This Text file is old! In a 🏛️Museum, an unsorted archive of (user-)pages. (Saved from Geocities in Oct-2009. The archival story: oocities.org)
--------------------------------------- (To 🚫report any bad content: archivehelp @ gmail.com)

from "Free Will and the Uncertainty of Knowing", chapt 27 in Rapoport,
Judith.  The Boy Who Couldn't Stop Washing.  (NY: Plume, l989) and chapt
7, "The Doubting Disease" pp 87-89, p 207-220


A major feature, and a strange one, of Obsessive Compulsive Disorer is the
inability to be reassured by the senses.  Obsessives have lost their
ability to "know" certain simple things that we all take for granted,
things that we all constantly check for by some mechanism of which we are
unaware, except when it doesn't work.  This mechanism is not working for
these patients at a level that astonishes me, for they are asking "How do
youknow about things that we find ourselves hard put to explain: Is the
grass really green?  Are my eyes blue? "Why," I say, "we just KNOW, that's
all."

...
Then there is the content of the rituals.  Compulsives (our term for
patients who mostly ritualize) and obsessives (those who mostly ruminate)
rarely have rituals or thoughts about neutral questions or behaviors....
What are their rituals about?  ...Everyoe agress taht the most common
precoccupations are dirt (washing, germs, touching), checking for safety
or closed spaces (closets, doors, drawrs, appliances, light switches) and
thoughts, often thoughts about unacceptable violent, sexual or blasphemous
behavior...These thoughts are virtually never acted upon.  But in all
these preoccupations, a basic function is out of control.

...
A father calling about his sixteen year old daughter.

"But she gets in shouting matches with her mother.  They scream and pull
hair.  Alice won't stop asking questions."
...
"But no other children I know ask questions like these," he persisted.

"What sort does she ask?"

"Well her most recent question is 'Is the sky blue?' said her father. 'But
before thata, it was the leaves.'

"The leaves?"

"Yes.  She asked, 'Are the leaves green?' For months she asked about the
leaves."

"What did you say then?

"Well, of course, I'd say 'Yes the leaves ARE green.' And then she'd
ask'Are tehy dark green or light green.' So I'd say 'Well some are dark
green and others light'.  But that doesn't satisfy her.  She points to a
particular tree and a particular leaf on it, and wants to know exactly
what color green that leaf is.  When I can't answer just right, she gets
upset and starts screaming."

"So you're still talking about leaves at home now, or have you refused to
answer?"

"Right now, the worst is her hair."

"What about her hair?"

"She asks if her hair is blond or dirty blond or brown.  Well, my wife
started to say how her hair is all different, that it's blond on top, and
medium blond in places, and brown in the back.  Just trying to be accurate
because by now she's afraid of what is coming, and as usual, Alice went
wild.  She screamed, she just shouted, over and over, 'What color IS it?"

...

Kim and William:  How do I know?

Kim, the first young girl I met with Obsessive Compulsive Disorder, had
only one symptom:  the thuoght that she had caused someone's death.
Sixteen years old, beautiful, blonde, and slim, Kim sat at the nurse's
station weeping over her destructive power.  Hours of staff time went into
reassureing her that she was not a killer, but it didn't seem to help.

"Kim", they would say, "your parents say you'd never hurt a fly.  How
COULD you have killed anyone?"

"Well, I MIGHT have looked angry one day and the man who waked by me ont e
street and saw that look might have gotten really upset and had a heart
attack."

This was about as much of a story as Kim could put together.  An obsessive
ruminator,...

William, a graduate student in English literature,had been brought in by
his mother, who asked, can't you reason with him,  Dr. Rapoport? He keeps
saying he MIGHT have MURDERED someone!"

I talked with William briefly on other subjects.  He spoke lucidly and
with enthusiasm about his thesis on modern American poetry.

"Now what is this about your doing harm to someone," I asked.  The
interview changed; I had set it off. Willaim got a worried look and then
began a repetitive monologue:

"Do you think I killed someone, Dr. Rapoport?  How do I KNOW if I killed
someone?"

I said some sensible, to him meaningless, things that didn't interest him,
couldn't hold his attention, and didn't help.  He left with an appointment
to return the following week.  His weekend proved to be dramatic and
eventful.  

At six that Sunday morning, William turned himself in at the local police
station saying, "I confess.  Who do I see? I've murdered someone."  AFter
a very short interrogation, William's story came apart.

"Where is the body?"

"I'm not sure."

"How was the murder committed?"

"Well, I MIGHT have pushed someone off the Calvert Street Bridge."

"When did this happen?"

"I think it was last night."

William had had a terrible night.  The thought "I have murdered" was
stronger than it had ever been.  Televeision hadn't broken through and
relaxed him and a half a bottle of gin hadn't weakened the inner voice
that accused him over and over again.

By dawn, the burden and the doubting were too much.  The station was slow.
The sergeant offered him coffee and listened.  Soon it was William who was
asking the questions.  "Seargant, DID I kill anyone?  HAVE their been any
bodies reported near the Calvert Street bridge?  TEll me, Sergeant, HOW DO
I KNOW IF I KILLED SOMEONE?"

...The sergeant told me later, "Doctor, I've seen strange things happen at
this station.  But the craziest part of this story was that the guy didn't
seem crazy."

William was asking a bizarre question, but he wasn't on drugs, was not
really drunk, and hadn't been injured...William was genuinely upset. After
teh sergeant had called to verify that Wiliam was a patient of miine, he
asked me a few questions of his own:  "How can anyone not know something
like that?  What's the matter with this guy?"..."What does he mean, 'How
do you know if you killed someone?' That's weird, really weird."

Kim and William face two bizarre and deeply troubling problems.  One is
their preoccupatoin with their danger to others.  The other is that they
can't be sure if they know something.  Their memory and their perceptions
are fine by every test we can devise, but they just don't 'sink in' the
way memories adn percepts usually do.  My severe doubters keep saying,
"How do I know?"

Obsessive-Compulsives don't have trouble "knowing" most things.  The
doubting disease is highly selective --- only certian things are doubted.
The doubts leave no room for anything else.  There is no problem with
memory; Kim and William could describe every step they took on the days of
their "murders".  A much more complex cognitive or perceptual process has
gone wrong.  If Alice met Kim or William, she wouldn't have understood
theri preoccupation with murder.  But if she heard them ask "How do
Iknow?" THAT would be familiar!

Doubts of the most simple observations may be the most fascinating side of
OCD.  The French called Obsessive-Compulsive Disorder folie purquoi and
folie de doute, literally the doubting disease.  Something in the mind -
in the brain - goes wrong.  ...SEtting aside the dramatic content of
doubts..is a problem just as basic:  that of KNOWING.  Something gets
stuck.  Most of us don't plan how to decide if the door is locked, we just
know it is after we lock it and tr the knob.  ...But my patients are
caught in endless loops of trying to be sure of the obvious.