psychiatry and spirit possession

In this year’s June issue of Ethos, Bambi Chapin (“Transforming Possession: Josephine and the Work of Culture” in Ethos no. 36 vol. 2, pp. 220-245) discusses a question that underlies a – perhaps THE – central assumption on which I base my own research: do cults of religious healing, and of spirit possession in particular, serve the same therapeutic purpose that psychotherapy does?

Cults of spirit possession have been the object of steady anthropological interest over the years. Ethnographers have described these traditions as they are practiced all over the world, from Africa to India to Native American cultures. Unfortunately I have not been able to read much on this topic beyond what has been written about these cults in Morocco (for a classic account, read Vincent Crapanzano’s work on the Hamadsha), but I can refer you to the work of scholars such as Gananath Obeyesekere, Melford Spiro, Janice Boddy, Erika Bourguignon, and George Devereux for accounts of practices elsewhere. The particulars of the way in which these cults are practiced varies widely, of course, but the general idea is fairly universal. In the most basic terms, communities in which such cults are practiced believe in the existence and presence of a certain kind of spirits, deities, or demons, who – at certain times, or for particular reasons – take possession of human bodies. Cults of possession prescribe certain treatments when this occurs. This may involve exorcism, but in a lot of cases it actually does not: rather, treatment consists of attempts, by healers and sufferer, to establish some kind of communication with the possessing spirit and subsequently transform the relationship between spirit and possessee into something more symbiotic – beneficial for both parties. As far as I know, communication with the spirit is in most cases established in ritual performances by inducing a kind of trance-state in the sufferer.

If exorcism is not always sought (even if that is the case because it is thought that exorcism is impossible), this means that spirit possession is not always absolutely negative. And in fact, you’ll often see that the healers in these possession cults are themselves involved in such a symbiotic relationship with a spirit, and that it is from this relationship that they derive their (positive) healing powers. Such healers work themselves into a state of trance to treat and assist supplicants who come to them with a wide variety of physical and social troubles. Many sufferers from possession go on themselves to become members of these cults, reinducing trance at frequent intervals to re-establish the relationship with their spirit.

Nevertheless, scholars of spirit possession mostly agree (as does the DSM-IV) that spirit possession is an expression of something psychologically pathological. In other words, the general consensus is that spirit possession is a culturally specific way of displaying symptoms of psychosis, dissociation, social anxiety, and such. That is, while a western psychotic may believe himself to be the reincarnation of Elvis Presley, a psychotic member of a community that believes in spirit possession may believe his body to be taken over by a demon.

The phenomenology of spirit possession is often described as episodes of a complete loss of control and consciousness – I imagine it as a sort of fainting or swooning – during which the spirit exerts complete power over the possessed body, displaying his (or her) control by making the body do extreme or inappropriate things (according to the standards of the cultural environment at hand). It is described by scholars as akin to what we in the world of the DSM and ICD know as an episode of dissociation – a state in which a person is so lost in internal goings-on that he or she loses touch with external reality. This becomes problematic when these episodes recur habitually, and do so outside of a person’s control. Dissociation often occurs in response to traumatic experiences, and may thus be a part of disorders like PTSD. Indeed, most possessees described in the ethnographic literature have experienced considerable (social) trauma in their lives leading up to the first experience of possessed trance (for some great ethnographic descriptions, see Obeyesekere’s Medusa’s Hair).

But while there is consensus on the pathology of spirit possession, there is disagreement about the purpose of these ritual performances. Specifically, there is disagreement about whether or not such performances – those ritual inductions of trance – work as a form of ‘treatment’, or whether they just allow the possessed person to express his or her symptoms. Chapin nicely lays down the point of contention in her article. Scholars like Mel Spiro believe that only western psychoanalysis can adequately treat symptoms of dissociation and/or psychosis. Ritual performances provide a space for a sufferer to express these symptoms, but that’s where it ends. For Spiro, the experience of spirit possession is a form of hallucination, and belief in its reality is pathological, because it shows an inability to distinguish between mental representations and actual reality. The cult lends cultural legitimacy to the symptom by ritualizing it – its expression thus gains a level of social acceptance. But because the cult ultimately reinforces this belief in the reality of possession, it only reinforces the pathology. No therapy is provided, because nothing is done to return the sufferer to reality.

Obeyesekere (and others with him, I’m sure, but Chapin – whose work I think relies heavily on his – mentions him as the representative of this viewpoint) disagrees. For him, the cultural meaning given to the symptoms actually carries the seed for resolution and catharsis. By providing the sufferer with culturally meaningful ways to express his or her inner conflicts, a kind of transformation becomes possible. When the mode of expression – the symbols used – are both deeply personally AND culturally meaningful, a connection between inner and outer worlds is established, the person is no longer lost inside himself but can reconnect; with this shared language, sense can be made of the experiences, control over one’s inner conflicts can be regained, and relationships with the outside world can be re-established.

Chapin, of course, sides with Obeyesekere, and provides an interesting ethnographic illustration of one woman ‘cured’ by her association with possession cults. What cures, she points out, reinforcing Obeyesekere’s arguments about “the work of culture,” is the cultural connection provided by these cults. For that cultural connection entails a few things that are crucial to catharsis. In a very simple sense, it provides an audience who understands. When you are able to express your experiences in words that make sense to your audience, those experiences don’t seem so anomalous and weird and ‘crazy’ anymore. They make sense, they can resonate with others’ experiences, or concepts and beliefs common to a cultural world. All this means that you have a basis to reconnect with your community. While psychiatric suffering often leads to marginalization and even ostracism, this kind of establishment of a shared language enables a re-integration.

But what “the work of culture” also effects – and this I think is very important – is a sense of control and mastery over one’s symptoms. In my research thus far, I’ve come to the belief that a loss of agency is a crucial element in suffering from a psychiatric disorder. It often goes along with an utter sense of having lost control over one’s mind, thoughts, and/or emotions. And, according to most scholars of possession cults as well as many scholars of mental illness in the west, the onset of such distress is often triggered by experiences of powerlessness (including trauma) in one’s daily life. Treatment, then, involves the regaining of control. Medication can regulate the chemical pathways in your brain, and you yourself can regulate the administration (dosage, timing) of medication. Alternatively, talk therapy can help you pinpoint exactly what’s gone wrong in your head (or behavior) – and once a problem is identified, a solution often becomes apparent. It’s Foucault’s power-knowledge: defining something means establishing control over it. Once you know something you can come to master it. The same is true of these possession cults. By lending meaning to one’s experiences, these cults help sufferers understand – come to know – what they are going through. Moreover, the ritualized performances provide a very overtly controlled way of giving expression to one’s experiences. In other words, these ritual performances allow the sufferer to regain some mastery over his inner conflicts, and thus enable him to resolve them. The trance – and loss of consciousness and control – that first occurs beyond the sufferer’s control – is transformed into a willfully and ritually induced state. A healer who him- or herself has a symbiotic relationship with a spirit, deity, or demon still experiences these trances, these episodes of dissociation. But the big difference is that now, they are deliberately induced in a very controlled fashion, and the individual remains in control of the experience – to the extent that he or she remains ‘present’ during the episode to effect healing cures through the power of the possessing entity.

In a sense, psychiatry works in the same way. I think that it, too, provides a culturally acceptable framework to understand one’s suffering – in this case, one that resonates with our beliefs in the truth of medical science and brain chemistry. Because it provides such culturally resonant meanings, the patient can re-establish a connection with the environment (it goes something like this: because it’s not him but a skewed brain chemistry, he’s not just acting out. It’s not his fault, so we can welcome him back into the family. There is, as you can see, a moral element involved here. That might be something for a future post). And, as already mentioned above, psychiatry provides ways for the sufferer to regain some control – whether it be chemical or psychodynamic.

My dissertation research will be comparing psychiatry to religious healing traditions in Morocco, exploring what makes individuals choose one form of treatment over the other, and the impact of that choice on their experience of illness. I base all this on the fundamental assumption that both are, in fact, valid forms of treatment, and on the assumption that both are forms of treatment that work because they attach some form of cultural meaning to an inner experience of suffering. I believe strongly in both assumptions, but I’m very glad that someone else does, too.

The article was interesting for me also because it brought up some issues that really intrigue me about spirit possession.

First of all, there is the question of what all this means for the definition of psychiatric illness and its treatment. If we believe that possession cults can treat (certain) psychiatric disorders, what does that imply for the nature of such disorders? For instance, does it deny a biochemical component? And if treatment is so culturally specific, what is the role of culture in the nature and experience of illness? If Spiro believes that only psychotherapy can treat psychiatric distress, even in areas of the world where this is not a common practice, this must mean that all psychiatric disorders everywhere are of similar nature. But if someone in Sri Lanka (in the case of Obeyesekere’s and Chapin’s work) responds to possession cults in the same way that a sufferer from PTSD responds to psychotherapy, does that mean that their illnesses are fundamentally different? Personally, I’m inclined to say no. I think that in the end, both biochemical and socio-psychological factors are involved in the development of mental illness. I think culture plays a huge role in our experience of such distress – because culture plays a role in shaping all of our mental activity. Anyone who has been used to speaking two languages from a young age will know that you think about things differently in different languages, because things are conceptualized differently. It makes sense, then, that the way you understand your inner conflicts should also be shaped by the meanings and beliefs prevalent in the culture you are a part of – and as such, it makes sense that each culture offers specific, culturally meaningful, ways of resolving those conflicts.

Chapin also brought up a few elements of possession that I have come across in my own research on these cults. My focus has been on Morocco, which is a literature that Chapin does not cite (it’s too outdated, probably), but the similarities with her discussion strike me. One such element is related to something I briefly mentioned above – the fact that spirit possession does not seem to be an absolutely negative phenomenon. When it takes you unawares, possession is a bad thing – that loss of control is undesirable, and the possessing spirit is depicted as a force of evil and maliciousness. Yet there is some seed of potential power in there, too. Possession can become a positive force of empowerment, too – it becomes a special connection with a spirit or deity, a link to the supernatural that lends one unique abilities such as that of healing. There seems to be a fine line, then, between the forces of good and evil. A possessing spirit can be both deity and demon, and possession can link you to the power of divine grace, or ensnare you in the temptation of a demon. Which way the scale tips, seems to be mostly up to you, and your ability to communicate with and control the spirit inside of you.

Another very interesting issue is the fact that possession always seems to carry a certain sexual charge. The relationship between spirit and victim always seems to carry certain sexual undertones – or a kind of gender-contrast, in the least. Chapin’s ethnography seems to draw attention to this, as did Obeyesekere’s. For the women who establish these intimate relationships with deities, it often means the renunciation of ‘earthly’ sex with her husband, and the symbols that express a woman’s relationship with a god are often sexual in a very Freudian way – phalluses everywhere. Moreover, most of the women described by Obeyesekere (and also the one described here by Chapin) have undergone rape, incest, or other kinds of forced sexual encounters, as part of the traumatic events of powerlessness that preceded their possession. It seems that sexuality (and perhaps there is a larger truth to that), like the spirits, can be both good and evil. For a woman, it can be synonymous with an ultimate powerlessness, the kind of serious trauma that would lead to dissociative symptoms. But of course, it can also be empowering, positive, the source of energy and life, the productive force one gains when a symbiotic relationship is established with a deity.

These accounts of women in Sri Lanka make me wonder how all this works for possessed women in Morocco. Vincent Crapanzano (1973, 1980) describes only men, but in his account too the gender contrast is important. He also identifies experiences of powerlessness as the source of the inner conflict expressed through possession. Crapanzano explains these experiences of powerless as a symbolic ‘feminization’ of the suffering man: because masculinity stands for dominance and femininity for submission, being possessed by a spirit means being deprived of one’s masculinity. Like it does in Sri Lanka, treatment involves the establishment of a more productive relationship with the spirit – the re-establishment of control over the relationship, the reclaiming of some dominance or autonomy, and as such, the reclaiming of one’s masculinity. Paradoxically and interestingly enough, the possessing agent is most often a female demon, a jinniyya. So it is a female force that deprives the man of his masculinity, that takes complete possession of a man and renders him unable to resist. To take this even further, Crapanzano suggests that treatment (the regaining of masculinity) must occur through infusion of the sufferer with the power of divine grace – a symbolic impregnation.

If it is a female force that takes possession of a man, femininity cannot stand simply for submission, it cannot simply be equated with weakness and dependence. It means that in fact, femininity is dangerously powerful. This idea is expressed forcefully by Fatima Mernissi, the well-known Moroccan feminist author who, in the days that she wrote about women and Islam, argued that Muslim women were not secluded in the harem because they are so weak, but because they are in fact so powerful that a woman’s simple gaze can send a man – and society as a whole – into frenzied chaos (another well-known feminist author – Nawal el-Saadaawi – makes similar arguments).

All this suggests to me that female participation in the possession cults of Morocco must be complex. I wonder how notions of gender and sexuality inform their experience of inner conflict, of possession, and of treatment. I wish I could end this post with some kind of answer to these questions, but I have none at the moment. All this is going to be a central pursuit of my dissertation research.