Exorcism as Psychotherapy: A Clinical Psychologist Examines So-Called Demonic Possession

The Rite

(2011), starring Sir Anthony Hopkins as a Jesuit priest and professional exorcist somewhat reminiscent of Father Marin (Max von Sydow) in The Exorcist, was recently released to tepid if not terrible reviews. Nonetheless, the topic of exorcism and demonic possession still touches a nerve in the movie-going audience, perhaps especially in horror fans, true believers and so-called recovering Catholics still not sure what to believe about such matters. Evidently, the movie makes reference to the reported growing demand for exorcisms and the need to train more priests to perform this religious ritual. Films such as this and previous others about possession and exorcism, like, for example, last year's The Last Exorcism (2010) (see my prior post), strive in part to convince their audience of the objective existence of the Devil, and, in turn, of God. But in dogmatically pursuing this fundamentalist agenda, the filmmakers are missing a golden opportunity to examine and explore the many important parallels between exorcism and modern psychotherapy, and to possibly reach and educate a far wider secular, spiritual and psychologically sophisticated segment of the public about this fascinating treatment for what I call the "possession syndrome."

The Rite

Exorcism can be said to be the prototypical form of psychotherapy. Despite the secular scientific persona of most mental health professionals today, simply scratching the surface of rationality and objectivity reveals a secret exorcist: Like exorcists, psychotherapists speak in the name of a "higher being," be it medical science or some psychological, metaphysical or spiritual belief system. They firmly (and, in the case of biological psychiatry in particular) literally believe in the physical reality of the pathological problem manifested in the patient's symptoms and suffering, and dispense drugs and/or encouragement while joining with the patient in a sacred "therapeutic alliance" against the wicked and debilitating forces bedeviling them. Notwithstanding today's economically-driven, simplistic trend toward brief psychotherapies such as CBT and myriad psychopharmacological treatments, sooner or later one inevitably is confronted in clinical practice with strikingly similar phenomena and principles to those educed by traditional exorcists: Psychotherapy, like exorcism, commonly consists of a prolonged, pitched, demanding, soul-wrenching, sometimes tedious bitter battle royale with the patient's diabolically obdurate emotional "demons," at times waged over the course of years or even decades rather than weeks or months, and not necessarily always with consummate success. (See my prior post.) And there is now growing recognition--not only by psychoanalytic practitioners--of the very real risks and dangers of psychic infection inherent also in the practice of psychotherapy. Counter-transference is what we technically call this treacherous psychological phenomenon, which can cause the psychotherapist to suffer disturbing, subjective symptoms during the treatment process--sometimes even as the patient progresses! Hence the ever-present importance for psychotherapists, like exorcists, to perform their sacred work within a formally ritualized structure, making full use of collegial support, cooperation and consultation, and to maintain inviolable personal boundaries. To paraphrase Sigmund Freud, no one wrestles with the emotional demons of others all day without themselves being affected.

Of course, the main difference between psychotherapy and exorcism is that psychotherapy is typically a secular treatment for figurative, metaphorical "demons"--mental, emotional or psychological traumas, memories or "complexes,"-- whereas exorcism takes the existence of demons quite literally. Doing so can have certain advantages in treating patients who believe in the Devil, demons and exorcism, if for no other reason than the extremely impressive power of suggestion. Someone in the midst of an acute psychotic episode, for example, is confused, disoriented and hypersuggestible. They desperately seek some meaning to hang on to. Unless we can offer a more or at least equally satisfying explanation of the patient's disturbing experience, it is, as clinicians well know from working with delusional patients, exceedingly difficult if not impossible to rationally dissuade someone of his or her fervent conviction that they are victims of demonic possession. Sometimes the best approach can be to go with where they are and use the patient's belief system to the treatment's advantage. Psychiatrist M. Scott Peck correctly pointed out that, unlike psychotherapy, exorcism makes more use of power in waging war against the patient's sickness, and is usually conducted by a team of exorcists who attempt to overpower the patient's efforts to resist treatment. He further notes that, unlike time-limited psychotherapy sessions, exorcisms can extend far beyond forty-five minutes, and often involve forcible physical restraint of the patient during these intense and typically angry confrontations. In religious exorcism, as opposed to psychotherapy, the team invokes the healing power of God via prayer and ritual, and attributes any success directly to God rather than themselves or the exorcism process itself, as with psychotherapy. Exorcism is based on a theological, spiritual or metaphysical model, unlike psychotherapy, which is generally rooted in a psychiatrically-based biopsychosocial paradigm. But both methods address similar symptoms or syndromes, especially as seen in the most severely disturbed patients. The Catholic Church is careful today to rule out malingering or demonstrable mental illness when considering candidates for exorcism, using medical doctors and mental health professionals to help distinguish between so-called genuine possession and pseudo-possession. But can such a distinction truly be drawn? And, if so, on what basis?

The Roman Catholic Church's official diagnostic criteria for discerning genuine demonic possession includes speaking in tongues or languages formerly unfamiliar to the possessed person, supernatural physical strength, and visibly negative reactions of the victim to prayers, holy water, priests, etc. But for the modern Church, physical and/or psychiatric disorders must first be ruled out. From a psychiatric perspective, the problem with such criteria is that these phenomena can be found in many mental disorders, including dissociative and psychotic disorders of various sorts. According to Dr. Peck (1983), the distinction between "human evil" and "demonic evil" is crucial: He distinguished "satanic possession" from mental illness, stating that though in such cases some emotional problem predisposes the patient to satanic or demonic possession, "the proper question to pose diagnostically would be: ‘Is the patient just mentally ill or is he or she mentally ill and possessed?' " This is a clearly religious conceptualization. But another way of looking at this same possession syndrome is that in such cases what we are seeing are the most extreme and treatment resistant states of mind manifested in patients who may truly believe themselves to be demonically possessed. The pertinent question then is how best to treat such severely disturbed and deeply suffering individuals? It seems that at least some familiarity with their religious beliefs and meaningful integration of these beliefs into their psychotherapy is essential. These patients have usually tried traditional psychiatric treatment, with its neurobiological bias, to no avail. Providing some way to help such patients make sense of their frightening and bewildering subjective experiences and integrate them meaningfully into a deeper psychological and spiritual understanding of themselves and the world is what real psychotherapy should, at its best, strive toward. Without such a meaning-centered, spiritually sensitive secular psychotherapy (see my prior post), exorcism is seen to be their only hope.