You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Ever since Freud (1909) reported his treatment of the Rat Man, psychoanalysts came to regard the obsessive compulsive disorder (OCD) as the prototypical neurosis. The defensive function of the symptoms seemed to be clear, the warded-off impulses readily inferable, the developmental background capable of plausible reconstruction. The understanding of the disorder seemed so complete that, as I have noted elsewhere (Esman, 1988), virtually nothing about it appeared in the psychoanalytic literature for many years, despite (or perhaps because of) the notable lack of therapeutic success that attended efforts to treat it psychoanalytically. A remakable paradox, therefore: apparently universal agreement on the theory of pathogenesis and dynamics, but minimal clinical effectiveness.
In recent years, spurred by the empirical discovery of the efficacy (however limited) of pharmacological treatments, biological psychiatrists have become intensely active in the study of OCD. The result