ECHO VIII/1: Christiansen, page 2

Of course, music that sounds obsessive is not limited to Eastern European composers, unless we consider Vienna "eastern." Schubert's Gretchen am Spinnrade, op. 1, has many features that taken together form the epitome of obsession. The left hand drone fifths with the constantly repeated eighth note pairs in the tenor combine with the right hand sixteenth note figuration to produce a hypnotic and motoric effect. The left hand depicts the steady pulse of the treadle, and the right hand, the spinning wheel itself. That this accompaniment can remind one of obsession is not surprising–Gretchen is, after all, yearning for Faust and fantasizing ceaselessly about him. Her preoccupation with him so overcomes Gretchen that she stops spinning altogether in a fit of erotic reverie. Throughout the literature of Western art music, similar examples are legion. The "obstinate" ostinato is not only reminiscent of obsession, it is in fact the quintessential obsessive musical device.

Gretchen am Spinnrade excerpt

To continue our discussion, we must also consider obsession from a medical standpoint. Obsession as a medical condition is often closely associated with its related condition, compulsion, and both together are diagnosed under the term obsessive-compulsive disorder (OCD). Like phobias, OCD constitutes a neurotic anxiety disorder, and thus is in contrast to psychotic disorders such as paranoia or schizophrenia. People with this condition frequently suffer from a feeling of helplessness, and the disorder has a significant impact on their lives, often causing serious problems in professional and personal relationships. One of the chief differences between an anxiety disorder such as OCD and a psychotic disorder is that patients with an anxiety disorder know that they have a problem, but feel powerless to resist their urges. (Psychotics, whose perception of reality is distorted, are not necessarily aware of their condition.) In order for a person to be diagnosed with obsessive-compulsive disorder, he or she will have obsessions, compulsions, or both.⁶ In addition to meeting this criterion, the person's condition must not be caused by another mental disorder and the obsessions or compulsions must cause distress to the person or have a profoundly negative influence on his or her life.⁷

For an exact medical definition of OCD, we turn to the Diagnostic and Statistical Manual of Mental Disorders, which explains the disorder and its component parts this way:

DSM-IV-TR Diagnostic Criteria
300.3 Obsessive-Compulsive Disorder.

A. Either obsessions or compulsions: Obsession as defined by (1), (2), (3), and (4):

(1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that caused marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions as defined by (1) and (2):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to the rules that must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly obsessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an eating disorder; hair pulling in the presence of trichotillomania; concern with appearance in the presence of body dysmorphic disorder (BDD); preoccupation with drugs in the presence of hypochondriasis; preoccupation with sexual urges or fantasies in the presence of paraphilia; or guilty ruminations in the presence of major depressive disorder).
E. The disturbance is not due to the direct psychological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. (902-3)

A person who is truly obsessed is, for example, someone who has the unwanted recurrent thought that he is contaminated by germs from strangers. Unpleasant fears of contamination or infection constantly besiege the victim, and he is unable to dispel the intrusive thoughts. The only relief is the immediate and temporary one that follows carrying out a particular compulsive action or thought. A compulsion that could accompany this obsession is the repeated and thorough washing of one's hands many times throughout the day, leaving the hands raw and irritated.

Obsessive-compulsive disorder is a true disability as defined by the Americans with Disabilities Act of 1990 (ADA): "a physical or mental impairment that substantially limits one or more major life activities." A person with OCD may have the habit of conducting her morning ablutions in exact order, repeating each action three times before moving on to the next (feeling compelled to start over from the beginning whenever she "makes a mistake"). Similar cases are described in the medical literature. It is not difficult to imagine how this person's life can be "substantially limited" by his condition. People who come into contact with someone who has OCD quickly become acquainted with the abnormality and this awareness significantly affects their perception of the person. A person with obsessive-compulsive disorder is not immediately revealed as disabled or abnormal in the sense of being disfigured or deformed. It is the subject‘s behavior that stigmatizes him or her.

There is evidence that the brains of people with OCD are physiologically different from those of people without the disorder. One study suggests that in OCD patients there is abnormally high activity in the frontal lobe and in one area of the basal ganglia, which is thought to be involved in providing stimulus for worrying.⁸ Another cause for the disorder could be low levels of certain neurotransmitters, specifically serotonin, norepinephrine, and dopamine. One recently concluded study recruited patients to participate in an investigation of this phenomenon.⁹ This research is meant to build upon earlier work along the same lines (Barr et al). Yet another possible cause is that OCD patients tend to have less white matter, which is found below the cerebral cortex and has axons that connect impulses between neurons in the cerebral cortex and other sectors of the brain (Jenike et al).

Footnotes

6 Some authors contest the necessity of separate definitions for obsession and compulsion and consider the distinction to be arbitrary; see, for example, Reed.

7 Some mental disorders are related and they have an accretive effect on each other. For example, people who exhibit symptoms of OCD or some form of obsessive-compulsive behavior are often also afflicted by Tourette's Syndrome. Other OCD patients battle with bouts of depression or recurring conditions such as Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).

8 Two studies that have investigated this question are Szeszko et al, and Zald and Kim.

9 The unpublished results of "PET Imaging of Monoamine Transporters in OCD-Related Disorders" are available online at: http://clinicaltrials.gov/ct/show/NCT00082550?order=1