The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine

by Robert S. Bobrow M. D. M. D.

  His burden of deceit is in many ways a consequence of the society and times he lives in. Believing oneself to be an animal, or being perceived as one by others, is a big negative. But in some cultures, lycanthropy may not be a bad thing. Kulick's paper refers to accounts of a Mexican Yaqui Indian shaman who metamorphosed into an animal via ritualistic use of psychedelic drugs. Also described is the Bororo tribe of Brazil, whose shamans experienced spirit possession, and whose transformations into native animals enhanced their healing powers. Some African shamans use a healing process in which the patient becomes an animal who is unable to suffer the human's disease. So in another time and place, the tiger/man could have been someone sought out by his contemporaries for medical help.

  The particular animal one becomes is also era- and culturedependent. Lycos is Greek for wolf, and technically the wolfman is the archetype. In Europe, the wolf, with its aura of fear, respect, admiration, and power, has been the traditional species identification, although in modern times the dog is becoming more popular. In Africa and Southeast Asia, the hyena, tiger, crocodile, or shark may be chosen.

  Fox Possession

  In Japan, where the fox occupies a special place in folklore, it may become the lycanthropic beast of burden. In "The Interpretations of Fox Possession: Illness as Metaphor," published in Culture, Merhi•iiae and Rsyehuatry in 1991, sociologist Matsuoka Etsuko describes the case of a woman who believes herself possessed by a fox spirit. In Japanese culture, the fox is considered by some to be a deity, and it occasionally becomes an object of worship. The fox is also considered a trickster that can change into a young woman and bend people to its will.

  Shamanistic practitioners still exist in Japan, although they are somewhat hidden. They may be consulted when one suffers from a condition that mainstream physicians can't remedy. Fox-possession would be such a condition, and the woman, known as Michiko, sought advice from a shaman in 1983. The author was studying the shaman and her cult group when Michiko, then age forty-three, presented herself with a complaint of' hearing voices and sounds, which she attributed to foxes. When asked by the researcher how she knew the spirits were foxes, she claimed to have seen one, "very small because it was a spirit."

  Michiko had always had some acceptance of a spirit world (she had tried to contact her dead parents through a medium). She also had a relationship with Japan's mental health system, having been hospitalized at one time for seven months, to no avail. She originally did not consider spirit possession to be her problem, but sought out shamans after the hospitalization, realizing that conventional medicine hadn't helped.

  At first, these shamans didn't help either, but Michiko kept trying and ultimately found the healer whom Etsuko was researching. After several months, however, the fox-possessed patient felt herself to be evolving shamanistic powers, which created a conflict and jealously in her relationship with this shaman. After about a year, she stopped going. Dr. Etsuko followed the patient until 1988. By then, she seemed calmer but still believed in the world of spirits and still felt herself to be possessed, although no longer by a fox.

  Unlike the cases previously discussed, Michiko did not feel she actually u'a a fox, and didn't act like one. She simply believed she was somehow taken over by the spirit of a fox, saw spirit foxes, and at times conversed with them. The parallels with the other lycanthropes, including the shamanistic transformation, are obvious if not identical. To the sociologist author, the fox is a metaphor that enables the patient to understand and explain her symptoms as something concrete and authentic.

  Etsuko also discusses common characteristics of spirit possessions in Japanese and other cultures. Spirits are perceived as capricious, demanding, vengeful, and potentially dangerous. They can adversely affect health and behavior. They must be dealt with: expelled, obeyed, or befriended.

  Past and Present

  Accounts of human/animal flips go back to the Bible. In the book of Daniel (4:32-33), God punishes Babylonian King Nebuchadnezzar by changing him into an ox. Greek mythology as well as ancient Greek medical treatises describe the condition. Then there's the werewolf (literally man-wolf) legend of European folklore. During the Middle Ages, the going belief was that this connoted Satanic influence or demonic possession. Recent medical theories include poisonings with hallucinogenics, either accidental (like the Salem witches' ergot ingestion) or purposeful. Another theory relates werewolfery to a rare, congenital disease known as erythopoetic porphyria, where the skin darkens and facial hair grows effusively, perhaps giving one a lupine appearance and a tendency, via embarrassment, to prefer darkness. Still another speculation posited rabies as a cause. Some feel Medieval "wolf-children" may have suffered from autism.

  Today, lycanthropy is considered a form of psychiatric illness. Unlike homosexuality, I don't see it being declassified any time soon. Four to ten percent of the American population identify themselves as gay, depending on the criteria used, but extensive studies from genetic, environmental, hormonal, and brain-scanning perspectives have provided no consistent data as to how or why homosexuality happens. Gender identity disorder, seen in a much smaller percentage of the population and still on the books as psychiatrically abnormal, must be caused by something, but current paradigms do not seem to be homing in on the answer. How does someone get it into their head, all their lives, that physically they are of the incorrect sex?

  Even more puzzling, how does someone come to believe they are of an entirely different species? Lycanthropy, which may or may not share some possible avenue of causation with gender identity disorder, also represents a bad fit of' body and soul. How does this happen? Even if the delusion, through psychiatric treatment, can be stuffed away out of' consciousness, where did it come from? How can a man, throughout his life and despite therapy, believe he is truly a cat? And how many more like him are concealed within our midst?

  seven

  Intimate Demons: Cacodemonomania,

  or Sex with the Devil; Ghost Possession

  Possessed by the devil. That's a concept that goes back to antiquity and continues to resurface, in all eras and cultures. Nowadays, the "possessed" are psychiatric patients, and most of them can be understood or even righted within the context of what we know about mental illness. But now and then, odd cases pop up.

  A Case of ...

  Consider a report of a British woman, published in 1987 in the journal Psychiatry, under the cacophonous title "Cacodemono- mania," which is the belief that one is possessed by a demon. In this woman's case, she experienced nothing less than having had sex with the devil. Psychiatrists Paula Salmons and David Clarke detailed this story of a married teacher known as Mrs. A.

  Mrs. A.'s history prior to her affliction was what we call unremarkable. She was adopted; infancy and childhood passed without incident or surprise. She completed her schooling and became a teacher. At twenty-three, she married another teacher; they would have three children.

  Her problems began ten years later. She became tired and depressed, and felt unconnected to the events of her life. To the psychiatrists, she appeared to be suffering from an atypical depression plus depersonalization (the technical term for "detached"). She was put on medication, but symptoms of unreality and depression continued for the next two years.

  At about this time, Mrs. A. commenced having strange hallucinatory occurrences. Lying in bed with her husband, she thought he had changed physically. Not the usual thing, like developing a paunch, but rather growing extra eyes and limbs and skin that felt scaly to touch. This only lasted a few minutes, but in its aftermath came persistent mood swings with well-punctuated highs and lows. Once, while taking a bath, she was sure she was shedding large chunks of her skin, and even saw them clogging the drain.

  She was still on medication while this occurred, but then she became pregnant with her third child, so all drugs were discontinued. The pregnancy passed uneventfully. A normal baby girl came into the world, and the situation remained copacetic until the child was four months old. Then,
one day, Mrs. A. suddenly became aware of an intense odor, which she likened to that of a newborn baby. Her own baby was in another room at the time, presumably out of smelling distance. The mother felt that her baby's skin was peeling off in a bizarre way. She saw these peelings wrapped around the refrigerator.

  Some months later, during a reading of the New Testament in a bible class, Mrs. A. got a distinct sense that her own god was different from the god experienced by others. A "force" inside her suggested that there were pleasures available well beyond anything she could experience through reading the Bible. Over the next two years, this woman believed she had sexual intercourse with this force, "as with a man." The episodes included a feeling of'penetration resulting in orgasm, sometimes pleasurable, often not. Sex with her own husband became unpleasant and ultimately repulsive to her.

  Mrs. A. held orthodox Christian religious beliefs. Her minister, whom she consulted, believed she was possessed by a "malevolent force" that was responsible for her behavior and general misery, and that successful treatment must be spiritual rather than medical. Despite his recommendation, she was shortly admitted to a psychiatric hospital.

  The doctors found her to be neat and well dressed. She appeared and behaved appropriately, and established rapport with the staff. But it was difficult for her to detail her "sexual" experiences, and she was a bit evasive on this point. Nevertheless, her emotional mood was normal, although slightly cool. She showed no evidence of any big-time psychiatric illness (or psychosis, as we call it); her thought processes and understandings of things were intact. Physical examination and routine bloodwork were normal. An electroencephalogram (brain-wave test) at first found a minor abnormality, but subsequent testing was normal. A brain CAT scan was also of no clinical significance. Mrs. A. ultimately declined further medical treatment.

  The psychiatrists did not know quite what to make of Mrs. A.'s case. No single psychiatric diagnosis would explain all her symptoms. Delusions and hallucinations are common in the psychosis known as schizophrenia, but this patient lacked other features of this condition. There were no biological features of depression (these might include problems eating or sleeping, unusual fatigue, or inability to concentrate). There was no physical illness found. The authors feel that this is a rare case, but one that is seen occasionally: no single discipline (like psychiatry) adequately explains it. The doctors conclude that "A broader perspective is required," which encompasses the patient's symptoms, subculture, and spiritual life.

  My Father, the Devil

  Others have come to that conclusion. Psychiatrists Eric Schendel and Ronald Kourany, in a 1980 paper, "Cacodemono- mania and Exorcism in Children," reviewed the cases of five children, aged seven through seventeen, whose families thought they were demon-possessed. All were seen at the Vanderbilt University Medical Center in Nashville, Tennessee.

  • An eleven-year-old white boy was brought in because of rebelliousness, school problems, and difficulty getting along with his peers and siblings. His parents had divorced when he was five, and he rarely saw his father. His mother felt that his problems had started when he was seven, after an accident that, she felt, made his legs grow unequally. She sought out faith healers and saw her son's short leg "grow out before her eyes." At ten, a religious group attempted an exorcism, which drove the boy "berserk" but reinforced the mother's belief that her son was possessed by demons. The doctors found the child to be alert, friendly, and well behaved, with normal speech and thought processes. A tinge of depression and low self-esteem was noted. They diagnosed adjustment reaction, depressive type, which means the same in medicalese or English, and recommended outpatient psychotherapy. After nine sessions, however, the mother and boy left town.

  • A seven-year-old white boy was admitted to the psychiatric unit because of aggressive behavior and fighting. His parents had divorced during his infancy; the mother remarried but had mental and marital problems herself. She had tried "everything" to set the child right, without success. A month before the admission, her church members informed her that demons had "taken possession" of the boy and needed to be "driven out." A church service was organized to do just that, but despite some dramatics and the boy's feeling that the demons had left, his behavioral problems worsened. On examination at the hospital, he was alert, cooperative, and clearthinking. He showed a wide range of emotion and had difficulty talking about his relationship with his mother. There was a sense of poor impulse control. He was diagnosed with possible severe anxiety reaction, and showed some improvement during the hospitalization, but his mother signed him out against medical advice.

  • An eleven-year-old white girl became a psychiatric inpatient due to headaches, violent outbursts, and difficulty getting along with her peers. Her parents had divorced when she was two, and she had only sporadic contact with her father. This was a girl who could get quite violent. She claimed to be aware of what she was doing, but was unable to control herself, that "someone else" was commandeering her body. Her family decided she was devil-possessed, and she agreed. She was prayed over by her church and felt better afterward for a while. Upon hospital admission, she was alert, intelligent, and articulate. She seemed older than eleven and a bit seductive. Thought processes were normal. Her diagnosis, tentatively, was conversion reaction, meaning that she converted mental conflicts into physical symptoms. She did well, but her mother had her discharged against medical advice.

  • A seventeen-year-old black girl, an outpatient, believed she was possessed by the devil and that she was seeing the spirit of her dead mother. For the previous three years, she had been paranoid and had been hearing things. Her mother had been murdered when she was twelve, and thereafter she lived with her grandparents and reported sexual molestation by other members of the family. The extended family believed in witchcraft and other supernatural phenomena. Examination found her emotionless, having delusions, and with scrambled thought processes. She was diagnosed with paranoid schizophrenia, the most common type of schizophrenic psychosis. A strong tranquilizer was prescribed, but the teenager never returned.

  • A thirteen-year-old white boy was admitted to the inpatient unit because he was withdrawn and exhibited bizarre behavior. He believed demons had entered his body two years earlier, and at times controlled him and rendered him violent. His parents had divorced when he was four years old, and his mother, with whom he lived, had been diagnosed as schizophrenic. The family subscribed to a number of occult beliefs, and there were frequent conversations about demons and spirits. To the physicians he was aloof and delusional, and he heard and saw things. He was diagnosed as schizophrenic and started on medication, but was removed from the hospital by his mother, against medical advice.

  These five cases have a lot in common. All came from families with connections to the occult. All had lost contact with a parent through death or divorce. Freud had described a case where he felt the devil was used as an unconscious replacement for a man's dead father. Psychiatrist James Bozzuto noted that the book and movie The Erorcia+t described the possession of a girl who had lost a father, and thought such states might represent a defense mechanism against parental loss. In any event, none of these families had much enthusiasm for "modern medicine," and they all turned away from it quickly. None of the five patients above stayed around to be treated by psychiatrists. Doctors Schendel and Kourany seize upon the point that any serious attempt at treatment here must include the families' cultural beliefs and involve a team approach, even involving "an empathetic yet enlightened religious figure from the patient's faith." This is reminiscent of the "broader perspective" needed to understand Mrs. A.'s illness at this chapter's beginning.

  Mrs. A., being adopted, could also be seen as having lost parents. And, like the children above, her worldview included the concept of evil spirit possession (her minister's view was that she was possessed by a "malevolent force"). As noted in the chapter on witchcraft, in order to be susceptible to such malevolence, a person has to believe, and has to exist within a
community of believers. Physicians who understand this may be able to intercede, like the one who made the South American Indian witch doctor reverse his curse, or the one who put a live lizard in his black bag to be produced at the bedside to convince a hospital patient that he was cured.

  I Am Not Myself

  Psychiatrists call it a dissociative disorder when someone seems to separate (i.e., dissociate) from who they actually are. As Kaplan e" Sadoek: Concea,e Terthook ?f Clinical R!yehiatry, 2nd ed., 2004, puts it, they've "lost the sense of having one consciousness. They feel as though they either have no identity, are confused about who they are, or experience multiple identities." Subclassifications of dissociative disorder include trance disorder, and its correlate, possession trance. These are "disturbances in . . . consciousness, identity, or memory that are indigenous to particular locations and cultures." An altered state of consciousness defines these conditions, and may involve hallucinations or feelings of being taken over by an alien, controlling spirit. There is often no memory of the episode.

  The five patients above might qualify. Their belief systems allowed for demons or the devil. Their perceptions and actions appeared not to be under their control. Sometimes the explanation is simple. In an earlier edition of the Textbook, an example is given where a husband's guilt over an extramarital liaison led him to believe that he was devil-possessed. Therapy, using hypnosis and directed at the underlying cause, was successful.

  But sometimes things are not so straightforward. The next patient you'll meet came from a culture where ghost possession was accepted. If his case sounds strange, psychiatry's bottom line, according to the 2004 Textbook, is that "possession and trance states are curious and imperfectly understood forms of dissociation." I'd have to agree.