EVEN IN MY earliest memories, I was consumed by terrifying worries and did everything in my power to alleviate my deepest fears. When I was 8, I can remember being plagued by guilt following the death of my aunt to cancer, worrying that it was somehow my fault. Intrusive thoughts and images flooded my mind at night, and I called my parents into my room to confess, seeking reassurance that I was not a dangerous monster. As I grew older, my fears began to consume every single area of my life that was important to me. By college, I was afraid to sleep out of fear that I had left the stove on or the door unlocked. And by graduate school, I moved through my day wondering if I had called people derogatory names or written horrific things in birthday cards before blocking the memories out. I repeatedly checked the stove, took pictures of locks, and called friends to make sure I hadn’t somehow caused harm. At the time, I was unaware that these acts, known as “compulsions,” only made my condition worse.
In my early 20s, I learned that I was experiencing the symptoms of a diagnosable mental illness known as obsessive-compulsive disorder (OCD). OCD is often represented in television and movies as something laughable—think Tony Shalhoub’s Monk. In reality, OCD is far more serious: a debilitating disorder defined by unwanted obsessions that terrify the sufferer and compulsions repeated over and over to alleviate overwhelming fear, guilt, or anxiety. Some obsessions might relate to more commonly known themes of contamination or organization, while others might include culturally taboo themes involving violence or sex. But they are all equally painful to those caught in OCD’s grasp.
We all have thoughts—happy, sad, violent, intrusive, and strange. But those with OCD tend to place more value on these thoughts, concerned that they may be true. When time spent experiencing these obsessions and engaging in compulsions impedes functionality, that’s when it becomes a disorder. But even in my struggles, I feared documentation of an official diagnosis would negatively impact my pursuit of ordination. I had always heard that we should turn our worries to God, so I wondered what those approving my psychological evaluations for ministry would think if they viewed me as in need of mental health treatment that could not be solved through prayer.
By the time I moved into my first role in ministry, my head was spinning with every worry possible: What if I said something mean to a student in class and forgot about it? What if I kicked the child on crutches? What if I snap and stab someone? What if I’m secretly a murderer and just blocked it out? What if I’m just pretending to be a moral minister and am secretly a horrible person? What if God hates me? I was living two lives—the calm, peaceful, joyful chaplain supporting students and the person inside my head telling me I deserved absolutely nothing. The pain of feeling like an imposter consumed every ounce of my being, and I was swimming upstream through quicksand just to move from one moment to the next.
Saying "maybe"
ACCORDING TO THE International OCD Foundation (IOCDF), 1 in 100 adults (2 million to 3 million in the U.S.) are diagnosed with OCD and experience many of the same things that made me feel so alone. Unfortunately, it can take 14 to 17 years for those struggling to find effective treatment, as many individuals—even clinicians not specializing in OCD—are unaware of the evidence-based treatment options.
My mom was frantically searching online to help me when she came across a treatment known as exposure and response prevention (ERP). According to the IOCDF, the treatment has “the strongest evidence supporting its use in the treatment of OCD,” along with a class of medications called SSRIs. As part of ERP, individuals, under the guidance of a trained therapist, are exposed to their most terrifying fears while prevented from completing compulsions to alleviate the anxiety. It is important to note that obsessions are ego-dystonic, meaning they vehemently oppose an individual’s values. The false warning alarm going off in the brain begins to subside as those in treatment begin to habituate. This has nothing to do with disproving the fears; rather, it retrains the brain to cope with the uncertainties of life in a healthy way. For some, this may mean not taking their temperature despite a fear that they may be sick. For others, it may mean a willingness to continue driving despite the fear that they could have hit someone on the road without knowing it. Or perhaps it means leaving the house without checking the stove or without taking a picture to check that it is off when the fear arises later in the day. Or it might mean ceasing to fix an imperfect prayer despite fear of eternal damnation.
ERP seemed to oppose every coping mechanism I had utilized throughout my life. After 15 years of reassuring myself by checking to make sure nothing bad would happen, I was being asked to say “maybe” to my greatest fears. I’d kept my struggles a secret for years, fearful they would negatively impact my vocation or change the way individuals viewed my ability as a clergy member. But after the loss of a close friend to suicide and a subsequent OCD relapse in my own life, I promised myself I would begin speaking up.
Mental illness is a painfully authentic part of my experience. And while it does not define me, the experience of navigating treatment and recovery has deeply impacted the ways I serve as a minister. It is a space where God created beauty out of brokenness in my life. In fact, since my relapse and plunge into advocacy, my biggest joy in life has become helping clinicians support individuals of faith, while helping faith communities better understand mental health treatments, especially OCD. I volunteer as an advocate with the IOCDF and helped form their faith task force, through which I spend a large amount of my time helping clergy and clinicians collaborate as they support patients experiencing a form of OCD focused on obsessions with a religious or moral character known as “scrupulosity.” I lead a support group with people who struggle to differentiate their daily religious practices from compulsive behavior. For some, repetitive prayer, washing, confession, types of fasting, fears of offending God, or worries about committing a sin might be manifestations of OCD. These members of our congregations often value their faith deeply, and yet OCD has taken every aspect of joy out of practicing the faith so important to them.
Those navigating religious scrupulosity feel their world shatter every time they are told to be “anxious for nothing” within the walls of their house of worship. As an interfaith chaplain at a large private school, I’ve found that this directive from Philippians 4:6 spans across religious traditions. Anxiety is characterized as a spiritual failing, and diagnosable mental health conditions are too often deemed the result of improperly living out one’s faith. Each day, I have students from Christian, Jewish, Muslim, or Hindu traditions enter my office to tell me they are struggling with their mental health but are fearful how their family or faith community might react. Some of these students have formal diagnoses and are still told they simply need to “pray harder.” And while prayer can play a role in treatment, the directive on its own can be fatal.
Breaking the stigma
THANKFULLY, MANY FAITH communities are becoming much more open to conversations around mental health. And yet, the focus on mental health within the church does not always include diagnosable mental illness. This seems to be a trend within our culture, as influencers use their platforms to encourage individuals to focus on self-care. While self-care and mindfulness are wonderfully important, they can also become stigmatizing, as the focus tends to be on general mental health that everyone needs as they move through their life. For those with OCD, talking about general mental health is different from opening up about intrusive thoughts. This understanding is crucial so that we can encourage individuals to move into the necessary treatment specific to their illness, the same way we would encourage an individual diagnosed with asthma to visit a pulmonologist as opposed to trying generic breathing techniques. Many clergy want to support the mental health of their congregations but lack the necessary tools.
For such ministers, I recommend the following:
1. Take steps to destigmatize mental illness in your congregation by discussing it openly in a homily or authentically sharing your own experience. Do not be afraid to share about your own struggles, recognizing our common humanity from the pulpit to the pews.
2. Attend a Mental Health First Aid training or host a similar training within the walls of your congregation to familiarize those in your community with symptoms of mental illness. Create and share a list of mental health resources in your area.
3. Collaborate with mental health networks, such as the IOCDF or the National Alliance on Mental Illness. Many organizations are becoming more open to collaboration with faith leaders, recognizing that patient-centered care involves the integration of spiritual and mental health.
4. Consider ways your congregation might support community members financially. One of the greatest barriers to treatment, outside of stigma, is the high cost of therapy, medication, or intensive treatment admittance—often without the option of insurance for evidence-based, specialized care.
5. Learn to acknowledge the line between individuals practicing their faith in a value-driven way, as opposed to those who might be experiencing religious scrupulosity. And if you notice something that might be concerning, always begin the conversation from a place of support and affirmation.
In many cases, simply acknowledging that someone in your congregation is struggling and taking the step to refer them to an expert can be lifesaving. While many clergy bear witness to mental health struggles, studies show they refer as few as 10 percent of cases to clinicians. Some fear that clinicians will deter an individual from participating in their spiritual practices. As IOCDF advocate Valerie Andrews says, “there is a fear of outsourcing God.” However, in the case of scrupulosity, many clinicians simply want to work collaboratively to help the individual regain a healthy relationship with their faith. In fact, many experts on the faith task force have credentials as both faith leaders and clinicians treating OCD. Our monthly conversations often center around ways to bring these communities together, as well as ways to remind individuals in our faith communities to love themselves as God loves them.
Divinely created
ONCE I LEARNED to embrace my own struggles, receive treatment, and become open about my identity as a minister navigating OCD, it seemed like space for people from all faiths to share their struggles with me was organically—or perhaps divinely—created. I now serve as a lead advocate with IOCDF, focusing on letting individuals know that faith and mental health treatment are not mutually exclusive and supporting other advocates with the IOCDF who are working to do the same. I hear from faith leaders and lay people multiple times a week who are struggling in silence with their mental health, because shame leads them to believe they simply aren’t “faithful enough” or aren’t “praying hard enough.” Despite what OCD says, these thoughts are not true. You can fully embrace your faith while receiving appropriate therapy and treatment. And we must all work in harmony to convey this message: Faith leaders must suspend the belief that clinicians will minimize faith, and clinicians must trust collaboration with faith leaders around spirituality and narrative-based care.
Growing up, I was often taught to “love my neighbor as myself,” based on Jesus’ directive in the gospels. But in the depths of mental illness, I often neglected the part of that directive that told me to offer that same love to myself. Through my recovery, I realized that without learning to love myself, I could never love my neighbor in the deep, meaningful way that God intended. I deeply believe that it is possible to have faith in God, faith in yourself, and faith in your treatment. For me, this “recovery trinity of faith” saved my life. Sitting in front of my seminary doctoral cohort and sharing about my mental illness—when I worked so hard to hide it just a decade before—felt completely freeing. I’ve finally become the authentic person God created me to be.
Katie O’Dunne is the interfaith school chaplain at Woodward Academy in the Atlanta metro region and an endurance athlete currently tackling 50 ultra-mar-athons for OCD awareness.
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