Most nights before I fall asleep, and sometimes during a quiet moment in the day, I can feel a knife floating above my right shoulder. It’s a distinctive knife, with a broad blade and a generous handle. A good knife for cutting up a pumpkin. Still, for a sharp, pointy object, it’s nebulous; I can’t tell exactly what shape it is. As it floats meditatively I feel a slight pressure. Then the knife begins to stab the side of my face. It focuses on my right side, burying itself in the little hollow below my cheekbone and moving across to my jaw, making short, but deep, strokes along the way. Occasionally the knife makes these incisions with care, as if getting started on a surgical procedure; other times the work is rapid and violent. And sometimes the knife shape-shifts into another pointed object, like a pair of chopsticks, or a long skewer, the sort that you’d use to test whether a leg of lamb was cooked through. It’s even been the little triangular wedge I put under my front door to stop the wind from slamming it shut.
“Because the right side of the body is governed by the left side of the brain,” an alternative healer tells me, “it could be that this imagined stabbing is to do with some avoidance or procrastination in your life.” The healer, who is massaging my head and face as I lie on a table, continues. “So it may be, simply, that you need to do your chores.” Then he draws a card for me from his tarot deck, and it’s the salmon. The wisest animal! The salmon is swimming upriver in search of a spawning ground, leaping over obstacles in its rush to get there. But somehow, according to the tarot cards, it’s also possible that I’m the opposite of the salmon. The silliest animal, recklessly swimming downstream.
Although the knife is not something I can truly see or feel, the thought of it creates an abstract pressure that spreads across my cheek and into my ear, so I often feel tense there, and have the sense that I shouldn’t make sudden movements. The head massage softens some of this pressure, at least. I pay the healer and go back to work, where I write a to-do list and do the first couple of things on it. But that night the knife is hanging around my head as usual, just as it has for the past year.
My ghost knife can probably be defined as an intrusive thought — an unwanted and unpleasant thought that pops up from time to time. Intrusive thoughts are near universal. They might feel unwholesome and seem to cast doubt on your moral character or even your sanity, but you don’t have to be suffering from any clinical condition to experience them. It’s intrusive to think of standing up in the middle of a formal meeting and shouting “Balls!” before overturning the table, but having the thought doesn’t mean you’ll go through with it. Most of us have the conscience and impulse control to stop us from carrying out such acts.
There are also those intrusive thoughts that are simply distressing mental images and not necessarily to do with the deliberate violation of a social norm. You might picture a person being run over by a bus, or imagine a shark barrelling toward you when you dive into a public pool. The images can visit in a single flash behind your eyes or play out before you as a detailed scene.
Sometimes when I’m arriving home at the end of the day, tired from riding my bike uphill, I am sure, sickeningly sure, that I’m about to see my cat’s body on the road. I brace myself as I cruise down the pathway to the letterbox, knowing that my mental image of a small white furry body in the gutter is about to come true. The fact that it doesn’t come true and that every day Jerry canters down the steps after me and into the house does not keep me from experiencing the same thought at the same time the next day, and I can almost feel the thought etching its shape permanently into my mind, like my first phone number or my own middle name.
Conventional psychiatric wisdom, and plenty of religious interpretation, say that such thoughts are involuntary: a minor misfiring in the brain rather than a reflection of who you are. The wisdom says that there is a definitive you, a core identity, and these thoughts come from not-you — a threatening outside entity that’s trying to make you come undone. “I call her Ollie,” writes one mental health blogger. “She’s the one whispering the intrusive thoughts to me.” The wisdom insists that if a sinister thought is frequent, it might point to some underlying problem, but it doesn’t mean that at heart you’re bad or unhinged.
I can believe this, utterly, of other people and their thoughts. But when it comes to my knife, I’m not convinced. Surely the knife means I’m at least slightly evil or slightly crazy. Where has it come from, if not me? Is it trying to warn me of something, like a dog that’s trained to sniff out cancerous tumors?
When I was a kid I read a story in the New Zealand School Journal about a herd of cows that snuck into a field of sweet clover and ate until they swelled up like balloons. Just in time, a farmer arrived and punctured the cows’ stomachs with a knife, and the cows were saved. If the cows hadn’t been stabbed, the fermentation gases from the clover would’ve remained trapped in their stomachs and they would’ve suffocated from the condition known as “frothy bloat.” The illustration shows the cows rising shakily to their feet and being herded out of the deadly clover field. It was a revelation to me, that a cruel act could also be merciful — the stabbing of the cows was the only way to save their lives.
I have a half-theory that my ghost knife is fulfilling a similar function: When it stabs me, it releases something that’s trapped. That thing is my anxiety. My personal frothy bloat. I feel a brief burst of relief, before inevitably I sneak into the sweet fields of worry again, gorging myself, the gas building up again, until I must be stabbed once more.
My knife is a violent thought, and although its form and intensity ebbs and flows, I don’t think it’s consuming enough to take me into the territory of “Pure O” — a lesser-known form of O.C.D., where obsessive thoughts exist without the compulsions (or any that are observable). With Pure O, the thoughts — always unwanted, sometimes violent, sexual or sacrilegious — are tortuous and difficult to articulate.
My knife thought does not give rise to compulsive rituals or literal self-harm. It’s a thought that leaves me feeling at best irritated and at worst bereft, but it turns up only once or twice a day; perhaps it doesn’t warrant treatment. Besides, some of the treatments sound, frankly, alarming. Exposure therapy is one. “To combat the thought of hitting a pedestrian with a car, it started with me sitting in the driver’s seat of the car and holding the wheel without the ignition on,” I read in one account of exposure therapy. “Eventually, I got up to driving in a parking lot with a behavioral specialist running in front of the car.”
I try thinking about the knife directly to see if that lessens its power, as if thought itself could act as a shield. But this makes me even more preoccupied with the knife, and it becomes inventive in its shape-shifting, morphing into the tip of a scalding hot iron. I try to mock the knife and see it as ridiculous rather than disturbing: It’s like a cartoon villain! He’s wearing an invisibility cloak and sneaking up on me — cue suspenseful violins — but he’s forgotten that everyone can see his giant knife! Then I worry that the ghost knife is somehow a phallic symbol and that I’m an even worse person than I’d thought, and this necessitates another stabbing.
Sometimes I just lie there staring into space, thinking how weird it is that I can wring a sensation out of nothing. It’s like rubbing your eyes and watching explosions unfurl under your eyelids, or seeing a thick woollen jumper on a bearded man and suddenly feeling itchy. There must be an endless store of things you can feel, see, taste, if you happen to turn your mind in the right direction at the right time, like a butterfly net.
“So it comes out of the blue. This image of a knife pops into your mind and starts stabbing your face. And then: What do you think about that? What goes through your mind when that knife pops up?”
I’m in a session with my counselor. To reassure me that I’m normal, she’s just shown me a list of intrusive thoughts that are reportedly very common, from a landmark study in 1992. Each of the thoughts is described as briefly as possible, as if the researcher wanted immediately to wash their hands of the matter. Insulting authority figure. Breaking wind in public. Stabbing family member. Disgusting sex act. Cutting off finger. Fly undone. Well, if I hadn’t already considered each of these acts, I have now.
I try to explain that while I don’t feel good about the knife, I do feel a sort of relief each time it gets me. Listening back to my recording of the session later is excruciating, filled with lengthy pauses and my enthusiastic Mmmm! as the counselor tries to help me clarify what it is I’m experiencing. I tell her about my guilty and self-loathing thoughts before the knife appears, and I say, “I think I probably deserve to be stabbed.”
My counselor writes this down, murmuring, “Think I probably deserve to be stabbed.” Then she says, “People have all sorts of intrusions, and some of them can be quite weird and wonderful, eh? Now, if you were having this knife thought a lot more, and possibly undertaking a ritual as a result, that would take us more into the realm of O.C.D., but you’re not. The thing that’s slightly different, here, perhaps, from common intrusive thoughts, is your thinking about the knife. You get stabbed, and you say to yourself, I deserved that.”
“Yes! And I never challenge it! I just think, ‘This is just the natural course of events for today.’” It feels good to acknowledge what a pushover my brain is.
Although she doesn’t offer any solutions, my counselor does help me clarify the experience, in that way that simply saying something aloud can help you figure out what you’re feeling. However, I’m finding that as I get older, I’m less and less satisfied by the answer “What you are experiencing is very normal.” I guess I want to be told that I am special and unusual, and, childishly, I want all mental health specialists to know this human weakness and indulge it. For another thing, knowing that what I am experiencing is normal makes me resent it more. Why must normality encompass such horrible strangeness? Why must it be normal to imagine that you’re under attack?
I wonder whether the thought of a knife is somewhat arbitrary — if it might be replaced, if I tried, by a feather, or a paintbrush, or a nonvenomous snake. One O.C.D. specialist whose blog I’ve been reading argues that the content of an intrusive thought doesn’t actually matter. “You will be equally tortured by any theme,” she says. “As long as it’s current, you decide it matters, and you are reactive to it.” So maybe it doesn’t matter particularly that my thought is of a knife, but I’m making it matter by asking what’s wrong with me. I already know that examining the thought closely or asking where it comes from only makes the knife more prominent, more autonomous. And when I go looking for it, there’s plenty of evidence that this is indeed a thing — that attaching significance to an intrusive thought has a major bearing on how tightly it holds on. “Greater attention and effort to control unwanted thoughts,” say intrusive thought researchers Clark and Rhyno, “may actually lead to greater difficulty with the very thoughts one desires to avoid.” This desperate need for avoidance, they say, causes the thinker to misattribute higher significance to the very thing they seek to minimize.
It seems that writing about the unwanted thought is the worst thing I could be doing. Well, I say to myself, that has never stopped me before.
I’ve read that a type of treatment called craniosacral therapy can help to “relieve compression in the bones of the head,” so I go to see a craniosacral therapist. The concept of craniosacral therapy sounds violent, but in practice it’s barely even physical. The idea is that by very lightly holding the skull, the feet, and the back, the therapist can normalize the circulation of the fluid that surrounds the brain and spinal cord, removing “blockages.” I describe my knife to the therapist and explain how tense it makes me feel. Maybe my knife is a blockage of some sort, I suggest, and maybe she can just, you know, remove it?
“Let’s find out,” she says.
She has me lie on the treatment table and takes my head into her hands. “Some people feel a ‘whooshing’ sensation as the cerebrospinal fluid flows upwards,” she says. I wait. Several fire trucks or ambulances blare past on the street outside. There is no whooshing sensation. The therapist holds my feet for a long time, with such a light pressure it’s almost aggravating. It’s like sitting at a table and wondering, Am I touching someone’s foot, or is that a chair leg?
“I can hear your energy,” she is saying. At that point I lose interest completely and fall asleep.
More helpful than craniosacral therapy is watching a YouTube channel I’ve discovered called the ASMR Barber. The ASMR Barber, a gentle-looking bald-headed man — but not actually a barber himself, as far as I can tell — travels around various countries, visiting barbershops along the way. He makes these videos, which are mostly very quiet but for distant noises of passing traffic, explicitly for the purpose of soothing the viewer. The ASMR Barber sits in the chair with his eyes closed as his head and face are sprayed with water, slathered in oil, and energetically rubbed to a shine. In one clip he visits a “cosmic barber,” whose signature head massage involves grabbing invisible, quick-moving things out of the air around the ASMR Barber’s head. Somehow, watching someone else’s head having attention lavished upon it has the effect of distancing me from my knife. At the end of one of these sessions, the ASMR Barber’s head looks pure and bright, untouchable, almost eternal, like a star.
It’s when I come across an essay by Matt Bieber, author of Life in the Loop: Essays on OCD, that I realize that there might be another way, albeit a harder way, of thinking about the knife, and thinking about what it’s attacking. Bieber writes about how Buddhist teachings helped to subdue his intrusive thoughts; what specifically helped was accepting the Buddhist notion that there is no unified self at all. There is no core self to invade, nothing to unravel. Therefore, his various rituals — which he’d perceived as ways to keep himself unified, to counteract moments of confusion and disarray, to reestablish forward motion — are pointless. “We are a kind of flux,” he writes, “a series of patterns and surprises, inextricably interwoven into the larger field of phenomena that we call reality. Which means that we can’t really let ourselves fall apart either, because we were never together in first place.”
This gives me the same vertiginous feeling I get when looking at a photograph of deep space. I don’t know how to let go of my sense that my knife is attacking me — the self I recognize — and how to fathom the idea that I’m just a mass of things swirling around in space and the knife is swirling around amid them all too, like a piece of space junk.
“The attempt to attain pleasure or avoid pain, to stay consistent with a story line, to ensure some kind of outcome, to be somebody,” writes Bieber, “this is what causes so much suffering.” Maybe I need to figure out a way to accept that I’m nobody, that I’m already in pieces. It almost seems too easy an answer. I make a final appointment, this time with a psychiatrist. I’ve been putting this off, because seeing a psychiatrist is expensive. This whole investigation has been expensive. I would’ve been able to buy a whole bunch of literal knives by now if I hadn’t been pursuing a solution to my ghost knife. As I sit in the psychiatrist’s waiting room one weekday morning, along with a scattering of other women, I can see the privilege inherent in my situation. That I’m able to take an hour away from my job. That I’m able to pay to speak to a psychiatrist at all. That I’m able to write about this, even, without facing any particularly worrying social consequences.
The psychiatrist listens patiently as I stutter along. Voicing this experience has become harder, not easier, through repetition, because I’ve come to expect that there won’t be an answer. But then she offers a simple take. “Your brain has figured out a way to commit emotional self-harm,” she says. “Just like with cutting, you feel a small release, almost pleasure, when you think that thought. It provides a focus.”
There’s something to this, I think. The knife’s intent is unambiguous. It gives me something to resist — a situation to fight, a story that I don’t want to be true. But it also provides a weird release. I find myself thinking of the cows in the field of clover again.
A friend tells me about a time when he’d just had his ears syringed, and later was walking home at night. Along the way he began to feel spooked because he could hear a strange sound. “I felt convinced I was being followed,” he said. Later, he realized: “It was the sound of my own trousers.” This is the most accurate descriptor of generalized anxiety I’ve come across: the sound of your own trousers. With my generalized anxiety (“You are haunted by persistent sensations of discomfort running through all the levels of your being,” one recent self-test tells me; I can’t help but imagine this sentence being hollered from a passing car), I can’t usually pinpoint what it is that causes the dread and chaos I sometimes feel; though in a quieter moment I might realize I was just lonely.
When I get home that night, I try something: I just hold my head in my hands and rub the side of my face for a long time, the muscles that feel sore and knotted from tensing. Jerry the cat watches me intently, probably wondering why I’m not stroking him instead. I am going to keep trying to solve my ghost knife; I want to burrow underneath it and prize it out forever. But in this moment, holding my head helps. This gentleness provides a different focus. It helps just to hold my head, feeling its weird, soft, whole fullness.
