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ABC

ABC (anthropology, biology, culture) of ghost and psychiatry

Shyamanta Das1, Uddip Talukdar2, Maheshwar Nath Tripathi3

1Assistant Professor, 2Registrar, Department of Psychiatry, Fakhruddin Ali Ahmed Medical College Hospital, Barpeta, Assam, 3Service Senior Resident, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Abstract

Possession is a common manifestation of distress in a multicultural setting and it is increasingly likely to be encountered by mental health professionals who may be unaware of the phenomenon. It can be said that a definition of delusions requires the invocation of cultural understandings, standards of acceptability, as well as conceptions of reality and the forces that animate it. Cross-cultural concepts of reality are related to the development and the threshold of hallucinations. Approaches to trance and possession in anthropology have tended to use outmoded models drawn from psychodynamic theory or treated such dissociative phenomena as purely discursive processes of attributing action and experience to agencies other than the self. Judging from the available anthropological and psychiatric literature on spirit possession in South Asia, it appears that if the possessing entity in not a supernatural being (e.g. ghost, demon, god, etc.), but rather a human personality, then the episode will be perceived as mental illness, and psychiatric treatment will be sought. Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the ICD and DSM classificatory systems are rarely made in this setting. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms. Locally prevalent ghosts help understanding phenomenology which in turn works in proper management.

Keywords: Possession, Delusion, Hallucination, Dissociation and Phenomenology

 

Introduction

An Indian man now in Britain explained his criminal behaviour as episodic ghost possession.1 Traditional exorcisms failed to help.1 A ‘Western’ diagnosis of dissociative state or paranoid schizophrenia was made.1 Treatment commenced using trifluoperazine and clopenthixol.1 The patient underwent remission during neuroleptic treatment, despite previous evidence of genuine possession.1 Many cultures give rise to apparently genuine cases of ghost possession.1 Neuroleptics may relieve symptoms of exorcism-resistant possession.1

The nature of ghosts2

Although ghosts and apparitions have been reported for thousands of years, surprisingly little information is available with regard to their nature or essence. Ghosts are elusive and unpredictable, and the ways in which they manifest are surprisingly diverse. Much of the available data is anecdotal and is therefore prone to exaggeration, embellishment, and sometimes outright deceit.

Although studies suggest that approximately one in ten of us has the ability to perceive ghosts, those of us who are actively looking for them are apparently the least likely to have a ghostly experience. Children seem more apt to experience manifestations, suggesting that adults develop some kind of blocking mechanism as they mature. Women seem more attuned than men, and it appears that the higher your intelligence quotient (IQ), the less likely you are to experience ghostly phenomena.

There are five interesting theories to consider regarding the basics of ghostly manifestations.

Theory one: Ghosts are the earthbound souls of the deceased—This is the most common interpretation when confronted with a visible apparition, and it certainly does fit many haunting where the apparition is more or less recognizable as someone who is deceased. For most of us, this theory is also comforting, as it hints at a life after the physical body is gone. We know from science that everything is composed of energy. The theory is that when the physical body dies, this energy continues on in some form and can be tapped by living persons sensitive enough to perceive it.

Theory two: Events are somehow recorded in certain surroundings to be replayed over and over to living people sensitive enough to discern them—This theory accounts for a lot of our ghost legends and is likely the source for virtually all haunting that repeat again and again, such as the many “lady in white” sightings and ghostly battle reenactments. The catalyst that starts the recording is usually very emotional or violent, such as a war or a mother losing a child. They are reported as walking through walls or just disappearing into thin air, and they do not appear to be conducive to photography, though electronic voice phenomenon (EVP) recordings are occasionally successful. Although most concur that these types of apparitions do appear to be “recorded” somehow in the surroundings, there is disagreement on how exactly we as observers perceive these recordings. One side postulates that it is something within the observer that sets the recording in motion, and that the recording thus “plays inside our heads.” The other side postulates that the recording is being played externally for all to see, but that only those with the right “antenna” can experience it.

Theory three: Apparitions are created from some type of naturally-occurring electrical, magnetic, or electromagnetic condition—Many serious paranormal researchers believe that measurable properties such as electricity or magnetism play a part in why we experience ghostly encounters. One of the few things we do know for sure is that paranormal phenomena is more likely to be experienced at night, and sure enough, there is an scientific explanation for why this may be. In short, the earth is covered by a fluctuating membrane we all know as the atmosphere, which is constantly being bombarded by a strong solar wind from the sun. During the day, this membrane is at its thinnest and densest because it is being directly hit by the solar wind. However, at night, when sheltered from the sun, it expands much farther into space and has much less resistance. This explains why television and radio stations come in better at night, and why you can tune into stations much farther away than is possible during the day. Therefore, the reason we see more paranormal activity at night is because there is much less resistance to every kind of magnetic and electrical current or force, making it easier for energy-based manifestations to appear.

Theory four: Ghosts are actual beings living in one or more parallel dimensions—The concept of a parallel universe is a fairly complex one. To put it simply, this theory suggests that there are one or more (perhaps an infinite number) of complete universes co-existing with us on a plane we are generally not aware of. Any type of spectral appearance, sight, sound, or anomaly can fit into the theory of parallel dimensions. Thus, when we see an apparition, especially one seemingly from another time and place, it could be that we are getting a rare glimpse into another dimension or reality and we are seeing events develop in that plane of existence. Interestingly, it is also theorised that each of us even have parallel selves living on different planes in different stages of development and that we may be aware of them at times on a subconscious level. Obviously, this theory is just that - a theory - but it is a particularly tantalising one.

Theory five: Ghosts exist only as figments of our imaginations—This theory can be made to apply to every kind of paranormal manifestation there is, and in some cases, it is probably at least in part correct. Medical studies have proven that when certain parts of the brain are stimulated, various perceptions are disturbed, such as visual, auditory, and tactile functions. Various external stimuli such as very low frequency sound waves and high fields of electricity can cause hallucinatory experiences that for the subject are indistinguishable from reality.

Indeed, schizophrenics often relate seeing, hearing, and even talking to very real entities that nobody else can see or hear. Are they really seeing things that nobody else can see or hear? The consensus seems to be no - it is “all in their heads” due to “short circuit” in the make-up of their brains. However, there are still a lot of questions left unanswered by this theory, such as when more than one person sees the same phenomena. Skeptics use the term “mass hysteria” for situations like this.

Ghosts: explained medical way3

Most ghostly encounters are not visual, but rather consist of noises, smells, sensations, voices, cold spots, electrical disturbances such as lights switching off or on, and displacement or movement of objects. Schizophrenic patients are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colours, and other features of their environment.

Sleep paralysis4

“I couldn’t move and there was a disorientating continuous buzzing down the side of my bed which I could not turn to look at because I couldn’t move, I struggled, I was petrified, I thought I was dying. After this first one, I told no one because I thought that there was some kind of demon that came to menace me, or was it just sleep paralysis?”

In Nepal, people often believe it to occur due to covering of the body by “khyaak” when they have similar experience of sleep paralysis. “Khyaak” is a kind of ghost/demon that is believed to reside in the dark. Sleep paralysis is something of different cultures has constantly reported about for thousands of years. Different cultures at different parts of the world have different figures associated with such kind of experience. But is sleep paralysis really caused due to demon or is there some medical reason?

Medical concept: Medically, sleep paralysis is a flaccid paralysis at sleep onset or on waking and in otherwise healthy person characterised by an inability to ‘kick start’ the voluntary muscles, resulting in a transient ‘locked-in’ syndrome. It is associated with narcolepsy, Pickwick Ian syndrome, sleep apnoea, cataplexy and hypnagogic hallucinations. Cases of reported alien abduction are also commonly associated with this condition.

Types

a.       Hypnagogic or predormital sleep paralysis: It occurs while you are falling asleep and as you fall asleep, your body slowly relaxes. Usually you become unaware of the change but if you remain aware while falling asleep, your motion and speech is ceased.

b.       Hypnopompic or postdormital sleep paralysis: It occurs when you are waking up. During sleep, your body alternates between REM (rapid eye movement) and NREM (non-rapid eye movement) sleep. During NREM sleep, your body relaxes and restores itself. At the end of NREM, your sleep shifts to REM. Your eyes move quickly and dreams occur, but the rest of your body remains very relaxed. Your muscles are “turned off” during REM sleep. If you become aware before the REM cycle has finished, you may notice that you cannot move or speak.

Hallucinations consist of strange electrical noise (sound), pressure on chest, false sensation of someone standing by or moving, etc.

 

Demonic possession5

“Demonic possession” is often termed as the paranormal phenomenon involving entrance of demon(s) inside a body (more commonly used for living person) to possess control over it. If we describe it as portrayed in the movie “The Exorcist”, it is characterised by erased personalities, fainting, convulsions, knowledge of foreign languages, hidden secrets and future, drastic changes in vocal intonation and facial structure, superhuman strength, etc. which persists until the demon leaves or is forced to leave the body.

Religious concept: Different religions have different concepts on demonic possessions. They suggest “exorcism” as the way to get rid of the possession though they are performed differently in different religion (performed by priest in Christianity and shamans in Hinduism). Prayers, sprinkling of holy water, beating, etc. are some forms of exorcisms.

In the Middle Ages, people or animals were believed to be possessed if they had any one of the following symptoms: ability to curse or speak in unknown languages, ability to make abnormal physical efforts, ability to read minds or predict future happenings, fear of holy objects like the sign of cross, lacked the ability to say the word Christ, spitted or vomited excessively.

Medical concept: It is considered to be one of the many forms of insanity in medicine (more precisely psychiatry). There are many psychological ailments commonly misunderstood as demonic possession. Some of them are hysteria, mania, psychosis, schizophrenia, dissociative identity disorder (DID). Of these, most commonly people misunderstand DID as demonic possession.

Accusations: It becomes equally important to discuss about those who accuse others of being possessed. In that case we may be facing “collective hysteria (also called mass hysteria)”. Collective or mass hysteria is the sociopsychological phenomenon of the manifestation of the same or similar hysterical symptoms by more than one person. A common manifestation of mass hysteria occurs when a group of people believe they are suffering from a similar disease or ailment. Between 1533 and 1697, many people lost their lives during exorcisms or similar stuffs due to accusations made by children and teenagers. Many of them apologized later due to remorse. This is a case of simulation. In Medicine, simulation is defined as the conscious process of feigning illness in order to gain some particular end. A person easy to influence can be convinced by others of being demon-possessed. The number of “demon-possessed” people and accusers was higher in women than in men because hysteria which is more common in women compared to men is the first step to all other diseases mentioned above.

Accusations made about witchcraft (occurs mostly in villages): The accusations generally rise with the reason for the illness of local people. Illiteracy is obviously the root cause for this but there is much news about such accusations due to superstitions, enmity against the victimised, and political interference. There are no clear legal provisions and null professional commitment of the educated sections of the society which makes the problem more severe.

 

Asomiyaa bhoot

Let’s analyse three local ghosts of Assam, India.

Setting: Men attending jaatraa party (a form of theatre), usually at a distant place, along with use of alcohol or other psychotropic substances, return late at night either by walking or cycling. They sometimes complain of seeing a group of children playing among themselves under groves of bamboo, which is abundant along the village roadside in Assam. However, no harm is complained of by these people but, they are frightened, chant some religious songs and they reach home safe. Sometimes, some of these men are found senseless in the roadside who later complain the apparition.

 

 

Interpretation: Sleep deprivation, possible electrolyte imbalance following exertion along with substance use may be responsible for visual hallucinations. Can jaaukaar paal be a local manifestation of Lilliputian syndrome, and thus suggesting the possibility of short-term delirious state due to exertion related or substance related dyselectrolytaemia?

 

Setting: Jakhinis are supposed to steal fried fishes from the kitchen while it is being kept aside during frying. The usual complaint is that the cook finds the fried fishes missing. Usually it is found only after the whole frying business is done. Sometimes, the cook also complaints seeing a hairy hand stealing away the fishes through the wall, and hears sound of chewing outside. 

Interpretation: In big joint families of Assam, the cooking for whole family is done by the daughter-in-laws (as. n. buwaari) of the family. However, the above phenomenon is found only when one person is working in the kitchen. The young daughter-in-laws in the family are supposed to eat only after the whole family takes food. Most of the time the bigger fishes, which are supposed to be the tastiest, are given to male members in the family. Thus, these daughter-in-laws usually do not get to eat these. So, the jakhini phenomenon may be interpreted as a dissociative amnesia (DA), in which the person consumes the delicacy by herself and the resulting guilt dissociates to interpretation of a ghost.

Setting: A tall, well-built elderly man dressed in white, mostly helpful, is met. He shows correct ways to lost one. At times thieves encounter him, usually when the attempt is to steal from religious places like kirtan ghar. The thief becomes unconscious seeing buraa daangoriyaa and reveals the incident later.

 

Interpretation: It may be the manifestation of the good unconscious. Confession of the thief may dissipate the guilt feeling of stealing from religious place, thus serving secondary gain. Encounter with buraa daangoriyaa and subsequent unconsciousness is the primary gain. So can we say it to be superego, and the phenomenon as another form of dissociative disorder?   

 

Ghost and psychiatry

Possession is a common manifestation of distress in a multicultural setting.6 It is increasingly likely to be encountered by mental health professionals who may be unaware of the phenomenon.6 The case of a 31-member family displaying mass hysteria in up to ten members at one time is reported by Mattoo et al.7 The mass hysteria emerged in the context of the strong religious and cultural beliefs held by this closely knit family. The varied presentations included somatoform disorder, recurrent vomiting, conversion, dissociative and possession attacks. Two members had bipolar affective disorder that was recognised by the family as a ‘medical’ illness in contrast to other problems attributed to religiosity.

A study of possession was made on 1,029 inpatients (male 562, female 467) in Japanese mental hospitals.8 The results were: (1) The incidence of delusion of possession in the sample was 20.7% for the sample as a whole. (2) As to the contents of delusion of possession, possession by a god was most common. In regard to the difference between the sexes, females were significantly more likely to be possessed by a god than were males. (3) As to the difference between the possession group and the non-possession group, religion, fortuneteller contact, age and diagnosis were significant. (4) As to the characteristics by district in regard to the incidence of delusion of possession, cases of possession were very few in Tokyo and many in Okinawa.

It can be said that a definition of delusions requires the invocation of cultural understandings, standards of acceptability, as well as conceptions of reality and the forces that animate it.9 For these reasons, the determination of delusional or normative ideation can only be effected properly within particular cultural contexts.9 The cross-cultural record suggests that it is difficult to separate the delusional from the cultural; a belief that is patterned and culturally specific is, by definition a cultural, not a delusional belief.9 One must rely upon particular, relevant local cultural understandings to ascertain when the bounds of culture have been transgressed and meaning has given way to unshareable nonsense.9

Cross-cultural concepts of reality are related to the development and the threshold of hallucinations.10 Attitudes toward hallucinations tend to affect the emotional reaction to, and the degree of control of, these experiences.10 Awareness of these attitudes may help the diagnostician to distinguish between pathological and culturally sanctioned hallucinations.10 It is important that therapists consider the functional significance and meaning of hallucinations as well as the social context and the stimuli associated with them.10

Approaches to trance and possession in anthropology have tended to use outmoded models drawn from psychodynamic theory or treated such dissociative phenomena as purely discursive processes of attributing action and experience to agencies other than the self.11 Within psychology and psychiatry, understanding of dissociative disorders has been hindered by polemical “either/or” arguments: either dissociative disorders are real, spontaneous alterations in brain states that reflect basic neurobiological phenomena, or they are imaginary, socially constructed role performances dictated by interpersonal expectations, power dynamics and cultural scripts.11 Integrative model, grounded in a cultural neuroscience, can advance ethnographic studies of dissociation and inform clinical approaches to dissociation through careful consideration of the impact of social context.11

Psychoanalytic theory appears flawed in its notions of universal oedipal conflict and repression, and unsuitable for the study of pathological spirit possession in South Asia.12 The biological theory of contemporary psychiatry is no more effective in this analysis because mental illnesses are constituted within culture-bound categories of experience.12 Dissociation theory offers a better theoretical tool for this type of research.12

Psychoanalytic theory appears flawed in the way it has been traditionally applied in anthropological studies of spirit possession in South Asia.13 It is suggested that pathological spirit possession in South Asia has a similar a etiology to multiple personality disorder in North America, which is caused by spontaneous trance reactions to extreme situations in the environment, particularly child abuse.13 Judging from the available anthropological and psychiatric literature on spirit possession in South Asia, it appears that if the possessing entity in not a supernatural being (e.g. ghost, demon, god, etc.), but rather a human personality, then the episode will be perceived as mental illness, and psychiatric treatment will be sought.13

Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD) and American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) classificatory systems are rarely made in this setting.14 Moreover, it was found that a significant percentage of patients seen in psychiatric practice may not fit into the defined subcategories of dissociative (conversion) disorders of these systems of classification.14 Spiegel et al.15 make the following recommendations for DSM-5: 1. Depersonalisation disorder should include derealisation symptoms as well. 2. Dissociative fugue should become a subtype of DA. 3. The diagnostic criteria for DID should be changed to emphasise the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative trance disorder should be included in the unspecified dissociative disorder category. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms.15

 

Take home messages

Locally prevalent ghosts help understanding phenomenology which in turn works in proper management. There is a need of central data collection unit with reporting from multiple sites and their proper analysis.

In conclusion, quotation from an Elizabethan playwright is relevant to the theme of this paper: ‘Beware you do not conjure up a spirit you cannot lay’ Ben Johnson, The New Inn (Act III, Scene ii).16

 

References

1.        Hale AS, Pinninti NR. Exorcism-resistant ghost possession treated with clopenthixol. Br J Psychiatry. 1994;165:386-8.

2.        The Nature of Ghosts. Mystical Blaze [Internet]. [cited 21 Feb 2012]. Available from: http://www.mysticalblaze.com/GhostsNature.htm

3.        Ghosts: Explained Medical Way. Medchrome [Internet]. [cited 21 Feb 2012]. Available from: http://medchrome.com/minor/psychiatry/ghosts-explained-medical-way/

4.        Sleep Paralysis: Alien Abduction, Demon or Physiological? Medchrome [Internet]. [cited 21 Feb 2012]. Available from: http://medchrome.com/patient/sleep-problems/sleep-paralysis-alien-abduction-demon-or-physiological/

5.        Demonic Possession: Medical Explanation. Medchrome [Internet]. [cited 21 Feb 2012]. Available from: http://medchrome.com/minor/psychiatry/demonic-possesion-explained-medical-concept/

6.        Pereira S, Bhui K, Dein S. Making sense of ‘possession states’: psychopathology and differential diagnosis. Br J Hosp Med. 1995,53:582-6.

7.        Mattoo SK, Gupta N, Lobana A, Bedi B. Mass family hysteria: a report from India. Psychiatry Clin Neurosci. 2002,56:643-6.

8.        Iida J. The current situation in regard to the delusion of possession in Japan. Jpn J Psychiatry Neurol. 1989,43:19-27.

9.        Gaines AD. Culture-specific delusions. Sense and nonsense in cultural context. Psychiatr Clin North Am. 1995,18:281-301.

10.     Al-Issa I. The illusion of reality or the reality of illusion. Hallucinations and culture. Br J Psychiatry. 1995;166:368-73.

11.     Seligman R, Kirmayer LJ. Dissociative experience and cultural neuroscience: narrative, metaphor and mechanism. Cult Med Psychiatry. 2008,32:31-64.

12.     Castillo RJ. Spirit possession in South Asia, dissociation or hysteria? Part 1: Theoretical background. Cult Med Psychiatry. 1994,18:1-21.

13.     Castillo RJ. Spirit possession in South Asia, dissociation or hysteria? Part 2: Case histories. Cult Med Psychiatry. 1994;18:141-62.

14.     Alexander PJ, Joseph S, Das A. Limited utility of ICD-10 and DSM-IV classification of dissociative and conversion disorders in India. Acta Psychiatr Scand. 1997;95:177-82.

15.     Spiegel D, Loewenstein RJ, Lewis-Fernández R, Sar V, Simeon D, Vermetten E, et al. Dissociative disorders in DSM-5. Depress Anxiety. 2011;28:824-52.

16.     Prins H. Besieged by devils--thoughts on possession and possession states. Med Sci Law. 1992;32:237-46.