Scrupulosity: Doubt, Obsession and Compulsion

I have discussed earlier in this blog’s life the concept of scrupulosity, sometimes referred to as religious OCD (obsessive-compulsive disorder.) That particular post was a bit of a mish-mash of things I found online, and I felt it had some shortcomings. Nevertheless it remains the most searched-for and viewed article on my whole site. I decided to write something a little more substantial, and so I bought two books on scrupulosity, in order to prepare this post. I hope it is a bit more thorough than the last.

A note of caution: I do not, myself, suffer from scrupulosity or obsessive-compulsive disorder, so I am not writing from first-hand knowledge, as I usually do, but am really relying on the books I have read. If you would like to comment and give a first-hand account of what it is like to live with scrupulosity, I would be delighted to include that.

What is Scrupulosity?

In its earliest sense a scrupulum was a small sharp stone, the sort of stone that you get in your shoe and which starts off as a little irritant, only to become more and more irritating until it is removed. In the sense I mean here, scrupulosity has been described as the “doubting disease” and “a thousand frightening fantasies” – it is an unreasonable fear of sin, a disordered view of the sinfulness of the sufferer, an anxiety and a fear of God. Sufferers magnify small faults into major sins, and are constantly on edge, feeling as though they will commit a dreadful sin against God at any time. It is closely tied with a feeling that certain actions have not been performed correctly, and a sometimes paralysing need to repeat actions to relieve the anxiety.

For example Mrs Smith may repeat family mealtime prayers over and over because her fear is that the prayers have not been heard, due to her own stray thoughts and distraction by fidgety children.

Scrupulosity is a disordered response – where one person might ignore stray thoughts during prayers, a scrupulous person may not be able to, and may imagine retribution from God for those distracting thoughts. It is usually recognised as not normal, or not affecting other people, and so can be accompanied by feelings of shame.

Scrupulosity, the term, is a Catholic one, and the books that I have on scrupulosity are Catholic in origin. Several famous saints (of whom more later on) have suffered from it, and written about it, and the guidance of the Catholic Church seems more organised and the condition more recognised than in Protestant churches. That is not to say that non-Catholics cannot suffer from scrupulosity – I suspect that it is just less recognised and even more hidden than among Catholics.

One of the books I have, that by Fr. Thomas M Santa [1] says that there are two “stages” of scrupulosity. The first is having a “tender conscience,” scrupulosity in a more minor form, where care must be taken and help received from a confessor or spiritual director, but this is distinguished from scrupulosity as a form of obsessive-compulsive disorder, where the scruples are so interfering with normal functioning, in life, work, day-to-day living, that it needs treatment by professionals as well as by spiritual counsellors.

Another book I have [2] further distinguishes types of scrupulosity into two major types: developmental and emotional. Developmental scrupulosity is triggered by adolescence, by a “newly emerging sense of conscience” whereby the person becomes more sensitive to sin. It tends to disappear with further guidance and development into adulthood. It can also arise as part of the conversion process, for example, Martin Luther had scruples before becoming the reformer we know him as today. Self-reflection and/or advice helps the person look past the minutae of sin-listing that they may be engaged in.

The other form of scrupulosity, which is the one that I suspect most people reading this post will be interested in, is emotional scrupulosity. This is more enduring, and contains many of the symptoms of obsessive-compulsive disorder, to a greater or lesser degree. My second book, by Joseph W Ciarrocchi, gives a list of things that may be involved for the obsessive-compulsive.

1. Obsessional checking (for example, to see if the gas is still on, or the front-door locked)
2. Obsessional cleaning
3. Obsessional slowness (precision in carrying out activities so that it takes excessive amounts of time to complete them – for example spending forty minutes making the bed to get it just right)
4. Obsessional doubting – or conscientiousness. This is the doubt that something is done properly, either by omission or commission. For example the person may believe they have offended a neighbour by their tone of voice on greeting them, or doubt that they greeted them at all even though they do so normally.
5. Obsessional ruminating – going over and over an idea or image. The person may have unpleasant intrusive thoughts such as the death of people they love, sexual thoughts, including blasphemous ones, any thought which the person absolutely hates, but which comes into their heads anyway. Most of us have intrusive thoughts now and then, including ones which we really don’t mean (such as saying prayers and getting a sudden impulse to swear) but, for most of us, these trouble us little, as we recognise that they are a normal by-product of the brain, and concentrating on them is more likely to make them happen than stop them.

People may also find that they worry about future disasters, or feel that their thoughts are dangerous to others – that if they think or wish something bad to happen then it will.

The “compulsive” element refers to the means by which the scrupulous person tries to make right what the obsession has made faulty. These may include repeated confessions, prayers, penances, repetition of certain words, actions or gestures, all intended to negate the affect of the original anxiety.

Famous Sufferers

There are a number of historical figures who have suffered with scrupulosity. The most famous of these are Ignatius of Loyola and Alphonsus Liguori, although other figures have had the diagnosis tentatively attached to them. It is hard to claim a definitive diagnosis for a figure from the historical past, but I have included information here, because it is present in the books I have been reading.

John Bunyan

“In his autobiography, Grace Abounding, Bunyan wrote that he had led an abandoned life in his youth and was morally reprehensible as a result. However, there appears to be no outward evidence that he was any worse than his neighbours or colleagues in the Parliamentary Army – who spent much of their time in Taverns and Brothels of Newport Pagnell. Examples of sins which John actually confessed to are; profanity, dancing, and bell-ringing. An increasing awareness of his un-Biblical life led him to contemplate acts of impiety and profanity; in particular, he was harassed by a curiosity in regard to the “unpardonable sin” and a prepossession that he had already committed it. He was known as an adept linguist as far as profanity was concerned; even the most proficient swearers were known to remark that Bunyan was “the ungodliest fellow for swearing they ever heard”.

He continually heard voices urging him to “sell Christ” and was tortured by fearful visions. While playing a game of Tip-cat on Elstow village green, Bunyan claimed to have heard a voice that asked: “Wilt thou leave thy sins and go to heaven or have thy sins and go to hell?” Because Puritans held the Sabbath day sacred and permitted no sport, John believed that this had been the voice of God, chastising his indulgent ways. John’s spirituality was born from this experience and he began to struggle with guilt, self-doubt and his belief in the Bible’s promise of damnation and salvation.”[3]

Some writers believe that Bunyan suffered from scrupulosity, and note that sometimes scruples occur in people who have spent time in the past violating religious or moral laws, and that some who become scrupulous are free from all piety or religious law in their adolescence and young adulthood. Bunyan was known for his moments of ecstatic grace followed by intense doubts about his salvation, where he did not believe he had faith, or feared that he was not called to salvation and that the time of grace was past. He searched the Bible for verses that gave reassurance and grace but his doubts always recurred. He also had obsessions about blasphemous thoughts, cursing and swearing, and worried that he had committed the unpardonable sin, as well as experiencing urges to commit it. He knew that his obsessions were foreign to him, and had distaste for them, but gained some comfort by sharing his troubles with another person.

Ignatius of Loyola

During his youth and early life Ignatius was a soldier, and experienced religious conversion in 1521 after being wounded in battle. He made a general confession, writing out every sin in great detail but he was tormented, thinking that he had forgotten something. He thought that he would find peace with the right spiritual director and confessor, but kept hopping from one to another as he did not trust the direction of each one. He had thoughts of suicide, but decided he never wanted that thought again, and made the decision not to confess his past sins again. From then on he was able to be free from his scruples. Earlier, he had come to the conclusion that scruples are temptations, when working with his confessor.

Alphonsus Liguori

This saint was born in 1696 in Naples. His mother had a tender conscience – if not scrupulosity, which may have influenced Liguori. He used to exhaust most confessors in his city trying to make decisions and choices in his life, as a young man, and, as a grown man, was never able to be entirely free from his scruples. He had many physical ailments, which possibly were the result of his mental difficulties, his scrupulosity. His teachings on scrupulosity are contained in his Guide for Confessors (also known as the Praxis Confessarii)

Treatments

The one thing that rings out loud and clear from the books I have read is that scrupulosity is not something that can be dealt with alone. They recommend first, a spiritual director who is familiar (or who can make themselves familiar) with scrupulosity, who is to be obeyed absolutely. The person must put themselves in their hands and trust them, even if they think that, for example, they just need to confess their past sins one more time, if they are told not to do so then they must not do so. This applies to non-Catholics as well – picking a spiritual director, who could be a friend, pastor, counsellor; someone who can provide good advice, and then sticking to that advice even when it is very hard to do so, is really important. I cannot tell you how often in these books has it been repeated that chopping and changing spiritual directors is bad for the scrupulous, it will not help to alleviate the problem.

Professional help, especially for the most severe type of scrupulosity, is very important too – if you can be sure of finding a therapist who is understanding of the religious content. They may use treatments such as Exposure and response prevention (ERP) or cognitive therapy. Sometimes, antidepressant medication is also used.

One of the principles of ERP is that of agere contra – doing the opposite. If, for example, you are troubled by blasphemous thoughts when reading the Bible, then you must read the Bible more, and face the fear. I should add that the book I gained this information from states quite clearly that self-help, and particularly the use of self-help books, is not ideal for those who are scrupulous. It does mention that what can be useful is keeping a record of circumstances surrounding scruples – of recording triggers, using the “who, what, when, where, why, how often, how many and how much” questions, and including the intensity of the anxiety, amount of time spent and so on. This presupposes a therapist to work with this system, and comes (along with lots of other information on this, from Ciarrocchi’s book)

Loved ones may also help, by interrupting rituals where they apply to themselves – for example if someone obsesses that they have offended their partner and must hear the words “I forgive you” over and over then to say it reinforces the problem. The advice is to learn more about scruples and say, for example, “The doctor said we were not to do that for you.”

Specifically Catholic advice about confessions

This comes from Thomas Santa’s book (although it is not directly quoting):

1. Confessor must convince the penitent that it is always safe to obey his/her spiritual director where there is no sure sin. This is the teaching of many saints.
2. The only anxiety the sufferer should have is in not obeying their confessor/spiritual director.
3. God does not weigh every last detail of our lives, but is merciful, understanding our weaknesses.
4. Do not read books that increase scrupulosity or mix with others who suffer from this, and may even be advised by a priest to avoid attending sermons on subjects which increase guilt and fear.
5. It should be presumed that the sins have not been committed unless it is extremely certain that they have.
6. The first obligation is to conquer scruples when what the person is doing is not clearly sinful.
7. Do not re-examine the confession that has been made.
8. It is not possible to commit a sin accidentally.

General Points

On a more general note, scrupulosity is an extension of what many people believe about God. We somehow believe – perhaps through early training – that he is constantly on the look-out for sin, that he is watching and waiting for the time when we make a mistake, for that sin we have failed to repent of, for any excuse to punish us either in this life or the next. We worry so much – even those of us who have not got anything like as severe as scrupulosity worry about whether God loves us, about whether we are worthy of him, about our sinfulness and the things we get wrong.

The truth is, of course, that no, we are not worthy of God. But that is just the point – there is no way any of us are ever going to be worthy of God. That is why Jesus had to come, because in him and through him we died to sin, are raised to life with him, and each and every sin we have or will ever commit has been forgiven, because we repent and because Jesus died for us. We repent our sins – but we serve a loving and gracious God, a God who went so far as to die for us, and if we forget any? I really don’t think that God has a list of all our sins, ticking off those ones we repent for, and waiting for us to forget one, and so deny us heaven. In fact, I think that is completely against what God would do – and, if I think I have forgotten something, I simply say “and may You forgive me for those sins I cannot now recall” – and then I trust in the God who keeps his promises, and who didn’t go to all that trouble, all that pain on the cross to turn around and say, sorry but you forgot one.

You are still a Christian. You are still a child of God, scrupulous or not. Being frightened, being worried, being anxious, does not stop that. It means you are not living the life God wants you to have, that life of freedom, but it does not mean condemnation.

Talk to someone. Someone who knows a lot more than I do about this. Get help, and don’t suffer in silence with something that is tormenting you – when it is the will of God that you delight in him, that he is a source of joy. You have a problem, and it will be hard to help it, but it can be helped.

Books

I have used two books in this article, which are a bit different from each other. I bought them both for the Kindle, from Amazon UK and the links will take you to that site.

The two books are “Understanding Scrupulosity: Questions, Helps, and Encouragement” by Thomas M Santa, and “The Doubting Disease: Help for Scrupulosity and Religious Compulsions” by Joseph W Ciarrocchi.

The book by Fr Santa is largely comprised of question-and-answers between scrupulous people, and priests. It contains very detailed advice on a number of dilemmas, set out in short sections. It goes into some detail about practises involving confession – so, for Catholics, this is an excellent book. Much of what is written will not be of much use to non-Catholics.

The book by Joseph Ciarrocchi is more general, and would be useful to non-Catholics as well as Catholics. It contains examples of worksheets to be used in treatment, and I found this the most useful source for a very general article such as this.

I would recommend either of these books as useful and interesting. Plus they are available on Kindle!

For my final thing here, I would like to recommend the website Scrupulous Anonymous which includes their newsletter and more information. It is run by the Redemptorists and involves Fr Santa – indeed this is where many of the questions in his book come from. I would particularly recommend the 10 Commandments for the Scrupulous and the revision of those commandments.

References

[1] “Understanding Scrupulosity: Questions, Helps, and Encouragement” Thomas M Santa (Rev. Ed. Missouri: Liguori/Triumph 1999, 2007 Kindle Edition)

[2] “The Doubting Disease: Help For Scrupulosity and Religious Compulsions” Joseph W Ciarrocchi (New Jersey: Paulist Press, 1995 Kindle Edition)

[3] Wikipedia, “John Bunyan” http://en.wikipedia.org/wiki/John_Bunyan accessed 20/05/2013