Obsessive compulsive symptoms mirror the relationship between thought and muscular activity. Tourette’s often accompanies OCD and responds to dopamine blocking agents. If a tic is an involuntary motor symptom which is slightly modifiable by the individual, a compulsion is a voluntary motor symptom which arises not from a physical imperative but a cognitive, conceptual one. For example, “I must recheck the front door or someone will break in and steal everything I own.” Instead of a physical sensation, a concept makes it difficult to resist. Thus it is analogous to a tic but perhaps on a different neurological tract. Acetylcholine, in concert with dopamine, is responsible for tics and other involuntary movements such as extrapyramidal symptoms and akathisia. Most likely acetylcholine is responsible for the conceptual imperative in OCD. Acetylcholine may well be the motivator behind all thought, but is compulsively insistent when dopamine is overbalanced.

Our ability to think, which arose since language, is analogous to muscular activity. When dopamine surges, as in schizophrenia, there is a conceptual flood that swarms the thought platform. Antipsychotic medications help restore the dopamine/acetylcholine balance, and quiet the schizophrenic mind, as well as manic intensity and helps with depression’s concentration difficulties. These universal dopaminergic perturbations lend further proof of the importance of the course correction imposed on evolution by language.

Published by Steven Lesk, MD

Board certified, adult psychiatrist for over 35 years. I have written a book on evolution and schizophrenia. It's call Neanderthal's Dream: How Changes In Evolution Brought Us Mental Illness and May Someday Take It Away Again.

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