Dear readers -
it's been a while. I will shortly continue with my current topic, namely alterations in visual tracts in OCD patients. It may seem odd that the visual system is implicated in the disorder... why should a hoarding or checking obsession be linked to the way we perceive things?
Now, patients often observe a special characteristic in themselves, that other people don't seem to have: staring intensely at objects that frighten and worry them so. For example: someone has trouble discarding useless stuff, and has some rationalizations for this worry. 'I might want to use it in the future', or: 'perhaps there's something inserted in that old newspaper that is very important'. Therefore the objects become of extreme importance and have a great potential value and/or danger if discarded wrongly. The fantasy lends an importance to the things that they don't possess. The only tactic for the patient is: staring, staring and staring again, sometimes in strange patterns over the surface of the object, for a set number of times. It takes a lot of time and trouble... and even then he or she may not be able to throw it in the bin.
This staring habit may have something to do with the visual system (of course), and perhaps the brain has an incapacity to really trust that which is perceived. The eyes see it, but the 'self', the integrative systems, can't really believe it. The picture that I showed presents a possible way to explain this deficit, of which more later. Patients also can call to arms other senses to aid in a proper decision-making: tactile (to run over an object to make sure that nothing is attached or inserted in the old paper), and speaking to oneself (hearing your own normal speaking voice telling you that it's OK can be helpful sometimes to reach a decision about discarding.
Again we see: the 'natural flow' is completely missing in the deciding proces. It is a troublesome, wearying affair, movements (also of the eyes) seem to be 'saccadic', i.e. structured in short, stop-and-start procedures in stead of a simple, flowing reassuring observation process that 'it's all safe'.
Let me address another striking inconsistency in OCD: in a devilish way, the checker/washer/hoarder can be misguided by his/her own brain. Because, he/she invests so much trouble in controlling whether the front door is closed, is so insecure, and so involved with the safety of personal territory, so that 'nothing can happen'... yet the same person may subsequently step into a sportscar and drive at maximum speed, easily negotiating dangerous curves in the road, and decide at a glance whether a traffic light is red or green. It's highly illogical. Because a little household accident ( by a leaky faucet, or something similar) won't cause the slightest harm for life, yet he/she checked it endlessly... and driving through a red light could cause death! Do you see the 'devilishness' I was aiming at?
