The History of OCD Treatment: From Ancient Remedies to Modern Approaches

Obsessive-Compulsive Disorder (OCD) is a mental health condition in which people experience unwanted thoughts (obsessions) and repetitive behaviours (compulsions). Compulsions are performed in order to reduce anxiety. Although our understanding of OCD has evolved significantly over time, treatment approaches have developed from rudimentary practices to sophisticated and evidence based therapies. This article explores the history of treating OCD around the world. How treatments have changed and how individual and group settings differ in addressing the disorder will be covered.

Ancient and Pre-Modern Understanding of OCD

The first widely known evidence detailing obsessive-compulsive symptoms can be traced back to ancient Greece. Hippocrates described symptoms resembling what we now understand to be OCD, even though there was little understanding of how to view OCD from a psychological paradigm. OCD, like most ailments, was often attributed to an imbalance of bodily humors.
Ancient cultures had a tendency to see obsessive behaviours through either spiritual or moral lenses. In some cultures throughout the world, people who displayed unusual rituals or compulsions were thought to be possessed by evil spirits or under some kind of divine influence.

During the Middle Ages in central Europe religious explanations tended to dominate. Obsessive behaviours were often viewed as sins or moral failings. People exhibiting these symptoms were sometimes subjected to harsh punishment or exorcisms in order to ‘cleanse’ them. The Renaissance and enlightenment provides the intellectual soil for the rise of early psychological thought. The first inclinations towards a more scientific understanding emerged. However, mental disorders were still often seen through a theological lense.

The Rise of Modern Psychiatry and Early Treatments

The 19th century experienced the emergence of psychiatry as a medical discipline. This laid the foundation for a more structured understanding of mental disorders. French psychiatrist Jean-Martin Charcot and his student Sigmund Freud made early contributions to the understanding of neurosis, including obsessive symptoms. Freud’s psychoanalytic theory linked OCD to unconscious conflicts, particularly those stemming from childhood experiences and repressed desires. This paradigm guided early approaches towards treating OCD. Treatments focused on uncovering repressed emotions through techniques such as free association and dream analysis.

Treatment options during the early 20th century were still largely experimental and often did not result in any meaningful reduction in symptoms. Interventions included methods like electroconvulsive therapy (ECT) and lobotomies. These were sometimes used for severe cases of mental illness. While these treatments had varying degrees of success, they were also often harmful.

The Birth of Cognitive Behavioural Therapy (CBT)

The landscape of OCD treatment began to change in the mid-20th century with the development of Cognitive Behavioural Therapy (CBT). Researchers such as Dr. Victor Meyer started to pioneer behavioural techniques specifically targeting the avoidance and compulsions associated with OCD through the development of ER. This entails exposing individuals to the situations that trigger their obsessions while preventing them from engaging in their usual compulsive behaviours. ERP has become a cornerstone in the treatment of OCD.

By the 1980s, CBT became recognised as the most effective non-medical treatment for OCD. The development of selective serotonin reuptake inhibitors (SSRIs) which are a type of of antidepressants which helped regulate serotonin levels in the brain also emerged as a very effective treatment option. SSRis and CBT to this day represent the most effective combination when addressing OCD.

Global Variations in OCD Treatment

To this day different regions of the world treat OCD differently. A uniform approach has not yet been implemented.
In Western countries, CBT with ERP is the gold standard for treating OCD.
In Eastern countries, particularly in parts of Asia, OCD treatment is heavily influenced by traditional beliefs. In countries like Japan and China, OCD symptoms may have been interpreted as a form of moral or spiritual imbalance. While modern CBT approaches are becoming more widespread, traditional forms of therapy such as acupuncture, herbal treatments, and spiritual counselling are sometimes still integrated into the treatment process. However, cognitive-behavioral interventions are gaining more and more recognition as the most effective treatment for OCD.