This blog is part of our Stories Across Faith Series and is one in a larger collection. This month the stories focus on Navigating Guilt/Shame.
Note: IOCDF is not affiliated with any religious groups and is not a faith-based organization.
Scrupulosity OCD, Intrusive thoughts, Guilt, Shame and Faith - By Bruce Fay
What do you understand an intrusive thought to be?
It is a thought that my brain produces that is contrary to my view of myself and what I value. I have had thoughts enter my mind relating to themes of harming others, having sexual thoughts about others, and blaspheming God. These were not things that I planned or intended to do. But my brain told me I was in immediate danger of doing them. Even worse, my brain was treating these not as temptations that I could succumb to but as facts that I was already guilty of. These thoughts were distressing, unwanted, and contrary to my values. They occurred out of what seemed like nowhere, but they were in fact triggered by internal or external stimuli. Treatment for the disorder involves identifying triggers of the intrusive thoughts and intentionally doing exercises that activate thoughts and the accompanying anxiety, guilt and shame. This helps you learn that you can tolerate the discomfort of these feelings and go one with your life.
How do you understand guilt?
We feel guilt when we say or do something that violates our sense of what is right and just and or fail to say or do something that is caring and helpful. We feel guilt when we say or do something that harms ourselves, another or our relationship with our creator. The good news about guilt is that one can admit one’s failing, and then confess the wrongdoing, seek forgiveness and forgive, attempt to make amends for the harm done which can include restitution, and one can resolve to not do that harm again. The problem for those with OCD is that when we have the thought, it feels to the sufferer that they have actually done the thing the thought is presenting. So it feels like they have done the harm, had the sexual experience or blasphemed their creator. The thought is treated as a fact. For me, that led to endless confession, because I treated the thoughts as facts. I know this seems crazy to an outsider. Oddly, it feels crazy to the sufferer as well, as they are stuck in a loop they can’t get out of, or so it seems.
How do you understand shame?
Shame is a deeply disturbing and distressing feeling that involves your sense of worth as a person. When one has an intrusive thought, the voice of shame says “you are a terrible person for having such a thought. You are an evil person. You are psycho. You are not fit to be a member of the human race. You are a reject. You are worthless and undeserving of any good because you are thinking these things.” This internal sense of shame that you are not a good person makes it difficult to hold one’s head high in social settings or to have confidence in oneself as a person. This often-unaddressed shame hinders forward movement in life.
What happened when these thoughts entered your mind?
I was stressed by the extreme isolation of the pandemic and the collapse of social support that had sustained my already fragile psyche. In December 2020 I had a life altering experience. I had an intrusive thought that was accompanied by what felt like life threatening anxiety. I knew I needed professional help. I could not handle this by myself. I self-diagnosed myself as having scrupulosity obsessive compulsive disorder. I was overcome with intense and excruciating anxiety that had a life or death feel to it. It was the worst anxiety I ever felt. I felt like my eternal salvation was at stake and that if I didn’t do something to fix this I would burn in hell for all eternity. It was all too real, immediate and intense. I felt an extreme urgency to do something to help me fix the situation and gain certainty that I was going to be okay. The thoughts were impossible to ignore. Those of us with OCD attach meaning and import to the thoughts as though they are facts. Rather than looking at the thoughts as temptations, we think they are facts. We feel as though we have actually done the things our intrusive thoughts are about, and the meaning we attach to the thoughts compounds the feelings of guilt and shame. The “what if” thought is treated as though it is a fact not simply a dreaded possibility.
What did you end up doing?
I am a Catholic, and part of our tradition is to go to confession if you believe you have committed a sin in thought, word or deed that impairs your relationship with God or others. So I would run to confession to relieve this overpowering anxiety. The temporary good news is that after the confession I would feel relieved for a little while. Sometimes it lasted for a few days, but often for only a short while. I remember going to confession once, and then feeling as if I hadn’t done it right or completely and getting back in line to fix my imperfect prior confession. This was tortuous. It felt as if my life was on the line. At the end of the confession, we express an intention to amend our lives with God’s help, to avoid the future occasion of sin, and to do penance. My psyche was where this occasion of what I thought was sin was occurring, and I couldn’t avoid my own psyche, so I was up a creek without a paddle. The thoughts kept coming unbidden in an endless stream and I seemed to have no control over their arrival or departure. I could neither escape from them nor make them go away. What help was there for me in this helpless state?
When did you learn that you had scrupulosity OCD?
I am a retired clinical psychologist, so you’d think I would have figured this out long ago. I was schooled in the early 1970’s in psychoanalytic and psychodynamic talk therapies. Behavioral approaches were looked down upon in my training as too simplistic. I had been in therapy before and stopped with my most recent therapist because I could tell that examining my past in endless detail was not helping my symptoms. After the acute attack of anxiety one day at Mass when I had an intrusive thought about someone who I cared about, I freaked out. “What kind of a monster am I? Am I a psycho? I must be! I am a terrible irredeemable sinner. I am lost. Surely, I will burn in hell for this one.” I wanted to escape from the thought but there was nowhere to go. I wanted to stop the thought, but the more I tried, the louder the thought got. At that point, I knew I was in crisis and needed a different approach to my inner fears. I was researching my problem on the internet and was just learning about newer behavioral treatments for OCD that had begun in the 1990s where one learned new skills to deal with intrusive thoughts and face the fears they precipitated.
What was that approach?
It is called exposure and response prevention therapy. I was able to get in touch with a psychologist who was trained in this approach. He confirmed my self-diagnosis that I had scrupulosity OCD. I began an intense treatment two times a week. It was the hardest thing I have ever done in my life, as I was changing my relationship with my inner world, with my thoughts, with my feelings, with my bodily sensations and with my urges and desires. The approach was completely counterintuitive. If I had a thought of harming someone, rather than trying to get rid of the thought, I was to intentionally trigger the thought and sit with the anxiety it created until the anxiety on its own began to fade. The way of doing this was to write a script that had the intrusive thought or obsession at the fore along with the worst-case consequence of what would happen if I acted on the thought. For example, if I had a thought of harming someone, I would write a script where I actually did the harm and lived with the consequences of doing it. This entailed facing the guilt of doing such a thing and the shame of being the kind of person that would do such a thing. At first, this made everything worse. Rather than running from thoughts that I feared or trying to escape them, I was intentionally facing them. The exposures triggered my anxiety. I was told not to go to confession, but to learn to sit with the anxiety. I didn’t go to confession for almost a year on both my therapist’s instructions and with the approval of my spiritual director, a Catholic priest, whom I spent an hour with once a month who offered priceless guidance in navigating my disorder. The instruction for Catholics with scrupulosity OCD is to follow the direction of the spiritual director and not your own judgment which is profoundly impaired by your OCD. He did two things that were extremely helpful. He performed an anointing of the sick, acknowledging my OCD as a sickness in need of healing, and not necessarily sin that needed confessing. He also encouraged me to continue to fully participate in the Mass and receive communion. God knows I have OCD and He wants to heal me. For Catholics, the consecrated host is the body, blood, soul and divinity of our risen Jesus and the source and summit of our faith. To be able to participate in this sacrament has been extremely helpful and healing. I do so aware that God is my judge, trusting in His mercy and desire to heal me. I face the uncertainty that I will not know if I get to heaven until the final judgment at my death or His coming again. I participate in life trusting that God is with me, giving me grace and courage to face life's uncertainties that arise moment by moment. Faith is going forward each day believing that God is true to Word whether I feel it or not and despite whatever thoughts my brain may generate. It is believing He is merciful and loving even to me, a broken and weak person and sinner who is prone to sin but who also delights in loving God, my neighbor and myself.
How are you doing now?
I continue to meet with my scrupulosity OCD therapist every other month. I meet with my spiritual director once a month. I participate in an online OCD support group for people with scrupulosity OCD that meets biweekly. I am managing my disorder better thanks to ERP, Acceptance and Commitment Therapy and meditation as well as and especially because of my life in Christian community with access to the Sacraments, including Reconciliation of a Penitent.
Artwork by Carolyn Ringenberg
Graphics by Annabella Hagan