This article was downloaded by: [Aston University]

On: 04 September 2014, At: 01:19

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK

Psychoanalytic Inquiry: A Topical Journal for Mental

Health Professionals
Publication details, including instructions for authors and subscription information:
[Link]

A Specific Developmental Deficit in Obsessive-

Compulsive Disorder: The Example of the Wolf Man
a b
Dr. Russell Meares M.D.
a
University of Sydney
b
Western Area of Sydney Mental Health Services
Published online: 01 Jul 2008.

To cite this article: Dr. Russell Meares M.D. (2001) A Specific Developmental Deficit in Obsessive-Compulsive Disorder: The
Example of the Wolf Man, Psychoanalytic Inquiry: A Topical Journal for Mental Health Professionals, 21:2, 289-319, DOI:
10.1080/07351692109348936

To link to this article: [Link]

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the
Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and
are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and
should be independently verified with primary sources of information. Taylor and Francis shall not be liable for
any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever
or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of
the Content.
This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
[Link]/page/terms-and-conditions
 A Specific Developmental Deficit in
Obsessive-Compulsive Disorder:
The Example of the Wolf Man
Downloaded by [Aston University] at 01:19 04 September 2014

R U S S E L L M E A R E S, M.D.

In this paper I suggest that the origins of the “contamination/

cleaning” form of obsessive compulsive disorder (OCD) include
a developmental history characterized by marked overpro-
tectiveness allied with parental failure to respond to core aspects
of the child’s personal reality. The combined effect of these
parental behaviors is likely to impede the establishment of a
mature conception of the boundary between inner and outer
worlds. The consequence of such a deficiency is the persistence
of the magical form of thinking which is essential to the
production of OCD. In addition, the individual is left with a
disruption of personality development, the main features of
which include timidity and falseness. The Wolf Man provides
an example of both the characteristic development history in
OCD and its consequences. Treatment based on this theoretical
background may provide benefit not predicted by current
psychoanalytic pessimism.

A LTHOUGH FREUD WROTE 14 PAPERS ON OCD he found, toward the end

of his life, that “as a problem it has not yet been mastered” (Freud,


Dr. Meares is Professor of Psychiatry, University of Sydney; Academic Head,
Western Area of Sydney Mental Health Services.

289
 290 RUSSELL MEARES

1926, p. 113). There has been little advance since his time. Indeed,
therapeutic disillusionment with the disorder has been such that very
little psychoanalytic inquiry into its nature has occurred over the
last few decades. A consensus has arisen that the traditional approach
to treatment is not likely to be effective. A new approach must be
found. Freud’s observations provide a starting point for working
toward a revised therapeutic method in OCD. Freud identified a
central feature of the illness. He called it “the omnipotence of
thoughts.” It is fundamental to the generation of OCD symptom-
Downloaded by [Aston University] at 01:19 04 September 2014

atology. I argue that this phenomenon is a consequence of the

particular kind of early family environment experienced by those
who later suffer OCD. The story of the Wolf Man illustrates this
kind of developmental history, which, it is postulated, has the effect
of impairing the formation of a mature conception of the distinction
between the inner and outer zones of experience.

The Biological Case

Before embarking on the main argument it is necessary briefly to

confront a prevailing viewpoint that mitigates against a psycho-
dynamic understanding of OCD and that potentiates the already
pessimistic attitude of therapists toward this illness. Those who see
OCD from this position contend that it has, primarily, a
neurophysiological basis. This view is based on two main bodies of
data: genetic and brain imaging.
Pauls et al. (1995) reviewed the principal evidence for a genetic
component in the aetiology of OCD. The findings of most family
studies favored the idea. In some cases, there was also a family history
of tics. In their own study, involving 100 cases, they found about 10
percent of relatives of those with OCD also suffered from OCD. This
compares with a prevalence in the general population of about 2
percent (Robins et al., 1984). Although there are negative findings
(e.g., Black et al., 1992; Bellodi et al., 1992) and adoptive studies
have not yet been reported, it is reasonable to conclude that in many
cases a genetic vulnerability is a factor in the genesis of OCD.
Brain imaging studies indicate that such a genetic vulnerability
may be mediated via the hyperactivity of certain neuronal circuits.
Although the evidence of coarse structural brain abnormalities in
OCD is minimal (Kellner et al., 1991), functional studies show
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 291

hyperactivity in the orbitofrontal cortex (Baxter et al., 1988; Nordahl

et al., 1989; Rauch et al., 1994), the left anterior cingulate gyrus
(Rauch et al., 1994), and caudate regions (Baxter et al., 1992; Rauch
et al., 1994) in those with OCD. This configuration of brain activation
in OCD is not immutable. It is no longer evident on recovery (Swedo
et al., 1992; Baxter et al., 1992).
These findings support the hypothesis that circuits involving the
basal ganglia, the limbic system, and the orbitofrontal cortex may
underpin OCD (Alexander, DeLong and Strick, 1986; Alexander,
Downloaded by [Aston University] at 01:19 04 September 2014

Crutcher, and DeLong, 1990). However, in my view, this activity is

not sufficient for the production of OCD. This view depends upon
the clinical observation that at least two characteristics of thought
are necessary to the formation of OCD. The first of these involves
repetition; the second characteristic, identified by Freud, is the curious
and magical power those with OCD attribute to their thoughts. My
argument rests on the assumption that the tendency to repetitive,
cycling thoughts, analogous to a “mental tic,” is an aspect of genetic
vulnerability, while the “omnipotence of thoughts” is a consequence
of development. It is the latter that is the disabling factor in OCD.
Iterative thought is not, in itself, pathological. Many people have the
experience, from time to time, of a thought or tune recurring in their
minds in a way that is often irritating and intrusive. Their lives,
however, are not taken over by the need ceaselessly to perform
senseless rituals.
The foregoing assumption implies a multimodal treatment
approach. Since the pattern of iterative thinking must be neuro-
chemically mediated, a pharmacological approach to it is appropriate
(Zohar and Inser, 1987; Goodman, McDougle, and Price, 1992).
However, the efficacy of pharmacotherapy can be overstated. This is
demonstrated in the outcome of a recent important multisite trial of
a selective serotonin uptake inhibitor involving over 300 patients.
About a third were placed on placebo while the others were given
varying drug doses. All patients were carefully monitored over a 12-
week period during which they were given eight extensive evaluations
involving questionnaires, interviews about side effects, and also, less
frequently, physical examination, ECG, and routine blood tests. Both
groups steadily improved over the 12-week period. Thirty percent of
placebo-treated patients were much improved or better. The figure
for the drug-treated group was 38 percent. In essence, this trial could
 292 RUSSELL MEARES

be seen as showing that ordinary medical care produced a 30 percent

treatment effect, while medication exerted an additional benefit of
8.9%. It should be noted that the durability of response to medication
is likely to depend on continuing medication (Pato et al., 1988).
In summary, these data and ideas lead to the view that medication
is unlikely to provide adequate therapeutic benefit for the typical
case of OCD. The argument put forward here is that the personality
structure that underpins the “omnipotence of thoughts” must, in many
cases, be approached psychotherapeutically.
Downloaded by [Aston University] at 01:19 04 September 2014

The Omnipotence of Thoughts

As previously remarked, the work of the psychotherapist is directed

toward the “omnipotence of thoughts.” Freud (1913) described a
person in the grip of this form of thinking. He is:

unable to believe that thoughts are free and will constantly be

afraid of expressing evil wishes, as though their expression will
lead inevitably to their fulfilment. This behavior, as well as the
superstitions which he practices in ordinary life reveals his
resemblance to the savages who believe they can alter their
external world by mere thinking [p. 87].

The magical beliefs that are the basis of the “omnipotence of

thoughts” are found in the rituals of most societies and also held by
children, as Freud noted. A consideration of this form of childhood
thought led Piaget to propose that magical thinking is a consequence
of the child’s not yet having formed the mature conception of an
inner life that is distinct from the outer world. The development of
this concept, which is to be distinguished from a percept, can be
charted by studying the attainment of the concept of secrecy (Meares
and Orlay, 1988) and by the observation of “false belief” (Perner,
Leeham, and Wimmer, 1987; Gopnik and Astington, 1988). These
studies suggest the concept of self-boundary is gained at about the
age of 4, with fairly wide individual variations.
Freud had noted the deficiency of the conception of boundary in a
tribal system dominated by magic. “Telepathy,” he remarked, “is taken
for granted” (1913, p. 81). He referred to Fraser’s (1954) classic The
Golden Bough in developing an understanding of magical belief.
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 293

Although he does not make it explicit, Fraser’s explanation of magic

resembles Piaget’s. He considered that magic depended upon two
main principles. He called them the Law of Similarity and the Law
of Contagion (p. 11). The latter clearly depends on the belief in an
incomplete boundary between self and world. An individual’s
feelings, thoughts, and wishes can, as it were, seep into the
environment, so influencing it. Contagion goes in both directions, so
that universal events or aspects of the environment can seep into
people and have an effect upon them. Examples of contagious magic
Downloaded by [Aston University] at 01:19 04 September 2014

include the belief “that epilepsy can be cured by striking the patient
on the face with the leaves of certain trees and then throwing them
away. The disease is believed to have passed in to the leaves, and to
have been thrown away with them” (Fraser, 1954, p. 539). Freud
(1913, p. 80) quoted another of Fraser’s examples involving rice
farmers and their wives engaging in sexual intercourse in the rice
fields at night in order to enhance the crop, as if their own fertility
would infect the field itself. The magical sense of contagion was
apparently experienced by the Wolf Man in a period when he was
free of OCD. One day, as he was driving with his future wife in a car,
she “suddenly felt ill, and a few minutes later I also felt unwell. This
feeling did not last long, but neither of us could explain what caused
it. Later I interpreted this as a presentiment of approaching trouble”
(Gardiner, 1971, p. 76).
A society dominated by the system of contagious magic is an
uneasy one. Various rituals are institutionalized in order to ward off
contagion. They closely resemble that of the individual sufferer from
OCD. Freud noted that the OCD patient lives in an atmosphere of
dread, as if some disaster were about to occur. He remarked:
“Whenever I have succeeded in penetrating the mystery, I have found
that the expected disaster was death” (Freud, 1913, p. 82). He found
that the obsessional was preoccupied with death. He wrote: “Their
thoughts are increasingly occupied with other people’s length of life
and possibility of death; their superstitious propensities have had no
other content to begin with and have perhaps no other source
whatsoever” (1909, p. 236). At bottom, the death that is feared is
their own.
The threat of death comes from two directions. The first is from
the environment. The subject is constantly at risk from malignant
universal forces represented in dirt, germs, feces, and putrefaction.
 294 RUSSELL MEARES

The fear of contamination is, in most studies, the single most common
obsessional theme. Thomsen (1991), for example, found that the most
frequent obsessive content in 61 Danish patients was thoughts about
dirt and contamination, followed by concern about death, illness,
and harm. Fears of contamination were the most common obsessions
in India (Khanna and Channabasavanna, 1988) and Japanese (Honjo
et al., 1989) and Egyptian studies (Okasha et al., 1994). In the latter
study, religious obsessions were equally common, followed by
somatic obsessions. Confirmation of these fears through bereavement
Downloaded by [Aston University] at 01:19 04 September 2014

or threats of health often precipitates the illness (Khanna, Rajendra,

and Channabasavanna, 1988).
The second threat of death arises through the magical effect of
feelings and wishes upon attachment figures. The individual fears
that not only wishes but also unbidden thoughts may harm those close
to him or her. Consequently, “an obsessional neurotic may be weighed
down by a sense of guilt that would be appropriate in a mass murderer,
while in fact, from his childhood onwards he has behaved to his fellow
men as the most considerate and scrupulous member of society.
Nevertheless, his sense of guilt has a justification; it is founded in
the intense and frequent death wishes against his fellows which are
unconsciously at work in him. It has a justification if what we take
into account are unconscious thoughts and not intentional deeds”
(Freud, 1913, p. 87).
A more fundamental fear arises from these wishes. Those who
may be damaged by the obsessive thoughts are those upon whom the
obsessional’s sense of existence depends. The demise of the
attachment figure will bring about a state in the subject analogous to
the threat of death. Sylvia Anthony’s (1971) studies showed that the
child’s concept of death was related to “separation from the mother
or the person who gave the child most care” (p. 145).
The sense of threat to one’s existence through the absence of the
other is a feature of life before a fairly mature conception of self-
boundedness is achieved. Attachment figures are conceived, at least
so Spitz (1950) supposed, as necessary parts of the self-system,
something like a rather special limb. Mahler’s (1968) views were
somewhat similar. Seen in this way, the separation anxiety of normal
development is a manifestation of the child’s failure to have yet
attained the concept of an inner world that is distinct from the outer
one (Meares, 1986). Since it is hypothesized that the formation of
this concept is immature in those with OCD, it will be predicted that
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 295

these patients will be particularly vulnerable to separation fears.

Clinical evidence supports the prediction. Threats to dependence
needs may precipitate the illness. This was so for Mr. A. He had
lived with his parents until rather late in his life. He was treated as a
special child in comparison to his younger brother. In his thirties he
married an extremely “good” woman, who cared for him inordinately.
They continued to live with his parents. His illness began with the
birth of their child. His obsessive thoughts were fears of killing it.
It will now be evident that the obsessive-compulsive is immersed
Downloaded by [Aston University] at 01:19 04 September 2014

in anxiety. First, there is the danger of contagion creeping in from

the environment. Second, there is the separation anxiety induced not
only by actual absence, but also through the harm inflicted by the
omnipotence of thoughts, as Klein (1934, 1935) suggested.
Reverberation between these two sources of anxiety may cause it to
escalate, heightening the apprehensive expectation of some disaster,
analogous to death. In such a situation, something must be done to
prevent the imminent catastrophe. As the Rat Man put it: “I had an
uncanny feeling, as though something must happen if I thought such
things, as though I must do all sorts of things to prevent it” (Freud,
1909, p. 162).
Freud pointed out that the obsessive now constructs a magical
counterworld in order to protect himself from the dangers that seem
to besiege him. The individual’s personal life now becomes like the
social system of those societies in which magical thought is dominant.
Against the pervasive fear of contagion is built an overrigid system
of rituals and controls that involve, “separations, demarcations,
purifications, and punishment of transgression” (Douglas, 1966, p.
4). The ritualistic behaviors of the OCD patient, since they are
designed to reduce anxiety, become conditioned. Learning theory
must not be neglected in the management of these symptoms. This is
consistent with the multimodal approach mentioned previously. It is
also consistent with the Freudian remark that: “One can hardly master
a phobia if one waits till the patient lets the analysis influence him to
give it up” (Freud, 1919, p. 165).

Boundary, the Environment, and Overprotection

The suggestion put forward here is that the magical behavior of the
patient with OCD has its origin in the obsessive’s failure adequately
to conceive a personal and interior zone that is distinct from the outer
 296 RUSSELL MEARES

world. This deficiency was observed by Freud in his work with the
Rat Man. Freud noted that his patient believed that the beginning of
his illness came with the “morbid idea,” as he put it, “that my parents
knew my thoughts: I explained this to myself by supposing that I had
spoken them out loud, without having heard myself do it” (Freud,
1909, p. 162). Freud italicized this remark, impressed by its
significance. A few sessions after this the Rat Man admitted that the
belief his parents knew his thoughts had persisted for the whole of
his life (p. 178).
Downloaded by [Aston University] at 01:19 04 September 2014

Similar experiences, with varying degrees of severity, are recounted

by contemporary OCD sufferers. For example, a woman of 23 said
that she was uncertain whether she had merely thought things or had
spoken them aloud. As further evidence of her ill-defined conception
of self-boundary, she remarked that, when people went away, they
took a part of her with them, as if this were literally so. Another
patient’s awareness of the fragility of “the privacy of the self” seemed
to be signalled by his need to perform an extraordinary series of
routines that guarded against the possibility of being observed from
the street while he undressed in his bedroom. This behavior heralded
the onset of OCD. He resembled those in Janet’s classic series whose
sense of exposure was such that they had to be quite alone while
undressing (Pitman 1984, p. 310).
What might be the origin of a deficiency in the formation of a
conception of self as bounded? In order to attempt an answer, we
must return to Piaget. Piaget (1929) considered that the period in a
child’s life in which magical thinking was prominent coincided with
a phase he called egocentric. During this period, self and the world
are not conceived as quite distinct. To some extent the child conceives
the universe as part of himself or herself, and those people in it are
also parts of self. The personal world is, to a large extent, exterior
(Gruber and Voneche, 1977, pp. 132, 200–205). In order to move
beyond this conceptual stage, children must discover that there are
other realities than one’s own. This comes about, at least to some
extent, through the child’s encounter with the world. This idea was
expressed by both Piaget and Vygotsky.
Piaget, like Freud, had noted that magical thinking was part of the
culture of so-called primitive, or hunter-gatherer, societies. Vygotsky
(1962) criticized this generalization, pointing out that “we could not
call agriculture and hunting negligible contacts with reality in the
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 297

case of primitive man; they are practically his whole existence”

(p. 23).
Despite Vygotsky’s criticism, Piaget was well aware of the
necessary effect of social life on the child’s emergence from the phase
of magical belief. He wrote: “Without collaboration between his own
thought and that of others, the child would not become conscious of
the divergences which separate his ego from that of others, and he
would take each of his perceptions or conceptions as absolute. He
would therefore never attain to objectivity, for lack of having ever
Downloaded by [Aston University] at 01:19 04 September 2014

discovered his own subjectivity. Without social life, he would never

succeed in understanding the reciprocity of viewpoints, and,
consequently, the existence of perspectives, whether geometrical or
logical. He would never cease to believe that the sun follows him on
his walk” (Gruber and Voneche, 1977, p. 137).
Both Piaget and Vygotsky suggest that where the adult individual
is able to grapple with the environment, to test it out, to find one’s
suppositions failing, magical thinking is not in evidence. On the other
hand, where the world cannot disprove one’s view of it, magical
thinking may persist. These ideas suggest that the child needs, at
times, to find that the environment is not as he or she has supposed,
that others are not merely an extension of oneself, that they have
their own wishes and feelings. In the interchange and “collaboration,”
as Piaget called it, with others, as with the physical world, the child
will take small risks in the testing procedure. In this way, the child
comes up against another reality, an “objectivity,” which, through its
difference, creates a sense of boundary between the “subjectivity”
of self and a world outside.
These ideas suggest that, where the parents are overprotective,
the child’s conception of the boundary of self will be impaired. This
notion leads to the prediction that OCD will be associated with such
a family background. The prediction is supported not only by the
author’s clinical observations on a series of inpatients with OCD
diagnosed according to DSM-IV criteria, but also by family studies
of OCD, which unfortunately are relatively few and limited in
methodology.
Overprotection in the developmental history of OCD sufferers has
been demonstrated in three questionnaire studies (Ehiobuche, 1988;
Hafner, 1988; Cavedo and Parker, 1994). This overprotection, allied
to the patient’s dependence, typically persists into later life, as in the
 298 RUSSELL MEARES

case of Mr. A. Ms. B provides a second example. She was a 46-year-

old spinster who still slept in her parents’ bedroom. Mrs. C, after her
marriage breakup in her twenties, returned to her mother, in whose
bedroom she slept. Miss E, aged 23, also slept in her mother’s
bedroom. This kind of story suggests a family enmeshment consistent
with data showing that those with OCD tend to be celibate and have
a low marriage rate (Hare, Price, and Slater, 1972). Thomsen (1995)
followed up 47 childhood OCD patients 6–22 years after their first
referral found that, compared with non-OCD patients, they had fewer
Downloaded by [Aston University] at 01:19 04 September 2014

partnerships and more were still living with their parents.

The overprotection that, in theoretical terms, underlies magical
thinking, involves parents accommodating to the child’s conception
of others as extensions of self. As Kohut pointed out, parents must
provide selfobject experiences for the child, but with maturation they
must also fail in this behavior, providing “optimal frustration” and
the experience of others as objects. A recent study from Calvorovessi
et al (1995) suggests that such accommodation, at least of a kind,
persists into adult life. They found that 30 of 34 families of an OCD
sufferer accommodated to the patient’s symptoms in a way that
seemed unreasonable. Unfortunately, such data shed no light on the
parents’ behavior in the patient’s childhood.
It appears that the child who eventually develops OCD, and who
is overprotected, is treated, at least in some ways, as “special.” The
family remarked, for example, on Mr. A’s “special” relationship with
his mother compared with that between his brother and the mother.
The coarse data of several studies support the notion of “specialness.”
For example, there are more male firstborns than expected in a sample
of OCD patients (Snowdon, 1979). Significantly more parents of OCD
patients belong to the highest social classes (Thomsen, 1994). There
is some evidence that those with OCD are of above average
intelligence (Slater, 1945; Lal, Gupta, and Agarwal, 1987). Contrary
to the findings in other anxiety-based disorders, in which females
predominate, OCD, in at least some studies, is more common in males
(Swedo et al., 1989; Okasha et al, 1994; Hanna, 1995). However, in
a large U.S. study (Karno et al., 1988) males and females are equally
represented. It may be that excess male representation is a product
of those cultures and subcultures in which maleness in children is
highly valued. However, Janet’s figures were strikingly different. He
found a 3:1 ratio in favor of females (Pitman, 1984). Perhaps this is
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 299

a reflection of very different cultural norms in European society a

century ago, when females were considerably more protected than
they are at present.

Realization and Doubt

Treating a child as special is an essential aspect of his or her

development. Kohut, for example, spoke of the adoration (Elson,
1987, p. 62) of the mother for her baby. However, the protection and
Downloaded by [Aston University] at 01:19 04 September 2014

the aura of “specialness” that surrounds the child who later develops
OCD is of an unreal kind. In important ways it is not connected or
related to central aspects of the child’s personal reality. The effect of
this lack of connection is to impede the emergence of inner experience
and the sense of self.
Self is defined here in the manner of William James (1890). It is
conceived as an awareness of the movements of an inner life, which
have the form of play (Meares, 1990, 1993, 2000; Meares and
Lichtenberg, 1995). It is a process, not a substance or a thing. (The
frequently used term structure is more appropriately tied to self-
representation.) Self as the stream of consciousness emerges rather
late in development, around the age of 4 (Flavell, Green, and Flavell,
1993). It seems clear from a multitude of studies of parent–child
interaction that the necessary precursors to this experience include
significant periods of “attunement” (Stern, 1985) on the part of the
parents to the most personal of the child’s experience, the core of
which is a feeling-state. In this way, the evanescent, partly formed
inner zone is made “real.” On the other hand, where this attunement
is lacking, reality is uncertain. The way in which the caregiver helps
in establishing the child’s personal reality is illustrated by the
interesting experiments of Sorce et al. (1985).
The responses of children aged about a year were studied as they
crawled out over the visual cliff. At some point, as they moved out
over the glass, they became aware of the space below them. They
would then glance at their mother. If the mother showed fear on her
face, the children were also afraid and scuttled back from the apparent
cliff. On the other hand, if the mother smiled and was reassuring,
then the baby continued moving toward her. The mother’s expression
gave shape to the child’s reality.
 300 RUSSELL MEARES

We might suppose that the child, poised precariously over the space
below it, was uncertain and had mixed feelings, including both
apprehension and curiosity. The mother’s expression can sometimes
encompass several aspects of the child’s feeling state. Often, she
makes a choice of response. There is, however, a third possibility.
She makes no response at all. What will be the effect? First, we
presume, the child will wait, however briefly, for the mother to play
her part in the child’s experience. She is required, as it were, to
complete it. If she continues to show no response, the experience has
Downloaded by [Aston University] at 01:19 04 September 2014

about it a feeling of being unfinished. Moreover, the child is now in

two minds. Is this situation dangerous or merely interesting? How
then should one act? The child’s situation is now very like that of the
sufferer from obsessive-compulsive disorder in which, as the early
French descriptions of the disorder show, the sentiment d’
incompletude and the folie du doute are central features. [In
etymological terms, doubt refers to being in two minds (Partridge,
1983).] The individual’s confidence in the reality of his or her
experiences, including memories, is diminished (McNally and
Kohlbeck, 1993).
In an early paper, Freud gave descriptions of obsessional states,
which included the folie du doute (Freud, 1895). In his study of the
Rat Man, it seemed central to an understanding of the disorder.
Obsessionals doubt everything—the significance of their thoughts,
the veracity of their feelings, the meaning of their acts, and their
worth as people. The pervasive doubts are accompanied by repetitive
internal questioning of the kind: “What if . . . ? How can I be sure?”
The centrality of doubt in OCD is accompanied by a fragility of
meaning. Meaning was a preoccupation of the Rat Man. For example:
“He forced himself to understand the precise meaning of every
syllable that was addressed to him, as though he might otherwise be
missing some priceless treasure” (1909, p. 190). Derealization is a
common accompaniment of OCD, as Janet had pointed out (Pitman,
1984, p. 299).
Freud viewed obsessive doubt as a kind of need. He wrote that
“the creation of uncertainty is one of the methods employed by the
neurosis of drawing the patient away from reality and isolating him
from the world” (1909, p. 232). What is suggested here is the reverse
proposition. The individual’s disconnection and isolation from the
world produces a diminished sense of reality.
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 301

The lack of attunement to the child’s experience seems, in the

case of those with OCD, to amount to more than empathic failure. It
involves actual evasion of central issues of family life. A facade of
genteel “niceness” is maintained while these issues are skirted about,
not spoken of. The sense is conveyed that conversation about these
issues might, in some way, be beyond what the child can cope with.
An example was provided by Miss E, who, as previously remarked,
still slept in her mother’s bedroom at the age of 23. A major event in
her childhood was the separation of her parents, which occurred when
Downloaded by [Aston University] at 01:19 04 September 2014

she was 4. Her parents, however, in order to “protect” the child, tried
to pretend that the marriage was continuing as before. The father
visited every weekend in order to preserve an appearance of “normal”
family life. It wasn’t until the child was 16 that she learned the truth.
A similar story of a family skirting about central issues in the
developing child’s life was given by another young woman. Her father
had died when she was a child, but she was never given any proper
explanation of what had occurred. She knew he had “gone to rest”
and believed that one day he would come back and that she would
see him walking in the street. Additionally, the family avoided the
issue of sexual abuse, which had been inflicted upon the child by a
family member and which, the patient sensed, the family knew about.
This kind of behavior was discussed by Calvocoressi et al. (1995)
in their study of parental accommodation to OCD behavior. These
investigators considered that the accommodation was a means of
avoiding unpleasantness; that is, it was intended to reduce the patient’s
anxiety or anger. However, it was Joseph Barnett who most clearly
described the characteristic familial system in OCD. Influenced by
Sullivan (1956, p. 267), he observed that “the obsessional way of
life is largely organised to meet the dilemma created by the hypocrisy
and ambiguity characteristic of the obsessional’s early family
situation. The self system of the obsessional develops in a climate of
hostility, rejection, and power struggles hidden beneath a facade of
loving care and concern. In lieu of warmth and acceptance, he was
the object of overprotective and restrictive demands” (Barnett, 1971,
p. 338). Typically, despite its dysfunctional nature, the marriage of
the parents persists (Thomsen, 1994). Their avoidance of crucial
aspects of their own and their child’s existence, amounting at times
to deception and self-deception, is internalized by the child, leading
Barnett to define the central dynamic of the obsessional is a conclude
 302 RUSSELL MEARES

that need to maintain innocence, that is, a need not to know about
himself or herself or about his or her relationships.

Apathy, Trauma, and the False Self System

The failure of the parents to respond adequately to a child’s personal

reality has consequences beyond the “need not to know.” First of all,
it has an effect on the child’s sense of vitality.
The issue of vitalization provided by the responsiveness of
Downloaded by [Aston University] at 01:19 04 September 2014

caregivers is vividly illustrated by Mahler et al. (1975). They

described a situation “in which the 5–8 month old, surrounded by
the admiring and libidinally mirroring, friendly adults, seemed
electrified and stimulated by the mirroring admiration. This was
evident by his excited wriggling of his body, bending his back to
reach his feet and his legs, kicking and flailing with the extremities
and stretching with an exaltedly pleasurable affect” (p. 221). Such
an enlivening effect of the caregivers’ behavior involved a “fit,” or
matching, between the child’s main experience and the response of
the other. The sense of “fit” experienced, at times, between oneself
and others is, of course, found throughout life and accompanied by a
feeling of well-being (Meares, 1977, 1993, 2000). Those relatively
deprived of this form of responsiveness may be left not only with a
persisting dysphoria, but also a diminished feeling of vitality.
Lack of connectedness between parent and child and the habitual
empathic failure displayed by the former have an effect on the
developing individual which at times is traumatic. Trauma is
understood here as “a break-up of whatever may exist at the time of
a personal continuity of existence” (Winnicott, 1974, p. 115).
Traumatic events are stored in a memory system that, it has been
postulated (Meares, 1995), develops earlier in the child’s life than
those memory systems upon which ordinary mature consciousness
depends. The traumatic memory system has been delineated by
Brandchaft (1993), who points out that it is activated, as if
automatically, by contextual cues. It is repetitive and beyond the reach
of reflective processes. In this sense, it is “unconscious.” The contents
of this system are malignant, telling the patient, for example, that he
or she is bad, useless, ugly, stupid, or the like. These depreciatory
and derogatory self-attributes are linked to attributes of the other,
which are also negative and involving such features as control and
accusation. Allied to these negative attributions are negative affects,
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 303

often involving intense hostility and a vengeful wish to harm.

Activation of this system, once again, knocks out the experience of
self.
The traumata impacting on children through their sense of
disconnection from an attachment figure are equivalent to mini-
abandonments. As previously remarked, separation fears seem to be
fundamental to the dynamics of OCD. The traumatic memory system
is often triggered in an overwhelming way by life events such as
bereavement (Khanna et al., 1988), which evoke these fears,
Downloaded by [Aston University] at 01:19 04 September 2014

precipitating the illness. Threats to health, which are linked to

separation fears through their association with death, are other
important precipitants (Khanna et al., 1988). Warfare provides an
extreme example of such a threat. Pitman (1993) points out that a
disproportionate rate of OCD is found among high combat-exposed
Vietnam veterans.
With the onset of the illness, the traumatic life event appears, at
times, as if it were the primary trauma, whereas it has fallen, as it
were, into a preexisting lacuna of the psychic system. Mr. A’s illness,
for example, was precipitated by his wife becoming pregnant, despite
Mr. A’s wishes that they have no children. Mr. A, a firstborn child
who, a relative said, had been given “unbelievable, perhaps excessive”
family support, feared that he would harm the child and was afraid
to pick it up. The child evoked separation fears, which had their origin
earlier in life.
Mrs.G’s history was very similar. She too could not pick up knives
or sharp objects that might harm her newborn child. She too felt the
child threatened her dependency needs. Magical thinking caused her
to fear that her hostility would cause actual harm to her child. After
some weeks in therapy she spontaneously began to talk of a life alone
and of the possibility that her husband might leave her.
The fears of abandonment, which lie at the heart of OCD, have a
major affect in shaping the personality of the future patient. Children
driven by separation fears will behave in any way that maintains the
attachment bond. Spontaneous expressions and behaviors are
sacrificed in favor of those that seem likely to gain parental approval.
Such behaviors and expressions will, at times, override the actual
emotional state of the child. Since that emotional state has somatic
accompaniment, the child’s behavior is cut off from the aliveness of
body feeling. The resultant sense of deadness compounds the
devitalization that is a consequence of repeated empathic failure
 304 RUSSELL MEARES

(Meares, 1993). The individual senses that his or her ordinary living
with others is false and unauthentic.
Barnett considered that the compliant “false self” (Winnicott, 1960)
was typical of the child who was vulnerable to the later development
of OCD. Barnett (1971) wrote: “Parental approval was predicated
upon the degree of the child’s conformity to parental needs and
expectations, disregarding or exploiting the needs, feelings and
capabilities of the child. He was caught, therefore, in the paradox
that he was most approved of when he was least himself or for
Downloaded by [Aston University] at 01:19 04 September 2014

himself” (p. 338).

Personality Disorder

The disruptions of development described so far will, in many cases,

lead to the diagnosis of personality disorder in adult life. However,
this personality disorder is unlike that traditionally associated with
OCD, namely, obsessive-compulsive personality disorder. Black et
al. (1993) found that, although personality disorder is common in
OCD, their data did not support a relationship between OCD and
compulsive personality. Their conclusion was consistent with the
findings of Baer et al. (1990), who detected obsessive-compulsive
personality disorder in only 6 percent of their patients.
The typical form of personality disorder underlying OCD has
characteristics that can be inferred from the foregoing description of
the family background of the OCD patient. These characteristics are
largely in accord with the observations of Joffe, Swinson, and Regan
(1988) on 23 patients with OCD. They found that a mixed personality
disorder with avoidant, dependent, and passive–aggressive features
was frequently observed in this group, whereas compulsive
personality was uncommon. Such studies, based on preexisting
schemata, have the disadvantage of not recording phenomena that
are not expected. Nevertheless, such labels as “avoidant,”
“dependent,” and “passive–aggressive” resonate with clinical
descriptions. Janet gave particular emphasis to the avoidant features.
He considered that timidity was a feature of the antecedent personality
of OCD (Pitman, 1984). “Their parents are controlling and prevent
them from confronting any dangers, emphasising prudence and
abstention. John’s maid accompanied him to school until he was 18,
hence he became a laughing stock among his peers” (p. 291).
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 305

It is of interest that Janet also confirms the observations made

earlier in this paper but which are not considered in studies of
personality depending on DSM. He identified a form of false self-
system in these patients. “The joy of causation is lacking and the
patient may feel that he is playing a role rather than acting sincerely”
(Pitman, 1984, p. 298). To this state is allied passivity and “a certain
pleasure from obedience” (Pitman, 1984, p. 301).

The Wolf Man: Diagnosis

Downloaded by [Aston University] at 01:19 04 September 2014

The upbringing and personality of Freud’s famous case, the Wolf

Man, illustrate the data and hypotheses regarding OCD presented so
far. However, before touching upon aspects of his biography, it is
necessary to consider the Wolf Man’s diagnosis, since some
controversy surrounds it.
Both Blum (1974) and Buckley (1989) consider that the Wolf Man
had a borderline personality. In my view, the evidence of such a
diagnosis is insufficient to meet current criteria. Moreover, his early
life is quite unlike the chaotic and often abusive childhood of the
typical borderline (Herman, Perry and van der Kolk, 1989).
Nevertheless, their suggestions are consistent with the notion that a
personality disorder provides the necessary matrix from which OCD
might emerge. They also accord with data that show cluster B traits
in association with OCD (Baer et al., 1990; Nestadt et al., 1994).
The evidence for OCD as provided by Freud seems, at least to me,
convincing. The Wolf Man told him that as a child, he performed a
ritual that was apparently designed to overcome anxiety about falling
asleep caused by his fear of bad dreams (Freud, 1918):

Before he want to sleep he was obliged to pray for a long time

and to make an endless series of signs of the cross. In the
evening, too, he used to make the round of all the holy pictures
that hung in the room, taking a chair with him, upon which he
climbed, and used to kiss each one of them devoutly. It was
utterly inconsistent with this pious ceremonial—or, on the other
hand, perhaps it was quite consistent with it—that he should
recollect some blasphemous thoughts which used to come into
his head like an inspiration from the devil. He was obliged to
think “God–swine” or “God–shit.” Once while he was on a
 306 RUSSELL MEARES

journey to a health resort in Germany he was tormented by the

obsession of having to think of the Holy Trinity whenever he
saw three heaps of horse-dung or other excrement lying in the
road. At this time he used to carry out another peculiar
ceremonial when he saw people that he felt sorry for, such as
beggars, cripples, or very old men. He had to breathe out noisily,
so as not to become like them; and under certain conditions he
had to draw in his breath vigourously [pp. 16–17].
Downloaded by [Aston University] at 01:19 04 September 2014

The magical thinking involving the beggars and cripples seems to

show the operation of both Fraser’s Law of Contagion and that of
Imitation. The frank manifestations of OCD, according to Freud’s
chronology (Freud, 1918, p. 121), were apparent between the ages of
8 and 10.
The second illness, which was treated by Ruth Mack Brunswick,
was described by her as

a hypochondriacal idée fixe. He complained that he was the

victim of a nasal injury caused by electrolysis, which had been
used in the treatment of obstructed sebaceous glands of the nose.
According to him, the injury consisted varyingly of a scar, a
hole, or a groove in the scar tissue. The contour of the nose was
ruined. Let me state at once that nothing whatsoever was visible
on the small, snub, typically Russian nose of the patient. And
the patient himself, while insisting that the injury was all too
noticeable, nevertheless realised that his reaction to it was
abnormal [Brunswick, 1971, p. 264].

Brunswick considered that this ideation was delusional and related

to a paranoid state. It is of interest, in this regard, that the Wolf Man’s
paternal uncle was institutionalized with a paranoid disorder
(Gardiner, 1971a, p. 13). However, the Wolf Man’s recognition of
the abnormality of his preoccupation suggests that his ideation was
not delusional.
This is not to say that a paranoid state may not be closely relation
to an obsessional illness (Meares, 1988) nor that the distinction
between delusion and obsession is always clear. Nevertheless, the
Wolf Man’s behavior suggested that he was afflicted with a “somatic
obsession.” Brunswick wrote:
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 307

He neglected his daily life and work because he was engrossed,

to the exclusion of all else, in the state of his nose. On the street
he looked at himself in every shop-window; he carried a pocket
mirror which he took out to look at every few minutes. First he
would powder his nose; a moment later he would inspect it and
remove the powder. He would then examine the pores, to see if
they were enlarging, to catch the hole, as it were, in its moment
of growth and development. Then he would again powder his
nose, put away the mirror, and a moment later begin the process
Downloaded by [Aston University] at 01:19 04 September 2014

anew. His life was centred on the little mirror in his pocket, and
his fate depended on what it revealed or was about to reveal
[Brunswick, 1971, p. 265].

In modern terminology, the Wolf Man’s diagnosis, on this occasion,

might be body dysmorphic disorder. This condition is characterized
by a preoccupation with an imagined or slight defect in appearance.
The available data suggest that this illness is an obsessive-compulsive
spectrum disorder (Phillips et al., 1995). Simeon et al. (1995), in a
study of 442 patients with OCD, found that 51 had a lifetime comorbid
history of body dysmorphic disorder. It would seem such a diagnosis
is consistent with Freud’s earlier diagnosis of OCD.

The Wolf Man: Development and Personality

The Wolf Man’s case is well known, and the details need not be
repeated here. However, the bare bones of his biography are as
follows. The Wolf Man first came to see Freud in 1910. He was 23 at
the time. He came from a very wealthy Russian land-owning family.
His only sibling was an elder sister, 2½ years older than himself,
who committed suicide in 1906. His father died suddenly in 1908 at
the age of 49. The Wolf Man suspected that the death may have been
cause by an overdose of sleeping medicine. At about 4, he experienced
the terrifying dream of wolves, which gave him his name. This
appeared to be a precursor to the later development of OCD. In his
twenties he suffered rather vague depressive symptoms, which
eventually brought him to Freud. He was treated by Ruth Mack
Brunswick between 1926 and 1927. By this time the Wolf Man’s life
had remarkably changed. He had lost the family fortune and vast
estates in the Russian Revolution of 1917. Following recovery from
 308 RUSSELL MEARES

the illness treated by Brunswick, he remained fairly well for the rest
of his life, leading a very restricted existence in Vienna and living to
a great age. His own biography, together with the observations of
Freud, Brunswick, and Muriel Gardiner, reveal a picture in which
overprotection and dependency are prominent features. In addition,
it shows the related egocentrism (in the Piagetian sense);
“specialness”; apathy, passivity and obedience; compliance leading
to a false self system; lack of a sense of connectedness with others;
derealization; and also “hypocrisy.”
Downloaded by [Aston University] at 01:19 04 September 2014

The Wolf Man’s severe dependence was apparent when he first

saw Freud. He travelled with his own physician and orderly, was
entirely dependent upon others, could not dress himself, and was
unprepared for any kind of work. Later, in treatment, Freud (1918)
found his “shrinking from a self sufficient existence” remarkable
Freud, 1918, p.11).
The background to this state of dependence was one in which the
protective care of the child was given over to servants. The Wolf
Man wrote, at the end of his life, “As our parents were often away,
my sister and I were left mostly under the supervision of strangers,
even when our parents were home we had little contact with them”
(Gardiner, 1971a, p. 8). His mother, he remarked, “was so concerned
about her health, she did not have much time left for us” (Gardiner,
1971a, p. 9). The most important caregiver was his Nanya, a devoted
peasant woman, whose own child had died and who transferred all
her maternal affection upon the isolated only son of her employers.
Of this isolation, the Wolf Man later remarked that his elder sister
was his only companion.
Muriel Gardiner remarked that his feeling of being “superfluous”
was a theme the Wolf Man often touched upon. His sense of
disconnection was profound. He wrote to her: “I think indeed that
the deeper cause of every neurosis and every depression must be the
lack of relationship to the world around one, and the emptiness which
results from this” (Gardiner, 1971b, p. 351).
A system of dependence that was initiated in his early days was
maintained for him in various ways for the rest of his life.
He married a beautiful nurse whom he had met in a period before
he went to Freud, during which for some time he was in a sanatorium
suffering from a vague depression. The nurse, Therese, came from a
family who had lost all their money. She herself had had a failed
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 309

marriage, during which she had had a child. Her daughter, Else, was
4 when Therese met the Wolf Man. After resisting his initial advances,
Therese eventually agreed to marry him. From the Wolf Man’s own
account, it is clear that he expected her to adapt to him and to his
style of living. He wondered whether someone who was very poor,
had no parents, and was German, would be able “to adapt herself to
life in our family circle and in surroundings completely alien to her.”
Therese herself realized that she must adapt and that in this way she
sacrificed herself. This intuition is apparent in the Wolf Man’s account
Downloaded by [Aston University] at 01:19 04 September 2014

of their marriage: “Soon after her arrival in Odessa we got married.

On our way home in the carriage Therese grasped my hand, kissed
me and said with a lump in her throat, ‘I wish you great happiness in
your marriage.’ These words struck me as strange. Why did she speak
of your marriage, instead of our marriage, just as if I had not married
her but another woman” (Gardiner, 1971b, pp. 95–96). Her adaption
to his needs involved her abandoning her daughter to relatives. The
marriage had been in 1914. Sometime in 1915–16 news was received
from Germany that Else had fallen ill with pneumonia. “Therese
reproached her relatives in whose home Else was living for not taking
care of the child, and tortured herself with self reproaches for not
having fulfilled her duty as a mother and for having sacrificed Else
for me.” It is clear that this sacrifice was not necessary in terms of
any financial difficulties since the Wolf Man was immensely rich.
We presume that in some way he may have conveyed to Therese the
idea that he required all her care.
Despite Else’s illness, nothing was done about the child. In 1918
the news arrived that the pulmonary disease from which she suffered
was not pneumonia but tuberculosis and that she was not expected to
live. Once again, the Wolf Man seemed unable to comprehend the
distress his wife might be likely to be suffering. She left for Germany
in September 1918. Before she departed, he had accompanied his
wife to the German Consulate in order to get a visa and was asked if
he too wanted a permit. He had not thought of it. “Although I had
originally not considered it, I answered in the affirmative” (Gardiner,
1971a, p. 102). He accompanied her only to Kiev and did not see her
or her daughter again until May 1, 1919. He was shocked to discover
that Therese’s beautiful black hair had now turned snow white, he
presumed from grief (Gardiner, 1971a, p. 110). Else died 2½ months
after his arrival.
 310 RUSSELL MEARES

The Wolf Man’s relation to Therese was egocentric, in the Piagetian

sense, in that he appeared to be unaware that she might have feelings
that were uniquely hers. The sense of living in an entirely personal
universe persisted into his later years. It is implied by the description
of Dr. F. Weil, who met the Wolf Man in 1949. Dr. Weil was impressed
“by the Wolf Man’s absorption in himself to the exclusion of all else”
(Gardiner, 1971, p. 363). Muriel Gardiner, visiting him in Vienna in
1938, was struck by the fact that “he seemed unaware of events about
him, even to the extent of scarcely knowing the Nazis were in power”
Downloaded by [Aston University] at 01:19 04 September 2014

(Gardiner, 1971b, pp. 312, 345–346).

Therese cared for the Wolf Man devotedly for the rest of her life.
He became completely dependent upon her so that Ruth Mack
Brunswick remarked, “My patient . . . was completely under the
control of his wife: she bought his clothing, criticised his doctors,
and managed his finances” (Brunswick, 1971, p. 282).
In 1938 she killed herself. Unknown to him, she had been having
suicidal thoughts for at least a year. She left him sad, devoted farewell
letters. Almost immediately, he left for Paris and London in order to
see Ruth Mack Brunswick. Some weeks later, he returned to Vienna,
having arranged for his mother, who was now living in Prague, to
move into his apartment. He also arranged for a devoted servant,
Fraulein Gaby to do his housekeeping. Later, she took care of “all
the little every day matters of his life” (Gardiner, 1971b, p. 324).
The Wolf Man was able to recreate this system of dependence
with Freud. Following the loss of his estates in Russia he no longer
had a private income. Nevertheless, he had no children and was able
to work, as he demonstrated for the rest of his life in Vienna. Freud,
however, arranged a collection of a sum of money for him from the
psychoanalytic group and repeated this collection every spring for 6
years (Brunswick, 1971, p. 266). The Wolf Man, it seems, had created
a countertransferential atmosphere, suggesting he was “special” and
uniquely requiring of care.
The Wolf Man’s acceptance of Freud’s financial support,
Brunswick discovered, involved something akin to self-deception.
She found that, at the time Freud was raising money for him, he was
in possession of jewels, which the Wolf Man thought, at the time,
were worth thousands of dollars. Brunswick remarked that her
patient’s “attitude was one of hypocrisy” (Brunswick, 1971, p. 280).
She was struck by the fact that “the man who presented himself was
guilty of innumerable minor dishonesties: he was concealing the
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 311

possession of money from a benefactor with whom he had every

reason to be candid. Most striking of all was his total unawareness
of his own dishonesty” (Brunswick, 1971, p. 279).
It seems that the Wolf Man simply considered the support was his
“due” (Brunswick, 1971, p. 282). He implied a special relationship
with Freud. Brunswick’s technique consisted in an attempt to
“undermine” the patient’s sense of specialness and “the patient’s idea
of himself as the favourite son” (Brunswick, 1971, p. 284). Following
her confrontations, “he was obliged to admit that he had never met
Downloaded by [Aston University] at 01:19 04 September 2014

Freud’s family. His replies were vague and unsatisfactory, perhaps

even to himself. His arguments had an extraordinary tone: they were
not exactly specious, but they contained an astounding mixture of
fantasy and fact” (Brunswick, 1971, p. 284).
The “hypocrisy” that Brunswick found in her patient is an echo of
the description of the familial background of OCD given by Barnett.
There is not enough evidence to support strongly the view that the
Wolf Man’s early life was characterized by a failure of the caregivers
to address essential and important feelings in the child’s life at the
time or by a tendency to skirt about anxieties as if the child might
not be able to deal with them. Nevertheless, he does recount one
episode occurring in his adult life, which is characteristic of such a
family environment.
Having married Therese, he took her back to the Russian estate
where difficulties were immediately created by the behavior of a
young woman named Lola who was married to the Wolf Man’s
younger cousin. It was discovered later that this marriage was asexual.
Lola behaved in an openly provocative and seductive manner toward
the Wolf Man, which upset Therese. The Wolf Man understood from
Therese’s response that the presence of Lola in the house was likely
to undermine his marital relationship. Compelled to do something,
he approached his mother. “I decided to talk openly with my mother
about the situation. However, my mother would not enter into a
discussion, but simply tried to calm me down and to make the whole
affair appear harmless and unimportant” (Gardiner, 1971a, p. 97).
This is a relatively minor incident, but it may reflect the way in which
the Wolf Man was treated. The source of an anxiety was evaded and
the pretense maintained that everything would be all right.
The “hypocrisy,” however, that Brunswick encountered went
beyond the deception relating to the jewels. It involved the compliant
false self-system. “He talked at great length about the marvels of
 312 RUSSELL MEARES

analysis as a science, the accuracy of my technique, which he

professed to be able to judge at once his feeling of safety being in
my hands, my kindness in treating him without payment, and other
kindred topics” (Brunswick, 1971, p. 280). It seemed that he was
trying to provide for her what he supposed she wanted. The result
was that Brunswick felt she wasn’t getting anywhere. He was
impermeable. The first dream was a replay of the famous Wolf Dream.
In the new version, however, the wolves, formerly white, were now
grey. Many others, “mere installments,” followed (Brunswick, 1971,
Downloaded by [Aston University] at 01:19 04 September 2014

p. 280). He was invulnerable on important topics but “brought the

clearest dreams in order that I might show my skill in interpreting
them, thus confirming his statement that he was better off in my
hands than in Freud’s” (Brunswick, 1971, p. 283).
Meissner considers that the Wolf Man’s behavior with Freud was
also of a false self kind. In Meissner’s view, he presented “a compliant
and analytically productive false self that served to satisfy Freud,
yet left the inner realm of introjective grandiosity untouched. The
Wolf Man gave Freud what he was looking for, and in return he
received the benign accolades and approval from Freud that a part of
him, even behind the rigidly defensive facade, had continually
yearned for” (Meissner, 1979).
Freud became a major figure in the Wolf Man’s life, seeming to
become an idealized selfobject. It seems not unlikely that his
realization of the serious nature of Freud’s illness in the latter half of
1923 was a precipitant of the illness that Brunswick treated and that
began in February 1924.
Like Freud, who commented on his patient’s entrenchment “behind
an attitude of obliging apathy,” Brunswick noted the Wolf Man’s
passivity and submissiveness (pp. 292–293). However, his passivity
had a controlling element in it, at times. He refused to discuss certain
topics and in many areas remained walled-off (Brunswick, 1971,
p. 280). The origins of a traumatic system of the kind referred to
earlier in the paper were apparent in the Wolf Man’s autobiography.
He described an incident involving a little accordion,

which was given to me when I was about four years old, probably
as a Christmas present. I was literally in love with it, and could not
understand why people needed other musical instruments, such as
a piano or a violin, when the accordion was so much more beautiful.
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 313

It was winter, and when darkness fell I sometimes went to a

room where I would be undisturbed and where I thought nobody
would hear me, and began to improvise. I imagined a lonely
winter landscape with a sleigh drawn by a horse toiling through
the snow. I tried to produce the sounds on my accordion which
would match the mood of this fantasy.
Unfortunately these musical attempts soon came to an end.
One time my father happened to be in an adjoining room and
heard me improvising. The next day he called me into his room,
Downloaded by [Aston University] at 01:19 04 September 2014

asking me to bring along my accordion. On entering, I heard

him talking to an unknown gentleman about my attempts at
composition, which he called interesting. Then he asked me to
play what I had been playing the previous evening. This request
embarrassed me greatly because I was unable to repeat my
improvisations “on command.” I failed miserably and my father
angrily dismissed me. After this painful failure I lost all interest
in my beloved instrument, left it lying around somewhere in
my room, and never touched it again [Gardiner, 1971a, p. 10].

A repetition of such parental behavior might lead him to a need to

“wall off” particular areas of psychic life so that core aspects of a
personal reality remain beyond the risk of damage (Meares, 1976).
It would seem that none of the Wolf Man’s caregivers, with the
possible exception of his Nanya, had the capacity to respond
appropriately to his emergent sense of self. After an unsatisfactory
English governess, a Bulgarian followed. At the age of 5, a new
governess was appointed. “Like most elderly spinsters she was
inclined to be domineering.” He and his sister “spent the whole day
under her influence” (p. 15). This woman, “Madamoiselle,” was
Swiss. Her

principal object of education was to teach her pupils good

manners and etiquette. As she had spent decades in Polish
families,she spoke a mixture of mutilated Polish and Russian
words, which however sufficed to make her understood by those
around her. Of course Madamoiselle taught us French also. She
would start to explain something, jump from on subject to
another, and then begin to reminesce endlessly about the days
of her youth [Gardiner, 1971a, p. 16].
 314 RUSSELL MEARES

Such a person seems unlikely to be able to respond empathically to

the small child’s nascent inner world of feelings and imaginings.
The Wolf Man’s sense of disconnection from others, as he intimated
to Gardiner late in life, must have been profound. There was nobody
who could make “real” the central aspects of his existence.
Consequently, derealization was among his most prominent symptom
on entering a sanatorium in Munich in 1908. “I had found life empty.
Everything seemed ‘unreal’ to the extent that people seemed to me
like wax figures all wound up, marionettes with whom I could not
Downloaded by [Aston University] at 01:19 04 September 2014

establish any contact” (Gardiner, 1971, p. 50).

Concluding Remarks

This paper elaborates the hypothesis that the principal features of

OCD have their origin in the patient’s immature conception of the
boundedness of self (Meares, 1977, pp. 63–79; Meares, 1994), so
leading to the “omnipotence of thoughts.” The predisposition to
magical thinking is understood as the consequence of an upbringing
that failed to foster the different experiences of both inner and outer
zones. Severe overprotection impedes the emergence of the concept
of objects and the external environment; failure to connect with, and
so make “real,” core aspects of the child’s personal experience hinders
the genesis of a nascent inner life. The developing individual remains
relatively egocentric, in the sense that he or she inhabits a largely
personal universe. The consequence of these specific deficiencies of
the caregiving environment is the development of a particular kind
of personality disorder, the central characteristics of which are
timidity and falseness. The story of the Wolf Man is consistent with
this general schema.
OCD is likely to be a heterogeneous disorder. Baer (1994) factor
analyzed the clinical features of 107 patients and found three main
groupings of symptoms. These factors were named “symmetry/
hoarding,” “contamination/cleaning,” and “pure obsessions.” Only
the first factor was significantly related to comorbid obsessive-
compulsive personality disorder or to a lifetime history of Tourette’s
syndrome or chronic tic disorder. These subtypes of OCD may have
different natural histories. Janet noted that in those relatively rare
cases, (about 5 percent in his own series of over 300), which have
their onset in the form of tics, the course was an “unhappy” one
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 315

(Pitman, 1984, p. 310). This paper has been concerned with the second
subtype, that is, “contamination/cleaning.”
The ideas put forward here have therapeutic implications that are
beyond the scope of this paper. Some of them, including the need to
foster the sense of the privacy of self and the “ownership” of thought
(Meares, 1986) have been touched upon elsewhere (Meares, 1994).
Brandchaft describes, in this issue, the approach to the developmental
impediments and the traumatic memory system. The therapist will
be required to adopt forms of behavior that differ from the traditional,
Downloaded by [Aston University] at 01:19 04 September 2014

as Freud demonstrated in instituting a time-limited therapy (Gardiner,

1971, p. 157). The need to be “real,” in a particular way, is implied
in Ruth Mack Brunswick’s description of her treatment and made
explicit by Barnett (1971). Finally, the therapist must not neglect the
significance of action. His or her encouragement of “action as choice”
(McMurray, 1957, p.1 39) is significant in helping the patient take
those “risks” that are necessary steps on the path to recovery.

REFERENCES

Alexander, G., DeLong, M. & Strick, P. (1986), Parallel organization of functionally

segregated circuits linking basal ganglia and cortex. Ann. Rev. Neurosci., 9:357–
381.
Alexander, G., Crutcher, M. & DeLong, M. (1990), Basal ganglia-thalamocortical
circuits: Parallel substrates for motor, oculomotor, “prefrontal” and “limbic”
functions. Prog. Brain Res., 85:119–145.
Anthony, S. (1971), The Discovery of Death in Childhood and After. London: Allen
Lane.
Baer, L. (1994), Factor analysis of symptom sub-types of obsessive compulsive
disorder and their relation to personality and tic disorders. J. Clin. Psychiatr.,
55:18–23.
, Jenike M., Ricuardi, J., Holland, A., Seymour, P., Minichiello, W., &
Bottolph, M. (1990), Standardized assessment of personality disorders in obsessive
compulsive disorder. Arch. Gen. Psychiat. 47:826–830.
Barnett, J (1971), Therapeutic intervention in the dysfunctional thought processes
of the obsessional. Amer. J. Psychother. 26:338–351.
Baxter, L., Schwartz, J., L. Mazziotta, J., Phelps, M., Pahl, J., Guze, B., &
Fairbanks, L. (1988), Cerebral glucose metabolic rates in non-depressed patients
with obsessive-compulsive disorder. Amer. J. Psychiat. 145:1560–1563.
 , Bergman, K., Szuba, M., Guze, B., Mazziota, J., Alazraki, A., Selin,
C., Ferng, H-K., Munford, P., & Phelps, M. (1992), Caudate glucose metabolic
rate changes in both drug and behavior therapy for obsessive-compulsive disorder.
Arch. Gen. Psychiat. 49:681–89.
Bellodi, L., Scuito, G., Diaferia, G., Ronchi, P., & Smeraldi, E (1992), Psychiatric
disorders in the families with obsessive compulsive disorder. Psychiat. Res.
42:111–120.
 316 RUSSELL MEARES

Black, D., Noyes, R., Goldstein, R., & Blum, N. (1992), A family study of obsessive
compulsive disorder. Arch. Gen. Psychiat., 49:362–368.
  Pfohl, B., Goldstein, R., & Blum, N. (1993), Personality disorder
in obsessive-compulsive volunteers, well comparison subjects, and their first
degree relatives. Amer. J. Psychiat., 150:1226–1232.
Blum, H. (1974), The borderline childhood of the Wolf Man. J. Amer. Psychoanal.
Assn., 22:721–742.
Brandchaft, B. (1993), To free the spirit from its cell. In: Progress in Self Psychology,
Volume 9, ed. A. Goldberg. Hillsdale, NJ: The Analytic Press, pp. 209–230.
Brunswick, R. (1971), A supplement to Freud’s “History of an infantile neurosis.”
In: The Wolf Man, ed. M. Gardiner. New York: Basic Books, pp. 263–307.
Buckley, P. (1989), Fifty years after Freud: Dora, the Rat Man, and the Wolf Man.
Downloaded by [Aston University] at 01:19 04 September 2014

Amer. J. Psychiat., 146:1394–1403.

Calvocoressi, L., Lewis, B., Harris, M., Trufan, S., Goodman, W., McDougle, C. &
Price, L. (1995), Family accommodation in obsessive compulsive disorder. Amer.
J. Psychiat., 152:441–443.
Cavedo, L. & Parker, G (1994), Parental bonding instrument: Explaining the links
between scores and obsessionality. Psychiat. & Psychiatric Epidem., 29:78–82.
Douglas, M. (1966), Purity & Danger: An Analysis of the Concepts of Pollution
and Taboo. London: Routledge & Kegan Paul.
Ehiobuche, I. (1988), Obsessive compulsive neurosis in relation to parental child-
rearing patterns amongst Greek, Italian and Anglo-Australian subjects. Acta
Psychiatr. Scand., 78:115–120.
Elson, M., ed. (1987), The Kohut Seminars on Self Psychology and Psychotherapy
with Adolescents and Young Adults. New York: Norton.
Flavell, J., Green, F. & Flavell, E. (1993), Children’s understanding of the stream
of consciousness. Child Devel,. 64:387–396.
Fraser, J. (1954), The Golden Bough: A Study in Magic & Religion. London:
Macmillan.
Freud, S. (1895), Obsessions and Phobias: Their psychical mechanism and their
aetiology. Standard Edition, 3:71–82. London: Hogarth Press, 1955.
 (1909), Notes upon a case of obsessional neurosis. Standard Edition,
10:155–218. London: Hogarth Press, 1955.
 (1913), Totem and taboo. Standard Edition, 13:1–161. London: Hogarth
Press, 1955.
 (1918), From the history of an infantile neurosis. Standard Edition, 17:7–
122. London: Hogarth Press, 1955.
 (1919), Lines of advance in psycho-analytic therapy. Standard Edition,
17:157–168. London: Hogarth Press, 1955.
 (1926), Inhibitions, symptoms & anxiety. Standard Edition, 20:87–175.
London: Hogarth Press, 1959.
Gardiner, M., (trans.) (1971a), The Memoirs of the Wolf Man. In: The Wolf Man,
ed. M. Gardiner. New York: Basic Books, pp. 3–132.
 (1971b), The Wolf Man in later life. In: The Wolf Man, ed. M. Gardiner.
New York: Basic Books, pp. 311–366.
Goodman, W., McDougle, C. & Price, L. (1992), Pharmacotherapy of obsessive
compulsive disorder. J. Clin. Psychiat., 53:29–37.
Gopnik, A., & Astington, J. (1988), Children’s understanding of representational
change and its relation to the understanding of false belief and the appearance-
reality distinction. Child Devel., 59:26–37.
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 317

Griest, J., Chouinard, G., DuBoff, E., Halaris, A., Kim, S., Koran, L., Liebowitz,
M., Lydiard, R., Rasmussen, S., White, K., & Sikes, C. (1995), Double-blind
parallel comparison of three dosages of sertraline and placebo in outpatients with
obsessive compulsive disorder. [Link]. Psychiat., 52:289–295.
Gruber, H. & Voneche, J. (1977), The Essential Piaget. New York: Basic Books.
Hafner, R (1988), Obsessive-compulsive disorder: A questionnaire survey of a self
help group. Internat. J. Soc. Psychiat., 34:310–315.
Hanna, G. (1995), Demographic and clinical features of obsessive compulsive
disorder in children and adolescents. J. Amer. Acad. Child & Adolesc. Psychiat.,
34:19–27.
Hare, E., Price, J., Slater, E. (1972), Fertility in obsessional neurosis. Brit. J.
Psychiat., 121:197–205.
Downloaded by [Aston University] at 01:19 04 September 2014

Herman, J., Perry, J. & van der Kolk, B. (1989), Childhood trauma in borderline
personality disorder. Amer. J. Psychiat., 146:490–495.
Honjo, S., Hirano, C., Murase, S., Kaneko, T., Sugiyama, T., Ohtaka, K., Aoyama,
T., Takie, Y., Inoko, K. & Wakabayashi, S. (1989), Obsessive compulsive disorder
in childhood and adolescence. Acta Psychiatr. Scand,. 80:83–91.
James, W. (1890), Principles of Psychology. New York: Holt.
 (1902), Varieties of Religious Experience. New York: Longmans.
Joffe, R., Swinson, R. & Regan, T. (1988), Personality features of obsessive-
compulsive disorder. Amer. J. Psychiat., 145:1127–1129.
Karno, M., Golding, J., Sorenson, S. & Burnam, M. (1988), The epidemiology of
obsessive compulsive disorder in five U.S. communities. Arch. Gen. Psychiat.,
45:1094–1099.
Kellner, C., Jolley, R., Holgate, R., Austin, L., Lydiard, R., Laraia, M. & Ballenger,
J. (1991), Brain MRI in obsessive compulsive disorder. Psychiatr. Res., 36:45–49.
Khanna, S. & Channabasavanna, S. (1988), Phenomenology of obsessions in
obsessive-compulsive neurosis. Psychopathology, 21:12–18.
 Rajendra, P. & Channabasavanna, S. (1988), Life events and onset of
obsessive compulsive disorder. Internat. J. Soc. Psychiat., 34:305–309.
Klein, M. (1934), On criminality. In: Love, Guilt and Reparation and Other Works.
1921–1945, ed. M. Klein. London: Hogarth Press, 1975.
 (1935), A contribution to the psychogenesis of manic-depressive states. In:
Love, Guilt and Reparation and Other Works. 1921–1945, ed. M. Klein. London:
Hogarth Press, 1975.
Kohut, H (1984),. How Does Analysis Cure? ed. A. Goldberg & P. Stepansky.
Chicago: University of Chicago Press.
Lal, N., Gupta, S. & Agarwal, A. (1987), Intelligence and personality traits in
obsessive compulsive neurosis. Indian J. Clin. Psychol., 14:68–71.
Mahler, M. (1968), On human symbiosis and the vicissitudes of individuation. In:
On Human Symbiosis and the Vicissitudes of Individuation, Vol. 1: Infantile
Psychosis, ed. M .Mahler & M. Furer. New York: International Universities Press.
 Pine, F. & Bergmann, A. (1975), The Psychological Birth of the Human
Infant. London: Hutchinson.
McMurray, J. (1957), The Self as Agent. London: Faber, 1969.
McNally, R. & Kohlbeck, P. (1993), Reality monitoring in obsessive compulsive
disorder. Behav. Res. & Ther., 31:249–253.
Meares, R. (1976), The secret. Psychiatry, 19:258–265.
 (1977), The Pursuit of Intimacy: An Approach to Psychotherapy. Melbourne:
Nelson.
 318 RUSSELL MEARES

 (1986), On the ownership of thought: An approach to the origins of

separation anxiety. Psychiatry, 49:80–91.
 (1988), The secret, lies and the paranoid process. Contemp. Psychoanal.,
24:650–666.
 (1990), The fragile Spielraum: An approach to transmuting internalization.
In: Progress in Self Psychology: Vol. 5, ed. A. Goldberg. Hillsdale, NJ: The
Analytic Press, pp. 69–92.
 (1993), The Metaphor of Play. Northvale, NJ: Aronson.
 (1994), A pathology of privacy: Towards a new theoretical approach to
obsessive-compulsive disorder. Contemp. Psychoanal., 30:83–100.
 (1995), Episodic memory, trauma, and the narrative of self. Contemp.
Psychoanal., 31:541–556.
Downloaded by [Aston University] at 01:19 04 September 2014

 (2000), Intimacy and Alienation. London: Routledge.

 & Orlay, W. (1988), On boundary formation: A study of the child’s
conceptualization of secrecy. Brit. J. Med. Psychol. 61:305–316.
 & Lichtenberg, J. (1995), The form of play in the shape and unity of self.
Contemp. Psychoanal., 31:47–64.
Meissner, W (1979), The Wolf Man and the Paranoid Process. Psychoanal. Rev.,
66:155–171.
Nestadt, G., Samuels, J., Romanoski, A., Folstein, M., & McHugh, P. (1994),
Obsessions and compulsions in the community. Acta Psychiatr. Scand., 89:219–
224.
Nordahl, T., Berkelfat, C., Semple, W. & Gross, M. (1989), Cerebral glucose
metabolic ratios in obsessive compulsive disorder. Neuropsychopharmacology,
2:23–28.
Okasha, A., Saad, A., Khalil, A., Seif ElDawla, A. & Yehia, N. (1994),
Phenomenology of obsessive-compulsive disorder: A transcultural Study.
Comprehens. Psychiat., 35:191–197.
Partridge, E. (1983), Origins: A Short Etymological Dictionary of Modern English.
New York: Grenwich House.
Pato, M., Zohar-Kadovich, R., Zohar, J. & Murphy, D. (1988), Returns of symptoms
after discontinuation of Chlomipramine in patients with obsessive-compulsive
disorder. Amer. J. Psychiat.,145:1521–1525.
Pauls, D., Alsobrook, J., Goodman, W., Rasmussen, S. & Leckman, J. (1995), A
family study of obsessive-compulsive disorder. Amer. J. Psychiat., 152:76–84.
Perner, J., Leeham, S., & Wimmer, H. (1987), Three year olds’ difficulty with false
belief: The case for a conceptual deficit. Brit. J. Dev. Psychol., 5:125–137.
Phillips, K., McElroy, S., Hudson, J. & Pope, H. Jr. (1995), Body dysmorphic
disorder: An obsessive-compulsive spectrum disorder, a form of affective spectrum
disorder, or both. J. Clin. Psychiat., 56:41–51.
Piaget, J. (1929), The Child’s Conception of the World. London: Routledge & Kegan
Paul.
Pitman R (1984), Janet’s obsessions & psychasthenia: A synopsis. Psychiatr. Quart.,
56:291–314.
 (1993), Post traumatic obsessive compulsive disorder: A case study.
Comprehen. Psychiat., 34:102–107.
Rauch, S., Jenike, M., Alport, N., Baer, L., Brester, H., Savage, C. & Fischman, A.
(1994), Regional cerebral blood flow measures during symptom provocation in
obsessive-compulsive disorder using oxygen 15-labelled carbon dioxide and
positron emission topography. Arch. Gen. Psychiat., 51:62–70.
 A SPECIFIC DEVELOPMENTAL DEFICIT IN OCD 319

Robins, L., Helzer, J., Weismann, M., Orvaschel, H., Gruenberg, E., Burge, J. &
Reiger, D. (1984), Lifetime prevalence of specific psychiatric disorders in three
sites. Arch. Gen. Psychiat., 41:949–958.
Simeon, D., Hollander, E., Stein, D., Cohen, L. & Arononitz, B. (1995), Body
dysmorphic disorder in the DSM-IV field trial for obsessive-compulsive disorder.
Amer. J. Psychiat., 152:1207–9.
Slater, P. (1945), Scores of different types of neurotics on tests of intelligence.
Brit. J. Psychol., 35:40–42.
Snowdon, J. (1979), Family size and birth order in obsessional neurosis. Acta
Psychiatr. Scand., 60:121–28.
Sorce, J., Emde, R., Campos, J. & Klinnet, M. (1985), Maternal emotional
signalling: Its effect on the visual cliff behavior of 1-year olds. Dev. Psychol.,
Downloaded by [Aston University] at 01:19 04 September 2014

21:195–200.
Spitz, R. (1950), Anxiety in infancy: A study of its manifestations in the first year
of life. Internat. J. Psychoanal., 31:138–43.
Stern, D. (1985), The Interpersonal World of the Infant. New York: Basic Books.
Sullivan, H. S. (1956), Clinical Studies in Psychiatry. New York: Norton.
Swedo, S., Pietrini, P., Leonard, H., Schapiro, M., Rettew, D., Goldberger, E.,
Rapoport. J. & Grady, C. (1992), Cerebral glucose metabolism in child-onset
obsessive-compulsive disorder: Revisualisation during pharmacotherapy. Arch.
Gen. Psychiat., 49:690–94.
 Rapoport, J., Leonard H., Lenane, M. & Cheslow, D. (1989), Obsessive-
compulsive disorder in children and adolescents: Clinical phenomenology of 70
consecutive cases. Arch. Gen. Psychiat., 46:335–341.
Thomsen, P (1991), Obsessive-compulsive symptoms in children and adolescents:
A phenomenological analysis of 61 Danish cases. Psychopathology, 24:12–18.
 (1994), Children and adolescents with obsessive compulsive disorder: An
analysis of sociodemographic background: A case-control study. Psychopathology,
27:303–311.
 (1995), Children and adolescents with obsessive-compulsive disorder: An
analysis of sociodemographic backgrounds. A case-control study.
Psychopathology, 27:303–311.
Vygotsky, L. (1962), Thought and Language, ed. & trans. E. Hanfmann & G. Vakar.
Cambridge MA: MIT Press.
Winnicott, D. W. (1960), Ego distinction in terms of true and false self. In: The
Motivational Processes and the Facilitating Environment. New York: International
Universities Press, pp. 140–152.
 (1974), Playing and Reality. Harmondsworth, U.K.: Penguin.
Zohar, J. & Insel, T. (1987), Obsessive-compulsive disorder: Psychobiological
approches to diagnosis, treatment, and pathophysiology. Biol. Psychiat., 22:667–
687.

Department of Psychiatry
University of Sydney
Westmead Hospital
Sydney, N.S.W. 2145
Australia