Other Symptoms And Symptom Complexes

Obsessive-Compulsive Patterns

There were seven men and twelve women diagnosed as psychoneuroses of the obsessive-compulsive type. Of these patients, two men and five women met the classically described combination of repetitive behavior and recurrent ruminative, indecisive and circuitous thoughts. They exhibited the well-known hand-washing, germ- dust phobia, rituals of cleanliness and food preparation and the endless self-debates and tenacious preoccupation with certain numbers, letters, words or ideas.

The others, also diagnosed as cases of obsessive-compulsive reaction, presented a limited, somewhat encapsulated obsessional reaction to a specific event which they found difficult to “digest” emotionally, or a particular obsession with a body function or body organ. In the first instance, examples would be the young girl rejected by a boy or the wife who discovers the husband’s infidelity. There was interminable rehashing of the traumatic event in the patient’s mind. If sex were an added issue, it occupied prominence in these tormenting ruminations. The young girl debated with herself about the intactness of her virginity, even if the sexual advances had not gone that far. The deceived wife went through every detail of the husband’s perfidy, often subjecting him to endless cross-examination for verification of details, not only to punish him but to feed her own fantasies. The suffering occasioned by these obsessional sieges was indisputable.

A few of the personality disorders were classified as obsessive-compulsive. Their rigid, perfectionistic personalities were combined with manipulativeness, a penchant for controlling and driving others, and sado-masochistic relationships with their loved ones. The availability of interpersonal and environmental outlets promoted in particular this talent for manipulating and controlling others. One woman rang a bell at four o’clock every morning to wake up her maids and start them on their dusting and cleaning schedules. Executives, department or section heads, or supervisors found their subordinates rather vulnerable to their domination.

Four women and one man had religion woven quite prominently into their obsessive-compulsive patterns, not only in their praying habits but also in philosophizing for hours to themselves about God. Two women fought intrusion of obscene four-letter words while they prayed. The clergymen and nuns showed none of these symptoms; their problems were more of depression and anxiety as related to unresolved anger and dependency. Patients in general did not use religion in an obsessional way. Rather, religion and God were experienced in an interpersonal context. Two conversion reactions occurred after intense, highly emotional religious retreats. Several young men and women noted the start of their illness “last Holy Week” or “after I took the retreat.” Whether the religious experience had actual correlation to the onset is not certain, but the patient seemed to suggest by association that there was one.

Rarely have I encountered among Filipino patients the classical involutional syndrome with its vicious depression described in Western patients with pre-morbid obsessive-compulsive character structure. In over a thousand patients of all diagnostic categories, only two (both women) presented the typical pre-morbid personality and classical agitated depression. There were several cases whose involutional illness was more of the paranoid type. There is, however, a high frequency of neurotic reactions, notably in women, entering this period in their lives. Their illness as well as their pre-morbid personality suggests that the Filipino obsessive-compulsive personality is likely to be admixed with hysterical features, which includes a facility to return to dependent relationships. Although the hallmarks are there of the rigid, moralistic, constricted, over-conscientious personality, the patient finds it relatively easy to revive dependency on others.