OBSESSIVE-COMPULSIVE DISORDER

I believe that the interpretative model of obsessive-compulsive disorders is the most original of the four models that I have developed also and above all because no one had applied a systemic-relational approach to understanding this psychopathology. At most we found clinical examples interpreted from a systemic perspective in the literature. DAVID: I believe that the interpretative model of obsessive-compulsive disorders is also the most original of the four models that I have developed, particularly because no one had applied a systemic-relational approach to understanding this psychopathology. At most, we found clinical examples interpreted from a systemic perspective in the literature.

A CONVERSATION WHERE LIFE IS ON THE SIDE OF EVIL

One of the hypotheses that I put forward (Ugazio, 1998, 2013/12, 2018) is that the semantic of goodness with its contrast between good and evil is at the center of the emotional dynamics of the families in which obsessive-compulsive organizations develop. DAVID: One of the hypotheses that I put forward (Ugazio, 1998, 2013/12, 2018), is that the semantic of goodness with its contrast between good and evil is at the center of the emotional dynamics of families in which obsessive-compulsive organizations develop.

The conflict between good and evil that we find here is the opposite of the Augustinian and Thomistic one and gives a certain tragic pathos to the dynamics of these families: it is not evil that is the deprivation of good, on the contrary it is good that is the absence of evil. Good people are those who renounce the expression of their desires and the defense of their interests, those who sacrifice themselves, those who move away from the "instinctual" dynamic - such as Degas's aunt, the baroness Bellelli that you find in the painting reproduced above - and not those who are available, welcoming, polite and generous towards others. Bad people are those who express their sexuality and  their aggressive "drives", but also those who affirm themselves, and act in recognition of their own abilities and merits. Life and death are in fact intertwined with good and evil - the critical polarity of this semantic -  and life is on the side of evil.

DAVID:
The conflict between good and evil that we find here is the opposite of the Augustinian and Thomistic ones, and gives a certain tragic pathos to the dynamics of these families: it is not evil that is the deprivation of good, on the contrary, it is good that is the absence of evil. Good people are those who renounce the expression of their desires and the defense of their interests, those who sacrifice themselves, and those who move away from the “instinctual” dynamic – such as Degas’s aunt, the baroness Bellelli, that you find in the painting reproduced above – and not those who are available, welcoming, polite and generous towards others. Bad people are those who express their sexuality and their aggressive “drives”, but also those who affirm themselves and act in the recognition of their own abilities and merits. Life and death are in fact intertwined with good and evil – the critical polarity of this semantic – and life is on the side of evil.
 
 

As a result, members of these families will feel, and be seen as, good, pure, responsible or alternatively bad, selfish, immoral. They will meet people who will save them, improve them, or, on the contrary, who will initiate them into vice, lead them to behaviour that will then make them feel guilty. They will marry people who are innocent, pure, capable of self-denial or, on the other hand, cruel egoists who will take advantage of them. Their children will be good, pure, chaste or alternatively will express their feelings without restraint, be aggressive in affirming themselves and their sexuality. Some of them will suffer from selfishness, and the malice of others or for the intrinsic badness of their own impulses. Others will be proud of their own purity and moral superiority. And some will feel gratified by the satisfaction of their own impulses. (Ugazio, 2013, p.XXX)  

Edgar Degas, Bellelli Family 1858-1867

A DIFFICULT MEDIAN POSITION

What distinguishes those who have an obsessive-compulsive organization from other members of their family is the impossibility of placing themselves both within the”goodness, purity” pole, and within “badness, vice”- the opposite extreme . The person with OCD is in the middle position even before the symptomatic onset. DAVID: What distinguishes those who have an obsessive-compulsive organization from other members of their family is the impossibility of placing themselves both within the “goodness, purity” pole, and within “badness, vice”- the opposite extreme. The person with OCD is in the middle position even before the symptomatic onset.

They generally place themselves in a position closer to the “goodness, purity, self-sacrifice” extreme, but always remaining mid-way and reducing the reflexivity of the loop through operations of compensation towards the two extremes. Fear/anxiety and mortification/annihilation are the emotions that accompany these movements. These emotions are systematically expressed by subjects with an obsessive-compulsive organization, even when the reflexivity of the loop is low. Those placing themselves in the median position express themselves, and therefore live their lives, by moving first towards one extreme and then towards the other. Only in this way can they define themselves as partners and take part in the conversation. For people with an obsessive-compulsive organization, to move in the “purity, goodness” direction involves feeling annihilating mortification, producing anger and bitterness, whereas to move in the “badness, expression of personal impulses” direction brings the risk of a terrible punishment which becomes more distressing the more indefinite it is. These movements are generally limited and balanced, over a relatively short space of time, by conduct of an opposite kind. Subjects therefore generally manage to avoid feeling prey to an annihilating mortification (as would happen if they moved too far in the “purity, goodness” direction) or of seeing themselves, and being seen, as wicked, and therefore of feeling unworthy of love and being in fact rejected (as would happen if they moved too far in the “badness, expression of personal impulses, sensual pleasure” direction). Nonetheless, when the reflexivity of the loop becomes greatest, any oscillation towards one or other extreme, however balanced, becomes intolerable. Every attempt at self-affirmation, at expressing personal impulses and desires, is accompanied by a feeling of personal corruption, disgust, fear and anxiety. Every search for asceticism and purity is marked by feelings of annihilating mortification and anger, or is clouded by the doubt that the asceticism is a mask behind which are hidden foul intentions. Subjects thus enter the disaster area of the middle position. (Ugazio, 2013,p.XXX)  

The result is symptomatic onset, characterized by obsessions and compulsions.

FOR THIS REASON, DOES LIFE BECOME A FORBIDDEN STORY FOR OBSESSIVE-COMPULSIVE PATIENTS?

Yes, if by the word life we ​​mean emotional involvement with others, but also participation in projects, and initiatives aimed at personal affirmation. However, for obsessive-compulsive patients, life is also tremendously craved. When they distance themselves too much, to avoid being “infected” by others or harming others with their behavior, they can feel overwhelmed by mortification and dejection that can turn into a real clinical depression. (ok,D)

Patients with obsessive-compulsive disorder and their families do not go to the psychotherapist only for obsessions, compulsions or because they are gripped by doubts so pressing that they are unable to make decisions. Often they require therapeutic intervention for depressive states that can last a very long time.  DAVID: Patients with obsessive-compulsive disorder and their families, do not seek out psychotherapy only for obsessions, compulsions, or because they are gripped by doubts so pressing that they are unable to make decisions. Often they require therapeutic intervention for depressive states that can last a very long time.

But why getting involved with others, affirming their personality can become a source of such acute suffering for obsessive-compulsive people? How come many of them feel like Dr. Jekyll and Mister Hide? Why on earth do they experience that split in their selves, which is recognized by almost all clinical orientations? What prevents them from embracing the path of asceticism as others in their families do without feeling disheartened or worse depressed? Why can’t they even be “bad”, displaying aggression and selfishness like some of their family members do without feeling anguish or fear? DAVID: But why does getting involved with others, and affirming their personality, become a source of such acute suffering for obsessive-compulsive people? How come many of them feel like Dr. Jekyll and Mr. Hide? Why on earth do they experience that split in their selves, which is recognized by almost all clinical orientations? What prevents them from embracing the path of asceticism, as others in their families do, without feeling disheartened or worse, depressed? Why can’t they even be “bad”, displaying aggression and selfishness like some of their family members do without feeling anguish or fear?

I answer this questions in the five chapter of

SEMANTIC POLARITIES AND PSYCHOPATHOLOGIES IN THE FAMILY. PERMITTED AND FORBIDDEN STORIES Routledge, New York, 2013.

In this chapter, I reconstruct the position of obsessive-compulsive people in their families of origin and the subsequent life arrangements. (ok,D)

HAVE THERE BEEN EMPIRICAL STUDIES CARRIED OUT THAT CONFIRM THIS MODEL OF OBSESSIVE-COMPULSIVE DISORDERS?

Yes, yes at least the hypothesis that the semantic of goodness prevails in the families where the obsessive-compulsive disorders develop has been confirmed by these studies: DAVID: Yes, at least the hypothesis that the semantic of goodness prevails in families where obsessive-compulsive disorders develop has been confirmed by these studies:

Ugazio, V,, Negri, A., e Fellin, L.(2015).

Freedom, Goodness, Power and Belonging. The Semantics of Phobic, Obsessive-Compulsive, Eating, and Mood Disorders

Journal of Constructivist Psychology, vol. 28, 4, 293-315, doi: 10.1080/10720537.2014.951109

Ugazio, V., Guarnieri, S., Anselmi, P., Castelli,D.  e Pandolfi.M. .

La relazione terapeutica con i pazienti con disturbi fobici, ossessivo-compulsivi, alimentari e depressivi: Quali significati prevalgono? Rivista italiana di Costruttivismo, 9,1, 19-46, 2021.

Ugazio, V.,  Guarnieri S., Anselmi P., Castelli, D.,  Pandolfi, M. (2020)  

The therapeutic relationship with clients with phobic, obsessive-compulsive, eating and depressive disorders: Which meanings prevail? Journal of Constructivist Psychology, 2020 on line. To link to this article: https://doi.org/10.1080/10720537.2020.1828203

Ugazio, V., Negri A., & Fellin L. (2017) Libertà, Bontà, Potere e Appartenenza: le semantiche dei disturbi fobici, ossessivo compulsivi, alimentari e dell’umore. Rivista italiana di costruttivismo, 5, 1, Aprile 2017, pp.4-27.

Ugazio, V, Negri, A., e Fellin, L. (2015) Freedom, Goodness, Power and Belonging. The Semantics of Phobic, Obsessive-Compulsive, Eating, and Mood Disorders Journal of Constructivist Psychology, vol. 28, 4, 293-315 doi: 10.1080/10720537.2014.951109

Ugazio, V., Negri, A., & Fellin, L. (2011). 

Significato e psicopatologia: la semantica dei disturbi fobici, ossessivi, alimentari e depressivi. 

Quaderni di Psicologia Clinica, 2 (pp.69-100). Bergamo: Bergamo University Press.

HOW TO KNOW MORE ABOUT THE SEMANTIC OF GOODNESS THROUGH LITERARY EXPERIENCES.

Reading Schopenhauer! In his major work -The World as Will and Representation -he expresses and takes the idea of ​​abstinent goodness - so peculiar to the obsessive-compulsive pathients and their families - to its extreme consequences. Among other things, it is a rare example of a very well written philosophical work. Have you ever tried your hand at a philosophical work? Do it with this text which is also a literary work. Reading it, it is a real pleasure in spite of  its very dark contents.

DAVID:
Reading Schopenhauer! In his major work –The World as Will and Representation -he expresses and takes the idea of ​​abstinent goodness – so peculiar to obsessive-compulsive patients and their families – to its extreme consequences. Among other things, it is a rare example of a very well-written philosophical work. Have you ever tried your hand at a philosophical work? Do it with this text, which is also a literary work. Reading it is a real pleasure in spite of its very dark contents.
 
 

Content and form are in open conflict! For Schopenhauer the world is an insatiable will to live, it is the cruel, selfish, blind and irresistible impetus that pervades and agitates the whole universe. The voluntas - that is the will to live that permeates and agitates the whole universe- is assimilated to evil. To deal with it, it is necessary to put into play the noluntas, which Schopenhauer equates to a voluntary mortification of pleasures and a search for suffering.

DAVID:
Content and form are in open conflict! For Schopenhauer the world represents an insatiable will to live, it is a cruel, selfish, blind and irresistible impetus that pervades and agitates the whole universe. It is the voluntas - the will to live -  that permeates and agitates the whole universe, and is assimilated to evil. To deal with this, it is necessary to put into play the noluntas, which Schopenhauer equates to a voluntary mortification of pleasures and a search for suffering

Schopenhauer had a great influence on Freud; and thanks to this influence the idea of ​​abstinent goodness entered in the psychoanalysis and more generally also in psychology. Does the fact that classical psychoanalysis shares with obsessive patients the idea of ​​abstinent goodness  explain the difficulties that it  has had in treating obsessive-compulsive patients? I discuss this  question in Semantic Polarities and Psychopathologies in Family. Permitted and Forbidden Stories and also in this interview

DAVID:
Schopenhauer had a great influence on Freud, and thanks to this influence the idea of ​​abstinent goodness entered psychoanalysis and more generally also into psychology. Does the fact that classical psychoanalysis shares the idea of ​​abstinent goodness with obsessive individuals explain the difficulties that it has had in treating obsessive-compulsive patients? I discuss this question in Semantic Polarities and Psychopathologies in the Family. Permitted and Forbidden Stories, and also in this interview
 

https://youtu.be/f6Q09r7BPEs
Unfortunately is in Italian, so only for those familiar with the Italian language

The semantic of goodness dominates Tim Parks' most autobiographical  novel too - Tongues ​​of Fire ( London:  Collins, 1987). It is really beautiful, I reccommend!
 

In this Parks’ novel, abstinent goodness and wickedness confront each other in a family of a Protestant pastor with three children progressively overwhelmed by an increasingly extreme religious fervor. We are in 1968 and radicalization also affects religious worlds….