Treating obsessive compulsive scrupulosity without ignoring genuine conscience

Question

I read a psychological paper that was linked to in a comment here, dealing with how obsessive-compulsive scrupulosity can be treated specifically for Orthodox Jews.

The paper gives a helpful and illuminating perspective about how this treatment would be affected, and yet possible, within the framework of an observant Jew's life and values. It comments that OCD is not caused or increased by religion, but instead that people who already suffer from it tend to have it manifest in the areas of their lives that matter most to them. Certain aspects specific to Judaism, like the care taken with mitzvot and the ability to seek rabbinic reassurance, should be healthy, fulfilling, and joyful overall; yet they can be taken as part of the obsession or compulsion. So the paper goes through numerous issues that psychologists might need to understand regarding normal behaviour in the Jewish community. Another focus is the fact that in many other situations, OCD sufferers can be treated by being exposed to their phobia in controlled settings or in mental imagination, but for Orthodox Jews it isn't appropriate to deliberately transgress a commandment in order to regain balance. Certain ways around this, and ways of framing the treatment in a meaningful way, are considered through the article.

Even though it contains some great content and observations about deeply important issues, I'd like to ask people's thoughts about this paper's discussion regarding deliberate exposure to unwanted thoughts. There are a few other problems in what was written, but this was the one that stood out to me. Even though the authors considered this issue and how such treatment may be inappropriate, I think that their suggestions still push the boundaries. I don't think it's ever okay to deliberately imagine or mentally verbalise doing sins, or to deliberately allow tempting thoughts into your consciousness. These would often intrude out of fear, rather than desire, for someone struggling with obsession, and the sense of guilt and avoidance makes that worse. Still, inviting them or considering them is inherently a real thing to avoid in honouring God, caring about others and the integrity of our relationships with them, and learning to live amidst what is truly valuable.

So this is my question, in practical terms. If a person dealing with internal stimuli of obsession is unwilling to accept or linger on certain thoughts (even purely for treatment), whether it be a mental imagination of going against ritual commandments (as would be the fear for some OCD sufferers) or an allowing of idolatrous, violent, rebellious, or (inappropriate) sexual thoughts to be pondered so as to neutralise obsessive fear of them... then imaginal exposure treatment will not be possible or desirable. It transgresses a person's core values. Some thoughts are destructive, even when they aren't actions. I'm wondering how else these obsessive fears, linked with intrusive thoughts, could get to the healthy stage of being ignored or absent rather than suppressed.

Maybe just gaining the ability to distinguish between obsessive avoidance and moral avoidance would be a helpful starting point. Asking Hashem for help and learning to rest in that help, and that relationship, are also important. A greater awareness of one's thought process and an acceptance that some fears or guilt are misplaced, unhelpful in life, even destructive to faith, might also inherently help. None of these things involve 'exposure' to the feared transgression, but they would help to disentangle obsessiveness from conscience.

I know that most of the people here are more familiar with matters of Judaism than they are in psychology. But from Jewish understanding and personal experience, does anyone have wisdom regarding this issue? Careful obedience and joyful wellbeing should be part of the one experience of life in relationship with God; they don't have to oppose each other in real life, nor should they.

Answer 1

Not sure if this answers your question, but here are a few anecdotes:

• A central thesis of the Tanya is that a "super-righteous person" will never even have thoughts occurring to them to do bad things. A "normal" person will occasionally have such thoughts, and then not act on them. It's acknowledged that not everyone's role is to be a "super-righteous person."

• A young Rabbi Chaim of Volozhin once sought out his mentor, Rabbi Elijah the Gaon of Vilna, and complained that he occasionally had improper thoughts, what was wrong with him?! The Gaon replied -- "you're trying to push for too much spiritual progress too far, too fast, and you're not getting G-d's help with it."

• The Talmud says that sexuality (yes I know it's a dirty word) is one of those things that you have to push away with one hand but pull back in with the other. Rashi explains that while it can't go unchecked, it's still a part of our humanity.

Answer 2

BSD

Firstly I wrote a piece for those with peers who may or may not have OCD here, which could prove helpful.

This is from my own experience so I am not paskening for anyone what to do. But I feel the only reason I went through these experiences are to help those who are in the same boat.

Firstly, the treatment you speak of is called Cognitive Behavioral Therapy. Its the most effective tool in treating OCD. In a nutshell, it means exposing those with OCD to their triggers in a mild step by step process. This brings up one's tolerance and assuages the fear.

Also obsessions arent the issue in OCD. Actually the compulsions are the issue because they invoke the obsessions. You cant stop obsessions but you can stop compulsions. Through that the obsessions come up less. This is because you are fearful of these obsessions so really you're body is always thinking about them.

Additionally,

From my experience

When I was being treated I worked with a Rav and therapist in tandem. The only thing I would have done differently would be to have a the Rav actually speak with the therapist, but as most therapists refuse to do this, it can be hard.

But when I spoke to my Rav we set down guidelines. I would concentrate firstly and mainly on positive commandments. Now the main thing is to consult a Rav, as there are certain positive things one cannot ignore, but we mainly dealt with prayer. I would often times repeat prayers to a tiring degree, a trigger for my OCD. So one exposure exercise would be to only say Shema and Amida everyday. Or do things that arent forbidden but seem forbidden. Like I would go to the market and hold pork or even in certain instances put the package to my mouth. Now this seems weird but as long as their isnt any pork juice on the cover there isnt any prohibition. As for maris ayin, I never asked a Rav about that issue so maybe you should ask. But really you have to get creative in exploring other avenues. We never really got to the exercises where I would be transgressing a negative commandment because we came up with so many inventive exercises.

As for initiating the improper thoughts and avodah zara thoughts, seek a Rav's psak. I once asked my Rav about improper thoughts and he told me that it doesnt invalidate the Shema and to just proceed. I guess its a matter of just waiting for those instances to come up in order to be exposed to them and not be fearful or repeat. But as for initiating those thoughts seek a Rav's advice.