May we intervene with Religious OCD sufferers?

Question

On what level may we (or may we not) intervene with OCD sufferers when they are not related to you in any way?

I am referring to a sizable demographic of religious OCD sufferers, who don't necessarily know what OCD is, and surely have not been diagnosed or treated for their anxiety disorder.

Within the religious context and practice it's very easy to spot OCD sufferers. At Synagogue they may spend more time than any other congregant pronouncing the words of prayer carefully or repeating the words many times. I'm in no way referring to the congregants that spend time truly meditating on the words with proper intent, or repeating words that have been pronounced correctly. I am referring to practices that catch the average person's attention. Repeating words 10 or 20 times, starting over from the beginning of a particular prayer repeatedly, or creating buzzing or clicking sounds in the misguided attempt to "pronounce the words properly". To the unfamiliar eye, this may appear to be religious fervor and zest. Unfortunately it's far from this, the sufferer is struggling with compulsions, intrusive thoughts, fear, and worry.

These behaviors can be treated. The question is how to approach the suffering individual.

Whether or not religion breeds or fosters OCD behavior is a separate argument, but a large number of religious sufferers simply believe they are acting in accordance with their religion. By repeating "Poseach Es Yadecha" in the "Ashrei" prayer 10 or 20 times for example, or repeatedly washing their hands, to get it "right" for "Netilat Yadayim" the sufferer believes he or she is merely following "Halacha" more strictly than anyone else.

On what level may we intervene to try and help the sufferer? Can we make them aware that their suffering is unnecessary and can be corrected? Surely outright confrontation wouldn't be advisable, What would be some other methods of intervention (or confrontation) that conform with "Halacha"?

Answer 1

It seems that many OCD sufferers' (regardless of what they obsess over) don't realize that they OCD'ing. They will usually give many 'excuses' and 'hidden reasons' for why it's not OCD.

When someone that we care about has a problem we try to help them, but the problem gets compounded when the person doesn't even realize that anything is wrong.

In this case (OCD) it would probably be most advisable to bring it up with a relative or friend who has considerable influence on him (obviously with the sensitivity it deserves).

Many times relatives and friends don't know where to get the professional help / advice, so it might be a good idea to do some research of professionals in your area (that are Frum, and have experience in this specific area - if possible), and to pass it on to the friend / relative (if it seems appropriate at the time)

Answer 2

Introductory Note of Clarification: Parts of the answer (below) that are critical, are not directed at the questioner, but rather to some people who jump to conclusions about whether another person has (or likely has) OCD - often based on faulty premises or a lack of context concerning the other individuals behaviors or perceived behaviors:

It is good that you note in your question examples that really stand out. There are halachos that require the individual to pronounce words a certain way and make the proper pauses so as not to change the meaning of what they are saying (see Hilchos K'riyas Shema, for example - Siman 61). An individual who had, in the past, been less familiar with the halachos concerning pronunciation, kavanah..., may be working on themselves to become accustomed to davening in accordance with halacha. For some people, this may take time and added energy. However, you would expect that the individual would get it right after a certain period of time. Another factor to consider is that in some minyanim, it is harder to have proper kavanah and pronounce the davening correctly due to other individuals in the minyan who daven loudly, in a way that really detracts from the kavanah of some congregants. If the person who "repeats" parts of the davening a-lot does not have such problems when davening alone in a quiet place, it may be better for that individual to daven in private. This is in accordance with the Sha'arei Teshuvah (Orach Chaim: 52: 1) who notes that if a person has difficulty with kavanah when davening with a minyan, they may daven alone.

Another matter to consider is that some people easily come to the conclusion that someone has OCD simply because they don't daven in the 25 minutes (or 45 minutes) that the minyan takes to complete Shacharis. If, as you note correctly, the person takes longer for reasons of kavanah or halacha, that certainly would not be a problem and assuming such a person has a problem of OCD would be incorrect.

There are some individuals who claim that a person who davens Shacharis for a substantially longer period than 25 minutes has OCD. This claim, for example, does not address tefillos that are recommended but that many people do not do (Ketores, Karbanos, Parshas HaMan...) as well as the halachos governing pronunciation and the fact that a person should daven slowly (rather than quickly) - b'nachas. In other words, the individual is not regularly repeating pesukim many times (as you noted), but is rather davening at a slower pace.

The main point is that some people recognize OCD for what it is, while others seem to jump at the "conclusion" that an individual is OCD if he does things that are viewed as OCD-like. Before speaking to people about a person "having OCD", it is important that this outside individual not have inappropriate criteria for what is and is not OCD. A person who is careful/scrupulous to follow halacha is certainly not OCD - that's absolutely absurd (even if he/she is following halacha where most other people are unaware of the halacha in the given case). First, make sure you are not incorrectly assuming an individual has OCD - as telling others about someone having OCD, when they do not could be Motzi Shem Ra (though unintended). If you want to help the person, the first step should be to not compulsively assume a person has OCD - in other words, make sure that you have truly objective criteria to determine whether OCD is involved AND that you understand the other person's situation properly - not coming to an incorrect conclusion.

If a person truly has OCD, try to help them in a way that avoids problems associated with Lashon Hara and Motzi Shem Ra - make sure you know the halachos as they apply directly to the specific situation you are trying to address.

Answer 3

It's important to distinguish between someone who is suffering from OCD and someone who is being religiously meticulous. Someone repeating words in prayer over and over again is not fulfilling the requirement to pray, and such a person is very likely violating the prohibition of saying G-d's name in vain. Someone who is washing over and over again is in danger of hurting his or her hands and could possibly put him or herself at risk of infection due to dried out and broken skin. While it is always a good idea to take into account a person's overall mental health and religious sensitivities, as well as general personality and how one might react to suggestions of seeking mental health services, there is no special need to be sensitive to a person's scrupulous observance of religious rules when the actions in question are not in accordance with the rules or are not improving upon the observance of the rules. If someone needs help, then the person needs help. Period.

Answer 4

BSD

Firstly I would like to preface that anything I say should be taken on case by case basis.

As one who is an Orthdox Jew and has a history of dealing with medium to mild OCD, I can only provide suggestions from my own personal experience, so dont take this post as scripture.

Your Question: Should we intervene with someone who has OCD. The answer is Yes but only if you so choose. Any person with any ailment or malady or injury should be cared for with the utmost care. However this should be done very delicately as not to shame that individual. This may mean restraint on ones part as well. Certain steps should be taken if one has a friend with OCD.

First things: People with OCD usually seem pretty normal. The others above in this forum have spoken about a difference between OCD and meticulously religious. A good rule of thumb would be to see if there is an overriding fear in this individual. Everyone has a little obsessive compulsiveness with themselves. It only becomes a disorder when one's life is being ruled by these obsessions and compulsions. If one is really fearful and anxious all the time, I think everyone in this forum agrees that something is wrong. Only appraoch those who you are pretty close with. Dont try to approach someone you dont know. If you feel there is a problem do it through his friends, peers, or Rav.

Now these suggestions arent perfect. Now thats a hard statement to make coming from someone with OCD. There are no perfect solutions. Thats the first step. So get ready to fail. These also only apply to those who are close to those with OCD. Also this can be a daunting task, so this only applies to one who chooses to take this on oneself. This isnt all or nothing one could help another by doing even a little. So dont feel too daunted by these suggestions rather try to do a little bit if you so choose. And if you so choose to...

Here are some suggestions:

• Dont be his therapist. A lot of people think its cool to act like one's therapists. But with severe illnesses this can be damaging.
• Firstly, contact a therapist. Specifically one that is frum. Personally I have had many therapists only one of whom was frum. He was the best. Not because he was the best therapist per se, but he was the best for me. It really helps to have someone that this person can relate to. The other therapists were good in treating my OCD but I always felt that they were trying to break me away from Judaism, even if they actually werent.
• People with OCD know something is wrong, this isnt like other psychological illnesses where a person is delusional or not all here. People with OCD can appear to be normal but could have certain rituals that they occupy themselves with. For instance just because a person seems normal doesnt mean that everything is ok.
• Be gentle always. Usually people with OCD know something is wrong with them but believe this is the true path. The best analogy in understanding OCD is illustrated by this scenario. Imagine a person running down the street screaming at the top of his lungs. Behind him is a lion chasing him. This picture makes sense right. Now imagine that same scenario without the lion. People with OCD have a real fear, its just like a false alarm. So he really feels that acting on this fear is the right decision but still knows there is a fear there. This fear is unhealthy.
• DONT BE THEIR OUTLET! The worst thing one can do with a person who has OCD is be their outlet for their OCD. There was a guy I know who makes sure to only eat off of plastic utensils that are covered. Certain shabbosim he would eat at a family that I know. They always cooperated with it and used to always give it to him with a smile. Everyone knew it was weird but acted like they didnt notice it. This guy grew a tolerance over this weirdness and subconsciously thinks its ok now. This is not acceptable. One needs to always remind this person, gently and without embarrassing him, that maybe this isnt the best option. Dont do this in front of other people. And only suggest it in private. And only if you are really close to him. Dont push though, if he isnt budging just shrug it off, but act disappointed. The only way to change one with OCD is through showing them that this is not OK. They will then try their hardest to do what they can.
• Try talking to this person indirectly. Talk to him about a friend (you could even use me) who has OCD and describe the symptoms. He will more often than not take solace that other people have this 'fear.' He will open a little more.
• Try and get as close as possible to him. People with OCD want to talk, but we just dont always feel confident that the world will listen. If he sense you are truly trying to help, he will open up.
• Get him to talk it out as much as possible. Try to to do this gently.
• Get him to talk it out only in the initial stages. He will be talking it out a lot initially, but slowly wean him off of you. Suggest he speak to his therapist. The less of an outlet he has the more he will work on correcting himself.
• Stay in touch with his family. Suggest to them that he should see a therapist. If he has a good support group of people who are nice and patient he will most likely oblige. But dont force him. Unless he is in a really bad situation.
• Try to get him to be surrounded by people and involved in activities. A person with OCD literally lives in his head. The mind is a vacuum that will suck in any potential thought. You just need to make sure he is involved in things that dont trigger his OCD and are of course fun. The happier he is, the less room there is for depression. He will handle exposure therapy in his treatments at the right dosage.
• Once a person knows they have an ailment it gets easier. They know what their triggers are and they avoid it, but arent always successful. Actually, more often than not they arent successful. Just be there as support.
• The most accepted method of treatment for people with OCD is CBT. Cognitive Behavioral Therapy. In a nutshell it means mildly exposing this person to his greatest OCD triggers in progressive stages of severity. This should only be handled by those who have received instructions from mental health professionals first. There are countless stories of patients who experienced flooding, basically CBT but with the most severe exposure possible, this can be very damaging, be careful. But the crux of the treatment is the more this person restrains from his compulsions, the less obsessions he will have. We basically have to get his body and mind to a tolerance so his fear vanishes.
• So the best treatment is cutting off outlets, by exposing him to his triggers in a mild slow step by step process. But all this should be confided with a mental health professional first.
• Above all treat him like a human being. OCD doesnt mean he is totally not normal. Everyone has a little obsessive quality in them but it doesnt become a disorder until it starts ruling your life. Be understanding and treat him like a friend. Dont walk on egg shells around him, he can sense that.
• Medications arent shameful and will most probably be a first step suggestion.

Now Some Warnings

• OCD isnt cool or trendy. OCD is a terrible illness that can hijack one's life.
• People with OCD most likely are ashamed of their condition. Do not turn it into a joke, this could propel this person into depression.
• If you plan to be that friend I spoke of earlier, be prepared for him to be a tad clingy. People with OCD want to get it out, so when they have an outlet they will utilize it, just be understanding. But dont be so passive as to be his own personal OCD punching bag. Calling you in the middle of the night to tell you he cant use the toilet. Suggest for him to talk it out with his therapist.
• Usually if a person with OCD has weird questions they will ask them non stop and ask the same question with slight variations. Be patient, but give him a general answer and leave it at that. If he keeps contacting you do not answer his question, this just feeds the OCD. Just assure him its fine in a consoling manner.
• Not everyone who has weird tendencies has OCD. I had a friend that I thought had OCD judging from his symptoms. But he had something much worse. The treatments really do vary so dont think one size fits all. When in doubt just try to get him to a therapist with some steps I spoke of above. Be gentle and non judgmental.

Now an optional quick story about OCD.

When I was at a mental health outpatient program I heard this story from one of the therapists. There was a guy at the program a few years prior who was 80 years old. The guy had seen it all from the invention of the first telephone to the first computer. But when he was in his 20s he developed a phobia of shaking other's hands. He wouldnt touch anyone ever. This grew into him wearing gloves. He pretty much became known as the glove guy. His situation became much worse. His family had given up on him. But when he was 70 they felt he needed to seek help. They got him into this outpatient program. The therapists said he just sat there with his gloves avoiding contact with any and all people. He was shomer negiah for all genders and objects pretty much. Then one day the therapists got him to take the gloves off. He progressed through the program. And on the last day they asked him he wanted to shake any of the other patient's hands. Another patient put his hand out, trembling, the man shook his hand. He then started to burst out in tears and he started crying. The therapists thought he was having a manic episode and immediately wanted to seek additional help. But he wiped his tears and looked at everyone. When they asked whats wrong, he answered "For the first time, I feel like I am a part of the human race."

OCD isnt just some cool trendy disorder it can ruin lives. If one chooses to take it on himself to help another I hope this post is informative.

Answer 5

I would like to exhort the questioner not to approach an acquaintance who he feels may have a problem, with one caveat. If he is a medical professional with significant training in psychiatric symptomatology and diagnosis, then he indeed has a duty to approach this person (or perhaps better still, to approach the rabbi, as discussed below.) Otherwise, I want to make you, the questioner, aware of these considerations:

*Why suppose you know whether this person is aware (s)he has OCD, and whether (s)he has already pursued treatment for it? It is possible, and indeed likely, that either the person does know, but has elected not to receive treatment--as is his human right--or, more likely, that he has already attempted (or is attempting) to seek treatment without success yet.

I would exhort you not to take it upon yourself to recommend "better" types of treatment unless you are a medical professional who is well acquainted with this person's medical history.

*Why suppose that no one else in this person's life is in a better position to observe this, and say something about it, than you are? Does this person have family, friends? Might any of them be medically literate enough to recognize his symptoms as disordered? If so, consider that people have already noticed, and are already thinking about what to do about it.

Please don't assume that "if someone had told him, he would be successfully treated"--there are a lot more obstacles to successful treatment of mental illness than you may imagine. Unless you are truly willing to take this person under your wing and provide ongoing emotional, financial, and legal support to him--which would indeed be a great reason to go ahead and speak--don't assume it is so easy and that nothing has been tried.

*Why suppose you know so well that it's OCD? In fact, the subset of brain disorders between neuropsychiatric illness and mood disorder is extremely complex. Even expert physicians have a lot of trouble teasing out the differences between OCD, OC-PD (that's "Obsessive-Compulsive Personality Disorder," a slightly different, but related syndrome), PTSD, Tourette's, tic disorder, ADHD, trichotillomania, PANDAS, autism-spectrum disorders, schizophrenia, bipolar disorder, and an array of personality and anxiety disorders too numerous to mention. It may be clear that the person is a little unbalanced, but don't assume you know it's OCD well enough that you can improve their life by telling them. Even doctors would never deliver a diagnosis only by observing symptoms.

*And now, my most important point.

Please, please consider the potential negative consequences of saying something to this person.

At best, he will simply be annoyed--and rightfully so!--that you have been watching his prayer and judging it, and that you think it is your business to point out what about his prayer is abnormal by human standards.

But most likely the effect will be much worse. Telling someone that you have noticed their behavior resembles mental illness is bound to provoke deep feelings of shame and embarrassment in anyone, mentally ill or not. To someone who indeed has a mental illness--who has probably felt alienated and/or conspicuous all his life, and who furthermore may have brain systems that are especially sensitive to rebuke--this could be damaging to the point of disaster.

I want to point out that while positive consequences of making such a remark are uncertain at best, negative consequences are a virtual certainty. The person will feel embarrassed, and most likely this embarrassment will follow them well beyond the time of the comment. I have personal experience with this disorder, and I can tell you that in my case, the type of shame that would result from such a comment would be enough to make me stop davening in that shul. I can also assure you from my experience that among those with OCD, this would not be an atypical response, and that many people without OCD would do the same.

At the very least consider whether there is another orthodox minyan within walking distance of this person before you make your remarks, but really, that is not enough. We have strenuous halachic prohibitions against embarrassing another person, even in private. (From this page: "The Sefer HaChinuch cites the Sifra on this verse that we should repeatedly rebuke someone, even several times. It then asks, “But what about if the person’s face changes from embarrassment?” No, the Midrash answers, then we do not rebuke him because the verse concludes with “and not bear a sin because of him.” In this case we are not necessarily referring to a public embarrassment, so it is clear that privately embarrassing someone is also strictly prohibited. For more, see "What about in Private?" here. For more general halachic prohibitions against embarrassing people, see the Talmud {Baba Metzia [58b-59a], Shabbos [54b-55a], Arachin [16b], and elsewhere}; the Mishneh Torah {third chapter of Hilchos Choveil u’Mazik}; the Sefer Hamitzvos {negative commandment #303}; and the Sefer HaMitzvos HaKatzar {negative commandment #79}.) This mitzvah is taken very seriously, to the point where we call embarrassment "akin to murder," and suppose that those who transgress it will lose their share in the World to Come (in Mishna [Avot 3:15] it is one of only five sins that are said to have that effect).

*So that leaves a very important question: What is to be done for this person?

First, continue to observe (only until step #4; thereafter, I would say stop observing). Second, don't gossip about it. Third, do what you can to improve this person's quality of life without having this conversation--if you see opportunities to do something for this person, take them.

Fourth, I would suggest speaking in private with the rabbi of your shul to mention the problem and ask for his help in taking care of this person. Clearly, the rabbi is in the best position to address this with the sensitivity, wisdom, and halachic correctness that are essential in such a serious matter.

If the rabbi doesn't [seem to] do anything, don't badger him about it. It may be that the best solution is in fact to let the person keep his dignity.