Everyone has that one friend on Facebook. You know the one I’m talking about: someone in the far orbit of your social sphere; someone you lost sight of for a while and who, in the intervening time, managed to achieve escape velocity from the sphere of reasonable political opinions and launched, like Albert II the space monkey, straight into Dingbat Galaxy.

Mine was a very good college friend from whom I’ve drifted away in the few intervening years. The moment I realized our worldviews were no longer reconcilable was when she “liked” a blog post titled something like “Snogging or Salvation?” Although, sadly, I can’t find the original column, I recall the argument was along these lines: any kind of premarital romantic contact, even kissing or hand-holding, places your eternal soul in immediate peril, because very few people resist the temptation to progress from these activities to sexual intercourse, and premarital immediately and irrevocably damns you to an eternity in Hell.

Now, a plurality of Americans would probably find fault with this line of reasoning, but even if you agree with it, think of all those times you’ve seen a statement you disagree with on your Facebook news feed. You probably just erased it, right? Or maybe you engaged in the storied and noble Socratic tradition of Facebook political arguments? Most likely you shrugged your shoulders and moved on.

It isn’t so easy when you have OCD.

I’ve written before about how OCD is, basically, the intolerance of uncertainty and the development of repetitive rituals to try to reduce the resulting . So, can you imagine how this interacts with religion, where absolute proof is unobtainable, and belief and tradition must suffice? Where ritual is non-negotiable? Where the for failure is existential, eternal?

Specialists call religious OCD “scrupulosity”, and it is distressingly common. Many religions make claims supported by longstanding traditions but unverifiable by any empirical standard. These traditions often demand restricted thinking and repetitive ritual to avoid eternal consequences. This combination, for many Obsessive-Compulsives, is like an unlocked liquor cabinet for an . If you pray, how can you be sure you really mean it? If you perform a sacrament, can you be sure you did it totally correctly? Most believers will shrug at these questions and say that their faith is enough. But “faith” can never be enough for an , because “faith” is not “certainty.”

I went to church as a child, and I spent literal weeks where my every waking hour was wracked with ceaseless, searching . My Sunday School classes taught me thought-action equivalency - that contemplating a sin is as bad as committing it. So, if I got bored during Mass and my mind wandered, was I putting idols before God? If I thought, silently, “I promise my soul to the devil,” would I be damned? Would I go to Hell because I believed in evolution instead of the literal truth of the Genesis creation story? For the Sunday mornings I skipped church, for those nights I skipped prayer, could I ever be forgiven? I could beg, but how could I be certain my prayers weren’t purely self-interested, that I was genuinely penitent? Was I damned? Did I deserve it? How could I ever, ever be totally sure?

These questions might seem laughable to you (as reasonable as you might be), or to any smug atheists or unshakable believers or indifferent agnostics reading. But for a young person struggling with mental illness, they were critical questions of life and death, demanding that I devote months and years of my life seeking an elusive resolution.

For the sufferer, the treatment for religious obsessions can be even more agonizing than the symptoms. As with all forms of OCD, the most effective treatment for scrupulosity is (ERP) , where the patient directly confronts the subject of their without performing protective rituals ("Full Exposure: The Sickening Treatment for OCD").

With religious obsessions, this means not only abandoning senseless behaviors invented by the OCD, but also disobeying actual religious traditions. So someone with a variant of OCD that demands that they not blaspheme, even in their head, might be required to curse out loud. Someone terrified of disrespecting the image of God might have to deface a piece of religious art. For someone like me, no longer a true believer but still haunted by religious concerns from , it meant all ties with Christianity, willfully and deliberately violating any creed that didn’t agree with my personal values - consequences be damned.

My own religious beliefs are complex these days, and difficult to articulate. For me, OCD therapy felt like a kind of conversion – it taught me a new way to live, and it gave me a new way to conceive of the holy. But it also raised theological questions without easy answers. I think about my old friend on Facebook and I wonder – what would she think of my therapy? Am I damned, because my ERP required that I violate God’s dictates for the faithful? Indeed, why would He create me with a disorder that causes such suffering, knowing that the only way I could escape it would be to violate His doctrine and condemn myself? I ask, earnestly, of any believer reading this – is God on the same side as my OCD?

There are no definite answers to these questions. All I have are my own best guesses, wrought from reason and experience and faith – answers more flexible and more compassionate than those of the doctrine and the disorder that both told me, each in their own way, that I was damned for thinking the wrong thoughts. So to any dogmatic conservative who stuffs a handful of Christian comic pamphlets in my face, to any militant atheist who scoffs because I cannot consider matters of faith with perfect rationality - please don’t think that you understand how the mentally ill suffer when they try to comprehend God. If indeed we were all created, we were not all made in the same image. We are agonistes, like Samson. We struggle.

Copyright, Fletcher Wortmann, 2012.

Author of Triggered: A Memoir of (St. Martin’s Press), named one of Booklist’s “Top 10 Science & Health Books of 2012”

Read my Psychology Today blog: Triggered

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