Congregants increasingly seek out the counsel of their rabbis during the holidays. It is a time when many people feel genuinely inspired to make a special effort to be extra observant. It is also a time when people with obsessive - compulsive disorder (OCD) are most likely to knock on the rabbi's door. How rabbis respond can make all the difference in whether religious OCD sufferers seek professional help - in some cases, it can be a difference between life and death itself. OCD is an incapacitating mental illness that often masquerades as religious zealotry. Research suggests that most people first seek out clergy rather than therapists for their problems. Therefore, rabbis need to know the difference between faith and OCD. Someone with OCD feels an all-consuming fear that some imminent calamity will happen to himself/herself or others if he/she does not engage in a turbulent cycle of repetitive behavior. Unlike the more publicized forms of OCD - excessive washing, constant checking, hoarding, endless counting, and never-ending placing things in order -the religious manifestations of OCD are often overlooked or confused for religious extremism. OCD occurs in 2% of the population, without regard to religious or ethnic background. In a congregation of 100 families, about five to ten individuals might have OCD. Common Occurrences While it is normal for most religious people to have occasional anxious moments of self-doubt regarding their observance and religious commitment, such doubts are never-ending, inescapable, and overwhelming for the OCD sufferer. For example, a congregant might repetitively visit his/her rabbi, asking the same sh'eila about seemingly trivial matters, double checking whether they "really" understood the rabbi's answer, in order to avoid an exaggerated fear of divine punishment. They might never seem completely satisfied with the rabbi's answers, leaving both rabbi and congregant flustered. On Rosh Hashana, for example, as an OCD sufferer reflects upon the past year's trials and tribulations and has a fleeting thought of complaint against G-d, he/she might be alarmed: "If I was capable of such a thought, I might, then, be capable of suddenly losing control and shout blasphemies in the middle of shul and be punished." Such thinking would lead him/her to exclaim repeated passionate assertions of faith. Another congregant who, while in a generous mood, gave pocket change to a few panhandlers might suddenly wonder, "Is it possible I actually forgot making a neder to give to all panhandlers, which I must now fulfill lest I be punished for breaking my word?" Then a frenzied search would ensue to locate every panhandler on the street. A tired, fast-weary Yom Kippur worshiper might wonder, "Maybe I missed a word in my Yom Kippur vidui or didn't say them ‘just right,' and I'll suffer a bad year," leading him/her to repeat entire confessional prayers from the beginning, slowly agonizing over each word. Other worries could be, "Maybe I didn't ask forgiveness earnestly enough from my friends and family and I need to ask again," not out of concern for others but rather out of fear for oneself. A woman anticipating her visit to the mikva, in order to eliminate all doubts and fearing the consequences of uncertainty in this case, may actually induce bleeding just then. A homeowner finding unexpected crumbs during bedikas chametz might suddenly fear that the entire household could be contaminated, leading him to begin cleaning from top to bottom all over again. Another OCD sufferer might notice some discarded non-kosher food on a park bench and worry, "If I pass this by, then a homeless Jewish person or child might be tempted to eat it and I will be help culpable for leading them to sin," and feel compelled to spend hours every day scanning the environs for potentially sinful temptations which need discarding. Some will check for proper placement of tefilin shel rosh dozens of times in the course of an hour, for fear lest their prayers for a refua shleima be rejected, and they be held responsible for someone's death. Most OCD sufferers feel they are losing control over their minds. Their intrusive self-doubts run counter to their values and beliefs. Even when they know their fears are unreasonable and behaviors excessive, they feel unable to stop. What's worse, they entangle friends and family, asking others to wash over again before reciting hamotzi or constantly ask for reassurance that they did not accidentally utter blasphemies while asleep. OCD is more than a mere nuisance; it is a serious condition. When left untreated, OCD is self-reinforcing and gets worse. Ironically and sadly, many religious OCD sufferers eventually can no longer attend shul, even on Yom Kippur, or engage in normal religious practices because their religious compulsions are simply too painful to endure. Many sufferers lose their marriages, their jobs, and their sanity. Some even take their lives. Fortunately, there is very effective treatment, without need for long term psychotherapy and often without medication. Hundreds of studies confirm the efficacy of cognitive-behavioral treatment for OCD. Cognitive therapy helps OCD sufferers to gradually overcome their fears by purposely exposing themselves to situations that trigger their anxiety and compulsions, but in small baby steps so as not to overwhelm them, and in a way which respects their values. There is a big difference between true religious observance and an OCD ritual. Genuine observance is a heart-felt offering. The person wants to do a mitzva out of inspiration; it provides fulfillment, satisfaction, and consolation. One feels better after having made a sincere atonement. The holiday rituals are beautiful. By contrast, OCD sufferers are motivated by exaggerated fear. They feel compelled against their will to engage in repetitive rituals and even acknowledge that their behavior is excessive. Their confessions never bring closure, but only renewed self-doubting that leads to another exhausting and painful round of double checking. Dos and Don'ts: Rabbis are potentially the most valuable link in an OCD sufferer's search for help. Unfortunately, they are sometimes uninformed about the malady, and worse yet, despite all good intentions, they might exacerbate the OCD sufferer's condition by endlessly reassuring them. Alternatively, they might mistakenly recommend that the sufferer's disturbing thoughts are true and reflect underlying hostility toward G-d or loved ones and urge that the sufferer "search his ways." Finally, rabbis might throw up their hands in frustration and send the congregant away, leaving the sufferer feeling he can never disclose his problems to anyone. What should rabbis do? First determine if the congregant's behavior reflects his genuine belief or OCD. Here are some tip-offs: o Does the congregant himself acknowledge his behavior is a bit excessive or unreasonable, even by his own standards? Asking the congregant this directly might make him respond, "I know it sounds ridiculous, but I just can't stop and I feel like I'm going crazy!" o Is the individual motivated by overwhelming guilt or dread of some perceived imminent danger to himself or others, as opposed to heartfelt faith? o Do the rabbi, family, and others feel repetitively pressured to reassure the congregant or perform the same compulsions? It is not the behavior per se that makes it OCD, it is why the person engages in the behavior. Sincere religious observance, consistent with an individual's personal beliefs or cultural norms, is not OCD. If OCD is suspected, however, the good news is that it is highly treatable by a cognitive behavioral psychotherapist who specializes in a technique known as “exposure” therapy, and who respects clients' religious values. Exposure is the only therapy endorsed by the Obsessive Compulsive Foundation. Dr. Shmuel Brodsky is an Orthodox psychologist who specializes in treating OCD in Monsey, Teaneck, and Manhattan. He has treated hundreds of OCD sufferers. He welcomes confidential questions without obligation and offers to reply within 24 hours at (212) 726-2390, at www.OCDHOTLINE.com or his e-mail: [email protected].