The Imagined Sin

I have been thinking about a particular quality that can come into adolescent OCD, especially when intrusive thoughts or images are bound up with shame, morality, sex, aggression, religion, or the fear of being the sort of person who could do something terrible. The young person knows, in one sense, that they have only had a thought. They may say this very clearly. “I know I have not actually done anything.” Yet the thought has already acquired the emotional weight of an action. Sometimes more than an action, really. It feels as though something has been disclosed, as though they have been found out by a part of themselves they had not known was there.

I am reaching, perhaps rather cautiously, for the old idea of the law of talion. An eye for an eye. The phrase is usually heard as a demand for vengeance, although its original legal function may have been more restrained than that, an attempt to limit retaliation rather than allow it to spread without end. That is worth holding onto, because OCD does something rather different and much crueller. It establishes a private law in which no injury has actually taken place, yet a punishment is still required. Not merely because the young person has done something wrong, but because they have imagined doing it, or because they cannot establish to their own satisfaction that the thought did not reveal something morally damning about them.

The punishment, I think, often has to rhyme with the imagined sin.

Take a teenager who has an intrusive image of harming their younger brother. They do not want to harm him. The very reason the image has such force is that the possibility is abhorrent to them. But after the image arrives, they may decide they are no longer allowed to be alone with him, or to pick him up, or to sit beside him on the sofa. The imagined act is followed by a kind of self exile from the relationship. Another young person might have a blasphemous thought and then need to pray in a particular sequence, repeat a phrase until it feels clean, or deny themselves something they enjoy. Someone else may have an intrusive sexual thought and feel compelled to confess, to search their memory, to withdraw from touch, to ask their parents the same question in slightly altered forms until an answer arrives that settles the matter for a few minutes.

It is not always literal. The thought and the compulsion do not necessarily match in a simple one to one way. But there can be a moral correspondence, a private logic of payment. If I have had the thought, I must lose something. If I have imagined harm, I must submit to restriction. If I cannot be certain that I am innocent, I must keep asking for a verdict.

And the mind can be remarkably severe in these moments. It does not always need a witness. The accusation, prosecution, conviction and sentence can appear almost together, before breakfast, on the way to school, in the bathroom while everyone else is trying to get out of the house. Adolescence is not a period in which questions of goodness, sexuality, aggression, loyalty, dependence and identity are especially quiet. They are often becoming more alive, more complicated, and less easily settled by the answers that worked in childhood. OCD seems to find these charged areas with an alarming accuracy.

I want to be careful here. This does not mean that the intrusive thought is a hidden wish in disguise. I do not think it is helpful, or fair, to treat a young person’s fear of stabbing somebody, contaminating somebody, sexually harming somebody, or offending God as evidence that they want to do these things. They usually do not. The distress is real precisely because the thought is so alien to the person’s conscious sense of themselves.

But nor do I think we need to retreat into the equally thin reassurance that the content is wholly meaningless. Something may be emotionally alive without being a secret intention. The thought may gather around what matters, what feels morally charged, what the young person has begun to worry they could lose, damage or become. This is a rather different proposition from saying that OCD is trying to reveal an unconscious truth. Often it is doing the opposite. It is creating so much noise around an imagined offence that the person cannot get near the more ordinary, difficult uncertainties of growing up.

The apparent question is, “What does it mean that I had that thought?”

The question underneath may be, “Can I know with certainty that I am a good person?” Or, “Can I be sure that nothing terrible will happen because of me?” Or perhaps, “Can the people I love remain safe if I cannot keep every part of my mind under control?”

These are not questions that can be finally answered. That is part of the problem. OCD gives them the appearance of being answerable by offering a procedure. Check the memory. Ask Mum. Say the prayer. Avoid the object. Confess. Start again. Do without the thing you wanted. The compulsion becomes a sentence that can be served, and there is a strange relief in that, because serving a sentence is easier than living with a question that has no final answer.

Freud noticed something about the ceremonial quality of obsessive symptoms in his 1907 paper on obsessive actions and religious practices. I am not sure his account takes us all the way, and I would not want to drag a teenager into a century old theory of ritual merely because it gives the clinician something interesting to say in supervision. Still, the thought that a compulsion can operate as a private ceremony of repair feels important. The young person is not simply being irrational. They are trying, with the tools OCD has given them, to put something right.

The tragedy is that nothing has happened which can be put right in this way.

The cognitive and behavioural models of OCD have given us very useful language for this. Thought action fusion, inflated responsibility, the tendency to treat a mental event as morally or causally equivalent to an action. Exposure and response prevention matters because it begins to interrupt the private legal system. The young person has the thought, does not pay the demanded price, and gradually discovers that the feared catastrophe does not follow. The thought can be present without becoming an offence. This is not a small achievement.

At the same time, I sometimes wonder whether ERP becomes more bearable when we also understand what the ritual has been trying to do for the person. Not because insight dissolves OCD. It does not. But because it may help a young person see that the voice telling them to confess, check, avoid or punish themselves is not a moral authority. It is a frightened and merciless part of the symptom, one that has mistaken suffering for proof of goodness.

Parents can get pulled into this very quickly. They reassure because their child is in agony, because the question sounds urgent, because it is hard to watch somebody you love look at you as though the answer might determine whether they are allowed to remain in the family. Parents accommodate for reasons, usually good ones. Yet reassurance can become another hearing in the private court. “Are you sure I am not bad?” “Are you absolutely sure?” “But what if I secretly meant it?”

Perhaps the task is not to win the argument about goodness. That is a standard OCD will always raise.

Perhaps it is to help the young person notice that a thought has arrived, that it has found a particularly painful place to land, and that they do not have to make payment for an imagined sin.That is not the same as saying the thought does not matter. It matters very much to them. The work is to make it matter less like a verdict, and more like something the mind can produce, survive, and eventually let go (even when that feels impossible)