Few mental afflictions are as humbling or as terrifying as what is known as ‘Pure’
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,
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
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
or fruitless action with manic intensity: handwashing, turning off gas pipes, checking

their pulse and so on. But in ‘pure’ OCD, there is no outward, physical action; the
their pulse and so on. But in ‘pure’ OCD, there is no outward, physical action; the

problem unfolds – hence the name – purely in the mind, yet it is, if anything, an even
problem unfolds – hence the name – purely in the mind, yet it is, if anything, an even

more distressing condition. Image result for Frank auerbach The Pure OCD sufferer is tortured
more distressing condition. Image result for Frank auerbach The Pure OCD sufferer is tortured

by thoughts that they want to do, or have done, some of the most censored and abhorred
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.
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
They grow convinced of their wish, for example, to murder a loved one, harm a child sexually

or assault a stranger. They cannot shut out the idea that they may become, or have already
or assault a stranger. They cannot 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
shown signs that they are, a psychopath, a rapist or a paedophile. They scan their minds

ceaselessly, looking for evidence to confirm their dreadful apprehension. So burdened are
ceaselessly, looking for evidence to confirm their dreadful apprehension. So burdened are

they by these thoughts, they may not be able to go anywhere near children or may take fright
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
at the sight of a knife in a drawer. Left alone with a colleague, they may panic that

they could lose control and lunge inappropriately at them. At the station, they are flooded
they could lose control and lunge inappropriately at them. At the station, they are flooded

with anxiety at the feeling that they may push their partner or their child under a
with 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.
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
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
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 assessments
condition – but discussions of how to approach it reveal large differences in assessments

of how the mind operates. Psychiatrists tend to prescribe antidepressants, in order to
of how the mind operates. Psychiatrists tend to prescribe antidepressants, in order to

lift the general mood of sufferers and thereby lessen the tendency to ruminate to the point
lift the general mood of sufferers and thereby lessen the tendency to ruminate to the point

of exhaustion. CBT psychologists will try to argue closely with the intrusive thoughts,
of exhaustion. CBT psychologists will try to argue closely with the intrusive thoughts,

so that eventually sufferers can logically acknowledge that they truly have no intention
so that eventually sufferers can logically acknowledge that they truly have no intention

of harming anyone or doing anything obscene. But it is psychotherapists
of harming anyone or doing anything obscene. But it is psychotherapists

who have what is perhaps the most imaginative and unexpected solution. They do not target
who have what is perhaps the most imaginative and unexpected solution. They do not target

the thoughts themselves or argue with them directly. They don’t try to reassure people
the thoughts themselves or argue with them directly. They don’t try to reassure people

logically that they are not about to murder a loved one or harm a child – because they
logically that they are not about to murder a loved one or harm a child – because they

don’t believe that this is what is actually at stake and judge that offering reassurance
don’t believe that 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.
on these points only legitimates a pattern of thinking that has no basis in reality.

They locate the origin of the problem somewhere quite different: the sufferer of pure OCD
They locate the origin of the problem somewhere quite different: the sufferer of pure OCD

has, first and foremost, a problem with self-esteem and shame. The unfortunate person feels, at
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
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
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
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
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 be
are attempts by the mind to find a match between their basic sense of self and what would be

needed by their society to concur with it. They are a move to bring about a form of dreadful
needed by their society to concur with it. They are a move to bring about a form of dreadful

inner equilibrium, ensuring that the judgement of the world falls in line with the judgement
inner equilibrium, ensuring that the 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
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
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
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
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
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
transgression particularly abhorrent, Pure OCD sufferers will be haunted by feelings

that they have offended God and are about to be outed as sinners. Behind Pure OCD is
that they have offended God and are about to be outed as sinners. Behind Pure OCD is

a person’s needs to find a reason to feel awful, it isn’t about this or that condemned
a person’s needs 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
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, not in blasphemy, incipient paedophilia or
thoughts. The disease is anchored in self-loathing, not in blasphemy, incipient paedophilia or

murderous intent.This analysis opens the way to treatment. What the sufferer of pure OCD
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
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
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
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.
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
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
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
to oneself. Our book what is psychotherapy tells us exactly what going through therapy

is like and why it is so important.
is like and why it is so important.