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… you get the general idea.
Levels of normal guilt
Normally, 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 on occasions when someone is likely to feel overly guilty for various reasons, such as having a fear of being morally bad for perceived indiscretions, they are still able to resolve the problem and eventually move on and let the emotion pass.
Guilt associated with Religious OCD
However, when religious or moral OCD plays a role in this otherwise natural emotion (guilt), 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. However, when he was 15 years old, he had thoughts to steal money from his local church’s donation fund. One day he gave into 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’ triggered thoughts about the earlier theft incident. The nature of what he did all those years ago began to play on his mind. He started to feel distressed about whether he should have owned up to stealing 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 stealing was wrong and was sorry for that. He was aware that having a conscience was enough to know 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.
In the above example, you can see how, when OCD is separated from natural guilt, the “what-ifs?” are appropriate in this situation, and therefore, the resolve for John fits with the emotions experienced. Moreover, this one incident was a learning experience for him; he knew his true morals were good and stealing was something he knew he would never do again. This 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
This time, John experienced intrusive thoughts about the theft. After reading the commandment ‘thou shalt not steal’, imagine he is beside himself with guilt and shame. Now imagine he’d already confessed to his parents, prayed with them for God’s forgiveness, paid back the money (plus extra, out of guilt), repeatedly asked for reassurance, and yet a year later the problem persisted.
Intrusive thoughts raged through his mind, such as, ‘You’re a thieving sinner, a traitor to your religion.’ Now, in an attempt to block the thoughts, John would conjure up good words, such as, ‘I respect my faith, I’m forgiven’. He suddenly felt corrupt in the eyes of God. He didn’t quite understand why he had these thoughts and often asked 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 truly sorry for what I did?, ‘Should I go to confession again?’ and ‘What if I’m not forgiven and God punishes me and sends me to hell, unless I confess just one more time?’
Again, lots of worst-case scenarios going on, just like in the first example, but in this case, the “what-ifs” were hard to define. They were hard to make sense of because intrusive thoughts are illegitimate. These illogical thoughts had latched on to what mattered most to John – his morals. Subsequently, and despite the real-event theft situation, he failed to see that his intrusive thoughts were at odds with his true moral values, or at least doubted it. This is an example of what is known as trait-guilt, meaning that the corresponding emotion is rigid. In other words, John’s previous healthy beliefs about himself shifted to thinking instead that he truly was a sinner and a traitor to his religion.
Time passed by, John grew up, and the intrusive thoughts had become less intense over time, and he was able to function well enough in all aspects of life. However, John came across a story in the newspaper of a man who’d been sent to prison for stealing from several Gospel Halls in and around his hometown. This had him wondering again whether his conscience had been cleared. He labelled himself morally corrupt and decided that perhaps “confessing” one more time could be the answer to relieving himself of the “guilt” and “shame” that he could no longer tolerate.
The thought of being morally unacceptable was too much for him to cope with. Once again, OCD had found its grip, and the frequency and strength of the obsession began to invade his mind. Subsequently, he felt an incredible urge to “tell” his closest and most trusted friend about his perceived “immorality” and sensed immense relief, afterwards, because his friend reassured him that all was fine. Even still, it wasn’t long before he started to think that perhaps he should seek out reassurance by going to a priest and “confessing” what he’d done years before, and so it went on.
Exactly how did OCD play a role in this otherwise natural emotion for John?
Earlier, it was noted that usually, an actual misdeed has a reciprocal relationship with the level of guilt experienced. Yet, when someone has an OCD episode one feels 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 an obsession as a result of an obsession.
For instance, John had justifiably resolved the theft issue years before (state-guilt). This was through the rational judgement of character and forgiveness as opposed to the present, in which his compulsion to “confess” was as a result of an obsession about perceived immorality. In other words, since obsessions are untrue pieces of information coming into consciousness, it means his recent confession and all his other rituals would be inconsistent with his true character and behaviours. The reason for this is that the real event is separate from OCD whether forgiveness and resolve has already taken place or not; also, trait-guilt has an invalid connection with an obsession.
So what was the solution for John?
John learned in cognitive behavioural therapy that his intrusive thoughts were, and are, just that. Cognitive strategies helped him 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, his belief changed to, ‘I can either live under OCD’s control and feel threatened forever, or I can live with the low probability that I could be a traitor to my religion, which makes uncertainty manageable.’ The behavioural part of therapy known as exposure response prevention helped John systematically resist giving into compulsions. With dedicated practice, his obsession weakened, and he found remission.
With new healthier beliefs people who have similar experiences as John place themselves in a better position to identify that their recently established praying, blocking, “confessing” and/or other compulsions no longer need to be given into. This is because the rituals in OCD only serve to reinforce and feed their religious or moral obsession. A secondary obsession (guilt) and fearing that one’s conscience hasn’t been cleared adds to the problem. Balanced perspective in cognitive therapy firmly addresses and resolves misplaced, intrusive guilt; also, it addresses trait-guilt and demonstrates, objectively, how this emotion is inconsistent with one’s true character and behaviours. Finally, systematically resisting ALL COMPULSIONS in exposure-response prevention builds distress tolerance and leads gradually to remission, or much reduced symptoms.