field of OCD. ‘Fine’, in terms of providing hope for better treatment. I will write about that.

Another field of interest, relatively new to me, is: autism, or rather: autism spectrum disorders (ASD), as it’s called now in DSM-V, the diagnostical manual in psychiatry. Autistic conditions share quite some ground with OCD. I will delve into that shortly. Even more broadly speaking: there are canny similarities between ASD, OCD, and substance use disorders (SUD). I think that the two disorders apart from OCD will get an important place in the blog.

Finally: what struck me in the study of the above three conditions was that one inevitably gets confronted with the question: what is free will? I don’t think I will solve this question that is as old as mankind itself. But there are intriguing indications from neuroscience, that give us a bit of insight into brain areas that have to do with aspects of our will, with our ability to make choices, informed choices.

People with OCD know that that what they do is odd, unnecessary, not normal. That is has the potential to damage their relationship, their occupational life, perhaps their own life, in the end. But they can’t stop their compulsive behaviours. Same goes for people who drink way too much alcohol. The proper balance has gone out of the window. One can say: I can see that my excessive washing behaviour makes me unable to keep appointments. My boss is complaining. He’s losing his patience. I may get unemployed. So from a rational point of view, I know that I’d be better off to limit my showering to ten minutes in the morning. But I can’t stop! I begin, and suddenly it’s 90 minutes later! I just can’t stop! It’d even be better to go to work with only my face cleansed and some deo on, than have to live this dangerous way! Help!

Free will is impaired. That person does something he very consciously does not want to do.

A conundrum, in many respects – and an unseen, but terrible human drama.

Existence may be at stake.


I just discovered a new science article of great interest. I will read it; for now I will leave you with its abstract:

Neuromodulation. 2016 Feb 21. doi: 10.1111/ner.12405. [Epub ahead of print]

Psychosurgery Reduces Uncertainty and Increases Free Will? A Review.



A definition of free will is the ability to select for or against a course of action to fulfill a desire, without extrinsic or intrinsic constraints that compel the choice. Free will has been linked to the evolutionary development of flexible decision making. In order to develop flexibility in thoughts and behavioral responses, learning mechanisms have evolved as a modification of reflexive behavioral strategies. The ultimate goal of the brain is to reduce uncertainty inherently present in a changing environment. A way to reduce the uncertainty, which is encoded by the rostral anterior cingulate, is to make multiple predictions about the environment which are updated in parallel by sensory inputs. The prediction/behavioral strategy that fits the sensory input best is then selected, becomes the next percept/behavioral strategy, and is stored as a basis for future predictions. Acceptance of predictions (positive feedback) is mediated via the accumbens, and switching to other predictions by the dorsal anterior cingulate cortex (ACC) (negative feedback). Maintenance of a prediction is encoded by the pregenual ACC. Different cingulate territories are involved in rejection, acceptance and maintenance of predictions. Free will is known to be decreased in multiple psychopathologies, including obsessivecompulsive disorder and addictions.


In modern psychosurgery three target structures exist for obsessive compulsive disorder and addiction: the dorsal ACC, the nucleus accumbens, and/or the anterior limb of the internal capsula. Research in all three areas reports favorable results with acceptable side effects. Psychosurgical interventions seem to exert their effect by a common final common pathway mediated via the pregenual ACC.


Successful neuromodulation increases the capacity to choose from different options for the affected individual, as well as inhibiting unwanted options, therefore increasing free will and free won’t.

© 2016 International Neuromodulation Society.







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