First, guilt is an emotion that most people experience. For example, if someone lies, they may feel guilt. If someone steals, it’s likely they’ll feel guilt. If someone has deliberate unkind thoughts about someone, guilt might follow. The list goes on, but there’s a general idea.
Levels of normal guilt
Usually, unkind thoughts and misdoings tend to have a relationship in terms of the level of guilt a person feels. The intensity of guilt, however, does not usually preoccupy the person’s mind for too long, not in the general sense of things, at least. Even when someone feels overly guilty for various reasons, such as having a fear of being morally bad for perceived wrongdoings, they can still resolve the problem. Eventually, they move on and let the emotion pass.
Guilt associated with Religious OCD
However, when someone has religious or moral OCD, it’s fair to say that it isn’t a fluke that OCD has found a person’s vulnerability about what matters to them most. As a result, their standards are “affected”. This is because misplaced guilt intrudes on the way they believe they should think, feel and behave according to their values, religion or other doctrines.
John’s normal guilt
Let’s take “John’s” situation as an example. His family is religious. They have brought him up to have strict moral standards. Still, when he was 15 years old, he had thoughts to steal money from his local church’s donation fund. One day he gave in to those thoughts. Later that day, he felt shame and guilt.
John’s guilty conscience followed with a series of “what-ifs”? For example, ‘What if I go back into the church and the priest announces that he saw me steal the money?’ and ‘What if the priest were to tell my parents or call the police?’ There were lots of worst-case scenarios going on, and all tangible, because something really did happen for John to feel shame, guilt and regret.
Thou shalt not steal
Time passed, John grew up, and the event faded from his mind. Then one day, he happened upon one of the Ten Commandments on Wikipedia while Googling something for his religious studies. The words ‘thou shalt not steal’ made him think about the earlier theft incident. He started to feel distressed about whether he should have owned up to taking the money or at least prayed for forgiveness.
On reflection, John decided it would be better for him to put the theft incident to rest rather than dwell on it. He felt he could do this because, deep inside, he knew that stealing was wrong, and he was sorry for that. He was aware that having a conscience was enough to see that he’d been dishonest and that this in itself was punishment enough. And so from this perspective, he was able to pray for God’s forgiveness, forgive himself and move on.
State-guilt is transitory
In the above example, you can see how, when OCD is separated from a natural sense of guilt for doing something wrong, it makes the “what-ifs?” appropriate. Therefore, the resolve for John is rational and fits with the emotions experienced. Moreover, this incident was a learning experience for him. He knew his morals were good and stealing was something he knew he would never do again. John’s situation is an example of what is known as state-guilt, meaning that the corresponding emotion is transitory. In other words, John knew, inherently, that the theft situation, although wrong, was out of character for him, and as a consequence, forgivable.
John’s intrusive guilt
Now imagine instead that John is beside himself with guilt and shame after reading the commandment ‘thou shalt not steal’. Picture intrusive thoughts are raging through his mind, such as, ‘You’re a thieving sinner, a traitor to your religion.’ In an attempt to block the thoughts, think of John conjuring up kind words, such as, ‘I respect my faith, I’m forgiven’.
But now picture John suddenly feeling corrupt in the eyes of God. He repeatedly asks himself “what-if” questions such as, ‘What if I’m not worthy of going to church?’, ‘What if the priest gets suspicious of my thoughts?’, What if God thinks I’m not genuinely sorry for what I did?, ‘Should I go to confession?’ and ‘What if I’m not forgiven and God punishes me and sends me to hell?’
Trait-guilt is rigid
Again, there are lots of worst-case scenarios going on, just like in the first example, but in this case, the “what-ifs” are hard to define. It’s because illogical thoughts have latched on to what matters most to John, which is that he is deep down a good person. Subsequently, and despite the real-event theft situation and, later, praying for forgiveness, he fails to see that his intrusive thoughts are at odds with his moral values. Or at least he doubts it. This is an instance associated with trait-guilt, meaning that the corresponding emotion after doing something wrong is rigid as opposed to transitory in state-guilt. In other words, John’s previous healthy beliefs about himself before and after stealing the money shifts to thinking instead that he truly is an unforgivable sinner and a traitor to his religion.
As time moves on, John feels more and more that being “morally corrupt” is too much for him to cope, and he wants desperately to clear his conscience. OCD has found its grip, and John has an incredible urge to “tell” his closest and most trusted friend about his perceived “immorality”. Afterwards, he feels immense relief because his friend reassures him that all is fine. John believes that his conscience is clear. However, he soon starts to think that perhaps he should seek out reassurance by going to a priest and “confessing” what he’d done years before. Before too long, John’s confessing ritual gets worse, increasing the severity of his OCD.
Exactly how did OCD play a role in this otherwise natural emotion for John?
Earlier, it was noted that when one does something wrong, subsequent “what-ifs” are legitimate, as is the resolution. Yet, when someone has an OCD episode, they feel intrusive guilt, not actual guilt. This is the part that is hard to define. In any case, a resolve can never be in accordance with the emotions experienced because the guilt is invalid; it’s intrusive as a result of the primary obsession. The real event (theft) is separate from OCD, whether legitimately resolved or not. It means that trait-guilt has an invalid connection with the obsession.
So what’s the solution?
Someone like John learns in cognitive behavioural therapy that intrusive thoughts are not real. Cognitive strategies help them alter thinking errors that link to entrenched beliefs, such as, ‘What if God hasn’t truly forgiven me for stealing? (thinking error); this will mean I’m evil and will go to hell (faulty entrenched belief).’ Instead, their belief can change to, ‘I can either live under OCD’s control or I can live with the low probability that I could be a traitor to my religion.’ By living with risk, it makes uncertainty manageable. The behavioural part of therapy known as exposure-response prevention helps people like John systematically resist giving into “confession” rituals, among other compulsions. With dedicated practice, their obsessions weaken and they can live in remission or with much-reduced symptoms.
With new healthier beliefs, people who have religious OCD are better able to identify how rituals reinforce the problem. They grasp that they no longer need to give in to praying, blocking, “confessing” or other compulsions. Also, not having to worry about whether or not they have a clear conscience. Gaining a balanced perspective in cognitive therapy addresses and resolves misplaced intrusive guilt; it redirects trait-guilt. It demonstrates, objectively, how this emotion is inconsistent with one’s true character and behaviours. By systematically resisting all compulsions in exposure-response prevention, people like John can build distress tolerance, leading ultimately to recovery.
By Carol Edwards
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