PARANORMAL AND DISSOCIATIVE EXPERIENCES IN MIDDLE-EASTERN JEWS IN ISRAEL: DIAGNOSTIC AND TREATMENT DILEMMAS
Eli Somer, Ph.D.
Eli Somer, Ph.D., is Director of tlle Israel Institute for involve involuntary behavior or influences by forces that are Treatment and Prevention of SU'ess and a Senior Lecturer notconsidered partofthe self. Persons manifesting both phe at the School ofSocial Work at the niversity ofHaifa, both nomena are usually good hypnotic subjects (Ackstein, 1982; in Haifa, Israel Putnam, 1989); amnesia is a central element in both cases (Ellenberger, 1970), and these two types ofexperience can For reprintswrite to Eli Somer, Ph.D., School ofSocial Work, be reproduced expel;mentally in hypnosis (Putnam, 1986; University ofHaifa, Mt. Carmel, Haifa 31905, Israel Richeport, 1992). Castillo (1994) reported that it appears that there are ABSTRACT two factors determining how a particular episode of posses Four Israelijewish persons ofMiddle Eastern cultural heritage pre sion will be perceived in the South Asian (Indian and Sri sentedfor consultationfollowing unsuccessful helpingattlmlpts deliv Lankan) cultural context. First, if the possessing entity is a ered by variousfolk and spiritual healers. Thefour patients suffered human personality, the episode will be perceived as a rare from the following DSM-IV defined problems: Post-traumatic Stress mental illness, and psychiau'ic treaunent will be sought. In Disorder, Dissociative Disordernot Othe>wise Specified, Schizophrenia most possession cases in South Asia, the possessing agent is - paranoid type, and Histrionic Personality Disorder coupled with manifested as a ghost, a demon, or a god. In the case ofbene a Conversion Disorder with Seizures. The patients construed their volent possession by a god or a goddess, treatment is usual suffering in cultural idioms implicating supernatural experiences. Iy notsoughtand the experience is regarded as a gift. In cases Many of their symptoms "esembled dissociative clinical pictures. of malevolent possessions, traditional folk healers are usu However, unlike many dissociative disorde>'patients described in the ally approached for help (Amarasingham, 1980; Kahar, Western scientific literature, these persons refused to accept any of 1982). A reanalysis ofpreviously published case histories of thei,' possession-like experiences as possible manifestations oftheir spirit possession illnesses in South Asia from the perspective own dissociated egl>-states. The paper desClibes the struggle to find ofdissociation theory suggested that, like dissociative disor common wound on which significant cross-cultural help could be ders in North America, these pathologies mightalso be reac offered to indigenous people manifestingdissociative and othersymp tions to extreme situations in the environment (Castillo, tomatology. 1994) . Many Hispanics in Latin America and in the United Anthropologist Erika Bourguignon argued that spirit States have been reported to hold beliefsystems ofEspil;tismo possession was a universal phenomenon, insofar as all known and Santeria, in which spirits are thought to have both the religions contained such types of experience, regardless of ability to make people physically and emotionally ill and the how they were defined (1976). Hers is a non-etiological per power to cure them (Berthold, 1989). Several articles about spective on the nature of spirit possession. She viewed the Hispanic patients' perception of their illness through a cul phenomenon mostly as a culturally shaped altered state of tural perspective have been published (Comaz-Diaz, 1981; consciousness influenced by social programming and uni Ruiz & Langford, 1976, 1982). The database on articles writ versal human cognitive features. Another theoretical per ten about Hispanics and dissociation is growing (Alonso & spective in the anthropology ofspirit possession stems from Jeffrey, 1988; Martinez-Taboas, 1989; Ronquillo, 1991) with Freud's psychoanalytic theory and views spirit possession as some papers warning that dissociative phenomena may be culturally shaped hysteria, viewed as an irrational, emotion misdiagnosed as schizophrenia in this ethnic group (Rendon, al state, caused by repressed oedipal desires in the uncon 1974; Steinberg, 1990). scious (Freud, 1962). Another influential perspective on tlle Another culturally condoned expression ofdistress fre phenomenon is based on Pierrejanet's dissociation tlleory quently seen among Hispanic women is ataque de nemios. and views possession as culturally shaped divided con Descriptions ofthis clinical presentation include dissociation sciousness Ganet, 1889). Several interesting parallels exist (Lewis-Fernandes, 1994), seizure-like responses (Guarnacia, between possession and dissociative phenomena. They both Canino, Rubio-Stipee, & Bravo, 1993), and panic-like respons-
174 DlSsoamo;.;. 1'01. X. ;';0. 3. September 1997 es (Liebowitz, et al., 1994). The phenomenon is seen more opporllmity to fulfill them. This is an act of divine Illere, frequently among women and is rcg:uded as a permissible llleant nOt only to purify the sinner's spirit, but also for the 1\<1y for woman to express rage (Oquendo, 1994). Elsewhere benefit of a lIni\·ersc. The ibbur of a wicked man into the in L.·uin America, in Brazil, spontaneous riuml trances are soul ofanother was called d}'bbuk. This kind ofspirit peru.... Icry common in everyday life and spiritist medicine is tJ 175 •• ..J L _ PARANORMAL EXPERIENCES IN MIDDLE EASTERN JEWS anthropologist and psychologist, suggested that spirits are sive guilt. vehicles for articulating unacceptable conflict-precipitating By the time I first saw him Boaz had developed a full desires and demands. Since among some Israeli ethnic blown post-traumatic stress disorder which he inexplicably groups the idiom ofspirits and possession are culturallycon managed to conceal for years from his commanders, col stituted, this articulation might be used by them because of leagues, and family alike. Prominent among his symptoms the reliefthese cultural constructions can offerfor their pro were nictophobia (fear of night/darkness) and agorapho tagonists. They do not seem to suffer the stigmatic conse bia. Boaz refused to leave home unaccompanied to any des quences of expressing these cultural idioms as much as tination other than work. He also had a very low tolerance Western mental health patients do. In a culturally changing for being left alone at home, particularly at night. Despite society, which Israel is, people afflicted with certain maladies his formidable distress he was not willing to confide in any may be confused as to what conceptual framework might bet one - even in his loving wife - fearing potential mockery. ter explain their pain: the culture-bound one or the more Boaz reported to me that he first consulted a kabbalist rabbi stigmatic psychiatric one. Thefour cases described below illus who not only blessed him but also gave him a talisman to trate this dilemma as faced by both patientand therapist. All protect him from evil spirits. The patient said he chose to four patients had visited either traditional healers or rabbis pursue this avenue for healing first because he did not see before they sought psychological help. In the first two cases, his most distressing and unrelenting problem as a mental bridging the cultural perspectivegap was less successful than health matter. Boaz had believed he was haunted by the in the latter two. deceased's soldier's spirit. The patient, who possessed oth envise intact thought processes, was convinced tl1ere was a ILLUSTRATIONS constant "presence"around him. Vigilantly attentive, he unre lentingly monitored what he perceived as the strange sounds Case One: A Man Persecuted By a Ghost the haunting spirit had been making at night. Even soft Boaz was a 35-year-old man who had immigrated to Israel sounds such as the rustle ofthe leaves on his front lawn, the from Tunisia at the age offive. Married and a father ofthree, movement ofbranches in his backyard tree, or the running he was a military payrOll non-commissioned officer in charge electrical motor ofhis refrigerator, would startle the patient of an electrical repair team in a divisional vehicle mainte and cause him to lock himselfin the safety of his bedroom. nance workshop. Eightyears prior to his referral, the patient Boaz was com~nced he was being punished for his wrongful discovered the bleeding, disfigured body of a soldier who negligence and constantly expected to be expo ed to a sur had blown himself up with a hand grenade in one of the prise attack by the spirit. The patient had interpreted all of armored vehicles he worked on. Boaz, who ran to seek help, his symptoms within this paradigm, rendering them com collapsed on the ground near the base commander's office. pletely untreatable within an intrapsychic conceptual model. He was weeping and trembling, and felt dazed as he became He rejected any information or interpretation of his symp aware ofthe base commander himselfstanding next to him, toms as othenvise plausible, but irrelevant to his own par seemingly amused by his agony. Boaz remembered feeling ticular case. Symptoms such as depersonalization and his fre deeply humiliated and helpless. He proceeded to develop a quent mid-sleep awakenings were experienced as the spirit's sense ofdazed detachment which evolved into severe dere attempts to gain possession over his body. This chronic alization. In the few days following the incident his anxiety patientdid not respond to minorormajor tranquilizers, and symptoms mounted and he began to experience flashbacks several anti-depressant trials yielded no positive effect eitl1er. and depressive guiltabout the soldier'ssuicide, which he felt The patientresponded only to a regimen ofcognitive behav he could have prevented. Nevertheless he received no psy ioral counseling that mildly improved his coping capacity. chological help. The onlyattention he received from the sys An attempt to employ a culture-sensitive approach and to tem was a prolonged and detailed interrogation by the influence the haunting spirit in some way failed as well. Boaz MiIitaryPolice, who suspected foul play. The patient, a proud, was too phobic to allow any such direct approach. masculine man, had become increasingly embarrassed by his mounting distress and by his incapacitatingfears. His shame Case Two: Woman Possessed by Her Dead Mother's Dybbuk was fueled by recurrent and intrusive recollections of the Maya was a 61-year-old female who had immigrated to mocking he felt he had been subjected to. He developed a Israel from Egypt in the mid-1950s. She was a divorced moth substantial distrust of people, which he associated with the er oftwo and had three grandchildren. The patientwas her deep disappointment at the emotional abandonment and parents' only child and had been sadistically abused by her perceived abuse he had experienced following the trauma. mother in childhood, mostly by arbitrary and unusually harsh Consequently, he gradually neglected mostofhis othersocial punishments. On one occasion Maya, then a child, had ties. AltllOugh he had never been accused for any wrong noticed creases in the blouse she was wearing. She asked her doing, Boaz felt he should have somehow prevented the sui mother to iron the blouse for her and was subsequently cide. Not atypically, he also developed considerable depres- burned ,vith the hot iron as her mother ironed the blouse 176 DISSOCIATJOIi. 1'01. X.lio. 3. September 199i while il was still on hel" IXKI}'. ~Iapi married in her mid-twen in Jewish teaching". She knew Ihat Israel's oOidal religion lic~ and emigr.ucd 10 Europe 'lith her husb.."1nd. She led a COlHrasts sharply with New Age lllediumship and channel <;()("ially isolaled blll functional life, and raised IWO psych!? ing. These praclices were prohibited in Ihe Hible. She went logically health)' daugillcrs. She ne\'cr saw her mother again to consult a mcdium, knowing vcry well thai she would be .u1d fell mildl}' guih), al>OlII il. Two )'eal"S before I firSI saw \'iolat-ing an imponant command from lhe lkK>k of the Ma)"1 her widowed mother died. Ma)'a al1cnded the fllner Covenanl: "YOll shall not tolenlt.e a s()rccress~ (Ex. 22:7 [Eng. .11 and flew back home innnediatel)' .. fter il. A few days 101 22:18]; cf. DeU!. 18: 1(}"12) . lowing the shiv(/ (the seven days ofJewish ritual mourning) Tir-DI w;lllted to ha\'e a "spirit guidc" ofhcr own. "A spir ~is ~hc became aware of a voice speaking to her ill her head. it guide, M she explained LO lIIe a spirit teacher and She recognized it as that of her mOlher, ,,'ho proceeded to guardian, who works with tbe medium tbroughom her life. ~ 1tI10rm Maya thai she had been reincarnated into her bod),. The patient dc~ired 10 be endowed with the gift of tiled i ,lIld IIml Maya had to die because lhe mother "' The symptoms diminished quickly. On a follow-up visit patientand to demand thatshe discontinue both college and after six weeks, she happily reported that the "Mazik" was therapy. The demon's unheeded threats were followed by increasingly weakened by the medication and that one frequent severe fainting spells that completely paralyzed morning four weeks after she commenced her psychotro Leah's social and academic lives. In one ofthe sessions dur pic regimen, she awoke and the possessing spirit was no ing this critical period, Leah implored me to exorcise the longer within her. Her psychiatrist continued to follow her demon despite her painful ambivalence about it. Although up for three more months, and reported she was well on a we carefully explored the possible function of the phe maintenance dose of medication. nomenon, the demon refused any cooperation, demanded sole protective control over the patient. Leah became Case Four: Demonic Possession in a Woman increasingly adamant about ridding herselfof the menace. Treated with Exorcism The "exorcism" process was both planned and carried Leah was a 19-year-oldJewish orthodox young woman, out in conjunction with the patient. The process was suc born in Israel to Moroccan immigrants. At the time ofrefer cessfully completed during one single session. The patient ral she lived in a neighborhood inhabited mostly by Middle was asked to describe the visualized and mutually constructed Eastern immigrant families. procedure. The ritual was an adaptation of an old ]ewish She was referred by her teachers' college counselor Morrocan exorcism rite described by Bilu (1980). because of frequent fainting spells associated with exami Mter a strenuous and painful half-hour labor process, nations and with chaperoned male visits. The patient will the demon was delivered through her abdomen. While still ingly confided with the therapist that a few months prior to in the exorcism trance, Leah reported a sad sense ofempti the referral she had started to notice a foreign presence in ness and loss. She asked for my help in finding an alterna her body. She claimed to have been possessed by a small black tive for the missed protective agent. Although she was posi demon which now resided in her abdomen. Leah had no tive about her decision to rid herself from the demon, she explanation as to how and why the demon had penetrated asked me iflwould help her correctthe internal deficit. Leah her, nor was she terribly alarmed by this unusual paranor indicated she believed the demon consumed partofher mah mal phenomenon. The patient proved to be an excellent and thatshe had desired that her neshamahexpanded. These hypnotic subject and entered very readily into trance with kabbalistic terms are known as two of the three faculties or almost no formal induction. Although the demon never dispositions ofthe unified human soul thatform a sequence gained full active control over her body, communicatingwith from lower to higher. Nefeshis the source ofman's/woman's it was made possible with the hypnotized patient reporting animal vitality and the totality ofhis/her psychophysical func to me the demon's replies and messages. tion, and is present from birth. Ruah, or anima, is aroused In response to her questions the demon explained that when a person succeeds in rising above his/her purely vital his role was to protect her undue distress by causing intense istic side and represents the power to distinguish between stomach pain that typically ended in a loss ofconsciousness. good and evil. The neshamah, or spiritus, is aroused when This patientmetboth Bourguignon's (1979) criteria for "non the person occupies himself/herselfwith the Torah and re possession trance" as well as DSM-Ncriteria for Conversion presents the virtue ofbeing "a part ofCod above" (Scholem, Disorder with Seizures and Histrionic Personality Disorder. 1971b). Although no clinical evidence in regard to a possible histo I suggested to Leah to visualize her neshama. She ry of incest was available, intense unresolved oedipal con described an ethereal presence in herchest. When I inquired flicts were still active in Leah's family. The oldest child, and as to how the neshama could be strengthened, she respond sibling to a 15-year-old sister and a ten-year-old brother, Leah ed with a silent prayer as tears rolled down her cheeks. Out had been a close ally ofher father and his favored child. She of trance, Leah said that she had experienced an unusual was openly hostile to her restrictive mother, who frequent spiritual experience in which she visualized a ray ofgolden ly clashed with the father on issues related to Leah's upbring light descending from Heaven and connecting with her ing. expanding neshama. The demon disappeared immediately Attempting to understand this patient through the the following that session and so did her fainting spells. The oretical schemata I was most familiar with, I first regarded patientremained in psychotherapyfor six months more. She the demon as a fragmented personality alter, and thus con learned to own her own drives and feelings, to resolve her ceptualized the psychotherapeutic effort as requiring an inte conflicts through enhanced personal skills, and also to bet grationalistapproach. Although this patientwas cooperative ter manage her own stress. At the same time she intensified and displayed genuine curiosity in exploring her possession her Torah studies. Leah was well and symptom-free at six, state, the demon refused to engage with the therapist direct twelve, and twenty-four months' follow-ups. ly, and communication with itwas relayed through Leah. The demon seemed to be threatened by the positive transference the patient developed, and proceeded to threaten the 178 DISSOCIATlO1'>, Vol. x, 1'>0. 3, September 1997 SOMER DISCUSSION the current Iiterdture, theo!")', and therap}'ofdissociative dis orders- (p. 293). This guideline \\.\5 ob\;ousl)' 1I0t heeded This paper described four clinical cases of ~Iiddle ill ~Iaya's case, rcsulting in a lasting damage. This unsuc EasterllJt:ws in Israel who prcsclllcd with I)aranormal expe cessful outcome points to a need to communicate with tra riences imoh-ing variOliS forms of possession phenomena. ditional and religious he.tlers in an allempt to educate them lkh't7 canstnlcd his ps)'choph)'siological arousal reactions in about dissociative disorders and how those can resemble their concepts Ihal reflected not only his deep sense ofguih blll concepluali/.ationsofpossession S\"lldromes. Such a dialogue al'iU his cuhllr-tl beliefs about the menacing influences of mal' result in producti\'c cooperations between traditional angry ghosts. Boaz's peritraumaucdissociative reactions pre he:tlers, who ma)'conlillue to help theirclients in non-malig \cnted adcqw:\tc mCL.1.bolizing oflhe shocking siglll he had nanl cases. and psycholhcr.:lpists. lx:cll exposed 1.0. This ps)'chopalhogenic event was exaccr The next two examplesdemonstrated attempts tu bridge h~.'cd by lhe hUI'ulIl lack of support he was subjected to by the gap belween the empiricist cult lire ofprofessional c1in his superior. Respecl for authority ligures ,\'as a basic Icnanl ie'll psycholob,)' and folklore-rehlled syndromes. ofHoa,-'s traditional Nonll-African.Jcwisll upbringing. In his In lhe third case the patient was olTered a "\Vestern" posnrau11'l,l1ic hypnotic condition, lhe p:llienl probably biOlnedieallreatmenlfrall1cd ill Ilerown explanatory model. .H:cepted his commander's implicit suggestion that he did Tirla \\~\s obviollsly ambivalent and confusedaooul the appro nol deserve 10 be supported for wilrlessing the catastrophe priale help she felt she needed. I believe she \\';IS aware of hl' ilT'llionall)' felt he himselfshould have pre\'emed. BaaL her psychotic condition when she SOUghl me. I also belie\'e ';(:emed to have externaliZl'd thc plilliti\'e aspect ofhis guilt she bec;llne frightened by the psychotic breakdown lhat •lIId framed it in concepl.'; that precluded an)' meaningful dc..'veloped while she was ilwolving herself with the occult. pwchotherapeutic interventions. Ilis paranoid vigilance Iler ambivalence was renectcd in the fact tll 179 DISSOCL-\TJO'-;. \01. X. \0, 3, Sl'pI('lI1beJ 199; I PARANORMAL EXPERIENCES IN MIDDLE EASTERN JEWS I tradition and its influence on personal characteristics on Ackstein, D. (1982). Psychotherapeutic aspects ofspiritualism: Cross Middle EasternJews. cultural psychiatric influences. Hypnos, 9 (3-4),129-135. Survival of the individual in the Arabic society is con Alonso, L., &Jeffrey, W.D. (1988). Mental illness complicated by tingent upon his/her relationship with the family. The fam the Santeria belief in spirit possession. Hospital and Community ily is a source of vital support for the individual. However, Psychially,39,1188-1191. such support is conditional. The individual will face rejec tion and punishment if traditional norms are disobeyed Amarasingham, L.R. (1980). Movement among healers in Sri Lanka: A case study ofa Sinhalese patient. Culture, Medicine and Psychiat,y, (Dwairy, 1993). M a result, individuals learn to detach them 4,71-92. selves from their true emotions and desires and adapt by developing a group and family-oriented conforming self American Psychiau'ic Association (1994). Diagnostic and statistical rather than an individual authentic self. Dwairy and Van manual ofmental disorders (4th ed.), Washington, DC: Author. Sickle (1996) claim that repression is an inevitable conse Berhold, S.M. (1989). Espiritismo as a form of psychotherapy: quence oftraditionalArabic society, in which members learn Implications for social work practice. TheJournal ofContemporary Social to practice Musayara, concealing one's true feelings and Work, Oct., 1989,502-509. behaving only in a socially sanctioned manner (Griefat & Katriel, 1989). The Middle Eastern individual experiences Bilu, G. (1980). The taming of the deviants and beyond: An anal control as external. Family, God, and the spirits are thought ysis of dybbuk possession and exorcism. The Psychoanalytic Study of Society, 11, 1-32. to exertvarious influences on individuals, who develop a col lective and a rather undifferentiated personality. Therefore, Bourguignon, E. (1970). Possession. San Francisco: Chandler & instead of offering personal, intrapsychic explanations for Sharp. one's distress, Middle Eastern people often tend to provide religious, social, and cultural explanations to their experi Bourguignon, E. (1979). Psychological anthropology. New York: Holt, Rinehart & Winston. ences. One of the reasons as to why dissociative disorders are Bowman, E.S. (1993). Clinical and spiritual effects ofexorcism in still relatively unknown in the Middle East could be that per fifteen patients with multiple personality disorder. DISSOCIATION, sons afflicted with these problems are not construing them 5(4), 222-231. as intrapsychic, but rather perceive them as manifestations Cardena, E. (1988). The phenomenology ofpossession: An ambigu ofexternal spiritist agents. Passive acceptance ofpatriarchal ous flight? Proceedings oftheFifth International Conference on the Study authority, strict prohibitions on manifestations offemale sex ofShamanism and Alternate Modes ofHealing (pp. 2-26). San Rafael, uality and the moral punishments often imposed on women CA. who are thought to have shamed their families due to sus pected improprieties can all contribute to the development Carena, R.A., & Cipolla, R. (1993). In tema di possessione diabol ica: Studio antropologico e c1inico [On demon possession: An of spiritist formulations of dissociative syndromes, particu anthropological and clinical study]. Rivista SperimentalediFreniatria, larly of those associated with incest and child abuse. 117, 439-456. This paper underscores the need to examine ethno-cul tural variables and how these features can inpacton the man Castillo, RJ. (1994). Spirit possession in South Asia, dissociation ifestation ofpsychopathology. This work specifically address or hysteria? Part 2: Case histories. Culture, Medicine and Psychiat1y, 18,141-162. es syndromes thatphenomenologicallyimplicate paranormal experiences resembling dissociative phenomena. The clin Comaz-Diaz, L. (1989). Puerto Rican espiritismo and psychother ical data presented here point to the need for further stud apy. 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