Unusual association of diseases/symptoms
Practicing exorcism in schizophrenia
Kazuhiro Tajima-Pozo,1 Diana Zambrano-Enriquez,1 Laura de Anta,2 María Dolores Moron,2
Jose Luis Carrasco,1 Juan José Lopez-Ibor,1 Marina Diaz-Marsá1
1Department of Psychiatry, Hospital Clinico San Carlos, Madrid, Spain;
2Department of Childhood and Adolescent of Psychiatry, Hospital Clinico San Carlos, Madrid, Spain
Correspondence to Kazuhiro Tajima-Pozo, [email protected]
Summary
Historically, many cases of demonic possession have masked major psychiatric disorder. Our aim is to increase awareness that symptoms of
schizophrenia are still being classified as demonic possession by priests today.
We report the case of a 28-year-old patient who had been diagnosed 5 years previously with paranoid schizophrenia (treated with clozapine,
risperidone, ziprasidone and onlanzapine without a complete response) and was also receiving treatment in a first episode psychosis unit
in Spain. The patient was led to believe by priests that her psychotic symptoms were due to the presence of a demon. This was surprising
because some of the priests were from the Madrid archdiocese and knew the clinical situation of the patient; however, they believed that she
was suffering from demonic possession, and she underwent multiple exorcisms, disrupting response to clinical treatment.
Patient insight is an important factor in response to treatment, so religious professionals should encourage appropriate psychiatric treatment
and learn about mental illnesses.
BACKGROUND occasionally vomited during the sessions. As a result they
The peculiarity of this case is that the patient attributed contacted therapists in the unit for an opinion on meetings
her symptoms to a malignant spiritual experience, pre- with the priest. We were very concerned about the patient’s
senting little awareness of the extant disease. Also, the situation and also disappointed with the clerics’ reaction.
patient was led to believe that her psychotic symptoms Given the unusual course of events and the fact that the
were due to an evil presence by religious clerics from the patient’s mood had been markedly depressed since her
Archdiocese in Madrid, Spain. She was given multiple exor- parents and our unit had forbidden her to visit priests, we
cisms, disrupting clinical treatment response. The patient contacted an official institution in an effort to convince the
had persistent kinesthetic hallucinations despite receiving patient that her symptoms were due to a mental disorder
pharmacological treatment (high doses of risperidone, and and not demonic possession, and to improve her insight
previously received treatment with clozapine, olanzapine into her mental disorder. We had previously explained the
and ziprasidone and psychotherapy). We conclude that psychiatric diagnosis to the clergyman. Also we started
religious professionals should encourage appropriate psy- antidepressive treatment with sertraline.
chiatric treatment and increase their knowledge of mental
illnesses. BIOGRAPHICAL HISTORY
When she was 22 years old, the patient began to hear
CASE PRESENTATION voices during a trip to the Canary Islands. The patient
This case report describes a single, 28-year-old woman who reported feeling that on one occasion someone or some-
attended sessions of exorcism and spiritualism as she said she thing invisible pushed her down the stairs. She stated, “the
felt the presence of an ‘evil spirit’. The patient had schizo- spirit got inside... raped me more than once… I started to
phrenia and at the time was receiving treatment at a first epi- feel a presence that made me squirm in bed, vomiting and
sode psychosis unit after a psychotic episode a year before. feeling sick….” These behaviours led to her first psychiat-
She had attended daily Mass during the previous 6 months. ric admission, following which she remained in hospital
The patient displayed partial insight, saying that half of her on a voluntary basis, describing a pattern of kinesthetic
symptoms were due to the mental disorder and the other hallucinations and delusional interpretations. Her diagno-
half were due to the presence of a spiritual being. At this sis at discharge was paranoid schizophrenia, treated with
point her only desire was to ‘remove all her symptoms’. risperidone (6 mg/day) and alprazolam (0.5 mg/day). After
Some months later the patient contacted a clergyman via 1 month, she had another psychotic episode which was
a website. The clergyman was a renowned expert on exor- treated with risperidone (9 mg/day), olanzapine (10 mg/
cisms and a frequent guest on TV programs on paranormal day) and lorazepam (3 mg/day). A year and a half later the
phenomena. During this period the patient received a total patient was admitted for a third time to the acute unit after
of eight sessions of exorcism, and described deeper sleep jumping from a railing in an airport in response to instruc-
and feeling more restful. tions from auditory hallucinations. During this period the
Family members began to express distrust about the patient was treated with clozapine (300 mg/day), alpra-
exorcisms because the patient shouted, writhed and zolam (0.5 mg/day) and lormetazepam (2 mg/day).
BMJ Case Reports 2011; doi:10.1136/bcr.10.2009.2350 1 of 3
Her last admission to the acute unit occurred after cessa- scores for histrionic personality disorder and narcissistic
tion of antipsychotic medication and cannabis use, result- personality disorder in this patient. We therefore consider
ing in promiscuous behaviour. Her treatment at discharge that the predominance of cluster B personality traits may
was risperidone (12 mg/day), risperidone depot (50 mg/14 explain the improvement in pharmacologically refractory
days), biperiden retard (8 mg/day) and lormetazepam symptoms through exorcism.8–12
(2 mg/day). We conclude that religious professionals should encour-
age appropriate psychiatric treatment and increase their
CURRENT MENTAL STATUS knowledge of mental illnesses. The peculiarity of this case
On examination, no particular psychomotor disturbance is that the patient attributed her symptoms to a malig-
was evident, and facial expressiveness was preserved. The nant spiritual experience, presenting little awareness of
patient displayed empathic contact with mood reactiv- the extant disease. Also the patient was led to believe that
ity. A significant interest in esotericism was highlighted. her psychotic symptoms were due to an evil presence by
Kinesthetic hallucinations were described as an agent priests from the Madrid archdiocese in Spain. She under-
which entered and left her body, twisting her stomach. The went multiple exorcisms, which disrupted clinical treat-
patient denied having auditory hallucinations, although she ment response. The patient had persistent kinesthetic
stated they had occurred in the past. She displayed apathy hallucinations despite receiving pharmacological treatment
and anhedonia, and social withdrawal, with a poor social and psychotherapy.
life outside the family environment. The patient appeared
to have partial insight, as she criticised past experiences
Learning points
and took medication correctly, but believed there was a
spiritual presence in her body.
▶ Historically there have been many cases of demonic
possession, which masked major psychiatric disorder.
TREATMENT
▶ Religious professionals should encourage appropriate
The patient had persistent kinesthetic hallucinations
psychiatric treatment and increase their knowledge of
despite receiving pharmacological treatment (high doses of
mental illnesses.
risperidone, and previous treatment with clozapine, olan-
▶ Cluster B personality traits of the patient may explain
zapine and ziprasidone, and psychotherapy).
the improvement of pharmacological refractory
symptoms through exorcism.
DISCUSSION
We report the case of a woman diagnosed with paranoid Competing interests None.
schizophrenia, but with a good prognosis as she had good
Patient consent Obtained.
premorbid adjustment, and has few negative symptoms
and predominately affective symptoms.1 The peculiarity of
this case rests not only in psychotic symptoms refractory REFERENCES
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Another important point to discuss is that the results
from the Millon Clinical Multiaxial Inventory showed high
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Reports 2011;10.1136/bcr.10.2009.2350, date of publication
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