A History of Dissociative Identity Disorder, Dr.Melissa A. Bromwell
Exorcism and multiple personality disorder from a catholic perspective, Fr J Mahoney
Demonic Possession, Dr Melissa A. Bromwell
Multiple personality disorder is not demonic possession, And possession is not MPD.
Psiquiatría y posesión diabólica, por Prof. Dr. Aquilino Polaino-Lorente
Dissociative Identity Disorder: An Analytical Overview, Jacqueline Costello
A History of Dissociative Identity Disorder
(formerly called Multiple Personality Disorder) Evidence of multiple personality is not a new development of the twentieth century. In fact, evidence of multiple personality is said to exist in the images of shamans changed into animal forms or embodying spirits in Paleolithic cave paintings(1). Throughout recorded history cases of demonic possession have been reported that many experts now believe are cases of of multiple personality(2). Beginning in the eighteenth century, more detailed accounts in terms of multiple personality being a mental condition began appearing.
Eberhardt Gmelin is sometimes credited as being the first to report a case of multiple personality(3). However, there are reports of an earlier account by Paracelsus who wrote of a woman who had amnesia about an alter personality who stole her money in 1646(4). Nevertheless, Gmelin's 1791 account of "exchanged personality" is very important as the first account of multiple personality written about in great detail(5). The case involved a 20-year-old woman living in Stuttgart who began to speak perfect French, behave like a French aristocrat and spoke German with a French accent. This took place the year the French Revolution began which is significant since, during the uprising, many French aristocrats left France and fled to Stuttgart. When she was the "French Woman" she remembered everything she did but as the "German Woman" she denied any knowledge of the "French Woman". Gmelin claimed he could cause the personalities to switch from one to the other with a movement of his hand(6).
Around the same period of time, Benjamin Rush collected case histories of dissociation and multiple personality(7). Rush, chief surgeon of the Continental Army(8), is recognized as the "Father of American Psychiatry"(9). He wrote the first American text of psychiatry, "Medical Inquiries and Observations Upon Diseases of the Mind", published in 1812(10). Rush is also the only man who signed both the Declaration of Independence and the United States Constitution(11). He theorized that the cause for the doubling of consciousness related to a disconnection between the two hemispheres of the brain, the first of many speculations about this possibility(12).
However, it is the case of Mary Reynolds, first published in 1816 in "Medical Repository" by Dr. Samuel Latham Mitchel that was more influential of these early cases(13). It also appears to be the first case to capture the attention of the public with accounts appearing in an article in "Harper's New Monthly Magazine" in 1860 and an autobiography by Mary Reynolds herself(14). Ms. Reynolds was born in England in 1785 and moved with her family to Meadville Pennsylvania. The atmosphere she was raised in was described as strongly religious and, as a child, she seemed melancholy, shy and given to solitary religious devotions and meditations. She was considered to be normal until her late teens. At 19, she became blind and deaf for five or six weeks. Three months later she awoke after sleeping eighteen to twenty hours seeming not to know things she had learned. Within a few weeks, however, she became familiar with her surroundings and learned reading, calculating and writing although her penmanship was crude compared to what it had been previously. Her personality at this time was described as "buoyant, witty, fond of company and a lover of nature". After about five weeks, she slept again and awoke as her prior self with no memory of what had happened(15). This new state alternated with the original one at varying length for fifteen or sixteen years until her mid thirties when the alternations stopped and she remained in the second state until her death at 61 years of age. Mitchell confirmed the account about Mary Reynolds with her relatives, the Reverend Dr. John V. Reynolds and his brother William Reynolds(16).
Estelle's case, described in a 1840 monograph by Despine, involved an 11-year-old Swiss girl who initially presented with paralysis and exquisite sensitivity to touch and later developed a second personality who could walk, play and could not tolerate her mother's presence. Estelle exhibited marked differences in behavior, preferences and relationships between the two personality states. Despine reported being able to cure the child through treatment principles, some of which are recognized as valid today(17).
In the late 19th century, Eugene Azam, a professor of surgery interested in hypnotism, published a number of reports of Felida X, an extensively documented case of multiple personality he followed for over 35 years(18). Felida X was born in 1843, lost her father in infancy and had a difficult childhood. She exhibited three different personalities, each considering itself to be Felida's normal state and the others to be abnormal. The second personality state first manifested when Felida was 13 years old and suffered none of the physical illnesses that the first personality suffered. Initially, switching was reported to happen almost every day after a pain in the temple and a profound sleep for two to three minutes but the frequency of switching decreased over time to the point that it would happen only every 25 to 30 days and last only a few hours at a time. The third personality, which appeared only on occasion, suffered from anxiety attacks and hallucinations. At one point, the first personality was pregnant without explanation and the second personality emerged and took responsibility for the pregnancy.
During the late 19th century and early 20th century, Pierre Janet described a number of case of multiple personality including the cases of Leonie, Lucie, Rose, Marie and Marceline(19). Leonie appeared to have three or more personality states including a child alter named Nichette, a childhood name. In the case of Lucie, who also reportedly had three personality states, there was an alter personality named Adrienne who would seem to experience flashbacks of a traumatic childhood event. In the case of Rose, she would suffer from a variety of somnambulistic states. In some, she was paralyzed and in others she was able to walk.
In 1906, Mortin Prince published the account of the Christine Beauchamp case in "The Dissociation of a Personality"(20). Miss Beauchamp was found to have three additional personality states including one calling herself Sally who was childlike and differed significantly from Miss Beauchamp's presenting personality, one that was very much like the presenting personality and one called the Idiot that was extremely regressed(21).
The published case literature on multiple personality during the 19th century and the early part of the 20th century would probably occupy several volumes(22) and yet the condition was declared "extinct" by E. Stengel in 1943(23). This has been explained by one writer as follows "French-speaking psychiatry dominated the English-speaking world during the 19th century; German-speaking psychiatry has dominated much of the 20th"(24). Yet only a few months after the condition was declared extinct, a landmark paper was published in the journal founded by Morton Prince now called "The Journal of Abnormal Psychology" which "was the most quoted reference in the history of the illness"(25).
Thereafter, there was a virtual blackout in the publication of accounts of multiple personality until the 1954 publication in Prince's journal of the case of Christine Costner Sizemore. In 1957, the Sizemore story was popularized by Corbett Thigpen and Hervey Cleckley(26) in "The Three Faces of Eve". The story was adapted for film with Joanne Woodward playing the title role for which she won the Best Actress Oscar. Viewed as extremely rare and bizarre at the time of this popularized account which fascinated audiences, the condition is now considered highly treatable and not nearly as rare as it was once thought.
The re-emergence of multiple personality begins with the publication by H. Ellenberger's extensively researched "The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry" which devoted attention to dissociation and multiple personality(27). Throughout the 1970s, a number of clinicians worked toward defining and establishing the legitimacy of the condition. Margareta Bowers along with six other contributors published "Therapy of Multiple Personality" in 1971. "Therapy of Multiple Personality" has been called "brilliant" and outlines rules for treating multiple personalities which are still used today(28). Cornelia Wilbur, M.D. (who treated Sybil) and others at the Department of Psychiatry at the University of Kentucky published a series of case reports and papers during the 1970s(29). The efforts of pioneers such as Ralph B. Allison, Dr. Wilbur, and David Caul, M.D. led to the availability of workshops on multiple personality thereby increasing the number of clinicians able to diagnose and treat the condition(30) leading to greater numbers of clinicians studying and treating the condition.
However, it is the case of Sybil Isabel Dorsett which is considered "the most important clinical case of multiple personality in the twentieth century"(31). It is certainly one of the most famous after the publication of the book "Sybil : The true story of a woman possessed by sixteen separate personalities" by Flora Rheta Schreiber which was a best seller. The television movie "Sybil" starring Sally Field and Joanne Woodward put Lorimar Productions "on the map"(32). Sybil was the vicitm of horrific abuse inflicted on her by her psychotic mother. Her father failed to protect her from it. As a result, she developed the alter personalities which embodied feelings and emotions the 'real' Sybil could not cope with. The waking Sybil was deprived of all these emotions, and was therefore a rather drab figure. She was unaware of her other personas; while they were in 'control' of the body, Sybil suffered blackouts and did not remember the episodes(33). Cornelia Wilbur helped Sybil integrate the personalities after sixteen years of therapy. Dr. Wilbur invited Schreiber to write the popularized account after being denied publication of the story in professional journals(34).
The case of Sybil is signficiant in several respects. Sybil's psychiatrist, Cornelia Wilbur, went to great lengths to validate the accounts of abuse including interviews with Sybil's parents, a visit with Sybil to her childhood home, and speaking with Sybil's doctor and reviewing his records(35). The case firmly linked multiple personality disorder with child abuse(36). The graphic treatment of the amnesia, fugue episodes and conflicts among alters in Schreiber's book "served as a template against with other patients could be compared and understood(37). Dr. Wilbur's therapy which included hypnosis and other therapeutic interventions and produced a successful resolution "served as an example for many multiples and their therapists"(38).
In 1980, the decade of work by the pioneers in the field of multiple personality culminated in the publication of the DSM-III by the American Psychiatric Association in 1980. The DSM-III created a separate category for the dissociative disorders and set forth the criteria for a diagnosis of Multiple Personality Disorder(39) giving legitimacy to the condition. Since then, there has been a virtual explosion in the publication of journals, books, biographical accounts, etc. In 1980 there were a number of landmark publications including E. L. Bliss' study of fourteen patients, P. M. Coons systematic treatment of making a diagnosis, G. B. Greaves "classic" review article, B, G. Braun's treatment recommendations and S. S. Marmer(40) psychoanalytic study. In 1984, four journals devoted special issues to discussion of multiple personality disorder(41). In 1989, Frank W. Putnam of the National Institutes of Mental Health published "Diagnosis and Treatment of Multiple Personality Disorder" in 1989 and Colin A. Ross, a noted clinician and researcher, published "Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment". 1994 was another landmark year in the field of multiple personality with the publication of the DSM-IV which renamed the condition Dissociative Identity Disorder (DID) and the publication of "Guidelines for Treating Dissociative Identity Disorder In Adults" by the International Society for the Study of Dissociation. During this same time period, screening instruments, structured diagnostic instrument, and a specialized mental status examination have been developed(42). Given the increasing availability of information to the general public and clinicians, the development of screening and diagnostic instruments, and the intensity of debate surrounding the controversies surrounding Dissocitive Identity Disorder, it seems likely that the future will bring continued growth in our understanding and ability to treat it. Yet even today there are still professionals in the mental health fields who continue to believe that Dissociative Identity Disorder is not a legitimate pscyhiatric diagnosis(43).
Footnotes
· 1. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder". New York: Guilford, p. 27
· 2. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 27; Greaves, G.(1993) "A History of Multiple Personality Disorder" in "Clinical Perspectives on Multiple Personality Disorder", Kluft, R. and Fine, C., editors. Washington, D.C.: American Psychiatric Press, Inc., p. 356; and Phillips, M. and Fredericks, C. (1995). "Healing the Divided Self". New York: W.W. Norton & Company. p. 1; and Golub, D. (1995). "Cultural Variations in Multiple Personality Disorder" in "Dissociative Identity Disorder", Cohen, L., Berzoff, J., and Elin, M., editors. New Jersey: Jason Aronson, Inc.
· 3. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 355
· 4. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 5. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 356
· 6. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 355 and Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 7. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 8. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 9. The Historical Perspective and Some Famous Unitarian Universalists.
· 10. The Historical Perspective.
· 11. http://www.voy.net/~alana/history.html
· 12. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 13. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p 28
· 14. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 357 and Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 15. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 356-7
· 16. Merskey, H. (1995). "The Manufacture of Personalities: The Production of Multiple Personality Disorder" in "Dissociative Identity Disorder", Cohen, L., Berzoff, J. and Elin, M., editors. New Jersey: Jason Aronson, Inc., p. 10
· 17. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 28
· 18. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 29 and Merskey, p. 12
· 19. Merskey, p. 12 and Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 29
· 20. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 358
· 21. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 30
· 22. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 357
· 23. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 361 and Kluft, R. (1995) "Current Controversies Surrounding Dissociative Identity Disorder" in Dissociative Identity Disorder", Cohen, L., Berzoff, J. and Elin, M., editors. New Jersey: Jason Aronson, Inc., p. 351
· 24. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 357
· 25. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 361
· 26. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 362
· 27. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 35
· 28. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 363
· 29. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 35
· 30. Kluft, R. (1995) "Current Controversies Surrounding Dissociative Identity Disorder" in Dissociative Identity Disorder", Cohen, L., Berzoff, J. and Elin, M., editors. New Jersey: Jason Aronson, Inc., p. 353
· 31. Greaves, G.(1993) "A History of Multiple Personality Disorder", p.364
· 32. Wilbur, C. with Torem, M. "A Memorial for Cornelia B. Wilbur, M.D., in Her Own Words: Excerpts From Interviews and an Autobiographical Reflections" in "Clinical Perspectives on Multiple Personality Disorder", Kluft, R. and Fine, C., editors, p. xxix
· 33. http://www.ncl.ac.uk/~n4002217/MPD/Sybil/
· 34. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 364 and Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 35
· 35. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 364
· 36. Gold J. (1993). "Cornelia B. Wilbur, M.D.: An Appreciation" in "Clinical Perspectives on Multiple Personality Disorder", Kluft, R. and Fine, C., editors (1993). Washington, D.C.: American Psychiatric Press, Inc., p. 4
· 37. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 35
· 38. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 35
· 39. Putnam, F. W. (1989). "Diagnosis and Treatment of Multiple Personality Disorder, p. 34
· 40. Kluft, R. (1995) "Current Controversies Surrounding Dissociative Identity Disorder", p. 353
· 41. Greaves, G.(1993) "A History of Multiple Personality Disorder", p. 367
· 42. Kluft, R. (1995) "Current Controversies Surrounding Dissociative Identity Disorder", p. 354
· 43. Merskey, H. (1995). "The Manufacture of Personalities: The Production of Multiple Personality Disorder"
Exorcism and multiple personality disorder from a catholic perspective
Fr J MahoneyConsulting Chaplain of the Office of Chaplaincies of the Archdiocese of Detroit
Some mental health authors have suggested that there may be cases where exorcism is "therapeutic." This belief is based, I feel, on a judgment that if the patient subjectively feels or fears that possession has occurred, providing the suggestion that they are now freed may lead to improvement. The therapist may also believe that true possession is not ever a possibility. There may be as well a sense that religious ideation and understanding is not really an important consideration.
Rarely is Christian theology seriously considered, except by fundamentalist "Christian counselors" or "Catholic Charismatics" who may consider possession and oppression to be common occurrences, with exorcism a tool to be freely used. I obviously consider the theology involved to be very important, but the idea of it being "therapeutic" also should be examined.
The most prominent writers in the field of the treatment of MPD have noted that exorcism for MPD is therapeutically contraindicated, with various forms of harm described.
The only organized, retrospective review I am aware of was done by Dr. Fraser from the Royal Ottawa Hospital in Canada. He reviewed the experiences of a number of his patients who had undergone exorcism in various circumstances. The patients varied in religious background, as did the religion of those doing the exorcisms and the form and nature of the exorcism activity. Some exorcisms were supported by the Church or religious community of the exorcist. Some of the exorcisms had occurred before, as well as after, the diagnosis of MPD. Based on his retrospective review of 7 cases, he reached several conclusions:
· The exorcisms had an effect in that they produced a change and had an impact on the personality system. Alternate personalities can be, at least temporarily, "banished" and new personalities can be created in response to the sense of trauma.
· The effect in each case was severely destructive.
· At least in cases where MPD is present or may be present, exorcism is contraindicated.
I do not have access to an extensive library regarding the Catholic practice of exorcism, and certainly no access to restricted sources of information. The sources that I have read indicate various diagnostic signs that are to be assessed before there can be a prudent assessment that possession is a possibility, and that exorcism may be appropriate.
Much of the assessment of the signs of actual possession involves the experience, perceptions, and understanding of the person making the assessment. Things that are not considered "an ordinary part of human life" or "part of the natural order" may simply be outside the experience of the evaluator.
Those working with Multiple Personality Disorder patients frequently encounter unusual phenomena that are the lasting aftereffects of their desperate adaptation to severe and chronic childhood abuse. The most striking of those phenomena are more common with MPD patients reporting severe ritual abuse, especially Satanic.
Those same patients often have personalities mimicking demons. Often, they were hypnotically suggested during the cult activity. Those personalities were developed as attempts at avoiding punishment by the cult by simulating the presence of demons. That certainly complicates the assessment process, but there are, I believe, criteria that could be used to distinguish a demonic MPD personality from a situation of true possession. The burden of reasonable proof is on the person alleging the presence of the demonic.
· If someone is diagnosed as having MPD based on other personalities, a demonic presentation should be presumed to simply be another personality, unless clearly demonstrated otherwise.
· An MPD personality will have an identifiable time of formation and functional role within the personality system consistent with the trauma as it was occurring. MPD specific therapy will result in psychologically consistent change in that personality, with improvement over time in the presence of a healthy therapeutic alliance.
· As the personality is worked with, emotions such as rage will be clearly "human" in origin, and if the personality is more developed there will be the clear existence of state-dependent learning. Knowledge possessed will be appropriate to the role and function of the personality.
· Unusual phenomena will be those seen and reported in at least some other patients clearly diagnosed with MPD, and will follow the general patterns for those phenomena.
· Unusual phenomena consistent with true possession would be clearly outside the "natural order" and/or would be situations not reasonably accounted for by science.
· An MPD personality will have an identifiable time of formation and functional role within the personality system consistent with the trauma as it was occurring. MPD specific therapy will result in psychologically consistent change in that personality, with improvement over time in the presence of a healthy therapeutic alliance.
· As the personality is worked with, emotions such as rage will be clearly "human" in origin, and if the personality is more developed there will be the clear existence of state-dependent learning. Knowledge possessed will be appropriate to the role and function of the personality.
· Unusual phenomena will be those seen and reported in at least some other patients clearly diagnosed with MPD, and will follow the general patterns for those phenomena.
· Unusual phenomena consistent with true possession would be clearly outside the "natural order" and/or would be situations not reasonably accounted for by science.
There are strange phenomena that are frequently seen and observed in MPD patients. They are accepted as MPD dynamics, and are often present with some personalities and absent with others. In different patients, they may or may not be linked with a subjective sense of "being evil" and are clearly linked both to trauma and attempts at adapting to that trauma.
These phenomena would include at least the following:
·Susceptibility to hypnosis and an unusual ability to cause others to enter hypnotic or trance states.
· Body memories having physical characteristics. These are reenactments of past trauma and follow the same characteristics as the classic stigmata phenomena. They may appear and disappear without external manipulation and may include rashes, welts, cuts, burns, blood, swelling, and significant physiological changes.
· Apparent telepathy, clairvoyance, and unexplained knowledge. These may reflect hyperacute senses, such as hearing thoughts reflected in the movement of the larynx. Photographic state-dependent memory, extremely acute awareness of others' body language and visual cues, and unusual mental feats are also common.
· Physical strength beyond ordinary perceptions of what is humanly possible.
· Highly accelerated healing, control of bleeding, and ability to regulate physiological states in ways not normally considered possible or under conscious control.
· Ability to cause in an observer a sense of cold, evil, or threat.
· Acts of self-harm and extreme self-mutilation, hatred of God and religious objects.
· Ability to go for long periods with neither food or sleep.
· Selective, personality specific anesthesia and the blocking of normal pain stimuli.
It should be noted that many unusual phenomena that are considered in popular culture to be "psychic" or otherwise unexplainable are often based on the skills and illusions of magicians, the use of various forms of trance states, suggestibility, intentional fraud, etc.
I am not discounting the possibility that a specific MPD patient may in fact also be possessed. I feel that in such a case there should be specific evidence leading to a prudent judgment and moral certainty that such is the case, and the pertinent information should then be submitted to the Ordinary of the Diocese. I do not believe that a pastoral diagnosis of possession should ever be made without such authority.
I am available to defend the conclusions that I have reached, to provide additional information in support of those conclusions, or to work toward a more full consideration of these issues. My basic concern is that I believe that exorcisms are dangerous and tend to target the victims of severe abuse. I see them as, in effect, an additional form of abuse for which there must be accountability.
Demonic Possession
Melissa A. BromwellBelief in the possibility of demonic possession has waned since the advent of sophisticated medical knowledge. What had previously been considered to be examples of control of an individual by a spirit or devil are now commonly accepted as numerous forms of mental illness, easily explained by nervous system activity. If all types of behavior (including emotional states and cognitive states) are produced and mediated solely by the brain, there leaves no potential for such a phenomenon as demonic possession to exist and such cases would clearly be instances of various illnesses. However, neuroscience has not yet been able to explain all of the characteristics common to purported cases of demonic possession (1).
A possessed individual is typically characterized by having strange physical ailments or disfigurements; verbal outbursts, mostly obscene or sacrilegious in nature; violent behavior and vulgar behavior; bodily spasms and contortions; ability to speak languages never before studied; self-mutilation; "superhuman" abilities such as psychic abilities, abnormal strength, or an ability to perform behaviors out of the realm of human possibility such as levitation; cessation of normal bodily functions for periods of time, including breathing and heart beat; and a pronounced revulsion to symbols, places, people, objects, and ceremonies having any religious context. Other phenomena associated with the presence of a demon include an acrid stench; marked decrease in the temperature of the room which a possessed individual occupies; writing appearing out of nowhere; sounds and voices arising from nowhere; and objects moving on their own and destruction of objects in the room, without anyone having laid a hand upon them (2), (3).
Despite the striking quality of this description, the expansion of the fields of medicine and psychology has led to diagnoses other than demonic possession for individuals who present circumstances similar to those mentioned above. These sorts of cases are now readily explained in terms of abnormal functioning in the brain and nervous system. There are various disorders which may mimic demonic possession; these include schizophrenia (and other periods of psychosis), dissociative identity disorder, and Tourette syndrome (4).
Schizophrenia is characterized by the presence of delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, affective flattening or inappropriate emotional responses, avolition, and alogia. General psychotic episodes, such as might accompany mood disorders, can also closely simulate a state of demonic possession by hallucinations or delusions. The delusions can be ones of thought insertion, thought broadcasting, delusions of guilt, delusions of grandeur, such as being God (or a demon), or delusions that God (or a demon) is speaking to the person and giving commands for a special mission (5).
The resemblance between several of these criteria and demonic possession is rather striking. The inappropriate emotional displays seen in psychoses correspond to those frequently documented in cases of demonic possession where the possessed individual expresses either flattened affect or outbursts of extreme affects; a possessed individual will often laugh at situations which are morbid, such as injury to another individual, or crying and screaming when there appears to be no appropriate stimulus for such a response, such as being presented with a crucifix or holy water (6).
Psychosis is generally thought of as a break with reality; society will frequently consider individuals who believe themselves to be possessed as delusional and not "in touch with reality." An individual who appears to be possessed and claims to be a demon may be viewed as suffering from a delusion of grandeur. Family members and friends caring for possessed individuals can become extremely disturbed by the state in which the individuals present themselves and often request an exorcism as a last resort. One might think of this as an example of Folie à Deux, in which one individual develops a delusion while in a close relationship with another person who already has an established delusion; the delusion is of the same content for each individual (5). It is possible that the possessed individual initially suffers from a delusion and eventually convinces loved ones that the possession is real.
The paranoid thinking present in many instances of psychosis is similar to that of an individual who is possessed and fears all items, people, and situations that contain religious themes. An individual who is possessed will react violently to the presentation of anything with a religious context, out of fear that harm will come to them; the reaction is elicited merely from being exposed to something such as a Bible or a priest. The disorganized thinking and speech that often occurs during periods of psychosis may also resemble the seemingly nonsensical speech a possessed individual may show (6).
The paranoid thinking present in many instances of psychosis is similar to that of an individual who is possessed and fears all items, people, and situations that contain religious themes. An individual who is possessed will react violently to the presentation of anything with a religious context, out of fear that harm will come to them; the reaction is elicited merely from being exposed to something such as a Bible or a priest. The disorganized thinking and speech that often occurs during periods of psychosis may also resemble the seemingly nonsensical speech a possessed individual may show (6).
Individuals who suffer from schizophrenia predominantly marked by catatonic behavior often arrange their bodies in bizarre or inappropriate postures for long periods of time; they frequently engage in stereotypic motor activity or have very prominent mannerisms and facial expressions. Conversely, these individuals might refrain from any movement whatsoever for prolonged periods of time, as if in a trance. This might be similar to the bodily contortions and exaggerated expressions of emotion noted in cases of demonic possession, as well as to the hypnotic-like state observed in possessed individuals (1).
The superhuman strength often exhibited by individuals who are possessed might be explained by the presence of a bipolar disorder; bipolar disorders are frequently accompanied by psychosis, particularly during the manic episodes. Manic individuals exhibit abundant amounts of energy and often have abnormal strength, similar to what can be seen in an individual who is possessed.
Schizophrenia, or any form of psychosis, is currently thought to be the result of a malfunctioning dopaminergic system, either a system which is too active or a system which is too sensitive. The dopamine system has been implicated in movement and coordination, emotional response, and the ability to experience pleasure and pain (7). It would then seem quite likely that many purported cases of demonic possession are merely instances of dopamine systems failing to work properly, given the aforementioned abnormal motor and affect behavior. It also seems quite plausible that individuals who believe themselves to be possessed are in a state of severe ahedonia.
Another disorder which has frequently been misdiagnosed as demonic possession is dissociative identity disorder, formerly known as multiple personality disorder. The criteria for this disorder is the presence of two or more distinct identities or personality states, each with its own way of perceiving, relating to, and thinking about the environment and the self; at least two of these personalities or identities recurrently take control of the individual's behavior; and an inability to recall important personal information that is too extensive to be dismissed as ordinary forgetfulness (8). The separate identities involved in this disorder and the physical changes that denote dissociation could certainly reflect the abrupt change in personality manifested by those who appear to be victims of demonic possession (9).
A demon in someone who is possessed has its own purpose, own beliefs, morals, and attitudes, mannerisms, even its own style of speech, including a different voice. Each of these is distinct from those of the individual prior to possession and to an observer, it is clear that a change has occurred in the individual. In addition, an individual who suffers from demonic possession may not be able to recall the periods of time in which the demon manifests itself, resulting in blackouts and time loss (6). This is quite comparable to the manifestation of multiple personalities, each unique from the other, in an individual with dissociative identity disorder. The different personalities also have different motivations, ways of behaving, types of knowledge, and types of speech. The differing speech patterns between identities might partially explain the phenomenon of "speaking in tongues" often witnessed in victims of demonic possession. Time loss and blackouts are also extremely common to individuals with dissociative identity disorder; the unrecalled periods of time occur when another personality is in control (10).
Extreme suggestibility and hypnotizability are prevalent among individuals with dissociative identity disorder, which may be important if someone has suggested to an individual with the disorder that they are not mentally ill, but are in fact possessed by a demon. An individual with dissociative identity disorder who has had this suggested to them might come to believe they are inhabited by a demon (11).
Motor activities common to those with dissociative identity disorder include anesthesia, eye rolling (especially during switching to another personality), and pseudoseizures (11). These are behaviors that are commonly observed in individuals who are reported to be possessed by a demon; individuals who are possessed may be unable to feel pain in certain areas of their body and some of the distortions involved in possession include eyes rolling back and seizures (6).
The commonly accepted etiology of dissociative identity disorder is an early history of repeated trauma and abuse, often to horrific degrees (12). There is currently no biological theory concerning the origin of dissociative identity disorder; this creates both a direction for future investigations into the disorder and a possibility that demonic possession is an occurrence that cannot be explained in terms of the brain.
Another disorder that has probably been mistaken for demonic possession throughout time is Tourette syndrome, characterized by multiple motor and vocal tics (13). Motor tics can range in complexity from eye blinking to sticking out the tongue to rapid jerking of the body and writhing. The vocal tics can be sounds such as coughing, barking, growling or repeating words and phrases over and over again. Perhaps the most well-known symptom of Tourette syndrome is coprolalia, the screaming of obscene and foul language (14).
It is obvious how these behaviors can be misinterpreted as demonic possession; possessed individuals are often described as flailing and thrashing about and shouting obscenities, sexually aggressive phrases, violent threats, and sacrilegious statements.
The superhuman strength often exhibited by individuals who are possessed might be explained by the presence of a bipolar disorder; bipolar disorders are frequently accompanied by psychosis, particularly during the manic episodes. Manic individuals exhibit abundant amounts of energy and often have abnormal strength, similar to what can be seen in an individual who is possessed.
Schizophrenia, or any form of psychosis, is currently thought to be the result of a malfunctioning dopaminergic system, either a system which is too active or a system which is too sensitive. The dopamine system has been implicated in movement and coordination, emotional response, and the ability to experience pleasure and pain (7). It would then seem quite likely that many purported cases of demonic possession are merely instances of dopamine systems failing to work properly, given the aforementioned abnormal motor and affect behavior. It also seems quite plausible that individuals who believe themselves to be possessed are in a state of severe ahedonia.
Another disorder which has frequently been misdiagnosed as demonic possession is dissociative identity disorder, formerly known as multiple personality disorder. The criteria for this disorder is the presence of two or more distinct identities or personality states, each with its own way of perceiving, relating to, and thinking about the environment and the self; at least two of these personalities or identities recurrently take control of the individual's behavior; and an inability to recall important personal information that is too extensive to be dismissed as ordinary forgetfulness (8). The separate identities involved in this disorder and the physical changes that denote dissociation could certainly reflect the abrupt change in personality manifested by those who appear to be victims of demonic possession (9).
A demon in someone who is possessed has its own purpose, own beliefs, morals, and attitudes, mannerisms, even its own style of speech, including a different voice. Each of these is distinct from those of the individual prior to possession and to an observer, it is clear that a change has occurred in the individual. In addition, an individual who suffers from demonic possession may not be able to recall the periods of time in which the demon manifests itself, resulting in blackouts and time loss (6). This is quite comparable to the manifestation of multiple personalities, each unique from the other, in an individual with dissociative identity disorder. The different personalities also have different motivations, ways of behaving, types of knowledge, and types of speech. The differing speech patterns between identities might partially explain the phenomenon of "speaking in tongues" often witnessed in victims of demonic possession. Time loss and blackouts are also extremely common to individuals with dissociative identity disorder; the unrecalled periods of time occur when another personality is in control (10).
Extreme suggestibility and hypnotizability are prevalent among individuals with dissociative identity disorder, which may be important if someone has suggested to an individual with the disorder that they are not mentally ill, but are in fact possessed by a demon. An individual with dissociative identity disorder who has had this suggested to them might come to believe they are inhabited by a demon (11).
Motor activities common to those with dissociative identity disorder include anesthesia, eye rolling (especially during switching to another personality), and pseudoseizures (11). These are behaviors that are commonly observed in individuals who are reported to be possessed by a demon; individuals who are possessed may be unable to feel pain in certain areas of their body and some of the distortions involved in possession include eyes rolling back and seizures (6).
The commonly accepted etiology of dissociative identity disorder is an early history of repeated trauma and abuse, often to horrific degrees (12). There is currently no biological theory concerning the origin of dissociative identity disorder; this creates both a direction for future investigations into the disorder and a possibility that demonic possession is an occurrence that cannot be explained in terms of the brain.
Another disorder that has probably been mistaken for demonic possession throughout time is Tourette syndrome, characterized by multiple motor and vocal tics (13). Motor tics can range in complexity from eye blinking to sticking out the tongue to rapid jerking of the body and writhing. The vocal tics can be sounds such as coughing, barking, growling or repeating words and phrases over and over again. Perhaps the most well-known symptom of Tourette syndrome is coprolalia, the screaming of obscene and foul language (14).
It is obvious how these behaviors can be misinterpreted as demonic possession; possessed individuals are often described as flailing and thrashing about and shouting obscenities, sexually aggressive phrases, violent threats, and sacrilegious statements.
There is also a high rate of comorbidity with obsessive-compulsive disorder in individuals who have Tourette syndrome (14). It seems likely that there would be a high frequency rate of obsessions with religion in individuals who claim to be possessed by a demon.
The origins of Tourette syndrome are thought to lie in either the dopaminergic system or the noradrenergic system. It is believed that the disorder results from either supersensitivity in the dopamine receptors or hyperactivity in the functioning of the norepinephrine system (14).
The concordance of the putative biological causes of schizophrenia and Tourette syndrome seem to imply some type of connection between the two disorders, and the phenomenon which they both imitate, i.e., demonic possession. It also lends credence to the belief that the brain is responsible for types of behavior which may initially seem remarkably beyond the realm of normal human behavior.
However, there is quite a bit about supposed demonic possession which cannot yet be explained by biology. This category includes such phenomenon as levitation, wounds appearing upon the victim that have not been inflicted by the self or another concrete source, knowledge of languages never before studied, sometimes never even heard, and psychic abilities such as knowing facts about other individuals that have never been met. In addition, the accompanying situations related to the area around possessed individuals do not seem to be explainable in terms of the brain or any aspect of biology; science cannot yet explain the distinct decrease in temperature of the room the individual occupies, the appearance of writing and sounds from an unseen force, and the movement of objects on their own (2).
One can come to two conclusions when faced with this evidence. The first is that the cause of such circumstances will eventually be determined by further study of the brains of reportedly possessed individuals. This might reveal that there is something biologically (and entirely secularly) unique about such individuals which allows them to be capable of creating such phenomena by themselves; in this case it could be determined that demonic possession is nothing but a myth perpetuated for centuries. On the other hand, the possibility that demonic possession is a real occurrence cannot yet be rejected; no thoroughly decisive evidence exists to the contrary. What is currently known about science cannot fully explain every situation reported to be a case of demonic possession, at least not by the methods which science currently employs. Until science can explain each detail, if indeed it ever can, one cannot dismiss the possibility that demonic possession is a real and true phenomenon.
WWW Sources
(it opens in a separate window)
1) Exorcism
2) A Brief Handbook of Exorcism
3) Rituale Romanum
4) The Ghostbusters of Psychiatry
5) Schizophrenia
6) Exorcism
7) Dopamine
8) Dissociative Identity Disorde
9) The Lost Daughter
10) Understanding Dissociative Disorders Through Dissociative Signs and Symptoms
11) Cast Out What?
12) Fact Sheet: Dissociative Identity Disorder
13) Exorcising a Damnable Disease
14) Guide to the Diagnosis and Treatment of Tourette Syndrome
MULTIPLE PERSONALITY DISORDER is not demonic possession, And possession is not MPD.
Many exorcists know about multiple personality disorder and disociative disorder:Formerly known as multiple personality disorder (MPD), DID results in a person's enactment of two or more selves, sometimes called "alters." Persons with DID may have tens or hundreds of selves, more or less developed: some speak with distinct voices, and have different names, likes, and dislikes. The alters' drawings, handwriting, and accents may differ. Some of them identify themselves as demons, causing well-meaning ministers to try to cast them out.
Psychologists explain the controversial disorder in four ways, says John E. Kelley, director of Biola Counseling Center in La Mirada, California:
1) DID results from a severe trauma, which usually takes place in childhood and often surfaces through controversial "recovered" memories. DID leads to fragmentation into at least two selves (one of whom is often an abused child). That is why survivors of alleged ritual abuse are often diagnosed with DID.
2) DID is a role-playing phenomenon that may or may not be based in a real-life trauma. "Dissociatives" play different roles because they are affirmed for doing so.
3) DID is faked by people who want attention.
4) DID is born in therapy. The disorder is brought on by therapists who use suggestion (intentional and unintentional) through which they end up convincing their patients that they have dissociated identities. But, even they know that, some exorcist, in some cases they mantein that there is possession. They know what a psychiatryst knows. It is not a fight between science and superstition.
Psiquiatría y posesión diabólica
Prof. Dr. Aquilino Polaino-LorenteCatedrático de Psicopatología de la Universidad Complutense
Introducción
La convocatoria de esta reunión científica me parece muy puesta en razón. Se ha dicho que estamos en la "sociedad de la comunicación" y, sin embargo, hay muchos sectores en el ámbito disciplinar que no se han abierto al profundo, fecundo y necesario diálogo con los especialistas en otras materias. A causa de esta incomunicación, nadie gana y todos pierden.
No se piense que la incomunicación en este caso se limita sólo al posible diálogo interdisciplinar entre psiquiatras y sacerdotes. Hay otros muchos ámbitos, lamentablemente, que también están afectados por esta incomunicación. Este es el caso sin ir más lejos, por ejemplo, de lo que sucede entre psiquiatras y jueces.
Por eso juzgo muy conveniente el hecho de que se haya organizado esta sesión científica para debatir una cuestión que, aunque se nos ofrezca como muy problemática y excepcional en el ámbito de la clínica, no obstante, puede plantearse en algunas ocasiones: las supuestas "posesiones diabólicas" y las manifestaciones psicopatológicas de los enfermos psiquiátricos.
El silencio respecto de estas cuestiones no suele ser buen compañero de viaje para encontrar soluciones. Es más, ese silencio puede ser causa de injusticias o del tratamiento inadecuado de ciertas personas en temas, por otra parte muy delicados, que afectan gravemente a su intimidad personal.
Estas situaciones ya se repitieron con anterioridad, aunque con un signo muy diferente. En los albores de la Edad Media es harto probable que ciertos comportamientos se atribuyeran, entonces, a la acción del diablo o de los espíritus malignos, cuando probablemente se trataba tan sólo de manifestaciones psicopatológicas, que de haberlos, debieron haberse remitido a los adecuados especialistas. La inexistencia de la psiquiatría como especialidad en aquella etapa histórica, además de otras variables relevantes de tipo cultural propias de la época, consintieron en una hermenéutica errónea , de consecuencias muy lamentables.
Algo parecido a lo que aconteció entonces, puede suceder hoy. En la actualidad, el importante desarrollo experimentado por la psiquiatría y su cada vez más poderosa eficacia en la solución de determinados trastornos de conducta y manifestaciones sintomáticas, condicionan poderosamente el que hagamos atribuciones de índole exclusivamente psiquiátrica a la hora de explicar determinados comportamientos. Si a ello añadimos que las convicciones y creencias religiosas están hoy a la baja en algunos contextos culturales, es lógico que trate de explicarse cualquier acontecer psicopatológico apelando a la psiquiatría y no a la religión.
Es muy probable, no obstante, que la mayoría de esas actuales atribuciones, en al marco de la moderna psicopatología, sean razonablemente justas y muy puestas en razón.
Pero, lo que no parece que sea conveniente, sin embargo, es interrumpir el diálogo entre psiquiatras y pastores. Pues si en la Edad Media probablemente se incurrió en un exceso al magnificar las atribuciones de tipo religioso para la "explicación" de estos comportamientos, es muy posible que hoy se esté incurriendo también en otro exceso: el de apelar únicamente a la psiquiatría, al mismo tiempo que se vuelve la espalda a cualquier fenómeno de naturaleza religiosa.
De otra parte, muchas de las manifestaciones que, según parece, comparecen en las personas supuestamente poseídas por el demonio constituyen, por su propia naturaleza, una situación muy compleja, ambigua y harto difícil de resolver.
De aquí que ninguna ciencia pueda configurarse o entenderse como omnipotente, especialmente, cuando hay que dilucidar la compleja naturaleza de ciertos comportamientos, que ocupan un ámbito fronterizo entre la psicopatología y al religión.
En síntesis, me parece una iniciativa muy afortunada tratar de recuperar el diálogo entre pastores y psiquiatras, diálogo que nunca debió interrumpirse. Entre otras cosas, porque para el esclarecimiento de estas cuestiones límite -al menos, cuando comparecen con ciertas posibles implicaciones psicopatológicas, lo que es muy excepcional-, se precisa no sólo de la concurrencia de especialistas en ambas materias (pastores y psiquiatras), sino, lo que es todavía más importante, del establecimiento de un diálogo fecundo, abierto y, de ser posible, sin prejuicios, de manera que puedan entenderse entre ellos salvando las diferencias ontonómicas de cada una de las ciencias cultivadas por ellos.
Otras causas concurrentes en esta incomunicación
A las anteriores causas relativas a la incomunicación existente hay que añadir otras, no menos importantes. Me refiero, claro está, a la escasa sensibilidad existente entre muchos creyentes respecto de ciertos factores relacionados con lo demoníaco. De hecho, hoy en el demonio se cree muy poco y por poca gente. Esta insensibilidad afecta no sólo a los sacerdotes en general, sino también a los obispos. De hecho, la figura del exorcista es casi inexistente en la mayoría de las diócesis españolas o, de existir, es desconocida por casi todos.
A las anteriores causas relativas a la incomunicación existente hay que añadir otras, no menos importantes. Me refiero, claro está, a la escasa sensibilidad existente entre muchos creyentes respecto de ciertos factores relacionados con lo demoníaco. De hecho, hoy en el demonio se cree muy poco y por poca gente. Esta insensibilidad afecta no sólo a los sacerdotes en general, sino también a los obispos. De hecho, la figura del exorcista es casi inexistente en la mayoría de las diócesis españolas o, de existir, es desconocida por casi todos.
Se comprende - aunque ello no lo justifica- que haya cierto silencio de unos y otros sobre este particular. En primer lugar, porque muy probablemente su incidencia es en realidad muy excepcional en la población genral. Pero, también, en segundo lugar, porque su contenido puede ser con toda justicia calificado hoy con el etiquetado de lo "políticamente incorrecto".
En unas circunstancias así, es hasta cierto punto lógico que unos y otros evitan o huyan de los problemas cuando estos se presentan. Entre otras cosas, porque tampoco se dispone de la suficiente sensibilidad social como para que los temas de esa naturaleza tengan cabida en los mass media, y se informe acerca de ellos con el mayor respeto.
Por eso, se comprende también la tardanza y pasividad en su afrontamiento, por quienes de ello deberían ocuparse, puesto que cualquier error - dada la complejidad que posiblemente caracteriza a cada caso en particular- puede ser una excelente ocasión para que los medios de comunicación susciten un cierto "escándalo" entre sus lectores, con lo que el conflicto estaría servido y resultasen impune e injustamente descalificadas personas con rigor que han de ser respetables.
Pero tanto a la ciencia psiquiátrica como a la ciencia teológica, les importa - o debiera importarles-llegar a una firme y esclarecedora conclusión, cuando estos problemas se presentan. Cierto que estas ciencias han de enfrentarse a un grave hecho demasiado rico en complejidad, pero no es menos cierto que, si se pretende avanzar y progresar, las ciencias aquí implicadas no deberían rehusar el afrontar aquellos problemas que son de su incumbencia, por complejos y difíciles que sean.
Ninguna ciencia ha de tener miedo a la verdad. Cuando una disciplina experimenta ese miedo a la verdad, entonces es que está poniendo en cuestión su propia naturaleza científica. De otro lado, allí donde no hay ciencia suele haber ideología. Por eso, si la ciencia rehusa afrontar y resolver los problemas que son de su incumbencia, entonces la ideología le sustituirá, con lo que el problema no sólo no se resolverá como es debido, sino que se enmascarará y su solución se aplazará hasta devenir en una cuestión todavía más difícil de resolver que, además, se deja siempre para un futuro que tarda mucho en llegar.
Un breve recuerdo de la psicopatología clínica
No son muy numerosas las manifestaciones clínicas, hoy diagnosticables, en las que los supuestos comportamientos o manifestaciones de posesión diabólica tengan cabida en el perfil sintomático que les caracteriza y en los criterios diagnósticos que les definen.
No obstante, la abigarrada y multiforme sintomatología psicopatológica que puede llegar a presentarse en algunos casos excepcionales, sí que puede plantear -y de hecho plantea- la necesidad de establecer un pertinente diagnóstico diferencial entre lo que es estrictamente psicopatológico y lo que habría de ser considerado, al menos, como un fenómenos extraño, por ejemplo a la sintomatología psiquiátrica conocida.
Al psiquiatra, y al psicopatólogo, considerados como peritos, no hay que solicitarles un juicio acerca de si las manifestaciones sintomáticas que comparecen en una determinada persona tienen su causa o no en la posesión diabólica. Esta petición excede con mucho el ámbito restringido de su especialidad, por lo que no ha de responderse a esta cuestión, dado que tal petición es completamente ajena al ámbito de las disciplinas psiquiátricas.
Esto quiere decir que el especialista no puede juzgar acerca de fenómenos que son completamente ajenos a la ciencia por él cultivada. Lo que, en cambio, sí es pertinente pedirles es que se pronuncien acerca de si ésta o aquéllas manifestaciones en concreto pueden ser razonablemente explicadas desde los actuales y bien fundados conocimientos psicopatológicos. Esta última cuestión está puesta en razón y es del todo pertinente; la otra, por el contrario, no es pertinente y ha de silenciarse en el dictamen del especialista.
Entre los numerosos trastornos psicopatológicos que hoy conocemos -y que están acreditados en la actual comunidad científica- hay algunos que acaso por su propia naturaleza y cuando se manifiestan en su máxima intensidad, sí que pudieran exigir la necesidad de establecer un diagnostico diferencial entre psicopatología y posesión diabólica.
Este es el caso, por ejemplo, del desdoblamiento de personalidad, la personalidad múltiple, el trastorno histriónico de la personalidad, ciertos síndromes delirantes, algunas psicosis agudas, la esquizofrenia y los comportamientos alterados como consecuencia del consumo de drogas. Para todos ellos disponemos de criterios diagnósticos bien establecidos que permiten, cuando se satisfacen, individuar y singularizar, con cierto rigor, la presencia o ausencia de estas enfermedades.
El exorcista no debiera solicitar al experto lo que el experto no tiene capacidad para definir. Es decir, el exorcista no debe trasladar su problema al especialista, para que éste se lo resuelva. El exorcista puede y debe solicitar su ayuda, pero sólo allí donde ésta sea necesaria. Por su parte, el psiquiatra no puede sustituir al exorcista en la decisión que a este último le pertenece, porque ni debe ni sabe hacerlo, además de que en la mayoría de los casos, tampoco quiera hacerlo.
De otra parte, así como el psiquiatra dispone de unos criterios clínicos rigurosos y bien definidos para establecer si un hecho o fenómeno es psicopatológico o no, también el exorcista dispone de otros criterios para determinar si está o no ante manifestaciones de posesión diabólica. Es pues, la criteriología pastoral y religiosa la que ha de iluminar y desde la que se ha de decidir con todo rigor la pertinencia o no de incluir determinar manifestaciones comportamentales a la posesión diabólica.
Por lo general, el psiquiatra desconoce los criterios del pastor a la hora de juzgar si un comportamiento determinado está relacionado o no con el maligno. Su misión acaba allí donde los conocimientos psicopatológicos actuales se lo permiten. Cualquier afirmación que vaya más allá de estos últimos le rebasa y desborda y, por consiguiente, no debiera formularla, puesto que pondría en un grave aprieto a su propio saber como experto y a la ciencia que cultiva.
Por consiguiente, corresponde al exorcista, y sólo a él, emitir el último juicio acerca de la "cosa juzgada". Corresponde en cambio al psiquiatra decidir si la cosa juzgada tiene o no una explicación psicopatológica, es decir, si puede o no ser explicada desde el horizonte de la clínica psiquiátrica. En caso negativo, bastará con que sostenga que las manifestaciones estudiadas por él en una determinada persona, no reúnen los suficientes y necesarios requisitos como para que sean explicadas desde la perspectiva psiquiatría. Esto y sólo esto, es lo que debe concluir el psiquiatra respecto de la peritación que se le ha solicitado.
Dos casos, psicopatológicamente inexplicables
Respecto de mi experiencia profesional en el ámbito de las manifestaciones psicopatológicas en los casos de posesión diabólica, he de informar que es muy excepcional y limitada. Después de casi treinta y seis años ejerciendo la psiquiatría clínica, he de afirmar que sólo en dos ocasiones me he visto en la necesidad de dictaminar que, tras la observación y exploración de dos supuestos pacientes, los comportamientos manifestados en ellos no podían explicarse desde la perspectiva de la nosología psiquiátrica.
El primer caso tuve la oportunidad de estudiarlo hace ya más de diez años, a fin de realizar el dictamen que se me solicitaba. Se trataba de un adulto ya anciano, que residía en un país centroeuropeo. Era una persona de un alto nivel sociocultural que, a los 53 años de edad, abandonó todo (su familia, su profesión, su país) para marcharse con una prestigiosa bailarina de ballet, a la que le llevaba casi treinta años. Dos décadas después regresó a su país empobrecido y deteriorado y con manifestaciones que supuestamente permitían calificarle como un enfermo psiquiátrico.
La exploración psicopatológica puso de manifiesto en esta persona un perfil sintomático compatible con el diagnóstico de trastorno de inestabilidad emocional de la personalidad. Sin embargo, la solicitud que se hacía en la peritación no se dirigía sólo a que informase acerca de las manifestaciones clínicas que hubiera podido encontrar en esta persona sino que, principalmente, debía pronunciarme acerca de si las manifestaciones expresadas por ella, precisamente en el contexto de las sesiones de exorcismo a las que el paciente estaba sometido, podían o no ser calificadas como psicopatológicas.
En favor de la brevedad aquí exigida, me ocupare de sólo dos de las manifestaciones que presencié en esta persona durante una sesión de exorcismo. La primera de ellas consistió en que, sin haber tenido ningún contacto a lo largo de su vida con el arameo ni con ninguna otra persona que lo hablase, era capaz de comprender y hablar esta lengua, cuando "estaba en trance", durante la sesión de exorcismo. En esas circunstancias, esta persona sabía discernir el significado de las preguntas que se le hacían y de las afirmaciones que en esa misma lengua oía.
Cuando esas afirmaciones tenían un contenido religioso o se le mandaba con cierto imperio, en nombre de Dios, que alabara a Dios o besara un crucifijo, respondía con palabras blasfemas a las que seguía un comportamiento radicalmente agresivo y, desde luego, hasta lesivo para las tres personas que le acompañaban. Por el contrario, cuando el exorcista le hablaba en esa misma lengua aramea de otros temas no religiosos cuyo contenido era más bien indiferente o neutro, el supuesto paciente no respondía en absoluto, sino que guardaba silencio y adoptaba el comportamiento normal que en él era el habitual.
La otra manifestación observada consistía en que era capaz de predecir, sin ningún error, si en el lugar en el que estábamos había o no algún objeto que tuviera alguna connotación religiosa o cristiana (un crucifijo, un rosario, etc.). Las circunstancias en que acontecía esta segunda manifestación aseguraban la imposibilidad de que esta persona se percatara de la presencia o ausencia de tales objetos, puesto que estaba echado sobre una camilla, con los ojos continuamente cerrados y las personas salían y entraban de la habitación sin hacer ningún ruido, llevando o no los objetos referidos en sus bolsillos, sin que ninguna de las personas allí presentes fueran capaces de detectarlos.
En este paciente concurrían, pues, las dos cosas: un conjunto de síntomas compatibles con el diagnóstico a que ya se aludió y ciertos comportamientos para los que la actual psicopatología no dispone de ninguna explicación.
Años más tarde fui informado de el paciente pidió la ayuda al demonio, a los 53 años, para conseguir su fin de "enamorar y marcharse con la bailarina", a cambio de lo cual juró servirle de por vida.
El otro caso excepcional lo he estudiado en fecha reciente. Se trataba de una joven, estudiante universitaria, que venía padeciendo de dolores incurables, a pesar de haber visitado a varios especialistas, con malestar generalizado, fracaso en los estudios, imposibilidad de concentrarse, y que se comportaba de forma muy extraña en las sesiones de exorcismo que le estaban practicando. También en este caso fui consultado a fin de emitir un informa acerca de las manifestaciones que justamente se presentaban en ella en el transcurso de las sesiones de exorcismo. Sólo mencionaré un hecho pues entiendo que no disponemos de más tiempo.
En el curso de la sesión que fui invitado a presenciar, además de otras muchas manifestaciones de evidente oposición en todo lo que se refiriese a la piedad y al culto divino, opté por tratar de explorar si era sensible, en ese estado, a la recepción comprensiva de una lengua que, según me constaba, en absoluto conocía.
En esas circunstancias, me atreví a ordenarle que repitiese ciertas frases, en alemán, relativas al culto a Dios. Sus respuestas no se hicieron de esperar, si no que, de forma súbita, arqueaba todo su cuerpo en disposición de ataque, profería insultos y hacía gestos de una violencia incontenible, de la que forzosamente tuve que apartarme a fin de no ser fatalmente alcanzado por ella.
En cambio, cuando en esa misma lengua alemana, le formulaba preguntas de contenido no religioso o sobre temas irrelevantes, jamás se produjo en ella ninguna respuesta.
En opinión de la madre de esta chica, a la que entrevisté a solas, los síntomas de su hija habían comenzado a presentarse en ella a raíz de que una compañera blasfema le formulara un maleficio.
La entrevista que mantuve con la supuesta paciente, fuera del contexto de la sesión de exorcismo, no me permitió en este caso, tras un afinado y extenso diálogo exploratorio, llegar a conclusión alguna respecto de la identificación, apresamiento y comprobación de signos, señales o síntomas de naturaleza psicopatológica. De donde inferí y sostuve que no disponía de ninguna explicación psiquiátrica para las conductas antes relatadas.
Los anteriores casos ponen de manifiesto la conveniencia e incluso de necesidad de que psiquiatras y sacerdotes estudiemos conjuntamente estos acontecimientos, lo que redundará en beneficio de la psiquiatría y también de la pastoral de estas personas.
Dissociative Identity Disorder: An Analytical Overview
Jacqueline Costello, York College of Pennsylvania Abstract
Dissociative identity disorder (DID) is not a new phenomena, yet it has remained controversial for years.Formerly multiple personality disorder, DID has many in the field of psychology undecided if it should even be included in the DSM-IV without reservation.
This paper will discuss the opinions of board certified American psychiatrists concerning DID and the various reasons why many remain skeptical about this disorder.The DSM-IV criteria, alleged claims of abuse, cultural specificity, and the clinical defining features of dissociative identity disorder will be discussed.The treatment of traumatic memories and the effectiveness of this treatment will also be discussed in this paper.
Dissociative Identity Disorder: Controversies and Treatments
Dissociative Identity Disorder, formerly Multiple Personality Disorder remains a highly controversial disorder.The diagnostic criteria for this disorder as cited in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994), states that an individual displaying at least two personality states in which these personality states take control of the persons behavior can be diagnosed with dissociative identity disorder (DID).
The individual diagnosed with this disorder tends to be depressed, passive, and often displays feelings of guilt. The last element of the criteria, which is the presence of amnesia, is often what leads the physician to suspect a dissociative disorder.According to the DSM-IV criteria (1994), the individual is often unable to recall important personal information and has frequent gaps in their memory.Research has discovered that the amnesia is often asymmetrical; the more passive identities will have more constricted memories while the more hostile identities will have more complete memories (DSM-IV ,1994).
According to the DSM-IV (1994), this diagnosis is more commonly found in females and is concentrated more heavily in North America, especially the United States.Not only are more women diagnosed with DID, but they also tend to have more alternate personalities.
The disorder tends to become dormant as individuals enter middle age, but the symptoms can resurface during periods of stress.With this disorder it is necessary to rule out any effects from substance abuse or a general medical condition. Since the DSM-IV (1994) has included it as an actual disorder, the logical next step would be to determine why so much controversy surrounds this disorder.
There are a few reasons why many are skeptical about the validity of this disorder.Accompanied with this disorder are often high rates of sexual and physical abuse.After Pope, Oliva, Hudson, Bodkin, and Gruber (1999) surveyed a group of 301 board certified American psychiatrists their results indicated that only 1/3 of those surveyed felt that DID should be included in the DSM-IV (1994) without hesitation, while the remaining felt that it should only be a proposed diagnosis. There are many that are skeptical about the claims of abuse in DID.Although the task is quite difficult, various researchers have sought to obtain objective documentation of the alleged abuse individuals with DID claim they have been subjected to.
Alleged Abuse in DID
Otnow-Lewis, Yeager, Swica, Pincus, and Lewis,M. (1997) conducted research which sought to verify dissociative symptoms and alleged abuse of a group of individuals diagnosed with DID.Their study included 11 men and one woman who had been previously convicted on murder charges.The study included an objective verification of childhood abuse and dissociative symptoms.Family and childhood friends were interviewed and the various records were reviewed (police, social service, psychiatric, etc.) in an attempt to verify that the symptoms were present before the murders and that childhood abuse did actually occur (Otnow-Lewis et al., 1997)
After Otnow-Lewis and colleagues (1997) completed the various interviews and review of the records, the researchers were able to objectively verify dissociative symptoms in all 12 of the participants, as well as extreme childhood abuse in 11 of the 12 participants.A common belief about dissociative identity disorder is that people "fake" the symptoms or false memories are produced during the course of therapy
.However, with these 12 participants, this was not the case.None of the murderers that took part in this study were even aware of their psychiatric condition and remembered very little, if anything of their childhood. The participants either had total or partial amnesia for the abuse that had occurred during their childhood.These individuals either claimed that the abuse never occurred or minimized the abuse.There was not one individual in this study that produced a memory concerning abuse that the researchers were not able to objectively verify (Otnow-Lewis et al., 1997).Another controversy concerning DID is the high prevalence of the disorder in North America.
Cultural Aspects
According to the DSM-IV (1994), DID is culturally specific.The United States has relatively high rates of this disorder.Many authors feel that Dissociative Identity Disorder is rare outside of North America although Sar, Yargic and Tutkun (1996) found that this view may not hold as much truth as once thought.Through the use of the Turkish versions of the Dissociative Disorders Interview Scale and the Dissociative Experiences Scale, Sar and colleagues concluded that DID may not be a culturally bound disorder.
The patients in their study were similar to many North American patients with respect to the fact that there were high rates of physical and sexual abuse.Although the rates of abuse and trauma were similar to North American patients, the rates of substance abuse were much lower among the Turkish patients.Sar and colleagues attribute this to the fact that substance abuse in general, is much lower in Turkish culture (Sar, et al., 1996). Aside from the fact that many believe DID to be culturally specific and even more are skeptical about the allegations of childhood abuse, there seems to be an even bigger problem, which surrounds the controversy of the disorder.In order for dissociative identity disorder to be taken seriously, there needs to be a set of defining clinical features which will differentiate individuals diagnosed with DID with individuals not diagnosed with DID (Scroppo, Weinberger, Drob, & Eagle, 1998).
Clinical Features
Scroppo and colleagues (1998) used structured interview assessments and gathered data using the Rorschach test and the Tellegen Absorption Scale in an attempt to differentiate individuals diagnosed with DID from psychiatric patients who have never been diagnosed with a dissociative disorder (Scroppo et al., 1998)
The findings of this research conducted by Scroppo and colleagues (1998) strongly indicate that diagnosed individuals with DID indeed display defining clinical features, which aid in differentiating them from individuals who have not been diagnosed with a dissociative disorder.Some defining features are a higher rate of substance abuse, frequent occurrence of changes in consciousness, and episodes of sleep walking. Scroppo and colleagues (1998) found that childhood trauma (sexual and physical abuse) was experienced much more often among the DID diagnosed group than the control group.
Through their research, Scroppo and colleagues (1998) also found that individuals diagnosed with DID differed in their use of imaginative and projective operations.On the Rorschach test, these individuals tended to bestow movement or dimensionality to the inkblots.Overall, the research of Scroppo and colleagues (1998) strongly suggests the notion that individuals diagnosed with DID possess defining sets of clinical features which can differentiate them from individuals that have not been diagnosed with DID.
The fact that these researchers have found defining clinical features may assist resolving some, but not all, of the controversy surrounding the disorder. Various research has presented the reader with the controversies surrounding the actual diagnosis of dissociative identity disorder, now the treatment of these alleged traumatic memories that emerge in therapy must be addressed (Kluft, 1996).
Treatment
Kluft (1996) conducted research concerning the treatment of traumatic memories.Treating these memories is one of the most important parts of the therapy, as well as the most painful.These memories should be dealt with very delicately otherwise the effects can be quite damaging to the patient.Once the memories emerge, the patient may feel very overwhelmed.Patients will often require hospitalization during the time that the memories are being worked through.Kluft, along with numerous other researchers, feels that the therapist should not attempt to deal with the trauma immediately.Rather, the first step is establishing safety.
This is the phase when the patient begins to trust the therapist.After trust is established, the remembrance of traumatic events can occur and then when that is worked through, a reconnection of the personality states can occur (Kluft, 1996).As with all disorders, individuals with DID will progress at different stages.
Kluft (1996) states that individuals with DID who are seeking treatment will generally fall into one of three progress categories.Kluft places these individuals in either low, middle, or high trajectory groups.Individuals in the low trajectory group are not yet ready to work on traumatic memories; they are not progressing very quickly.Those in the middle trajectory group are apt to deal with trauma work occasionally when it is necessary.
Individuals that fall into the high trajectory group are able to deal with trauma work and they are recovering much more quickly than the other two groups.Even those individuals in the high trajectory group should not engage in uninterrupted trauma work (1996).Many researchers theorize whether or not treatment of dissociative identity disorder is effective and if so, if the effects are long lasting.
Ellason and Ross (1997) examined the effectiveness of the treatment for dissociative identity disorder in a two-year follow up study.In their research they use the concept of integration. Integration occurs when behaviorally separate identities are no longer present and the individual has had three stable months of memory that are current.Of the original 135 patients, a total of 54 agreed to participate in this study and complete the various interviews and complete questionnaires (Dissociative Experiences Scale and the Dissociative Disorders Interview Scale).
The results of Ellason and Ross' research (1997) indicate that 12 out of the 54 participants achieved integration in the two-year follow up.The reports of childhood abuse documented by the individuals in 1993 did not differ from their reports in 1995.The integrated patients in this study showed a more substantial improvement with symptoms of depression, as evidenced by their scores on the Dissociative Disorders Interview Schedule.
Overall, the findings of their research indicate that both patients who achieved and didn't achieve integration showed improvement on the two-year follow up.However, the patients who achieved integration were doing extremely well in the two-year follow up.These findings suggest that over a sufficient time period, treatment can be quite beneficial for patients diagnosed with dissociative identity disorder (Ellason and Ross,1997).Now that the diagnosis, controversies, and treatments concerning DID have been addressed, the review of a well-known case study will further clarify the distinctiveness of the disorder.
In the DSM-IV casebook (Spitzer, et al.,1994), a case study of Mary Kendall, a 35 year-old caseworker is discussed.Mary does not have much of a social life, but rather devotes herself to helping others.Mary has a quite extensive medical history, including chronic pain in her right hand and forearm, which is actually what led her to meet with a psychiatrist. She displays many of the characteristics common in individuals diagnosed with DID such as the ability to be easily hypnotized and frequent gaps in her memory (especially memory for events that occurred in her childhood).
The case study of Mary Kendall (Spitzer, et al., 1994) describes her frequent gaps in memory, which she realized when she noticed that her gas tank would often be almost full when she returned home from work, but almost empty in the morning.After Mary began to keep track of the odometer reading she realized that 50-100 miles were often put on the car overnight, even though she could not remember driving anywhere.During a hypnosis session with the therapist, one of the hostile personalities (Marian) emerged.Marian described rides that she often took at night in an attempt to work out her problems.
The alter personality, Marian, displayed strong contempt for Mary.Marian felt that Mary was very pathetic and that it was a waste of time to always be concerned about others.In the course of therapy about six personalities emerged, who were often in conflict with one another Spitzer, et al., 1994).
Various childhood memories emerged through the course of therapy including abuse (physical and sexual) committed by her father and guilt surrounding these events since she did not protect her other siblings from encountering the same fate (Spitzer, et al., 1994).
Psychotherapy, especially in the case of DID, is not a rapid process.Mary Kendall participated in therapy for four years before a gradual integration of the personality states was evident.Although some of the personality states were able to integrate, others were not and remained in conflict with one another (DSM-IV casebook, 1994).
Conclusion
In conclusion, although DID remains a highly controversial disorder, the clinical criteria for this disorder are still included in the DSM-IV (1994).There remain critics who feel that DID is a "fake" disorder suggested to highly hypnotizable patients.Many of these critics also feel that the memories that emerge are often false and the supposed abuse never actually occurred.However, recent research has objectively verified the accusations of abuse of patients diagnosed with DID (Otnow-Lewis et al., 1997).
Sar and colleagues (1996) have conducted research in an attempt to dispel the myth that DID is a culturally bound disorder.Scroppo and colleagues (1998) have discovered defining clinical features that differentiate DID diagnosed individuals from those not diagnosed with a dissociative disorder.All of this research is attempting to objectively examine the defining features of this disorder and answer many of the critics' arguments with objective data.
However, future research is necessary to further examine DID and gain a deeper understanding of the disorder and the individuals it affects. In psychology, as in all fields, it is impossible to draw conclusions from a few studies.The present research needs to be replicated numerous times in order for researchers to begin to draw conclusions concerning this controversial disorder.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. (4th ed.). Washington DC: Author.
Ellason, J., & Ross, C. (1997).Two-year follow up of inpatients with dissociative identity disorder.American Journal of Psychiatry, 154 (6), 832-839.
Kluft, R.P. (1996).Treating the traumatic memories of patients with dissociative identity disorder.American Journal of Psychiatry, 153 (7), 103-109.
Otnow-Lewis, D., Yeager, C., Swica, Y., Pincus, J., & Lewis, M. (1997).Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.American Journal of Psychiatry, 154 (12), 1703-1710.
Pope, H., Oliva, P., Hudson, J., Bodkin, J., & Gruber, A. (1999).Attitudes toward DSM-IV dissociative disorders diagnoses among board certified American psychiatrists.American Journal of Psychiatry, 156 (2), 321-323.
Sar, V., Yargic, L., & Tutkun, H. (1996).Structured interview data on 35 cases of dissociative identity disorder in Turkey.American Journal of Psychiatry, 153 (10), 1329-1333.
Spitzer, R.L., Gibbon, M., Skodol, A.E., Williams, J.B., & First, M.B. (Eds.). (1994).DSM-IV casebook: a learning companion to the diagnostic and statistical manual of mental disorders.Washington DC: American Psychiatric Press, Inc.
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