‘Do you believe in spirits?’ is a question relatives ask me of patients suffering from possession or trance states. Usually they have come to see me out of desperation, the usual rituals and ceremonies having failed to cure the patient.  Trance and possession states are commoner in Asian countries than in the West. Trance states are a detachment from one’s surroundings. In possession states, the personal identity is replaced by a new identity, attributed to the influence of a spirit, power, deity, or other person. They are associated with stereotyped “involuntary” movements and amnesia.

Possession states are seen in almost all societies of the world. In a global survey in 252 societies, states of altered consciousness were attributed to possession. In most cultures possessing agents were thought to be spirits of deceased individuals, deities, animals, or devils. However, the identity depends on the culture.

Sri Lanka is home to the Theravada form of Buddhism. In its pure form, it is not a religion that endorses superstition. There is, however, a strong belief in the occult that pervades our culture. Its origins predate the arrival of Buddhism. There are two forms of healing ceremonies practised in Sri Lanka, the Bali and the Thovil. In the Bali ceremony the presiding deities of the planets (graha) are invoked and placated in order to ward off their evil influences. When a person is seriously ill the horoscope would be consulted, and if the person is under a bad planetary influence, the astrologer might recommend a Bali ceremony. A Thovil ceremony is an exorcism to drive away malevolent spirits, known as yakshas, who are capable of bringing about pathological states of body and mind.

A trance deliberately induced as part of a ritual is not regarded as a disorder. If such states occur spontaneously or persist outside of the ritual practice, they are classified as a mental disorder. These disorders pose a problem for Western oriented psychiatric diagnostic systems such as the ICD-10 (International Classification of Diseases). In this classification trance disorder and possession states are classed under a category called dissociative disorder.

In trance disorder, the individual’s attention narrows down to one or two aspects of the immediate environment. They lose a sense of personal identity. In possession states, individuals act out an identity different from their normal one. Individuals speak in a strange voice and take on the identity of the spirit that supposedly possesses them.

The group of psychiatric disorders called dissociative disorders was originally called hysteria. The origin of the term is traditionally attributed to Hippocrates. Derived from the Greek word hystera for uterus, it was thought to occur only in females. The term was popularised by the French neurologist Jean Marie Charcot, who held public demonstrations showing him hypnotising ‘hysterical’ patients. In the 1890s Freud wrote a series of articles on hysteria later compiled into his book Studies on Hysteria. Freud thought that hysterical symptoms protect the patient from mental stress (anxiety) or conflict.

Due to its pejorative connotations, hysteria is now called ‘dissociative disorder.’ Dissociative disorders are characterised by a disruption to the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behaviour.

Several types of dissociative disorders are described depending on the affected function. The most dramatic form is motor paralysis where an arm or leg becomes paralysed even though the nerves supplying the muscles are normal. In the sensory type, a part of the body becomes insensitive to pain. The loss of sensation is sufficiently complete for a needle to be inserted into the area without causing any pain. In dissociative amnesia, the person loses memory for a specific usually traumatic memory. In another type, the person forgets his or her identity and wanders away from home. In dissociative possession states, the person takes on the identity of another person usually a dead relative and speaks in that person’s voice.

Dramatic though they may be, there is nothing magical or supernatural about dissociative states. Psychological models explaining dissociative states have been described by Freud and others and have been successfully used in therapy. Freud postulated that hysteria was caused by the unconscious emotional conflicts, the resulting anxiety is reduced by being converted into a physical symptom. He called this the primary gain. Secondary gains are external advantage such as not having to work, which arise as a result of the symptoms.

Let me illustrate these theories with a few case examples. A schoolboy good in his studies was bullied at school. He did not want to tell this to his parents as he thought he would be called a sissy by his classmates. He suddenly became paralysed in both legs. This dissociative paralysis enabled him to resolve his conflict. Because his legs were paralysed he had a legitimate excuse not to attend school. He also did not need to reveal the real reason for avoiding school.
In another case, a young man on reading a letter from his girlfriend breaking off the relationship suddenly became blind. He could not remember what caused his blindness. A young woman who was mentally and physically abused by an alcoholic husband for years was possessed by the spirit of the husband’s dead mother who severely warned the husband of dire consequences if he continued his abuse.

In all these cases, no magic was used in treatment. Simple psychotherapeutic techniques overcame the problems. In the case of the schoolboy, further questioning revealed the problem at school. After intervention by teachers and the parents the bullying stopped, the paralysis disappeared, and he went back to school. In the case of the young man who became blind, the treating psychiatrist was a competent hypnotist. A hypnotic trance state was induced, and the man taken back in time to the moment just before he became blind. He was suddenly able to see and remembered reading the letter from his girlfriend. He of course had to deal with the grief of losing his girlfriend. In the case of the possessed woman, you might well say that the possession is useful in preventing the husband from abusing her.

owever it is likely that over time the husband would lose his fear of his dead mother’s spirit and resume the abuse. A considerable amount of money had been spent on rituals to exorcize the spirit of the dead mother and the husband’s alcohol problem was not helped. A family meeting was held, and the woman was allowed to go on about the husband’s abuse. She was taught better coping skills and the husband treated for his alcohol problems. The spirit of the dead mother went away at least for the time being.

Hippocrates (460 BC to 370BC) is the father of Western medicine. He taught that diseases were caused by natural causes and not by Gods or supernatural forces. His greatest contribution to medicine was to separate the discipline of medicine from religion. Yet more than 2000 years after his death people continue to attribute supernatural causes for disease. This is especially so for mental illness. Perhaps it is because there is a cause for most physical illnesses but mental illnesses are identified by their symptoms and not by their cause. For example, we know that tuberculosis is caused by an organism visible under the microscope but manic depressive psychosis, a mental illness, is transmitted genetically and has a definite physical cause. We do not as yet know the exact cause; therefore it is diagnosed by a characteristic cluster of symptoms.

Why should this be? As Hippocrates said, “Men think epilepsy is divine, merely because they do not understand it. But if they called everything divine which they do not understand, why, there would be no end to divine things.” People are more likely to attribute supernatural causes to events or phenomena for which there is no scientific explanation. But again to quote Hippocrates, “We will one day understand what causes it (referring to epilepsy), and then cease to call it divine. And so it is with everything in the universe.”

Isn’t belief in astrology, horoscopes, spirit possession and its connected rituals harmless? Isn’t it a part of the culture of a nation and hence to be respected and valued? I do not believe that it is harmless. Consider the huge amount of time and money spent on these rituals with little benefit to the person. Consider the mental trauma that a person undergoes when given a dire prediction about the future that never happens. Consider all the problems that remain unresolved and the illnesses that are untreated because the patient or relatives are pursuing the occult. It is evident that such pursuits are extremely harmful.

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