Understanding Obsessive Compulsive Personality Disorder Using Gestalt Therapy

After reading a bit of Gestalt Therapy Verbatim, I am reminded of the basic model behind Gestalt Therapy: the organism directs itself. Everything else is neurosis/pathology.

 

More specifically, we have three things we can be aware of:

1.     Inner Zone: Our bodies (we can tune into our hands, legs, eyeballs, sinus passages)

2.     Outer Zone: Our environments (we can smell peanut butter and hear birds singing to each other)

3.     Intermediate Zone: Our Imagination (we can invent and solve problems, make plans, rehearse conversations, imagine our future)

 

For Fritz Perls (founder of Gestalt Therapy), psychological problems (such as obsessive compulsive personality disorder) always take place in the Intermediate Zone, which creates a blockage between our awareness and the here and now. Healing comes by growing our awareness of the Inner and Outer Zones, which always occur in the here and now. The completely healthy person has maximum awareness of these two zones and zero awareness of the Intermediate Zone. The neurotic is partially in the Intermediate Zone, and the Psychotic is completely in the Intermediate Zone (that is, they lack all awareness of reality).

 

Turning this model to my obsessive compulsive personality: I can learn about my problem by watching myself. I will feel a strong pull or desire to do something—say, to eat a bowl of cereal. This is an Inner Zone awareness of hunger, specifically hunger for a higher glycemic meal. I crave carbohydrates.

 

But rather than attend to this awareness, I get trapped in the Intermediate Zone. I think, “You shouldn’t eat breakfast cereal. It isn’t good for you. It will make you fat.” In this instance, what Perls calls the “Topdog” (for Freud it’s the “Superego;” for Berne it’s the “Critical Parent”) jumps in and gives a prescription for better living. My mind runs wild with rules to follow and worst-case-scenarios if I don’t.

 

You see, I have a phobia about getting fat. I don’t trust my body to eat when I’m hungry. I don’t trust my desire. I worry about what will happen if I eat whatever and whenever I want to eat. I believe I must control both. So I ignore my Inner Zone and give preference to my Intermediate Zone. I willingly adopt an unhealthy personality because I believe it comes with the promise of weight control. This is the sort of environment in which OCPD thrives. 

The Obsessive Compulsive Personality in Gestalt Therapy

For Perls, you and I don’t have selves. We don’t have selves. We simply are what we are what we are. Right now I am sitting on my patio in pajamas with my legs up on the table and computer in my lap. 

 

“Hey Patrick, what kind of person are you? Describe yourself to me”

 

Gladly. I am the kind of person who is sitting on his patio in pajamas with his legs up on the table and computer in his lap.

 

“And what do you do?”

 

Well, right now I’m typing on my computer.

 

And so on.

 

The healthy personality is dynamic, always changing in response to changes in the environment. (I actually wrote an article about this in The Humanistic Psychologist several years ago. In it I link a fun theoretical school of biology—biosemiotics—to the self-actualization theory of neuropsychiatrist Kurt Goldstein.) The unhealthy personality is static. The unhealthy person wears armor that protects them from the environment. Kindness may be virtuous. It might be high in social value. But kindness is an impediment for circumstances that don’t call for it. And even in circumstances that call for it: forced kindness is hardly the same thing as genuine kindness.

 

The obsessive compulsive personality is afraid to let go and just be whatever is called for them to be in a particular moment. Instead, they must prepare in order to be a particular way:

·      I must prepare to be responsible

·      I must prepare to be morally upstanding

·      I must prepare to be smart

·      I must prepare to be the best

·      I must prepare to be attractive

These are elements of a superlative personality. But imagine each as a piece of metal cladding around your body, blunting your awareness of the world around you. Instead of just existing and letting our personality emerge dynamically and in response to the environment, I plan and I posture so that only certain qualities are on display. Ironically, this extra work does the opposite of what I hope. My efforts to be smart or funny or attractive are self-defeating.

 

For example: I go through periods of disdain for my physical appearance. I feel fat, and I don’t want to be fat, so I eat less and I exercise more. I practice discipline to control my narrative. I grab my life by the reins, and so on. Paradoxically, however, I gain weight. How does this happen? 

 

Well, the human metabolism is the most dynamic and adaptable metabolism in the animal kingdom. By cutting calories, my body immediately responds to the calorie deficit by slowing my metabolism. Without trying to, I help my body prepare for famine. I could survive weeks without eating due to this feature. But I don’t want to survive for weaks, I want to metabolize the fat around my waist! Now when I do eat, those precious calories are stored away as fat because the survival mechanism has my body thinking there is famine all around.

 

The same sort of thing happens with increases in exercise. Now I’m burning 1000 calories a day running or hiking or biking, so my body prioritizes the exercise and creates this energy surplus by cutting energy to other less important functions (such as creativity, mood stability, and some endocrine and immune function). So I have no interest in writing or being civil to my wife and students, but I can accept this if it means I will lower my body fat percentage. I may lose weight, but it’s mostly muscle. I gain fat, and I wind up weaker and more tired than I was before I started exercising. (The science behind the dynamic metabolic function and exercise I have summarized comes from the book Burn by Duke anthropologist Herman Pontzer.)

 

I know all this, but I still believe that I’m better off controlling my future than trusting the process.