8th Annual Year in Ideas: Scrupulosity Disorder
By JASCHA HOFFMAN
In a paper published in the August issue of The Journal of Anxiety Disorders, Chris Miller and Dawson Hedges of Brigham Young University estimate that as many as one million Americans may suffer from a moral-anxiety-cum-mental-illness known as “scrupulosity disorder.” They define it as obsessive doubt about moral behavior often resulting in compulsive religious observance — and they warn that it can lead to depression, apathy, isolation and even suicide.
As the believing man’s version of obsessive-compulsive disorder, the diagnosis raises questions about where, exactly, the line is to be drawn between probity and perversity. It isn’t obvious how to treat someone who can’t sleep for worrying about their rectitude — or a devout Christian who is seized by the urge to exclaim, Goddamn! and repeatedly reproaches himself for it. Rather than try to fight off obsessive worrying, therapists might ask patients to give in to it, so that they can see that their supposed transgressions might be harmless. “If you believe in a God that’s all-knowing, you should trust him to know these blasphemous thoughts are mental noise and not what’s in your heart,” says Jon Abramowitz, director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill.
The diagnosis might raise some difficult issues. Ritual hand washing could seem compulsive in an atheist, but surely it isn’t for a Muslim, for whom such behavior is ordinary religious observance. Are the anxieties and fears that may accompany a passionate religious life themselves pathological? Abramowitz, who has treated scrupulous Christians, Muslims and Jews, is confident that a therapeutic approach to obsessive spirituality does not threaten religion. He says that when patients are gradually released from crippling doubt about their own virtue, they can emerge with a new sense of faith.