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 one’s 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 there’s nothing halachically wrong with sleeping with pork."
Motivation is one factor that can distinguish piety from pathology, he
said.
"When someone is pious, it’s not an anxiety-driven belief system
and behavior. There is in Judaism a concept of the fear of God,
but it’s 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.
"That’s 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:
Scrupulosity;
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."
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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 ba’alei 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 don’t want to pathologize someone if they’re just exploring
their spirituality," she said.
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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 don’t just have it or not
have it. It’s across a spectrum." For religiosity to be considered
scrupulosity, "it has to be defined as unwanted and intrusive. It’s
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. It’s fear
driving them more than faith," he said.
"Part of the challenge of treatment is to show the patient what
they’re 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;
Religion/morality.
He said OCD prevalence is "2-3 percent in modern society. Depression
is more common." 
Copyright © 2005 by David Holzel
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