Classic case: Psychiatric treatment of ghost possession

In 1994 a curious case-report was published in the British Journal of Psychiatry. It described a man who believed he was possessed by a spirit and was successfully treated by medication. Unusually however, the article mentioned that other people had seen the ghost.

Belief in possession is not uncommon in psychosis, the mental state that can sometimes accompany severe mental illness and typically involves delusions and hallucinations.

Psychiatry usually assumes all such experiences to be tricks of the mind, rather than the result of other-worldly powers.

The case-report by Anthony Hale and Narsimha Pinninti (summary) is almost unique however, in that it suggests that the authors are unsure whether the possession was mental illness or spiritual intervention.

As well as making for a gripping read, it reveals some of the assumptions and difficulties of contemporary psychiatry.

Hale and Pinninti entitled their article Exorcism-resistant ghost possession treated with Clopenthixol. It discusses the case of a 22-year old Hindu male who believed he had been possessed by the ghost of an old woman. The ghost reportedly forced him to do ‘wicked things’, including theft of a car, for which he was remanded in prison.

The patient experienced his body being taken over by her spirit and also heard the voice of the ghost commenting on his actions and commanding him to act. These are classic first rank symptoms, first listed by psychiatrist Kurt Schneider as being particularly distinctive of schizophrenia.

So this might be an otherwise unremarkable psychiatric case if it were not for the fact that the prison chaplain, and several of the patient’s cellmates, saw the spirit possess the patient as a ghostly mist. The chaplain was convinced this was a genuine case of possession, as had priests from several other faiths who had previously carried out exorcisms on the patient.

This begs the question, if the patient was treated for his belief in spirit possession and his apparent hallucinations as to the reality of the ghost, why were the chaplain and the others not considered to be ill ?

This article highlights the uncomfortable relationship between beliefs in the paranormal and the assumptions of psychiatry. The results of a recent gallup poll suggested that over 40% of Americans believe in possession by the devil and 15% believe spirits can ‘temporarily assume control of a human body’.

Although psychiatrists would argue that the content of a belief is not enough in itself to diagnose a delusion, the criteria for distinguishing between ‘healthy’ and ‘pathological’ beliefs are notoriously incoherent.

Psychiatrists might be forgiven for sticking to their guns, especially in Hale and Pinninti’s case, where the possession seemed to disappear when psychiatric medication was used. It is all the more surprising then, that the authors consider they may have had a genuine case of possession on their hands.

The article made little impact in the world of psychiatry, although it did generate a little discussion in the Lancet. One notable comment was from UK-based Indian psychiatrist Sushrut Jadhav who remarked on the relationship between the uneasy bedfellows of science and folk-belief:

By juxtaposing ghost possession and exorcism-resistance with clopenthixol, and by equating folk explanations with superstition, one comes face to face with questions that lie at the heart of culturally sensitive psychiatry and public health. Can exorcism and ghost possession be incorporated into the same paradigm of illness that clopenthixol claims to treat ?

The question remains as yet unanswered.

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This is the full case report from Hale and Narsimha’s paper:

A 22-year old unemployed Hindu Indian male, in Britain with his family since the age of six, was interviewed while remanded for theft of a taxi, robbery, and kidnap of the driver. He was apprehensive about prison despite previous remands and one short custodial sentence. He admitted the charges, but claimed that his behaviour was under control of a ghost. Prison staff considered him to be malingering. He was admitted under Section 35 of the Mental Health Act 1983 for reports.

His history emerged from the patient himself, family members, the family doctor, and hospital and prison records. The patient said his problems began at a family gathering when he was aged 11. An aunt, jealous of the success of the patient’s family, fed him and his elder brother cursed sweet rice, rendering them susceptible to spirit possession. His brother was afflicted by years of physical weakness and impotence. The ghost of an old woman intermittently possessed the patient, taking control of his body and rendering him a powerless observer while she made him do wicked things.

Warning of imminent possession was a fog which the patient would see drifting towards him, settling initially on his chest and making him breathless, then entering his body through his nose and mouth, making him retch and wheeze as he resisted, and taking control of his whole body, including his voice. There was no hyperventilation or other features suggestive of a panic attack. There was no history of antecedent events, conflicts or stresses. While possessed, lasting from half an hour to several days, the patient was aware of his surroundings through all senses, although often blunted as though through a haze. He lost motor control, but retained awareness of emotions, remembering fear, anger and guilt. He would ‘struggle’ mentally to prevent his body’s actions, usually unsuccessfully. He experienced command hallucinations, and occasionally the ghost’s voice commented on his actions to unheard others. Even when not possessed, he thought the spirit could listen to his thoughts, punishing him if he told people about her. He remembered most events while possessed.

The ghost forced him into petty pilfering, truancy, shoplifting, car theft (to kidnap, to travel to a cemetery and look at her grave), and to jump from a bridge in front of a train (a punishment for struggling against the ghost’s will).

The patient was an intelligent, well educated and insightful young man, westernised in his appearance and apparent outlook. He said he gained nothing from his behaviour, deriving no excitement from his adventures while possessed and did not need the things he stole, receiving a generous allowance from his family who were financially comfortable professionals. He recognised the effects of his behaviour on the family, from which the jealous aunt took pleasure. Evidence of her continuing malign involvement were spells written on paper and charms of bird feathers scattered around the patient’s home. His parents initially would not listen, fearing stigma, but eventually consulted local religious leaders. They sent him to holy places in India where he was exorcised, by a Hindu priest and later a Moslem peer. Inpatient with the failure, which seemed to increase the ghost’s anger, he unsuccessfully consulted Christian priests.

During the period of remand, the patient displayed periods of nocturnal anxiety, withdrawal, depersonalisation and apparent response to hallucinations. Routine physical examination and blood chemistry, haematology and endocrinology were normal. The patient was apyretic, although complained of being hot. Blood and urine screens for illicit drugs were negative. EEG and computerised tomography scans were normal. Family relationships seemed comfortable and supportive.

We were disturbed by a telephone call from the prison chaplain who described seeing the ghost possess the patient in prison, seeing a descending cloud and an impression of a face alarmingly like a description of the dead woman given to us by the patient, of which the chaplain denied prior knowledge. Similar reports came from frightened cellmates. He and our hospital chaplain concurred on genuine possession. This is an acceptable belief within pastoral counselling (Issacs, 1987).

Western medical belief systems led us to a differential diagnosis of dissociative state or paranoid schizophrenia. However, we were conscious that the beliefs of at least four priests from three different religions cast doubt on the delusional nature of the phenomena.

Exorcism having failed, we prescribed trifluoperazine (4mg daily) producing apparent remission. Following return to remand prison, he was commenced on a depot neuroleptic, zuclopenthixol decanoate, remaing in remission 12 weeks later following hospital transfer.