Religion and Spirituality in Psychiatry

154 Pierre-Yves Brandt and Laurence Borrasspiritual authorities are unaware of the relationshipthat is established between themselves andthe person in need of help when they begin anexorcism. A lack of professionalism in the managementof the therapeutic bond and the environmentthat is established through the practice ofexorcism can have very damaging effects. Insteadof considering that spiritual and psychic sufferingare mutually exclusive and necessitate two differentmodes of treatment, it seems wiser, in certaincases, to try to integrate both approaches.7. ANTHROPOLOGICAL CRITICISMThere is a principal criterion given in the DSM-IVto differentiate a possessed person from a personsuffering from a DID, meaning someone who hasseveral identities whether they are conscious ofeach other or not. In cases of possession, the identitythat takes the control of the person is felt to becoming from the outside. The difference is essentiallya question of how the person identifies withthe different entities: a possessed person would atleast sometimes identify himself or herself withthe spirit he or she feels possessed by. In otherwords, in a case of possession, when the spirit orthe entity speaks through a human being using “I,”the spirit or entity is not thought to have its originin the subject it talks through. In the list of examplesof dissociative trances that are not consideredas pathological, the DSM-IV tends to use the termpossession with cultural differences. However, thecase of Barbara, the presence of exorcist priests ineach diocese of the Roman Catholic Church allover the world, and the practice of exorcism inPentecostal evangelic churches in North Americaas well as in Europe show that the phenomenonof possession should not be exclusively associatedwith or limited to the non-Western world. Thisconcept is part of the modern Western world aswell. Certainly some would say that anthropologicalpre-modern conceptions are still presentin the Western world and that religious environmentssupport their conservation. But we believethat the opposition between what comes from the“inside” and what comes from the “outside” goesbeyond culture. This opposition makes it possibleto describe the multiplicity of the human psycheand identity and makes us question whether theterm dissociation is appropriate to describe thisphenomenon. When an individual describes himselfas being confronted with or having to face aspirit or an entity that comes from the outside andlives within him, why should we only talk about“dissociation” and not about “association” also?Systematically using the term dissociative revealsthat, although we recognize that subjects can feelthat external entities have penetrated their bodies,only one diagnosis is acceptable to us: theirpsychic cohesion is fragmented. This brings us toquestion an implicit assumption in this categorization;a fragmented identity or a multiple identitycan only be the result of dissociation. Thus,before such a fragmentation, the human psychewas necessarily a coherent whole, complete andunified. From this point of view, every kind ofpsychic evolution that leads toward a certain multiplicitycan only be the result of a loss of cohesion.The Western world is influenced by whatClifford Geertz calls “the occidental notion of theperson” (15) which1 tends to use the terms individual and personas if their meaning were equivalent; in otherwords, individual identity and personal identityare thought of as synonyms.2 qualifies identity, in particular individual identity,according to two criteria: unity and uniqueness.Accordingly, the person is seen in the Westernworld “as a cognitive universe that more or lessdetermines behaviour, like a dynamic centre ofconsciousness, emotion, judgement and organizedaction integrated into a distinctive whole, and that,at the same time, is opposed to other wholes andto the natural and social environment.” However,Geertz notes that in a broader global context ofdifferent cultures, this conception of a person isquite unusual. Several studies of intercultural psychology(16) or studies concerning the personalityin the ancient world (17–19) (p. 55) (note 17)and (pp. 72–73) (note 18) have shown that, inmost cultures, identity in the sense of uniquenessis assigned to a social group such as a family or a