Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011.
Dr. Dombeck received his Ph.D. in Clinical Psychology in 1995
The Washington Post printed a story the other day on a priest by the name of Andrzej Trojanowski who is planning to build out a center for exorcism in Poland. The act of exorcism involves the expulsion of an evil spirit or demon who has taken residence inside a person. As an activity designed to rid a person of negative influences affecting their mental state and behavior, exorcism is remarkably like psychotherapy. It is, however, definitively not thought of as a variety of psychotherapy by practitioners, who are careful to separate it from a treatment for mental illness. A quote from the Post article makes the point:
"Exorcists said they are careful not to treat people suffering from mental illness and that they regularly consult with psychologists and physicians."
In other words, exorcism is specifically thought of as a treatment for a spiritual problem (e.g., demon possession) and this class of problem is thought of as distinct from a mental or physical problem. This distinction being made between mental and spiritual problems is a critical point to focus on, I think. The basis on which this distinction stands or falls is, it seems to me, a cultural or religious one; on whether or not you are one of the faithful. If you have faith in the system of theological thought underlying the exorcism rite, then the distinction between the mental and spiritual is sound and the treatment is absolutely important, necessary and even precise. If you do not believe, then the distinction collapses and the treatment is just another non-evidence-based folk remedy which might do more harm than good if mis-applied. I wrote about just this sort of cultural faith vs. science clash in my recent essay on the nature of psychosis, in which I pointed out that in such cases, each side of the divide tends to view the other as being a little psychotic (e.g., a little out of touch with true reality). I find this sort of belief divide to be fascinating and powerful. It’s just the sort of distinction that forces people who focus on it to stop being wishy-washy and come to a conclusion about their own personal understanding of who is out of touch with reality and who isn’t.
I’m wondering what assessment criteria might be used when trying to determine when a problem is spiritual and when a problem is mental. The article does not speak to how this determination is made and it is important to know more about it. How do we know when a person’s problem is caused by evil forces and when their problem is caused by maladaptive behavior or belief patterns or subtle disease issues? The Post article doesn’t go into detail, but does describe some typical scenarios where exorcism is deemed an appropriate treatment:
"Typical cases, he said, include people who turn away from the church and embrace New Age therapies, alternative religions or the occult. Internet addicts and yoga devotees are also at risk, he said."
As part of my past caseload as a psychotherapist, I worked with a patient with Dissociative Identity Disorder , better known as Multiple Personality Disorder. It was a very disorienting, difficult and heart-breaking case. One of the truly remarkable things about sitting with this patient was how she would shift between personalities during session. At one moment she’d act like a normal adult, and in the next moment, like a regressed and abused five year old. It would have been very easy to think that this patient was possessed by a demon or three or eight, and yet, to my mind, demons had nothing to do with why the patient acted as she did. Vicious abuse had a lot to do with it, as did a talent for dissociation and a strong survival instinct, but I never met a demon. Would Rev. Trojanowski have come to the same conclusion as I did? Would he refer such a patient for psychotherapy and psychiatric assistance, or would he view this sort of case as an instance of demon possession?
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For that matter, how would Rev. Trojanowski triage a person experiencing auditory hallucinations and paranoid delusions characteristic of Schizophrenia ? There is, unfortunately, no shortage of faithful persons of every religious persuasion who have paranoid schizophrenia and sincerely believe they are being assaulted by demons. To my mind, however, what they are actually being assaulted by are subtle but disabling forms of brain damage and dysregulation.
How exactly do you tell what is mental illness and what is a spiritual affliction. I sincerely doubt there is any test that will please devotees of both sides of the cultural divide.
If the Post article is correct in suggesting that being tempted away from the church is sufficient grounds for being "plagued by evil" then are all lapsed faithful in need of exorcism? That seems more than a little like circular reasoning to me. But then what do I know. I’m on the Internet all day during the work week, and I have great respect for yoga. I should probably be making an appointment with Rev. Trojanowski myself….
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