BY FATIMAH ALI WANI
26-year-old gentleman walked into my hospital chamber, anxious and perplexed. “So, what brings you here?” I asked. With a cracked voice and welled up eyes he answered, “I am not a disbeliever but lately I have been getting repeated thoughts that incite religious dilemmas in me leaving me guilt-ridden. Even though these thoughts are against my fundamental beliefs, I cannot seem to stop them. It is so distressing to see myself turn into an atheist.”
Upon probing further, I found out that he had also been getting violating images about his holy scriptures every time he looked at it or tried reading it. Besides that, he was also having many other disturbing thoughts regarding his faith. He attributed these blasphemous thoughts to God’s angry retribution against something sacrilegious he must have done unintentionally.
Soon a grip of fear encompassed his life and his sense of subjective well-being came crashing down. Even before he knew it, these thoughts and images made his social and occupational life dysfunctional.
He was drowning in shame and spent most of his time doing things that helped him neutralise the guilt caused by these sacrilegious thoughts. Fearing punishment from the divine-being, he would continuously be in a state of worship to obtain forgiveness for his self-perceived sins.
With mental health taking a front seat globally, there is only so much we know about mental disorders. There is an inadequate emphasis on mental health literacy which explains why most of the patients still come in with “Depression” as the umbrella term for all their mental health issues. Similarly, for the few who are familiar with the term OCD (obsessive- compulsive disorder), their understanding of the disorder is restricted to excessive ritualized washing, flicking switches, and keeping things in order. Even though this is what a prototype of OCD would look like in an ordinary cinematic representation, this information is not just inadequate but limits our understanding of the disorder leading to a stereotypical picture in our mind. Consequently, it leads to the inability to recognize other symptoms of OCD and different mental health conditions and could make people suffer from disabling symptoms in silence, never reaching out for professional help!
Obsessive-compulsive disorder (OCD) is characterised by obsessions (recurrent, intrusive, distressing thoughts, impulses or images) and compulsions (repetitive motor or mental acts which are carried out to alleviate the distress caused by these obsessions). These obsessions and compulsions can have different themes like aggressive obsessions, contamination obsessions, sexual obsessions, somatic obsessions, religious obsessions; washing/cleaning compulsions, order/arranging compulsions, checking compulsions, counting compulsions, hoarding compulsions and other miscellaneous obsessions and compulsions.
The individual quoted in this article is suffering from Religious OCD or scrupulosity. Obsessions and compulsions associated with religiosity are known as scrupulosity and can manifest as pathological doubt and guilt about self-perceived sins and moral transgressions where there are none. It also includes excessive religious behaviors and hyper morality. Thistheme of OCD is not restricted to any specific religion but can interrupt any faith. Hence, scrupulosity is not a faith problem but a manifestation of OCD within the ambit of your religion.
Studies show that scrupulosity is the fifth most common form of OCD after contamination, aggressive thoughts, symmetry, and somatic concerns (Foa, et al, 1995). The recorded cases of scrupulosity date back to centuries.
Martin Luther, the 16th Century theologian was tormented by urges to curse God and Jesus (Baer, 2001). Writer John Bunyan (1628-88) was also retrospectively diagnosed of Religious OCD; his obsessions of being a sinner resulted in his compulsive reading of the religious scriptures.
Scrupulosity versus healthy religious belief
Occasional reprehensible and unwanted thoughts or impulses do not amount to OCD. It is normal to have such thoughts if they arise occasionally and are easy to dismiss. Many devout people who hold themselves to high religious and moral standards strive for perfection in religiosity and good conduct. However, their acts of worship and morality are not driven by pathological doubt or guilt but are a means to attain true spiritual enrichment.On the contrary, someone with OCD “sees a sin where there isn’t” and the dire anxiety and discomfort caused by these thoughts lead them to seek constant forgiveness from God. They tire themselves with religious rituals as there is a perceived fear of unpleasant consequences because of the sacrilegious obsessions experienced by them.
Among Muslims, these religious obsessions may include thoughts, impulses, or images like:
¢ Blasphemous thoughts/ images especially while praying
¢ Thoughts of being a religious or moral failure
¢ Fear of obliterating the religious and moral code of conduct
¢ Intrusive sexual thoughts about anyone and fear of loss of impulse control
¢ Fear of being contaminated by biofluids especially during acts of worship/Ibadah
¢ Thoughts of being a sinner
¢ Fear of acts of worship not being accepted because of the waswasa (apprehensions)
These are some examples of waswas al-qahri or religious presentation of OCD in Muslims. However, in Islam these waswas are not seen as negative indicators of faith. On the contrary, Abu Hurayrah (R.A) narrated, that some of the companions of the Prophet (PBUH) told him about the ordeal of the shameful thoughts that they were having. The Prophet (PBUH) positively responded by saying “It is in fact a clear sign of faith” and not the absence of it (Muslim, 2007). Even empirically, obsessions contain themes that are personally repugnant to that individual. For a non-believer, blasphemous thoughts will not be as distressing as they are for a believer. So, the amount of distress a person experiences because of these obsessions is directly proportional to their religiosity. This explains the paradox of the priest who has blasphemous thoughts.
Subsequently, these recurrent, intrusive, and distressing thoughts compel the individual to avoid situations that trigger these obsessions. For example, a person who gets sacrilegious thoughts while reciting their religious scriptures may avoid doing it altogether. But despite the avoidance, the obsessions may occur, which drives the individual to carry out certain rituals or voluntary behaviors that temporarily relieve the distress caused by these obsessions.
In case of someone who gets obsessional thoughts about being killed, they can display ritualistic behavior of checking their door lock again and again to reduce the distress caused by the obsessional thought. For someone with scrupulosity, they might indulge in excessive acts of worship or ibadah to relieve the distress caused by the sacrilegious obsessions. However, these compulsions relieve the distress only temporarily and in contrast strengthen the relationship between obsessions and compulsions which leads to the individual spending most of his time carrying out these neutralizing rituals.
Some of the compulsions of religious OCD among Muslims are:
¢ Excessive praying to counter blasphemous or sacrilegious thoughts
¢ Re-performing prayer to achieve perfection
¢ Excessive, repetitive acts of worship seeking forgiveness
¢ Taking a lot of time doing wudhu (ablution) and repeating it several times till you reach perfection and are convinced that you are clean
¢ Spending a lot of time in acts of washing and purification
¢ Taking daily acts of worship to extreme lengths to reduce the shame and guilt.
Consequently, compulsions are driven by the fear rooted in obsessions. The obsessional fear of perceived sins and moral shortcomings lead to pathological guilt, shame, and anxiety. This distress is temporarily alleviated by drowning yourself in acts of worship and perfecting them. However, compulsive, or neutralizing behaviors momentarily terminate exposure to the feared obsessions only for it to resurface later with greater intensity.
Getting help for scrupulosity
The prognosis of your illness trajectory will be determined by whether you seek help from a mental health professional or not. Since people with scrupulosity do not realize that OCD underlies their problem, they fail to seek help from the right professional and instead keep seeking reassurance from others (friends, family, and priests). This might further blur the line between what is a consequence of OCD and what is coming from religion.
Qualified and licensed mental health professionals must be approached for treatment of OCD. Psychotherapy adjunct with pharmacotherapy must be used to treat any type of OCD. Scrupulosity can be treated with Cognitive-Behavioral Therapy (CBT), specifically with Exposure with Response Prevention (ERP), a form of CBT which is commonly the first line of treatment for all forms of OCD and can be administered only by professionals. Seeking help is crucial, and the key lies in reaching out to the appropriate individuals or professionals, as their expertise can greatly impact the outcome.
Fatimah Ali Wani, Licensed Clinical Psychologist, Institute of Mental Health and Neurosciences-Kashmir. Presently, Fatimah is a PhD Scholar at the University of Kashmir
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.