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What is the prognosis for patients with Obsessive–compulsive disorder (OCD)?


People who have OCD have it because it provides them with relief from anxiety—from anxiety so intense as to be almost inconceivable to people who have not had OCD. But OCD is just a defense-mechanism. And as is the case with most defense-mechanisms, there comes a time in the subject’s life when it starts to do more harm than good. At that point, the obsessive-compulsive has to make a decision: What do I want? Do I want mere freedom from anxiety? Or do I want to live and grow? It is 100% up to him what he chooses. If he chooses to grow, he will, and his OCD, without exactly vanishing, will assume productive forms. If he chooses not to grow, he won’t.

OCD, though an affliction, is ultimately a voluntary one. If the obsessive-compulsive chooses to remain in his defensive bubble of isolation from the world, then his OCD will defeat him. If he chooses to re-engage the world, then his OCD will assume non-pathological and in fact productive forms, as it did with Beethoven and Einstein.

OCD, though an affliction, is an affliction of the will—and is thus unlike cancer or asthma, which have nothing to do with the integrity of one’s will. And OCD is eliminated, or at least made to assume adaptive forms by duly exercising one’s will in growth-oriented ways.

The symptoms of OCD are involuntary only in a relative sense. Relative to a determination to remain within his defensive bubble of non-engagement, there is nothing much that the obsessive-compulsive can do about those symptoms. He can engage in a bit of ‘cognitive-behavioral therapy’, but the effects of such therapy will be shallow and short-lived, absent a determination on the obsessive-compulsive’s part to grow and change himself in a way that makes his OCD irrelevant. On the other, if he does choose to leave his defensive bubble and re-engage the world, then, indeed, his OCD will become irrelevant. So relative to a determination on his part to re-engage the world, the symptoms of OCD are voluntary.

So ultimately OCD is indeed voluntary, and if one sees it for the voluntary condition that it ultimate is, then the prognosis is 100% positive. But if one sees it as a garden-variety pathology, then the prognosis is negative. A garden-variety condition is one that does not afflict one’s will and that falls outside the scope of the one’s will. OCD is an affliction of one’s will; it is a weakening of one’s will, in consequence of a withdrawal from the world. And by choosing to go back out into the world, the obsessive-compulsive strengthens his will and causes one’s OCD to assume benign if not productive forms.

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