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It appears that "the truth of what you fear" that the doctor is talking about is that the obsessive person isn't really going to do the terrible things he thinks he will. I think this apparent pagan, by pointing out that the compulsive acts make it worse, is proving that works won't fix what's wrong with us. I think these thoughts should be confronted with the Gospel - that Jesus lived the life we should have lived, never doing, or thinking, anything that violated the law of God, and that this is imputed to us. It's possible that these obsessive thoughts are an attack from the enemy. Just my opinion.
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