Scrupulosity: my EAGxBoston 2019 lightning talk

By Holly Elmore ⏸️ 🔸 @ 2019-05-02T23:08 (+65)

This is a linkpost to https://mhollyelmoreblog.wordpress.com/2019/05/02/scrupulosity-my-eagxboston-2019-lightning-talk/

This was a 5 minute talk, so I basically only had time to read the slides (dynamically!). I’m going to provide the slides and whatever extra info I said at the time in italics and give commentary and context in plain text.

Obviously, this is a matter of degree. It’s not a disorder unless it’s distressing and interferes with your functioning, but I was more interested in the way of thinking than what counts as clinically significant symptoms. I should also mention there’s a lot unimportant disagreement about whether Scrupulosity should technically be considered its own thing or a form or OCD or as a part of Obsessive Compulsive Personality Disorder (OCPD). Again, this introduction is so broad that you can ignore all of these subtle distinctions. The general pattern of relieving guilt and anxiety from obsessions with compulsions is not in dispute.

I neglected to give an example then, but here are a few:

I feel wretchedly guilty because I think about sinning all day long (obsession), so I spend hours each day reciting prayers for absolution (compulsion).

I am plagued by guilty and sad thoughts about the deaths of animals in factory farms (obsession), so I keep looking for more ways to make my vegan diet 100% cruelty-free (compulsion).

I feel guilty and undeserving of my money (obsession), so I devote myself to being as frugal as possible (compulsion).

Most people do not realize when they are acting compulsively because we think of compulsions as physical rituals, such as tapping and counting in “classic” OCD. But you can do any physical or mental behavior compulsively. One of my personal compulsions is self-doubt, though it’s only compulsive when I do turn to it to relieve anxiety from feeling exposed rather than simply noticing organically arising doubt about specific things. I learned to do this in part from dicourse norms in science and rationalism, because it’s a very safe position to say you don’t know or don’t trust your own thinking. Because self-doubt is such a virtue in those worlds, both my healthy doubts and my compulsive, goodharting doubt get reinforced.

There are many stories of compulsions starting when the person has an experience of great relief from their guilt or anxiety by adopting a certain belief or performing a certain behavior. Scrupulosity is also called a process addiction because it’s an addiction to a certain algorithm for dealing with distress: in this case, making or obeying rules. I first remember experiencing this when I stopped eating meat as a little kid. All the guilt and turmoil I had been feeling about the blood on my hands was gone as a result of sticking to this rule. It made me think on some level that all distress could be prevented or dealt with if you just followed the correct rules.

An excessive sense of personal responsibility is also called “overresponsibility,” “hyper-responsibility” (in the context of OCD), or the dysfunctional attitude of omnipotence. In Cognitive Behavioral Therapy (CBT), it is considered one of three universal attitudes anxious people share (the other two are perfectionism and intolerance of uncertainty). I have a lot more to say about overresponsibility and its relationship to EA in an upcoming blog post.

Thought-action fusion is this diabolical cycle that’s very common in anxiety and OCD. Essentially, when we are in fight-or-flight, the distinction between thoughts and actions gets blurred, so that just thinking something can have the weight of having done it. This usually makes the person more anxious, thoughts and actions get more blurred, and the downward spiral continues. 

The doubt and confusion is usually fixated on the true meaning of moral precepts or rules. When scrupulous people begin to doubt their own ability to discern moral behavior, it is understandable that they would want to conform to ideologies. Unfortunately, this makes them very vulnerable to cult behavior and fundamentalism, simply because each addresses their need for certainty.

“Long periods of highly distressing moral rumination”– this is is the thing that made me want to give this talk. The paper I drew from went on to say “that patients believe are helping them solve their problem rationally.” So, obviously, in EA we recognize long, highly distressing periods of moral rumination. I’m not saying they are all unproductive or symptoms of a problem, but I think we could stand to remember that we aren’t always trying to solve a problem in the external world. Sometimes we’re trying to solve our feelings in the guise of the problems we’re most comfortable solving. 

Many experts say that a “debilitating fixation on moral issues” is scrupulosity’s most damaging symptom because it leaves little proccessing power for the rest of life. 

Prioritization and economic thinking have scarcity baked in. There’s an acknowledgment from the get-go that not everything is going to get done and no one’s record is going to be perfect. 

I personally have seen a lot of respect for self-care in EA, moreso than in other moral communities I was a part of, anyway.

Maximizing is a hard one, because it’s only our whole thing. I think drawing a line as to how much you can do is difficult in principle, and if you’re a scrupulous person who doesn’t have a natural sense of their person line, it’s even worse. 

Totalizing: people who get really involved in EA tend to get REALLY involved in EA, which means being surrounded by messages of moral maximizing and sacrifice. I believe that EA selects for scrupulous people (like me), which concentrates these tendencies in a very connected community.

EA introduced me to things I would never have felt responsible for on my own. Such as picking the most effective career or the entire future.

Essentially, for me EA has helped a lot by taking morality seriously as a real world project. With evidence-based charity comes a lot of sobriety. But it’s also hurt because my way of thinking is magnified in this community and I’m constantly made aware of all the things I could, in theory, be doing to help the world.

Your selfish desires are a part of you, worth keeping in touch with. If you actually don’t know your selfish desires or feel like that part of you is blocked, that’s a huge red flag. It means you’re not being honest with yourself, perhaps because you don’t feel safe being honest with yourself. Going from my personal experience alone, I would suggest that all people with scrupulous tendencies check in with their selfish desires regularly as on-going hygiene. Having trouble finding them is an early warning sign for me. (Plus, it’s kind of a fun “intervention” because there’s the promise of gratification when you figure out what you want. :P )

Exposure and response prevention is just “exposure therapy,” where the scrupulous person exposes themselves to the guilt- or anxiety-provoking stimulus without doing the compulsion to relieve the anxiety. After repeated exposure with no feared consequence, the limbic system learns that the stimulus is not dangerous, and the reaction extinguishes. Depending on how severe your symptoms are, you might want to do this with the help of a therapist. 

Be kind to yourself and forgive yourself for struggling with this. It’s okay to be small human with limited powers, it’s okay to struggle with scrupulosity, and it’s okay to be you. In my case, scrupulous symptoms are related to feelings of worthlessness, like I alone have to live up to this perfect moral standard because somehow I can’t afford to be as immoral as a normal person. I can’t effectively tackle particular obsessions or compulsions if I don’t start by healing my sense of fundamental worthiness, because then I’m just playing whack-a-mole with new symptoms.

Boundaries, here I’m talking about protecting your psychic and emotional space. Give when your cup runs over, but what’s in the cup is yours. It’s important to set expectations with others, but for scrupulosity I’m talking about setting boundaries with yourself to respect your own needs and happiness.