Sines and Cosines
When in Doubt:
Jennifer Traig

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In researching scrupulosity, a malady I was unfamiliar with, I spoke to three psychiatrists who had treated patients with the disorder. From these experts, I tried to learn how scrupulosity affects religious observance and what divides piety from pathology.

Jonathan D. Huppert is assistant professor of clinical psychology in psychiatry at the University of Pennsylvania's Center for the Treatment and Study of Anxiety. An Orthodox Jew who has treated Orthodox Jews suffering from scrupulosity, he is co-author of the study, "Penn Inventory of Scrupulosity."

That study found that "both religiosity and OCD-ness were predictors of scrupulosity," he said. In the case of religious Jews, "OCD can glom onto oneís observance."

One of his patients was a woman who was afraid she would somehow bring pork into her kosher home. "Not only was she afraid of bringing it into her kitchen, she was equally afraid of bringing it into her bed."

Dr. Huppert treated the woman with a form of cognitive therapy called exposure and response therapy. Success of the treatment would come when she believed that she would not somehow by accident defile her house or herself.

"I told her she could sleep with bacon. That was a goal of ours, because thereís nothing halachically wrong with sleeping with pork."

Motivation is one factor that can distinguish piety from pathology, he said.

"When someone is pious, itís not an anxiety-driven belief system and behavior. There is in Judaism a concept of the fear of God, but itís not supposed to be a fear that makes you paralyzed in your functioning."

Another hint: "If the behavior is outside the norms of  a person's community, how quickly is the person able to change behavior, given the corrective?"

And since halachah is often vague, a scrupulous person will constantly be coming up with exceptions to the generally accepted rule. "Thatís a hallmark of the disease."

How prevalent are OCD and scrupulosity? Dr. Huppert said that between 0.3 percent and 3 percent of the population suffers from OCD sometime in their lives. Of these people, 10 percent have scrupulosity as an element of the disorder.

The prevalence of OCD is pretty similar in all societies, he said. But the type of OCD varies from society to society. That's because "OCD attaches to the things that are important in your life."

Dr. Huppert treats people whose OCD is manifested by three primary obsessions:
Fear of physically harming someone;
Intrusive sexual thoughts.

"Most people have intrusive thoughts. Most religious people have blasphemous thoughts that bother them," he said. "People with OCD tend to respond to these intrusive thoughts with fear. They fight them with rituals. By trying to constantly neutralize these thoughts they become even more important and anxiety provoking. By attaching such importance to the thoughts, it proves to them that they are bad people."

Carol E. Watkins is a psychiatrist at the Northern County Psychiatric Associates in Baltimore, Maryland. She offered this example of how an obsession over a particular religious ritual can override other mitzvot, the welcoming of guests or respect  for parents and family, for example.

"Imagine someone who feels like they have to say a particular prayer just right. That person might make the family sit and wait at the dinner table" as the scrupulous person continues to repeat the blessing until satisfied."

Are baíalei teshuvah, Jews who have undergone a religious awakening, and particularly those who have embraced a highly form of Orthodox observance, candidates for scrupulosity?

Dr. Watkins said to answer that question, one should ask: "How flexible is the person and are they getting something out of their practice? They should not be getting stuck in a particular ritual. And is their observance a cause of anxiety?

"You donít want to pathologize someone if theyíre just exploring their spirituality," she said.

Simon A. Rego is assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine of Yeshiva University. He said a quarter of all OCD patients have some sort of religious obsession.

OCD is on a continuum, he said, "so you donít just have it or not have it. Itís across a spectrum." For religiosity to be considered scrupulosity, "it has to be defined as unwanted and intrusive. Itís interfering with their ability to carry on their religious life in a creative way.

"With OCD you see more of an urge to act out of fear. Itís fear driving them more than faith," he said.

"Part of the challenge of treatment is to show the patient what theyíre doing versus what someone else is practicing. Treatments are becoming more specialized and customized."

The OCD patients Dr. Rego treats display four major obsessions:
Fear of contamination;
Fear of aggressiveness;
Arranging and rearranging;

He said OCD prevalence is "2-3 percent in modern society. Depression is more common."  

Copyright © 2005 by David Holzel
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