OCD and Free Will

This is an interesting concept –

the freedom of our will has been a central topic in philosophy all through human history. When the neurosciences had their big lift-off in the 1990s, they too began to make inquiries into brain areas thought to be key in making choices.

Decision-making is something that is more difficult than it may sound at first. We must try to somehow sketch what choices we can reasonably make at all. We also need to see into the future: which action of ours will have which practical consequences?

One may think: what action is profitable for me? What promotes my health and well-being? Or: what brings money into my bank account? On the other hand: one can consider: how can I make my wife or husband happy? My children? I am the happiest whenever I see those around me happy.

Actually, there are a multitude of motives, reasons, and feelings at play.

It is typical for these, our, times that I often see the motive of personal interest and profit rear its head, as if unselfishness and the love for others weren’t ‘cool’ enough to mention in the context of decision-making.


Over to OCD.

All those who suffer from the illness, and those who are in their vicinity, know that there is something dreadfully wrong with a patient’s freedom to choose. People with OCD are living at the wrong side of a thick wall of clear glass: they perceive all too well how ‘the others’ live, enjoy life, act spontaneously, make mistakes, forgive and forget about those mistakes, eat well and carefree, and make music and love.

That is painful to see. For someone with OCD wants nothing more than to live like the others. But she/he can’t. There are the inner commands, the duties, the demon that wants to perform the patient all the unnecessary and irrelevant, ever-repetitive checks, controls, acts of cleaning or hoarding, and so on and so forth, ad infinitum et ad nauseam.

OCD is more about surviving than about living.

The only hope that is there for the patient is the brief time window of very relative freedom that will open after the exhausting rituals.

Even within this window (e.g. if one has succeeded in attending a dinner with others, or a movie together) there is this piece of knowledge lurking in the background: the demon hasn’t been conquered; he will return.


It is clear that the freedom of choice, the scope of one’s free will, the ‘freedom to be spontaneous and impulsive’ – in order to experience life’s true joys, is by far not as broad and rich as it should be.

Neuroscience has described a number of brain areas that are closely associated with our capacity for decision-making. At this point it is important to emphasize that ‘being associated’ is not the same as ‘causal relationship’. ‘Associated’ can best be thought of as ‘occurring together in time’; a person may be in a test situation in the lab, perform a task that is about making choices, and a brain scan can be made. Certain phenomena in the scan are observed, that are different for people with OCD, as compared to healthy subjects. We cannot say at this point in time that these differences cause, or are the result of OCD. They co-occur (which is always a good starting point for refining the methods used, in order to get on the trail of what actually might be causal, in a later stage of research).

Three areas thus identified are: the dorsal anterior cingulate cortex (dACC), the nucleus accumbens (NAcc), and the anterior limb of the internal capsule (ALIC).

I came across this scientific article, recently:


Neuromodulation. 2016 Apr;19(3):239-48. doi: 10.1111/ner.12405. Epub 2016 Feb 21.

Psychosurgery Reduces Uncertainty and Increases Free Will? A Review.

The authors looked at numerous results achieved with the method of psychosurgery – that is an invasive type of surgery, tiny modifications, changes are performed in the brain itself.
(I find this unsettling: actually meddling with someone’s brain tissue? But on the other hand: there are forms of OCD that can’t be treated well enough with cognitive behaviour therapy and/or pharmalogical treatment. And these can be so degrading for one’s quality of life, that in the end they may be the lesser of two evils.
And, let’s not forget: the other form of brain treatment in depression and anxiety, deep brain stimulation (DBS) is also an option: a tiny pacemaker that can alter neuronal activity in affected areas of the brain is implanted. Pilot projects have shown good results so far – and with our ever-evolving micro-technology there really a reason for good hopes.)
Here are the (literal) conclusions of the above authors:
MethodologyIn 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.




I think they put it very simple, and very well.

What we see here is not the outcome of a small set of smart and smooth investigations. Not at all. It is the preliminary result of long years of trial and error, great effort, serendipity, courage, and foremost: the willingness and cooperation, as well as the sheer guts of patients with OCD, who dared to go hand in hand with researchers into unknown areas of our brains.


I will look if I can find a nice picture of the areas involved, labeled as such in a photo or drawing of our brain.


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