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:

在標準的強迫症中，一個人因焦慮作祟，迫使他們瘋狂重複進行適得其反或無結果的動作

handwashing, turning off gas pipes, checking their pulse, and so on.

例如洗手、關瓦斯、檢查脈搏等行為

But in 'pure' OCD, there is no outward, physical action;

但在「純粹」強迫症中，沒有外在的身體行為

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

問題來了 — 因此這個名稱 — 純粹只有在心理上而不會於外在有所表現，但這仍然是令人困擾的情況

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,

純強迫症患者被他們想做或做過的想法折磨、被一些我們社會中最受公評、憎惡的行為折磨

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

被他們具備的認知下所鄙視、恐懼的行為折磨

They grow convinced of their wish, for example, to murder a loved one, harm a child sexually, or assault a stranger.

他們越來越相信自己的期望，例如，殺害親人、對小孩性侵害，或攻擊陌生人。

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.

他們不能排除這種想法，表明他們可能會成為，或者已經顯示出他們是精神病患者、強姦犯或戀童癖者。

They scan their minds ceaselessly, looking for evidence to confirm their dreadful apprehension.

他們不斷審視自己的思想以找尋證據證明他們可怕的恐懼。

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.

他們被這些想法壓得喘不過氣來，他們可能無法靠近孩子，或者看到抽屜裡的一把刀就會嚇一跳。

Left alone with a colleague, they may panic that they could lose control and lunge inappropriately at them.

與同事單獨相處，他們擔心自己會失控作出不適當的行為而感到恐慌。

At the station, they are flooded with anxiety at the feeling that they may push their partner or their child under a train.

在車站，他們感到非常焦慮，因為他們可能會將伴侶或小孩推下月台

Having to think of oneself in these terms quickly drains life of any of its pleasure.

以這樣的方式看待自己，很快就讓生活失去樂趣

The Pure OCD sufferer wakes up every morning certain that they are one of the worst people ever to have walked on the planet.

純粹強迫症患者每天早上醒來，都會認為自己是存在這個星球上最糟糕的人。

But there is not, as yet, a foolproof way of treating the condition–

迄今為止，還沒有一個安全的療法可以改善這個情況

but discussions of how to approach it, reveal large differences in assessments of how the mind operates.

但是關於如何治療這種疾病的討論顯示出人們對大腦運作方式的評估存在很大差異

Psychiatrists tend to prescribe antidepressants, in order to lift the general mood of sufferers and thereby lessen the tendency to ruminate to the point of exhaustion.

精神科醫生傾向開立抗憂鬱藥好提升患者的整體情緒，從而減少患者反覆思索到疲憊的傾向

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

認知行為療法 (Cognitive Behavioral Therapy，CBT) 的心理學者會試著與侵入性思想爭辯

so that eventually sufferers can logically acknowledge that they truly have no intention of harming anyone or doing anything obscene.

如此患者最終可以合乎邏輯地承認他們真的無意傷害任何人或做出任何猥褻的行為

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

但心理治療師擁有的可能是最具想像力也最意想不到的解決方法

They don't target the thoughts themselves or argue with them directly.

他們不會針對那些負面想法，也不會直接與它們爭論

They don't try to reassure people logically that they are not about to murder a loved one or harm a child –

他們不會試著從邏輯上向人們保證他們不會謀殺親人或傷害孩童 —

because they 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.

因為他們不認為這是一個問題，並認為在這些方面給予保證只會將現實中沒有根據的思維模式正當化

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.

他們認為問題的根源在一個完全不同的地方：純強迫症患者首先擁有的問題是自尊與羞愧。

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.

在某種程度上，不幸的人會感到完全的噁心且完全不能接受— 並且在不起眼的地方長時間有如此的感受。

Somewhere in their past, normally as a result of very traumatic and degrading childhood relationships,

在他們過去某個時期，經常因為某個非常痛苦以及有辱人格的童年關係，

they will have derived an impression that they did not deserve to exist.

而產生一種覺得他們根本不應該活著的印象。

Their current thoughts are not plans for the future.

他們當前的想法不是為了計劃未來

They 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.

他們在腦中試著進行配對，從對自我的基本認知與社會需求中達成一致。

They are a move to bring about a form of dreadful inner equilibrium, ensuring that the judgment of the world falls in line with the judgment of the self.

他們是為了實現一種可怕的內在平衡的舉動，以確保世界的判斷與自我的判斷保持一致

Cases of Pure OCD are sometimes diagnosed just after sufferers have achieved something rather positive in the eyes of others:

純粹強迫症的案例有時候會在患者達成其他人眼中相當積極的成就後才被診斷出來

they have been promoted or begun a fulfilling relationship or mastered a project.

他們被晉升或開始一段滿意的關係或掌握了一個專案

It should be a cause for celebration but happiness simply feels unwarranted.

這應該是值得慶祝的理由，就是覺得不應該高興

By latching onto thoughts of complete illegality, one is assured that one's self-esteem will remain at rock bottom.

將自己困在完全不正當的想法中，可以確定一個人的自尊將會保持在谷底

Interestingly, in societies that find religious transgression particularly abhorrent,

有趣地是在特別憎恨宗教犯罪的社會裡，

Pure OCD sufferers will be haunted by feelings that they have offended God and are about to be outed as sinners.

純強迫症患者會被冒犯上帝以及被視作罪人的感覺困擾

Behind the Pure OCD is a person's needs to find a reason to feel awful, it isn't about this or that condemned act –

在純粹的強迫症背後，一個人需要找到一個讓自己感覺糟糕的理由，這不是關於這個或那個被譴責的行為

and as the definition of awful changes, so too will the manifest content of the intrusive thoughts.

並且當可怕的定義改變時，也會表現在侵入性思想上

The disease is anchored in self-loathing, not in blasphemy, incipient paedophilia or murderous intent.

這個疾病根植於自我厭惡，而非褻瀆神明、初期戀童癖或殺人意圖

This analysis opens the way to treatment.

這個分析為治療開啟了道路

What the sufferer of pure OCD needs, above all else, is to begin to repair their self-loathing and shame.

純強迫症患者最需要的便是修復他們的自我厭惡與羞愧

They need to learn, through repeated encounters with an outsider who casts a generous and sympathetic eye on them,

他們需要學習透過不斷碰到施以雅量與同情心的局外人

that they are not the worthless being they take themselves for.

讓他們知道他們不是自己認為的無用的人

Their problem began with a deficit of love – and needs to be healed by a loving act of witnessing.

他們的問題始於缺乏愛 — 需要透過充滿愛的行為來治癒

Pure OCD thoughts are not wishes, they are symptoms of radical self-distrust –

純強迫症想法並不是願望，反而是激進的自我不信任的症狀

and these will start to lift once the afflicted learn that most vital of arts: being a friend to oneself.

一旦他們在這痛苦的過程中學習到最重要的藝術：作自己的朋友，一切將會開始好轉

Our book what is psychotherapy tells us exactly what going through therapy is like and why it is so important.

我們有關心理治療的書確切地告訴我們治療過程是如何以及為何它如此重要