What causes Obsessive-Compulsive Disorder? Why can't the sufferer just summon enough willpower to shake off the entangling obsessions? Are there spiritual issues involved or is OCD a purely physical problem in the brain? To someone who has never struggled with this disorder, these questions are merely theoretical. But when you watch someone agonize over the smallest things, when waking life becomes torment and even dreams are haunted with the all-mastering obsessions, these questions — and their answers — take on a pressing practical importance. The daughter of a dear friend of mine lives in the stranglehold of OCD, and I wanted to educate myself a little about the disorder and its spiritual consequences and possible causes. Though OCD: Freedom for the Obsessive-Compulsive is just a short pamphlet, it does a good job of describing the disorder to a layperson like myself and compassionately outlining its spiritual implications from a biblical perspective.

A big question for Christians is whether OCD is a disorder or a case of disobedience. If it's just a physical problem within the brain, the OCD sufferer is not really culpable for his or her behavior and can do little to change a physical defect. If it's disobedience, the OCD sufferer is responsible for his or her behavior and can do something about it. How we define OCD is crucial because the implications are immense. In this essay, author and counselor Michael Emlet appears to take a stance somewhere in the middle of these two opposing definitions. There is, of course, so much that we don't know about the disorder and its causes, and so much fuzziness among both Christian and secular therapists and researchers. But this is what I think Emlet is saying: some cases of OCD may have physical factors that contribute to or perhaps cause the disorder, but our sinful hearts amplify the consequences of our obsessions. For Christians, we can never brush aside the foundational doctrine of human depravity. It influences everything and has to be our starting-point in any definition of human ills.

This is not to say that OCD sufferers are worse sinners than other people, just that they have unusual circumstances (their OCD-entangled brains) which provide the arena for their individual struggles with obedience and truth. I struggle with those two things on a daily basis, just not in the realm of obsessions and compulsions. My friend describes her daughter's disorder as almost being unable to reject the lies that her OCD tells her, even though she knows they are false. Emlet writes that the obsessions themselves are not sinful; just as with temptations, it's what we do with them that leads us into sin or godliness.

The reason we don't know if OCD is caused by physical factors, despite some differences between the brains of OCD and non-OCD people, is that we can't prove a causal relationship. Does OCD come from those brain irregularities, or does the OCD actually develop those characteristics in the brain? We might as well ask what came first, the chicken or the egg. One thing that I found fascinating is that young children with strep throat sometimes can display OCD-like symptoms that dissipate with the strep throat when antibiotics are taken. Is that real OCD, or just some strange flukey state that mimics OCD symptoms? Right now we just don't know.

Emlet acknowledges the physical aspect of OCD while emphasizing the truths that OCD sufferers are missing when they act on their obsessions, writing, "While affirming that the body and brain are ultimately not the "cause" of sin, we should not underestimate the overwhelming tyranny that these bombarding thoughts can exert on these sufferers. At the same time, we can also affirm that as the OCD struggler addresses the heart issues involved, the symptoms (the frequency and severity of the obsessions and compulsions) should decrease" (24). He lists a series of heart (that is, spiritual) issues that may be related to OCD: the need for certainty, the demand for control and mastery, the desire for a "black and white" world, perfectionism, guilt, and self-atonement. Each of these issues represent faulty theology in some form, and that can be combated with the truth of Scripture.

But I want to stop and clarify something here. While we affirm the sufficiency and power of God's Word, Emlet is not saying that memorizing a few verses will cure the person. Though the exact causes of the disorder are not known, there is a physical component to OCD and to ignore it is dangerous. Medication may be needed, though all it can do is treat the symptoms. But we can't stop there, just treating the symptoms; there are always spiritual implications. Emlet writes, "there may be a time and place for _targeting the symptoms themselves, particularly if the person's struggle is so severe that he cannot benefit from counseling. The use of medication is a wisdom issue and must be individualized for each counselee. There are biblical guidelines for making such a decision, but there is no "one size fits all" approach... The Bible speaks positively about both the relief of suffering and the benefits of enduring it... [medication] may be wise for certain individuals with severe symptoms, but we must never lose sight of the heart dynamics invariably present with OCD" (25).

As I think and work through these issues, I am reminded of the limits of human wisdom. I really don't see the purpose of OCD in my friend's daughter's life — why, God? Why do You let people suffer like this? Is there an end (besides Heaven) in sight for her? But the answer for Christians doesn't change: trust God, trust His wisdom. We walk by faith and not by sight; we know that He loves us and that He is good. That's all we need to know. It isn't a platitude when you cling to this truth in the middle of the OCD nightmare.

This pamphlet is part of the "Resources For Changing Lives" series published by P&R. I recommend it. ( )