Obsessive-Compulsive disorder or Obsessive Neurosis is one of the most complex structures. Its symptoms reflects that complexity. The symptom is a way to process a desire the person can not tolerate. For that person, at that moment, the symptom is a solution. It is a way to position themselves in relation to their unconscious desire.
Repression is a psychic mechanism: when we want to avoid something in the outside world, we run, we scape but because we cannot scape from ourselves, from our desires, what we do is … to repress. What does “to repress” mean? It means to put something away from the consciousness. However, when we repress something, it does not disappear, it becomes unconscious. When something is repressed it is even more powerful. Why? because it is completely out of our control, it has big impact on us: we can only see its effects.
People can suffer from OCD many years and when they finally go to the psychoanalyst, symptoms are very severe. A symptom is a necessary reaction to an unconscious psychic process and because it is unconscious, it does not respond to any logical reasoning. What is even more, sometimes the patients find relief in their symptoms. In many occasions, thanks to the symptoms, patients end up going to the doctor or psychoanalyst.
A good example of an OCD would be Jack Nicholson in “As good as it gets”. He has to jump following the lines of the road to avoid stepping on the ground. His thoughts are attached to apparently absurd ideas, the obsessive ideas. He can’t avoid thinking over and over again about what it could be considered… nonsense. That absurd idea becomes an obsession. If someone tries to convince him about how stupid is what he is thinking he would say… “ I know but … I cannot take it out of my head”.
These absurd ideas are the starting point of very intense intellectual activity that exhausts the patient. He is obliged against his will to reflect over and over again about that idea as if it was a super important personal matter. Most of the times the obsessive ideas are scary: they have to do certain rituals to avoid feeling anguish, to avoid something bad happening to someone else. These rituals consist of repetitions of every day life activities: going out, dressing up… all these activities become very complex time-consuming rituals: checking 10 times that the door is locked, folding the sheets in a certain way before being able to sleep; washing the hands many times to the point they injure their skin; putting, taking off the socks many times … those behaviours are extravagant but also very common.
People suffering from OCD find pleasure in thinking. This is how they interact with the world around them: in their thoughts, they repeat over and over again things they have to do, they relate to people but in reality… they never do any of those things. They end up isolating themselves. They tend to be energetic, perseverant, highly intellectual, perfectionist and with strict moral. These patients tend to blame themselves for things they have not done. Guilt and remorse are the main affects in these patients.
This disorder impacts the professional life of the patients not only due to their isolation but also due to the ongoing distractions and waste of time caused by the obsessive ideas.
The objective of the treatment is to understand the meaning of those obsessive symptoms, interpret them and provide the patient with the tools to learn to joy in a different way. To put their energy in reality and reach their full potential. They can in fact be very productive! Medication in theses cases is specially ineffective. It can also mask the symptoms without solving the conflict the patient has with his unconscious desire.