Ideas, question and remedies for obsessional neurosis

Ideas, question and remedies for obsessional neurosis

An obsessional neurosis is I guess a compulsive, repeated behaviour, where certainty is searched to allay a fear but is never achieved. The person who acts like this can often feel out of control citing their obsession as something that has got hold of them and threatens them with madness.
So by obsessional neurosis by example I mean repeated hand washing, or not being able to leave the house as you need to check the gas is really off. There are a few structures at play here. Firstly there’s an inability to feel something as true, secondly there’s an inability to tolerate uncertainty and lastly there’s a displacement of importance onto a seemingly trivial event.

So what is at play when there’s an inability to feel something as true?
When things are felt as true they don’t need to tested and checked for being right, 2+2=4 is obvious to most, as is when you turn the gas off and leave the house, you know you did it and you don’t need to test, or to check to see if this is so. So this feeling as true is the self evident, the obvious and for some people just simple experience. This feeling of the true, the obvious is for someone behaving obsessionally, missing.

What is the structure of an inability to tolerate uncertainty?
On uncertainty, with any fact there is always an element of uncertainty be it large or small as to whether it is true. Generally when people leave the house they feel certain that they turned the gas off. Of course if you sat them down and interrogated them, it would soon become clear that they couldn’t be absolutely certain, but that didn't stop them feeling certain. For others this uncertainty cannot be tolerated and they strive for an unreachable certainty.

What is the nature of displacement of importance onto a seemingly trivial event?
Obsessional behaviour is specific, and whilst might grow into other areas, linked from the first, it doesn’t focus on all aspects of their lives. Thus the conscientiousness which people might show to the most important events of their lives is now repeatedly shown on something trivial. Alternatively it could be that that the trivial is elevated in significance.

So we have a lack of feeling of something being true, an inability to tolerate uncertainty and the misapplication of conscientiousness to the trivial or the inverse of this which would be making a single event hugely significant. So what’s going on here?

I think conjecture will have to be my friend here. Firstly the aiming at the trivial seems to be a displacing, and condensing of modes of being in the world. So the displeasure of uncertainty in the world at large is focussed on one trivial event which hopefully can be made certain.
There is a second element around the repetition, the fear of oncoming psychosis and the potential negative feelings about the act itself, of shame or guilt. Now the neurosis has been used to relieve anxiety, but yet is creating its own anxiety. Relief from this anxiety is then attempted by the obsession, which provokes more. It is for this reason, you can see an increase of speed, of cadence of the obsession, which increases the amount of anxiety that needs to be dealt with. After an obsessive flurry and calm isn’t restored the person collapses, exhausted until the next time.

The thing that strikes me about obsessional neurosis is that it’s just an extended form of normal human behaviour. The devoted football fan, the businessman, who works all hours, the stamp collector all exhibit obsessive behaviour and these are still types which in themselves are still extensions of human behaviour.

So how can we make things better? Well there are three components, courage, humour and objectification. Because the obsession is self creating, then we need to stop fighting it, and just accept it. Now for someone with a high level of anxiety, who has focussed much of their world into this is a tall order.

So for someone to improve their obsession, then we need to reduce anxiety. Firstly there is anxiety that obsession will lead to psychosis and we need to show that obsession is part of normal human behaviour and that madness will not follow, which is strongly supported by clinical evidence. We can also reduce the anxiety through objectification and humour, which reduces the anxiety about anxiety.

If you repeat any word or action, a few things happen. Firstly meaning drops away repeat the word apple 100 times and see what I mean. Secondly the ability to achieve what you set out to is diminished. If you run and concentrate on every different aspect of your running, then you will find your speeds far down on what you usually do. Therefore, caught up in a repeated action, with hyper-attention on it will prevent you from achieving your aims. Thus if you can objectify, step out of your hyper-reflection to and reconnect with the purpose of your action, it can free you from your obsession. For the stutterer to think of wanting to communicate, not how it is done. For the compulsive washer then to focus on the desire of tasks, as opposed to requiring certainty with them, for someone who sweats chronically when meeting people, to focus on why they want to meet people.

On one level there is comedy and an oddness about obsession that if you can detach yourself from, is worthy of many things, of laughing at, of taunting. This leads to Frankls idea of paradoxical intent where you positively encourage the thing you most fear to reduce the anticipatory anxiety you currently have attached. The position is fate gives you the initial fear or activity and how you respond to it, is up to you.

So in summary, obsession is part of human behaviour, when it goes wrong, is when it becomes a flame that fuels itself, fuelling its action by the anxiety about its action. It also goes wrong when the behaviour is divorced from its original intent, such that difficulty with engaging with the uncertainty of life is focussed on one event.

Whilst these things are complex, and only relevant to the specific instance, the specific person that lives with them. The motions to help with this are to reconnect the behaviour to the original event. To reduce anxiety provoked through the behaviour, through Frankl's paradoxical intent, that uses humour, objectification, and the final and most important ingredient, love.

The one paradoxical idea that I will leave with you, is part of the structure of obsession, is hyper-reflection. This also seems one aspect that can be part of the 50 minute therapeutic hour and I would wonder if sometimes therapy can be the self fuelling fire.

By way of reference much of the thoughts above are taken from Doctor and the Soul, by Viktor Frankl, the section on obsessional neurosis, which I found moving.

With love and obsession.