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Psychopathology 2008;41:245–253 DOI: 10.1159/000125558
Received: October 26, 2006 Accepted after revision: July 3, 2007 Published online: April 11, 2008
Possession States in Northern Sri Lanka
Daya Somasundaram T. Thivakaran Dinesh Bhugra
Department of Psychiatry, University of Jaffna, Jaffna, Sri Lanka
Key Words Possession states Cross-cultural psychiatry Phenomenology South Asia
Abstract Background: Possession states are still commonly seen in developing societies as acceptable cultural phenomena in normal persons as well as in those with psychiatric illness. ‘Possession’ is defined here as the experience of being taken over, controlled or occupied by another spirit or force. Sampling and Methods: This is a descriptive cross-sectional study of possession states among psychiatric patients, general population and popular adepts in Northern Sri Lanka, using semi-structured questionnaires and clinical observations. Results: Thirty psychiatric patients were identified as having possession states. They were compared with 30 controls each from the general population admitted to a general hospital outpatient department and selected popular adepts in the community. The latter are individuals who are well known as having possession states. An analysis of social factors and other variables showed that education, marital status, age, employment, strength of belief, alterations in personality, past or family psychiatric history, previous exposure to similar phenomena, help-seeking behavior and treatment outcome differed between the three groups. Religion of the subjects or recent changes in values showed no correlation with possession while monetary gain from possession states showed only a partial correlation. Western medical treatment was of value only when possession states were seen as part of psychotic illness. Discussion: Possession is a spectrum of experiential and behavioral phenomena seen in culturally acceptable form in normal people, popular ad-
epts, as well as manifestations of psychotic illness. Possession states which fit normal cultural stereotypes could, if necessary, be better managed by traditional methods. However, clinicians need to be familiar with culturally abnormal forms of possession which are manifestations of psychotic illness that benefit from western psychiatric treatment.
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The [possession] merely opens the door to the secret recess of the heart where man hides those thoughts and emotions, those unfulfilled wishes and dreams or crude desires that are not permitted gratification in normal everyday life … It is from this untamed area of the unconscious, semiconscious or subconscious that the storms originate, and under certain circumstances whirl him into insanity. August Wimmer (1924)
Among the varied phenomena found in normal life and psychiatric practice, possession states are perhaps the most colorful, dramatic and exotic but least understood. It has been at once described as a subcultural variation of normal life, a form of hysterical dissociation or actingout behavior with a multitude of neurotic causes or manifestation of psychosis [1–5]. Indeed, Wimmer  equated possession states with psychogenic psychoses – reactive psychoses to psychological trauma with a good prognosis. Even in orthodox western psychiatry, possession was first considered a form of passivity or delusion of control, a first-rank symptom of Schneider, or diagnostic of schizophrenia [1, 5]. However, it was soon recognized as
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Mannar and Vavuniya. Method This is a descriptive cross-sectional study. Of the 71 individuals aged 18–65. The Psychiatric Unit at the District Hospital Tellippalai functions as the main inpatient facility for all patients from Jaffna and the entire Northern Province. however. belonging during this period mainly to Hindu and some Christian religious faiths. This needs to be and is clearly differentiated from those whose possession state is related to their psychiatric state. Some patients also come from other provinces. Obeyesekere  noted that cultural symbols inform and are informed by individual experience.a subcultural phenomenon fitting a culturally sanctioned stereotyped behavioral pattern in non-western countries [1. words for these phenomena include: kalai (‘artistic’) and uru. the typologies are achieved at the expense of context and inevitably reflect the interests. However. and in people who are ‘revered’ and recognized in the community. Tamil. The predominantly Tamil society is very conservative and caste based from the middle and lower socioeconomic classes. He observed that those possessed are unwell and subordinate women. social class remains important but the impact of colonialism would be of a different kind as this group is already a minority and their life experiences are likely to be colored by their relationship with the majority community. stereotyped movements and behavior with or without an associated trance state. Seligman  demonstrates that the subjects are victims of both racial and gender discrimination. Lewis  talks of possession within the rubric of ecstatic religion. in medical patients. Looking at possession states from an anthropological view. Most people would simply indicate that a spirit or force has come in. This is almost exactly what we see in the community sample where personal symbols become socially and emotionally meaningful at once. Somasundaram/Thivakaran/Bhugra . family and socioeconomic history. This seems to be true of the general population . literally meaning ‘form or conforming to form and to dance taking a form’.41:245–253 ute to the possession. The description was both quantitative and qualitative. Thus the pendulum swung to the other extreme where the modern tendency now is to discount all forms of possession as merely subcultural and benign and thus of no serious psychiatric significance. She found that the social and economic marginality of Candomblé participants was confirmed. based on a semi-structured questionnaire with the data collected from the available records and interviews of the patient and relatives. 2003 to January 31. in psychiatric settings those manifesting possession states are often found to be suffering from psychoses. Seventy-one individuals were interviewed with the aim to investigate why certain people become Candomblé and what distinguishes them from those who do not become mediums. and pey addichitu (‘being hit by a demon or ghost’). We also agree with Crapanzano’s  suggestion that an adequate account of possession must grant the spirits’ existence in the lives of their hosts which is the key point of the study. sami vanthidu (‘the spirit has come’). Kilinochi. The individual’s expectations based on culturally held etiology of mediumship become embodied in mediums. phenomenological data and details of the possession and a mental state examination. The three types of possession states seen are those in the psychiatric patients. 3]. The local. Seligman  describes the dynamic interactions between individual and social characteristics and cultural environment using data from a study set in Brazil. or more descriptively. Using the practice of Candomblé in her study. uru edethu adethal. is staying within or has a presence. Lewis  emphasizes that it is crucial to note that scholars are embedded in cultural frameworks and hence it becomes important for research within the same culture to be looked at by people who are embedded in these frameworks. values and fascination of the society which is being analyzed and that is being presented here. We set out to study the clinical and social aspects of possession states. in whom possession experiences have occurred during the period from August 1. Boddy  notes that the otherness of the phenomenon demands explanation. 2004. present. The main population under study are psychiatric patients receiving inpatient treatment at the Psychiatric Unit at the District Hospital Tellippalai. and as Boddy  emphasizes. The interviewer-administered questionnaire elicited basic demographic information: previous. The mediums appear to have little access to power and resources and thus these marginal positives might contrib246 Psychopathology 2008. having four other districts namely Mullaitivu. Other words which are used in this context are adkollal (‘being taken over’). Possession intersects with numerous cultural domains including medicine and religion but is itself reducible to none . Looking at Sri Lankan ascetics possessed by ghosts and deities. Kapferer  argues that in Buddhist Sri Lanka demonic exorcism is rooted firmly in the context of colonial history and social class. The northern region is mainly of a rural nature with small towns. recently caught up in a civil war situation. in our sample which is largely Tamil. For the purposes of the study we defined possession as the episodic experience of being controlled by another spirit or force with the loss of one’s personal identity often manifested in culture-specific. but the flexibility of the spirit idiom is evident. some were mediums and others were seen as controls.
All subjects in the community possession group were over 35 years old. Psychopathology 2008. There were fewer possessions among white-collar workers. the highest number of housewives were found in the community group (over 50%). or 2%) was noted. or mediumship. but part of the clinical picture. 1. Gender distribution. Although no statistically significant differences emerged.492 persons visited the general outpatient department at the General Hospital. Occupation Not surprisingly. 2004). Possession States 247 . After a preliminary screening of all attendees. Sri Lanka. possession states were twice as likely in females compared to males in each of the three samples (fig. A comparative analysis of some significant variables is presented in what follows. 4). The psychiatric patient group included all those who had experienced a possession state which was not necessarily the presenting complaint nor the main manifestation. Age Possession states were either not seen or seen rarely at the extremes of age – none under 10 years and in no patients over 74 years of age (fig. or 7%) and medical patients (30 out of 1. Jaffna. Age distribution. oracle. A total of 1.30 Community Medical Psychiatric patients Numbers Numbers 20 20 15 Community Medical Psychiatric patients 10 10 5 0 Male Sex Female 0 <10 10–19 20–34 35–54 Age (years) 55–74 >74 Fig. on 3 days. University of Jaffna. Nearly 50% of the possession states occurred in the age group 30–40 where all three populations share roughly the same proportion. Informed consent was obtained from the participants after a complete description of the study. Ethics approval for the study was obtained from the Ethics Review Committee. They often provide a social function or service through their possession such as divination. a total of 426 patients (196 males. The frequency of possession states in the psychiatric patient population (30 out of 426. and were screened for possession in the mornings of 3 days (November 21 and 28. and January 2. Faculty of Medicine. However. 3).41:245–253 Results During the period of the study. 2003. The psychiatric patient group was compared to two other population groups that had experienced possession states. those who acknowledged having had recent possession experiences were invited to participate in the study and the first consecutive 30 patients were included. 230 females) were admitted to the Psychiatric Unit at the District Hospital Tellippalai. Fig. Jaffna. medical possession or community possession. Another sample was selected from all those who visited the general medical outpatient clinic (not psychiatric clinic) at the General Hospital. Thus the three groups included in the study consisted of subjects with either psychiatric possession. Gender In all three samples. there were a large number of housewives (fig. Educational Level The majority of persons having possession experiences across all three groups had had an education up to the 10th year (fig. 2. while unsurprisingly more of the psychiatric patient group tended to be unemployed. The sample size aimed at was 30 in each group. only the first 30 acknowledging a recent possession experience were studied. The third population studied included people who were well known in the Jaffna community for their possession states which were claimed as supernatural within the cultural context. 2).492. 1).
In the psychiatric patient group. something akin to divine. 20 Community Medical Psychiatric patients 15 Numbers Marital Status Over 81% of possessions were reported in married persons (fig.20 15 Numbers 10 5 Community Medical Psychiatric patients 30 25 Numbers 20 15 10 5 Community Medical Psychiatric patients 0 Over ordinary level Under 5th grade Formal education No data 0 Divine Ghostlike Humane Category Others More than (ill defined) one type Fig. 248 Psychopathology 2008. the patient said she was being possessed by a scientist working for NASA indicating an impact of globalization.41:245–253 No . 6. 4. Possessing spirit or force. Details of this case are given in Appendix 1. Educational level. 5. 5). Religion The religion of the possessed was representative of the local population across all three groups. In one of these cases. while in the patient group only 53% were married. over 20% claimed they were being possessed by a bad spirit or force. In addition. which was perceived to have a negative effect on them. 35 30 25 20 15 10 5 0 Married Not married Status Numbers Community Medical Psychiatric patients Widow/er Fig. 3 persons complained of multiple possessions compared to 1 in the community group. Twenty-six (87%) of the community group. Even in the community group. Marital status. Occupational status. 6) also described their possessing force as good. which was perceived to have a positive effect on them and their lives. a person with multiple possessions had been possessed by both divine and ghostly forces. Fig. the possessions were by subcultural divine and ghostlike forces. all in the community group and 90% of the medical group were married. 4 individuals in the psychiatric patient group had been possessed by humans compared to 1 in the community group. In the psychiatric patient group. 6). In the medical group. 3. Three persons (in the category ‘others’ in fig. The Possessing Spirit or Force The great majority (66 or 73%) of those experiencing possession states across all the groups attributed it to divine forces (fig. 20 (67%) of the medical and 27 Somasundaram/Thivakaran/Bhugra 10 5 0 -c o w llar or k Sk i la lled bo r Un sk i la lled bo r Un em pl oy ed ife Ho us ew to th sp er w ec is ifi e ed W hi te Occupational status Fig. Significantly.
nearly half (n = 14 or 47%) had lost money due to their behavior. common mental disorder (n = 6 or 20% in the community group and n = 12 or 40% in the medical group). There were a few cases where persons recently converted to a new religion (Pentecostal) seemed to have been pursued by the spirits from the old faith and as a result some had converted back to their original religion. and of the community group. with 40 (44%) denying any need for it. anger. Those lasting for more than a day were only seen in the psychiatric patient group . 24 (80%) had witnessed a possession state earlier. 14 (47%) had seen a possession state manifestation. Change in Economic Status Economic gain through the possession state was reported in the medical (27%) and community groups (43%). trying of charmed thread. This included more respect. feeling bad. 5 (17%) of the medical and 2 (7%) of the psychiatric patient group belonged to orthodox. while only 6 (20%) psychiatric patients reported a positive gain. dignity. dissociative disorder (n = 3. non-orthodox Christian faiths. holy gaze. social ostracism. This often meant some payment for services renPossession States dered while in the possessed state such as oracle function (fortune-telling. In 71 out of all the subjects (79%). or 13%). elimination of Psychopathology 2008. or 3%). 12 (40%) of the medical group and 9 (30%) of the psychiatric patient group. Other diagnoses were affective disorder (n = 1. lowering of status.(90%) of the psychiatric patient group were Hindus. 26 (86%) had not sought treatment. and isolation were predominant. Five from the community and medical groups (16%) had features of psychotic illness while 1 adept from the community group had chronic psychotic illness. the episodes had lasted more than 6 months. prayer. better relationships and understanding by others. 10 (33%) of the medical and 21 (70%) of the psychiatric patient groups had long episodes continuing for several hours or even days. On the other hand.41:245–253 249 . Family History of Possession States or Psychiatric Illness There was a family history of possession states in 13 (43%) of the community group. Eleven (37%) of the community. Thus psychotic illnesses were found in 73%. family or social. explaining the past. economic difficulties (n = 7 or 23% in the community group and n = 12 or 40% in the medical group) and alcohol abuse (n = 6 or 20% in the community group and n = 3 or 10% in the medical group). None had only a single attack. possession attacks lasted less than an hour in 48 (53%) subjects. The religion of the possessing spirit did not necessarily correspond to the religion of the person being possessed. only 1 went away after assessment denying the need for treatment. while 5 (17%) of the community and 1 of the psychiatric patient group were from the charismatic. Four (13%) of the community. Hindu spirits possessed Christians and vice versa. sprinkling or application of various holy materials. mainly due to loss of work. others accepted donations whether in cash or kind. Problems identified in the medical and community groups included family and social problems (n = 14 or 47% in the community group and n = 7 or 23% in the medical group). 5 (17%) of the medical group and 13 (43%) of the psychiatric patient group. many did not have a choice as they were usually brought by relatives who insisted on treatment. blessing. while acute psychotic disorder accounted for 6 cases (20%). Initially. Timing of the Possession Across all groups. Diagnosis among the Patients Using ICD-10 criteria. Some charged a fee. Change in Personal/Social Status Twenty-four (80%) of the community group and 25 (83%) of the medical group claimed that they gained in personality or social status by being possessed. In the medical group. or 10%) and somatoform disorders (n = 4. Of the psychiatric patients. but the phenomena had continued for less than a month. increased self-esteem. Of patients who were seen in the psychiatric services. or 53%). providing solutions for problems) as well as healing and advising on various problems such as relational. Around 13 (43%) of the community group felt they could be without treatment. Treatment Sought Overall 41 (46%) people with possession states had sought any form of treatment. schizophrenia was seen as the commonest diagnosis among the psychiatric patient group (n = 16. exorcism. 21 (70%) patients reported a decrease in their personal or social status following possession especially if possessed by negative or evil forces where fear. Witnessing Possession States Elsewhere Among psychiatric patients. Half of them had also sought traditional treatments such as religious rituals. conventional Christian churches. A family history of psychiatric illness was obtained in only 1 person from the community group.
confirms that marriage confers social acceptance while being single could increase the tendency towards social pathology. Those with psychiatric illness would also tend to remain single. When looking at the educational level of those with possessions. change. i. Treatment Outcome Western medical treatment showed a much better outcome (n = 20 or 72%) than traditional methods (n = 5 or 33%) in the psychiatric patient group. The occurrence of possessions in 35-year-olds in the community group may indicate that they are well adapted to this state or have good control over themselves. In the psychiatric patient group.  studied 61 chronically psychotic outpatients (25 had a history of delusional possession compared with 36 who did not). their possession states are accepted by the community. as Boddy points out. The higher number of unemployed subjects among the psychiatric patients would obviously be due to the disability caused by psychiatric illness. The Southern study had also found a threefold female preponderance . They may also be taking this control back on behalf of their families. However.5% . their femininity culturally prefigures them as prone to demonic attack. There are differences between Sinhalese and Tamil women. The increase in culturally abnormal forms of possession in the psychiatric patient group such as multiple or human possessions indicates the tendency in this group towards a form of possession deviating from the normally accepted pattern. The fewer white-collar workers among those with possession states could be due to possession being a hindrance or stigma for white-collar workers. Boddy  highlights urban rural differences in her review and suggests that ancestry and family play a key role. The proportions are equal in the three groups irrespective of the outcome of the behavior. accepted or disapproved (in case of psychiatric illness) by the community. Thus. one should explore how possession as an idiom of communication is constructed and used in specific societies. The twofold female preponderance in all three samples could be explained by the perceived and real inferior social status of women in this culture. The possession behavior could be a manifestation of the psychosocial distress as well as a way of coping. Boddy  and Crapanzano  indicate that possession must be viewed as an idiom for articulating a certain range of experience. while 1 person out of 2 benefited from the traditional methods. perceived as supernormal by the society and hence themselves. Thus it would appear that psychiatric patient status is more likely to be associated with possession than simply educational status. which may explain the need for help. among others. In the medical group.evil objects. friends and colleagues. children. Discussion The prevalence rate of possession states (7%) in our study is much higher than that from the community survey done three decades earlier in the South of Sri Lanka which found 37 cases out of 7. found a high number (over half) of people with psychosocial problems . Indeed. An issue threading through the literature is that of selfhood or identity. particularly in the subcultural family dynamics. Kapferer  points out that because Sinhalese women are considered more firmly attached than men to relationships of the human world.e. thus the possession states may be a way of gaining attention and expressing suppressed feelings or somatization. which is what we set out to do. a study at the outpatient department of the General Hospital. treatment or some intervention. Goff et al. Jaffna. Of those who reported deluSomasundaram/Thivakaran/Bhugra . while those with possession experiences and more than a grade 10 education were more likely to belong to the psychiatric patient group. but there is no reason to believe that similarities do not exist. In other words. particularly in the medical and community groups. The cultural expectations of marriage and social status accorded to wives would indicate that a housewife has 250 Psychopathology 2008. The example of possession by an NASA scientist illustrates the pathoplastic effect of modern technology and knowledge on the substratum of morbid passivity experience which was being experienced or explained by the patient through cultural idioms or forms (possession) albeit in a deviant manner. The surprisingly large number of married persons exhibiting possession. the majority had had an education up to grade 10. economic and psychological factors. See Appendix 2 for a case that illustrates social. Gender is an important factor especially as women can be marginalized in patriarchal societies and they may have been taking this control back through possession. the number with malignant or evil possessions increases (over 20%). traditional methods showed a better outcome (n = 3 or 75%) than western medical treatment (n = 2 or 33%) in the community group. western methods were helpful in none. cure.41:245–253 a greater need for expression through this particular mode or that the community perceives a housewife’s possession as more culturally acceptable.653 or 0. prior to psychiatric intervention.
In addition to a reduction in stress. more cannabis use and more experiences of thought control were noted. we did not explore this. and finally the pathological types found in psychiatric illness. ventilation of emotions. catharsis and. cultural stereotypes found in the general population would suggest. psychopathological form determining the psychiatric diagnosis. something akin to modeling. This could be due to an underlying disease or disturbance of the normal psychological processes along with the behavior change. Another possibility is psychological stress including war trauma as the primary pathology and the possession then occurring as a cultural coping strategy. but the financial gain and positive changes in personal and social status through possession in the community and medical groups could explain the occurrence and persistence of possession in this culture. Although possession states per se are said to become rare in western countries . the study did not detect a single case of consciously stimulated possession states. possession states could be considered a variation of behavioral patterns beginning with the culturally ascribed stereotypes found in the general population. if a psychiatric diagnosis is to be made. The authors suggested that possession beliefs in some psychotic patients may reflect childhood trauma and dissociation. Interestingly.sional possession. It could also work the other way. We would have expected a much higher number to feel satisfied with the enhanced social acceptance they enjoy. particularly in psychosis. modern-day variants in western culture could include multiple personality disorder . It could be that there is only an objective measurement of Psychopathology 2008. ‘possesses’ the original self. and in the general population states during religious charismatic movements . Recurrence or chronicity may correlate with social integration when community tolerates or accepts the behavior. The difference may be that in possession the second personality invades and takes over. shaping and maintaining possession states. showing that possession is a well-accepted cultural phenomenon. Sims  in considering the view of Jaspers on possession emphasizes the importance of psychiatric diagnosis in assessing psychopathological form. then the more venerated states seen in well-known community members who would be using possession for wellknown social ends like mediumship. charismatic religious belief system were overrepresented in the medical group. Possession States The finding that 24 (80%) of the community group had witnessed a possession state (and many of the general group had a family history) supports the notion that possession could be seen as a learned behavior. while the more benign. these mediums interviewed by Seligman  also experienced an increase in secondary gain as seen by more social support and general emotional benefits. to the supernormal.41:245–253 251 . Here the second personality that episodically takes over the self is the possessing spirit or force. In our sample. higher dissociation scores. It could also exist as a cultural archetype in the collective unconscious. except when looked for in immigrant populations from non-western cultures [4. manipulation of the environment. a neurosis. A clear religious sanction for divine possession is found in Hindu holy texts and philosophy where the highest achievement is said to be the passive experience of the divine taking full control of the self and carrying out all actions. Their behavior should be causing psychological distress to themselves if not to the society. The individuals reflected on their own self-narrative in spiritually significant terms. the religious affiliation of the possessing spirit cut across the religion of the person (a Hindu could be possessed by a Christian spirit and vice versa). Treatment outcome shows some remarkable findings. It is probable that many in the medical group and even in the psychiatric patient group would have seen or heard about possession states as they are so pervasive in this society. Surprisingly. Thus. showing the overriding influence of the underlying common culture. Thus there may be cultural differences in our sample and the American sample of Goff et al. only 13 (34%) of the community group felt they could be without treatment. particularly hysterical dissociation. Culturally abnormal forms of possession should suggest a psychotic illness. higher levels of childhood sexual abuse. perhaps.  described a high number of comorbid disorders (46%) in their cohort with possession serving the psychological function of projection of aggression. Interestingly. which could have been for financial gain or personal status. Overall only 41 (46%) from all three groups have sought help for their condition. 17]. They may have forgotten about this past encounter or there could be an element of denial. divination or oracle function. with control and mastery of the timing and pattern even veneration is achievable. Past experience or exposure can play an important role in causing. Wijesinghe et al. Those belonging to the nonorthodox. The high exposure could have contributed to the mastery and popularity of the members of this group. . higher trances of saints.
none of the medical group was helped by western medical methods. and speak in a strange voice with unusual impoliteness (‘eha vasanam’). fear and perplexity. Six months ago at the office while on duty with several other senior staff officers. For the whole previous month now. Being the eldest she had been dominant and obsessive to some degree though helpful and sociable. Her belief in the NASA scientist as a possessing force was firm. Appendix 2 Mrs. 2 years ago. There was no family or past psychiatric history of note. After receiving a provisional diagnosis of acute psychosis. Andrew Sims made in 1988. His continuing guidance in designing the study and preparing the questionnaire ensured its completion. 252 Psychopathology 2008. at times she was convinced that this force was not the scientist but the ‘Amman’ (female goddess). As pointed out. she responded well to high-dose antipsychotics and her belief in the scientist as a possessing force disappeared. she had been restless. She had frequently seen possession states (‘Amman Uru’ and soothsaying) in her village during her childhood. She returned home at 7 p. To correlate it with objective measurements one would need long-term case-control studies or the interviewers should observe the subjects before and after the traditional treatment.m. Channa Wijesinghe made available to us the results of his thorough and detailed study of possession states in Southern Sri Lanka and made constructive contributions to the analysis of the data and writing of the report. The dance was typically like a snake with movements of the upper Acknowledgements This study of possession states is a fulfillment of a suggestion Prof. she suddenly started to dance like a snake. They also suggest that dissociative phenomena can be seen in socially sanctioned rituals under the guidance of a healer or religious leader. Although she claimed that a scientist from NASA who lived in London had taken over her and controlled all her activities. along with her husband and stayed awake till 11 p. All family members were ardent devotees of the Goddess of Nainatheevu Island (a female. This may indicate that their state fitted the normal cultural stereotypes for possession or that there is a need to change the type of treatment to more traditionbased methods. relying on the perception of the subjects and society. she had to get up early in the morning at 4 o’clock and do the household chores. But premature retirement would make her lose financially on the pension benefits and the only way to preserve it and to retire prematurely was to be discharged medically for illness. While being familiar with the culturally appropriate possession behavior patterns. not distress. One of her uncles had had a possession state called ‘Annamar’. other beliefs included ‘cheivinai’ (a subcultural belief of witchcraft). was an orthodox Hindu. On an average day. god-fearing and responsible.m. In the last 2 years. Her mood and speech returned to normal. continuously present and was claimed to give a good feeling. The family members brought her for treatment as they did not believe her. cobra goddess called ‘Nagapoosany Amman’) for whom they had built a shrine in their premises a few years back. Appendix 1 A 24-year-old student sat for the ordinary level examination last year with average results. In the other groups it is subjective. She was married to an executive bank officer and had had an unremarkable happy family life from which her children had now left for their higher education. She also showed irritable outbursts. described as hard working. those who had benefited from traditional methods would not seek western medical treatment. to midnight to complete the work at home. They said that ‘Amman’ could do such things but not a scientist. The western medical system could refer those with possession states from the general population to the traditional system and the traditional sector could recommend those with psychotic illness for western medical treatment. J.m. Significantly. in those with a clear-cut psychiatric illness.41:245–253 Somasundaram/Thivakaran/Bhugra . she had shown transient retarded behavior for 2 weeks following a febrile illness. she had consulted a few doctors for nonspecific symptoms of tiredness.. The facial expression was said to be strange with fixed eyes and a challenging or angry look (similar to a cobra). she had dreamt that the goddess asked her to do so. Another more progressive way forward would be to develop a better relationship and understanding between both systems. The improvement would be in the illness and not in the possession phenomenon itself which may cease as a manifestation of the illness. Western medical methods are more effective in the psychiatric patient population.treatment outcome in the psychiatric patient group. Six years ago. clinicians from both sectors could be more aware of some of the abnormal manifestations and patterns of behavior of pathological possession states found in psychotic illness. to reach the bank on time. She had no family history of possession or psychiatric illness. a 50-year-old assistant manager of a well-known bank. In fact. Prof. Kirmayer and Santhanam  emphasize that the higher prevalence of conversion symptoms in some societies may be attributable to the fit of symptoms with local ethnophysiological notions and cultural idioms of distress as well as the stigma attached to frankly psychological or psychiatric symptoms. Thus bodily control may be seen as a form of social control or vice versa. She felt that the maintenance of the shrine was a problem and she believed it would be better for her to stay at home to look after the deity. clean the shrine and go to work before 7 a. and behaved aggressively towards her mother.
and at temples always disappearing again after 5–15 min.39:71–99. Aust NZ J Psychiatry 1976. 13 Seligman R: Distress dissociation and emotional experience: reconsidering the pathways to mediumship and mental health. 8 Lewis IM: Ecstatic Religions: A Study of Spirit Possession and Shamanism. Oxford University Press. 1986. 18 Kirmayer LJ. 10 Obeyesekere G: Medusa’s Hair: An Essay on Personal Symbols and Religious Experience. 3 Castillo RJ: Spirit possession in South Asia.165:386–388. pp 188–206. 1989. Garrison V (eds): Case Studies in Spirit Possession. 2003. Santhanam R: The anthropology of hysteria. Bhui R. London. translated by Schioldann-Nielson J). Amico E: The delusion of possession in chronically psychotic patients. The behavior subsided within a few minutes. neck and trunk. 1981. 6 Wimmer A: On possession states (original 1924. 2 Sims ACP: Symptoms in the Mind – An Introduction to Descriptive Psychopathology. New York. in Halligan PW. Ethos 2005. tiredness. because of which she had neglected the house and shrine. aches and pains all of which she attributed to the excessive office work. Gaskell. Almost all the staff fled from the scene.18:1–21. Saunders. Edinburgh. dissociation or hysteria? 1.4:413–419. 53: 582–586. in Crapanzano V. Possession States Psychopathology 2008. She noted that she was not in control of the behavior but that the deity made her do all the things. She acknowledged that this behavior really made her feel better and that she was able to help others by uttering prophecies. Wiley. Then the frequency of the possession increased from once for many days to more than twice per day and the utterances became more authoritarian insisting on quick retirement with full pension benefits.23:407–434. References 1 Leff L: Psychiatry around the Globe – A Transcultural View.10:135–139. pp 251–270. Annu Rev Anthropol 1994. J Med Ethics 1976. 1988. 1991. in Turner VW. Chicago. Int Med J 2001.2:127–137. Dein S: Making sense of ‘possession states’: psychopathology and differential diagnosis. 17 Hale AS. After admission to the psychiatric unit for a few days she improved with counseling. ed 3. Cult Med Psychiatry 1994. Br J Hosp Med 1994. pp 1–39. Hist Psychiatry 1993. Smithsonian Institute Press. Oxford. Mendis N: Possession trance in a semi-urban community in Sri Lanka.limbs. 16 Goff DC. 1977. 12 Wijesinghe CP.179:567–571. Since then this behavior had reappeared now and then at work and home. 9 Crapanzano V: Introduction. both the frequency and duration decreased. traditional relaxation exercises and a short course of anxiolytics. University of Illinois Press. ed 2. Bruner EM (eds): The Anthropology of Experience. Br J Psychiatry 1994. London.8:193–197. Bass C. 4 Pereira S. Chicago. she complained of fatigue. 14 Somasundaram DJ: War trauma and psychosocial problems: patient attendees in Jaffna. which was confirmed by some villagers and her husband. Routledge. Psychiatric assessment revealed mild depression and sick role behavior but no psychotic features. 5 Trethowan WH: Exorcism: a psychiatric viewpoint. Pininnti NR: Exorcism-resistant ghost possession treated with clopenthixol. Her voice claimed to be the Goddess who instructed the people around not to torment the poor woman and to help her. 11 Kapferer B: Performance and the structure of meaning and experience. Waiters M. 15 Kapferer B: A Celebration of Demons: Exorcism and Healing in Sri Lanka. Dissanayake SAW. However. especially in front of the shrine. Though the behavior could be precipitated by interviews. Marshall JC (eds): Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspectives. Brotman AW Kindlon D.41:245–253 253 . ed 2. University of Chicago Press. J Nerv Ment Dis 1991. Washington. Theoretical background. 7 Boddy J: Spirit possession revisited: beyond instrumentability.
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