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Can you treat OCD with no medication?

Medications, specifically SSRI’s, are enormously useful in the treatment of OCD. But OCD is about emotional conflict. The compulsions are about doing, albeit in a very distorted way, what one would like to do but will not permit oneself to do. (The compulsions involve muted or otherwise warped expressions of sexual or violent urges. Hence their repetitive and, in their muted way, violent nature.) The obsessions---the obsessive fears and doubts, and specifically---are displaced desire.

The obsessive’s fear that so and so will die or that such and such a catastrophe will happen is actually an unconscious desire that so and will die or that such and such happen. And to the extent that one can (for lack of a more apt phrase) ‘get over’ OCD, one does so by reintegrated oneself with one’s desires.

The obsessive-compulsive’s desires are ‘ego-dystonic’, meaning that he does not identify with them: they are in him but not of him. And the way for him to make his symptoms cease to be symptoms is for him to make them of him, and not merely in him. In other words, he must reconcile himself to the desires embodied in those symptoms.

Given the heavy-duty anxiety and depression that is associated with OCD, and that mediates it, SSRI’s (or, possibly, other medications) are de rigueur at certain junctures. But their (very considerable) therapeutic significance is subordinate to the just-mentioned psychological remodeling (that is, to the reconciliation of the subject from the desires from which he is now alienated, as they have been repressed, and which, because he is alienated from them, make their back into his consciousness through the subterfuge of obsessive fear and compulsive action). The SSRI’s lift the depression and modulate the anxiety that inhibit the process of re-integrating the obsessive compulsive with his own feelings and thereby disinhibit the restoration of his psychological architecture.

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