A pious Muslim doubts whether his ritual ablutions are correct. He goes back and repeats them. This doubt becomes stronger. It becomes a regular part of his religious life. He takes 20 minutes to make his ablutions, repeating each act of washing over and over again.
The worshipper doubts whether he has made a mistake in his prayers. He repeats the acts of prayer, and even full prayers over and over again.
For such a person, daily worship, which should be his greatest comfort and solace, becomes a source of anxiety, frustration, and despair. The arrival of each prayer is welcomed with dread, though the person has strong faith and deep down inside truly loves prayer.
This person needs to understand that he is not having a problem of faith. Rather, he is suffering from an illness that brings him to suffer from worry and despair.. This illness is known as obsessive-compulsive disorder.
The misgivings and doubts that dominate the persons mind and thoughts are obsessions. Obsessions have four characteristics:
1. They are specific thoughts that dominate a person’s thinking.
2. These thoughts do not have any real connection to the problems that the person is facing.
3. Trying to ignore or dispel the thoughts causes great psychological stress for the person. This person is not schizophrenic. He fully realizes that his misgivings are baseless, but he simply cannot resist succumbing to them.
4. The person who has these thoughts is aware that they are the product of his own thinking. He is not adopting them from someone else.
Compulsions are the behaviors that the person cannot resist carrying out. The following can be said about compulsive actions:
1. The action is carried out over repeatedly even though the person carrying out the action wishes to cease doing so. However, the pressure to continue repeating the act is greater than the will to stop doing so. Washing hands over and over again is a common manifestation of compulsive behavior.
2. The person afflicted with these compulsions constantly tries to overcome them. Every time he resists the urge to carry out the action, he suffers from severe psychological stress on account of it. This is only relived temporarily when he resumes the action again.
The types of thoughts that people have severe misgivings about can vary. Some people are constantly worried that they left the door unlocked or the gas stove on. A mother might constantly fret over her child’s safety oversees.
Behaviors commonly associated with severe misgivings are ritualistic behaviors. This is where certain specific activities are repeatedly carried out to appease the inward psychological pressures. The actions are performed in hopes of ridding the person of the troublesome thoughts. A common example is the belief that the hands are contaminated with germs. The person obsessed with this belief will wash his hands with soap and water over and over again. For some people, this means repeated visits to the washroom. For others, it means taking 45 minutes to wash the hands.
Another manifestation of obsessive behavior is ritually re-arranging things in very precise arrangements. Common targets of this kind of behavior are the appliances in the kitchens and the clothing in the clothes closet.
Muslims who suffer from obsessive-compulsive behavior often suffer from doubts in relation to their purification (doubting their wudû’) and their prayer (doubting whether they performed their prayers properly).
The good news is that 80% of those who seek proper medical treatment respond readily and positively to the treatment. Some do suffer from relapses and need further treatment.
Medical Treatment for This Condition
There are three aspects to this treatment: pharmacotherapy, behavioral therapy, and group therapy.
Pharmacotherapy entails the use of anti-depressants. Most patients require only one kind of anti-depressant, though some severe cases require a combination of them. Improvement is usually seen within six to ten weeks from the start of treatment.
Behavioral therapy is conducted by a clinical psychologist employing cognitive behavioral therapy (CBT). The patient is exposure to the stimulus that instigates the repetitive behavior while trying to gradually reduce the performance of that behavior. For example, if the patient usually washes his hands 40 times, he will be made to reduce this number down to 20 then to 10 then to 5 times, until the compulsive behavior is eliminated. The patient will try to become relaxed along with this reduction. This entails the application of relaxation techniques.
There are other treatments that have proven efficacy. The choice of an appropriate treatment should be determined by qualified medical professionals.