Is OCD pathological Platonism?
And is Aristotelianism the cure?
I’m The Overthinker and this is The Big Q. This week I’m diving into the philosophical underpinnings of OCD and its treatment.
I was recently reflecting with my husband on how I used to be such a Platonist, such a Kantian moral imperative girlie, such a total wreck. I sincerely believed that there was one right way to live, and it was my job to figure it out and follow it to a T. But then something changed: I got treated for OCD.
Is OCD just a pathological Platonism? I asked my husband. He laughed. How so?
Well, remember Plato’s Allegory of the Cave? There are these people who have been chained since birth, and they see these shadows of life outside the cave. A shadow of a chair, a shadow of a tree, a shadow of a child. The prisoners know only the shadows. They have no concept of the true “form” from which the shadows are cast. The prisoners, Plato says, are all of us. The shadows are the corrupted “reality” we perceive through our senses. And the “forms” are those purer things we hope to access through science, deduction, and philosophy.
In OCD, I argued, there are obsessions — the shadows in the Allegory of the Cave, the same ones popping up again and again. And then there are the compulsions — the need to figure out if the shadow is actually a projection of a true form, and what form that might be, and how to neutralize/ritualize/avoid that shadow in the future.1
I have to say, I was (and remain!) impressed by my own OCD/cave analogy. It’s pretty tidy. It corresponds to a lot of what I know clinically. And it feels true to my own experience: When I was still floridly OCD, every single normative statement I read or saw or heard or detected beneath the surface of an artistic work, I had to grapple with. Was it true? Was it right? Was it just? And what did that mean for me?
Samantha: Well, relationships aren’t always about being happy, right? I mean, how often do you feel happy in your relationship?
Charlotte: Every day.
Samantha: You feel happy every day?
Charlotte: Not all day every day, but every day.
Me: *screaming, crying, throwing up*2
Then I took the whole thing a step further: Does this “Platonism run amok” theory explain why OCD can’t be treated effectively with talk therapies like psychoanalysis — in fact, is contraindicated for these interventions?
I think you could argue that Freud’s notion of the unconscious is the modern Allegory of the Cave. Slips of the tongue and transference and dreams are treated as the shadow plays of what the mind has chained in the cavernous unconscious, where all intolerable material is stored.
Talk therapy aims to identify these unconscious ideas — to make them conscious. For many people, this seems to be helpful. Happy clients report gaining insight into their old relationship patterns and learning how to enact new ones through analysis. But for people with OCD, a Platonist worldview is kind of the whole problem. A Platonic therapy can keep them locked in an obsession/compulsion (or shadow/form) cycle, with the therapist unwittingly working as their #1 enabler.
The gold standard treatment for OCD is exposure and response prevention, or ERP, which, I’ll now argue, is a fundamentally, dare I say gloriously, Aristotelian intervention. Aristotle, a student of Plato who lowkey hated his teacher’s ideas, had a lot to say about a lot of things. But for the purposes of this argument, let me just offer you a single representative quote: “We are what we repeatedly do. Excellence, then, is not an act but a habit.”
Behavioral therapies (including ERP) are all, whether implicitly or explicitly, premised on this notion: You have to cultivate new habits in order to heal. In the case of ERP, it’s made quite literal. ERP takes it as axiomatic that obsessions/shadows are a natural and neutral process of the mind and that the “real problem” of OCD is in taking those thoughts seriously — by engaging in compulsions or, to put it in these Platonic terms, by searching for the form behind the shadow.
Talk therapy ends up encouraging this compulsive search, as its premised on the notion that the unconscious holds forms we have forgotten, and that shadows are clues that will lead us back to the original source. ERP takes a different route: If you are what you repeatedly do, then stop fucking performing compulsions!? It’s not glamorous or interesting work; Aristotelianism is quite out of vogue. But at the end of the day, it works. Something like 80% of the people who stick with ERP get better.
As for me, I still enjoy thinking about what is right or true or good. I think such queries have real value. But it’s more contextual — what’s right or true or good not for the world, or for all time, but for me in this moment. And, crucially, these reflections are now voluntary. Rather than falling into a Platonic glue trap every time I watch SATC or read a sticky internet headline, I go spelunking only when I actually think there’s a question worth reflecting on.
Anything I missed? Send your advice column queries to asktheoverthinker@gmail.com or comment below.
Credits: Original art by Seattle-based illustrator Mara Parks Potter. Follow her on Instagram @maraparkspotter.
The comedian Maria Bamford, summed her own OCD up like this: “Have you ever not wanted to go to Sea World because you're worried if you're left alone with a baby starfish you'd try to kiss its poop hole?” The joke focuses on the OCD strategy of avoidance (don’t take the risk of going to Sea World!) but I imagine there’s also a mental OCD struggle taking place, too: Why would my brain even worry about this in the first place??? What is the “form” behind the “shadow” of kissing the baby starfish’s poop hole? The only thing this shadow could possibly be revealing to me is my own true form as a bad, dangerous person, right?
In this SATC dialogue, the obsession/shadow here for me is asking myself, “is this a happy relationship?” and the compulsion/search for form is the urge to then “answer” that “definitively” by deciding what “happy in a relationship” would “really” “mean.” I’m exhausted just recounting it.
Although Aristotle predated the scientific method and did not use control groups or statistical methods, he studied the "faculties of the soul through close observation: nutrition, sensation, imagination, intellect, and desire, In biology, he "swam with the dolphins," and discovered the dog-fish, later rediscovered in the 19th century! He used dissection and watched horses copulating to see the physiology of climax. And he wrote about everything that was literally available to the Hellenic world. So, yeah. Aristotle!