‘Chaplain, Can You Do an Exorcism?’
A hermeneutical approach to spiritual care can help patients.
The Blind and Mute Man Possessed by Devils (Le démoniaque aveugle et muet), gouache over graphite on gray wove paper, 25.1 cm x 16.5 cm, by James Tissot (between 1886 and 1894). Wikimedia Commons CC-PD
By Jeremy D. Sher
One of the most intriguing questions I’ve encountered in my psychiatric chaplaincy practice is whether I can exorcise a patient. Between Langley Porter Psychiatric Institute in San Francisco and Lemuel Shattuck Hospital in Boston, I’ve worked with some 30 psychiatric inpatients who approached me with concerns about possession by the devil, demons, or evil spirits. In perhaps 15 of those cases, a psychiatric inpatient specifically asked me to perform an exorcism upon them. The question has been quite simple: it is not whether there is any such thing as exorcism, or whether it is efficacious, but simply whether the chaplain will perform one.
Many of these care seekers were psychiatric inpatients diagnosed with command auditory hallucinations. Auditory hallucinations (AH) are common and often manifest as “hearing voices”—perceiving voices that do not originate from the person’s environment.1 Pathological AH involves unwanted, intrusive voices, often harshly self-critical, that interfere with the patient’s life. A frightening complication of AH is command auditory hallucinations (CAH), in which the patient experiences one or more voices commanding them to take certain actions. CAH is dangerous because the commands often involve self-harm.
It is not difficult to see how patients with auditory hallucinations, especially CAH, might interpret their voices as demonic.
It is not difficult to see how patients with auditory hallucinations, especially CAH, might interpret their voices as demonic. Studies show that schizophrenia patients, some 75 percent of whom hear voices, tend to attribute experiences such as AH or CAH to external forces. Most hallucinatory content is negative, although some patients also perceive positive voices, and may feel pulled between demons and a “protector” angel or angels. Patients subjectively experience the voices they hear as intrusive; as singling them out; and, especially with CAH, as being immensely powerful and difficult to refuse. It may not be coincidental that those characteristics are shared by the demonological lore of religious traditions around the world. Further research might find connections between demon-possession lore and CAH as a human medical symptom. In any case, when a patient attributes their hallucinations to external forces and draws on their religious beliefs to interpret those forces as demonic, their conviction that they suffer demonic intrusion or possession may cause them to approach the chaplain for an exorcism.
The question of exorcism in psychiatry cannot be considered without acknowledging that the relationship between psychiatric and religious practitioners has been a fraught one. Whether due to competition for pride of place as the practitioner of choice to cure those symptoms that would lead a patient to report demonic possession, or to science explaining away questions that were once the domain of religion, or to a humanistic concern about the brutality of historic religious exorcisms, modernity has driven psychiatry and religion apart. Some psychiatrists still distrust religion entirely. This was the attitude of the first psychiatrist I encountered during my first chaplaincy internship in Boston, who told my supervisor to get me off his floor and make sure I didn’t come back, because a chaplain could only feed his patients’ delusions.
Fortunately, that kind of hostility between psychiatry and spiritual care is no longer the rule. Today, spiritual care plays an important role in psychiatric inpatient programs like Langley Porter. In examining this relationship, exorcism is illustrative as an extreme case: it makes a literal claim to be interventional and efficacious, thereby placing it within the orbit of pharmaceutical and psychotherapeutic treatments.
Lorna Rattray, a chaplain writing for Psychiatric Bulletin,2 presents an ethical objection to performing an exorcism ceremony in a psychiatric context: what if the ceremony doesn’t work? Rattray collaborated with a psychiatrist who felt that exorcism “could do no harm and might ease some of [the patient’s] anxieties.” However, Rattray worries that “an exorcism that did not ‘make her better’ could result in her feeling extreme guilt, believing that she was so evil that even God could not help her.” Rattray and her psychiatrist colleague ultimately decided not to attempt exorcism.
Rattray approaches the patient’s exorcism request quite literally, and her concern for the implications of a ceremony’s outcome is a step forward in the integration of spiritual care with interdisciplinary medical practice. While neither Rattray’s psychiatrist colleague nor Rattray herself appears to take seriously the idea that exorcism might cure the patient, it seems Rattray and her colleague feel that medical and spiritual practice may collaborate in treating the same patient for the same condition.
At this point, it may be surprising to note that of some 15 patients who used the word “exorcism” to request my help, not a single one had a specific exorcism ceremony in mind. My interventions have consisted of classic spiritual care: listening, spiritual assessment, and verbal intervention through intentionally crafted counseling and prayer. These spiritual care interventions did not differ materially from other spiritual care interventions I have performed. They certainly were not exorcism ceremonies. Yet, when we were finished talking, my patients would typically get up, thank me, say they felt better, and walk away. None ever followed up to ask when their exorcism ceremony would be. All seemed satisfied, and all seemed to benefit from the spiritual care interventions I provided.
They need someone to guide them on the journey they’re on, to help them make theological and philosophical sense of the world as they experience it.
A request for exorcism need not be met specifically with exorcism. The patient is suffering from frightening experiences that they need to talk about. They need someone to guide them on the journey they’re on, to help them make theological and philosophical sense of the world as they experience it. A patient who asks for exorcism is asking for help. It is the job of every member of the interdisciplinary team—psychiatrist, therapist, nurse, chaplain—to provide that help within the scope of service each professional provides, and in collaboration with the rest of the interdisciplinary team.
The theoretical, clinical, and ethical investigations of exorcism in mental health care do not require us to get bogged down debating whether exorcism is real. For one thing, as noted above, my patients have not appeared to take their own requests for exorcism as literally as Rattray took them. For another, where religion is concerned, the project of distinguishing reality from delusion poses philosophical problems that may be insurmountable.
If delusion is “a persistent false belief held in the face of strong contradictory evidence,” the definition used by Richard Dawkins in his book The God Delusion and attributed by him to “the dictionary supplied with Microsoft Word,” then to label religious beliefs delusional is to make quite a strong claim: it is not only to posit the objective falsehood of those religious beliefs but to posit also the existence of “strong contradictory evidence” against them.
Suppose that “Annie”3 is a patient who believes that the CIA is after her. Suppose for the sake of argument that “strong contradictory evidence” can be mustered to show that the CIA is not after Annie, yet Annie persists in that belief. Annie’s belief is a delusion.
Now consider patient “Bill,” who states that he is Jesus Christ—an extreme case, but one I’ve seen many times. It may be tempting to call Bill’s belief a delusion, but clinical methodology gives us no tools to prefer some religious beliefs over others. I may not think Bill is Jesus Christ, but then again I, as a Jewish practitioner, do not believe in Jesus Christ, so who am I to say? Perhaps Bill believes that Jesus Christ can be reborn somehow in the person of a modern-day individual. There can be no contradictory evidence to falsify Bill’s claim, because Bill’s claim is not falsifiable. Bill’s belief may cause problems for him in his life, and it may very well be a factor swaying doctors toward a diagnosis of mental illness. But by Dawkins’s own definition—or, as the case may be, Microsoft’s—delusion is not the right concept to characterize Bill’s belief.
MacKenzie Peltier et al., doctors writing in Ethnicity and Health,4 provide a cultural reason to doubt the reliability of delusion as a meaningful theoretical framework for religious claims. They find that higher numbers of African Americans than European Americans report “being in touch with the dead” and “believing in ghosts,” although “many of these experiences…are not psychotic in nature.” In fact, “endorsing unusual experiences…based in spiritual or culturally acceptable beliefs may contribute to the overdiagnosis of [African Americans] with [schizophrenia spectrum disorders].” In A Casebook of Cognitive Therapy for Psychosis, Anthony Morrison likewise concludes that “cultural differences in the experience of hallucinations are observed, because expectations about what kind of events are likely to be ‘real’ are related to cultural practices.” The problem is that when any patient presents with “unusual experiences” based in “spiritual…beliefs,” the idea of delusion does not fit the situation’s need for a theoretical tool.
In the biblical story found in 1 Samuel 3:2–8, a young prophet Samuel hears a voice. He first attributes this voice to his mentor Eli, and later attributes it to God. This can be read as a story about an auditory hallucination with subjectively meaningful religious content, but it does not follow that Samuel is delusional. If Samuel had persisted in the belief that Eli had spoken after it became known that Eli had not, that would be a bona fide delusion. But nobody is delusional for believing God speaks to them. Samuel’s perception of a voice not originating in an external worldly stimulus was certainly hallucinatory, whether or not it was God speaking through the hallucination. But to call Samuel’s religious belief delusional is to stake out a sectarian position.
In addition to being fraught with bias and dependent on cultural construction, the idea of delusion misses the point of the religious content. The question of the existence of the characters in the patient’s hallucinatory experience is not the topic of what the patient is saying. The patient is trying to tell us about their problems through an illustrative story within whose midst they have found themselves living. Spiritual assessment—assessment of the emotional and spiritual distress dynamics the patient is experiencing—is concerned with the plot of that story, not the question of whether the characters in that story exist. Indeed, spiritual assessment is entirely independent of these reality/unreality questions. The spiritual assessment of Annie, who believed the CIA was after her, would be exactly the same if the CIA really were after her. As a chaplain, getting hung up on the idea of delusion misses an opportunity to spiritually assess patients who complain of demonic possession.
To provide that companionship while not impeding the work of interdisciplinary professionals on reality orientation—while not “feeding the patient’s delusions,” as that first psychiatrist I encountered in Boston put it—is a key balancing act for the psychiatric chaplain.
My purpose here is not to discount the necessity of helping the patient with reality orientation. Helping the patient focus on worldly reality is often an important part of psychotherapeutic care. It’s just that the chaplain’s role is to provide companionship on the journey the patient is on. To provide that companionship while not impeding the work of interdisciplinary professionals on reality orientation—while not “feeding the patient’s delusions,” as that first psychiatrist I encountered in Boston put it—is a key balancing act for the psychiatric chaplain.
In working with a patient concerned that demons were bothering them, I might ask gently, “What did they say?” My intervention must neither endorse nor argue against the patient’s experience. To thread that needle, I work within the patient’s experience while maintaining an analytical professional remove rather than jumping to the patient’s side against their demons. The required neutrality comes naturally to me as a chaplain of a minority religious faith. It is the same neutrality I show when facilitating Christian prayer. Creating meaningful spiritual experiences for people within their own religious framework, without personally endorsing that framework, is core to the hospital chaplaincy profession.
Richard R. Kopp’s concept of metaphor therapy is useful here.5 In metaphor therapy, patients are encouraged to endorse a metaphor for a problem they’re facing; for instance, a patient might imagine a difficult relationship as a brick wall blocking their path. The therapist might then ask the patient what the bricks are made of, what the mortar is made of, how it might feel to add a brick to the wall or to take one away. The therapeutic idea is that the patient’s own metaphor provides a rich palette of high-level concepts ready-made for the therapist and patient to explore together.
The approach I recommend may be seen as a spiritual-care application of the idea behind metaphor therapy. The patient has come to the chaplain with a ready-made metaphor structure intact: that of the patient’s existing religious belief system. There is no reason to exit that metaphorical framework; indeed, cultural humility militates against challenging or destabilizing a patient’s spiritual belief system. Rather, my approach works within the patient’s spiritual belief system while conceptualizing that system theoretically as a metaphor structure. This conceptualization as metaphor insulates me as a practitioner, not only from ethical and methodological perils, but also from theological ones such as syncretism or tension between the patient’s religious beliefs and my own.6
The potential efficaciousness of religious belief within the context of metaphor therapy can be illustrated by the story of “Tim,” a middle-aged professor at a California university. During his adolescent years, he experienced auditory hallucinations, including CAH. Due to his deeply religious upbringing in a remote rural community, he never sought diagnosis; rather, he interpreted his experiences as the devil trying to tempt him. So real was his religious faith to him that Tim was much older before he entertained the possibility that those experiences might have been hallucinatory.
Tim struggled with his voices for two difficult years as a late adolescent. He identified one overarching command voice, which urged him to self-harm and which he found very difficult to resist, as well as a “protector” voice, whose content was positive and which urged Tim not to self-harm.
As much as Tim attributes to the strictures of his religious upbringing the onset of what he now recognizes as likely a psychotic break, Tim ceased experiencing any form of auditory hallucination about two years after the onset of those hallucinations and has not experienced any hallucination since, and he attributes that outcome, too, to the religious framework in which he had been living. Tim no longer subscribes to the religion of his childhood due to what he sees as its overly strict approach, which makes all the more striking his endorsement of the effectiveness of his childhood religion in helping him combat his demons. Tim believes that his religious framework at the time gave him tools that allowed him to fight the devil, or what he thought of as the devil, because his childhood religious framework taught that individuals are so empowered. Believing firmly that God was on his side, the young Tim engaged in spiritual warfare and beat back the devil in his life. Tim believes that, earlier in his life, in an environment in which obtaining secular medical or therapeutic resources was unrealistic and seeking them out had not occurred to him, the teachings of his childhood faith enabled him to put his demons to rest.
Tim’s journey illustrates the power of religious faith as spiritual metaphor. It is far from clear that any secular approach could have helped Tim analyze his situation within a reasonable amount of time, and in any case, no such approach was available. His religious faith at the time fortunately contained just the right mix of concepts to allow Tim to quiet his voices. The issue was never whether the characters to whom Tim attributed his voices were fictitious or real. The issue was how Tim could skillfully manipulate the concepts they represented to enable himself to overcome them.
Just as spiritual assessment does not require us to believe in the existence of a patient’s legendarium, neither does it require us to debunk it or explain it away. Relaxing our focus on reality/unreality questions leaves room for the patient’s theology to remain true. “Alejandra” was a Catholic woman whom I met in a transitional care unit where she lay recovering from a suicide attempt. Alejandra said that the devil had been telling her to kill herself for some time. After spiritual counseling, Alejandra said she did not want to kill herself. Yet, to increase the likelihood of Alejandra remaining safe, I assessed that the situation required that Alejandra agree to seek help if she should feel suicidal again. Taking a risk, I summoned the pastoral authority I had developed in the conversation, stood up very straight, and said to Alejandra: “It may happen in the future that you feel like you may harm yourself; you may feel that the devil is back. If that happens, I think you know what you’re going to do. What are you going to do?” Alejandra thought about it for a moment, and replied that she would go to her local Catholic church. I strongly affirmed this pact and encouraged Alejandra to go to the nearest Catholic church without delay, should she ever again feel bothered by the devil. Alejandra agreed that she would.
From a clinical perspective, this had the hallmark of a good suicidality intervention. (I leave aside a current controversy over the efficaciousness of suicidality prevention pacts; I believe this was the right intervention for Alejandra.) If I were looking for a place that would be easy for Alejandra to find in an emergency, would likely be open when she needs help, and would be staffed by people who feel strongly about preserving human life, I can think of few better places for her to start than a neighborhood Catholic church. The spiritual metaphor Alejandra and I had been working with no doubt facilitated her agreeing to this pact with me. She probably would not have agreed to such a pact if I had restricted my clinical approach to the cognitive and logical.
Yet the clinical validity of this intervention does not prevent it from being valid on a theological level, too. A Catholic woman was tempted by the devil, and she made an agreement with the hospital chaplain to seek refuge in a Catholic church, there to be safe from the devil. This can be seen as a useful clinical metaphor that enabled Alejandra and me to reach a suicide prevention pact, or it may be viewed within Alejandra’s religious belief system as a theological intervention on its own. My interdisciplinary colleagues and I focus on the former view of this intervention, because our job is to function as clinicians, not theologians. Alejandra, however, was exclusively concerned with the latter.
The unavailability of delusion as a useful category for religious content presents no barrier to spiritual assessment. It is not necessary to get bogged down evaluating whether the patient’s claim of being demonically possessed is real, and it is not necessary to get bogged down in sectarian disputations about the reality or unreality of devils, demons, or supernatural evil. What is necessary is to assess what the patient’s words reveal about the patient’s spiritual distress dynamics.
The characters to which patients attribute their voices personify the patients’ inner struggles. The reality or unreality of those characters is as much beside the point for spiritual assessment as it would be to ask whether literary characters like Rodion Raskolnikov or Charles Darnay are real. But anyone who has read Crime and Punishment or A Tale of Two Cities knows those characters and could probably glean information about a patient’s mental state if a patient were to speak about those characters. There is a difference between fiction and fib. Not everything patients say may be great literature, but their words may be treated as text, which is to say, hermeneutically, and that suggests a broad set of methodological contributions hermeneutical scholarship might yet make to the care of psychotic patients.
Spiritual assessment hears the patient’s words hermeneutically, as text, and considers the plot of that text. A hermeneutical approach to patients’ words enables spiritual care practitioners to identify the psychotic patient’s metaphors in order to care for the patient. A hermeneutical approach leaves room for both the scientific and the theological to be true. It allows science to explain what happened with Alejandra without explaining away the miracle of it.
When I work with a patient complaining of demonic possession, I begin with a salute to modern science. I tell the patient that I’m very glad we have modern science and medicine, because medication can effectively mitigate their symptoms. I don’t want the patient to think I’m opposed to science, and I certainly don’t want the patient to triangulate me into the middle of a struggle they may have with the psychiatric team. It is necessary in the first place to put to rest the old tension between religion and medicine. This is not a competition for the patient’s heart or mind; this is an interdisciplinary team.
As I listen and probe, I attempt to assess what spiritual distress dynamics might be coming up for the patient through the lens of what the patient’s voices say.
I begin with Active Listening, using body language, simple prompts and brief probing questions, and the intentional use of silence, to encourage the patient to talk. I find that most patients readily share their experiences of spiritual struggle. When the patient mentions demons or evil spirits in ways that I suspect might be consistent with psychosis, I do not express in any way that I believe the patient may be psychotic. Diagnosis is not only outside my scope of service, training, and expertise; it also gets in the way of my pastoral role. I avoid all attempts to argue the patient out of their belief in such entities through logic. Rather, as I listen and probe, I attempt to assess what spiritual distress dynamics might be coming up for the patient through the lens of what the patient’s voices say.
Of the many spiritual assessment models available, the Spiritual Assessment and Intervention Model (Spiritual AIM), developed by Michele Shields et al., offers three key advantages.7 First, its focus on three clear and qualitatively different emotional dynamics—anger, fear, and shame—provides granular assessment of real differences in mental health patients’ spiritual distress in superficially similar situations, often even in diagnostically similar situations. Second, Spiritual AIM is simple enough that I have been able to explain it to psychiatrists, therapists, and nurses in the few minutes available to us for conversation in the charting room or hallway. Third, Spiritual AIM uses spiritual assessment to recommend avenues for intervention.
Spiritual AIM categorizes spiritual distress dynamics as either anger-based or relationship-reconciliation dynamics, in which the chaplain plays the role of a supportively confrontational truth-teller; fear-based or meaning-and-direction dynamics, in which the chaplain guides the patient toward a sense of purpose or meaning; and shame-based or community-belonging dynamics, in which the chaplain affirms and validates the patient’s belonging in community. To illustrate the role of Spiritual AIM, consider two patients, both presenting with the (bona fide) delusion that the CIA is after them. The two patients might have identical psychiatric diagnoses and might be treated with identical medications. Acute care psychotherapists might also take identical approaches to the two patients, perhaps redirecting them to pragmatic concerns of the here and now. But, in spiritual assessment, it emerges that one patient has an anger-based, other-blaming spiritual distress dynamic, while the other patient has a shame-based, self-blaming spiritual distress dynamic. The other-blaming patient blames all of her problems on the CIA, claiming that the government has defrauded her, or claiming that the world is stacked against her and she has to fight, and so forth. She presents with the same confrontational attitude toward the treatment team, perhaps refusing medications or overloading nurses with nitpicky demands. Meanwhile, the self-blaming patient is motivated by a concern that the CIA will expose her for being an impostor; she shuts down and isolates, perhaps declining group therapy or sleeping excessively.
Spiritual AIM suggests different spiritual care interventions for these two patients. The first needs a truth-teller who will challenge her assumptions and show her that taking greater personal responsibility will lead to the self-empowerment she seeks. The second needs a supporter who will assure her of her self-worth, likability, and place in community. Although the patients have identical diagnoses and may need identical psychopharmaceutical interventions, their spiritual distress dynamics indicate opposite chaplaincy interventions.
Spiritual assessment that combines a hermeneutical approach with Spiritual AIM has guided effective spiritual care for inpatients reporting demonic possession. “Gene” was an inpatient whom I assessed as suffering from a relationship-reconciliation dynamic. Gene was cordial, but there seemed to be an underlying anger about him. Gene seemed frustrated and disempowered by his voices, which included evil spirits as well as a quasi-protector whom Gene identified as “God Almighty,” with a quick gesture (I could not tell whether it was conscious) toward the “G|A” logo on his Giorgio Armani glasses. The disempowerment Gene felt suggested that a greater sense of personal responsibility could benefit him; to support that, Spiritual AIM suggested that Gene could benefit from my acting as a truth-teller. I intervened with Gene by using Socratic questioning to help him explore the nature of his voices. When Gene began to repeat his complaint that the voices always seemed to know what he was about to say and would preempt him, as if he felt this preemption was unfair, I took the risk of asking Gene with firmness, “Why do they all know what you’re about to say?” Gene suddenly exclaimed, “Oh! They’re all me, aren’t they? That’s a light. Talk therapy isn’t bullshit!” I am not a therapist and cannot speak to what ended up being therapeutic for Gene, but a review of his chart showed a dramatic reduction in his CAH, after a hospitalization that had already lasted several weeks.
In another case in which I assessed a patient with CAH as suffering a relationship-reconciliation dynamic, I asked the patient whether he’d ever tried saying “no” to the demonic voices. The thought had not occurred to him, and after reviewing his theological beliefs and confirming a belief in God-given personal agency, the patient thought that approach was worth a try. This intervention may have helped the patient, perhaps along the lines of Tim’s experience; it certainly did not hurt. It is another example of the patient’s existing religious beliefs serving as a useful metaphor, providing options for intervention and for the patient’s own recovery work that would probably not have been available if the underlying religious belief had been absent or clinically rejected.
“Ted” was a patient with CAH whom I assessed as suffering from a meaning-and-direction dynamic. Like many of my other CAH patients, Ted heard many, mostly negative, voices along with one positive, “protector” voice. Ted attributed the negative voices to demons and the “protector” voice to an angel. Ted felt torn between the command content of his CAH to self-harm, which he said he knew to be wrong but found difficult to ignore, and the protective voice of his “angel,” which featured content such as, “Don’t do it, think of your family.” Because I saw Ted repetitively weighing options, and because I did not detect significant self-blaming or other-blaming patterns in him, I assessed him as needing meaning and direction, which in Spiritual AIM calls for the chaplain to act as a guide to help the patient find and focus on his sense of purpose. A sense of life mission was too elusive for Ted, but his clear moral sense, which he expressed in protest of his CAH, struck me as a spiritual strength in him. I said to him, “You already know right from wrong”—he nodded to signify endorsement—“can you focus on the angel?” I suggested Ted try to get to know the angel, perhaps trying to draw what he thought it might look like. The more attention Ted paid to the angel, I said to him, the more he might be able to focus on its guidance instead of on the other voices.
It bears remarking that Ted might have been harmed by a clinical approach that needlessly challenged his religious beliefs. It was Ted’s underlying belief in the spiritual power of his angel that enabled Ted to place his attention there. To disabuse Ted of his notion that this “protector” voice was angelic might have deprived him of a potentially powerful clinical metaphor.
“Lisa” was a patient I had served multiple times over several hospitalizations. A rather low-functioning adult who presented with a childlike, concrete operational understanding of the world, Lisa showed clear signs of a shame-based spiritual distress dynamic. Her CAH consisted of one main character, the commander, whom Lisa identified as an imaginary alter ego named Lucy. Lisa would say things like, “Lucy made me do it,” or, “Lucy gets inside my head and makes me do it.” Lisa’s constant attempts to deflect her own guilt onto Lucy signaled that shame was her prevailing distress emotion.
Lisa professed deep Protestant Christian beliefs. Through continued work with Lisa, I developed the conjecture that the name Lucy was in fact an abbreviation for Lucifer, the abbreviation perhaps itself a mark of shame, as if Lisa could not bring herself to finish saying the devil’s name. Lisa’s report that studying the Bible protected her from Lucy supported that conjecture. After several weeks developing rapport, I was able to test this hunch by asking Lisa who she thought Lucy was. When she responded “Devil!” as if to spit the offending word out of her mouth, I assessed that Lisa was subjectively experiencing demonic possession but with a shame-based dynamic, which Spiritual AIM connects to a missing sense of belonging in community. Therefore, to develop her sense of belonging, I assured Lisa that “God loves you very, very much, no matter what, do you know that?” and repeated this assurance until Lisa endorsed it.
In all of these interventions, I am confident that my work was firmly within the scope of spiritual care, but patients retrospectively believed my interventions to have helped them toward conquering their demons. None of these interventions was curative, of course, but all appeared to be helpful as part of an institution’s interdisciplinary approach to care.
Spiritual assessment combining a hermeneutical approach, Spiritual AIM, and the concept of metaphor therapy suggests an effective model for interdisciplinary collaboration when patients complain of demonic possession.
As Gene’s reaction showed, the line between spiritual care and psychotherapy is not always entirely clear. In a nonpsychiatric hospital unit, the boundaries of the chaplain’s scope of service are clearer: the chaplain says whatever they assess as needed, and the chaplain does not touch the medical instruments. In the psychiatric inpatient environment, that boundary can be harder to find, although spiritual care and psychotherapy certainly have different orientations; the former provides companionship and spiritual growth, while the latter treats disease. But better avenues of interdisciplinary collaboration are available than the counterproductive standoffs of yesteryear between mental health care providers and clergy—and richer conceptual frameworks are available than a literal focus on exorcism ceremonies. Spiritual assessment combining a hermeneutical approach, Spiritual AIM, and the concept of metaphor therapy suggests an effective model for interdisciplinary collaboration when patients complain of demonic possession.
I am grateful to have had opportunities to offer effective and, I believe, substantially novel approaches to spiritual care when patients complain of demonic possession. I’ve argued for a theoretical model that insulates me from needing to endorse or reject my patients’ beliefs in demons. I care for Christian patients all day without personally endorsing their beliefs; my ability to do so is a cornerstone of my profession, and my experience doing so might have prepared me to listen to my patients’ demon-possession stories without being distracted by tension with my own beliefs. Still, as I’ve written and spoken about this topic, people often ask what I personally believe. Has my clinical demonology work changed me?
It wasn’t just caring for non-Jewish patients that prepared me to take my patients’ demon-possession complaints at face value. Difficult life experiences got me thinking about the role of evil in Judaism and affected the development of my beliefs, as did a lifelong interest in heavy metal music and Dungeons & Dragons. (My career goal is to be featured in the clergy section of Iron Maiden’s website.) Finally, while I was studying to become a rabbi, I met and confronted a personal demon. And while I thought of that demon more as a theoretical metaphor than a literal supernatural personality, I was already paying enough attention to demons before my work at Langley Porter that, perhaps, taking patients’ demon-possession complaints seriously was a smaller leap than it might have been.
Based on a Jewish belief in the uncompromising monotheism of Job, of a God who “makes peace and creates harm” (Isaiah 45:7), I reject the notion of a devil power independently opposing God. God’s omnipotence, in my view, does not admit of competition. In Judaism, Satan works for God: Satan is a heavenly prosecutor who argues that humans should be punished for sin. There is no dualism or power opposing God.
The Hebrew word for angel, mal’akh, literally means “messenger.” A demon, then, is an angel with a message that we don’t want to hear.
Out of this belief, I came to the idea that a demon is an unpleasant angel, and an angel is a messenger of God. The Hebrew word for angel, mal’akh, literally means “messenger.” A demon, then, is an angel with a message that we don’t want to hear. Twice, I’ve used this idea clinically with psychiatric inpatients. Each time, I assessed that my idea might help the patient, and I asked the patient if they’d like to hear something from my own faith tradition. With their assent, I told them that the demon conceals a holy message that God wants us to hear, but it appears demonic because there is hurt somewhere in God’s creation. So, if we listen very carefully to the demon’s expression of hurt, we might be able to identify the hurt and, in soothing it, dispel the demon. Patients were helped by this intervention.
So, do I believe in demons? I believe there are real spiritual forces that represent hurt in the world, that personifications of the world’s hurt can appear in the subjective experience of humans, and that clinical demonology along the lines I’ve outlined can help people who feel besieged by those frightening personifications, whether the form of the patient’s experience is caused by mental illness or not. I believe that my professional training, my ordination as a rabbi, and my vocation as a chaplain appropriately position me to help people who complain of demonic possession. And I believe there is clinical—and communal—value to taking psychiatric patients’ experiences seriously.
- Auditory hallucinations are not uncommon, but most of these incidents are isolated or nonpathological.
- Lorna H. Rattray, “Significance of the Chaplain within the Mental Health Care Team,” Psychiatric Bulletin 26, no. 5 (2002): 190–91.
- Names of subjects have been changed to protect their privacy.
- MacKenzie R. Peltier et al., “Do They See Dead People? Cultural Factors and Sensitivity in Screening for Schizophrenia Spectrum Disorders,” Ethnicity and Health 22, no. 2 (2017): 119–29; published online 16 June 2016, DOI: 10.1080/13557858.2016.1196650.
- Richard R. Kopp, Metaphor Therapy: Using Client-Generated Metaphors in Psychotherapy (Brunner-Routledge, 1995).
- The history of Christian demonological imagery is also a concern from which conceptualizing the patient’s religious belief system as metaphor insulates me, especially where that history intersects anti-Semitism.
- Michele Shields, Allison Kestenbaum, and Laura B. Dunn, “Spiritual AIM and the Work of the Chaplain: A Model for Assessing Spiritual Needs and Outcomes in Relationship,” Palliative and Supportive Care 13, no. 1 (February 2015): 75–89.
Jeremy D. Sher, MDiv ’16, is a medical and psychiatric hospital chaplain in San Francisco and is rabbi of Kanfot Ha’aretz (“Corners of the Earth”), an online Jewish community. His was the first rabbinic ordination ceremony to occur on campus at Harvard Divinity School. Before studying for the rabbinate, he was director of technology at the Washington State Democratic Party and led the software company behind ActBlue.com. He can be contacted at email@example.com.