Belief in demons as the cause of mental health problems is a well-known phenomenon in many cultures of the world. However, there is little literature on this phenomenon in Protestant subcultures of the West. The author conducted a systematic investigation of the prevalence of this attribution in 343 mainly Protestant out-patients of a psychiatric clinic in Switzerland, who described themselves as religious. Of these, 129 (37.6 per cent) believed in the possible causation of their problems through the influence of evil spirits, labelling this as 'occult bondage' or 'possession'. One hundred and four patients (30.3 per cent) sought help through ritual 'prayers for deliverance' and exorcism. Prevalence of such practices was significantly related to diagnosis (p < .01) and to church affiliation (p < .005). Patients in charismatic free churches suffering from anxiety disorders and schizophrenia reported the highest rate of exorcistic rituals (70 per cent), and patients with adjustment disorders from traditional state churches the lowest (14 per cent). The various forms and functions of these healing rituals are described. Although many patients subjectively experienced the rituals as positive, outcome in psychiatric symptomatology was not improved. Negative outcome, such as psychotic decompensation, is associated with the exclusion of medical treatment and coercive forms of exorcism.

The relationship between psychopathology and religious commitment was explored in a group of psychiatric patients (n = 44) with depression, anxiety disorders and personality disorders, compared with a control group of healthy subjects (n = 45). Neuroticism and the degree of religious involvement were measured in all probands. The findings did not show any correlation between neuroticism and religiosity. While life satisfaction was negatively correlated with neuroticism, there was a significantly positive correlation with religious commitment. Anxiety concerning sexuality, superego conflicts and childhood fears of God was primarily associated with neuroticism and not with religious commitment. The findings support the clinical observations that the primary factor in explaining neurotic functioning in religious patients is not their personal religious commitment but their underlying psychopathology.

No abstract

Objective: Belief in demonic influence has repeatedly been described as a delusion in schizophrenic patients. The goal of this explorative study was to examine the frequency, as well as the psychodynamic and social functions of such beliefs in a sample of nondelusional patients. Method: The sample consisted of 343 psychiatric outpatients who described themselves as religious. In semistructured interviews they were asked to give their view of demonic causality of their illness. Results: A high prevalence of such beliefs was not only found in schizophrenic patients (56%) but also in the following groups of nondelusional patients: affective disorders (29%), anxiety disorders (48%), personality disorders (37%) and adjustment disorders (23%). Belief in demonic oppression tended to be associated with lower educational level and rural origin, and was significantly influenced by church affiliation. Conclusions: Beliefs in possession or demonic influence are not confined to delusional disorders and should not be qualified as a mere delusion. Rather they have to be interpreted against the cultural and religious background which is shaping causal models of mental distress in the individual.

A 52-year-old Swiss female patient suffered from intermittent fever up to 39°C, headache, moderate diarrhea and dizziness within 2 months after arriving in Haiti where she worked for a non-governmental organization. She collapsed three times but regained consciousness immediately after being placed in a lying position. Although the patient interpreted these events as resulting from a mild flu-like illness combined with orthostatic collapse, she was hospitalized 3 days later to rule out underlying cardiac disease. The initial clinical examination showed hypotension (blood pressure 80/60 mmHg), bradycardia (pulse rate 40 beats per minute) and severe fatigue (Fatigue Severity Score 6-7). The day following her admission to hospital, she developed a psychiatric syndrome characterized by the following symptoms: ideas of reference and delusions with vivid acoustic and visual hallucinations, accompanied by agitation and psychotic fears. She had the impression that part of the staff was trying to harm her, as she heard voices denouncing her from people close to a (non-existent) swimming pool. She also had the impression that there was writing on the bed linen, red in color, and that this writing was a list of judgmental comments on her (mis)behavior. To counteract this ''judgments'', she tore the linen and began to write her ''defense'' on the linen using a pen with black ink. The intravenous drip intended to rehydrate the patient was another object of psychotic fears: she hallucinated embryos in the saline solution and therefore tried to tear out the drip. During the night she suffered from nightmares in which she mixed childhood experiences with the grim reality of poverty in Haiti. All of these hallucinations resulted in a fluctuating emotional state that ranged from fear and sadness to anger and a call to action. When addressed by her husband and staff, she was able to answer simple questions, and she did not refuse eating and drinking. Fever was not a leading symptom during the hospitalization period, and it subsided after a few days.The laboratory tests revealed a leucopenia of 4,000/mm 3 at admission and 2,000/mm 3 the following day (normal value 4,000-10,000/mm 3 ), slightly elevated values for both the liver tests and creatine phosphokinase. Slides for malaria tested negative, and the results of the analysis of the urine were normal. A 24-h electrocardiography and echocardiography showed normal results.The treatment included rehydration with intravenous and oral fluids as well as vitamin and iron supplementation. The psychosis was treated with oral doses of lorazepam and the antipsychotic drug risperidone and a single injection of long-acting fluphenazine, all of which had a marked sedative effect. The hallucinations and delusions vanished over the next 3 days, and the general condition of the patient improved satisfactorily over 6 days. No signs of bleeding were observed at any stage of the disease, but the patient had a strong menstruation. A viral disease or encephalitis were considered as a possible diagnosi...