Stanford University School of Medicine explains that symptoms of obsessive-compulsive disorder, or OCD, appeared in history dating back to the early 1600s. Initial understandings about the cause of OCD were laden with misconceptions and from these misconceptions, ineffective or unsafe treatment practices were developed. However, the evolution of psychiatry and understanding of the disorder has changed treatment methods significantly. To clarify, OCD is characterized by ritualistic thoughts and behaviors that develop from unexplained fear of general or specific triggers. In the past, symptoms of this condition were not diagnosed until early adulthood. However, it is now known that OCD exists in various stages of life. Historical treatment was aimed at alleviating the symptoms through surgical procedures, use of drug sedation or talking to a physician trained in psychology.
Medical Procedures
Prior to the 1700s, mental illness was not yet addressed by the medical community and was thought to stem from the work of the devil. Penn Medicine explains that with the recognition of psychiatric conditions as diseases of the mind by Dr. Benjamin Rush, who practiced from 1783 to 1813 at Pennsylvania Hospital, new technologies led to medical procedures such as bloodletting, the removal of tainted blood via leeches or incision.
In the early 1900s, psychosurgical procedures were employed to rid the brain of unnecessary elements thought to cause the obsessive thoughts and compulsive actions. According to Massachusetts General Hospital, the prefrontal lobotomy, a procedure involving severing or destroying white fibers connecting the thalamus area of the brain to the prefrontal and frontal lobes, was the forerunner of procedures to cure symptoms of OCD and numerous other psychiatric conditions. The symptoms of OCD were thought to stem from improper connections in the orbitofrontal cortex, thalamus and frontal loop of the brain, thus making lobotomy necessary for healing.
Early Psychodynamic Therapy
The American Academy of Family Physicians explains that OCD was considered a highly treatment-resistant disorder in the early 1900s, since the prevailing psychodynamic therapies were not working effectively on symptoms. Psychoanalysis, a therapeutic technique popularized by Sigmund Freud, focused on OCD symptoms stemming from unconscious sexual and aggressive impulses to control unacceptable urges. However, the mind was unable to process properly and had to act, or compulse on the urges despite knowing the action was inappropriate.
Stanford University School of Medicine explains that psychoanalytic theory attempted to uncover the hidden agenda in the mind by motivating the patient to talk freely to the therapist, who would then summarize and interpret the information shared by the patient so that insight into the behaviors was gained.
Pharmacology
Clomipramine was the first effective medication introduced to people with OCD that had a significant effect on treating symptoms, the American Academy of Family Physicians says. This drug was introduced in the 1960s in the medication class tricyclic antidepressants. Clomipramine acts on the naturally occurring brain chemical serotonin to decrease obsessive thoughts that lead to compulsions. This drug is still in use today, but serious side effects such as paralysis of internal organs, heart disruptions and toxicity make this it a last resort.
References
- American Academy of Family Physicians: Recognition and Treatment of Obsessive-Compulsive Disorder
- Stanford University School of Medicine: History of Treatment of OCD
- Brain Physics: Surgical Procedures for Obsessive-Compulsive Disorder
- Massachusetts General Hospital: Psychosurgery
- Drugs.com: Anafranil Side Effects
