How Obsessive-Compulsiveness Affects Psychiatry and Psychology

To succeed as a professional, it helps to have some obsessive-compulsive traits. Attention to detail, interest in rules and in material reality, conscientiousness, and an ability for extended concentration are common obsessive-compulsive features that have great adaptive advantages for many scientific and professional pursuits. Obsessive-compulsiveness also carries disadvantages, including tendencies to downplay emotion, engage in excess repetition, favor the quantitative over the qualitative, and focus on procedure rather than meaning.

In a recent article in Culture, Medicine, and Psychiatry, called “Minding Our Minds: Obsessive-Compulsiveness, Psychiatry, and Psychology,” I argue that the unrecognized obsessive-compulsive tendencies of so many of us who choose careers in science and in the mental health professions have had a profound influence on our science and practice. These obsessive-compulsive inclinations have helped us to organize and categorize, and to pursue essential empirical research. They have also sometimes led us to overlook the crucial roles of emotions and of fantasies in human life, and to pretend that what experiences mean to people is less important than symptom reports.

After reviewing the most frequent obsessive-compulsive defenses and their adaptive and maladaptive qualities, I focus on the role of obsessive-compulsiveness in the formation and use of two of the most prevalent paradigms in our field, the Diagnostic and Statistical Manual (DSM), and Cognitive-Behavioral Therapy (CBT). To illustrate briefly, the DSM divides diagnoses into many separate discrete categories, as though the peas and potatoes on the plate should never touch each other. In addition, it often makes diagnoses by quantitative checklists. Relatedly, CBT’s very name takes account of cognition and behavior and leaves out emotion. Although it is changing gradually, traditional CBT has also often emphasized rote procedures, checklists, and rating scales. The obsessive-compulsive basis of these paradigms has contributed to their utility, and it has likewise limited it. Remarkably, as far as I can tell, the obsessive-compulsive qualities of the DSM and CBT have never previously been discussed in print.

I suggest that if we can recognize our obsessive-compulsive tendencies and take them into account, we will be able to shift the balance between their advantageous and disadvantageous qualities in a more favorable direction. We need to keep in mind the qualitative as well as the quantitative, and that procedure is important only if it’s meaningful; it’s not meaningful in and of itself. How things feel and what things mean are essentially important to human beings, and our psychiatric and psychological science has often overlooked this. It is important in psychiatry and psychology to expand our attention to the human mind. Exclusive focus on the brain, or on external behavior, has so far had limited clinical benefit. More attention to how our obsessive-compulsive tendencies have limited us can help us take a more comprehensive approach to understanding people, facilitating better diagnosis, better therapies, and more useful research.

"Minding Our Minds: Obsessive-Compulsiveness, Psychiatry, and Psychology” is available via open access and can be viewed or downloaded.