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Key points
- OCD treatment is enhanced when researchers and clinicians explore new ways of understanding OCD.
- Having only one majority treatment places conformity pressure on other potential treatments.
- Knowing why certain clients do not benefit from current treatments will help expand treatment options.
At Swarthmore College in 1951, 50 students were placed in a room and charged with matching the length of two vertical lines (Asch, 1951). Seven confederates gave the wrong answer for the lion’s share of the experiment, and nearly 75 percent of the participants went right along. After just one dissenter was placed in the group, conformity dropped 80 percent (Asch, 1956).
When it comes to the treatment of obsessive-compulsive disorder (OCD), I’m that guy. Clients from all over the world tell me that the mainstream therapy has failed them, while secretly in their hearts they feel like failures. They look to me as the lone dissenter: Are you seeing what I’m seeing, too?
Standard OCD Treatment
There’s currently one gold standard for OCD treatment—hard to imagine for a disorder that causes a staggering loss of £5 billion per year in the United Kingdom (Kochar et al., 2023) and takes between 14 and 17 years to properly treat (Ziegler et al., 2021). Poll any therapist with a pulse and ask them what’s the best intervention for OCD, and, just like in the famous Solomon Asch experiment, you’ll get the same answer: exposure-response prevention (ERP).
ERP is a cognitive-behavioral technique whereby OCD sufferers stare down their biggest fears and learn not to blink. Trained to conjure their personal worst-case scenarios—the terror of harming a newborn child, the yuck factor of hands submerged in an overflowing trash can in Times Square, or entertaining the possibility that they just might be a psychopath—ERP performs an unusual sleight of hand. By leaning into rather than avoiding anxiety, sufferers break OCD’s unruly spell.
Big Hearts and Imaginative Minds
Unfortunately, ERP misses the most astounding feature of people with OCD: their enormous hearts and imaginative minds.
OCD sufferers are amongst the kindest and loveliest clients with whom to work. Research confirms this big heart, showing that individuals with OCD possess higher empathy compared to healthy controls, sharing the suffering of others in both self-reports and in a naturalistic task designed to test empathy in real time (Salazar Kampf et al., 2021). For this emotional sixth sense, however, they pay the price of taking on the world’s pain.
Most people don’t recognize the brilliance of the OCD mind, either—the kind that enabled Charles Darwin to dissent from the conformity of creationism, that sparked Greta Thunberg to protest against the complacency of climate change, and that spurs Jack Antonoff to craft megahits of musical possibility. Nor do they realize that all of these notable individuals struggled with OCD and excelled using its hidden upside.
Ironically, the treatment tailored for OCD doesn’t offer the same open heart and mind that those with OCD so easily give away. Therapists tell clients their sensitivity is only noise, "sound and fury, signifying nothing," but what if they are exquisitely alert to a more apt Shakespearian question, "To be or not to be?" What if they need support taking up more space without worrying about stepping on so many toes?
About two months into the COVID-19 lockdown, I woke up with a toothache and a thought spiral: What if I need to go to the dentist and they’re all closed down? What if I’m forced to suffer with this pain for days, weeks, or—gasp—months on end? What if I luck out with an appointment, catch COVID-19, and murder my entire family?
OCD sets up a problem and throws you off the trail. It’s like 15 minutes into a "Law & Order" episode, when you think you’ve got the case solved, but it’s really just a dead end. Slowly, I questioned myself. Is there something you aren’t allowing yourself to feel?
I was trying to be calm and optimistic for my 2-year-old—come on new daddy-o, you be cool, so the kid will be cool. At the same time, in secret, I was panicked—what if this lockdown goes on for days, weeks, months, or even years?
Jackpot! Here were the beginnings of a classic OCD conflict: feeling for my son, feeling for the world, and now, as if for the first time, feeling for myself.
I kept interviewing for more clues. Dr. Alcée, do you remember anything else about that day that seemed a little out of the ordinary?
We were playing downstairs, and my son could only pretend to visit the bagel and grocery stores. It broke my heart. A fear and sadness that had been far off in the distance had made its way closer like an enveloping but strangely welcome summer storm. We’re all in this together, it rained down. Welcome home to your powerlessness.
As I turned the spigot on this pipeline of feeling, the obsession (and toothache) vanished. The perp was a friend and messenger, holding out the meaning and coherence I was looking for to be the rightful author of my own story.
OCD sufferers aren’t mentored in harnessing the awesome power and beauty found within their emotional sensitivity. Like poets and philosophers, they are on constant alert that all those we love, we must lose. Few in the group notice the lines Carl Jung placed right in front of us: “All true things must change and only that which changes remains true" (Jung, 1953). We must inhabit our own losses to hold on to ourselves, too.
OCD sufferers grok the complexity and nuance that most take for granted. And, yet, hardly any treatments these days focus on this crucial feature of their experience. None recognize the full merit of what the OCD mind and heart can measure when brought together with more subtlety and humanity.
I’m hopeful that one day the rest of the psychological community will see the lines that I and so many others in the group see when we look at OCD. Who knows, maybe like Darwin, Thunberg, Antonoff, and Asch, it will touch off our next revolutions of rebel ideas worth marveling at.
References
Asch, S. E. (1951). Effects of group pressure upon the modification and distortion of judgments. In H. Guetzkow (Ed.), Groups, Leadership and Men; Research in Human Relations (pp. 177–190). Carnegie Press.
Asch, S. E. (1956). Studies of independence and conformity: I. A minority of one against a unanimous majority. Psychological Monographs: General and Applied, 70(9), 1–70.
Jung, C. G. (1953). The Collected Works of Carl Jung. Pantheon.
Kochar, N., Ip, S., Vardanega, V., Sireau, N. T., & Fineberg, N. A. (2023). A cost-of-illness analysis of the economic burden of obsessive-compulsive disorder in the United Kingdom. Comprehensive Psychiatry. DOI: 10.1016/j.comppsych.2023.152422.
Salazar Kämpf, M., Kanske, P., Kleiman, A., Haberkamp, A., Glombiewski, J., & Exner, C. (2021). Empathy, compassion, and theory of mind in obsessive‐compulsive disorder. Psychology and Psychotherapy: Theory, Research and Practice, 95(1), 1–17. https://doi.org/10.1111/papt.12358.
Shakespeare, W. (2015). The Collected Works of William Shakespeare. Pergamonmedia.
Wolf, D. (Executive Producer). (1990–). Law & Order [TV series].
Ziegler, S., Bednasch, K., Baldofski, S., & Rummel-Kluge, C. (2021). Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLOS One, 16(12). https://doi.org/10.1371/journal.pone.0261169.
