A recent book by an English professor who specializes in disability studies at the University of Illinois at Chicago has put obsessive compulsive disorder into perspective as a product of Western cultural trends starting with the Industrial Revolution. In Obsession: A History (U of Chicago Press, 2008), Lennard Davis examines how obsession is a cultural artifact with a fairly recent history as a psychiatric illness.
He begins this academic study with a bit of autobiography. He describes his own experience in an immigrant family, where more than one member exhibited classic obsessive-compulsive behaviors like repeated checking, hand washing, and sorting. As a child, he was very careful to cut his food into bits that he separated so that none of them touched each other before he could eat his meal. He describes these preoccupations as the norm in his family, where no one thought twice about thinking twice, and doing OCD-type things came naturally.
I expect this starting point in family experience goes far to explain his interest in the subject as well as something of his take on it, because he is interested in how obsession is inherent in our thinking about certain aspects of our world. We expect romantic love, for instance, to have an obsessive potential. We admire success to such an extent that we accept obsession as a possible requirement to achieve it. In work as well as love, we expect commitment to come with a fair dose of obsession. While we might not be able to embrace it in ourselves, we are more than willing to see it and even admire it in others.
Davis sees obsession as a product of Western culture’s entrance into ‘modernity’. Preoccupation with precision and repetition are inherent in the manufacturing processes that were part of the Industrial Revolution. Even scientific method itself requires a certain degree of attention to detail and adherence to procedures for experiments to be valid. The darker side of obsession as something objectionable emerges in 19th-century literature, where some characters are depicted as experiencing uncontrollable thoughts and behaviors run amok. Psychoanalysis has its roots in the effort to cure patients of uncontrollable impulses and obsessive thoughts.
Davis is skeptical of the diagnostic categories that medicine and mental health professionals use to identify obsession as a disease. He points out the dichotomy in the DSM-IV-TR’s differentiation of OCD as an anxiety disorder on the one hand, but also a personality disorder on the other. An important distinction between the two is that OCD sufferers are aware that their obsessive thoughts and compulsive behaviors are extreme, often embarrassing or out of control, and they seek relief. Obsessive compulsion as a personality disorder, on the other hand, can be experienced as a set of rules for living and expectations for self and others that the holder believes in and therefore finds satisfactory, despite potential difficulties it might create in interpersonal relationships or other aspects of daily living.
Because obsessive compulsive disorders are culturally bounded, Davis calls for treatment approaches to recognize this cultural context and to consider that sufferers seeking treatment have some ability to rethink their willingness to embrace the disease, to question their need to participate in its ‘tradition’, and to enhance their self-worth by sorting through the received wisdom about obsession for elements they accept and those they reject. Davis believes that obsession is a biocultural phenomenon that we all participate in to some degree, and persons whose obsessions or compulsions rise to the level of diagnostic criteria are more intensely involved in something that we all share. He sees value in this perspective not only because it acknowledges both the positive and negative aspects of obsession, but also because it breaks down the wall that separates the patient/sufferer from the doctor/healthy and opens up more possibilities for empathy, reduces stigma, and gives the patient more options to find relief.
For more discussion of this book, check out a review and the comments for Obsession: A History, by Lennard Davis.