Obsessive-compulsive Disorder (OCD) Dr. Mohammed Sadiq
An increasing number of obsessive-compulsive disorders are surfacing among Muslim communities around the world. This article is intended to provide some information about OCD to those who are suffering from this disorder. As such, the symptoms of this disorder, some contributing factors as well as some treatment alternatives will be discussed. Both the Western and Islamic perspectives will be presented.
Definition and Description
Obsessive-compulsive disorder (OCD) is characterized by unwanted recurrent thoughts and images that are invariably distressing because they are violent, loathsome, threatening, or obscene in nature. They are recognized as the individual's own thoughts even though they are involuntary and often repugnant. They are largely out of control of the person, and often the more the person tries to resist them the worse they become. These unwanted thoughts generally produce a very high amount of anxiety. This is the obsessive component of the disorder.
These thoughts lead a person to engage in such behaviors that would relieve the anxiety or threat. Since the thoughts are recurrent - non-stopping, the resultant defensive behavior is also repetitive. For example, if the obsessions are about catching germs or becoming unclean, the person frequently washes himself/herself. If the obsessions are about personal safety and security, the person engages in to repeatedly checking the doors and locks in his house. This is the compulsion component of the disorder. These repetitive behaviors take up so much time of their daily life that they become unable to live a normal life. Paradoxically, the more they engage in these defensive behaviors, the more they are attacked by these obsessions. Thus, the obsessions followed by compulsions become such a vicious cycle that they cannot easily break out of it.
Here is a case example that sufficiently illustrate the nature of this disorder and how it renders a person totally helpless and dysfunctional. The person states:
“I always feel that there is urine on my clothes so I feel unclean (napaak) and keep checking my clothes to see if they are wet. I keep changing my clothes. I always feel that if I step on something wet and my feet get wet than it is urine. If I burp or cough than or throw up, I think my clothes are now dirty and I feel unclean; so I change my clothes and keep washing my mouth. When I make wudu, I keep thinking it is not done right. When I pray Salah I keep thinking that my hands are dirty because my mind keep telling me that I have put my finger into my private part so I am unclean (napaak). So I keep washing my hands. The same thing happens when I recite the Qur’an. When I drive, I keep wiping my hand with damp tissue because I feel my hands are dirty. When I cook I keep washing my hands because again I keep thinking that I have touched my
private part and have become unclean. I always carry tissue in my hands so I know I did not touch my private part. I put safety pins on my dress to hold my dress down, so as to ensure that I don’t touch my private part. Because of the fear of throwing up, I have started putting tissues in my month, so I don’t throw up. I know all of these thing or so weird, but If I don’t do it, I feel scared and unclean (napaak), and lots of anxiety. I feel that I am crazy, my husband and the kids think so too. I try to stop thinking about these feeling, but they keep getting stronger so I give in to the washing so the feelings will go away, but they keep coming back.”
From an Islamic perspective, these unwanted thoughts are called ‘Wasaawis’ (plural of Waswasah), which are whispered in the minds and hearts of people by Shayaateen. We find evidence of this in the holy Qur’an and Ahadith. Allah (swt) says: “Then Shaitaan whispered suggestions to them both in order to uncover that which was hidden from them of their private parts….” (7:20)“Then Shaitaan whispered to him saying, ‘O Adam! Shall I lead you to the tree of eternity and to a kingdom that will never waste away?’” (20:120)“Say: ‘I seek refuge with Allah, the Lord of mankind, the King of mankind, the God of mankind, from the evil of the whispers of the devil, who whispers in the hearts of men…. (114:1-4)
Abu Huraira (r.a.) narrated: Allah's Apostle said, "Shaitaan comes to one of you and says, ‘Who created so-and-so and so-and-so?’, till he says, ‘Who has created your Lord?’ So, when he inspires such a question, one should seek refuge with Allah and give up such thoughts." (Bukhari, Muslim)
These Wassawis play a significant role in many mental disorders that involve anxiety and cognitive distortions.
To a lesser degree, these obsessions and compulsions result in what is known as Obsessive Personality Disorder. A person suffering from this disorder shows peculiar idiosyncrasies. For example, he/she may be quite particular about a specific way of maintaining cleanliness, or washing dishes, or wearing clothes, or making their beds, or doing their work, etc. If things are not done exactly in that way, they become quite annoyed and frustrated. Some end up being perfectionists; they are hard to satisfy. They have very high expectations of themselves and others, and become very disappointed, frustrated and annoyed if those high expectations are not met. Causes and Contributing Factors
Recurring thoughts about catching germs, being unclean, and questioning one's faith, appear to be the most common forms of obsessions among Muslim men and women.
The fear of catching germs and being unclean are most often found among women. Although globally the incidence of OCD appears to be about equal between men and women; in my practice with Muslim clients, I see more women seeking help for this disorder. This could be either because women are more willing to seek help than men, or that Muslim women suffer from OCD more than men.
The definite causes of OCD remain elusive. Genetics, some physical disorders, and environmental factors have been presumed to contribute to this disorder. Although there is no clear genetic evidence, obsessive-compulsive disorder tends to run in families. A person with OCD has a 25% chance of having a blood relative who has it. In my practice I have found that a person's sexual and interpersonal history may also be contributing factors.
Often, people suffering from OCD also end up suffering from depression, a lack of self-esteem and self-confidence, a very weak will-power, relationship problems, and social withdrawal.
A thorough clinical assessment is required to determine the nature and severity of the symptoms and the possible causes and contributing factors before a treatment plan can be devised.
Let's look at a case example that exemplifies the influence of these environmental factors on OCD's.
“I remember that after my son died, I decided that I will be a better Muslim. So, I looked at the most religious person that I knew. It was my mother-in-law. This person is on the prayer-mat all the time – always praying, always fasting. So, I thought that she was a good example. I started thinking about the ways she does things and that because she was so religious that she must be right. I started to see the behavior that she had toward things. She would not let anyone touch her things, made me think we were not clean enough. If I washed something like a spoon, pots, etc., then she would wash that item again 3 times. So I started thinking that everything had to be washed 3 times to be clean. So, I started doing the same thing. Even though before my son died, I was ‘normal’. My mother-in-law does not put her clothes in the washing machine with ours; hers had to be washed separately. My husband even got her a separate basket for her clothes. Looking through her behavior, I thought that I was not clean enough. So, I began to be like her, so that I will go to Jannah and see my son again.”
From an Islamic perspective, these Wassawis from Shayateen are meant to weaken the will and beliefs of a person, to make them anxious and worried, and to lead them away from their faith. Let us look at some of the verses from the holy Qur’an in this respect. “O Adam! Dwell you and your wife in Paradise and eat thereof as you both wish, but approach not this tree otherwise you both would be of the transgressors. Then Shaitaan whispered suggestions to them both in order to uncover that which was hidden from them of their private parts before. He said, ‘Your Lord did not forbid you this tree save you should become angels or become of the immortals. And he swore by Allah to them both saying, ‘Verily I am one of the sincere well-wishers for you both.’” (7:19-21)“Shaitaan threatens you with poverty and commands you to commit evil deeds.” (2:26)
Let’s also look at a couple of Ahadith.
“Uthman bin Abu al-'As reported that he came to Allah's Messenger (may peace be upon him) and said, ‘Allah's Messenger, Shaitaan intervenes between me and my prayer and my reciting of the Qur'an and he confounds me.’ Thereupon Allah's Messenger (may peace be upon him) said, ‘That is (the doing of the Shaitaan) who is known as Khinzab, and when you perceive its effect, seek refuge with Allah from it and spit three times to your left.’ I did that and Allah dispelled him from me.” (Muslim)
“Urwah bin Zubair narrated from ‘Aisha (r.a.) that one night the Prophet (s.a.w.) left her during the night and went out. ‘Aisha (r.a.) said that she felt envious. When he returned to her, he found me in deep thoughts. He asked, “What happened to you O ‘Aisha? Did your shaitan overpower you? ‘Aisha said, “O Prophet of Allah! Why wouldn’t a woman like me be envious over a man like you? Is there a shaitan with me, O Prophet of Allah?” He responded, “Yes.” She asked, “Is there a shaitan with every one?” He replied, “Yes.” She said, “Even with you O Prophet of Allah?” He responded, “Yes, with me also, but Allah has made him obedient to me.” (Muslim, as reported by Ibn Al-Jauzi in Talbees-i-Iblees)
All human beings suffer from these Wasaawis regardless of their age, sex, faith, or creed. However, the nature, content, severity and influence of these Wasaawis vary from one person to the other. For some, they only cause mild anxiety and worry, while others are more severely affected to the point of becoming spiritually, mentally, emotionally, psychologically and socially paralyzed. In my experience, age, faith, family, sexual and religious history – all play a significant role in determining the nature and content of these Wasaawis; while the severity and impact are determined by the premorbid spiritual, emotional and psychological maturity of a person.
Obsessive-compulsive disorders are treatable. Several treatment modalities have been traditionally used in the treatment of OCD including drug therapy, behavior therapy, cognitive behavior therapy, and relaxation exercises in various combinations depending upon the nature, severity, and history.
Most of the drugs used to treat OCD are antidepressants, such as, Anafranil, Celexa, Luvox, Paxil, Prozac, Zoloft. These drugs have variable effectiveness in the control of the symptoms of OCD and depression. Apparently these drugs do not completely stop the obsessive thoughts or the compulsive behavior, but reduce the anxiety and depression associated with them thereby reducing the felt severity of the disorder. So,
they manage the severity of the symptoms, but don't seem to get rid of them. This is why drug treatment is generally used in conjunction with psychological therapies.
Psychological therapies, on the other hand, attempt to help the client understand the roots, dynamics, and the possible contributing factors of the disorder. The stress and anxiety are treated with relaxation exercises. Faulty beliefs arising out of the obsessions and leading to compulsions are examined. Here is a case example. The client says:
“In the Qur’an, there is a verse that says, ‘And Allah loves those who purify themselves’. Also the Prophet (saw) says "Purity is half the Iman". So I keep thinking that I must keep myself clean (paak) or that I am not good enough.”
With relaxation, education and cognitive behavior therapy, the person is gradually guided in correcting the faulty beliefs. Past traumas, like sexual/physical abuse, and unsavory conduct and life styles of the past that may be responsible for severe guilt leading to the OCD, are dealt with. Appropriate home assignments are given to promote new and healthy thought process and beliefs. And, over a period of time, the obsessive thoughts and the compulsive behaviors begin to decrease.
In cases where the symptoms of the OCD are so severe that they render the person completely dysfunctional lacking any control over the thought processes, psychological therapies by themselves are not often very effective. In such cases, drug therapy is combined with psychological therapies to initially reduce the anxiety and depression followed by counseling and therapy.
From an Islamic perspective, where Allah (swt) has given Shaitaan the power to inject his poisonous whispers in the minds and hearts of the people, He has also guided the mankind to defend themselves from them. We find in the holy Qur’an: “So when you intend to recite the Qur'an, seek refuge with Allah from Shaitaan, the outcast. Verily! He has no power over those who believe and put their trust only in their Lord (Allah). His power is only over those who obey and follow him (Shaitaan), and those who join partners with Allah. (16:99-100)“And deceive among them those whom you can with your voice. Verily! On my true servants you would have no authority. Sufficient is your Lord as a guardian.” (17:64-65)
“And whosoever turns away (blinds himself) from the remembrance of the Most Beneficent (Allah), We appoint for him Shaitaan to be a his intimate companion.” (43:36)
“Shall I inform you upon whom the Shayaateen descend? They descend on every lying sinful person.”(26:221-222)
“And say: "My Lord! I seek refuge with You from the whisperings (suggestions) of the Shayaaeein. And I seek refuge with You, My Lord! Lest they may come near me.” (23:97-98)
“Say: I seek refuge with Allah, the Lord of mankind, the king of mankind, the God of mankind, from the evil of the whisperer, who whispers in the breasts of mankind, of jinns and men.” (114:1-6)
“Abu Hurairah (ra) narrated: the Prophet (saw) said: Allah (swt) has forgiven the Wasaawis that arise in the hearts of the people of my nation until one acts upon them or talks about them.” (Bukhari, Muslim)
“Abu Huraira (r.a.) narrated: Allah's Apostle said, "Shaitaan comes to one of you and says, ‘Who created so-and-so and so-and-so?’, till he says, ‘Who has created your Lord?’ So, when he inspires such a question, one should seek refuge with Allah at such times and give up such thoughts." (Bukhari, Muslim)
In summary then, if one lives by his faith according to the guidance provided by the Creator, seeks Allah's protection from Shayaateen and their whispers, does not keep talking about or give in to these obsessions, and protects his mind and heart through the remembrance of Allah (swt), Allah will protect him from the evil effects of these offensive and threatening or obsessive thoughts, and will give him strength to keep them under control.
Combining these teachings of Islam with the modern treatments of OCD, while treating a believing client, has been found to be extremely valuable, effective and efficient. However, it loses its effect if the therapist and/or the client does not believe in these teachings, or is unwilling to live by his faith.
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