EFFECTS ON LANGUAGE DURING AND AFTER OCD 12
Running head: EFFECTS ON LANGUAGE DURING AND AFTER OCD 1
Effects on Language During and After OCD
A study on the construction of language produced by current and post sufferers of the autogenous type of Obsessive-Compulsive Disorder.
Abeer A. Hakami
Effects on Language During and After OCD
Abstract
Obsessive-compulsive disorder is a common psychiatric illness that is frequently disabling. The disease affects many people and the effects are obsessions that often translate to compulsive acts. Research shows that there are two types of Obsessive Compulsory Disorder which produces various kinds of obsessions among the victims; autogenous and reactive. Depending on the category of OCD, the impacts experienced by the victims mainly perception of self and use of language during the narration of obsessive thoughts and compulsive experiences differ. People with OCD usually appear to be daydreaming, not interested in anything, distracted and lazy. During such times they focus on the stressful, nagging urges of the obsessions that lead to acts of compulsion. During the occurrence of OCD, victims experience serious impacts on their language thus making it difficult for them to communicate properly. There is no study that investigates the impacts of this illness on the perception of self-concept and language used in expressing the obsessive thoughts among victims of Saudi origin. Therefore, the proposed study seeks to investigate the linguistic properties that r in Saudi Arabia exhibit in their narrations, compulsions and self-concept.
Keywords: obsession, compulsion, obsessive-compulsive disorder, autogenous, reactive, self-concept, linguistic properties, culture, Saudi Arabia.
Introduction
Background
Compulsive disorder is a mental disorder that is prevalent among people of all ages and cultures. It is characterized by a form of anxiety that predisposes the affected individual to repetitive, unwanted obsessive ideas and thoughts which often translate to undesirable compulsive actions. Lee & Kwon (2003) propose the existence of two types of obsessions: autogenous and reactive. The autogenous obsessions are the abrupt thoughts that come into the individual’s consciousness with no apparent stimulus and the individual can repel them (Lee & Kwon, 2003). Such autogenous obsessions include sexual thoughts and aggressive and immoral impulses. The reactive obsessions, on the other hand, result from traceable external stimuli and are relatively more realistic and rational as compared to the autogenous type (Lee & Kwon, 2003). According to the International OCD Foundation (IOCDF), obsessions can involve unwanted sexual thoughts, loss of control resulting from fears, harm, religious scrupulosity, perfectionism, contaminations in the environment, and superstitions (IOCDF, 2019). Some of these obsessions are undesirable to members of a conservative and private community such as the Saudi culture.
Justification of the Study
Little or no research has been conducted to assess the experiences of individuals diagnosed with OCD in the context of Saudi Arabia. Consequently, there is little information available to mental health professionals in the country to help them to understand the nature of the struggles that individuals suffering from psychological disorders and OCD undergo. Therefore, the proposed study seeks to investigate the narratives that members of the Saudi Arabian culture who have been diagnosed with OCD present on their episodes of obsession and compulsion.
The researcher has suffered from autogenous OCD on two separate occasions and relates to the psychological suffering that OCD patients endure. Being a Saudi female, the researcher identifies with the extremely private and conservative Saudi culture and understands the plight of female members who suffer from the condition in the community. This background will be crucial to the close and direct interaction with OCD sufferers from the Saudi culture and will help in digging deep into the participants’ community and value systems to understand the perspective of identity among the members of the culture who experience OCD. The researcher’s belonging to the Saudi culture will also enhance her ability to interact freely with both male and female members of the culture.
With that, the researcher will maintain objectivity when conducting the research. It will be done carefully by considering the following. Firstly, participants will not be informed of the fact that the researcher has suffered from OCD before, so they will do their best to explain their narratives of struggles with OCD to the researcher. Secondly, the benefit of the fact that the researcher has suffered from OCD before is that she can ask questions about specific occasions and experiences, and motivate participants to answer which can be helpful to understand different experiences, especially before and after suffering from OCD. Finally, and most importantly for the researcher being a female, she can conduct interviews with Saudi females easily as it is a known fact that the Saudi culture is very conservative and reserved when it comes to females.
Furthermore, the proposed study’s researcher is a lecturer of linguistics at the Jazan University in Saudi Arabia, and the institution has granted her a fully-funded Ph.D. scholarship. It is in her sense of responsibility, therefore, to obtain a comprehensive understanding of how OCD affects people’s perceptions of self-worth and self-function in the Saudi culture. The researcher also seeks to play a significant role in promoting awareness of the condition among Jazan University students and the community at large.
Study Approach
According to Lee & Kwon (2003), the understanding of the occurrence of OCD episodes is best achieved using a cognitive approach. The cognitive model that they propose classifies OCD based on the content of the obsessive thoughts that the sufferers experience as a result of the internal or external triggers (Lee & Kwon, 2003). Consequently, the proposed study will adopt the cognitive approach to the understanding of self among people who are suffering from OCD. The autogenous-reactive (AR) cognitive model will, therefore, be an integral part of the proposed research since it will be useful in categorizing the thoughts of individuals based on the relation of the triggers to self.
The proposed study will focus on the narratives of people who are currently suffering from the autogenous type of OCD in Saudi Arabia and the narratives of past episodes of the obsessions and compulsions among people who have fully recovered from OCD in Saudi Arabia. The study will also incorporate a linguistic analysis of the sentence structure of the Arabic language. There are various linguistic differences between Arabic and English that inform the study of the language structure. Some of the differences include the subject position in the Arabic verb phrase, the construction of the verb phrase as SV or VS in standard Arabic, and the removal of the subject as the doer to be replaced by a single morpheme connected to the verb indicating the doer of the action in the Saudi dialect.
The second linguistic variable that the proposed research will pay attention to is the descriptive words that Arabic-speaking sufferers of OCD use when reflecting on the voices that are controlling and causing the obsessive-compulsive thoughts and ideas. As O’Neill (1999) explains, the obsessive-compulsive thoughts can be described as “the controlling voice” that the typical OCD sufferer refers to as “it.” In Arabic, the concept of the gender-free pronoun “it” does not exist since objects in the language are gender-oriented. Therefore, the proposed research will investigate what gender, personification, or analogy Arabic-speaking current sufferers of OCD use when narrating the episodes of OCD; whether they use euphemism, anaphora/cataphora, types of deixis, and what voice the sentences are structured on. The study will also examine whether these choices of words and sentence structures describing the voices or causer of the obsessive-compulsive thoughts change in narratives of people who have fully recovered from OCD.
Therefore, the proposed research will include linguistic analysis of the subject positions in the narratives of autogenous obsessions among Arabic sufferers in a model similar to Knapton’s (2018) research. It will then compare the subject positions in Knapton’s (2018) study with the choices of subject positioning that Arabic speakers make when describing their OCD obsessions. The study will also compare the choice of subject positioning in narratives among current Arabic-speaking sufferers and former Arabic-speaking OCD sufferers. Consequently, the study will identify the choice of words that individuals who are currently suffering form the mental condition make as well as the choice that former sufferers make when explaining the controlling causes of the obsessive thoughts.
The significance of the Study
The proposed study will explore the concept of self and its role during active episodes of OCD and present an analysis of whether the language can be limited in use during such episodes. The findings of the study will help therapists and recovered clients have a comprehensive understanding of the changes that OCD might make on the victim’s understanding of self and use of language structures. Such an understanding will be beneficial in informing the strategies that therapists can use to examine patients who have been diagnosed with OCD and to formulate reasonable plans for helping them deal with the obsessions and compulsions.
Research Questions
The following are the research questions that the proposed study seeks to address through the linguistic analysis approach:
How does a person who has fully recovered from autogenous OCD describe self?
Will there be differences between the subject positioning in Arabic narratives of sufferers of OCD and the subject positioning found in the Knapton (2018) study?
Will there be differences between subject positioning in Arabic narratives of recovered sufferers of OCD and the subject positioning found in Knapton’s (2018) study?
How does the feeling of being ashamed of the obsessive-compulsive thoughts and ideas to influence the linguistic resources and features sufferers of OCD use when narrating their current experience with OCD?
How does OCD limit an individual’s freedom of word choice? In what ways does it limit such freedom of choosing words?
What specific linguistic features and devices, sentence structures, or the person’s voice does OCD limit the language of the sufferer to?
How does the language used in describing OCD change among individuals who have suffered from OCD in the past?
Does language change during the treatment period? (The language includes the sentence structure, choice of words, and words of blame or guilt. The changes can be analyzed in periods of six months or 12 months after the commence of OCD treatment).
Does society influence the construction of the descriptive language of the episodes of OCD?
Does gender (male and female) affect the language that an individual uses to describe the episodes of obsessions in the context of the Saudi community?
Definition of Terms
Obsessions: The undesirable, intrusive thoughts that produce distressing feelings. They comprise of images, urges, and ideas that reoccur in the individual’s brain.
Compulsions: The behavior that an individual displays in an attempt to rid themselves of the obsessions or to reduce the levels of distress (IOCDF, 2019).
OCD: The mental illness that involves a cycle of intense and extreme obsessions and compulsions (IOCDF, 2019). The vicious cycle of unwanted thoughts and behaviors affects the individual’s value system and their ability to perform important life activities.
Dissertation Structure
The proposal contains an introduction to the research study that presents brief background information on OCD, justifies the study, presents the approach employed in the proposed study, the research questions, and the definition of important terms. The proposal then presents an analysis of the literature that addresses the topic and its related concepts applicable to the study, a brief overview of the methods to employ in the proposed study, and a synthesis of the research findings. The proposal then explains the conceptual framework and the methodology to use in the study.
Literature review
Review of the literature
One of the best models that best describes OCD is the autogenous reactive (AR) model. According to Lee & Kwon (2003), Autogenous Reactive Model describes two main types of obsessions; the reactive obsessions that result from external stimuli and the autogenous obsessions that result from internal stimuli including thoughts and memories. Both types of obsessions produce significant differences in the role of self-concept. When victims of OCD narrates about the obsessions and compulsions, they display different problems in linguistic construction of self, depending on the type of obsession and AR spectrum (Knapton, 2018). O’Neill (1999) argues that there are different voices in an OCD victim’s narrative and the voices present different self-presentations. Therefore, OCD affects the sufferer’s understanding of themselves as well as their use of language to explain their experiences.
Knapton (2018) points out that symptoms of anxiety and disorders are the major mental problems faced by victims of OCD. The anxiety will lead to the violation of cultural standards that will cause emotional and mental suffering to the victims. OCD which is generally classified as a general anxiety disorder will cause obsessive and compulsive behaviors that will recur hence causing impairment to the speech and communication. The manifestation of psychological disturbances, mental illnesses, and, consequently, OCD, differ among cultures. Ratner & El-Badwi (2011) argue that mental illness is a cultural experience. They explain that individuals who undergo such mental disturbances have different psychological experiences shaped by their cultures’ portrayal of gender roles, religion, family, and dressing among other factors (Ratner & El-Badwi, 2011). Knapton (2018) cites that obsession may bring fears which include violent and aggressive obsessions thus causing harm to self and compulsions of doing the same thing over and over because the victim fails to understand self. Therefore, members of the Saudi culture may have different manifestations of OCD from other cultures around the world. As a result, the language that they use to narrate their experiences differs.
Methodology Review
Berg & Lune (2012) provide a comprehensive analysis of the qualitative techniques that researchers can use when conducting studies in the social sciences domain. One of the techniques that they espouse is the use of semi-standardized interviews which are not extremely formal or too casual (Berg & Lune, 2012). Such interviews are essentially useful in engaging people in an informal setup. Potter & Wetherell (1997) then present an analysis of the method of discourse in social psychology. They mention that the discourse method is essential in analyzing linguistic philosophy, semiotics, studying attitudes and the concept of self, and ethnomethodology among others (Potter & Wetherell, 1997). The discourse investigation tool that they propose is especially useful when analyzing the experiences of people with psychological disorders. The tool incorporates Interpretative Repertoires in which people with psychological disorders use linguistic resources to construct their experiences (Potter & Wetherell, 1997). For the analysis of the functional grammar that the OCD sufferers use in their narrations, the systematic functional grammar approach is the most feasible. Matthiessen & Halliday (1989) explain that the approach applies to any context. (Knapton, 2018)
Synthesis of the Research Findings
The existing research reveals that OCD can be classified as autogenous or reactive based on the AR model. The category of OCD also has an impact on the victim’s perception of self and the choice of words, phrases, sentence structure, and other linguistic properties to use in narrating their experiences. The research also reveals that there are significant differences in the manifestation of mental illnesses among different cultures, which also impacts how victims from various cultures use language to explain their experiences. Furthermore, the unique properties of Arabic make the narrations of obsessions and compulsions significantly different between Arabic speakers and English speakers. However, only Al-Sabaie, Abdul-Rahim, & Al-Hamad (1992) have explored the cultural aspects of the clinical manifestation of OCD in Muslim and Arab cultures. The gap, therefore, is that no studies are investigating the linguistic properties of the language that members of the Saudi culture who have been diagnosed with OCD use in their narrations of the OCD episodes.
Methodology
Conceptual Framework
Systematic research is to be conducted through conducting interview with the victims of OCD, answering questionnaires and survey based on the effects of OCD on the language of the victims and conducting research from literature materials such as documents and reports. From the analysis of the literature of Knapton (2018), a linguistic analysis of subject positioning in clauses within narratives of autogenous and reactive obsessions and reports that the role of self with OCD has varying constructions was performed by Knapton. Examining the existing data from reports, newsletters and minutes of meeting that discussed the effects of OCD on the language of the victims. Conducting structured and semi-structured interviews with the victims of OCD who are experiencing obsessive and compulsive disorders. Answering questionnaires and survey and the responses analyzed with quantitative methods and comparing the behaviors analyzed. Comparing the OCD performance of a healthy control group from one known and validated group that is affected.
The first part will employ the same tools and follow the same structure as the study conducted by Knapton (2018) with a focus on Arabic-speaking OCD sufferers. The second part will be an investigation of the narratives of people who have fully recovered from OCD to understand their descriptions of the obsessions and ensuing compulsions. The discursive (language-based) approach that the study will employ will form the basis of the linguistic analysis and the utilization of various tools in the research.
Ethical Approval
This study will seek the ethical approval of the Institutional Review Board (IRB).
Research Methods
The proposed study will adopt a qualitative linguistic approach to enable the exploration of the concept of self among individuals suffering from OCD and to understand their utilization of various linguistic features when narrating their experiences with obsessive thoughts and compulsions. The qualitative analysis will enable the analysis of the linguistic patterns during the process of examining participants’ responses in terms of subject positions. The use of in-depth semi-standardized interviews will allow the participants to freely express themselves without fear of victimization.
Population and Sample
The participants in the study will be selected from three cities in the Western region of The Kingdome of Saudi Arabia: Makkah, Jeddah, and Taif. The study population will be from these three cities because each of the cities has a unique social structure, social tradition, and dialect. The cities also have distinct geographical characteristics and are strategically located in the Kingdome. These distinct characteristics will be important since the proposed study will explore differences in gender, culture, geography, and dialects.
The selected sample will comprise of both male and female participants aged between 18 and 23 years. The participants will be selected from various psychiatric clinics in the three cities. An official permit for data collection and participant selection will be sought with the assistance of the Department of English to which the researcher belongs as a member of the faculty. The participants will be divided into two groups. The first study group will comprise of participants who are still experiencing episodes of autogenous OCD. The group will be further split into individuals who just commenced treatment (at least one week of treatment) and individuals who have finished at least six (6) months of treatment. The second study group will be composed of individuals who have finished treatment for autogenous OCD and have taken at least five (5) months since the last date of treatment.
Data Collection and Analysis
The main method of data collection will be the conduction of interviews. All participants from both groups will be interviewed using a semi-standardized interview approach that Berg & Lune (2012) describe. The participants will be asked to narrate their experiences during OCD episodes. The study will then use Potter & Wetherell’s (1997) Interpretative Repertoires discourse investigation tool alongside Matthiessen & Halliday’s (1989) systemic-functional grammar approach to analyze the grammatical structures that present and past sufferers of OCD use in their narrations of obsessions. The Interpretative Repertoires tool will be useful in analyzing the aspects of linguistic philosophy, semiotics, attitudes, and the concept of self from the participants’ responses. The systemic-functional grammar approach will then be employed in analyzing the linguistic features in the subject position among the Arabic-speaking participants.
Reference
Al-Sabaie, A., Abdul-Rahim, F., & Al-Hamad, A.-R. (1992). Obsessive compulsive disorder. Annals of Saudi Medicine, 12(6), 558-561.
Berg, B., & Lune, H. (2012). Qualitative research methods for the social sciences. Boston, MA: Pearson.
IOCDF. (2019). What is OCD? Retrieved from International OCD Foundation (IOCDF): https://iocdf.org/about-ocd/
Knapton, O. (2018). The linguistic construction of the self in narratives of obsessive-compulsive disorder (OCD). Qualitative Research in Psychology, 1-51. doi:10.1080/14780887.2018.1499834
Lee, H., & Kwon, S. (2003). Two different types of obsession: Autogenous obsessions and reactive obsessions. Behaviour Research and Therapy, 41(1), 11-29.
Matthiessen, C., & Halliday, M. (1989). Introduction to Functional Grammar. Language, 65(4).
O’Neill, S. (1999). Living with obsessive-compulsive disorder: A case study of a woman’s construction of self. Counselling Psychology Quarterly, 12(1), 73-86.
Potter, J., & Wetherell, M. (1997). Discourse and social psychology: Beyond attitudes and behaviour. London, UK: SAGE Publications.
Ratner, C., & El-Badwi, E. (2011). A cultural psychological theory of mental illness, supported by research in Saudi Arabia. Journal of Social Distress and the Homeless, 20(3), 217-274.