OCD and Biblical Counseling

Why OCD is a real diagnosis and has a spiritual reality

Photo by Vitaly Gariev on Unsplash

Over a week ago, I came across this tweet from a ACBC biblical counselor who said, “OCD is not a disease like cancer. The cure has already been discovered and it is Jesus Christ. His Word is more powerful than this diagnosis.” As someone who has profoundly suffered from OCD for 18 years and prayed to Jesus Christ and poured over the Word for answers, I found this tweet to be both ignorant and dangerous. But it was a good reminder that there are many Christians today who still believe that conditions like OCD should only be treated with the Word and prayer, Christians who don’t believe that OCD is a real “condition” at all. Their argument, as I understand it, is that secular psychology has taken God and his Word completely out of the counseling picture. Instead of looking to Christ for healing, people turn to medications and secular counselors. What I want to argue today is that God works through those medications and secular methodologies to bring healing and restoration to people, just as God works through other secular scientific fields to bring human flourishing. But I also want to acknowledge that there are spiritual realities to OCD that secular counselors can fail to account for. Recovery in OCD often looks like growing in trust in God’s love for you, his provision for you, and his compassion for you.

To some extent, I dealt with this argument last year when John MacArthur announced that OCD, PTSD, and ADHD are “noble lies.” But it’s worth addressing specifically in regard to OCD. The accusation is that because we cannot measure and diagnose OCD like we can cancer, it’s not real. It’s a made-up condition that excuses sin and is a fundamental failure to trust God. As one ACBC counselor put it, OCD is really “Obsessed with Control Disorder.” So the solution is simply to stop acting like God, as if you had control when you don’t.

There are many problems with this understanding of OCD. One is that it ignores the bodily and genetic aspects of OCD, which have been well established. Something physical is going on. Second, this diagnosis can be traced in 1-2% of the population who suffer terribly. So it seems to accurately describe something. Third, it’s bigger and different than “control.” Many people suffer from fear that they hit someone with their car or will harm children. They live in terror of imagined possibilities, unable to act in the real world, unable to function or leave the house. Fourth, prayer and turning to God’s Word, while important are not sufficient for treating OCD. The Word is not a clinician’s guide for every mental illness. And that’s okay. It is what we need for life and life abundantly.

And part of the wisdom we learn from the Word is to turn to wise counselors, in this case, the counsel of those trained to treat OCD, either in ERP or I-CBT. If you ask those who have suffered from OCD if they tried trusting God more, turning over control, or praying more, they will tell you they did. I certainly did. Those were some of the first things I tried. And I tried them for years. And it’s not that those actions were wasted. They were good disciplines. But they weren’t sufficient to cure my OCD. I needed to learn to trust God more and I needed a course of treatment with ERP or I-CBT. I’m sure these “biblical therapists”¹ would say that I just didn’t do it right, that with their help I would really learn to turn over control to God, but I don’t buy that. I know that the experience of OCD involved more than an obsession with control. It involved confusion about reality and my senses that had to be addressed through treatment. It had nothing to do with sin, it had everything to do with seeing.

My concern with these particular styles of biblical counselors is that they place a burden upon the shoulders of those who are struggling to stay alive. They think they are offering hope in saying, “turn from sin to Christ!,” but in labeling OCD a failure of sin, they are heaping guilt and shame onto an already guilty and condemned conscience. What the OCD sufferer needs to realize is the reality that there is hope for recovery through discipline, trust in God, and working through therapy (and maybe medication). What they don’t need is another reason to feel bad.

What I do appreciate about biblical counselors is their insistence that God has something to say about our mental health, that our relationship with God plays a role in our mental health. This can too easily be overlooked by secular therapists who mean well but don’t approach therapy from a Christian perspective. In the case of OCD, I do think it’s natural and right for someone who goes through the process of recovery to grow in their faith, to grow in their understanding of adoption as a child of God, to grow in their understanding of grace rather than living under than Law. It’s common for people with OCD to see or feel God as a distant, condemning or indifferent figure, even though they know he is not. In my experience and the experience of other people I know, part of the recovery process involves correcting that view of God. If you don’t have a Christian therapist who can help you process these epiphanies, I highly encourage you to work with a pastor alongside your therapist as you recover. But I still believe in the value of ERP or I-CBT as behavioral practices of learning to respond differently to your doubts.

OCD is real. I wish it weren’t, but it is. And trying to reduce it to a simple failure of sin is ignorant and dangerous. It is a denial of reality and burdening the vulnerable. But there is wisdom in remembering that our faith does relate to OCD. As you recover, you should grow in your faith as well as your mental health, and that requires spiritual discipleship. Surround yourself with spiritual mentors, pastors or elders, who can help you grow during this process. My hope is that more Christians would go into counseling, training themselves, taking the gold from Egypt, the wisdom from secular psychology, and adding godly wisdom for Christian clients to aid them in their recovery. This is one reason I’m grateful for my friend Justin K. Hughes, MA, LPC and his work.

So if you are struggling with OCD, know that it is a result of the Fall, like all disease, and that you should not feel ashamed or condemned for your struggle. You will grow in your faith through recovery, but it is not a lack of faith that is keeping you stuck. It is a disorder that is keeping you stuck, and it needs a specific treatment. And the good news is that treatment is relatively successful! And God loves you and desires your good. So there is reason to hope.

1. I know this is a loaded term. I know that some licensed therapists identify as biblical therapists. And some biblical counselors do not blame OCD sufferers for their suffering. And so I want to acknowledge that biblical therapy can be a good thing, and should be, in fact.