Incidently, I am not patient X - so do not worry about possibly offending me with your response.

Patient X accepts that this rationalisation is irrational, and that there are no empirical or a priori grounds which connect his repetetive behaviour to any kind of catastrophic event.
When challenged as to why he continues to carry out the behaviour given this acceptance, patient X claims that his mental illness is just like diabetes and just as diabetes cannot be cured by reason, neither can his OCD.

Could patient X be right about that? — MetaphysicsNow

You just described the situation that heis right about that, so why do you ask - it seems irrational of you. It is very similar to a phobia, X is frightened of not repeating the way one might be frightened of spiders, and the cure is not rational argument but facing the fear and desensitising it through actual contact. Reason is the slave of passion, not the master.

"Facing the fear" as you put it is to use one's reason to overcome a problem - you are basically reasoning yourself into acting in a way that you are initially aversed to, in order that (perhaps) by doing so, eventually you deal with the issue. I am well aware that aversion therapy is a technique used to treat OCD. My specific interest - perhaps I was not sufficiently clear about that - is in X's claim that X's problem is just like diabetes, insofar as no kind of application of reason (or passion for that matter) will help.

I don't think there is a general answer. He could be right, and he could also be wrong.

Mental illness is a sub-category of illness. And insofar that reason can help in curing ills that is how far reason can help curing mental illness.

So at one point someone died of diabetes. And then some time later we figured out some of the mechanisms for diabetes and developed medicines which allow a person to cope. Diabetes is actually pretty similar to mental illness in that there is no cure in the sense that a broken leg has a cure -- there are medicines, there is something you need to know, and then there's the part of attempting to build better habits to help manage the disease.

What is required, I would say, is that the passion to overcome fear is stronger than the fear. Reason will serve both. So again there is no sense in trying to contradict the patient's claim which is confirmed by his action.

X's habit is to allay his fears with ritual, and it has the effect of strengthening the fear in the long term as it allays it in the short. Perhaps he does not fully understand this, and then reason can clarify, but as he has (I presume) put himself in the position of patient, it seems that his reason has already set him on the road of looking for some other support for the resolution of the conflict he is in. He needs the therapist to hold his hand and lend him some strength, not tell him he is being unreasonable. Because, as he says, he already knows that and it doesn't help.

If the illness is like diabetes, then just as diabetes is incurable but can be managed by rational behaviour, e.g. compliance with a medication regime and lifestyle advice, then so can his OCD. It's not true to say: "I can't help having diabetes therefore nothing I do will affect the course of the disease."

I'm interested that you say you are not patient X. I think most of us are all patient X in one way or another.

X's reasoning certainly led him to seek therapeutic help. Before therapy X had about a dozen distinct OCD rituals. The therapist regarded these rituals as symptoms of chronic depression. The rituals that could be replicated within the context of a therapy session were subjected to aversion therapy. For instance, one fairly minor ritual involved picking up and putting down a glass a certain number of times before drinking from it - the therapist simply "forced" X to drink from a glass of water having picked it up fewer times, and then eventually to drink from the glass having picked it up only once.
There was some success in management of the symptoms, roughly half of the rituals were no longer engaged in, including some which could not - for contextual reasons - themselves be subjected to aversion therapy during sessions. So, X was clearly capable of applying the techniques used during the sessions outside of those sessions and was capable of managing at least some of these rituals by bringing them under the control of reason.
However, the therapy stopped (for diverse reasons, including but not limited to financial). Some of the OCD behviours that had been under X's control returned, new rituals also started to be engaged in. When X is questioned why, since X clearly has the rational capacities to control OCD rituals, X no longer does so, it is at this point that the reply along the lines "I have a disease like diabetes, the symptoms of which I cannot control" is given. When it is pointed out that X certainly could control them with weekly "hand-holding" sessions, which makes it at least curious that X is unable to continue to do so in the absence of those sessions, the response is "I cannot control the fact that I need therapeutic support in order to control my OCD".

I'm interested that you say you are not patient X. I think most of us are all patient X in one way or another.

Do you mean that we all engage in OCD rituals, or do you mean that we all have psychological hang ups of one kind or another? If the former, I don' think you are right, if the latter, you probably are.

I mean we all struggle with distinguishing what is in our control from what is not and what is comforting and helpful to us from what is damaging and unhelpful and what is our personal responsibility from what is visited upon us by circumstances.

Agreed. However X appears to be trying to exonerate himself for not engaging in those struggles by appealing to the fact that he has a disease which puts the symptoms beyond his control.

Could patient X be right about that? — MetaphysicsNow

That might depend on the severity of the OCD. I think "reason" can help, but being as aspiring Stoic I suppose that's to be expected. The Stoic maxim that we shouldn't let things beyond our control disturb us is, I think, useful in these cases if practiced. CBT seems heavily influenced by Stoicism, and may be helpful. Medication can help as well, I would think. I think reason can help, but may not be able to eliminate OCD in itself.

Yes, I think patient X is right. Even if he could understand why he is acting the way he is acting, if for wild example it evolved from his bed wetting as a child and the subsequent and sever parental admonitions that he received, that would not stop him from acting the way he is acting. There is no direct method I am aware of for solving the problem of this sort, it takes time and a lot of talking with a trained analyst, one who can help guide patient X into unraveling the knot he has gotten himself into.

OCD is based in fear, I understand, the compulsions designed to basically control life which is really all but out of our control, and reason such as CBT can help but may not be a total solution. Actually, the same approach to treating and possibly curing type 2 diabetes (controlled diet, exercise, and stress reduction) could be effective in treating OCD.

My conception of OCD is that is a disease in itself, not a way of dealing with fear, not sourced in some disabling childhood trauma, etc. The disease causes the discomfort and the repetitive ritual temporarily relieves the discomfort.

I have a small OCD tick: when I pick up a clean glass in my own kitchen, or in someone else's kitchen, I always rinse it before I drink from it. I don't have to rinse it, but I generally do. I'm happiest if the outside of the glass is wet, as well as the inside. If I am at a restaurant or someone's dining room, I feel no need to rinse the glass.

Wild animals in captivity and domestic animals (i.e., dogs) also develop OCD behaviors: They lick, for example: their paws, your feet, the couch, the floor... there is always something available. If you interrupt the behavior, they will generally stop, maybe for hours, before they resume.

Many animals will pace along a barrier fence, even if they have quite a lot of room to roam in.

Habit or OCD? Don't know. Some drugs help suppress severe OCD, which seems to be more than a habit.

[quote="MetaphysicsNow;d3334"patient X claims that his mental illness is just like diabetes and just as diabetes cannot be cured by reason, neither can his OCD.
Could patient X be right about that?[/quote]

No. The proof is in the lack of any definition. Where there is no definition, there is no understanding. No understanding, no cure. In that sense he's correct: for so long as he can avoid understanding, he can avoid being cured. Which leaves the obvious questions, what does he think his cure will be, and does he want to be cured? Or another way, he'll be correct until he decides otherwise.

As to behavioural therapies like desensitization, and others, they can be useful sometimes, for a while, for some people: they're not a cure.

I don't know. I have a fear of spiders and spider webs. Not all spiders, not all webs. I could elaborate, but you get the idea. I don't seem to have any OCD behaviors that have ever been related to this long standing phobia.

I sometimes feel fear when I find myself in a dark, unfamiliar street. It isn't a phobia, it's just "what kind of dangers lurk around here" kind of thing. I respond with an effort to find a more familiar, more brightly lit up area.

Repeated and/or graduated exposure and flooding seem to work for phobias. I don't see how they would be appropriate for OCD.

So again there is no sense in trying to contradict the patient's claim which is confirmed by his action. — unenlightened

That is true! I didn't mean to give the impression that we should contradict the patient. I was more just trying to focus on how the particularities of each case are important in assessing the truth -- so even if this guy is right, the next may be wrong, and there is no reason to believe the cases are related in spite of using the same name for similar behaviors.

X's habit is to allay his fears with ritual, and it has the effect of strengthening the fear in the long term as it allays it in the short. Perhaps he does not fully understand this, and then reason can clarify, but as he has (I presume) put himself in the position of patient, it seems that his reason has already set him on the road of looking for some other support for the resolution of the conflict he is in. He needs the therapist to hold his hand and lend him some strength, not tell him he is being unreasonable. Because, as he says, he already knows that and it doesn't help. — unenlightened

Good points.

I should also say that just because the patient may be wrong, that does not then mean that the analyst is in a better position than the patient to make that judgment.

There are issues about freedom of will involved here aren't there? X's position seems to be that his OCD rituals are out of his control because caused by some physiological condition. But if OCD rituals are caused by abnormal physiological conditions, then so presumably X's "normal" behaviour patterns are caused by "normal" physiological conditions, and would thus equally be out of his control. Is X prepared to accept the consequence that absolutely nothing he does is within his control? By trying to avoid responsibility for his OCD, he seems to be commited to having no responsibility at all for anything he does, which means - amongst other things - he can take no pride in any of his acheivements.

No. The proof is in the lack of any definition. Where there is no definition, there is no understanding. No understanding, no cure. In that sense he's correct: for so long as he can avoid understanding, he can avoid being cured. Which leaves the obvious questions, what does he think his cure will be, and does he want to be cured? Or another way, he'll be correct until he decides otherwise.

As to behavioural therapies like desensitization, and others, they can be useful sometimes, for a while, for some people: they're not a cure.

I disagree and I agree.

No amount of understanding will enable patient X to escape his compunction, it is not so much that he is avoiding a cure but rather that in order for someone like this to be cured, it has to be of his/her own doing. The knot that they have wrought, only they can undo, but rarely can this be done alone, which is why there is group therapy where the power dynamic of the group may help a patient see their problem for what it is, to help them unravel it.

And, I agree that removal of the symptom is not a cure, which is why I find CBT problematical.

I'm no psychologist but OCD is apparently classified as an anxiety disorder, and indeed CBT for OCD utilizes exposure therapy.

Being anxiety based, in my opinion the first step of treatment should be diet, exercise, and stress reduction. But I suppose that's too much work and people would rather take a pill, and big pharma would rather like to make a lot of money selling drugs. :sad:

People with OCD do experience a lot of anxiety, I gather.

Of course! Good diet, reasonable exercise, and practical stress reduction are good things and help people. So does getting 8 hours of quality sleep. So does having supportive friends. It isn't reasonable to expect good habits to cure everything (and you weren't saying it would).

Medication isn't appropriate for mild conditions, because people can deal with them on their own -- or with brief professional guidance. Where medication comes in is for conditions that are severe, where people's lives are seriously impaired by OCD, depression, anxiety, or whatever. Bi-polar people, for instance, generally have to use medication to maintain enough equilibrium to remain employed and/or out of the hospital.

In some cases, conditions don't have to be treated at all. Mild phobias, mild obsessive-compulsive trains, a little anxiety, a bad temper, etc. are tolerable. People who like to count steps, for instance, can get away with doing that. People who are afraid of snakes can usually avoid them, almost all the time, especially if they live in northern cities. I haven't seen a snake in years.

Of course! Good diet, reasonable exercise, and practical stress reduction are good things and help people. So does getting 8 hours of quality sleep. So does having supportive friends. It isn't reasonable to expect good habits to cure everything (and you weren't saying it would). — Bitter Crank

Is it getting 'good habits' or is it discontinuing the bad habits (sugar, caffeine, processed food, sedentary and stressful lifestyle, etc.) that were directly causal in the condition to begin with? I've come to understand recently that our emotional life is intimately linked to our body. That probably sounds obvious. What I mean is more like that our emotions exist to help regulate our metabolism appropriately for the environment. We didn't evolve to consume the amount of sugar, fat, etc. that people normally do today, or to be as sedentary. It's a wonder that we aren't crazier than they are.

It's a wonder that we aren't crazier than they are. — praxis

We're pretty crazy!

I don't know whether it was bad food that led to all this crazy behavior, or not. I wouldn't be surprised. Something is causing a lot of problems. The problem of diagnosis our social ills is that there are multiple causations going on all the time. Everyone (OK -- 99.4%) have grown up with extensive media exposure: radio, television, film, recorded sound, print, internet. Up until the mid 50s at the latest, a lot of people ate much more "organic" food because the smorgasbord of pesticides and herbicides didn't become iniquitous (not a spelling error) until a bit later. Since the mid 60s (at least) more and more chemicals have been distributed as fertilizers, herbicides, pesticides, medications, cosmetics, cleaning agents, and so on. A lot of these chemicals are "endocrine disruptors" -- their molecules are quite similar in effect to hormones and screw things up in our bodies.

Then there is the absurd diet that many people are eating -- too much protein, carbohydrate, salt, fat, etc. and way too little fiber, too few micronutrients, and too many calories. That just can't be good.

Then there are antibiotics and the microbiome -- we know that ordinary antibiotics taken appropriately to quell bacterial infections often cause diarrhea--loose stools, because the normal host of bacteria are greatly reduced. Food just isn't getting processed normally. If the antibiotic regimen is long and strong enough, one may suddenly have a totally different colony of flora and fauna in one's gut. "Gastro-psychologists" (just invented new specialty) think that bacteria may have quite a bit of effect on our emotions. Hasn't been proven, but... again, I wouldn't be surprised.

"Gastro-psychologists" (just invented new specialty) think that bacteria may have quite a bit of effect on our emotions. Hasn't been proven, but... again, I wouldn't be surprised. — Bitter Crank

Funny you should mention that, just this week I started a regiment of probiotics as a treatment for social anxiety. I’ve planned to try it for at least 30 days before assessing. I have noticed a general increase in energy so far, which may not be coincidental.

I've read that probiotics can/may be helpful, but if you feel better already, it could be coincidental or a placebo effect (placebo effects are nothing to sneeze at). Please do report back and let us know how it worked after a couple of weeks.

I don't think anyone has perceived the mechanism for HOW the biome affects mood, except that how food is digested and absorbed is largely due to the efforts of all those various organisms. There is a slightly more understood relationship between the biome and the immune system -- the biome helps train the immune system in self/not self.

It's a very intriguing area. Were I a young biologist, I might dive into it, figuratively.

Yes, and that self-exoneration is another thing that most of us share with X. We try to duck responsibility by pointing to circumstances or other people beyond our control. For we are sons of Adam and daughters of Eve. But X may be right. He may not be able to stop himself. It's hard enough for each of us to tell in our own case, never mind someone else's.

There are issues about freedom of will involved here aren't there?

I think this is spot on. Norman Malcolm's paper "The Conceivability of Mechanism" and Strawson's "Freedom and Resentment" come to mind as relevant here. Obviously, doing philosophy isn't going to cure X in and of itself, but my feeling is that X is being dishonest with himself and giving himself bad reasons for giving up the (no doubt, for him, difficult) struggle involved in simply being human and doing a little philosophy might help him see that, which may in turn motivate him to pick up the struggle again on his own terms.

What exactly is dishonest in the scenario you posited? In what way is the patient lying to himself?

The lie is that X's behaviour is not within his control. The bad reason he is giving himself for insisting on this is that his behaviour is caused by the physiological abnormalities in which (for him) his mental illness consists.