Religion and Spirituality in Psychiatry

Religion/Spirituality and Dissociative Disorders 155clan rather than to an individual. In other words,the individual identity is thought to be determinedby the social group of origin.The modern Western world conveys the projectto mold distinctive individual identities witha high level of self-awareness and a high levelof autonomy. We cannot contest the legitimacyof such a cultural project. Nevertheless, it doesseem valid to question the actual degree to whichthis project has been accomplished in Westernpopulations. What proportion of the populationhas actually achieved such maturity? The questioncan be considered from a sociological pointof view and also from the point of view of developmentalpsychology. At what point in developmentis this psychic maturity attained? We wouldlike to examine the following problem: Becausethe integration of psychic functions and the differentiationof identity are not innate, dissociationcan only jeopardize that which has alreadybeen integrated. When a unified, differentiatedidentity has not (yet) been constructed, whatparadigm can be used to examine the disturbancesstemming from multiplicity?Two hypotheses underlie our line of reasoning.First of all, the hypothesis of the incompleteasserts that a being is in a constant process ofgrowth (becoming). A being is never a whole,nor a finished entity. This statement is nothingoriginal; it is amply affirmed in psychotherapy:The confrontation with what lacks (failings,absence, project not yet achieved) is decisive forthe elaboration of desire. But this aspect has beensystematically forgotten in the exploration of thephenomenon of possession – the notion that asubject can be confronted with situations forwhich he is unprepared and which he is psychicallyunable to elaborate on a psychological levelseems to be inconceivable. The second hypothesisis that of the possibility of intrusions, of abreak-in. The trauma theory (20) examines psychiccontents that break into a psyche that is notready to assimilate them (for example, soldierswho witness traumatic scenes of violence duringthe war, persons present when a bomb explodesin a subway). Such contents can become obsessing:Although the scene took place a long timeago, every time it is evoked it seems to be as vividas it was the first time (for example, a soldier whowas suddenly attacked during the night; manyyears later, he is woken up with a start everynight by this scene). In that case, it means thatthese contents are not developed, not fantasized,not symbolized. If such contents trigger a dissociation,this would only be a secondary effect; itwould be a disorder resulting from a weakenedpsyche trying to integrate these contents (comparethe crypt concept introduced by Abrahamand Torok).(21)When the subject is not undergoing a psychicdisorganization of what has already been constructed,but suffers from the presence of psychiccontents that he is unable to deal with, wouldn’tit be wiser to designate this as an “associative disorder”rather than a “dissociative disorder”? Thismight help to show that the subject has taken elementsinside himself (for example, fantasies andfears) that do not belong to him (for example, proxytraumas). The same can be said of victims of torture.Some disorders result from the assimilation of thetorturers by persons tortured.(22) In other words,the disorder appears because the person was tryingto integrate a psychic content that he shouldn’t.8. COLLABORATION BETWEENPSYCHIATRISTS AND RELIGIOUSPROFESSIONALSWhen a person is said to be possessed, a questioncomes to the fore: What should the clergymanor religious authority (priest, pastor, exorcist,or shaman) be responsible for and what shouldthe psychiatrist be responsible for? Both parties,based on their systems of reference, are concernedabout the person’s autonomy. For the clergyman,the exorcist, or the shaman, the person who complainsof being possessed is thought to have losthis autonomy to think or act. The person is dominatedby forces that he cannot control. To be liberated,the possessed person counts on the authorityof the expert on spiritual matters. The spiritualauthority assumes that benevolent spiritual forces(gods, protecting ancestors, spirits, among others)will intervene and serve as allies to the exorcist or