Religion and Spirituality in Psychiatry

11 Religion/Spirituality and Dissociative DisordersPIERRE-YVES BRANDT AND LAURENCE BORRASSUMMARYTh e connection between religion/spiritualityand dissociative disorders is complex. Possessionstates cannot always be interpreted as a kind ofdissociative disorder. The chapter begins withthe famous case of Achille being “exorcised” byPierre Janet and reminds us of how the healingtask of medical doctors is distinct from thatof priests. It then continues by discussing howthe Diagnostic and Statistical Manual of MentalDisorders, Fourth Edition, (DSM-IV) approachescomplaints of possession (Code F 44.9). Duringthe twentieth century, the multiple personalitydiagnosis was renamed “dissociative identitydisorder” and constitutes only one subcategoryof dissociative disorder. The prevalence of dissociativedisorders is difficult to establish. Itdepends on cultural aspects (the Ross-Spanoscontroversy). Descriptions of cases show thevariety of relationships between religion and dissociativedisorders: identity disorder with religiouscontent but without possession (case 1),divine possession (case 2), and demonic possession(case 3). Anthropological criticism appliedto the assimilation of possession with dissociativedisorders brought about the introduction ofthe concept of “associative disorder.” The chapterconcludes with the discussion of the possiblecollaboration between psychiatrists and clergy,exorcists or shamans when a person is said to bepossessed. This chapter attempts to show underwhich conditions an ethno-psychiatric consultationmay be helpful.1. CHAPTER OVERVIEWAccording to epidemiologic studies, dissociativedisorders have a lifetime prevalence of about 10percent.(1) Dissociative symptoms may occur inacute stress disorder, posttraumatic stress disorder,somatization disorder, substance abuse,mood disorders, psychoses, dissociative identitydisorder, trance, and possession trance. Althoughdissociative trance disorders, especially possessiondisorder, are probably more common thanis usually thought, little systematic research intothis phenomenon has been done in psychiatry.Moreover, encounters with these disorders areincreasingly likely for mental health professionals,who may be unaware of the phenomenon.The experience of being “possessed” by anotherentity holds different meanings in different cultures.Possession states are often interpreted asbeing nonpathological: affected individuals caneven achieve higher status when they are viewedas having supernatural powers of healing andunderstanding. Alternatively, when individualsbecome so distressed and dysfunctional that theyseek assistance from healers and mental healthprofessionals, the interpretation of their sufferingas the consequence of a possession by entities likebad spirits depends on the cultural backgroundof the healer. In other words, such cases are challengingto diagnose and treat: viewing the diagnosisof possession as abnormal constitutes aculturally oriented decision.Th e first issue to discuss, then, is the questionof diagnosis. In the international classificationsof mental disorders, dissociative or possessiontrance is not considered to be a normal part of a145