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A 35 YEAR OLD MAN Mr A, develops an extraordinary series of routines which guard against the possibility of being observed from the street while he undresses in his bedroom. This is the first symptom of an obsessive-compulsive disorder. He resembles those in Janet's classic series whose sense of exposure was such that they needed to be totally alone when undressing (Pitman, 1984, p. 310). Mr A exhibits what might be called a pathology of privacy. This is the main point of this paper, the thesis of which is that an important determinant of obsessive-compulsive disorder is a threatened or deficient conception of an inner life. This idea links to Sullivan's remarks about the hypocrisy which characterises the early family life of those with obsessive-compulsive disorder. Such a background, it will be argued, is likely to impede the mature attainment of the concept of self-boundary. The main thesis leads to a therapeutic approach to obsessive-compulsive disorder which focuses on a central feature of the illness, which Freud identified and called "the omnipotence of thoughts" (Freud, 1913).
Freud wrote fourteen papers on obsessive-compulsive disorder. He found it "unquestionably the most interesting and repaying subject of analytic research." He also considered that "as a problem it has not yet been mastered" (Freud, 1926). His remark still applies. The illness remains a mystery. Since Freud's time, psychoanalytic interest in obsessive-compulsive disorder has waned. No systematic examination of the subject has been made since the 1965 Congress of the International Psychoanalytical Association as Esman notes (Esman, 1988). The relative theoretical neglect of