什麼是純強迫症 (Pure OCD)？：英語精讀講義

Few mental afflictions are as humbling or as terrifying as what is known as pure OCD or more colloquially intrusive thoughts. 講解

很少有精神疾病能像所謂的「純粹強迫症」（或通俗地稱為「闖入性思考」）那樣讓人感到自卑或恐懼。

In standard obsessive-compulsive disorder,

在標準的強迫症中，

a person is haunted by a worry 慣用語

患者會被一種擔憂所困擾，

that compels them to repeat 文法

驅使他們重複

an often counterproductive or fruitless action with manic intensity. 用詞

以狂熱的強度去執行往往適得其反或徒勞無功的動作。

Hand-washing, turning off gas pipes, checking their pulse and so on.

洗手、關瓦斯管、檢查脈搏等等。

But in pure OCD,

但在純粹強迫症中，

there is no outward physical action.

沒有任何外在的身體動作。

The problem unfolds,

問題的展開，

hence the name, 表達脈絡

顧名思義，

purely in the mind.

純粹是在大腦中。

Yet, it is, if anything, 表達脈絡

然而，如果非要說的話，

an even more distressing condition.

它是一種更加令人痛苦的狀況。

The pure OCD sufferer is tortured by thoughts that they want to do or have done 文法

純粹強迫症患者會被想要做或已經做了某些事情的想法所折磨，

some of the most censored and abhorred acts in our societies,

那些在我們的社會中最受審查和痛恨的行為，

acts that they themselves despise and fear at an intellectual level. 片語搭配

那些他們在理智層面上都鄙視和害怕的行為。

They grow convinced of their wish, for example,

比如，他們會漸漸堅信自己有這種願望，

to murder a loved one,

要謀殺親人，

harm a child sexually,

對兒童進行性侵犯，

or assault a stranger.

或者襲擊陌生人。

They cannot shut out the idea 片語動詞

他們無法把這種念頭拒之門外，

that they may become or have already shown signs that they are

覺得自己可能會變成、或者已經顯露出的跡象表明他們是

a psychopath,

一個精神病態者、

a rapist,

一個強姦犯，

or a pedophile.

或者一個戀童癖。

They scan their minds ceaselessly,

他們不斷地審視自己的內心，

looking for evidence to confirm their dreadful apprehension. 片語搭配

尋找證據來證實自己那可怕的憂慮。

So burdened are they by these thoughts, 文法

這些想法給他們帶來了如此沉重的負擔，

they may not be able to go anywhere near children 片語搭配

以至於他們可能無法靠近兒童，

or may take fright at the sight of a knife in a drawer. 片語搭配

或者看到抽屜裡的一把刀也會感到恐懼。

Left alone with a colleague,

和同事單獨待在一起時，

they may panic that they could lose control

他們可能會因為擔心自己失控而恐慌，

and lunge inappropriately at them.

並對他們做出不適當的猛撲。

At the station,

在火車站，

they're flooded with anxiety with the feeling 慣用語

這種感覺讓他們充滿了焦慮：

that they may push their partner or their child

覺得自己可能會把伴侶或孩子

under a train.

推到火車下面。

Having to think of oneself in these terms

被迫如此看待自己，

quickly drains life of any of its pleasure. 慣用語

會迅速抽乾生活中所有的樂趣。

The pure OCD sufferer wakes up every morning

純粹強迫症患者每天早上醒來，

certain that they are one of the worst people ever to have walked on the planet.

都確信自己是地球上有史以來最糟糕的人之一。

There is not, as yet, 片語搭配

到目前為止，還沒有

a foolproof way of treating the condition.

一種萬無一失的治療這種疾病的方法。

But discussions of how to approach it reveal large differences

但關於如何著手治療的討論，揭示了

in assessments of how the mind operates.

在評估大腦如何運作方面的巨大差異。

Psychiatrists tend to prescribe antidepressants

精神科醫師傾向於開立抗鬱劑，

in order to lift the general mood of sufferers 文法

以提升患者的整體情緒，

and thereby lessen the tendency to ruminate to the point of exhaustion. 講解

從而減少反芻思考直到精疲力竭的傾向。

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

認知行為治療（CBT）心理學家會嘗試與闖入性想法進行嚴密的辯論，

so that eventually sufferers can logically acknowledge

以便患者最終能在邏輯上承認，

that they truly have no intention of harming anyone 片語搭配

自己是真的沒有任何傷害他人

or doing anything obscene.

或做任何淫穢之事的意圖。

But it is psychotherapists 文法

但精神分析治療師

who have what is perhaps the most imaginative and unexpected solution.

擁有或許是最富想像力、最出人意料的解決方案。

They don't target the thoughts themselves

他們不把目標對準想法本身，

or argue with them directly.

也不直接與之辯論。

They don't try to reassure people logically

他們不會試圖用邏輯來讓人們安心，

that they're not about to murder a loved one or harm a child

告訴他們不會去謀殺親人或傷害孩子，

because they don't believe that this is what is actually at stake 慣用語

因為他們認為這並不是真正的癥結所在，

and judge that offering reassurance on these points

並且判定在這些點上提供安慰，

only legitimates a pattern of thinking that has no basis in reality. 片語搭配

只會使一種脫離現實的思維模式變得合理化。

They locate the origin of the problem somewhere quite different.

他們認為問題的根源在完全不同的地方。

The sufferer of pure OCD has first and foremost 表達脈絡

純粹強迫症患者首先並且最重要的是，

a problem with self-esteem and shame.

在自尊和羞恥感方面存在問題。

The unfortunate person feels,

這個不幸的人會覺得，

at some level,

在某種層面上，

utterly disgusting and beyond the pale 慣用語

自己極其噁心、不可救藥，

and will, in the background,

並且在內心深處，

have been feeling like this for a long time.

長期以來一直都有這種感覺。

Somewhere in their past,

在他們過去的某個地方，

normally as a result of very traumatic and degrading childhood relationships,

通常是由於非常痛苦和帶有侮辱性的童年人際關係，

they will have derived an impression

他們會產生一種印象，

that they did not deserve to exist.

覺得自己不配存在。

Their current thoughts are not plans for the future.

他們現在的想法不是對未來的計畫。

They are attempts by the mind to find a match

它們是大腦試圖尋找一種契合，

between their basic sense of self

在其基本自我意識

and what would be needed by their society

和社會對他們的要求之間，

to concur with it.

以求達成一致。

They are a move to bring about a form of dreadful inner equilibrium, 片語動詞

它們是為了帶來一種可怕的內在平衡，

ensuring that the judgment of the world

確保世界的評判

falls in line with the judgment of the self. 慣用語

與自我評判相一致。

Cases of pure OCD are sometimes diagnosed

純粹強迫症病例有時被診斷出來，

just after sufferers have achieved something rather positive in the eyes of others. 慣用語

恰好在患者取得了一些在別人看來相當積極的成就之後。

They have been promoted or begun a fulfilling relationship

他們得到了晉升，或者開始了一段令人滿意的感情，

or mastered a project.

或者是掌握了一個專案。

It should be a cause for celebration, 片語搭配

這本該是值得慶祝的事，

but happiness simply feels unwarranted.

但幸福感卻讓人覺得沒有根據。

By latching onto thoughts of complete illegality, 片語動詞

透過抓住那些完全非法的想法，

one is assured that one's self-esteem

人們就能確信自己的自尊

will remain at rock bottom. 慣用語

會一直保持在谷底。

Interestingly, in societies that find religious transgression particularly abhorrent,

有趣的是，在那些認為宗教犯罪尤其令人痛恨的社會中，

pure OCD sufferers will be haunted by feelings

純粹強迫症患者會被這種感覺所困擾：

that they have offended God

他們冒犯了上帝，

and are about to be outed as sinners. 片語動詞

並即將作為罪人被揭發。

Behind pure OCD is a person's need

純粹強迫症背後是一個人的需要——

to find a reason to feel awful.

需要找個理由讓自己感覺糟糕。

It isn't about this or that condemned act. 片語搭配

這與具體的某個受譴責的行為無關。

And as the definition of awful changes, 文法

而隨著「糟糕」的定義發生變化，

so too will the manifest content of the intrusive thoughts.

闖入性想法的具體內容也會隨之改變。

The disease is anchored in self-loathing, 慣用語

這種疾病扎根於自我厭惡之中，

not in blasphemy,

而不是褻瀆神明，

incipient pedophilia,

萌芽的戀童癖，

or murderous intent.

或者殺人的動機。

This analysis opens the way to treatment. 慣用語

這種分析為治療開闢了道路。

What the sufferer of pure OCD needs,

純粹強迫症患者需要的，

above all else, 表達脈絡

首要的是，

is to begin to repair their self-loathing and shame.

開始修復他們的自我厭惡和羞恥感。

They need to learn,

他們需要去學習，

through repeated encounters with an outsider

透過與一個局外人反覆地接觸，

who casts a generous and sympathetic eye on them, 慣用語

一個對他們投以寬容和同情目光的人，

that they're not the worthless being they take themselves for. 片語搭配

明白他們並不是自己所認為的那種毫無價值的人。

Their problem began with a deficit of love

他們的問題源於愛的缺失，

and needs to be healed by a loving act of witnessing.

需要透過一種充滿愛的見證之舉來治癒。

Pure OCD thoughts are not wishes.

純粹強迫症的念頭不是願望。

They are symptoms of radical self-distrust,

它們是極度自我懷疑的症狀，

and these will start to lift 用詞

這些症狀便會開始消散，

once the afflicted learn

一旦受折磨的人學會了

that most vital of arts,

那門最至關重要的藝術——

being a friend to oneself. 片語搭配

成為自己的朋友。

Our book What is Psychotherapy

我們的書《什麼是心理治療》

tells us exactly what going through therapy is like 片語動詞

確切地告訴了我們接受治療是怎樣一種體驗，

and why it is so important.

以及為什麼它如此重要。