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Egiven a chance to sit back and reflect for a minute, the afflicted person just can’t figure out why the tormenting thought would ever have occurred in the first place. There seems to be no earthly reason for it.Mental health professionals use the term “egodystonic” to describe this characteristic. The term means “against a person’s very nature,” a mismatch to a person’s sense of self. When I had my needle obsession, I knew it was irrational for me to be thinking such thoughts. They didn’t match with who I was. They didn’t fit in with my goals, my desires, or my fears. When an OCDer must check the light switch for the hundredth time, the reaction is: “Why am I thinking this crazy thought? This isn’t me.”Raymond knew very well that his spill visions were only “killer fantasies.” It was because he did that he went to such great lengths to hide his checking compulsions. A new student in our OCD group described her obsessions this way:I will fully admit right now that my worries are unrealistic and completely stupid. Like before I go to bed, I will keep having the thought that the door isn’t locked. I lock it and unlock it, lock it and unlock it, a dozen times. But the thought still comes back: What if I didn’t lock it right? I will get up and go over and check the door again. It’s so crazy that I’m reduced to tears.An obsession, is not a psychosis. Sometimes the recognition of the ego-dystonic quality of an obsession—realizing that a thought is violating who you are—causes people to think that they are “going crazy.” This is a common reaction to severe obsessions: “I should be locked up!” Jeff felt this way because he thought he was “hearing voices.” Even though he recognized that these “voices” came from his own mind and did not sound like real voices, still, because his tormenting thoughts were so inappropriate and senseless, so unlike himself, he mistook his obsessions for psychotic hallucinations.Melissa also feared that she was losing her sanity. At first, I myself wasn’t sure on this point. Her inner preoccupations and abrupt lapses in conversation gave her the appearance of a person who might be actively hallucinating; furthermore, her intense concern about Satan raised the question as to whether she might be suffering delusions. When I questioned Melissa, however, as to whether she was in fact hearing voices, she said no. And when I asked her about common delusions—such as the idea that other people could overhear her thoughts, or the idea that messages were being sent to her over the television or radio—she denied these as well. Her beliefs about Satan turned out to be shared by other members of her church and therefore were not signs of mental illness. It was soon clear that Melissa had OCD, not a psychosis.OCDers often feel like they’re going crazy because they experience a loss of control over their thoughts. Yet obsessions never—repeat, never—lead to a true loss of contact with reality, to a psychosis. People who are psychotic lack the ability to discern what is sensible. OCDers, on the contrary, are intensely aware that their thoughts don’t make sense. OCDers probably have less of a chance of going crazy than anybody else.The four qualities of intrusiveness, recurrence, unwantedness, and inappropriateness are what set clinical obsessions apart from the preoccupations, temptations, and worries of everyday life.An adolescent male, starry-eyed over a new girlfriend, is not really “obsessed.” He’s merely preoccupied. Likewise, the lady who has to grit her teeth and punch down on the gas pedal to get past the liquor store is not “obsessed with alcohol,” not clinically, at least. She is tempted, perhaps addicted. And consider what happened to me not long ago. I was fretting aloud about my ten-year-old daughter going away to college. Crime, cut-throat competition, men trying to take advantage of her. . . . My wife chided me, “Stop your obsessing!” But these were not unwanted thoughts that I resisted, nor were they completely inappropriate. It makes sense to be a bit fearful about your daughter’s future. These were not obsessions; they were simply worries.With ordinary temptations, addictions, and worries, there are ways to fight back—willpower, for instance, or thinking more rationally. But for obsessions there seems to be no defense at all. They are like body snatchers from outer space. A person will do anything to find relief. And that’s where compulsions enter in.*10/338/2*