Since the age of 16, my thoughts have been invisible and tormenting. In an article I published in 2014 entitled The Unseen Obsession I described my experience as having quit university in the middle of my studies because of a single, powerful thought. I wrote:

I’ve had obsessional thoughts about my hands for four years and I can say with confidence that it is not about cleanliness.

Since my teenage years, I have had many obsessions. My obsessions began when I wondered if things were real, if my parents were who they claimed to be, and if I was a danger to my family, my friends, or even my dog.

We all know how it feels to obsess over a person, an event, or another thing that makes us anxious. For those who have obsessional thoughts, whether they are diagnosed or not, this is different from “overthinking”. In my article, I tried to explain:

As the thought flits through your head, conversations falter. The thought seems less important and you have time alone to analyse and find evidence that the thought is ‘true.’ [Obsessing] feels like fighting. You push your thoughts and they return with double the force. They taunt and mock you for your inability to run away.

After six months of weekly sessions, I finally felt comfortable enough to tell my therapist about my obsessional thoughts – someone who I’d known for many years. I was ashamed of the taboo nature of this thought, and also couldn’t see it as a disorder.

I studied to understand how OCD was recognised as a mental disorder.

My research shows, in particular, that important insights can be gained from a group influential clinical psychologists who worked in south London during the early 1970s. This sheds light on the reasons why many people, including myself, struggle to understand and recognise our obsessional thoughts.

The origins of concepts

Mental illness categories are constantly changing. As medical, scientific and public knowledge of an illness changes, it also affects how the illness is diagnosed and experienced.

Before the 1970s “obsessions”, “compulsions”, and other psychiatric terms were not grouped together. Instead, they were classified in different ways. In the early 20th century, British doctor James Shaw described verbal obsessive thoughts as “a mode cerebral activity where a thought, usually obscene, or blasphemous, forces itself into consciousness”.

According to Shaw, such cerebral activity can be a sign of hysteria or neurasthenia. It could also be a precursor to delusions. One of Shaw’s patients, a woman with “irresistible thoughts that were blasphemous, obscene and unutterable”, was diagnosed as having obsessional melancholia.

Shaw explained that the symptom was caused by “nervous weakening”, which echoed the view of 19th century, that obsessional thinking is indicative of a nervous system that has been weakened due to overwork, alcohol, or promiscuous behavior (also known as “degeneration theories“). Shaw didn’t mention repetitive behavior in relation to verbal obsessions.

Sigmund freud was the founder of psychoanalysis. Max Halberstadt via Wikimedia Commons

Sigmund, the Austrian psychoanalyst, created his ” Zwangsneurose, which is translated as “obsessional Neurosis” in Britain and “compulsion Neurosis” in the US. Freud used the term “Zwang” to describe persistent ideas that arise from the repressed conflict of unresolved childhood urges (love and hatred) and the critical self.

In Freud’s famous case study published in 1909 was the “Rat Man”, an Austrian officer with a number of complex symptoms. He was obsessed with the idea that he’d be punished by a rat, as a former Austrian army officer had told him. The patient said that if his father, who had already died, “would die” if he expressed certain desires like wanting to see a naked woman.

Freud described the Rat Man as engaging in “a system of ceremonial defenses” and “elaborate maneuvers full of contradictions”, which have been interpreted by some as the behaviours that would eventually lead to OCD. There are important differences between Freud’s “defences”, and OCD compulsions, such as the fact that the former involved more thinking than acting and was not consistent or stereotypical.

This article is a part of Conversation Insights

The Insights Team produces long-form journalism that is based on interdisciplinary research. The team works with academics who come from diverse backgrounds and have worked on projects that address societal and scientific issues.

The psychoanalytic category of “obsessional neurosis” was adopted and modified in Britain during the first world war, and became a staple – but inconsistently defined – diagnosis in British psychiatric textbooks of the inter-war period. Up to the 1950s, the terms “obsession” and “compulsion” were being used interchangeably in psychiatric writing. The complexity surrounding their meaning is demonstrated in the writings of Aubrey Lewis , a leading figure in post-war British psychiatry, who referred to “obsessional illnesses” as being made up of “compulsive thoughts” and “compulsive inner speech”.

Lewis, like Freud also mentioned “complex rituals”, such as the patient who “perpetually puts himself in the most trouble” to make sure he doesn’t step on a worm by accident”. He warned against the dangers of equating repetitive activities with obsessionality, writing that it “certainly cannot be judged based on behaviourist criteria”.