Catholic Medical Quarterly Volume 69(4) November 2019
Darkness Visible: Responding to Patients Who Claim to be Possessed
Paul Green, Carer Liaison Nurse, Sheffield Memory Service
I have spent much of my career in mental health nursing and psychotherapy working with older adults who have anxiety, depression and dementia. However, my latest role as a chaplaincy volunteer bringing communion to Roman Catholic patients on acute mental health wards has exposed me to problems I have not encountered since my student days. Among these have been occasional encounters with patients who attribute their distress to demonic influence. I was recently asked to visit a young woman who had requested communion and contacted the ward where she was an in-patient to arrange this, arriving one Sunday morning after Mass with the Blessed Sacrament in a pyx and my missal. The person I had come to see appeared somewhat agitated, expressed concerns about `bad thoughts' and that her problems 'could be demonic'. I suggested that, rather than receiving communion, she ought to see a priest who could hear her confession and absolve her of whatever sins might be troubling her, assuring her that this could easily be arranged by the senior chaplain whom I would contact. This seemed to alleviate her distress and I read the Gospel for that day before finishing with a prayer asking that God grant her pardon and peace. This experience reminded me of an incident I witnessed at an early morning Mass several months previously. A young woman entered the church, strode towards the altar muttering curses, wailing and making aggressive gestures with her fists before collapsing. A married couple from the congregation then gently approached her and led her away before the Mass was resumed. My wife asked me what I thought might be wrong with her and I replied that, whatever it was, she certainly appeared to be in great torment.
I usually have no knowledge of a patient's previous history or diagnosis but the DSM-5 uses the term 'Dissociative Identity Disorder' (DID) to classify phenomena in which a person feels that a spirit, supernatural being or external entity has taken control.Ell During et al argue that the 1989 ICD classification of Dissociative Trance Disorder (DTD) is more accurate, identifying psychosocial stressors and cultural factors as the main explanatory frameworks.E21 Stephenson is dismissive of what he regards as attempts to medicalise cultural and religious experiences[31 while Irmak points out that spirit possession serves as an explanation in some cultures for symptoms associated with pyschosis.E41 Sanford asserts that there is no single mental disorder in to which all subjective experiences of being possessed can fit but regards the diagnostic criteria for DID as useful for understanding cases likely to receive exorcism.E51 The possibility that there might be cases which defy genuine scientific explanation is not one that is generally considered in the literature, however. Trethowan accounts for the apparent success of exorcism in some cases to the belief of both the sufferer and the practitioner in its efficacy, offering Freudian notions of buried complexes interacting with 'primitive cultures' as his own explanatory model.E61 Paradoxically, his faith in psychoanalysis probably seems as outdated to health professionals today as the medieval demonology he excoriates. However, the view that exorcism may have a therapeutic effect comparable to abreaction techniques in psychotherapy is echoed by Khan and Sahni.rn
There is a view that cooperation between psychiatrists, other mental health professionals and practitioners of exorcism and deliverance ministries is possible with Scrutton arguing thaf scientific and spiritual explanations are not mutually exclusive.f81 Bull puts forward a model of 'therapeutic exorcism' for Christian patients diagnosed with DID, arguing that negative effects will only occur if practitioners are coercive or controlling in their approach and that patient-centred procedures based on informed consent should be performed by exorcists trained in psychological methods.E91 Certainly, the lived experience of difficulties as demonic should be respected by health professionals, whatever the true explanation might be. However, the dangers of an unbalanced approach are evident in a paper by Tajma-Pozo et al. The authors cite the case of a patient diagnosed with paranoid schizophrenia whose treatment was disrupted by a series of exorcisms because the clergy involved ignored the established diagnosis in favour of a purely spiritual explanation.  This exemplifies the need for exorcists and health professionals to work together towards a shared understanding of a person's difficulties.
The Roman Catholic Church has a clear set of established regulations and codified procedures in which exorcisms can only be performed by a bishop or priest delegated by him, where clear signs of diabolic possession have been confirmed and psychiatric assessment and treatment attempted. Sanford suggests that exorcisms of this kind lend themselves to systematic study and comparison so that their effects can be measured whereas the range of methods employed in other denominations make that process more difficult. Mercer contrasts the Roman Catholic approach with the varied rituals practiced by Pentecostal and Charismatic Christians, arising from the assumption that a whole range of mental health problems are due to demonic influence. This results in claims of private revelation being prioritised over boundaries of competence and scientific and professional knowledge, creating ethical dilemmas for health professionals wishing to meet patients' cultural and spiritual needs.
The late Fr Gabriele Amorth, who served for many years as the Vatican Exorcist, asserted that cases of actual possession are rare with vexation, obsession and infestation by evil spirits being more common. The sage advice provided in his final book includes recommendations that psychiatric assessment and treatment should be attempted first in suspected cases, that a good confession may be more efficacious for some people than exorcism and that members of the lay movement, Catholic Charismatic Renewal should be asked to support troubled souls through prayers of deliverance.[141 Eucharistic ministers and those in chaplaincy roles should not therefore feel deterred from offering support to Roman Catholic patients in these circumstances. Assuring them of one's prayers and God's mercy towards them, recommending that they avail themselves of the Sacrament of Reconciliation and providing details of a Catholic Charismatic Renewal group, should one be available locally are supportive interventions that can do no harm and avoid the danger of making potentially unwise judgements about the source of the person's distress. If staff caring for the patient are unaware of any fears regarding possession, these can be communicated to them so that any further mental health assessments that may be required can then be carried out.
- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Publishing, 2013
- During EH, Elahi FM, Taieb 0, Moro MR, Baubet T. A critical review of dissociative trance and possession disorders: etiological, diagnostic, therapeutic and nosological issues. The Canadian Journal of Psychiatry 2011; 56 (4); 235-42
- Stephenson C. The epistemological significance of possession entering the DSM. History of Psychiatry 2015; 26 (3); 251-69
- Irmak MK. Schizophrenia or possession? Journal of Religion and Health 2014; 53; 773-77
- Sandford JR. Facing our demons: psychiatric perspectives on exorcism rituals. The Hilltop Review 2016; 8 (2) http://scholarworks.wmich.edu/hilltoppreview
- Trethowan WH. Exorcism: a psychiatric viewpoint. Journal of Medical Ethics 1976; 2; 127-37
- Khan ID, Sahni AK. Possession at high altitude (475m/15000 ft). Kathmandu University Medical Journal 2013; 11 (3); 253-55
- Scrutton AP. Schizophrenia or possession? A reply to Kemal Irmak and Nuray Karanci. Journal of Religion and Health 2015; 54; 1963-68
- Bull DL. A phenomenological model for therapeutic exorcism for dissociative identity disorder. Journal of Psychology and Theology 2001; 29; 131-39
- Tajima-Pozo K, Zambrano-Enriquez D, De Anta L, Moron MD, Carrasco JL, Lopez-lbor JJ, Diaz-Marsa M. 2011; BMJ Case Reports; doi:10.1136/bcr.10.2009.2350,
- Catechism of the Catholic Church (Second Edition). New York, London, Toronto, Sydney and Auckland, 1995
- Sanford JR. Facing our demons.
- Mercer J. Deliverance, demonic possession and mental illness: some considerations for mental health professionals. Mental Health, Religion & Culture 2013; 16 (6); 595-611; http://dx.doi.org/10.1080/13674676.2012.706272
- Amorth, G with Stimamiglio S. An Exorcist Explains the Demonic: The Antics of Satan and His Army of Fallen Angels. Manchester, New Hampshire: Sophia Institute Press