When Faith becomes obsession

Religious scrupulosity can be destructive, writes Colm Fitzpatrick

 

Although piety is a  virtue that should be extolled, there are circumstances when devotion can become neurotic and damaging.

All of us have compulsive tendencies at times that take shape in either the form of thought or action. This may be as simple as wondering if you should have behaved a different way when you met your friend for coffee, or perhaps making sure that you actually closed the fridge before going to bed.

We all, at times, have a niggling inclination to think or behave in a particular way that other people might perceive as odd. These types of proclivities are natural, normal and healthy, varying innocently in degree from person to person.

However, when taken to the extreme these usually benign tendencies can become destructive, taking over your life and leaving you in a continuous state of self-doubt. This problem may be a symptom of Obsessive Compulsive Disorder (OCD), a condition where people experience repetitive and upsetting thoughts and/or behaviours.

OCD is in the top 20 illness-related disabilities worldwide according to the World Health Organisation. It affects about one to two people in every 100, and yet despite this it takes, on average, 17 years for someone with OCD to be diagnosed.

There is no one specific obsession that people develop, says Fionnula MacLiam, a cognitive behavioural psychotherapist and lecturer at Trinity College, Dublin.

“It’s haphazard in what people become concerned about”, she said, adding that “people become attached to something that has meaning for them”.

Impulses

Common obsessions arising from this disorder include fears about contamination, infection and disease, fear of acting out violent or aggressive thoughts or impulses, and intrusive thoughts incompatible with one’s own comfortability. The main features of obsessions are that they are automatic, frequent, sporadic, upsetting or distressing, and very difficult to control or eradicate.

Compulsions are observable actions that are carried out in order to reduce the anxiety created from an obsession. This may take the form of excessive cleaning and washing, repeating words or phrases or acts that reduce obsessional fears such as only wearing a particular colour.

OCD tends to arise in adolescence and early adulthood, and it doesn’t always have the same form over one’s lifespan. Everyone’s presentation of the disorder is idiosyncratic and genuine.

Religious scrupulosity is a branch of OCD and usually involves a doubt about carrying out an action to do with religious belief. Although only a small percentage of people in Ireland experience it, it can cause immense stress. This scrupulosity is expressed in a thought where the individual interrogates their religious behaviour with questions such as: “Did I really say the prayer properly?”  “Did I maintain my fast for an hour before taking Communion?” “Will I suffer in the afterlife for having had an impure thought?” “Did I confess every single sin thoroughly?”

According to Fionnula, this type of OCD can be more daunting and destructive because of its religious aspects. Whereas in other cases people may worry about the finite consequences of not carrying out a particular action, for sufferers thoughts concerning the soul, hell and eternal life are “highly stressful because the stakes are high”, Fionnula explained.

Reaction

Although most people are able to dismiss intrusive thoughts, even ones that provoke a strong emotional reaction from violence or sex, those suffering from scrupulosity figure that “the random things that bubble up in your brain”, have some sort of meaning, Fionnula said, adding that they may interpret the thoughts to mean that deep down they are an evil person.

So, while the rest of us dismiss such thoughts as weird and disgusting, but meaningless, the person with OCD see themselves as bad or evil. They may see these thoughts as meaning that, if they don’t watch themselves very carefully, they might carry out an associated action. ‘What ifs’ loom large in their vocabulary. “If I see an attractive person in the Mass, what if I had a sexual thought about them?” “What if I actually touched them in a sexual way?”

The thoughts emerge and develop in various forms. Some ascribe them to the devil and so perceive them as having supernatural cause. Others experience thoughts that are specific to a religion, such as crude, visceral images of Jesus which evoke personal disgust. Compulsions are also a product of religious scrupulosity which may result in continually rechecking and reassuring oneself about questions of Faith. Another form of compulsive action is the meticulous adherence and observance to religious rules and rituals. For example, if a prayer was said accidentally the sufferer would restart or begin excessive praying in order to ameliorate the fault. In an explicitly Catholic context, one might begin the decades of the Rosary and restart because they had forgotten how many they had said during recital.

Although religious scrupulosity can often be disguised as piety there are distinct ways to identify one from the other, as the former intrudes on people’s lives and well-being.

“How much of this is interfering with person’s ability to live a life, to work and engage with the family and family obligation?” said Fionnula. “When it gets to the state of high anxiety, when someone is always watching to see what is happening in their mind, when their thinking affects their abilities to engage in normal life.”

Thoughts

These types of thoughts can be tormenting and debilitating, and sufferers will often seek reassurance from their families and priests. However, no matter how often they are reassured, the intrusive thoughts and behaviour continue to persist. They may also dismiss the assurances as they aren’t convinced you understood the question properly, or they have a new variation of the thought that you must now reassure them about.

The reason for this is that reassurance from others is usually futile. While it may assuage their anxiety for a short time the doubts will inevitably continue.

However, because religious scrupulosity is recognised as an OCD disorder, treatment is available and easily accessible. The treatment must be very specific because general counselling is not effective, and in many cases can actually worsen the condition. The only effective treatment is Cognitive Behavioural Therapy (CBT).

As this is often viewed as a religious issue, Fionnula explained that most people ask a priest for direction, but this can actually be an impediment to receiving treatment faster.

“The first port of call is the priest, and priests aren’t always aware of what the problem is, and where to send people”, she said.

“The main role of the priest is recognising it and sending people on to the correct kinds of treatment. CBT is the only treatment that is really effective, and it’s just a matter of finding someone that is qualified.”

The therapy teaches the sufferer a form of mindfulness, allowing them to willingly accept intrusive thoughts without behaving in an erratic manner. It will also challenge clients to question the veracity and importance of unwanted thoughts. There may be an emphasis on Exposure and Response Prevention which will eventually help the client to reduce their unwanted and compulsive thoughts, allowing them to be free of these burdens.

CBT therapists can be found working in the HSE Mental Health Services, often as Clinical Nurse Specialists, and treatment is free of charge.

For more information about OCD and religious scrupulosity a list of accredited CBT therapists is found at the Find a Therapist page of the Irish Association for Behavioural and Cognitive Therapies www.babcp.com/IABCP and at CBT Ireland, cbti.ie