Tormenting Thoughts and Secret Rituals Read online

  A psychiatrist was consulted, and he recommended hospitalization because of the severity of her depression. She refused. “Please God, I’ll make a deal,” she prayed. “I’ll go to the hospital if it gets really bad, but give me the strength to fight the thoughts.” She began to see the doctor for psychotherapy and, with the help of antidepressant medication and the support of her husband, regained the ability to cope.

  But four years later, after her husband landed a new job and the family moved to Pennsylvania, her equilibrium was shattered. She was again overwhelmed by OCD.

  OBSESSIONS OF LUST: JEFF

  Jeff, a thirty-year-old high school science teacher, slightly built with delicate features and dressed neatly in a coat and tie, lumbered solemnly into my office. Speaking so softly that I could hardly hear him, he politely introduced himself, then sat down with a pained expression.

  “There is a voice in my head that keeps saying … really awful things,” Jeff said, stammering and pausing frequently. “It’s hell.… It’s just terrible.… I can’t relax.”

  In an attempt to ease his discomfort, I began right away to ask questions. “Can you describe what the voice is like?” I said.

  “It says various things … like that I’m homosexual,” he said, adding quickly, “It’s not that I have anything against gays. Anyone who wants to be gay, that’s fine with me. But I have never been and I don’t want to be gay.”

  “What else can you tell me about the voice?” I asked.

  “It’s loud. It’s nonstop,” Jeff said. “My mind has two levels. On the surface, I can think normally. I can still go to work every day and do an okay job. But in the back of my mind there is a voice that keeps repeating things over and over. It’s like an endless loop cassette that’s always there.”

  “What does it say?”

  “Things like … ‘Are you gay?’ Or, ‘Are you a pervert?’ ” Jeff looked anxiously around the room.

  “Does the voice sound real?” I said. “Do you think other people can overhear it?”

  “No, no,” Jeff said. “It’s just in my mind.”

  “Well,” I said, “does it come from you or does it come from someone else?”

  “That’s what’s confusing,” Jeff said. “It seems as if I am the one who’s saying these things, but these are not things that I would ever think. Believe me, they are not. Anyone would tell you that.… So that’s why I guess I must be hearing voices.”

  “Okay, Jeff. I think I understand,” I said. “You’ve got these thoughts, sort of like voices, that keep coming into your mind when you don’t want them to, questioning whether you are gay. Is that the main problem?”

  “Not exactly. There are pictures.… Explicit and very gross homosexual pictures. I can’t even look at my male friends in the face any more because I will start to have these homosexual pictures.… I can’t imagine what’s happening to me.”

  “It would be very helpful,” I said, “if you could pick one especially bad time you’ve had in the last day or two and describe it in some detail. You needn’t go into all of the gory details. Just give me a sense of what goes on.”

  Jeff stared at the floor and I occupied myself taking notes. Then he shook his head with a sense of resignation. “I was doing my exercises before breakfast. I was working out on my rowing machine in my basement. My dog was there in the corner. And I started having thoughts and pictures come into my mind of going over and having sex with my dog.”

  I asked, “When these awful thoughts start coming into your mind, do you do anything to try to get rid of them?”

  “I fight them with all my might,” Jeff said, “but I can’t stop them. The only thing that helps at all is to keep on answering them back. The pictures start coming, and I’m saying, ‘That’s not me, that’s not me, that’s not me.” Or the voice says, ‘You’re a pervert,’ and I’m answering back, ‘No, I’m not, no, I’m not, no, I’m not.’ My life is a mind battle. The thoughts control me.”

  It was now completely clear that Jeff suffered from obsessive-compulsive disorder. Nobody but those who share Jeff’s peculiar combination of an extremely timorous conscience and an uncommonly deadly imagination can appreciate the gut-wrenching shame and profound guilt that can accompany sexual obsessions.

  I leaned forward and attempted to reassure him. “You’re not hearing voices. You’re not a pervert. What is happening to you is that you are getting hit with obsessions—thoughts that come into your mind out of the blue, usually the worst thoughts that you could ever think. They do not in any way represent who you are.

  “Sometimes,” I continued, “terrifying urges go along with the awful thoughts. I see a loving young mother who gets hit with the obsession to kill her baby. Sometimes when the terrible thought hits, she has what seems like an urge to carry it out. But the urge is completely counterfeit. It is just another obsession. Following it is the last thing she would ever do.”

  “Yes,” Jeff said. “I have urges, too.”

  “The truth is, Jeff, that most people get unwanted, terrible thoughts. The only difference between you and them is that they say, ‘What á stupid thought!’ and turn their minds to something else. You, on the other hand, become horrified by these thoughts and try to fight them, and by doing so, you make them worse.”

  After this Jeff perked up somewhat and talked more readily. His life had been going fairly well until he became romantically involved with Beth, another teacher at his school, about six months before he came to see me. Jeff, having had only one previous serious relationship, and that having ended painfully, felt insecure. Did he perform well enough sexually? Would he fail in this relationship as he had in the last? Did he have a good enough job to suit her? Yet although these worries were very stressful, Jeff still recognized them as normal.

  Then his anxieties took a profound turn for the worse one day when he was carpooling to a conference with several other teachers. He had slept poorly the night before, and constipation was causing a discomfort in his lower rectum. Adding to his discomfort was being cramped in the backseat of the car, so that his shoulder and hip were unavoidably touching the man next to him. As Jeff shifted uneasily, he worried that his friends would notice his nervousness. He began to sweat profusely and swallow frequently. Suddenly, an exceptionally strong and vivid image flashed into his mind of his engaging in homosexual intercourse with the friend who sat beside him. Jeff was crushed. It literally took his breath away. He sat paralyzed in fear and disbelief. Shouting out in his mind was the question: “Am I gay?” To which he answered back, over and over, “No, I’m not. No, I’m not. No, I’m not.”

  Intense, homosexual fantasies proceeded to invade Jeff’s consciousness over the subsequent weeks and months, sometimes continuing unabated for hours at time, particularly when he was alone and unoccupied. Jeff walked the streets near where he lived, crying, wondering whether he was going crazy, or becoming, against his will, homosexual. He tried shouting back at the thoughts. He tried substituting in heterosexual fantasies. He tried praying repeatedly, like a mantra, “God give me the strength to deal with this.” Sometimes these countermeasures, compulsions, worked for a while to chase away the thoughts, but the unwanted ideas, images, and urges always came back.

  It seemed to Jeff that his mind searched out those thoughts that were most base. When he was with Beth, thoughts of painful and perverted sexual acts prevented him from being able to enjoy their sexual relationship. When in the company of Beth’s four-year-old daughter, ideas jumped into his mind of seducing her and fondling her. Much in the news at that time was Jeff Dahmer, the sexual psychopath who sliced out body parts and kept them in his refrigerator. When Jeff heard these stories, thoughts rushed into his mind of his doing the same. Sometimes he was haunted by the “crazy idea” that since Dahmer shared his first name, Dahmer’s spirit might be invading him and would force him to perform similar bloody rituals. Even though Jeff was able to realize that these ideas were absurd, he still became terrified and overwhelmed. Usual
ly at those times he thought that he was going crazy.

  As I explored Jeff’s history, I learned that he had suffered OCD symptoms as a child. He checked the placement of every single object in his room before he went to bed, a ritual that took about twenty minutes. Then he often had to get out of bed and recheck items. He “went nuts” in the morning if he found something out of place. In fact, Jeff later learned that his older sister, well aware of his compulsions, sometimes played the trick on him of sneaking into his room late at night and ever so slightly changing the placement of one single item. (What OCDers have to put up with!) Jeff also always demonstrated the over-responsibility and guilt that typifies the OCD personality. He held himself to the strictest ethical standards and tended to blame himself for every failure that had ever occurred in his life. He did few things for fun. For instance, reading novels was impossible because he felt too guilty: All reading should be work-related.

  Toward the end of our interview, I spelled out for Jeff a nuts-and-bolts understanding of obsessive-compulsive disorder. By then he was sitting up and animated. For the first time in six months he had reason to be optimistic.

  OBSESSIONS OF BLASPHEMY: MELISSA

  An eighteen-year-old freshman at Penn State presented to our University Counseling Service late in her first semester in 1992. She was accompanied by her parents, who had called earlier in the day saying that she needed to be seen immediately, that she had gone overboard in her religion and was behaving strangely.

  I introduced myself to Melissa—tall, dignified, aloof, dressed neatly in a white shirt and plaid skirt—and walked with her into my office. Ignoring my inquiry about what brought her to the clinic, she sat perfectly still for a full minute, neither talking nor making eye contact, but simply staring straight ahead. Then she suddenly looked at me and said, in a halting voice, “If I’m going to talk to someone, it should be someone from my church.”

  I agreed that would be a good idea but suggested that she fill me in as well. There followed another minute or two of immersion in her own thoughts—I couldn’t tell whether she had heard what I said or not—before she glanced at me and said softly: “The problem is questions. They keep coming into my mind, and I can’t stop them.” Melissa proceeded to share her story, all the while shifting abruptly back and forth between two very different mental states. For a few minutes she would speak normally in a composed manner, carefully choosing her words, at times becoming animated or humorous; then she would lapse back into her mute, staring state, as if something very important had come up in her mind that had to be dealt with right away.

  Melissa explained that she was being bombarded by questions, all dealing with what was right or wrong for her to do. The questions were incessant and overpowering, causing her mind to, as she put it, “constantly spin.” Is it right to listen to popular music? What is the greatest commandment? If someone commits suicide, do they always go to hell? Is it okay to use the telephone on the Sabbath? Should I wear a dress? The questions stopped only when she was asleep. No answers would satisfy them; every seeming solution was challenged by a new consideration. Should she decide that she could wear a dress, she would immediately have to grapple with whether it could be a colored dress. If she decided her dress should be black, she would next have to consider how long it should be. Soon she would be back to doubting whether she should even wear a dress at all.

  When she needed to study for her classes, she would attempt to block out the questions, but to no avail. “I try to stop thinking them,” Melissa said, “but I cannot get them out of my mind. It’s like I’m involved in a battle with Satan, like he’s forcing these thoughts in my mind.”

  I asked Melissa whether she ever performed certain actions over and over, or thought certain thoughts repeatedly, in order to get rid of the questions. “Yes,” Melissa said, “there are things I do to make them go away. I’ll say verses from the Bible. I say them continuously, over and over. It’s the only way to stop the anxiety, the only way I can get through a day. ‘Be ye perfect’—that’s the one I’ve been saying as we’ve been talking. I’m saying it right now.”

  “Do you think that repeating verses like that is a good thing to do?” I asked.

  “Well, actually,” Melissa said softly, “the Bible prohibits vain repetition, and that is just what I’m doing. These aren’t real prayers; I wish I didn’t have to say them. It’s stupid. I just say the verses to get rid of the anxiety.”

  I was soon fairly certain that Melissa was suffering from obsessive-compulsive disorder and had no other major psychiatric or medical problem. I asked Melissa whether I could speak with her parents for a few minutes. Her mother, a petite, energetic homemaker, and her father, a reserved elementary school teacher, informed me that Melissa had never before had mental health problems. The youngest of three children, she was always the quietest and the most anxious to please. She socialized only with a few friends and never dated. They were surprised when she joined a charismatic Christian church in junior high school since they seldom attended church themselves; but they considered it a good thing since the church provided a social outlet for their stay-at-home daughter. Melissa graduated as one of the top students in her high school class, with a particular aptitude in math and science, and came to Penn State to study engineering.

  I ended that interview by explaining to Melissa and her parents that the problem appeared to be obsessive-compulsive disorder. I told Melissa that if she wished to look at her illness as being due to Satan, then Satan was causing a chemical disorder in her brain that rendered her incapable of ridding herself of fearful thoughts. I recommended that Melissa take a medical withdrawal from school, and Melissa was quite happy to move home immediately. Since she came from a nearby town, it would be possible for her to see me regularly for treatment. Melissa agreed to see me again in two days.

  In subsequent interviews, Melissa was able in a composed manner to share further details on how her disorder had started. Shortly after coming to college, she had begun to feel vaguely unsafe. It was, she explained, as if she were missing something important and something bad were going to happen. Then as the weeks passed, this fear began to focus on the idea that she was in some way living wrong. Since junior high school, she had lived according to biblical convictions. She prayed regularly, attended Bible studies and prayer groups, and memorized Bible verses that she carried in her purse on index cards. Now a feeling of dread assailed her in this most important area of her life. She would be in class, in her dorm room, or just walking down the street, when suddenly, insistently, she would experience what she came to call “the first and the greatest question”: Am I doing what’s right in God’s eyes?

  She asked her pastors for advice. She cornered them in church or called them on the phone, and they patiently attempted to reassure her, suggesting Bible verses that might be consoling. “It’s spiritual warfare,” one campus minister stressed. “You can overcome it if you fight it with scripture and faith.” She took to searching for the one verse that would give her a feeling of peacefulness, a sense that she was right with God. “I can do all things through Christ who strengthens me”; “Trust the lord with all your heart and lean not on your own understanding”; “We know that all things work together for the good for those who love God.” Each verse would work for a day or two, quelling her fears, but then the first and greatest question would return.

  She began to stay up late into the night sitting at the small desk in her dorm room, a study light illuminating the bulletin board, arranging and rearranging index cards of Bible verses. She would tack them up and take them down, shift their order back and forth, looking for the verse that would show her how to live perfectly for God. Many times she thought she had found it. She would grow excited, elated, after hours and hours of concentrated, intense searching. She would go to bed, some nights as the first rays of dawn were breaking, thinking that she had finally found the way she could be certain that she was always doing what was right in God’s eyes.


  On one occasion, Melissa found her answer in the verse, “Abide in faith, hope, love, these three, but the greatest of these is love.” This, Melissa thought, would cover everything. For a week she made a solid, determined effort to love everybody every minute of the day. What if her roommate left dirty clothes on her side of the room? No reason to be mad. What if people talked behind her back? She would love them, anyway. But after a week she was in shambles. “It seemed like by the end of each day I just realized how much I hate some people,” Melissa explained. “I was just exhausted. It was too hard. I gave up.”

  Next she thought she found the answer in “Love is patient, love is kind.” Accordingly, she undertook a full-scale effort to answer criticisms with kind words and selfish acts with acts of charity. Soon, of course, she was overwhelmed. “I worried and worried about what I said to people. Maybe I was short with them. I would have to go back to them and apologize. I was asking people’s forgiveness all the time. It was very draining. I slept a lot. I couldn’t take it.”

  Still another time Melissa settled on this verse: “Let no one seek his own good, but that of his neighbor.” She resolved simply not to think of herself, living only for others. Why hadn’t she seen this before?! But this yoke, too, proved impossible to sustain. She could not, to her satisfaction, eliminate self-seeking. Nor, although she attempted to follow yet another verse and fill herself always with joy, could she prevent herself from snapping back when someone made her angry. “I blew it! I blew it!” she would lament. Her thoughts became a frantic collage of questions and verses compelling her to love everybody, pray continually, spread the Gospel, fight the good fight, and be always gentle, kind, patient, loving, and joyous. “It never stopped,” she told me, “and I felt guilty when it did.”