Religion and Spirituality in Psychiatry

148 Pierre-Yves Brandt and Laurence BorrasThese disorders are limited to occurrences thatare involuntary, unwanted, and occur outsideof accepted religious or cultural experiences.Psychoses, multiple personality disorders, substance-induceddisorders, and temporal lobe epilepsyare excluded. This classification takes intoconsideration the sizable number of dissociativedisorder diagnoses that occur in nonindustrializednations and were previously diagnosed asatypical dissociative disorder or dissociative disordernot otherwise specified.(7)4. POSSESSION IN VARIOUS CULTURALCONTEXTSThe concept of possession exists in all parts of theworld. A review based on 488 societies showedthat 74 percent had one or more forms of possessionbelief (p. 249).(8) Possession beliefs mayor may not be linked to trance behavior. In somecultures, when someone becomes the new king,the soul of his predecessor enters him. Duringthe enthronement ritual, a brief possessiontrance can accompany the entrance of the soul.Afterwards, the new king will be considered aspermanently possessed by the soul of his predecessor.Similarly, when Christians say they areinspired by the Holy Spirit, this kind of “divinepossession” may be expressed by trance behavior.These two examples, the king possessed by thesoul of his predecessor and Christians possessedby the Holy Spirit, represent positive conceptualizationsof possession.Possession can also refer to negative experiences.Bourguignon considers trances as a kindof altered state of consciousness. She noticed thattrances were not necessarily associated with theconcept of possession, and when examining geographicdistribution, she observed that tranceswere highly correlated with America. She describedhunter-gatherer societies in which trances wereactively sought out, especially by men, and sometimeswith the help of drugs (South America). Incontrast to this type of trance with positive connotations,the possession trance is significantly correlatedwith agricultural societies in sub-SaharanAfrica and with the circum-Mediterranean region.This type of trance, which mostly affects women,has more negative connotations.Two main modes of traditional interventioncan be undertaken when a person complains ofbeing possessed by bad spirits or demons, whethera state of trance is observed or not: exorcism ormanipulation. Exorcism denotes rituals that aimto expel negative forces. Manipulation involvesrituals that seek to integrate negative forces. Inmany cultures, the coordination of such ritualsis entrusted to a person who has special knowledgeabout altered states of consciousness andpossesses special healing powers. This person isthought to have a kind of authority over negativeforces, either to chase them away or negotiate analliance with them. Exorcism can be understoodas religious coping, with God, gods, or good spiritsagainst demons, whereas manipulation can beunderstood as religious coping with demons.In a study focused on traditions in Morocco,Hell (9) shows that the treatment of possessionincludes a differential diagnosis. When the misfortuneis caused by a spirit ( djinn ) of lesser importance,the exorcism is performed by a learned andlettered man (a fiqh or taleb ) reciting verses fromthe Koran and carrying out purification rituals.But if the spirit ( djinn ) is more powerful, the onlysolution may be to seek the help of a traditionalbrotherhood that practices a possession ritual. Thebrotherhood of the Gnawa is the most renownedfor its practice of rituals of possession. By workingwith the spirits over extended periods during theserituals of possession, the possessed person learnshow to establish an alliance with the hostile forces.The idea that exorcists deal with different levels ofnegative forces is common in different cultures.5. THE DISTRIBUTION OFDISSOCIATIVE DISORDERSEpidemiologic studies find a prevalence of dissociativedisorders of around 10 percent in thegeneral population and of around 16 percent inpsychiatric inpatients, with a female predominance.(1)The higher rate of dissociative disorder diagnosesin the United States compared to other