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One trembles to think of that mysterious thing in the soul, which seems to acknowledge no human jurisdiction, but in spite of the individual's own innocent self, will still dream horrid dreams, and mutter unmentionable thoughts.
—Herman Melville (1819-1891)

Why do I have such thoughts? I know all the psychological and physiological theories—which I will discuss in detail later—yet for me, a literary description often captures most vividly what is happening: Here is none other than my own personal Imp of the Perverse, perched perhaps upon my right shoulder, whispering thoughts about running the dog over into my mind's ear. Just who is my imp? For me, Edgar Allen Poe depicted him perfectly in his 1845 short story "The Imp of the Perverse":

An innate and primitive principle of human action, a paradoxical something, which we may call Perverseness, for want of a more characteristic term.... Through its promptings we act, for the reason that we should not. In theory, no reason can be unreasonable: But, in fact, there is none more strong. With certain minds, under certain conditions, it becomes absolutely irresistible. I am not more certain that I breathe, than that the assurance of the wrong word or error of any action is often the one unconquerable force which impels us, and alone impels us to its prosecution. Nor will this overwhelming tendency to do wrong for the wrong's sake, admit of analysis, or resolution into ulterior elements. It is a radical, a primitive impulse—elementary....

We stand upon the brink of a precipice. We peer into the abyss—we grow sick and dizzy. Our first impulse is to shrink from the danger. Unaccountably we remain. By slow degrees our sickness, and dizziness, and horror, become merged in the cloud of unnamable feeling. By gradations, still more imperceptible, this cloud assumes shape, as did the vapor from the bottle out of which arose the genie in the Arabian nights. But out of this our cloud upon the precipice's edge, there grows into palpability, a shape, far more terrible than any genie, or any demon of a tale, and yet it is but a thought, although a fearful one, and one which chills the very marrow of our bones with the fierceness of the delight of its horror. It is merely the idea of what would be our sensations during the sweeping precipitancy of a fall from such a height. And this fall—this rushing annihilation—for the very reason that involves that one most ghastly and loathsome of all the most ghastly and loathsome of images of death and suffering which have ever presented themselves to our imagination—for this very cause do we now the most vividly desire it. And because our reason violently deters us from the brink, therefore, do we the more impetuously approach it....

Examine these and similar actions as we will, we shall find them resulting solely from the spirit of the Perverse. We perpetrate them merely because we feel that we should not. Beyond or behind this, there is no intelligible principle ...

Based upon my research and clinical experience with patients, I am convinced that Poe captured a universal human condition in his description of the imp. This phenomenon has been described by others, by various names at various times: the French neurologist Pierre Janet called it "association by contrast," in which the patient feels driven to do precisely the opposite of what he wants to do. Yet, these descriptions, to me, lack the elegance of Poe's.

As I have already admitted, at times my own imp makes his presence felt, through unwanted thoughts and impulses that go counter to the norms of polite society: to swerve my car off the road or to shout an obscenity in public, for example. And few in number are those people who can honestly say that they have never recognized this imp at work in themselves.

Fortunately, for me, and for most people, these occasional bad thoughts are nothing but a fleeting annoyance. But many people who come to see me are not so fortunate. Their bad thoughts may be about violence or sex or blasphemy and may bombard them every waking hour. These bad thoughts—when severe they are called obsessions—may cost people the most important things in their lives: Some cannot bear to be around their own children; others cannot have relationships; and others are so paralyzed they cannot perform simple everyday activities—such as leaving their house—because of their bad thoughts. Many contemplate suicide at some time. These are obsessions of clinical severity and require treatment.

Just about two years ago I began conducting a group at McLean Hospital for men and women who suffer from clinical bad thoughts. Since that time I have spoken to dozens of patients suffering from these thoughts who've never before admitted them to anyone, but were relieved to find that many other individuals suffer from similar thoughts. The degree to which these bad thoughts have devastated the quality of life of these people has amazed me. Virtually all the people who've come to my group for severe violent or sexual obsessions have thought about suicide, some have even tried suicide, and all have had their social lives disrupted. Some cannot date because of these thoughts; others have been divorced because of the thoughts. Many avoid being around children; most will turn away from television shows, movies, books, magazines, and newspaper accounts of violent or sexual activities, lest they find their own bad thoughts triggered.

Apparently, the Imp of the Perverse visits every one of us from time to time, with two possible outcomes: (1) We give the thoughts little attention and no credence and go on with our lives, or (2) we are strongly affected by the bad thoughts, so that the thoughts occur frequently during the day and interfere with our functioning socially or at work.

An example of the latter outcome was Isaac, a patient of mine in his midtwenties who had always loved animals. Yet by the time I met him he cringed every time he passed a dog or cat on the street. Just a glance at the wagging tail was enough to start the bad thoughts—he felt compelled to stare at the dog's anus and his thoughts would start. They were always the same, thoughts of intercourse with the dog, followed by the worry that this meant he was really a pervert. He was often convinced it was true: "Why in the world," he asked himself, "should looking at a dog or a cat on the streets lead me to stare at their private parts or trigger these thoughts about having sex with them—unless that is what I really want?"

After Isaac had told me his story at our first meeting, I told him that if he was to tame his bad thoughts, the first key fact that he had to understand, and believe, was:

You are not so abnormal as you think. Every human being is visited from time to time by the Imp of the Perverse, who makes you think the most inappropriate thoughts at the most inappropriate times.

To help convince Isaac of this, I showed him a list of bad thoughts that were part of a questionnaire given to normal college students in a London study by pioneering psychologist Dr. Stanley Rachman and his associates. Isaac was surprised when I told him that virtually all of the students said that they had one or more of these thoughts from time to time. I have included part of this list in table 1.

• Thought of acts of violence in sex
• Thought of sexually punishing a loved one
• Thought of "unnatural" sex acts (including sex with animals)
• Impulse to engage in sexual practices that cause pain to the partner
• Sexual impulse toward attractive females, known and unknown
• Impulse to sexually assault a female, known and unknown
• Repetitive blasphemous, obscene images of the Virgin Mary

• Thought of causing harm to elderly people
• Wishing or imagining that someone close to one is hurt or harmed
• Impulse to violently attack and kill a dog
• Impulse to violently attack and kill someone
• Thinking or wishing that someone would disappear from the face of the earth
• Impulse to hit or harm someone
• Thought of intense anger toward someone related to a past experience
• Impulse to harm or be violent toward children, especially smaller ones
• Impulse to shout at and abuse someone

• Impulse to attack and violently punish someone (e.g., to throw a child out of a bus)
• Impulse to say something nasty and damning to someone
• Impulse to say rude and inappropriate things—"wrong thing in wrong place" impulse
• Impulse to push people away or off in a crowd
• Blasphemous thoughts during prayers

Next I told Isaac that not only are these bad thoughts universal among all humans today, but they have almost certainly always been a part of the human condition, at least since man first developed language and then rules to govern appropriate behavior in groups.

An early reference to something resembling the Imp of the Perverse (i.e., the human curiosity and inability to stop thinking about the very thing we are told not to do) is the Greek myth of Pandora: In bestowing their gifts on Pandora, the gods of Olympus gave her a box, warning her never to open it. But, inevitably, Pandora's curiosity finally overcame her, and she opened the mysterious box, from which flew innumerable plagues and sorrows for humankind. In terror, she tried to shut the box, but only Hope remained inside to comfort humanity against its new misfortunes.

Similarly, in the Judeo-Christian tradition, the biblical story of Eve in the Garden of Eden casts the serpent—here an agent of Satan—in the role of the imp. As soon as God specifically tells Adam and Eve that there is only one tree in the Garden that they may not even think about eating from, the release of humanity's troubles (as in the Pandora myth) seems inescapable.

Dr. Ian Osborne, a Penn State psychiatrist, and author of the excellent book Tormenting Thoughts and Secret Rituals, recently uncovered two examples of the Imp of the Perverse at work in past centuries. First, there is the record of a sixteenth-century woman who admitted to having evil thoughts about harming her children and her husband, and who barely escaped burning at the stake for these perverse thoughts. This unfortunate woman lived in a time when the Imp of the Perverse was understood—not metaphorically, but in a deadly literal way-as possession by Satan himself. Only through the intervention of an understanding justice of the peace, who recognized these as "the meaningless intrusive thoughts of a good, but 'melancholy' woman," did she escape burning to expel the "devil" within her.

Nearer to our own time, in the eighteenth century, the patron saint of France, Thérèse of Lisieux, received a letter from her female cousin who wrote about being tormented by horrible sexual obsessions and asking Thérèse for help. Thérèse, who Dr. Osborne notes, probably had obsessions herself, replied reassuringly to her cousin: "You haven't committed the shadow of any evil. I know these kinds of temptations so well that I can assure you of this without any fear.... We must despise all these temptations and pay no attention whatsoever to them.... Don't listen to the Devil. Mock him." Here again, the imp is thought to be the devil himself, yet Thérèse views him as an annoying and mocking tempter, not one to be deathly afraid of.

A useful rule of thumb I have developed from talking to hundreds of patients with bad thoughts is:

The Imp of the Perverse will try to torment you with thoughts of whatever it is you consider to be the most inappropriate or awful thing that you could do.

To illustrate this point, each of my patients whose thoughts are summarized below (many of whom you'll meet in later chapters) told me that his or her particular bad thoughts focused squarely on whatever was for him or her the most inappropriate, awful, or shameful thing he or she could think of doing:

• the man who thought he had killed people while driving
• the woman who worried she'd throw her grandchildren off a bridge
• the new mother who thought she'd poison her infant
• the schoolteacher who thought she'd killed her students
• the doctor who worried about mutilating babies with a scalpel
• the priest who worried about staring at women's private parts
• the woman tormented by thoughts of lesbian sex with her sister
• the man who thought he had sex with people he passed on the street
• the man who feared he would stab children with a knife
• the man who worried he wanted to have sex with animals
• the nun who thought she was damned for having impure sexual thoughts
• the woman who was terrified to go to sleep because the devil would take her for her "bad" sexual thoughts

Can what seems to be the worst possible thing that we can imagine doing change with the passage of time? Absolutely. And a closer look at Isaac's history clearly illustrates this.

Through further questioning I learned that the imp had attacked Isaac at other vulnerable points earlier in his life. When he was an adolescent—although he was heterosexual—the worst possible thing Isaac could think of was being gay, which could cause relentless teasing by his classmates in school. So this is where the imp began his torment of Isaac. Perhaps he would stare at an attractive female classmate and feel pleasantly aroused; but the imp would lead him to think that perhaps it was really the boy sitting next to her that he was really attracted to. Soon, whenever he saw an attractive boy in school or on the street or in the gym, he would find himself scanning his body to try to feel certain that he wasn't sexually aroused. "Was that the first tingling of an erection?" he'd ask himself. Of course, simply thinking about the area would sensitize it, which might be enough to convince him that he really was homosexual. He might then go home and lie in bed, depressed and thinking about suicide, certain that his classmates would soon discover the truth and begin teasing him mercilessly.

But after a year or two of this, something amazing happened: Isaac realized that he had many friends who were gay, and it no longer seemed a big deal to him whether he was teased about this or not. Since being gay was no longer the most embarrassing and inappropriate thing he could think of doing, the Imp of the Perverse changed his plan of attack: It was now time to torment Isaac with another bad thought.

At this time, for Isaac was now a liberal college student, the worst thing he could think of would be to be a racist. So now, if he saw an African-American walking toward him on the street, the urge would come to shout "Nigger!" Although he was able to fight it off, it stayed in his mind and tormented him. Did it mean he really was deep down a racist? He didn't want to believe it, but maybe it was true. He hated these thoughts, which continued for a couple of years. Finally, one day, Isaac realized he was not a racist, and soon the thoughts no longer seemed real; then one day, they were gone. But the Imp of the Perverse was not through with Isaac yet.

At this time, to Isaac, anyone who had sex with animals was the lowest form of life—beneath his contempt, and of course, this is where the Imp of the Perverse now struck. This is how the obsession that had brought him to our clinic had begun. And it seemed the worst of all. By now it seemed safest simply to stay in his house and take no chances. The imp almost had Isaac beaten. Fortunately, he was soon to turn the tables, but that is getting ahead of our story.

For some people, the way they react to the Imp of the Perverse can determine whether their bad thoughts will reach clinical severity, requiring treatment.

For example, Father Jack, a priest in his late fifties, came to our clinic several years ago for help with inappropriate sexual obsessions that threatened to ruin his professional and personal life. For him, the worst thing he could imagine doing would be to be caught staring at a young woman's private parts. Naturally, his personal Imp of the Perverse chose to torment him at this vulnerable point.

Seeing an attractive young woman walking down the street or talking with a female parishioner one-on-one, the priest would have the thought and urge to stare at her buttocks, breasts, or crotch. Over the years he fought this urge with all his strength, but with little success. So he finally found his way to our clinic to seek treatment. Here are parts of the story he told me.

Despite his attempts, the priest found himself staring at a woman's breasts as she walked toward him on the street. He tried to avert his gaze, but as usual, the more he tried, the more he was aware of her, now noticing her breasts bounce as she approached. He finally willed himself to look away until she was past him, but then, against his will, he turned to stare at her shapely buttocks as she walked away. He prayed that people hadn't noticed him staring at her. Had they? If so, what did they think of him, a man of God, ogling a strange young woman's private parts? Would they think him a pervert or rapist?

He turned forward, resolving to keep his eyes focused only on the pavement as he made his way to see me at the hospital, to discuss these vulgar thoughts that plagued him so. "There, that's better," he thought. "If I just keep my eyes downcast, it will be okay." This worked for about a city block, until he looked up again, his gaze fixing on a young woman, alternating between her breasts and crotch. And then the images of having sexual relations with her flooded his mind, filling him with guilt and disgust. Despite his strongest efforts, he was staring at a woman again, he couldn't help it, and he knew that she had noticed. Would she call a policeman? Would she run? If only he could break free from her grip, but it was no use: He was fascinated, compelled to stare at her private parts. The guilt rose, until she was safely past. Mustering all his strength, he resisted the pull to turn around and look at her again. Two more blocks and he'd be safe, in my office, for a change confessing his sins to another.

Father Jack tells me he used to deaden the thoughts by drink. But because it had taken larger and larger amounts of alcohol to do this, he had stopped drinking years ago. But now he had no defense left against the thoughts. Was it, he wondered at times, the devil mocking him? Some days he felt certain of this. Who else could taunt him with feelings and thoughts so strong, so unbearable?

He had been but a teenager when the thoughts began. When he had told his superior about them, he was told they would pass with time, and to be patient. Only they didn't. It wasn't that he had trouble maintaining his vow of chastity—that he was sure he could do. Rather, it was the vulgar images that played over and over in his mind, and the way he felt compelled to stare at women's private parts. The very thing he was most afraid of doing—the very thing that seemed most disgusting to him—why was he having these very thoughts and urges?

No one who saw him performing ceremonies in his church knew the torment going on inside his mind. Although he had taken the vow of chastity, his mind refused to cooperate. Finally he confided to a parishioner about the thoughts and images that were forcing themselves into his mind whenever he saw an attractive female on the streets or in church. He soon regretted this confession. He got a call from his superior, who told him about a complaint he had received from a parishioner and a warning that the father might be a dangerous man. Providentially, the superior had heard of obsessive thoughts like Father Jack's, and he arranged for him to receive treatment at our clinic.

Father Jack had been referred to our clinic to participate in a study of medication for obsessive-compulsive disorder. He knew that he had a fifty percent chance of being assigned to take either the active medication or a placebo sugar pill. At the end of our first visit, as I handed Father Jack the bottle of pills he had been assigned by the computer to take in the study, he asked me a question that took me aback. He told me that he had read my book6 and others about how to deal with obsessions, and he wanted to know if he had understood them correctly: Was it true that the best thing to do was to stop resisting his obsessions, and to put himself in the situations that triggered his obsessions, rather than avoid them?

The difficulty for me, I told him, was that because of the rules of the study, I was not allowed to give anyone instructions about using behavior therapy for their symptoms (since behavior therapy is a highly effective treatment for obsessions and compulsions and could invalidate the results of the drug trial). However, I felt obliged to at least tell him that his understanding of the basic principles of behavior therapy were correct—although I could not give him any specific help in using these techniques while the study was going on.

As Father Jack returned for his weekly, and then biweekly, visits, I was pleased to hear that he was feeling better. Apparently the medication was starting to work, and he now noticed that he no longer needed to fight the obsessions or to avoid attractive women on the streets of Boston, since the thoughts passed rapidly through his mind and disappeared.

At the end of the three-month study, when I assessed Father Jack's symptoms using the Yale-Brown Obsessive Compulsive Scale (YBOCS), both he and I were delighted to find that he was the first person in any of our drug studies to that time whose final score was zero. Father Jack returned to his parish, and not until he returned to Boston several months later for a follow-up did he and I learn that he had been taking the placebo throughout the study! To my surprise Father Jack was not upset by this news at all—he told me that he had suspected that his progress was largely due to his decision after our first visit to try his hardest to follow the behavioral principles I had explained in my book. By letting himself look at whatever he wanted to look at; by letting whatever thoughts came simply pass through his mind; by recognizing the bad thoughts as nothing more than thoughts—he had cured himself of his obsessions.

In further discussions, I explained to Father Jack the strong scientific basis for what he had experienced. It is called the "thought to suppression" effect and was introduced by psychologist Daniel Wegner and explained in his excellent book White Bears and Other Unwanted Thoughts. College students were instructed to resist thinking about white bears during the experiment. Needless to say, most students had a difficult time keeping the thought of a white bear from intruding in their mind despite their efforts to keep it out. What was more interesting, however, was that after they were told to stop trying to resist thinking about white bears, a rebound effect occurred. That is, after they stopped suppressing thoughts about white bears, these thoughts came into their mind at a higher rate than if they had not tried to suppress these thoughts in the first place.

This certainly seemed to be at least part of Father Jack's problem. The more he fought looking at attractive women, the more he felt compelled to stare at their private parts. This led him to try to avoid streets where he might see attractive women-and as I will explain later, avoiding almost any situation increases our fears of it. In short, Father Jack was trapped in a downward spiral that is common in our patients and is often what leads them to seek treatment with us. Fortunately for Father Jack, simply stopping thought suppression and no longer avoiding places where he would see attractive women were enough to tame his bad thoughts.

Many harbor, but few admit to, the sneaking suspicion that deep down we are really another person, far darker than the polite face we present to other people. For many then, when the Imp of the Perverse visits, and they notice having bad thoughts, these can seem to signal for them the "awakening" of this other, evil part of themselves.

The classic literary description of this fear made real is Robert Louis Stevenson's story The Strange Case of Dr. Jekyll and Mr. Hyde. At the conclusion of the story, in confessing his dastardly experiments to his friend, the upstanding citizen Dr. Jekyll writes:

I was driven to reflect deeply and inveterately on that hard law of life which lies at the root of religion, and is one of the most plentiful springs of distress. Though so profound a double-dealer, I was in no sense a hypocrite; both sides of me were in dead earnest; I was no more myself when I laid aside restraint and plunged in shame, than when I laboured, in the eye of day, at the furtherance of knowledge or the relief of sorrow and suffering. And it chanced that the direction of my scientific studies, which led wholly towards the mystic and the transcendental, reacted and shed a strong light on this consciousness of the perennial war among my members. With every day, and from both sides of my intelligence, the moral and the intellectual, I thus drew steadily nearer to that truth by whose partial discovery I have been doomed to such a dreadful shipwreck: that man is not truly one, but truly two. I say two, because the state of my own knowledge does not pass beyond that point. Others will follow, others will outstrip me on the same lines; and I hazard the guess that man will be ultimately known for a mere polity of multifarious, incongruous and independent denizens. I, for my part, from the nature of my life, advanced infallibly in one direction and in one direction only. It was on the moral side, and in my own person, that I learned to recognize the thorough and primitive duality of man; I saw that, of the two natures that contended in the field of my consciousness, even if I could rightly be said to be either, it was only because I was radically both; and from an early date, even before the course of my scientific discoveries had begun to suggest the most naked possibility of such a miracle, I had learned to dwell with pleasure, as a beloved daydream, on the thought of the separation of these elements. If each, I told myself, could but be housed in separate identities, life would be relieved of all that was unbearable; the unjust might go his way, delivered from the aspirations and remorse of his more upright twin; and the just could walk steadfastly and securely on his upward path, doing the good things in which he found his pleasure, and no longer exposed to disgrace and penitence by the hands of this extraneous evil. It was the curse of mankind that these incongruous faggots were thus bound together—that in the agonized womb of consciousness these polar twins should be continuously struggling. How, then, were they dissociated?

Sadly, many of my patients, when they first experience violent, sexual, or blasphemous bad thoughts, believe that there is deep down in them—like the ruthless Mr. Hyde living deep within Dr. Jekyll and waiting to be unbound—an evil murderer or molester, their "true" self, whose appearance is heralded by the appearance of the bad thoughts. For my patients who come to this conclusion, thought suppression seems to them the only logical approach—that is, to block all attempts of their evil nature from forcing itself into their consciousness. Sadly, as we now understand, this makes a bad situation far worse (as do artificial attempts to suppress the thoughts by drinking or illegal drugs).

Consequently, another rule of thumb in taming one's bad thoughts is:

Bad thoughts do not signify that you are truly evil deep down, and voluntarily suppressing these thoughts will only make them stronger.

As a tangible example of the widely different outcomes that can result from this simple change of outlook, compare the reaction of Father Jack to his bad thoughts with that of a former president of the United States, Jimmy Carter.

While Father Jack viewed his sexual thoughts and urges as evil and shameful, and needing to be suppressed at all costs, Jimmy Carter viewed his bad thoughts far differently. In a famous interview in Playboy magazine, Carter was asked if his strong religious beliefs would cause him to be "a rigid, unbending president." His controversial reply:

I've looked on a lot of women with lust. I've committed adultery in my heart many times. This is something that God recognizes that I will do—and I have done it—and God forgives me for it. But that doesn't mean that I condemn someone who not only looks on a woman with lust but who leaves his wife and shacks up with somebody out of wedlock. Christ says, don't consider yourself better than someone else because one guy screws a whole bunch of women while the other guy is loyal to his wife.

Here was Carter, a deeply religious man, a Sunday school teacher, admitting that he had inappropriate sexual thoughts at inappropriate times—even admitting that he had broken one of the Ten Commandments. Yet he did not consider these thoughts themselves as shameful, or as something God would punish him for. As a result, he did not suppress such thoughts or avoid situations that triggered them. Had he suffered from either depression or obsessive-compulsive disorder, the effects of these bad thoughts on his life, and on U.S. history, might have been vastly different.