Few mental afflictions are as humbling or as terrifying
as what is known as “Pure OCD”
or, more colloquially, Intrusive Thoughts.
In standard Obsessive Compulsive Disorder,
a person is haunted by a worry that compels them to repeat an often
counterproductive or fruitless action with manic intensity:
handwashing, turning off gas pipes,
checking their pulse so on.
But in”pure”OCD,there is no outward, physical action;
the problem unfolds–hence the name–purely in the mind,
也就是 可以说 一种更加
yet it is, if anything, an even
more distressing condition.
The Pure OCD sufferer is tortured
by thoughts that they want to do, or have done,
some of the most censored and abhorred acts in our societies,
acts that they themselves despise and fear at an intellectual level
They grow convinced of their wish, for example,
to murder a loved one, harm a child sexually
or assault a stranger.
They can not shut out the idea
that they may become, or have already
shown signs that they are, a psychopath,a rapist or a paedophile.
They scan their minds ceaselessly,
looking for evidence to confirmtheir dreadful apprehension.
So burdened are they by these thoughts,
they may not be able to go anywhere near children or may take fright
at the sight of a knife in a drawer.
Left alone with a colleague,they may panic that
they could lose control andlunge inappropriately at them.
At the station, they are floodedwith anxiety at the feeling
that they may push their partner or their child under a train.
Having to think of oneself in these terms
quickly drains life of any of its pleasure.
The Pure OCD sufferer wakes up every morning certain
that they are one of the worst people
ever to have walked on the planet.
There is not, as yet,a foolproof way of treating the condition
but discussions of how to approach it
reveal large differences in assessmentsof how the mind operates
Psychiatrists tend to prescribe antidepressants,
in order to lift the general mood of sufferers
and thereby lessen the tendencyto ruminate to the point of exhaustion.
CBT psychologists will try to argue closelywith the intrusive thoughts.
so that eventually sufferers can logically acknowledge
that they truly have no intention
of harming anyone or doing anything obscene.But it is psychotherapists
who have what is perhaps the most imaginativeand unexpected solution.
They do not target
They do not target
They don’t try to reassure people logically
that they are not about to murder a loved one or harm a child,
because they don’t believethat this is what is actually at stake
and judge that offering reassurance
on these points only legitimates a pattern
of thinking that has no basis in reality.
They locate the origin of the problem somewherequite different:
the sufferer of pure OCD has, first and foremost,
a problem with self-esteem and shame.
The unfortunate person feels, at some level,
utterly disgusting and beyond the pale
–and will in the background have
been feeling like this for a long time.
Somewhere in their past, normally as a result of
very traumatic and degrading childhood relationships,
they will have derived an impression that
they did not deserve to exist.
Their current thoughts are not plans for the future,
they are attempts by the mind to find a match
between their basic sense of self and what would beneeded by their society to concur with it.
They are a move to bring about a form of dreadful
inner equilibrium, ensuring thatthe judgement of the world falls
in line with the judgement of the self.
Cases of Pure OCD are sometimes diagnosed
just after sufferers have achieved something rather positive in the eyes of others:
they have been promoted or begun a fulfilling
relationship or mastered a project.
It should be a cause for celebration but happiness simply feels unwarranted.
By latching onto thoughts of complete illegality,
one is assured that one’s self-esteem will remain at rock bottom.
Interestingly, in societies that find religious transgression particularly abhorrent,
Pure OCD sufferers will be haunted by feelings
that they have offended God andare about to be outed as sinners.
Behind Pure OCD,
is a person’s need to find a reason to feel awful,
it isn ’ t about this or that condemned act
and as the definition of awful changes,
so too will the manifest content of the intrusive thoughts.
The disease is anchored in self-loathing,
而不是亵渎神明 初期的恋童癖 或杀人意向
not in blasphemy, incipient paedophilia or murderous intent.
This analysis opens the way to treatment.
What the sufferer of pure OCD needs, above all else,
is to begin to repair their self-loathing and shame.
They need to learn, through repeated encounters
with an outsider who casts a generous and sympathetic eye on them,
that they are not the worthless being they take themselves for.
Their problem began with a deficit of love
and needs to be healed by a loving act of witnessing.
Pure OCD thoughts are not wishes,
they are symptoms of radical self-distrust
and these will start to lift
once the afflicted learn that most vital of arts:
being a friend to oneself.
Our book What is Psychotherapy tells us exactly what going through
therapy is like and why it is so important.