Two figures dominated the early 20th-century history of OCD: the French psychiatrist Pierre Janet and the Austrian psychiatrist Sigmund Freud. While Janet expanded on existing medical ideas,1 Freud represented a significant break from the past, a paradigm shift.
Freud interpreted Os and Cs symbolically. This can be seen in his interpretation of a young woman's compulsive bedtime ritual. The 19-year-old could not go to sleep until she made sure the clocks and watches in her room would not wake her up, arranged her bed covering and pillows in exactly the right way, and took a dozen other steps as part of a one- to two-hour nightly ritual. Freud interpreted the fluffy bedding as a symbol of pregnancy and the clocks as sexual symbols, as he explains: "Clocks and watches—though elsewhere we have found other symbolic interpretations for them—have arrived at a genital role owing to their relation to periodic processes and equal intervals of time," wrote Freud, explaining why the patient removed the clocks from her room. "Our patient gradually came to learn that it was as symbols of the female genitals that clocks were banished from her equipment for the night."2
Freud's theories about such matters gained influence and continued to be fairly well-accepted up to the 1970s in certain countries,3 although, of course, other ideas and approaches also existed.4
For the clergy, Freud's ideas about Os and Cs must have been quite difficult to endure. The clergy resumed their own writing on the subject and offered useful advice about "scruples" (a term for Os and Cs) in books by Patrick Gearon (1921), Dermot Casey (1948) and others.5
Freud called the illness Zwangsneurose. In England this term was translated as "obsession" and in America it became "compulsion." The term "obsessive-compulsive disorder" was eventually adopted as a compromise.6
1Pierre Janet (1903). See also Berrios, 1996, p. 150.
2Sigmund Freud (1917). See also Dolnick, 1998, p. 251.
3Osborn, 1998, p. 228.
4See Jakes, 1996.
5Patrick Gearon (1921) and Dermot Casey (1948).
6More about the origin of the term "obsessive-compulsive disorder." See also Berrios, 1996, p. 141.