Religion and Spirituality in Psychiatry

146 Pierre-Yves Brandt and Laurence Borrasbroadly accepted, collective cultural or religiouspractice. A short historical perspective on possessionphenomena and exorcism will be followedby a brief reminder of what the DSM-IV and theInternational Statistical Classification of Diseasesand Related Health Problems 10th Revision( ICD-10 ) say about dissociative disorders. Theplace of possession in these classification systemswill open the discussion of cross-cultural variations.How do members of different cultures differand agree in their experience of and responseto the phenomenon of possession? What is thisphenomenon like in different cultural settings?The different approaches will be presented here.This discussion will then allow us to considerthe diagnosis and the treatment of dissociativedisorders from a differential diagnosis point ofview. Once again, cultural factors play an importantrole: Dissociative disorders are not diagnosedwith the same frequency in Europe andNorth America.Th e discussion will be illustrated by descriptionsof modern cases of psychiatric patientswho believed they were possessed and how theywere managed from both religious and medicalperspectives. An anthropological analysis willthen lead up to the conclusion, which is dedicatedto the question of how religious authorities,ethnopsychiatrists, and clinicians couldcollaborate.2. A HISTORICAL PERSPECTIVEHistorically, the diagnostic category of dissociativedisorders developed in several stages. Accordingto Spanos, (2) the history of dissociation beganin the nineteenth century with the diagnosis oftraumatic hysteria. Charcot believed that the“nervous shock” following a traumatic accidentcould produce a frightening idea, which was thenunconsciously transformed into hysterical symptoms.Janet (3) used the concept of dissociation todescribe the process of splitting and automatismof ideas. According to his theory, these dissociativeideas are organized into a state of consciousnessthat is different from normal consciousness.To illustrate this model he presented the case ofAchilles, a 33-year-old man who believed he waspossessed by the devil, which developed due to hisremorse at having been unfaithful to his wife ona business trip. (4) This thought, which tormentedhim unconsciously, was experienced by Achillesas a secondary demonic personality. Janet unhesitatinglyqualified the treatment, which consistedof modifying the traumatic memory throughhypnosis, as a modern exorcism. Later, this specificclinical case was reinterpreted according tothe theory of multiple personalities. Multiple personalitydisorder later became a diagnostic categoryof its own in the DSM-III .Janet’s explanation of the phenomenon ofpossession as a dissociative symptom withreligious content contrasts with the religiousinterpretation, which describes possession asthe expression of an invasion of the body byspiritual forces. The conflict between thesedifferent interpretations of the phenomenonof possession originally began several centuriesearlier. The conflict came to a head in1707, when King Louis XIV promulgated thelaw under which priests, monks, and nuns whopracticed medicine in France had to pay a fineof 200 French livres (p. 15).(5) This decisionwas a result of the concerted efforts of medicalprofessionals to legitimize the practice ofmedicine. It allowed them to obtain socialrecognition and even gave them the supremeauthority over health. With the establishmentof medical schools in different universities andsteadily increasing political support, physicians(doctors), who were considered as mereartisans in the Middle Ages, gained the statusof recognized scientists. This evolution wasaccompanied by a new definition of the lineseparating religious and medical treatments.From that point on, everything belonging tothe domain of the spirit was answerable tothe authority of the church or of philosophy,whereas the human body, considered as ananimal or a machine, fell under the authorityof medicine. Therefore, a priest, for example,who practiced the laying on of hands on a sickperson suffering from a fever and who prayedfor that person’s health, could be accused by