by Caitlin Claggett Woods, Ph.D. and Fr. Thomas Santa, CSsR
God is the encompassing all. He is a mystery beyond our comprehension. A perpetual uncertainty that we seek to understand. Through our belief in God, we surrender ourselves to faith, knowing that we can never truly comprehend God and the divine mysteries.
Logically, we may know that we can never be 100% confident about anything in our life. But OCD demands the impossibility of absolute certainty. OCD tells you that you can and must be 100% confident in your beliefs about the divine, the Catholic Church, and whether you are adequately and devoutly honoring God. That having any doubt about any facet of religion and the divine teachings is an offense against God. That any minute deviation from religious tenets or doubting even 1% will result in God’s rejection.
The Main Issues: Doubt and Fear
The main issues are doubt and fear. Doubt is a part of healthy spiritual development. Doubt begins a spiritual quest – within it initiates and grows the hunger for a connection with God. In the spiritual journey, faith follows doubt’s lead. Fear is an adaptive human emotion. It exists to keep us alive. If there were no fear, we would not protect ourselves from a dangerous situation. We would not tend to the well-being of those we love. OCD exploits the experience of doubt and fear as something dangerous to be avoided. OCD is called “the doubting disease” – obsessively making you question things that you’re logically sure of. But at the core, doubt grows us. Fear protects us. We need every emotion that the body produces.
Your level of confidence in your beliefs and commitment to the Catholic faith may be the highest that it can be. But OCD does not care. Any doubt is dangerous and must be eradicated. Any fear must mean something critical, that there is danger present. The doubt and fear experienced within OCD leads people to excessively pray, research, debate, confess, or seek reassurance. But just as the fear that surges when faced with the house spider doesn’t mean we’re actually in danger, so too is the fear in OCD exaggerated. As the doubt about whether we will finish a race doesn’t actually mean we won’t cross the finish line, the consequences of doubt are similarly inflated.
Doubt is doubt. You can doubt anything. You can doubt your belief in something, you can doubt whether you fully agree with how an organization addressed a situation, and you can doubt whether the bump you just drove over was a person’s body. It does not matter whether you actually believe that your faith is strong, that God is loving and merciful, that you are devoutly committed to the Catholic Church. Just as it does not matter that you actually believe that you didn’t hit anyone with your car on the way to work, OCD will cause you to doubt each and every one of these things. And OCD will tell you that this doubt is unacceptable, and needs to be eliminated. But in the realm of the divine, certainty is an impossibility.
To alleviate the doubt and fear, you can seek counsel from trusted sources to achieve reassurance that you have not offended God. You can compulsively confess in an attempt to ensure that there is no mortal sin cutting you off from God’s sanctifying grace. You can beg God’s forgiveness and salvation through desperate, repeated prayer. You can surrender your life to these fears and the attempts to purge the feelings that cause you distress.
No Matter What, OCD Can Wiggle In
No matter what, in any domain of life, OCD can wiggle its way in and make everything feel overwhelming. It amplifies fear and doubt and the meaningfulness of these to something imminent and dangerous. It can ruin the most beautiful day, taking you down a path towards discomfort, pain, and anguish. OCD will punish you for not being 100% confident in whatever it is you believe or understand.
Compulsive Self-Shaming/Self-Criticism
A fairly common and harmful action that accompanies scrupulosity is compulsive self-shaming/self-criticism, such as is observed through repeated self-defeating statements. Some individuals believe that, in shaming themselves about their possible religious shortcomings, then just maybe they will receive mercy. Consistent self-shaming can act as a constant reminder to be on guard so as to prevent potentially doing something that may offend God. Though this self-shaming is tied tightly to distress and hopelessness, it serves the function of diverting the attention from sitting with uncertainty. In a paradoxical sense, shame feels ‘safer’ than not knowing. Shame is ‘certain,’ lacking the tension of uncertainty. Self-shaming is an attempt to put doubts to rest, only for intrusive thoughts to inevitably come back. The OCD cycle continues, exacerbated by the addition of low mood and decreased self-worth.
Treatment
Exposure and response prevention (ERP) is the gold standard treatment for Obsessive Compulsive Disorder, including religious scrupulosity. Exposure is the process by which an individual systematically confronts the thoughts and situations that trigger fear. Response prevention refers to making a choice not to do a compulsive behavior that would serve to push away the emotions and the thoughts that have been elicited by the exposure. ERP involves allowing oneself to experience their fear and to allow it to pass naturally.
What does ERP look like for Catholic scrupulosity?
With respect to response prevention, treatment involves identifying the compulsive rituals that aim to eliminate fear and doubt and resisting these compulsions throughout the course of therapy. This includes limiting confessions to a single confessor and reducing the frequency of confession to align with the rest of the Catholic community. Response prevention also includes eliminating prayer that is compulsive and fear-driven, engaging with prayer instead only when its function is to foster a relationship with God.
With respect to exposure, an exposure list is collaboratively identified with the clinician. This list comprises situations that evoke feelings of fear and doubt, that the individual can approach in service of reclaiming their life and their faith. An example of an exposure may be taking Holy Communion even when the mind is saying that you’re in a state of mortal sin. Another exposure may include saying prayers imperfectly, in the presence of distractions.
The shame described above may initially increase with engagement in effective therapy, as approaching uncertainty will inevitably expose oneself to the fear that they are disappointing God. These feelings are expected. During the recovery process, a cut may itch and burn during the process of healing.
The purpose of treatment is to learn to place our trust in God. To live a rich and meaningful life – occupational, personal, faithful – even in the presence of fear and doubt. To learn that no matter the amount of compulsive rituals, attempts to 100% alleviate uncertainty and fear are futile. The purpose of treatment is to learn that doubt, uncertainty, and fear are neither dangerous nor meaningful. Rather, that they are emotions that occur within the body. That these are feelings that can be coped with.
Summary
Doubting is not the same as denying one’s faith; it is not ‘unbelief.’ Faith is not the absence of doubt, the absence of struggle. Through surrendering ourselves to the Holy Spirit, through letting go of our need for total control over the unknown, doubt can be the opportunity for deeper faith, hope, and love. Even in the presence of doubt, in the absence of certainty, and with the terror of vulnerability, we can live rich and meaningful lives. We can experience peace. We can feel God’s love. We can live the life and experience the joy that God desires us to have.