Religion and Spirituality in Psychiatry

Religion/Spirituality and Dissociative Disorders 149regions of the world, notably in Europe, has givenrise to different interpretations. Some believe thereason is a better capacity to diagnose a complicateddisorder. For others, the reason is a socialmovement that encourages physicians to diagnosevery sensitive patients with this disorder.It is a fact that only a limited number of psychiatristsare responsible for the vast majority ofdissociative disorder diagnoses. These differentpoints of view have prolonged the Ross-Spanoscontroversy about multiple personality disorder.Spanos believed this disorder was an artifact ofthe doctor-patient relationship, whereas Rossthought that it was simply a disorder that was verycomplex to diagnose.(10) The DSM-IV shows agreat deal of precaution by stating that this disordercould be specific to certain cultures. Couldthis be an indication that the cultural dimensionof personality should not be underestimated?Possession cannot always be interpreted asa kind of dissociative disorder. From a crossculturalperspective, we have seen that it is notnecessarily considered pathological. When theindividuals who complain of being possessedrequire medical treatment, their psychologicalorganization is not always of a dissociative nature(that is, exclusively falling within the dissociativedisorder category). In fact, as the expression of abelief, possession can be combined with differentforms of disorders. According to Janet, possessionwas considered a form of hysteria. However,it can also appear in association with schizophreniaor dissociative symptoms, as the followingcases will illustrate.6. DESCRIPTIONS OF CASESNone of the cases described below of patientssuffering from DID manifested an identity of areligious nature. Patients who believe that theyare God, Jesus, or a religious leader to whoma higher mission has been addressed are usuallyconsidered to be suffering from delusionsof grandeur. These delusions are classed withinthe category of positive symptoms of psychoticdisorders, which are more severe than dissociativedisorders. The first case presented belowhas similarities with this diagnosis. The descriptionof the second case provides an example ofdivine possession. The predominant trait of the“presence” inhabiting the sufferer contrasts withdemonic possession, of which an example will bedescribed in the third case.6.1. Case 1At the age of around 20, Mr. H. decompensatedafter a frightening experience when he wasattacked with a knife. He began to have regularauditory hallucinations. He heard voices, either ofJesus talking to him or maybe his future self. Lateron, he realized that he had heard voices when hewas about 13 or 14 years old. These voices sometimesseemed to belong to dissociated personalitieswho controlled his body. He said, “Becauseif I connect myself to my core personality, I feellike I am paralyzed” and “Someone else has controlledmy muscles for the past two years.” He thenexplained that it was either his future personality(self) or Jesus who controlled his body, and thatthey were very careful to closely imitate his corepersonality. He recounted that the dissociativesymptoms were at first associated with posttraumaticstress disorder, because they appeared afterhe was attacked. The diagnosis of schizophreniawith dissociative symptoms was only establishedlater. He himself believed that he was sufferingfrom a dissociative disorder (multiple personalitydisorder). If a psychiatrist had confirmed thediagnosis of multiple personality disorder, wouldhis suffering have more clearly taken on that form?At one point, he attempted to commit suicide. Hediscussed this event in these words: “At that time,another personality controlled my body …; it wasthe other personality who swallowed the pills; itwas not my current personality.” However, he didnot identify that personality. His religious beliefsdid not help him to cope with his suffering; on thecontrary, they seemed to intensify it. Voices toldhim that he would become the greatest saint inhuman history, but examples of the saints beforehim, such as Jesus, show that sanctification cannotbe attained without experiencing severe suffering.However, he thought that the voices were