History of OCD: from Medieval to Current Times

Obsessive Compulsive Disorder (OCD) can be grouped together with mental illness in general, as well as with specific sub-domains of mental illness.  However, OCD has unique characteristics that differentiate it from typical aspects of other mental illnesses, and have also, at times, given it the social conceptualization of personal idiosyncrasy and/or a problem with self-control.  The history of OCD is characterized by evolving notions of human nature, spirituality, medicine, and philosophy, and reflects themes experienced at the large social level.  A number of well-known individuals throughout the last few centuries, including Martin Luther (the leader of the Protestant Reformation in Europe), Charles Darwin (Evolution of the Species), Howard Hughes (whose life story was told in the movie The Aviator), and Katherine Hepburn, all are now considered to have suffered from OCD.   Additionally, the spectrum nature of OCD has led it to be classified at various times as a number of distinct, unrelated conditions.

In the pre-Renaissance world (prior to the 14th century) the belief was widely held that mental illnesses were caused by demons or supernatural forces.  “Scruples” was one term that was used to refer to the manifestations of OCD.  The ensuing treatment often involved the church, in which people sought the help and advice of clergy, and included things like exorcisms and other types of religious rituals.  During the European Renaissance (1300’s – 1500’s), society started to move away from these ideas.

During the Age of Enlightenment (starting in the 1600’s), clergy and other thinkers developed specific recommendations for the treatment of OCD, including not trying to suppress distressing thoughts, keeping oneself occupied with daily activities, and maintaining the company of others.  The beginnings of a type of behavioral therapy for OCD emerged around this time through autobiographical and self-help writings from current thinkers, including Richard Baxter.  The Roman Catholic Church also developed a system of recommendations that posited that OCD could only be treated by absolute adherence to the advice of one’s spiritual adviser.  Obedience became a dominant theme in the church’s recommendations for OCD treatment.

In the 1700’s, treatment of OCD shifted away from the church and became more medicalized, although physicians did not have many tools for treating OCD. This reflected a shift in societal consciousness towards rationalism and positivism and away from pure faith in the established spiritual systems.  Physicians used the same standard medical treatments that were applied to a broad array of medical conditions at the time, including bloodletting, laxatives and enemas to get rid of “bad thoughts”.  This time period was largely negative in the life experience of OCD sufferers, as medical practice was ill equipped to deal with psychological conditions and the era witnessed an increase in the institutionalization of OCD sufferers in insane asylums.  Institutionalization was a trend that continued with increasing prominence through the 1700’s, 1800’s, as OCD during this time period was conceived of as a type of insanity.  In the late 1800’s, a consensus was reached in the medical community that OCD was not a type of insanity, and it became less common to institutionalize OCD sufferers.

The growth of pharmaceutical treatment of OCD grew during the 1900’s, as the medical community and growing interest in psychological analysis debated the causes, nature, treatments, and outcomes of OCD.  Treatment with bromides, opium, and morphine became more common, although treatments during this time period were largely experimental and based on the hunches of individual physicians, who wrote about their experiences.  An emergent discussion about OCD as a neurological disease also began during this time period.

During the 1900’s, the emerging predominance of the psychoanalytic paradigm popularized by Freud came to view OCD symbolically, as representations of conflicts in primal urges experienced by patients.  Psychologists in the tradition popularized by Freud posited talk therapy as the appropriate treatment for OCD.  The psychoanalytic approach to OCD, and  the Freudian view of connection with basic primal conflicts, clashed with the ideas of the church, which maintained an emphasis on “scruples”.

Also during the latter part of the 1900’s, behavioral psychology began to take over as the dominant paradigms in the conceptualization, study, and treatment of OCD.  Behaviorists  moved away from talk therapy and came to view behavioral therapy as the appropriate treatment for OCD.  Exposure and Response Prevention (ERP), a treatment rooted in the behaviorist tradition, is still the dominant treatment used for OCD today.

Over the course of the history of OCD, understandings and treatment of OCD have largely stemmed from and reflected the state of societal consciousness, and philosophical and cultural developments at the social level.  As dominant views in society have shifted, so has the approach to psychological conditions such as OCD.  The history of OCD is reflective of the history of mental illness in general, as well as the evolving societal view about religion, medicine, rationalism, and the nature of human beings.

For more information, see http://www.ocdhistory.net/index.html