American Psychiatrist Says Mental Illness is Spiritual. Nigerian Psychiatrist Disagrees

About 3 weeks ago, the medical world and in fact, the whole universe was thrown into an intellectual chaos. Science has always been known to roll without demons and genies. Officially science doesn’t respect mythical beliefs that form the bases of religions. The supernatural doesn’t exist in the world of scientific reality. That’s why doctors are expected to treat patients without paying attention to urban legends of spiritual attack and all whats-not. But behold, on July 1, 2016, a psychiatrist who goes by the name Richard Gallagher, caused a quake. He said he believed that mental illness was a spiritual attack. In fact, the Washington Post titled the news article ‘As a psychiatrist, I diagnose mental illness. Also, I help spot demonic possession.’ That sounds like something that should’ve been posted in a Nigerian tabloid, not a highly rated news hub like the Post. Well, basically, he’s now been employed by some catholic priests who chase out demons from psychiatric patients. His duty is to help them separate so-called spiritual attack (‘ayepathy’ or ‘ise aye’ in Nigerian parlance) from ordinary sickness.

Richard Gallagher, American psychiatrist

Richard Gallagher, American psychiatrist, believes that mental illness can be due to demonic activity.

How did he arrive at his belief about mental illness of spiritual origin? He narrated thus:

‘I’m a man of science and a lover of history; after studying the classics at Princeton, I trained in psychiatry at Yale and in psychoanalysis at Columbia. That background is why a Catholic priest had asked my professional opinion, which I offered pro bono, about whether this woman was suffering from a mental disorder. This was at the height of the national panic about Satanism. (In a case that helped induce the hysteria, Virginia McMartin and others had recently been charged with alleged Satanic ritual abuse at a Los Angeles preschool; the charges were later dropped.) So I was inclined to skepticism. But my subject’s behavior exceeded what I could explain with my training. She could tell some people their secret weaknesses, such as undue pride. She knew how individuals she’d never known had died, including my mother and her fatal case of ovarian cancer. Six people later vouched to me that, during her exorcisms, they heard her speaking multiple languages, including Latin, completely unfamiliar to her outside of her trances. This was not psychosis; it was what I can only describe as paranormal ability. I concluded that she was possessed.’

To give you further perspective, let me tell you this. This is not Richard Gallagher, the British Catholic bishop. The Richard Gallagher I’m talking about here is actually a board-certified psychiatrist and a professor of clinical psychiatry at New York Medical College. And you know what? He’s presently working on a book about demonic possession in the United States. Ironic, you said? Wonders shall never end? No, they shan’t! But are you surprised that someone that’s trying to sell a book on demons quickly introduced himself to the whole world as a psychiatrist-cum-exorcist? When you think inanity exists only in Nigeria, they quickly remind you that it didn’t originate here. This reminds me of our top doctors in Nigeria who have also become pastor-exorcists. If Prof. Gallagher could come to Nigeria, it wouldn’t take long for him to appear on the Forbes list, owning private jets and an Olympic stadium-size auditorium on the Lagos-Ibadan expressway! Nonsense and ingredients!

Demonic possession is a fundamental belief in Christianity and other supernaturalist religions.

Demonic possession is a fundamental belief in Christianity and other supernaturalist religions. Mental illness is commonly believed to be a demonic possession.

Anyway, his professional association is against what he has just said and his colleagues have been firing back at him. In fact, so many people have been condemning his speech. One person even published his rebuttal in the same Washington Post and titled it ‘The self-possessed psychiatrist Richard Gallagher should exorcise his delusions.’ Serves him right, doesn’t it?

Because of the peculiarity of the Nigerian society (we’re a people whose reasoning has been damaged by nonsensical superstitious and supernatural beliefs), this news has enjoyed so much rotation in this country. We were struggling to enlighten the public on the nature of sickness generally and mental illness more specifically and this oyinbo doctor-pastor vomited this? Too bad! For this reason, Dr. Ayinde Olatunde, a Nigerian psychiatrist, has decided to reply his American senior colleague. His response is as follows:

Re: As a psychiatrist, I diagnose mental illness. Also, I help spot demonic possession

I read with curiosity the article written by Richard Gallagher with the title above. It is indeed an interesting article for several reasons. Firstly, it talks openly about a subject many self-respecting psychiatrists and neuroscientists would rather not talk about openly, out of fear or arrogance. Secondly, the article is a testament to the professional humility that is lacking in many men of science, but which enables scientists to collaborate with and learn from others who do not operate within the same academic and professional culture as them. Thirdly, it opens the floor for discussion the subject of religion and spirituality in clinical practice, which sadly is missing in many medical school curriculums. However, I have to disagree with Richard on a number of issues.

Exorcism, the art of casting out demons, keeps so many Catholic priests and pentecostal ministers busy.

Exorcism, the art of casting out demons, keeps so many Catholic priests and pentecostal ministers busy.

I have a deep interest in religion and spirituality, both as a general scholar and as a psychiatrist. Psychiatrists acknowledge that religion and spirituality can feature prominently in the aetiology, presentation and treatment of mental illnesses, and it is therefore imperative for clinicians to be very conversant with the language of religion and spirituality in treating patients. For example, while treating patients using the biomedical model, a clinician also has to help patients navigate their subjective supernatural model of disease causation in a respectful, non-judgemental manner, irrespective of his/her own belief system, by encouraging helpful beliefs and gently steering them away from dangerous beliefs, based on empirical evidence. This background I just provided is needed for balance before going on to the next stage of the discourse.

I am lucky to have had animist, Islamic and Catholic Christian backgrounds, as well as finally capping it with science and psychiatry, in that order. In the search for what is true, my religious backgrounds tell me that one can admit as evidence revelations, scriptures, other people’s experiences as well as one’s personal experiences. This worked well for me in childhood and adolescence. However, training in science as the years go by began to show that concepts that have been hitherto said to be immutable truths, using the evidence base of religion, were proving to be false one after the other. There have been many. One that I recall is the concept of abiku in Yoruba cosmology, before and after the advent of childhood immunisation and effective management of sickle cell disease in Western Nigeria. An abiku child was born and reborn into the same family and died unfailingly in infancy or childhood. Nothing the traditional medicine men did could persuade an abiku child to stay and put an end to his mother’s tears of anguish. In the end, myth came to the rescue. An abiku child, said the helpless native doctors, was a spirit child that had made a pledge to his colleagues in the spiritual realm to return to them after a short stay on the physical plane, and to be reborn over and over again into the same family. This aetiological model worked well for Yorùbá communities for the period it lasted, not for devising an effective cure, but for the psychological relief of a community in distress. Subsequently, orthodox medicine came, shattered the abiku myth and established another aetiological model that works better. It is important to note that the abiku myth was a deeply held belief among the Yoruba of Western Nigeria. It was the “truth” and the recurrent infant and child deaths were the hard evidence it required to back it up.

The lesson I keep learning is that one should not approach science with preconceptions and previously held beliefs. One would do well to approach with an open mind and follow the evidence wherever it leads. So for me, and in the tradition of my most admired thinkers in science, observed phenomena are grouped into two: currently known and understood phenomena and currently unknown and poorly understood phenomena. Not scientifically explainable and supernatural phenomena. Tagging some phenomena “supernatural” is simply shutting the door of enquiry and depriving the world of the benefit of knowledge. Saying that a phenomenon is “supernatural” is not a conclusion based on the rigorous scientific method of observation-hypothesis proposition-data collection-hypothesis testing-inference cycle of arriving at the truth. It is the product of our preconceptions before approaching the subject at all! It almost always gets scientists into trouble. Intellectual honesty demands that we say we don’t know for now, if and when we truly do not know. This is the beauty and the excitement of science: to want to know.The hope of wanting to know and the excitement of finally knowing. That is the driver of all our scientific advancements so far.

As Richard said, the vast majority of cases of “demonic possession” are well known psychiatric disorders: psychoses, mood disorders and somatoform disorders. They are well studied and well known, and therapies for them are fairly well established. However, a tiny percentage of them belong to two groups: culture-bound syndromes and dissociative disorders in the ICD system of classification. The former are a group of mental disorders that have been described in specific cultures and may or may not be related to the well-known mental illnesses such as anxiety disorders. Many of them are well studied and characterised. The latter is a group containing fairly well known conditions such as dissociative amnesia and dissociative fugue, as well as some less well studied conditions such as trance and possession states. Indeed the ICD 11 draft document has three diagnoses: trance disorder, possession trance disorder and complex dissociative intrusion disorder to address these phenomena. As far as science is concerned, they are labels for observed phenomena for study over and over until they are well understood, not endorsements of previously held beliefs or misconceptions. In the vast ocean of what the lay public refer to as “demonic possession”, when professional diagnostic tools are employed, trance and possession states are a tiny minority. The problem with studying them is often their low base rate as well as methodological and technological limitations such as finding suitable markers and neuroimaging issues. It is with this tiny left over group of disorders and at this point that scientists and clinicians often have problems with how to proceed.

When humans are confronted with mysteries for which there is little or no information, they often resort to what psychologists refer to as cognitive biases, which are really errors in systematic deductive reasoning. One of them is confirmation bias, ” which is the tendency to search for, interpret, favour, and recall information in a way that confirms one’s pre-existing beliefs or hypotheses, while giving disproportionately less consideration to alternative possibilities”*. It is the reason clinicians from different backgrounds would interpret a poorly understood phenomenon, based on their own unique cultural and religious heritage, which are indeed universal anthropological realities in all human populations. A Catholic clinician would therefore relate easily to demonic possession, a Muslim clinician to jinni, and an animist clinician to ancestral spirits. As has been said earlier, these are not conclusions reached from the application of the scientific method, but products of previously held beliefs without any empirical evidence whatsoever.

 

Dr. Ayinde Olatunde holds a scientific view about mental illness.

Dr. Ayinde Olatunde holds a scientific view about mental illness.

Luckily for us clinicians, we often employ therapies that work well, long before we even understand their mechanisms of action. The mechanism of action of electroconvulsive therapy was not understood for the earlier part of its history. That we have evidence that these therapies work well to help patients in distress is often enough for the time being, until we know more. An illustration is how child soldiers in some African communities are treated for PTSD. The indigenous people already have a well-established ritual of letting the children go into a purification hut directly from battle. Here they discard all accoutrements of war, have a ritual bath of purification and atonement and emerge on the other side, physically and psychologically”clean”, and are then reintegrated back into society. Indeed children treated this way as opposed to the conventional psychotherapies that are known to work well elsewhere, report resolution of the symptoms of PTSD shortly after. For now we only know sketchy details of how this works, but we do know that it is not an endorsement of the superiority of the beliefs that produced this therapy over other beliefs, or an endorsement of the correctness or otherwise of these beliefs. What is important to science is that we have do have EVIDENCE that it works. We are intellectually honest enough to admit that we DO NOT KNOW the details of how, for now, but we are willing to continue to study it until we DO KNOW.

In conclusion, when we see cases tagged“demonic possession”, the onus is on us as clinicians to suppress completely our individual preconceived notions, and apply every evidence-based diagnostic and therapeutic tool available in the service of the patient. The vast majority of cases will be taken care of. A tiny minority will be unknown. The intellectually honest thing to do is to admit that we do not know yet, as opposed to making a diagnosis of “demonic possession”. If there are “spiritual” therapies that Orthodox medicine does not understand yet, I would advise that patients have access to them, if every other empirically tested therapy has been exhausted, and there seems to be some evidence of efficacy for the said therapy, even if the details of the mechanisms of action is still unknown. The said therapies should be safe and acceptable to the client, and his human rights should be safe-guarded at all times. It is also important that the patient or his next of kin give consent. In all of this, our duty as clinicians is to ensure continued orthodox medical help at all times, for all we are and do are for the benefit and well-being of the patient.

*Plous, Scott (1993). The Psychology of Judgment and Decision Making. p. 233)

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