Schizophrenia or Possession?

 Schizophrenia or Possession?

 Springer Science+Business Media New York 2012

Abstract Schizophrenia is typically a life-long condition characterized by acute symp-

tom exacerbations and widely varying degrees of functional disability. Some of its

symptoms, such as delusions and hallucinations, produce great subjective psychological

pain. The most common delusion types are as follows: ‘‘My feelings and movements are

controlled by others in a certain way’’ and ‘‘They put thoughts in my head that are not

mine.’’ Hallucinatory experiences are generally voices talking to the patient or among

themselves. Hallucinations are a cardinal positive symptom of schizophrenia which

deserves careful study in the hope it will give information about the pathophysiology of the

disorder. We thought that many so-called hallucinations in schizophrenia are really illu-

sions related to a real environmental stimulus. One approach to this hallucination problem

is to consider the possibility of a demonic world. Demons are unseen creatures that are

believed to exist in all major religions and have the power to possess humans and control

their body. Demonic possession can manifest with a range of bizarre behaviors which

could be interpreted as a number of different psychotic disorders with delusions and

hallucinations. The hallucination in schizophrenia may therefore be an illusion—a false

interpretation of a real sensory image formed by demons. A local faith healer in our region

helps the patients with schizophrenia. His method of treatment seems to be successful

because his patients become symptom free after 3 months. Therefore, it would be useful

for medical professions to work together with faith healers to define better treatment

pathways for schizophrenia.

Keywords Schizophrenia -

 Demonic possession -

 Hallucination -

 Delusion -

 Faith healer

Schizophrenia is generally viewed as a chronic disorder characterized by psychotic

symptoms and relatively stable interpersonal deficits. It is one of the most important public

health problems in the world. A survey by the World Health Organization ranks schizo-

phrenia among the top ten illnesses that contribute to the global burden of disease (Murray

1996). It appears to affect 1 % of people worldwide. Because of its early age of onset

(average age 25 years) and its subsequent tendency to persist chronically, it produces great

suffering for patients and also for their family members (Andreasen 2011). It is an illness

that affects the essence of a person’s identity—the brain and the most complex functions

that the brain mediates. Some of its symptoms, such as delusions and hallucinations,

produce great subjective psychological pain. Other facets of the illness produce great pain

as well, such as the person’s recognition that they are literally ‘‘losing their mind’’ or being

controlled by forces beyond personal control. Consequently, it can be fatal—a substantial

number of its victims either attempt or complete suicide (Andreasen 2011; Pompili et al.

2007).

The primary treatment of schizophrenia is antipsychotic medications, but about 25 % of

people with schizophrenia are resistant to this type of treatment (Hunter 2012). Of those

people with schizophrenia who do benefit from antipsychotic medication, an additional 30

to 40 % are residually symptomatic despite adequate antipsychotic treatment (Kane et al.

1988). All the antipsychotic medications currently in use share a common putative

mechanism of action, namely dopamine antagonism. The dopamine hypothesis of

schizophrenia proposes that excessive subcortical dopamine release linked to prefrontal

cortical dopaminergic dysfunction is central to the pathogenesis of schizophrenia (Van

Rossum 1966). Although all antipsychotics modulate dopamine activity in the brain, via

dopaminergic antagonism, there is no incontrovertible evidence that schizophrenia is the

result of a primary dopamine abnormality. Dopamine dysregulation is likely to be a sec-

ondary consequence of the primary biological causes of the condition (Coyle 2006). The

biological basis of schizophrenia is therefore complex and much more than a dysregulation

of dopamine metabolism.

Delusions and Hallucinations of Schizophrenia

According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental

Disorders (DSM-IV-TR), to be diagnosed with schizophrenia, two or more of the following

characteristic symptoms are required together with the social dysfunction and significant

duration:

a) Delusions.

b) Hallucinations.

c) Disorganized speech (known as word salad), which is a manifestation of thought

disorder.

d) Inappropriate behavior indicative of abnormal control (e.g. dressing inappropriately,

crying frequently) or catatonic behavior.

e) Negative symptoms: blunted affect (decline in emotional response), alogia (decline in

speech), or avolition (decline in motivation).

If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice

participating in a running commentary of the patient’s actions or of hearing two or more

voices conversing with each other, only that symptom is required above (Penades and

Catalan 2012).

A delusion is an unshakable, false idea, or belief that cannot be attributed to the

patient’s educational, social, or cultural background, which is held with extraordinary

conviction and subjective certainty, and is not amenable to logic. Delusions are extremely

variable in the content (Arango and William 2011; Vreugdenhil et al. 2004). The most

common delusions with respect to type of content are as follows:

Delusions of persecution ‘‘No matter wherever I go, there are cameras filming me to

know what I do’’

Delusions of control ‘‘My feelings and movements are controlled by others in a

certain way’’

Thought withdrawal ‘‘They take my thoughts out of my head or steal them’’

Thought insertion ‘‘They put thoughts in my head that are not mine’’

Thought broadcasting ‘‘Everyone knows what I am thinking because my brain is

transparent’’

Patients with schizophrenia also experience abnormal perceptions, mainly in the form of

hallucinations. A hallucination is a perception without object, and the most common

hallucinations in schizophrenia are auditory (DeLeon et al. 1993). Hallucinatory

experiences are generally voices talking to the patient or among themselves. On many

occasions, the voice, which can be identified as male or female, is not associated with

anyone known by the patient. The voice is experienced as coming from the outside.

Particularly, characteristic of schizophrenia is voices that repeat the patient’s thoughts

aloud, give commentaries on the patient’s actions or thoughts, or argue with one another

and talk to the patient in the third person (Arango and William 2011).

Hallucinations are a cardinal positive symptom of schizophrenia which deserves careful

study in the hope it will give information about the pathophysiology of the disorder. The

problem is to determine whether the alleged hallucination relates to an event in the real

world. The nervous system always operates on sensory input even if that input is internally

generated (Locke 2011). When asked a patient, ‘‘What are the voices saying?’’ the answer

is something like ‘‘Bad things.’’ That is not an answer to the question, maybe because the

voices are not saying well-articulated words; they are just sounds construed by the patient,

operated on to be ‘‘bad things’’ (Locke 2011). We thought that many so-called halluci-

nations in schizophrenia are really illusions related to a real environmental stimulus.

Illusions are transformations of perceptions, with a mixing of the reproduced perceptions

of the subject’s fantasy with the real perceptions. One approach to this hallucination

problem is to consider the possibility of a demonic world.

World of Demons

In our region, demons are believed to be intelligent and unseen creatures that occupy a

parallel world to that of mankind. In many aspects of their world, they are very similar to

us. They marry, have children, and die. The life span, however, is far greater than ours

(Ashour 1989). Through their powers of flying and invisibility, they are the chief com-

ponent in occult activities. The ability to possess and take over the minds and bodies of

humans is also a power which the demons have utilized greatly over the centuries

(Littlewood 2004; Gadit and Callanan 2006; Ally and Laher 2008). Most scholars accept

that demons can possess people and can take up physical space within a human’s body

(Asch 1985). They possess people for many reasons. Sometimes it is because they have

been hurt accidentally, but possession may also occur because of love (Ashour 1989;

Philips 1997). When the demon enters the human body, they settle in the control center of

the body–brain. Then, they manifest themselves and take control of the body through the

brain (Whitwell and Barker 1980; Littlewood 2004; Gadit and Callanan 2006; Ally and

Laher 2008). Demonic possession can manifest with a range of bizarre behaviors which

could be interpreted as a number of different psychotic disorders (Al-Habeeb 2003; Boddy

1989). On many occasions, the person has within him more than one demon, and often they

talk from their voices. They therefore cause symptoms such as hearing voices and certain

delusions (Littlewood 2004; Al-Ashqar and Umar 2003; Pereira et al. 1995).

Possession or Schizophrenia

As seen above, there exist similarities between the clinical symptoms of schizophrenia and

demonic possession. Common symptoms in schizophrenia and demonic possession such as

hallucinations and delusions may be a result of the fact that demons in the vicinity of the

brain may form the symptoms of schizophrenia. Delusions of schizophrenia such as ‘‘My

feelings and movements are controlled by others in a certain way’’ and ‘‘They put thoughts

in my head that are not mine’’ may be thoughts that stem from the effects of demons on the

brain. In schizophrenia, the hallucination may be an auditory input also derived from

demons, and the patient may hear these inputs not audible to the observer. The halluci-

nation in schizophrenia may therefore be an illusion—a false interpretation of a real

sensory image formed by demons. This input seems to be construed by the patient as ‘‘bad

things,’’ reflecting the operation of the nervous system on the poorly structured sensory

input to form an acceptable percept. On the other hand, auditory hallucinations expressed

as voices arguing with one another and talking to the patient in the third person may be a

result of the presence of more than one demon in the body.

Faith Healers and Future Directions

It has been shown by World Health Organization (WHO) studies that faith healers may

help patients with psychiatric disorders (Gater et al. 1991). Currently, the churches in the

United Kingdom retain the services of faith healers (Friedli 2000), the task of whom is to

expel the demons in cases of real possession. Rollins is an Anglican priest in London. Prior

to the priesthood, he was a trained and qualified psychiatrist. He turned to the priesthood

and exorcist feeling that medicine failed to address certain human sufferings (Leavey

2010). Similarly, B. Erdem is a local faith healer in Ankara who expels the evil demons

from many psychiatric patients with the help of good ones. B. Erdem contends that on

occasions, the manifestation of psychiatric symptoms may be due to demonic possession.

An important indicator of his primary suspicions about the possession is that, if someone

has auditory hallucinations, he would remain alert to the possibility that he might be

demonically possessed. His method of treatment seems to be successful because his

patients become symptom free after 3 months.

Above considerations have led to the suggestion that it is time for medical professions

to consider the possibility of demonic possession in the etiology of schizophrenia, espe-

cially in the cases with hallucinations and delusions. Therefore, it would be useful for

medical professions to work together with faith healers to define better treatment pathways

for schizophrenia.

Acknowledgments This work is dedicated to the American mathematician John Forbes Nash and to all

schizophrenic patients.

References

Al-Ashqar, U. S. (2003). The world of the jinn and devils in the light of the Qur’an and Sunnah. Columbia:

International Islamic Publishing House.

Al-Habeeb, T. A. (2003). A pilot study of faith healers’ views on evil eye, jinn possession, and magic in the

kingdom of Saudi Arabia. Saudi Society of Community and Family Medicine Journal, 10, 3.

Ally, Y., & Laher, S. (2008). South African Muslim faith healers perceptions of mental illness: under-

standing etiology and treatment. Journal of Religion and Health, 47, 45–56.

Andreasen, N. C. (2011). Concept of schizophrenia: past, present, and future. in Schizophrenia (pp 3–8).

Edited by Daniel R. Weinberger, Paul J. Harrison (3rd ed.). UK: Wiley-Blackwell Publishing Ltd.

West Sussex.

Arango, C., & William, T. (2011). The schizophrenia construct: symptomatic presentation in Schizophrenia,

(pp 9–23). Edited by Daniel R. Weinberger, Paul J. Harrison (3rd ed.). UK: Wiley-Blackwell

Publishing Ltd. West Sussex.

Asch, S. S. (1985). Depression and demonic possession: the analyst as an exorcist. Hillside J Clin

Psychiatry, 7, 149–164.

Ashour, M. (1989). The jinn in the Qur’an and the Sunna. London: Dar Al-Taqwa.

Boddy, J. (1989). Wombs and alien spirits: Women, men, and the zar cult in Northern Sudan. Madison:

University of Wisconsin Press.

Coyle, J. T. (2006). Glutamate and Schizophrenia: beyond the Dopamine Hypothesis. Cellular and

Molecular Neurobiology, 26, 365–383.

DeLeon, J., Cuesta, M. J., & Peralta, V. (1993). Delusions and hallucinations in schizophrenic patients.

Psychopathology, 26, 286–291.

Friedli, L. (2000). A matter of faith: religion and mental health. International Journal of Health Promotion,

2, 7–13.

Gadit, A. A. M., & Callanan, T. S. (2006). Jinni possession: a clinical enigma in mental health. The Journal

of the Pakistan Medical Association, 56, 476–478.

Gater, R. A., De Almeida, E., Sousa, B., Barrientos, G., Caraveo, J., Chandrashekar, C. R., et al. (1991). The

pathways to psychiatric care: a cross-cultural study. Psychological Medicine, 21, 761–774.

Hunter, R. (2012). Treatment of Schizophrenia in the 21st Century: Towards a more personalised approach

in schizophrenia in the 21st century (pp.3–26). Burne, InTech, Rijeka, Croatia: Edited by T.H.J.

Kane, J. M., Honigfeld, G., Singer, J., et al. (1988). Clozapine for the treatment-resistant schizophrenic.

Archives General Psychiatry, 45, 789–796.

Leavey, G. (2010). The appreciation of the spiritual in mental illness: A qualitative study of beliefs among

clergy in the UK. Transcultural Psychiatry, 47, 571–590.

Littlewood, R. (2004). Possession states. Psychiatry, 3, 8–10.

Locke, S. (2011). Hallucinations in UNBALANCED. A view from the Vestibule—schizophrenia and

hyperattention (pp 57-69). by World Scientific Ch 6.

Murray, C. J. L. (1996). The global burden of disease: A comprehensive assessment of mortality and

disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA:

Harvard School of Public Health on behalf of the World Health Organization and the World Bank;

distributed by Harvard University Press.

Penade´s, R., & Catala´n, R. (2012). Cognitive remediation therapy (CRT): Improving neurocognition and

functioning in schizophrenia in Schizophrenia in the 21st Century (pp 69–86). Burne, InTech, Rijeka,

Croatia: Edited by T.H.J.

Pereira, S., Bhui, K., & Dein, S. (1995). Making sense of possession states: psychopathology and differential

diagnosis. British Journal of Hospital Medicine, 53, 582–585.

Philips, A. A. B. (1997). Ibn Taymeeyah’s essay on the jinn (demons). Abridged, annotated and translated

by A. A. B. Philips (4th ed.). Riyadh: International Islamic Publishing House.

Pompili, M., Amador, X. F., Girardi, P., Harkavy-Friedman, J., Harrow, M., Kaplan, K., et al. (2007).

Suicide risk in schizophrenia: learning from the past to change the future. Annals of General Psy-

chiatry, 6, 10.

Van Rossum, J. M. (1966). The significance of dopamine-receptor blockade for the mechanism of action of

neuroleptic drugs. Archives Internationales de Pharmacodynamie et de Therapie, 160, 492–494.

Vreugdenhil, C., Vermeiren, R., Wouters, L. F. J. M., Doreleijers, T. A. H., & Brink, W. (2004). Psychotic

symptoms among male adolescent detainees in the Netherlands. Schizophrenia Bulletin, 30, 73–86.

Whitwell, F. D., & Barker, M. G. (1980). Possession in psychiatric patients in Britain. The British Journal of

Medical Psychology, 53, 287–295.