Some experimental analogues of obsession

SOME EXPERIMENTAL

ANALOGUES

RALPH

OF OBSESSION

METZNW

Harvard University Summary-This paper is an attempt to analyse some of the features of obsessional neurosis in terms of learning theory. First, the syndrome is described and found to have three main features: brooding, stron impulses to do unacceptable things, and ritualistic, defence-substitute activities. Second, the cIassl.A psychoanalytic explanation of the etiology of obsession is reviewed. This theory locates the source of conflict in the anal stage, but fails to give a satisfactory account of the precipitating conditions and of the cause for the persistence or fixation of the neurotic responses. In the third section both the precipitating conditions and the fixation conditions are analysed in terms of factors shown to be operative in animal learning experiments.

IT WILL be argued in this paper that in order to understand look both at the nature of the original conflict or trauma and the behaviour. Psychoanalysis has concentrated its ingenious first problem. Behavioural learning theory principles should of the second. Obsessional neurosis is chosen as an example

THE

neurotic behaviour one must at the conditions maintaining detective-work mainly on the be used in the investigation for this approach.

SYNDROME

Three apparently very different kinds of behaviour are generally considered criterial of an obsessional neurosis. They may appear alone or in combination. The first is the occurrence of prolonged spells of brooding, doubting and speculation, without ever reaching any definite conclusion: the patient seems unable to terminate these questionings, even while admitting that the problems are insoluble. The second is the occurrence of very strong temptations or impulses to do things, such as kill, confess, attack or steal certain objects, which are viewed with utmost horror, disgust, shame or anxiety by the patient experiencing them. These impulses may or may not be carried out: we may have obsessive thoughts or compulsive behaviour. The third, and most typical kind of obsessive behaviour is the elaborate and sometimes incredibly time-consuming rituals and ceremonial actions surrounding everyday activities such as eating, going to the toilet, dressing and undressing, and sexual performance. Features of these rituals are (1) that anxiety is evoked if they are not performed; (2) that they appear senseless and embarrassing to the patient, and (3) that they frequently show, on close inspection, a Januslike quality of serving two functions at the same time. An illustration of the last point is the patient described by Ferenczi (1927), who began by washing excessively as a precaution against masturbation and ended by “masturbating with the nozzle of the irrigator” while she was washing herself. Freud repeatedly stressed this “compromise character” of symptoms as perhaps the crucial diagnostic criterion of obsessional neurosis. Some authors (e.g. Frink, 1934; Stekel, 1949) also mention the impelling or “musC quality that patients experience in connexion with these actions. However, this might not 231

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distinguish neurotic patterns from overlearned habits in everday life-the impo~ant difference being that the latter are acceptable behaviours in the culture and, hence, do not give rise to the revulsion or despair of the neurotic at his insensate procedures. PSYCHOANALYTIC

EXPLANATIONS

Freud’s early theory (expounded in the drafts he sent to Fliess and in the papers in Vol. I of the Collected Papers 1896) was that at the core of every neurosis lurks a traumatic sexual experience in childhood, which is repressed but remains as an unpleasant, unconscious memory. When, after puberty, the sexual urge reappears with greatly intensified strength, the unpleasantness of the memory will also be intensified. If the sexual experience occurs at a time of sexual immaturity and the memory of it is aroused during or after maturity, then the exciting effect of the reconciliation wit1 be very much stronger than that of the experience itself; because in the meantime puberty has increased to an incomparable degree the capacity of the sexual apparatus for response (Freud, 1896). Further defences will then be necessary to counteract these impulses which are emerging in distorted forms. That is, the ceremonial actions really represent ‘%econdary defences” against these repressed memories which are evoking a great deal of unpleasant affect. Hysteria and obsessional neurosis differed only in the nature of these secondary defences: in hysteria, the mechanism was renewed repression or isolation, rather than distortion and reaction formation. In the later theory (Freud, 1913; Jones, 1923; Fenichel, 1945) al1 neuroses were considered to issue from the Oedipal conflict, the choice of neurosis being determined by fixation. Obsessionals were assumed to be fixated at the anal-sadistic stage. When, in response to intolerable Oedipal conflicts, they regress to this stage, one of two things may happen. If the problems of the anal stage had themselves been adequately solved (i.e. the impulses properly sublimated), the “anal character” developed, with his triad of traits representing the residues of attitudes adopted in toilet-training: orderliness, frugality and obstinacy being at once sublilnations, extensions and exaggerations of obedience, retention and defiance, respectively. If, however, the anal stage had itself been left with unsolved conflicts, then the conditions were met for the development of an obsessional neurosis. Some of the conditions making for conflict in the anal stage were (1) unusually strong, innate, anal erotism, i.e. pleasure in expulsion, and (2) severity of training which elicits defiant rage, which in turn is linked to guilt via fear of parental punishment. The guilt over hate is given further force by the fact that at this stage a belief in the omnipotence of thought is still operative. The love-hate ambivalence thus generated in the boy vis-a-vis his mother, is generalized to all areas and leads to the pattern of doubt and questioning. An easily testable consequence of this view, pointed out by Jones (1923), is that girls should show the brooding pattern less often than boys since, with girls, the Oedipal and anal reactions to the mother reinforce each other (they are both negative) rather than being in conflict, as is the case with boys, Later theorists appear to have accepted the pattern of the second of these two types of explanations and sought to elaborate and extend the analysis of the factors making for conflict in the anal stage. Thus, Rado (1959) argues that the toilet-training situation is only one example of thwarted self-assertion followed by rage and guilt, and that any such situation could lead to obsessional patterns. Weissman (1959), on the other hand, argued that

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the prime conflict could be more precisely located within the anal stage, namely in the earlier retentive phase, where the impulses get into conflict with an archaic excessively strict superego. No one, however, has questioned the progressive “inward” shift of the explanatory concepts used. Whereas Freud’s first theory was firmly linked to observable events occurring in the environment, in its latest developments the causative factors are I am not concerned, for the moment, with the truth or almost entirely “intrapsychic”. falsity of the theories but solely with their logical character. This change in type of theory seems to be general in Freud’s work and not restricted to the case of obsessions. OBSESSIONS

AS LEARNED

BEHAVIOUR

Though we now have no dearth of ideas about the “root-conflict” in this form of neurosis, which enables us to make some kind of sense out of the content of the symptoms (i.e. what conflicts and motives they subserve), we know very little about the “exciting cause” of breakdown, i.e. what specific events lead to obsessive behaviour. There is a need for supplementation of Freudian theory with analysis of the situation in which neurotic behaviour originates, in terms of factors known to be important in learning. There is an interesting hint in Freud’s analysis of the so-called “rat-man”, where he uses a form of explanation wlhich he never makes explicit in any of his purely theoretical papers (Freud, 1909). There is, first, a system of ceremonial defences, learned in childhood, around a punished scopophiliac impulse. These defences lay dormant until they were brought into use again when the patient found himself in a severe m&i-determined conflict involving his fiancee and his father. This pattern is exactly reproduced in an experiment by Fonberg (1956), who trained dogs to perform an instrumental response using food as reinforcement. She then trained them to perform an instrumental avoidance response using different stimuli as CS and different responses. The noxious stimulus was either an electric shock to the right foreleg or a strong puff to the ear. The animal was thus able to avoid the noxious stimulus by performing a particular response, e.g. by lifting its foreleg. The dogs were then made “neurotic”, using the Pavlovian technique of making a discriminated salivary response increasingly difficult, i.e. by bringing the “excitatory” and “inhibitory” CS closer and closer together. Finally, the animal had a “breakdown”, manifesting diffuse neurotic behaviour; and simultaneously, the instrumental avoidance response, established in the second part of the experiment, appeared. Also “shaking-off” movements were observed in those dogs in whom the noxious stimulus had been the puff of air. The alimentary conditioned responses disappeared, indicating that this was not a general regression phenomenon, but rather regression to a previously learned successful anxiety-reducing reaction. In other words, it seems that an avoidance response to some traumatic anxiety-provoking stimulus is first learned, and subsequently reappears as a response to any similar anxiety-provoking situation. The problem for learning theory now arises: Under what conditions does behaviour get fixated, i.e. performed repeatedly and apparently without motive? To be sure, in many cases of obsessional neurosis this is not the problem; that is, the behaviour is still elicited by definable situations and reinforced by obvious rewards. In such instances, we need appeal to no more than the well-known resistance to extinction of traumatic avoidance responses (Solomon, Kamin and Wynne, 1953) under conditions of recurrent presentation of the CS. In cases where the CS is not under the control of the experimenter, i.e. the animal simply

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makes an avoidance response at fairly regular intervals-which has the effect of “postponing” the shock (Sidman, 1953)-we have a situation analogous to the repeated performance of a ceremonial action to relieve spontaneously recurrent, internally produced anxiety. There remains here the much thornier enigma: What is the cause of the recurrent attacks of anxiety? In terms of human psychopathology, why do the “fits of horrific temptation” (described under “The Syndrome”, above) not become extinguished by the anxiety they evoke ? There are three types of experimental situation in which a response may get “fixated” until it does take on some of the “senseless” qualities of obsessional behaviour: (1) A positive approach response may get fixated when it also becomes an avoidance response, so that the response which satisfies the approach response also reduces a learned anxiety (double reinforcement). Farber (1948) found that a group of rats which were shocked after the choice-point in a T-maze while running to food, took much longer to extinguish than a control group which simply learned to run to food without getting shock. Herrnstein and Sidman (1958) found that if a rat has learned to press a lever to avoid shock in response to a clicker stimulus, then when the clicker and shock are later superimposed upon bar-pressing for food, there is an increase of response rate to the clicker. Without previous avoidance training, there is ordinarily a decreased response rate under such distracting conditions. (2) An instrumental avoidance response may get fixated by being punished, i.e. by becoming an unsuccessful avoidance response. This is demonstrated in the experiment by Solomon et al. (1953) who found that if shock is delivered after an avoidance response, this not only fails to extinguish the avoidance response, but in fact leads to faster and more stereotyped responding. Maier’s famous studies, in which animals jump off a platform to escape an air-blast and are punished by bumping their noses against the wrong card, also illustrates this principle (Yates, 1962). Maier himself concluded that “the fixated animal has learned which card punishes and which does not... the animal has made the required differentiation but is unable to practice the required response. This property of the fixation makes it appear as a form of compulsion” (Maier, 1949). (3) Avoidance behaviour may also be fixated by the delivery of “free” shocks, i.e. shocks not contingent upon any behaviour the animal shows. Sidman et al. (1957) trained monkeys to press a bar in a “non-discriminated avoidance procedure”: the animals are shocked if they allow a 20 set interval to elapse without pressing the bar, and pressing delays the shock for another 20 sec. There are no CS associated with the shock. If on this sort of schedule shocks are delivered “freely” or at random intervals, the rate of responding both during acquisition and extinction increases markedly. Both (2) and (3) are examples of unsuccessful avoidance. The first paradigm can be used in the analysis of cases where some stimulus is both an approach incentive and an anxiety-evoking CS for a learned avoidance response. For example, if sexual behaviour has been punished, then sexual impulses become anxiety stimuli. But they also remain sexual impulses. “Compulsive masturbation” reduces both the sexual drive and the learned anxiety elicited by sexual stimuli. Fenichel (1945) gives a case of a man who had learned to do gymnastics as a defence/substitute for masturbation. Because it was a “substitute”, he felt sexually excited after a session of gymnastics and would then masturbate. The masturbation then reduced both the sexual drive and the anxiety elicited by it. Freud’s early theory (see above) is essentially a statement of this

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principle-it is a theory of traumatic avoidance learning. The idea that with the increased urgency of the sexual drive at puberty there will also be increased anxiety was an important concept unfortunately omitted from later formulations. The approach response need not be only sexual. Wolpe (1958) describes the case of a man who felt an irresistible impulse to strike out at people when he felt himself to be in a socially inferior position. We may infer that striking out reduced both his strong hostility and the tension he experienced in the situation. It had become an avoidance response which also satisfied his aggression. The second and third paradigms can be used to explain the various rituals and ceremonial actions of obsessionals. Freud showed why washing is chosen as a response to analsadistic impulses: because of the belief that “dirty” thoughts can be washed away just like physical dirt. This infantile theory is probably encouraged by certain parental practices, e.g. washing out the mouth of a child who has cursed. The problem for learning theory is to explain why the washing response is maintained even when the original justification for it is no longer believed. This can be done if we make the plausible assumption that compulsive washing is equivalent to the unsuccessful avoidance mentioned above: i.e. the dirty thoughts do not, in fact, go away, or only temporarily do so; or if they do, they are just as likely to reappear again at “random” intervals. It is precisely because the kind of impulses and ideas which the obsessional seeks to avoid are impulses not under his control (obsessive impulses), that all his attempts at complete avoidance are doomed to failure. It seems consistent with learning theory that under such circumstances an ever-widening range of responses should be attempted, so that we end up with the crippling ritual systems described by Frink and Stekel. But it is also in the nature of these kinds of stimuli, e.g. sexual impulses, that they do fluctuate, so that every now and again some anxiety will get reduced-a perfect condition for the maintenance and spread of defensive actions. CONCLUSIONS Some qualifiers are necessary: I have not wanted to suggest that the animal experiments cited are exact analogues to obsessional neuroses. In addition to the usual gap separating controlled experiment from real life, there is the gap due to the fact that the experiments have been done on animals and not on humans. There is every reason to suppose-indeed some evidence-that in humans the features of avoidance acquisition and extinction may be rather drastically more complex, especially when we consider the role of verbal learning which makes it possible to learn a traumatic avoidance response without ever having experienced the unconditioned traumatic stimulus. Given these facts, it is indeed surprising that there is this much congruence between animal experiment and clinical observation. It has been the purpose of this paper to argue for the theoretical usefulness and even the need for this type of approach, and to give examples which should be regarded as primarily suggestive rather than definitive. Finally, the distinction between internal processes and external behaviour introduces a further complicating factor. In animal experiments we can observe movements in spacetime, not thoughts or impulses. It has been assumed, for the sake of the argument, that internal thought-patterns are subject to the same conditions of acquisition and extinction as external behaviour patterns. In the long run this will probably turn out to be an oversimplification.

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REFERENCES FARBER1. E. (1948) Response fixation under anxiety and non-anxiety conditions. J. exp. Psychol. 38, 111-131. FENICHEL0. (1945) Psychoanalytic Theory of Neurosis. Norton, New York. BRENCZI S. (1927) Washing compulsion and masturbation, in Further Conrributions to the Theory of Psychoanalysis. Liveright, New York. FONBERGE. (1956) On the manifestation of conditioned defensive reactions in stress. (Cited in Wolpe, 1958, p. 92.) FREUDS. (1896) Further remarks on the defence neuro-psychoses. (In CollecredPupers, Vol. I, pp. 155-182. Basic Books, New York, 1959.) FREUD S. (1907) Obsessive acts and religious practices. (Ibid. Vol. II, pp. 25-35.) FREUD S. (1909) Notes upon a case of obsessional neurosis. (Zbid. Vol. III, pp. 296-383.) FREUD S. (1913) The predisposition to obsessional neurosis. (Zbid. Vol. II, pp. 22-32.) FRINK H. W. (1934) Morbid Fears and Compulsions. Dodd, Mead and Co., New York. HERRNSTEINR. J. and SIDMANM. (1958) Avoidance conditioning as a factor in the effects of unavoidable shocks on food-reinforced behavior. J. camp. physiol. Psychol. 51, 380-385. JONESE. (1923) Hate and anal erotism in the obsessional neurosis, in Papers on Psychoanalysis. Wood, New York. MAIERN. R. F. (1949) Frustration: The Srudy of Behavior Without a Goal. McGraw-Hill, New York. RADO S. (1959) Obsessive behavior, in American Handbook of Psychiatry (Ed. S. ARIETI). Vol. 1, pp. 324-344. Basic Books, New York. SIDMANM. (1953) Avoidance conditioning with brief shock and no exteroceptive warning signal. Science 118, 157-158. S~MAN M., HERRNSTEINR. J. and CONRADD. C. (1957) The maintenance of avoidance behavior by unavoidable shock. J. camp. physiol. Psychol. 50, 533-557. SOLOMON R. L., KAMIN L. J. and WYNNE L. C. (1953) Traumatic avoidance learning: The outcome of several extinction procedures with dogs. J. abnorm. (sot.) Psychol. 48,391-301. %EEKELW. (1949) Compulsion and Doubt. Liveright, New York. WEI~~MANP. (1959) Characteristic superego identifications of obsessional neurosis. Psychoanal. Quart. 28,21-28.

WOLPEJ. (1958) Psychotherapy by Reciprocal Inhibition. Stanford University Press, Stanford. YATESA. (1962) Frustration and Co&r. Methuen, London.