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 a 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 clay 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. Usually 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.
*3/338/2*
OBSESSIONS OF LUST: JEFFjeff, 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 a 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 clay 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. Usually 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.*3/338/2*