Magical thinking and superstition play a significant role in OCD. Magic connects things that do not really connect, but lets you think you can control things that in reality, you can never control. Having intrusive, unpleasant thoughts would make anyone feel that their own thinking was out of control. The reason that OCD sufferers are so strongly drawn to magic seems to be due to three reasons. First, in OCD, doubt and anxiety are so great, sufferers will go to almost any length to achieve ‘perfect’ certainty that they can prevent the negative things their thoughts tell them will happen to themselves or others. Second, human beings appear to have a natural tendency to think superstitiously. Third, when no real-world solutions are possible, magic can seem like the only option. This is a bad combination for OCD sufferers.
OCD sufferers may use magical thinking to protect themselves, but it ultimately works against them, and can lead to even more frightening and seemingly real obsessive thoughts. The types of magic that can be incorporated into obsessive thoughts come in many forms. One type that has not been written about very much has to do with a sufferer’s fears of somehow taking on or absorbing the negative characteristics of other people with whom they have some type of contact. This is actually a variation on obsessive contamination fears, rather than a unique type of OCD.
In better known (almost a cliche) type of contamination fears, sufferers fear to come in contact with such non-magical things as bacteria or viruses, and things excreted or secreted by other human beings (or animals), and include blood, mucus, urine, feces, sweat, semen, etc. They may also fear such things as toxic chemicals, spoiled food, radiation, broken glass particles, etc. Despite the fact that these are things that can be seen, smelled, or touched, sufferers can still have powerful doubts about whether or not they have actually come into contact with them.
Those with magical contamination thoughts involving other people may fear being touched by, being near, or touching things belonging to or touched by, or that may have touched someone (either a stranger or someone familiar), or hearing or touching the name of, or seeing or touching a picture of anyone:
an unpleasant character (aggressive, mean, insulting, strange acting, bad manners, etc.)
suffering from a physical or mental illness
having a developmental disability (such as autism, etc.)
who is visibly who is physically unattractive (overweight, having acne, shabbily or strangely dressed or unkempt, having an unpleasant odor, poor personal hygiene, etc.)
who has disabled (blind, deaf, in a wheelchair, on crutches, etc.)
who is somehow contaminated in a way that the sufferer cannot explain (When asked, they may say, “I don’t know, they just seem contaminated.”)
who died of an illness or disability
Recently, a 13 year-old boy named Ethan was brought to see me for what appeared to be a problem with school refusal. Learning problems seemed unlikely, as he had always been a good student. It also didn’t seem to be a social problem, as he was popular and had many friends. At first, he simply wouldn’t go to school, and became upset and had temper outbursts each morning. When asked why, he said he didn’t want to talk about it. Ethan’s parents thought that it might be due to bullying. Eventually, he would not go near the school, and later, wouldn’t even go to the side of the town where the school was located. The school provided home tutoring, but also threatened to charge his parents with educational neglect for not making him go to school. They saw it as a discipline problem. However, it appeared this might be a more serious problem than simply being bullied. His parents took him to a therapist who didn’t get very far with Ethan, and diagnosed him as suffering from Oppositional Defiant Disorder. At this point, a friend of the family, whose daughter I had once treated for OCD, suggested that Ethan had a similar problem, and referred them to me.
At his first visit, I could see that he was really edgy. Bringing up the subject of bullying, brought a quick denial. I switched to discussing his favorite subjects in school, as well as his after-school soccer playing and his team’s excellent record. I asked him if he missed these things. He sadly agreed
I sympathized, and told him that since he missed these things so much, I was puzzled at his non-attendance. He replied that it was embarrassing and that I wouldn’t get it. I asked him to try, and that if I didn’t get it, I wouldn’t bother him any further. I asked that if I did get it, would he give me a chance to help him. He accepted the deal.
Ethan related, “There are two boys in my school who are mean. It’s not like they’re bullying me, but they push kids, cut in lines, and I think their clothes don’t look very clean. One of them picks his nose, and I heard that their grades are bad. I never hung out with them or went near them. One day, one of them brushed against me in the hall, and then the other one bumped into me in the cafeteria. I worried that something from them rubbed off on me, and that it would make me mean and get bad grades. When I got home, I showered and changed my clothes because I thought it would help. When I went back to school the next day, I tried to not go near them.” I asked Ethan, “So you were worried about becoming like them?” “Yeah,” he replied, “Like I would turn into being the way they were.” “Like you were contaminated?” “That’s it.” Ethan answered. “I know it sounds stupid,” he added.
I looked at him and said, “Did you start worrying about how to avoid touching things they touched, like desks, chairs, books, or doorknobs?” Ethan stared at me in surprise. “How did you know that?” he asked. Still looking at him, I added, “And that’s why you don’t want to go to school anymore? Was it because there were too many things to avoid, and you would feel totally contaminated if you went there.” “That’s right,” he shrugged.” I didn’t tell anybody because they would think I was crazy.” “Would you like me to explain it to them?” I asked. I think they’ll listen to me.” “Okay,” Ethan replied uncertainly. “If you think it can help.”
I asked, “Would you be willing to work with me, if I could help you to get rid of these worries and get you back to school and sports? It will take work, but I think you can do it.” “Yes,” Ethan stated with sudden enthusiasm. “I would like that.”
I informed Ethan’s family and school about the situation, and got everyone on the same page. The school eased off, and his parents brought him for weekly treatment sessions. Because Ethan’s thoughts were so believable to him, and because his anxiety was so high, I also referred him to a child psychiatrist I work with, who started him on an SSRI-type antidepressant.
We started Ethan’s behavioral therapy by making a complete listing of all his magical anxiety-provoking thoughts, all the things he was avoiding, and all the physical and mental actions he was taking to avoid or neutralize his anxiety. Next, we made a hierarchy, which is a rating scale of all the people, places, things, and activities that could trigger Ethan’s fears. Having this would allow us to be able to tackle his fears starting with the lowest level ones, and gradually work toward the highest. I explained to him that if he stayed with what he feared long enough, he would learn the truth, and wouldn’t be fearful anymore. I told him it would be like visiting a Halloween haunted house a hundred times. “Do you think that by the hundredth time it could still scare you,” I asked? Ethan agreed it wouldn’t.
We began by looking at pictures of the feared boys, and writing down and looking at their names many times each day. We also posted their pictures and names in his room. Along with this, we moved on to drawing on a map, the limits of how close to the area of the school he could go. Each week, we set as targets, places he would visit and remain in for a while, that were closer to the feared zone. He would also bring home objects or things to eat from these locations, which included stores, movie theatres, diners, etc. Next he had to drive closer to the school each day in a car with the windows closed. He was later able to get out of a car across the street from the school when it was closed. He also listened to recordings telling him how he would be contaminated and become like the two feared boys.
A breakthrough came when Ethan entered the building on a day when it was closed. It wasn’t easy for him, but he was brave. He gave me a tour of the building, to see his classrooms. He seemed relieved to finally be back there. Soon afterward, we visited the building at the end of a school day, and next walked around during a school day (without going to class), sitting through a few subjects where the feared boys wouldn’t be seen, and then finally, attending a full day of class. During this time, he was instructed to bring home some small things and touch them to many things there. The last phase was walking and inhaling near the feared boys, touching things they touched, and finally brushing against them in the hallways.
This work took about nine months. It can sometimes take longer, but Ethan was really motivated. Magical thinking doesn’t respond to logic but facing what you fear will significantly reduce both doubt and anxiety.
Fred Penzel, Ph.D., is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and related disorders. He has written numerous articles that have been featured in many issues of the International OCD Foundation Newsletter.
If you would like to read more about what Dr. Penzel has to say about OCD, take a look at his self-help book, "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well (2nd edition)," (Oxford University Press, 2016).