by Jed Siev
OCD is opportunistic and often latches onto whatever is most important to someone, so it is no surprise that religious people with OCD often have religious OCD symptoms. Judaism has many behavioral rituals, requirements, customs, and proscriptions, and observant Jews with OCD often have symptoms in areas of Jewish law (halakha) and practice. Following is a representative – though certainly not exhaustive – list of common manifestations, with the important caveat that like everyone else, Jews with scrupulosity may have any type of religious or moral symptom, including those that are not focused on religious law, per se.
Common domains of scrupulosity for Jews:
- Laws of keeping kosher, including cross-contaminating dairy and meat, and eating or owning chametz on Passover
- Sabbath laws, including prohibitions related to carrying or sorting
- Ritual purity laws, including those related to menstrual purity (niddah, mikvah), preparations for prayer, and spiritual impurities related to sleeping or touching certain other things (e.g., hair)
- Careful articulation, enunciation, and concentration (kavanah) during prayer (davening), or excessive precision with how one is oriented during prayer, how one’s tefillin are aligned, etc.
- Vows and other concerns about honesty, including hedging when talking to someone (e.g., adding “bli neder”), obsessions related to inadvertent commitments such as by repeating something three times or possibly having the intention to assume a charitable responsibility
- Obsessions about needing to understand or remember one’s “learning” (Torah study) sufficiently
- Sexual immorality, including stoking sexual fantasies (hirhurim) in an inappropriate context
- Idolatry or blasphemy
- Over-asking rabbinic authorities ostensibly halakhic questions (shaylas)
Religion or OCD?
At a superficial glance, it can be difficult to distinguish a religious ritual from a compulsion. Consider someone who won’t touch their eyes in the morning until washing their hands a very specific way to remove harmful spiritual contamination. Is that religion or OCD? You may recognize it as a common religious practice (negel vasser), but how can one tell? Following are criteria that can help with this judgment:
- What do others do? Community norms are helpful as a benchmark to identify when someone exceeds typical behavior.
- What motivates the behavior? Just as one can wash their hands appropriately to get clean or compulsively as an OCD symptom, ostensibly religious behavior can be either religious or compulsive depending on how and why it is performed. A behavior performed in order to reduce anxiety associated with obsessional fears is a compulsion even if it masquerades as religion.
- Functional impairment: Religion is functional for most people, and in fact is often associated with reduced stress and anxiety. If religious observance interferes with someone’s life functioning or if the religious observance is performed in ways that are not themselves functional or sustainable, this indicates a problem.
These criteria are reflected in an amazing passage in a compilation of guidance attributed to Rabbi Y.Y. Kanievsky, an almost universally admired 20th century Ultra-Orthodox religious leader and halakhic decisor known as The Steipler:
Ordinarily, a person may occasionally find himself in a situation where it is difficult to carry out a commandment so that he cannot perform it with the usual appropriate pleasure, for this is the nature of man. He sees this as a challenge and on the next occasion will carry it out with pleasure, since he usually performs commandments with enthusiasm and pleasure. However, the person who, whenever he performs the will of the Creator, finds his soul and his energies contorted by feelings of discomfort, fear, tension and misery over the carrying out of the commandment — and, on the contrary, this is his usual state, and to carry out commandments out of joy is the exception — this then is clear proof that this was not God’s intention. (Grinwald 1991, as translated and quoted by Greenberg & Shefler, 2008)
Does religion cause scrupulosity?
When OCD latches onto religious practice, it can seem that the problem is religious. However, religion does not cause OCD, and OCD would find expression in another domain if a person were not religious. Religion – and a person’s culture and values more generally – influence the manifestation of OCD symptoms. In fact, not only do most religious people not struggle with scrupulosity, religions often have mechanisms in place to obviate the need for obsessional doubt or excessive concerns about possible transgression.
In Judaism, for example, the rabbis rely on several legal mechanisms so that a person does not have to worry about trace amounts of prohibited substances (bitul), can rely on unproven assumptions (rov), and does not have to hedge against certain kinds of unlikely considerations (e.g., sfek sfeika). Similarly, the rabbis expressly dismiss the possibility that one should repeatedly check something just in case it changed even when it could have changed (ein l’davar sof), and assert that perfection can never be a religious legal standard (lo nitnah Torah l’malachei hashares). More broadly, the rabbis invoke the verse, “[the Torah’s] ways are pleasant ways, and all its paths are peace” (Proverbs 3:17), to indicate that religious observance should not be the source of misery.
The first-line treatment for OCD is exposure and response prevention (ERP), a type of cognitive-behavioral therapy tailored for OCD. Treatment involves repeated exposure to things that trigger obsessions and anxiety while refraining from compulsions. It is important to recognize that ERP for scrupulosity is done in service of ridding one’s religious life of the unwanted influence of OCD. Treatment can be implemented in a way that is respectful of one’s religious beliefs and laws; a person does not have to choose between their values and their mental health.
At its core, ERP for scrupulosity involves finding ways to violate the rules of OCD without violating actual religious (halakhic) law. Of course a prerequisite for this is to distinguish between the two, and then to find ways systematically to face the uncertainty and discomfort of confronting obsessional fears while staying in the bounds of what is halakhically permissible. For people with scrupulosity about halakha, this may involve consultation with a rabbi or legal decisor (posek).