An Eastern Approach to a Western Disorder
A New Model for the Treatment of Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD), characterized by recurring unwanted thoughts and/or behaviors, wreaks havoc in the lives of many. It is resistant to many therapies, including the insight-oriented approaches that often help other conditions. Frequently, symptom management is possible through the use of Cognitive-Behavioral Therapy (CBT) and drug-based treatments. An actual cure remains out of reach.
One can wonder whether the standard treatments are wide reaching enough to resolve this disorder. These approaches target symptoms but seem unable to rectify the systemic causes of symptoms. By comparison, Traditional Chinese Medicine views all symptoms as an outgrowth of systemic imbalances, so that treatments improve the individual’s overall equilibrium. Symptoms related to rectifiable imbalances may improve. With balance restored, optimal health and vitality return. Why? Because balance is health.
Many years of clinical work have prompted my development of an Eastern-inspired approach that has helped some of my clients. Individuals who are prone to OCD often have a “conscientious personality style” (Oldham & Morris, 1991) characterized by traits such as perfectionism, self-discipline and a strong drive to do the right thing.
Experience has led me to infer that the conscientious individual develops OCD when deficiency states (chemical or otherwise) disrupt constitutional balance. Under these circumstances, an innate spiritual drive to acquire wisdom and to act in a morally superior manner dwindles into obsessive/compulsive tendencies.
Imagine a supersonic jet. It normally soars the heights but is grounded when it lacks adequate fuel and maintenance. It repetitively circles the runway, unable to take off. The pilot, deprived of the higher heights, fixates on the dust and debris of the runway.
Treatment must rectify the deficiency situation thereby restoring balance. Robust physical and psychological health becomes the goal, and symptoms may improve as treatment progresses.
Areas of Deficiency
A closer look at possible areas of deficiency associated with OCD helps explain the treatment protocol.
Biochemical Issues
Studies have shown that drugs which increase the availability of the brain chemical serotonin for neurotransmission provide relief from OCD’s symptoms. While drug therapy addresses the biochemical imbalance of some individuals, orthomolecular physicians maintain that in some cases these imbalances can also be rectified by using natural supplements and having the client make changes in lifestyle and dietary habits. Actress Margot Kidder had made headlines years ago when she shared her account of using functional medicine to (at least temporary) manage a Manic Depressive condition. She achieved several years of drug-free wellness.
Functional medicine practitioners explore nutritional factors as they relate to mental health. Mental health symptoms can accompany deficiencies of ascorbic acid, folic acid, niacin, riboflavin, and thiamine. Diet-related disorders such as hypoglycemia and allergic conditions can trigger or exacerbate symptoms. These specialists evaluate the contributing biochemical aspects of a problem and prescribe treatment in an effort to restore balance and promote health. I often refer my psychotherapy clients to be seen at the local naturopathic clinic, which offers consultation with supervised students, an affordable way of accessing this sort of treatment.
‘Yin Deficiency’
A second possible deficiency occurs on the level of the body’s energy system. It can be diagnosed using Chinese Medicine, which presumes that energy (Chi) flows through the universe, the world and the body of every living creature in a rhythmic dance of expansion and contraction.
In their book, Firebrace and Hill (1994) explain:
Life takes place in the alternating rhythm of Yin and Yang. Day gives way to night, night to day; a time of light and activity (Yang) is followed by darkness and rest (Yin). Flowers open and close, the moon waxes and wanes, the tides come in and go out; we wake and sleep, breathe in, breathe out. Yin/Yang is a continual flow through which everything is expressed on the one hand and recharged on the other. They are an inseparable couple. Their proper relationship is health; a disturbance in this relationship is disease. (p.57)
This alternating rhythm also manifests in every society. For example, a healthy society is best governed by a culture within which the cycle of Yin and Yang are balanced. In North America, Yang values of function, performance and (hyper) activity seem to dominate. Yin values governing nurturance, rest, and other restorative activities are, in some contexts, undervalued and even neglected. The result: ‘Yangaholism’, a lifestyle of overachievement at the expense of health and balance. There is a high incidence of Chronic Fatigue Syndrome among highly stressed, over-worked professionals (hence the naming of the ‘Yuppie Flu’).
Individuals with OCD, usually motivated, even as children, to “do the right thing”, are often most vulnerable to compelling cultural values and obediently adopt intense work habits. These young achievers adapt to their culture and, in the terms of Chinese Medicine, may develop medical conditions associated with a deficiency of Yin and an excess of Yang. Like Chronic Fatigue Syndrome, OCD can be considered a Western disorder, promoted by certain pressures and values.
The Yin/Yang icon graphically depicts the Chinese premise that in health, Yin and Yang are balanced. According to Chinese medical theory, too much exertion (Yang), including an excess of work, exercise or even thinking, creates a condition of “heat” in the body, throwing off the balance of hot (Yang) and cold (Yin). As the excess heat rises upward in the body, potential symptoms include neck and shoulder tension, headaches, racing or excessive thoughts, anxiety and dry skin or hair.
Excess Yang in the lifestyle becomes a vicious cycle: too much thinking promotes heat, which further motors a tendency to over-think. Perhaps insight-oriented psychotherapy is less useful to those with OCD — the over-thinkers — because it promotes self-analysis to an individual who is already analyzing excessively, and so may not benefit from more analytical thinking.
The proposed (hypothetical) Yin deficiency can further be demonstrated by using another model, the distinction between right and left brain function. Some research supports the notion that different skills are situated in different brain hemispheres. The left hemisphere is supposedly associated with analytical thinking, sequential ordering, verbal skills and digital computation. Right hemisphere skills include artistic, visual and spatial ability, holistic thinking, intuition, and emotional processing (Springer & Deutsch, 1993). According to this model of OCD, the hypothetical Yin- deficient individual overuses the left hemisphere and so develops the cognitive equivalent of a repetitive strain injury!
Unmoored from the holistic thinking skills associated with the right hemisphere, the individual fixates on details, may become engrossed in compulsions involving sequential ordering, counting or other left brain abilities. The left hemisphere has run amok, overwhelming the person and creating symptoms of agitation and anxiety. The OCD sufferer leads the painful existence of an individual whose mental functions are operating in an imbalanced way. To rectify the imbalance, treatment must strengthen Yin/right brain function. “Yin” practices such as meditation, herbal supplementation, and spiritual development or other meditative exercises may be useful.
Reduced Emotional Dexterity
The right brain/left brain paradigm posits that an overly active thinking function will often be associated with a weaker and less active emotional processing function, a consequence of under-use. Individuals with OCD are often exceptionally developed intellectually; their emotional development, including psychological-mindedness, may lag. Emotional strength, like physical strength, is acquired through exertion. If one uses emotional processing faculties to navigate emotional situations, those faculties strengthen and more dexterity is acquired.
When these faculties are not adequately developed, there is a tendency to experience depression, anxiety and confusion, and the individual may find it difficult to interpret one’s own feelings and/or those of others. There may be difficulty dealing with the emotional realm of life, including aspects of social and sexual function.
Individuals with OCD, who strive above all else to do “the right thing,” truly struggle when they are unable to determine what “the right thing” is in emotionally complex situations. This can heighten an individual’s experience of shame and anxiety, and can promote shyness and a tendency to withdraw. Withdrawal, of course, deprives the individual of opportunities to use and subsequently develop emotional processing skills and so the problem gets further entrenched.
Sometimes painful experiences in the past prompted the development of OCD while thwarting emotional development. OCD symptoms helped the individual avoid emotional processing. Treatment must promote the re-integration of emotional processing back into daily life.
Deficient Self-concept
Individuals with OCD are usually talented, intelligent and complex, possessing a heightened capacity for spirituality, insight and accomplishment. Despite this, these individuals tend to have a deficient self-concept. Ideally, a self-concept is a holistic view of the self informed by both left-brain and right-brain thinking. For the left-brain dominant individual the self-concept is rigidly fixated on small, often negativistic details relating to the self. This detail-orientation is unmoored from the right-brain holistic perspective; the bird’s eye view is lost.
Assessment tools can be used at the outset of therapy to provide the client with feedback about his or her personality, thereby promoting more realistic self-appraisal. Ultimately it is the strengthening of positive self-esteem which eliminates the need for self-defeating coping devices and promote a healthier posture from which to navigate life.
The Therapeutic Curriculum
The Therapeutic Curriculum is a treatment approach designed to address the deficiency conditions associated with OCD. While these therapy sessions involve therapeutic dialogue about current issues in the client’s life, there is also a curriculum. Sessions serve as individualized lessons about different facets of life. I draw upon content from various disciplines including social psychology, Chinese Medicine, biology, world religions and physiology. The curriculum varies according to the needs of each client. These needs are determined when an initial psychosocial assessment is performed, resulting in a detailed portrait of the client’s personality style, strengths, intra-psychic function, growth edge, etc.
I perform the assessment with the aid of measures that allow clinicians to learn about the personality of an individual by examining how he or she completes different tasks. Findings about personality are used to help the client develop a healthier, more realistic and more satisfying sense of self. Treatment starts by addressing the issue “who am I?” and is followed by “lessons” about the psychology of personality, allowing the client to develop better understanding of self and others. Later sessions address aspects of social interaction, intimacy and other topics. The client is taught, through these sessions, how to navigate social and emotional situations. The model is predicated on the task of ego-strengthening and resource building.
Though educational content is covered in most sessions, it is delivered in a format that strengthens right brain thinking functions. Right brain language patterns such as metaphor, humour, storytelling, and analogy are used. By participating in sessions, clients are required to use their weaker processing style, thereby strengthening it. Dream work and other techniques that engage the unconscious mind and its resources also promote Yin function and right hemispheric activity.
Homework assignments, too, are designed to correct the balance of Yin and Yang. To cite one example: a client I treated had episodic obsessive symptoms. She was a scientist, and was frustrated by self-critical ruminations which appeared during busy times associated with longer work hours. It appeared possible that the presence of these symptoms were indicative of a Yin deficiency prompted by excessive work-related thinking (Yang). Her homework entailed doing right brain activities — emotional contact with friends, listening to music or painting — when symptoms emerged in order to address the identified imbalance. Therapy was discontinued once the client was able to effectively use this method to stop her ruminations each time they occurred.
Treating our hypothesized Yin deficiency is multifaceted. If Yin function is impeded by traumatic memories, trauma resolution methods, such as Eye Movement Desensitization Reprocessing (EMDR), are used to remove the block to healthier emotional function. A biochemical regime is best addressed by a qualified health practitioner who is knowledgeable about the indications/contra-indications between natural supplements and pharmaceutical drugs. Clients continue to take all prescribed medicines. Other techniques are used as required, towards the goal of allowing the genius of personality to flourish, unmoored from fixations and compulsions.
When the effort to remove barriers is successful, the individual’s quest towards truth and righteousness can be actualized. The result of a successful therapy may be a more satisfied and productive individual who benefits from a persevering nature and a detail-oriented approach by channeling these strengths towards invention, discovery or service.
References
Beinfeld, H. & Korngold, E. (1991). Between Heaven and Earth. A Guide to Chinese Medicine. New York: Ballentine Books.
Firebrace, P. & Hill, S. (1994). Acupuncture.’ How it Works, How it Cures. New Canaan, Connecticut: Keats Publishing, International.
Oldham, J. W. & Morris, L. B. (1991). The Personality Self-portrait. My You Think, Work, Love, and Act the Way it Do. New York: Bantam Books.
Springer, S. P. & Deutsch, G. (1993). Left Brain, Right Brain. New York: W. Freeman and Company.
Annette Poizner, MSW, Ed.D, RSW, is a social worker/psychotherapist practicing in Toronto who specializes in the treatment of OCD and anxiety disorders. She graduated with a Master of science in Social Work from Columbia University of New York, has a Doctorate of Education specializing in Counselling Psychology and is a published author, presenter and community educator. She has been practicing in the field for the last 30 years.
