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"The Catholic Church and OCD", in Appendix, the religious perspective, in
Rapoport, Judith. The Boy Who Couldn't Stop Washing. NY: Plume, l989
237-241


The Catholic Perspective on OCD constitutes a vast literature which has
remained untapped by mainstream psychiatry.  The Catholic cncept of
scrupulosity dates back at least to the twelfth century....

Scrupulosity, in the New Catholic Encyclopedia (l967) signifies "habitual
and unreasonable hesitation or doubt, coupled with anxiety of the mind, in
connection with the making of moral judgements."

From 1522 to 1523 Ignatius Loyola wrote the Spiritual Exercises to Conquer
Self and Regulate One's Life and Avoid Coming to a Determination through
any Inordinate Affection".  This provided the Catholic Bhurch with its
first definition of scrupulosity through a description of Loyola's own
obsessive behavior, and his insight into its irrational yet distressful
force.

"After I have trodden upon a cross formed by two straws, or after I have
thought, said or done some other thing, there comes to me from 'without' a
thought that I have sined, and on the other hand it seems to me that I
have not sinned; nevertheless I feel some uneasiness on the subject,
inasmuch as I doubt yet do not doubt."

In l730 Saint Alphonus Liguori described scrupulosity as a groundless fear
of sinning that rises from "erroneous ideas."  Since then, a series of
theologians provided similar definitions of scrupulosity,most saying it
was a condition of the mind that creates futile and unreasonable motives.

....
Table l
Comparison of Scrupulosity with Obsessive Compulsive Disorder

Scrupulosity

l.  Persistent concern with thought, word or deed.

2.  Thoughts cause uneasiness and distress

3.  Person compelled and obsessional

4. Occurrs in healthy person

Obsessive compulsive disorder

l.  Persistent intrusive idea, thought or impulse

2. Ego dystonic (ie ritual or thought causes distress, and is seen as
alien.

3. Thoughts or actions performed with subjective compulsion

4.  Not due to another mental or physical disorder

Theological writers considrered scrupulosity to be judicium conscientieae
erroneae (an error in practical concscience).  In 1660 Jeremy Taylor, a
Cambridge-educated clergyman and writer, produced the fascinating relgious
text Doctor Dubitantium in which he gave case materials to show how
religous scruples merge into obsessional disorder, and then into madness:
"They repent when they have not sinned. (Scruple) is a trouble where the
trouble is over, a doubt when doubts are resolved."

The church writers of Taylor's time felt the presence of these scruples
actualyl interfered with an individual's religious development.  They
usually didn't go on to suggest any supernatural cause.

But theologians did not always agree tha scrupulosity was merely a form of
fearfulness.  Somewhat rotured reasoning argued that God would not cause
interior suffering, anxiety, and bad judgment in the afflicted person, but
that He ight withould enlightenment to punish sin and promote eht victim's
spiritual development.  God might use obsession as a punishment for
"inclinations of vainness" or as a trial to expiate past faults to bring
about a higher degree of sanctity.  It's God's way of " fitting souls for
contemplation."

An alternate cause was Satan.  The devil's object was to impoede or
destroy the victim's health.  Scrupulous behavior was te result with which
the devil injected his activity "into the moribid predisposition of our
nervous system in order to create a turmoil in our souls."  As late as
l949, both God AND THE DEVIL are listed as causes of scrupulous
conscience.

"The cause of scruples is the devil.  Teh method adopted by this tireless
enemy is to broaden the conscience of evil doers by a rash trust in the
divine mercy, and to narrow the conscience of the good by undue fear.  He
seizes upon their imagination and fills it with dark and chimerical ideas;
he kindles in just men apprehensins of sin which, though vain, are
terrifying and capable of inspiring the  greastest fear; he attacks their
sense of humours which usually engender consternation of mind, anguish,
bitterness and disturbace so that these poor stiffs become like skiffs
exposed to the fury of an angry sea." (from Tesson, l964)

How to tell which scruples come from where?  Saint Laurence Justian
proposed that scruples that emanate from hell are "usually accompanied by
a special darkening of the mind and by a ntable bitterness of the heart,
wherein they seek to engender distrust, lukewarmness and the cooling of
charity."

On the other hand, scruples deriving from human nature preserve " a
constant pattern, because they re consistent in their manifest effects.
Naturally scrupulous people nearly always act in fear and perturbation of
mind" (from Tesson, l964).

To a psychiatrist, the scruples "from hell" sound as if the victim were
also seriously depressed.  Those from "human nature" sound milder and
mostly anxious.

Many connections recur between religion and OCD.  Ritual purification,
order, and danger are related.  It is probably no oicicidence that the
prsonalities of two great religious leaders were deeply affected by their
obsessional thought.  John Bunyan, author of The Pilgrim's Progress, wrote
in Grace Abounding an incomparably vivid account of his obsessions.
Blasphemous thoughts were among his chief troubles.

"I could not tell how to speak my words for fear I should misplace them.
Oh, how cautiously did Ithen go in all I did or said!  I found myself as
in a miry bog that shook if I did but stir...Whole floods of blasphemies
were poured upon my spirit to my great Confusion and
Astonishment....Instead of lauding and magnifying God the Lord, if I had
but heard him spoken of, presently some horrible blasphemous thought or
other would bolt out of my heart against him.

Obsessive doubts and impulses also plagued antoher religious genius,
Martin Luther.  From 1517, when he first celebrated mass, Luther worried
greatly for fear he had carried out some trifling act of omission which
would be a sin.  Blasphemous thoughts pressed in on him;he wanted to
confess several times each day.  Eventually his preceptor in the monastery
had to discipline him for this.

Note how these obsessive symptoms, even as severe as both these men
suffered, wre compatible with busy, energetic, and profoundly successful
lives.  Will modern public figures be more forthcoming about suffering
from this particular disorder?  If it is as common as we believe, we
should expect some revelations as others come out of the OCD closet.