Norman Kraft, LST, DCH, MTOM, Dipl.Ac., L.Ac. July 17, 1999
Wei Chi, the last hexagram of the I Ching, indicates a time when the movement from disorder to order is under way, but not yet complete. This ﬁgure embodies our current level of understanding about this difﬁcult disorder, as neither East nor West has asolid grasp of the causes or treatment of Obsessive- Compulsive Disorder (OCD). While Chinese medicine gives us the opportunity for a sophisticated approach to disorders such as OCD, so little is understood about this disorder and the people whom it affects that we often don’t know where to begin to apply our ideas. In this article I discuss some of what we know about OCD from the West, andexplore some ideas about how we might approach it from the East.
c 1997,1998,1999 Norman Kraft. All rights reserved. This document may not be copied or distributed, in whole or in part, without the prior express written authorization of the author.
1 OCD: The West
“It seems to me essential for the understanding of the neurotic to go at the human problem from the side of fear, not fromthe side of instinct; that is to consider the individual not therapeutically as an instinctive animal but psychologically as a suffering being.” - Otto Rank, Will Therapy Obsessive-Compulsive Disorder (OCD) is primarily a disorder of the afﬂuent West, with an incidence in North America and Europe that is 15 times that of Central America and Asia.1 Like many of the diseases that have accompanied uson our journey to wealth and comfort, the low incidence of this disorder in China leaves us on our own in applying the ancient medicine we practice to patients with OCD. Therefore, it is vitally important that we take the time to explore what the West has learned about OCD toward a better understanding of our patients and the worlds in which they live. It is important to consider ﬁrst that OCD isdescribed in psychiatric texts in the grouping of anxiety disorders. That is to say that anxiety plays a major role in OCD and may be assumed, if unspoken, in the formal deﬁnitions below. From the perspective of Chinese medicine, this is an important distinction: consideration of OCD as an anxiety disorder will lead us down one path; considering the primary issue to be one of obsession will leadus down another. In my experience, the former is the more useful path. 1.1 Deﬁnition Obsessive Compulsive Disorder is a Western psychiatric diagnosis, referring to a group of patients who ﬁt the criteria found in the Diagnostic and
This statistic is often heard at OCD and psychiatric conferences, attributed to the World Health Organization.
Statistical Manual of Mental Disorders.This manual gives the following diagnostic features for OCD: The essential features of Obsessive-Compulsive disorder are recurrent obsessions and/or compulsions that are severe enough to be time consuming (i.e., they take more than 1 hour a day) or cause marked distress or signiﬁcant impairment. At some point during the course of the disorder, the person has recognized the obsessions or compulsionsare excessive or unreasonable. . . Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate. . . The individual is able to recognize that the obsessions are the product of his or her own mind, and are not imposed from without. . . 2 The most common obsessions are repeated thoughts about contamination (e.g., becoming contaminated by shakinghands), repeated doubts (e.g., wondering whether one has performed some act such as having hurt someone in a trafﬁc accident or having left a door unlocked), a need to have things in a particular order (e.g., intense distress when objects are disordered or asymmetrical), aggressive or horriﬁc impulses (e.g., to hurt one’s child or to shout an obscenity in church), and sexual imagery (e.g., a...