I-CBT Topics: OCD and (A Lack Of) Direct Evidence

Let’s pretend for a moment that you run a true crime podcast, and one case has been bothering you for years. John and Bethany were married for 15 years. They had no kids and were high school sweethearts. Bethany was found dead in their shared home. John was not even considered as a suspect, and you are sure John did it. So, you hire a private investigator to do some digging. Here’s what the P.I. comes up with after tailing John for three weeks.

“Statistics show that if a woman in a heterosexual marriage is murdered, it’s typically her male partner who has done it. John and Bethany were married, so statistically, John likely murdered her. I’ve seen many such cases. Bethany was found with multiple stab wounds, indicating the murderer likely had an intimate relationship with the victim. Like anyone, John is susceptible to bouts of anger, so it’s possible he got very angry with his wife and murdered her. As I was tailing John, I personally witnessed John scowling periodically, and demonstrating a rather foul attitude. I overheard him being rude to a barista. You shouldn’t be rude to people, so maybe he has some deep-seated anger issues. It’s possible that John is Bethany’s murderer.”

With the data the PI provided, would you feel confident stating in your podcast that John murdered Bethany? Probably not. That's a rather weak case. It's important to notice what’s missing from the PI’s file: Direct evidence. There is no murder weapon, no blood, no fingerprints, nothing tying John to the murder except for hearsay and weak circumstantial evidence.

Let’s rewrite this with direct evidence, and see if it changes the way that you feel.

“Statistics show that if a woman in a heterosexual marriage is murdered, it’s typically her male partner who has done it. John and Bethany were married, so statistically, John likely murdered her. I’ve seen such cases. Bethany was found with multiple stab wounds, indicating the murderer likely had an intimate relationship with the victim. Like anyone, John is susceptible to bouts of anger, so it’s possible he got very angry with his wife and murdered her. As I was tailing John, I personally witnessed John scowling periodically, and demonstrating a rather foul attitude. I overheard him being rude to a barista. You shouldn’t be rude to people, so maybe he has some deep-seated anger issues. Furthermore, John was found with Bethany’s blood on him, and his fingerprints were found on the scene. Bank records indicate that he then drained Bethany’s retirement account and I found CCTV footage of him with another woman. Real estate records indicate he fled the state to live with his mistress in the Hamptons. It’s certain that John is Bethany’s murderer.”

This is a much stronger case. Do you see the difference?

Now let’s tie this back to OCD.

Obsessions occur without direct evidence. That is what differentiates a reasonable doubt (reality) and an obsessional doubt (imagination). When OCD comes into play, the person experiencing an obsession will rely on their imagination to draw a conclusion, instead of their perception. 

Let’s take a look at an obsessional doubt.

“Statistics show that if a woman in a heterosexual marriage is murdered, it’s typically her male partner who has done it. I’m married to a woman, so I might snap and murder her. I love her very much, but I’ve seen many such cases. Like anyone, I am susceptible to bouts of anger, so it’s possible I could get very angry with my wife and murder her. Sometimes other people say I scowl and have a bad attitude. Last week, I was kind of rude to a barista when they got my order wrong. You shouldn’t be rude to people, so maybe I have some deep-seated anger issues. It’s possible that I could snap and murder my wife. I will avoid her, monitor my thoughts, and seek reassurance that I’m not a dangerous person.”

Notice how this is written very much like the above case in that it completely lacks direct evidence, and therefore isn’t very convincing to anyone but the person experiencing it, and perhaps some less experienced or very anxious clinicians. 

What is direct evidence anyway?

I-CBT defines “direct evidence” as information coming through the five senses, the real self, inner sense data (including real intent and real desire) and common sense.

First, information that is coming through the five senses. 

• I smell my own body odor, so I could be offending others.

• I see that the stove is on, so it must be on.

• I heard myself call my friend an offensive name, so I might have offended them.

• I saw the trash can fall over as I hit it with the car, so I must have backed into it.

• I feel intense heat when I pick up my mug, so my coffee is too hot to drink.

Equally important is what we do not perceive, which can also be direct evidence that contradicts an obsession. To quote one of my good friends and mentors Mike Heady, "a lack of evidence is still evidence." In other words, perceiving that there isn't a problem is enough to conclude that there isn't a problem. Here's some examples:

• I don’t smell cat urine, so my cat did not urinate on my gym bag.

• I don’t see a car coming, so it’s safe to cross the street.

• I did not hear anyone run after me shouting when I left the grocery store, so I paid for all of my groceries.

• I didn’t see anyone fly up and over my windshield, so I didn’t hit anyone.

• I don’t feel sick, so I don’t have the flu.

Common sense includes shared social, scientific and cultural knowledge, as well as an individual body of knowledge acquired through experience. This can also include someone’s common sense about their own obsession, as obsessions defy common sense.

• If food is steaming, it’s probably too hot to eat.

• You should not walk out in front of a moving vehicle.

• If you’re sick, it’s a good idea to avoid people.

• Doors generally don’t unlock themselves.

• Dull knives are more dangerous than sharp knives.

• Tanning beds can increase risk of skin cancer.

  
  

Internal sense data includes someone’s real desires, real intentions, and emotions.

• I can’t wait to have lunch.

• That dog is so cute, I just want to run over there and pet it.

• I don’t want to harm anyone.

• My friend is crying, and I want to comfort them.

• Green is my absolute favorite color.

• I’m feeling calm right now.

Finally, real self is what others might perceive about us, the culmination of our actual actions, and who we are day-to-day.

• I hold the door open for others.

• I save spiders from the drain.

• I donate to children’s funds.

• I have never hurt anyone on purpose.

• I show up to work on time.

• I’m patient with my children.

To sum up, another quote from a good friend and mentor Carl Robbins: "If the evidence for an obsession is not coming through your retinas, it's being generated behind the retinas." That is the to say, if the justifications for an obsession are not being perceived by any of our senses, then the justifications are being generated internally by our own imaginational processes, and this renders the obsession false.

Back to the case at hand.

One of the questions we often ask when using I-CBT is: what would have to happen in reality in order to make the obsession something you should actually worry about? We know now what direct evidence is. Let us consider the obsession that we wrote about above, and introduce some direct evidence.

“Statistics show that if a woman in a heterosexual marriage is murdered, it’s typically her male partner who has done it. I’m married to a woman, so I might snap and murder her. I despise her. Like anyone, I am susceptible to bouts of anger, so it’s possible I could get very angry with my wife and murder her. Sometimes other people say I scowl and have a bad attitude. Last week, I was kind of rude to a barista when they got my order wrong. You shouldn’t be rude to people, so maybe I have some deep-seated anger issues. I often sit and have violent daydreams about murdering my wife. I actually find them quite pleasant. I could think about it all day. I've hurt others in the past and want to do it again, my wife is the perfect target. It’s possible that I could snap and murder my wife."

Compared to the first story, that's a big difference. Now we may consider this a reasonable doubt, rather than an obsessional doubt. This is someone who actually intends to harm their wife, not someone who is suffering through the possibility that they might do so. This is the same with all obsessions - all obsessions occur with a lack of direct evidence. That's how we know that all obsessions are false. This seems like a bold claim, but it's true. It's because of the way obsessions are constructed. Since obsessions occur as the result of reasoning process that relies on distrust of the senses and self to thrive, as well as over-relying in possibility (imagination), obsessions are automatically rendered false. They are occurring wholly within the imagination and not perception.

Adapted by Katie Marrotte from: O’Connor, K., & Aardema, F. (2012). Clinician’s handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell. www.icbt.online