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psychosis and spirituality

Joe Szimhart (August 2020) 

Whether mentally disturbed patients come in voluntarily or police bring them handcuffed, my job at a psychiatric hospital requires that I meet mentally ill people at their worst. Most are relatively compliant with processing and intake interviews, but some require restraint and sedation either due to out-of-control psychotic behavior or violence to self or staff. After more than twenty years of crisis management as an intake worker, my memory of thousands of encounters is basically a blur, but some cases stood out. In this one, a young male patient struck me as indicative of a wider social spiritual dysfunction. We will name him, Daniel.

Daniel was twenty-six, lived as an only child with his mother, had a high school diploma and no job. He was feeling more stress during the 2020 pandemic lockdown. His vital signs and a drug test (negative) indicated nothing unusual though his pulse rate was high at first, likely due to anxiety. He had no history of a medical condition. Several weeks before we met, Daniel began experiencing disturbing “voices” from spirits for the first time in his life. The voices got so disturbing at times that he took to punching walls. He damaged his knuckles with abrasions and may have broken a metacarpal bone. Daniel was not able to sleep soundly for days at a time. He told his mother one way to end this invasion in his mind would be to end his life. He refused to seek help, fearing being misunderstood and locked up. In desperation, his mother called the police. The officers had been trained well. They approached Daniel with sympathy and calm. Daniel trusted them. He came with them to our psychiatric emergency center voluntarily without handcuffs. Nevertheless, the female officer filled out an involuntary commitment form in case he refused treatment.

Indeed, Daniel could not stay focused during my intake with him to grasp the voluntary process or sign voluntary papers. He was very suspicious and responding to internal stimuli. Daniel was losing control in our lobby, could hardly stay seated, and was clearly in deep distress. He stood up, became hyper vigilant and overly focused on another patient that our ambulance brought in after Daniel arrived. Our highly seasoned and efficient psychiatrist saw Daniel immediately after my report and ordered a sedative injection of Thorazine. Daniel resisted taking the medication, arguing that one of his voices or “God” wanted to prove that his voices were real. Daniel argued that spirits from the past were sending out a warning that humanity was in danger. He claimed that he was sent to the hospital on a mission to “save” someone, and that if we gave him time, he could prove it. Daniel insisted that he had been in touch with magical beings that included God, angels, demons and one that was a “machine” or cyborg. He felt that he entered the real world of Wiccans and Druids, an explanation that came to him when he looked up his symptoms on the Internet. The voices became more intense when he was online trying to contextualize his experience. He said his friends online began to shun him. One friend told Daniel to be “dead” which meant to cease being online, which Daniel tried but the voices would not cease “guiding” him. Daniel also turned to his Catholic faith when he thought he was possessed. He seemed confused by what some parishioners told him. In any case, possession was only part of his self-understanding of his voices, which ranged from good to evil to grandiose.

A female nurse in the lobby had the needle ready while another, male nurse and I tried to get Daniel to lay down on his stomach so the nurse could inject Thorazine into his buttocks. Daniel demanded that we allow him to prove to us that his voices were real first. He had been claiming all along to me that the voices could predict the future and that “God” could read my mind. I had been through situations like this hundreds of times, not only at the hospital, but also as a cult interventionist with people making similar psychic power claims for themselves or their gurus. I gave Daniel several chances to prove his voices were real. I told him I had a thought in mind, a simple three-letter word. Daniel tried to let “God” read my mind, but after a minute and three guesses could not come up with “cat.” Then I allowed him one last test, one in which I wrote a word hidden on a piece of paper that I folded in front of him and gave to the nurse to hold. Daniel’s God guessed “aardvark” and “police.” I said he was wrong. The male nurse and I grabbed Daniel’s arms and lowered him gently onto the couch to assist the nurse with her injection. Daniel kept trying to guess the word. After the injection, the nurse showed him what I had printed: Thorazine. Daniel eventually fell asleep after more attempts to convince me that his voices were “real” and autonomous.

The typical patient who is hearing voices, even the voice of God, will not submit to tests like this due to suspicion that even if he did prove that the voices were real, hospital staff might lie to insist that a patient is crazy so that we could make money by admitting him (or her). But Daniel was having his first psychotic break, so his defenses and insights were not that sophisticated. A minority of patients on the schizophrenia spectrum and with years of treatment history will check themselves in for treatment when their “voices” again begin flowering, knowing that a change in medication will often reduce the problem to manageable levels.  One of my patients like this was a working psychiatrist, age fifty-five, when he checked into our clinic for a week.

The “wider social dysfunction” that I mentioned earlier has to do with humankind’s creative strategies to reify the “voices” in their heads. Perhaps the voices are deep, mysterious thoughts that seem to come from transcendent forces and beings as with ancient prophets and shamans. Or the narratives in the mind may appear in dreams or during extraordinary states induced by drugs, recovery from head injuries, epilepsy, depressions, manias, ecstasies, or during contemplation for creating poems and to solve scientific dilemmas. So, what might be a dysfunction by some standards might also be a creative act by others. Strict or fundamentalist Roman Catholics might view the Prophet Muhammad’s visions that led to the Quran in Islam as schizophrenic if not demonic episodes yet indulge visions by Hildegard of Bingen, a 12th Century German nun, as an enrichment of Catholic piety. In fact, the Church endorses her as Saint Hildegard. The history of The Prophet of Islam tells us that he was terrified after his initial encounter with the Angel Gabriel, but with the comforting support of his first wife, Khadijah, he submitted to his fate. The Prophet continued for years to recite the Quran to his scribe as dictated to him through Gabriel. Had Khadijah not been there (and had Muhammad seen a modern psychiatrist), one can wonder whether Islam might have ever been born.

We are not about to explore thousands of instances of people hearing the “voice” of God or a spirit who were never hospitalized and who made a career out of their “mental dysfunction” as psychics or may have started entirely new religions. This fuzzy division between a functional prophet, seer, or psychic and my mental patient example, Daniel, has been explored often by scholars and religious writers (McNamara, 2011; Taves, 2011).  But why do we treat one as a disorder and the other as a spiritual act? We can regard the modern tension between psychology and religion with psychology taking the place of religion in an increasingly secular society—the collective belief system collapsing into the personal one or the guru losing ground to mindfulness—as one factor. But there is something much more basic.

Patrick McNamara in his study Spirit Possession and Exorcism: History, Psychology, and Neurobiology (Vol. 1, p 99) wrote: “It was probably clear to the shamans of the Upper Paleolithic that spirit-possession techniques could harm people not able to control them. That is why they required that a novice engage in years of apprenticeship to a shaman before one could “practice” or use spirit-possession techniques to gain powers to heal illnesses or to seek visions and the like.” The argument here for traditional shamans remains the same for any new religious enterprise. Possession is at its most basic a creative act, produced from within the symbol-making world of the possessed who may nevertheless believe that the possessing “spirit” is autonomous. Daniel wanted to believe that his voices were autonomous, but he was ill-equipped to place his “spirits” into a collective social object like an existing cult or tradition. Both Hildegard and Islam’s Prophet mentioned above were well equipped. Hildegard was a highly functional nun, educated and protected within a rich tradition. However, despite a strong cult following within the church, it took ten centuries until 2012 before a Pope extended her sainthood to the entire Catholic Church. Muhammad was not a believer in a tradition, but he was exposed extensively as a merchant to Judaism, Christianity, and various Arabic cults devoted to various gods. The Prophet’s genius was to re-form those religions and cults under a new revelation as he gathered strong initial support from family and friends. Daniel could not gather any support and he had no collective footing on which to stand. Tellingly, Daniel had no creative control over his voices that were literally driving him crazy. The devotional collectives surrounding Hildegard and The Prophet Muhammad support divine agency as the source of inspiration and not human imagination. Daniel could adequately demonstrate neither divine agency nor creative imagination, thus his initial diagnosis as having a brief psychotic disorder.

Another question arises when a psychic or seer appears to gain sufficient control over possessing spirits and gains a significant following that seems to remain at odds with the accepted norms of a surrounding collective. We tend to call these special groups “cults” or “new religions” to distinguish them from more established religions. Had Daniel a better foundation as a physician or priest, for example, his psychotic break might have paralleled the career of Emanuel Swedenborg, founder of the Church of the New Jerusalem or New Church in the 18th Century, or that of Helen Schucman who heard a “Voice” she identified as Jesus in 1965. Schucman’s “Voice” urged her to take notes from 1965 through 1971 to produce A Course in Miracles, first published in 1976. Swedenborg was a prominent scientist before he began, in middle age, to experience visions and contact with heavenly spirits. Schucman with her new Ph.D. was working as a psychologist at a hospital when “the Voice” first emerged in her mind. In Schucman’s case, she was disturbed by her voice until she shared it with her boss, a medical psychologist who encouraged her to engage it. She shared her notes with her boss nearly every day for seven years until “the Voice” said it was finished. Swedenborg knew that his new religion bordered on heresy, illegal in Sweden, so he went to London to publish his many volumes of inspired text. Schucman’s manuscript attracted a devoted editor and the endorsement of the Edgar Cayce Foundation at Virginia Beach, VA. Compatible with New Thought churches including Unity, A Course in Miracles eventually sold in the millions worldwide and has been highly regarded by celebrities.

Both Schucman and Swedenborg had developed serious religious interests prior to their breaks into another reality. Daniel had only himself and the Internet with his basic Catholic faith. There is no way to determine whether Daniel will retain his beliefs in autonomous voices. I have known patients who have frequented my hospital for two decades and never let go of what physicians call fixed delusions despite medications and reality testing therapies. Swedenborg died in 1772 at age 84 with no desire to start a new religion nor regard himself as a prophet, yet his belief was that his writings heralded a paradigm shift in how Christianity would be understood going forward. Schucman seemed troubled by her participation in A Course in Miracles, never quite as comfortable as her supporters in promoting it. She died in 1981 at age 71 from cancer. Swedenborg’s writings were his immortality project that ironically cements him as a founder of a new religion that has yet to transform Christianity with less than 10,000 members. A Course in Miracles seems destined to fail in its quest to “require” every human being to take the Course: The Voice told Helen Schucman that “this is a required course” and only the time you take it is in your power (ACIM, introduction). Its basic “miracle” is to teach the reader to realize instant and eternal forgiveness in God because, in the end, you never were not God. Now, this profound if simplistic insight may be true and is true according to thousands of mystics, but that does not excuse the clumsy and ponderous way it is presented in A Course in Miracles.

Daniel’s “God” voice may be the same God that inspired Muhammad, Hildegard, Swedenborg and Schucman, but when it comes to God talking, context is everything and context limits God within the person, art form, scripture, or language game in which God appears. Personal taste has something to do with this, but spirituality rarely reaches what I experienced in 1989 in a Budapest cathedral during an Easter Sunday service that featured an orchestra and choir performing Handel’s Messiah! This was months before the totalitarian Communist regime crumbled. At the end of the service, every Hungarian “communist” stood up to sing the traditional Hungarian anthem.  As I indicated, context for spirituality is everything.

Ann Taves in her book Religious Experience Reconsidered: A Building-Block Approach to the Study of Religion and Other Special Things explores sleep paralysis research in Chapter Four. Without trying to engage the complexity of the science in her study, I only wish to reference her mention of distinctions that cognitive scientists make between “cognitively optimal” and more reflective or “cognitively costly” beliefs. Experimental research shows that “people readily ascribe agency to perceptions based on very sketchy information and then make inferences about the agents’ behavior based on assumptions (theory of mind) that we apply to agents more generally. This happens particularly in situations of ambiguity and threat. [Researchers] found that subjects possessed and used at least two different parallel god concepts, an anthropomorphic concept that they drew upon unreflectively in contexts requiring relatively automatic or on-line processing (in this case interpreting stories) and a more theologically complex concept that they drew upon when asked to reflect. Combined with the human tendency to over-attribute agency to situations of ambiguity or threat, this distinction between relatively automatic and reflective god concepts helps to explain why people may spontaneously refer to agents that under other circumstances they would say did not exist.” (Taves, 137-138).

Daniel felt both threatened by and ambiguous toward his voices, thus readily ascribed autonomous agents, including God, to his experience. Schucman did the same, as she was highly disturbed at first and continued to be troubled by a “Jesus” voice in her head. Perhaps Muhammad, Hildegard, and Swedenborg were able to draw upon more theologically complex concepts, but enough ambiguity and threat existed for each of them to ascribe an agent to their personal visions. Sustaining belief may have been less threatening than admitting to a flaw in consciousness, which is consistent with cognitive dissonance theory. Another way to look at this is through the work of Otto Rank (Art and Artist: Creative Urge and Personality Development) who offers a more valuable role for spirit possession. Rank would call “spirit possession” an object of creative will, conscious or unconscious, when that activity leads to a valued “immortality project” for a wider collective among human beings. No one can dispute the immense value that The Prophet Muhammad’s interaction with an angel has given to various cultures despite the negative history within Islam. We could say the same about all the great religions. Hildegard remains relevant as a proper saint in a grand tradition. It is less apparent that Swedenborg or Schucman approached the universal cultural impact that their “agents” spelled out for them or, in Rank’s analysis, that they managed to create as a collective social object (new religion or cult). As for Daniel, we will have to wait and see.   

References:

Patrick McNamara (2011) Spirit Possession and Exorcism: History, Psychology, and Neurobiology

Otto Rank (1932) Art and Artist: Creative Urge and Personality Development

Helen Schucman/Foundation for Inner Peace (1976) A Course  in Miracles

Ann Taves (2011) Religious Experience Reconsidered: A Building-Block Approach to the Study of Religion and Other Special Things

A Course in Miracles