The Role of Psychotic
Disorders in Religious
The authors have analyzed the religious figures
Abraham, Moses, Jesus, and St. Paul from
a behavioral, neurologic, and neuropsychiatric
perspective to determine whether new insights can
be achieved about the nature of their revelations.
Analysis reveals that these individuals had
experiences that resemble those now defined as
psychotic symptoms, suggesting that their
experiences may have been manifestations of
primary or mood disorder-associated psychotic
disorders. The rationale for this proposal is
discussed in each case with a differential diagnosis.
Limitations inherent to a retrospective diagnostic
examination are assessed. Social models of
psychopathology and group dynamics are proposed
as explanations for how followers were attracted and
new belief systems emerged and were perpetuated.
The authors suggest a new DSM diagnostic
subcategory as a way to distinguish this type of
psychiatric presentation. These findings support the
possibility that persons with primary and mood
disorder-associated psychotic symptoms have had
a monumental influence on the shaping of Western
civilization. It is hoped that these findings will
translate into increased compassion and
understanding for persons living with mental
illness.
(The Journal of Neuropsychiatry and Clinical
Neurosciences 2012; 24:410–426)
410 http://neuro.psychiatryonline.org
History Considered
Evan D. Murray, M.D.
Miles G. Cunningham, M.D., Ph.D.
Bruce H. Price, M.D.
A man in his late 20s with paranoid schizophrenia
explained during a neurological evaluation that he
could read minds and that for years he had heard voices
revealing things about friends and strangers alike. He
believed he was selected by God to provide guidance
for mankind. Antipsychotic medications prescribed by
his psychiatrists diminished these abilities and reduced
the voices, and therefore he would not take them. He
asked, “How do you know the voices aren’t real?” “How
do you know I am not The Messiah?” He affirmed, “God
and angels talked to people in the Bible.”
Later, we reflected on what he had said. He raised
poignant questions that are rarely discussed in academic
medicine. Every day, physicians, nurses, psychologists,
and social workers alike encounter and care for people
who experience psychotic symptoms. About 1% of emer-
gency room visits and 0.5% of all primary care visits in
the United States are related to psychotic symptoms.1,2
As many as 60% of those with schizophrenia have
religious grandiose delusions consisting of believing
they are a saint, God, the devil, a prophet, Jesus, or some
other important person.3 Diminished insight about
having a mental disorder is part and parcel of the
condition, occurring in 30%–50% of persons with schizo-
phrenia.4 How do we explain to our patients that their
psychotic symptoms are not supernatural intimations
when our civilization recognizes similar phenomena
in revered religious figures? On what basis do we
Received September 13, 2011; revised March 15, 2012; accepted March
22, 2012. From the Dept. of Neurology, McLean Hospital, Harvard
Medical School, Belmont, MA (EDM, BHP); Dept. of Psychiatry,
McLean Hospital, Harvard Medical School, Belmont, MA (MGC);
Dept. of Neurology, Massachusetts General Hospital, Harvard Medical
School, Belmont, MA (EDM, BHP). Send correspondence to Evan D.
Murray, M.D., Dept. of Neurology, McLean Hospital, Belmont, MA;
e-mail: emurray@mclean.harvard.edu
Copyright © 2012 American Psychiatric Association
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012

distinguish between the experiences of psychiatric pa-
tients and those of religious figures in history?
A review of the medical literature revealed little dis-
cussion of these specific issues utilizing modern neu-
ropsychiatric and behavioral neurologic principles. An
examination of the revelation experiences of prominent
religious figures was needed to determine whether new
insights could be achieved about their nature through the
application of neuropsychiatric and behavioral neurologic
principles. We undertook this examination with the intent
of promoting scholarly dialogue about the rational limits
of human experience and to educate persons living with
mental illness, healthcare providers, and the general public
that persons with psychotic symptoms may have had
a considerable influence on the development of Western
civilization. The selection of personalities for analysis was
based on 1) the existence of narratives recounting the in-
dividual’s mystical experiences and behaviors; 2) the po-
tential similarity of these experiences to psychiatric
phenomena; 3) the high degree of impact their life stories
had on Western civilization in terms of influencing themes
found in literature and art, religious thought and practice,
philosophy, concepts of social order, and jurisprudence.
The following is a retrospective diagnostic examination of
Abraham, Moses, Jesus, and St Paul. It is hoped that this
investigation will help translate the veneration, love, and
devotion felt by many for these religious figures into in-
creased compassion and understanding for persons with
mental illness.
ABRAHAM
The Bible is the earliest source of information about the
life of Abraham, the patriarch of Judaism, Christianity,
and Islam. The historical existence of Abraham is the
subject of some academic controversy. Our discussion
will proceed on the premise that he was a historical
figure. The events occurring during his lifetime are
generally thought to have taken place sometime between
2000 BCE and 1630 BCE, but this is a subject of some
debate. He is described as having had interactive mys-
tical experiences of an auditory and visual nature (see
Figure 1), that influenced his behaviors throughout most
of his life (see Table 1). This phenomenology closely
resembles that described in the Diagnostic and Sta-
tistical Manual of Mental Disorders (DSM-IV-TR).5 Apply-
ing the DSM-IV-TR paradigm, Abraham’s auditory and
visual perceptual experiences and behaviors could be
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
understood as auditory hallucinations (AH), visual hal-
lucinations (VH), delusions with religious content, and
paranoid-type (schizophrenia subtype) thought content
(see Table 1 for examples). These psychiatric features
occur together as a constellation in psychotic disorders
of both primary psychiatric origin and secondary to
medical and neurological conditions.5 According to the
DSM-IV-TR, the diagnosis of schizophrenia requires at
least two out of five symptoms from Criterion A
and then fulfillment of the five remaining criteria (see
Table 2). Criterion A might theoretically be fulfilled
by the presence of his auditory and visual perceptual
experiences. Abraham is not recounted as having had
symptoms that can now be appreciated as disorganiza-
tion, catatonia, negative psychiatric symptoms (affective
flattening, alogia, or avolition), or cognitive difficulties
such as impaired concentration, attention, or memory.
The lack of detailed information about his life prevents
us from understanding whether he experienced a decline
in social or occupational functioning, as compared with
the period before the onset of his perceptual experiences,
as required by Criterion B. Criterion C’s requirement
about persistence and duration of symptoms is fulfilled
by the period of 100 years or more during which he had
these experiences. His generally good state of health is
indicated by a purported lifespan of 175 years without
mentioned infirmity. Abraham appeared not to suffer
from debilitating depressive- or manic-like symptoms,
thereby diminishing the likelihood of mood disorder
associated psychoses, such as depression with psychotic
features, bipolar disorder, or schizoaffective disorder.
Other potential causes of such experiences need to be
explored. The ingestion of hallucinogenic substances is
known to produce mystical experiences. There has been
speculation that plants with psychoactive properties
were valued by the ancient Israelites, but no direct evi-
dence has been uncovered for their actual use for in-
ducing mystical experiences in this population.6 Another
possibility would be that of epilepsy-induced mystical
experiences. Persons with epilepsy may experience ic-
tal, postictal, or interictal schizophrenia-like symptoms,
which can be indistinguishable from primary psychotic
disorders7,8 and occur in roughly 2%–7% of persons with
epilepsy;9 2.2% of temporal lobe-onset seizures may be
associated with religious experiences.10,11
Grandiose and messianic-type delusions are recog-
nized as occurring in association with complex partial
seizure disorders.12 Published cases show ictal religious
experiences to be awe-inspiring or ecstatic, but generally
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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY
FIGURE 1. Abraham Being Stopped From Sacrificing His Son Isaac by a Vision of an Angel (Genesis 22:9–12)
Laurent de la Hyre: Abraham Sacrificing Isaac (c1650), Musée Saint-Denis, Reims, France
not successful in imparting detailed or complex infor-
mation.10,13–17 Postictal psychosis (PIP) is more common
and tends to occur in close proximity to seizure clusters
and can also be associated with a recent exacerbation
in seizure frequency.18 It is estimated to account for a
quarter of psychosis in epilepsy19,20 and occurs in up to
18% of medically intractable focal epilepsy patients.21,22
Of persons with PIP, up to 25% may have religious
delusions.
Only 2% of those who go on to have interictal
psychosis have religious delusions.23,24 Interictal psy-
chosis is otherwise not readily distinguishable from
schizophrenia, but may manifest preservation of affect,
fewer negative symptoms, and, arguably, greater in-
sight. The greater similarities may lay in positive symp-
tomatology; that is, that of thought disorder, delusions,
and hallucinations.7 Reliable prevalence data are lack-
ing, but it has been proposed that between 30% and
60% of patients with partial seizures will also have
secondary generalized seizures.25–27
Abraham is not recounted as having had any in-
firmities that might resemble the phenomena we now
commonly understand to accompany seizures. Specifi-
cally, there are no signs of repetitive behaviors, such as
uncontrolled generalized or partial shaking, orofacial
412 http://neuro.psychiatryonline.org
automatisms, stereotyped behavioral changes, recurrent
and consistent auras of fear (although fear did accom-
pany some episodes), staring spells, loss of conscious-
ness, falling spells, tongue-biting, or incontinence. His
ability to engage in varied dialogue with his halluci-
nations would not be very typical of an ictal per-
ceptual change, since seizures tend toward being
stereotyped in nature and not to be so changeable
and interactive.10,13–17,28,29 Most generalized seizures,
and, often, complex partial seizures, are associated with
amnesia for the period during and immediately after a
seizure, and persons often have baseline day-to-day
cognitive impairments in memory and executive do-
mains.30,31 There are no indications that Abraham ex-
perienced uncontrolled motor events, amnestic periods,
or cognitive impairments of any kind. A postictal or in-
terictal psychotic state cannot be excluded, but is not
particularly suggested on the basis of the available
information.
The absence of apparent affective, medical, or neuro-
logical conditions increases the possibility that a psy-
chotic disorder could have been present. Schizophrenia
is often accompanied by both disorganized behavior and
thought processes that interfere with life functioning.5
In the case of Abraham and in the others that follow,
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TABLE 1. Selected Examples of Passages With Features
Resembling Psychiatric Phenomena
Abraham
Auditory and visual hallucinationsa: Genesis 12:1–3; 12:7; 13:14; 15:1–
11; 17:1–21;22:1–2; 22:11–12 (Figure 1)
Paranoid Type (PS subtype) thought processesb: Genesis 12:3 (implies
a very Abraham-centered worldview of dispensing universal
blessings and curses based on one’s interactions with Abraham);
12:11–13; 14:22; 17:14; 20:11; 21:11–14 (potential mistrust, as seen by
the sending-away of his first-born son to eliminate competition for
his second son); 23:4 (He referred to himself as a stranger in a land he
understood to be his inheritance from God); 24:3 (potential mistrust
seen in the rejection of intermarriage for his son Isaac with any
women in his region); 25:6 (potential mistrust as seen by the sending-
away of of all his sons so as to remove Isaac’s competitors).
Moses
Auditory and visual hallucinations of a grandiose nature with
delusional thought contenta: Exodus 3:2 (Figure 2); Exodus
33: 21–23 related to 34:5–6
Paranoid Type (PS subtype) thought contentb: Exodus 32:25–29
Phobia: Exodus 34:33
Referential Thought Processes: Exodus 8:12–13, 8:31, 9:23, 9:33,
10:13–15, 10:22 (possible sandstorm)
Jesus
Paranoid-type (PS subtype) thought contentb: Matthew 10:34–39, 16:
21–23, 24:4–27; Mark 13:5–6; Luke 10:19; John 3:18; John 14:6–11
Auditory and visual hallucinationsa: Matthew 3:16–17, 4:3–11; Luke 10:
18; John 6:46, 8:26, 8:38–40, 12:28–29
Referential thought processes: Mark 4:38–40 (Figure 3); Luke 18:31
Paul
Auditory and visual hallucinationsa: Acts 9:4–6,16:9,18:9, 22:7–11
(Figure 4), 26:13–18; 2 Corinthians 12:2–9
Paranoid-type (PS subtype) thought contentb: 1 Corinthians 10:
20–22; 11:29–32; 1:20–21; 2 Corinthians 6:14; 7:1; 11:12–15; 11:21–23
a
Hallucinations in PS are typically related to the themes of
delusions.5
b
Paranoid-type (PS subtype) thought content: Delusions are typically
persecutory or grandiose or both. Delusions with other themes, such as
jealousy, religiosity, or somatization may also occur. They are usually
organized around a theme.5
All biblical references are from The New Oxford Annotated Bible
with the Apocrypha, Revised Standard Version. Edited by May HG,
Metzger BM, New York, Oxford University Press, 1977.
disorganization and cognitive impairments are not ap-
parent. Paranoid schizophrenia (PS), however, is a subtype
of schizophrenia that tends to manifest little or no disorga-
nization, has preserved functional affect, and is associated
with better occupational and social functioning.5
Psychotic disorder, not otherwise specified (PD NOS)
is another reasonable diagnostic alternative. PD NOS
includes those persons with psychotic symptomatology
for which there is inadequate or contradictory informa-
tion or symptoms that do not meet criteria for any
specific psychotic disorder.5 Abraham’s clinical profile
would appear to best resemble that of PS or PD NOS,
and perhaps, less likely, an affective disorder-related
psychosis. Abraham stands as the earliest case of a pos-
sible psychotic disorder in literature.
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
TABLE 2. Diagnostic Criteria for Schizophrenia
A. Characteristic symptoms: Two or more of the following, each
present for much of the time during a 1-month period (or less, if
symptoms remitted with treatment).
Delusions
Hallucinations
Disorganized speech
Grossly disorganized behavior or catatonic behavior
Negative symptoms: affective flattening, alogia, or avolition
Note: Only one Criterion A symptom is required if the delusions are
bizarre or hallucinations consist of a voice keeping up a running
commentary on the person’s behavior or thoughts, or two or more
voices conversing with each other.
B. Social/occupational dysfunction: For a significant portion of the
time since the onset of the disturbance, one or more major areas of
functioning, such as work, interpersonal relations, or self-care, are
markedly below the level achieved prior to the onset.
C. Duration: Continuous signs of the disturbance persist for at least 6
months. This 6-month period must include at least 1 month of
symptoms (or less, if symptoms remitted with treatment)
D. Schizoaffective and mood-disorder exclusion
E. Substance/general medical condition exclusion
F. Relationship to a pervasive developmental disorder
Adapted from the Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, Text Revision. Washington, DC, American
Psychiatric Association, 2000, pp 297–343.
MOSES
The story of Moses in the Bible is thought to have its
setting sometime between 1550 BCE and 1200 BCE.32
The stories about Moses include a great deal of infor-
mation about his background, life functioning, beliefs,
actions, and perceptual experiences (see Figure 2).
Moses had perceptual experiences and behaviors that
find closest parallel today with the DSM-IV-TR–defined
phenomena of command AHs, VHs, hyperreligiosity,
grandiosity, delusions, paranoia, referential thinking,
and phobia (about people viewing his face). (See Table 3
for examples.) Many of these features may occur to-
gether in schizophrenia, affective disorders, and schiz-
oaffective disorder.5 Moses also did not appear to have
any disorganization, catatonia, or negative psychiatric
symptoms, or difficulties with concentration, attention,
and memory (see Table 2). Criterion A for schizophrenia
could theoretically be fulfilled by his experiences that
resemble delusions and hallucinations. In fulfillment of
Criterion B, Moses’ social and occupational functioning
could be said to have declined from that of a presumably
educated member of the Egyptian royal family to having
fled Egyptian society to become a shepherd working on
the periphery of the desert in a foreign land (Exodus 2:
15–22). His flight from Egypt occurred before the onset
of AH and VH, thereby suggesting a prodromal decline
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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY
FIGURE 2. Moses’ Vision of the Burning Bush (Exodus 3:2)
Moses Before The Burning Bush (1613–14) By Domenico Feti, at
Kunsthistorisches Museum, Vienna, Austria
in functioning before the onset of psychosis. A prodrome
refers to the early symptoms and signs of an illness that
precede the characteristic manifestations of the acute,
fully developed illness. A prodromal period may pre-
cede the onset of schizophrenia by months to up to 10
years in 70% of patients33 and up to 20 years in some
cases.34 The period over which Moses had these ex-
periences was in excess of 40 years, fulfilling Criterion
C. His social functioning and leadership skills were
sufficiently intact to have made it less likely that he had
periods of debilitating major depression or florid mania
that might have undermined his effectiveness as a leader.
This could fulfill Criterion D by reducing the likelihood
of mood disorder-associated psychosis. It should be
noted that the religious writings attributed to Moses’
414 http://neuro.psychiatryonline.org
authorship, the Pentateuch, could suggest the presence
of an exaggerated urge to write. Such hypergraphia is a
nonspecific finding more commonly associated with
mania, hypomania, or mixed states; however, it is also a
feature of schizophrenia and temporal lobe epilepsy.35–37
Trimble writes that the hypergraphic output of schizo-
phrenic and epileptic patients is rarely creative. They are
often loosely mystical, and both perseverative and vague
in content.37 In contrast to the relative paucity of poets
with schizophrenia or epilepsy, he observes that the
number of poets suggested to have mood disorders are
represented in far greater numbers.37 Therefore, mood
disorder-associated psychoses remain quite viable in the
case of Moses.
There is no indication in the Bible that Moses ex-
perienced metabolic dysregulations or that he used
hallucinogenic intoxicants as an explanation for his be-
havioral or perceptual changes. There are also no key
features, as previously mentioned, to implicate epilepsy
as a cause of mystical experiences. He lived a long life, in
excess of 100 years, arguing against the presence of
progressive medical or neurological illnesses. The cri-
teria for diagnosis of PS would be fulfilled by the pre-
dominance of delusions and hallucinations in the absence
of disorganization, negative psychiatric symptoms, or
cognitive impairment.
An increased propensity for violence has been ob-
served in some individuals with PS.38 Moses’ increased
propensity for violence could be viewed as corroborative
for a diagnosis of PS. Reasonable diagnostic alternatives
might include PD NOS, bipolar disorder, and schizo-
affective disorder. If the first five books of the bible are
credited to Moses’ authorship, then a bipolar disorder or
perhaps schizoaffective disorder would be more compat-
ible with his writing abilities.
JESUS
Jesus is the foundation figure of Christianity, who is
thought to have lived between 7–2 BCE and 26–36 CE.
The New Testament (NT) recalls Jesus as having ex-
perienced and shown behavior closely resembling the
DSM-IV-TR–defined phenomena of AHs, VHs, delu-
sions, referential thinking (see Figure 3), paranoid-type
(PS subtype) thought content, and hyperreligiosity (see
Table 1). He also did not appear to have signs or
symptoms of disorganization, negative psychiatric
symptoms, cognitive impairment, or debilitating mood
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 MURRAY et al.

TABLE 3. Clinical Signs and Symptoms of Schizophrenia

Religious Figures
Behaviors Resembling Abraham Moses Jesus St Paul
Auditory hallucinations + + + +
Visual hallucinations + + + +
Hyper-religiosity + + + +
Grandiosity + + + +
Delusions + + + +
Paranoia + + + +
Disorganization — — — —
Negative symptoms — — — —
Duration of symptoms years .40 years .1 year years
Decline in occupational functioning I + I I

+: present; —: not present; I: inconclusive evidence or unknown.

disorder symptoms. NT accounts about Jesus mention
no infirmity. In terms of potential causes of perceptual
and behavioral changes, it might be asked whether
starvation and metabolic derangements were present.
The hallucinatory-like experiences that Jesus had in the
desert while he fasted for 40 days (Luke 4:1–13) may
have been induced by starvation and metabolic derange-
ments. Arguing against these as explanations for all of
his experiences would be that he had mystical or
revelation experiences preceding his fasting in the desert
and then during the period afterward. During these
periods, there is no suggestion of starvation or metabolic
derangement. If anything, the stories about Jesus and his
followers suggest that they ate relatively well, as
compared with the followers of his contemporary, John
the Baptist (Luke 7:33–34). Epilepsy-associated psy-
chotic symptoms are possible, but Jesus is not recounted
as having any of the previously-mentioned common
hallmarks of epilepsy. A decline in his occupational and
social functioning cannot be established because of a lack
of sufficient information. His experiences appear to have
occurred over the course of at least the year before his
death. The absence of physical maladies or apparent
epilepsy leaves primary psychiatric etiologies as more
plausible. As seen with the previous cases, Jesus’
experiences can be potentially conceptualized within
the framework of PS or psychosis NOS. Other reason-
able possibilities might include bipolar and schizoaffec-
tive disorders.
There is a 5%–10% lifetime risk of suicide in persons
with schizophrenia.39 Suicide is defined as a self-inflicted
death with evidence of an intention to end one’s life. The
NT recounts Jesus’ awareness that people intended to
kill him and his taking steps to avoid peril until the time
at which he permitted his apprehension. In advance, he
explained to his followers the necessity of his death as
prelude for his return (Matthew 16:21–28; Mark 8:31;
John 16:16–28). If this occurred in the manner de-
scribed, then Jesus appears to have deliberately placed
himself in circumstances wherein he anticipated his
execution. Although schizophrenia is associated with
an increased risk of suicide, this would not be a typical
case. The more common mood-disorder accompani-
ments of suicide, such as depression, hopelessness,
and social isolation, were not present,40 but other risk
factors, such as age and male gender, were present.
Suicide-by-proxy is described as “any incident in which
a suicidal individual causes his or her death to be carried
out by another person.”41,42 There is a potential parallel
of Jesus’ beliefs and behavior leading up to his death to
that of one who premeditates a form of suicide-by-
proxy.
ST. PAUL (SAUL OF TARSUS)
St. Paul lived during the first century CE. It has been
speculated that his religious experiences resulted from
temporal lobe epilepsy.43 We would argue that it is not
necessary to invoke epilepsy as an explanation for these
experiences. St Paul’s mood in his letters ranged from
ecstatic to tears of sorrow, suggesting marked mood
swings.44,45 He endorsed an abundance of sublime
auditory and visual perceptual experiences (2 Corinthi-
ans 12:2–9) that resemble grandiose hallucinations with
delusional thought content. He manifested increased
religiosity and fears of evil spirits, which resembles
paranoia. These features may occur together, in asso-
ciation with primary and mood disorder-associated psy-
chotic conditions.

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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY

FIGURE 3. The Boat That Held Jesus and His Followers Before Jesus Bid the Storm to Subside (Mark 4:38–40)

Storm on the Sea of Galilee By Rembrandt van Rijn (1633; whereabouts unknown since the Isabella Stewart Gardner Museum robbery in 1990)

In 2 Corinthians 12:7, St Paul relates “a thorn was
given me in the flesh, a messenger from Satan, to harass
me, to keep me from being too elated.” This thorn has
been speculated to be a reference to epilepsy.43 Other
theories have proposed that the thorn was a physical
infirmity, the opposition of his fellow Jews,46 or a ha-
rassing demon.47
We propose that he perceived an apparition or voice
that he understood to be a harassing, demonic messenger
from Satan. This perception might have afflicted him with
some amount of negative commentary of the type char-
acteristic for psychotic conditions, resulting in psycho-
logical distress.
The complexity of Paul’s interactions in his perceptual
experiences weighs against a seizure ictus as a cause, as
does the lack of evidence for more common epileptic
accompaniments, such as repetitive stereotyped behav-
ioral changes and cognitive symptoms, as previously

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discussed. Paul does, however, manifest a number of per-
sonality characteristics similar to the interictal personal-
ity traits described by Geshwind,48–50 such as deepened
emotions; possibly circumstantial thought; increased con-
cern with philosophical, moral and religious issues; in-
creased writing, often on religious or philosophical
themes; and, possibly, hyposexuality (1 Corinthians 7:8–
9). These characteristics are controversial as to their spe-
cificity for epilepsy,51,52 with a preponderance of larger
studies not confirming a specific personality type asso-
ciated with seizure disorders.51–57 Similar features may
also be present in bipolar disorder5,35,36 and schizophre-
nia.35,36 As previously mentioned, productive writing tends
to be more strongly associated with mood disorders than
psychosis or epilepsy. This is persuasive toward Paul hav-
ing a mood disorder, rather than schizophrenia or epilepsy.
Paul’s religious conversion on the road to Damascus
(Acts 9:1–19, 22:6–13, 26:9–16) is an event understood as
marked by the acute onset of blindness. This blindness
has been hypothesized to have been postictal in nature43
or psychogenic.58 There appears to be a lack of clarity as
to whether this was literal visual blindness or meta-
phorical, since Paul refers to persons outside his im-
mediate belief system as spiritually blind or having their
eyes closed to spiritual truth (Acts 28:26; Romans 11:8,
11:10; 2 Corinthians 4: 3–5; Ephesians 1:18). Differences
in the three most detailed conversion-experience ac-
counts contribute to this ambiguity. Acts 26:12–18 relates
his conversion, during which a vision of Jesus tasks him
to spiritually open the eyes of the people to whom he
will be sent (see Figure 4). In this account, there is no
mention of acute-onset visual loss followed by its re-
storation. The application of the blindness metaphor in
Acts 26:12–18 may suggest that Paul’s own loss of vision
was equally metaphorical and served as a descriptor of
his profound realization of feeling suddenly bereft of
spiritual understanding; that is, realizing his eyes to be
spiritually closed, before the completion of his conver-
sion to the new religious sect. In such an emotional state,
it is speculated that he might have required encourage-
ment and emotional assistance to reach Damascus.
Another possibility would be that of blindness due to
conversion disorder. The absence of other episodes of
visual loss (i.e., lack of event stereotypy), the absence of
features often seen with postictal blindness (a general-
ized seizure, anosognosia for deficit, or a gradual return
of vision),59 the presence of complex, mood-congruent
auditory–visual experiences resembling hallucinations,
and the possible sudden return of his eyesight with a
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
compassionate touch does not fit well into a readily
discernable neurological pattern of vision loss. His per-
ceptual experiences, mood variability, grandiose-like
symptoms, increased concerns about religious purity,
and paranoia-like symptoms could be viewed as re-
sembling psychotic spectrum illness (see Table 1). Psy-
chiatric diagnoses that might encompass his constellation
of experiences and manifestations could include para-
noid schizophrenia, psychosis NOS, mood disorder-
associated psychosis, or schizoaffective disorder. Paul’s
preserved ability to write and organize his thoughts
would favor a mood disorder-associated explanation for
his religious experiences.
COMMENTARY ABOUT DIFFERENTIAL
DIAGNOSIS
Although Abraham had a revelatory experience during
sleep (i.e., the prophecy foretelling his descendants’
being enslaved in Egypt [Genesis 15:12–16]), and Paul
had visions during the night (Acts 16:9, 18:9); most of the
revelations experienced by these figures are not well
explained by sleep phenomena such as dreams. A host of
other conditions might precipitate revelation-like per-
ceptual experiences (Table 4). Perhaps the foremost of
these possibilities would be postictal and interictal psy-
chotic states, which cannot be entirely excluded, since
convulsions can be absent in some cases, and an absence
of description in the sources does not exclude the pos-
sibility of seizures. Fear did occur with a number of
Abraham and Moses’ experiences, raising the prospect
of a seizure aura of fear. Not all of their mystical ex-
periences are recounted as associated with fear, indi-
cating a lack of seizure-like stereotypy. In the event that
seizure-related psychotic states were etiologic, the path-
way to psychosis would be different, but the premise of
psychosis having a formative role in their revelatory
experiences would still be viable.
Nevertheless, based on the available descriptions that
mention features bearing a striking resemblance to psy-
chotic symptoms and the absence of mention of events
resembling overt seizures, it is more parsimonious to
explain these experiences as potentially due to a primary
psychiatric condition. The remaining conditions in Table
4 are not particularly suggested by a medical review of
the source material.
A shared psychotic disorder (folie à deux) is a possi-
bility for each of the subjects discussed. The essential
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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY

FIGURE 4. Saul of Tarsus Experiencing a Vision of Jesus While on the Road to Damascus (Acts 9:1–19, 22:6–13, 26:9–16)

The Conversion of Saul by Michelangelo Buonarroti (c.e. 1542–1545), Cappella Paolina, Vatican Palace, Vatican City

feature of this condition is that of a delusion that de-
velops in an individual who is involved in a close
relationship with another person, sometimes termed the
“inducer” or “primary case,” who already has a psy-
chotic disorder with prominent delusions. The individ-
ual completely or partly comes to share the delusional
beliefs of the primary case.5,60 In our subjects, there are
no known close associates having an equivalent spec-
trum and magnitude of symptoms who might serve the
role of a primary case. Conversely, each of our subjects
might also have theoretically served as a primary case in
a shared psychotic-disorder relationship. Among other
psychiatric explanations, which should be mentioned for
completeness, are those of mystical experiences occur-
ring as a result of unconscious forces.61 These may
manifest by way of conversion disorder or a dissociative
condition such as a trance-like state or dissociative
identity disorder (DID). Another possibility would be
that of a deliberate misrepresentation of supernatural
revelation. This hypothesis would require significant in-
terpolation to support. An argument against this would
be that the sources used appear entirely sincere about
their belief in the divine origin of these experiences.
A very complex state of affairs would be that of a psy-
chotic disorder comorbid with deliberate misrepresen-
tations, conversion symptoms, dissociative trance-like

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TABLE 4. Causes of Psychosis Secondary to Medical or
Neurological Conditions
Brain neoplasms
Complex migraine
Delirium
Dementing illness
Encephalitis (infectious, autoimmune, or paraneoplastic)
Endocrine dysfunction
Epilepsy (ictal, postictal, and interictal)
Hypnagogic imagery
Infection (such as neurosyphilis)
Malnutrition/starvation
Metabolic derangements
Metabolic storage diseases
Parasomnia
Poisonings and intoxications
Stroke
Traumatic brain injury sequelae
Vitamin deficiencies (B1 or B12)
states, and DID. These hypotheses are mentioned to
ensure an adequate appraisal of the possibilities despite
an acknowledged inability to substantiate any of these
processes being at work.
LIMITATIONS OF THE ANALYSIS
The sources relied upon to derive information about our
subjects are not medical records. The modern reader
faces challenges interpreting events far removed from
our own time and culture and which are recounted in
a different language by authors who had their own
biases. It might be supposed that our subjects can only be
understood in the context of these factors and according
to the norms of religious experience of their day. Others
might advise that these religious writings should only be
interpreted nonliterally, that is, metaphorically and
abstractly, thereby eliminating the possibility of medical
scrutiny.
Still others might propose that medical knowledge is
always in a state of flux, which renders impermanent
this type of analysis because of its dependence on the
prevailing medical vogue of the day.62 Retrospective
diagnosis may also be asserted to be a transgression of
medical principles, since a medical opinion is rendered
on a patient who was never seen or examined.62
Starting with the last point, since it would offer an
obstacle to any prerequisite ability to derive information
about persons not present for examination, it is our view
that it is an oversimplification to state that all diagnosis
must ethically and methodologically rest upon having
the patient present in person. The behavioral and
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
neurological fields of medicine frequently rely upon the
observations of family, friends, and associates of our
patients because of patients’ sometime reticence to talk
about their symptoms, insufficiency of information, or
inaccuracies of self-reporting. Samples of a patient’s
writing are frequently used to assess movement,63
thought content, language function, organization, and
ability to abstract. Moreover, advances in understanding
human physiology have afforded us some confidence for
interpreting certain types of findings, such as those at-
tributed to the 6th century BCE Indian physician
Shushruta, who described sweet urine.64 We need not
have been present to recognize a probable case of di-
abetes mellitus. Similarly, other conditions may bear
sufficient signs through their descriptions in literature to
allow discussion about their causes. The figures we have
discussed have information to draw upon, some of
which is held by religious tradition to be authored by the
individuals (Moses and Paul), and some authored by
close associates (of Jesus and Paul), who have potentially
provided more information about them than available
for most persons born before the present age. We re-
cognize an important limitation inasmuch as we ap-
proach these source documents as most likely being
composites of the perspectives and beliefs of authors,
most of whom would not have personally known our
subjects.65,66 This would be similar to other ancient
writers who related stories about people and events that
they were not present to witness. This analysis depends
upon our sources’ reflecting, in some measure, actual
people and events as they were.
The reader is then reminded that the medical in-
terview and examination are not fixed in any general
way. It is understood that a physician must adjust both
interview and examination according to purpose and
circumstance.67,68 A psychiatrist may restrict examina-
tion to discussion about relevant feelings and percep-
tions, never physically touching the patient, but still
reliably deducing level of alertness, orientation, atten-
tion, ability to self-regulate and perceive social cues,
thought organization, language abilities, memory, in-
sight, judgment, and general intelligence, among other
things. A surgeon may emphasize the need to palpate
a mass to determine its characteristics. These approaches
are very different and are adjusted according to specific
goals. The paradigm for understanding behavior in terms
of a brain–behavior relationship is largely a product of
the last century of brain research, and it was not avail-
able to our predecessors.69 It is a useful exercise to apply
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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY
our modern models of how behavior correlates to neural
anatomy to test limits for localization and diagnosis while
recognizing and offering scrutiny to their limitations.
We can briefly outline an example of how an un-
derstanding of modern functional neuroanatomy can
allow a previously unattainable degree of discernment
about an individual not present for examination. Setting
aside questions about authenticity of authorship and
actuality of events, we will look at what might be de-
termined about St. Paul, ostensibly from his own hand.
His writings indicate that he traveled extensively, even
surviving many physical hardships (2 Corinthians 11:
23–27). These activities would minimally necessitate ge-
nerally intact motor function, sensation, and coordina-
tion. These abilities are now known to be accomplished
through the action of specific brain cortical–subcortical
circuits (in frontal and parietal lobes) that are linked
in a type of parallel processing and modulated by the
cerebellum. The cortical–subcortical circuits are com-
posed of their cortical target regions, and have as their
constituents the striatum (caudate, putamen, ventral
striatum), globus pallidus, and substantial nigra, and
thalamus, which then projects back to the cortex.70 These
systems would appear to be grossly intact, to endure
such extended travel and hardship. Paul’s detailed re-
collections of events and his references to the contents of
previous epistles advocate for intact memory systems,
both semantic and episodic, at the time of his writing.
These memory systems are now understood to be reliant
on a deep-brain circuitry consisting of the hippocampus,
fornix, mamillary body, mamillothalamic tract, anterior
nucleus of the thalamus and cingulated gyrus (circuit of
Papez). Paul spoke to many people on his journeys,
indicating adequate function of language, which is de-
pendent on perisylvian cerebral structures. His ability to
form social relationships and speak persuasively using
some metaphorical language suggests relatively pre-
served basic functions of frontal lobe and limbic systems,
which oversee self-regulation, emotions, abstraction,
ability to organize thoughts, and focus attention. His
ability to maintain wakefulness, speak, eat, and breathe
supports an adequately functioning brainstem. For cir-
cumscribed purposes, this examination can be more
enlightening than that of a 1st-century-trained physician
sitting in the room with St Paul or that of a 21st-century
physician without the appropriate training. More
nuanced assessment of cognition and behavior might
be achieved via application of neuropsychiatric and be-
havioral neurological approaches that utilize modern
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understanding about patterns of neurological and psy-
chiatric illnesses. The preceding inventory of St. Paul’s
generally intact neural systems can be largely extended
to each of our subjects. This would be the first such
inventory supporting a general preservation of such neu-
ral systems for Abraham, Moses, Jesus, and St Paul. It
is acknowledged that medical analyses are, in the end,
susceptible to being incorrect or incomplete and should
always be open to revision when new information be-
comes available. Without academic scrutiny of methods
and conclusions, improvements in understanding can-
not be achieved.
We now turn to several lines of reasoning that favor
the credibility of our proposals.
First, schizophrenia research has yielded compelling
evidence to support the model for genetic vulnerability,
coupled with environmental and psychosocial stressors,
the so-called diathesis–stress model, as a mechanism by
which schizophrenia occurs.71–73
Cross-cultural clinical characteristics,74 an increased
risk of having the disorder according to degree of kinship
to those affected, a host of identified genes affecting risk
for developing schizophrenia, and an increased preva-
lence of subtle brain developmental abnormalities in per-
sons with schizophrenia70,75 suggest interactions between
genetic and environmental influences75,76 that, so far as is
known, would not be expected to have been different in
persons living in the ancient world.
A second point hinges upon recognizing psychosis in
the pages of ancient writings. Psychosis has been known
by many names throughout history. Only recently has
more precise nomenclature been developed. It should be
no surprise that we would have difficulties recognizing
cases in ancient writings when gazing through the eyes of
ancient authors. Modern understanding about psychosis
holds that a central feature is thought processes reflecting
a highly distorted view of reality or a complete loss of
contact with reality. DSM-IV-TR indicates that the term
“psychotic” refers to a constellation of symptoms that
may vary to some extent across diagnostic categories, but
it generally refers to delusions, any prominent hallucina-
tions, disorganized speech, or disorganized or catatonic
behavior.5 A delusion is a false belief based on incorrect
inference about external reality that is firmly sustained
despite what almost everyone else believes and despite
what constitutes incontrovertible and obvious proof or
evidence to the contrary.
The belief is not one ordinarily accepted by other mem-
bers of the person’s culture or subculture.5 Delusional
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012

conviction occurs on a continuum.5 The depictions of our
subjects indicate that they may have either found their
own experiences not entirely believable to themselves,
understood that their experiences would be hard for
others to believe, or that they were perceived by their
contemporaries as being mad. Genesis: 12–20 recounts
that God made promises of blessings, progeny, and land
to Abraham. Despite these assurances, Abraham’s fear of
death prompted him to surrender his wife to the affection
of kings on two occasions in order to forestall his own
execution. Moses, for his part, points out to God in
Exodus 4:1 that the message he was given to bring to the
Israelites stood a good chance of not being believed
by a people whom we would now characterize as
polytheistic,77 superstitious, and therefore more likely to
have accepted such happenings. Their rapid reversion to
previous religious practices despite a series of miracles
(Exodus 32) appears to support Moses’ concern. Mark 3:
21 confirms an occasion where Jesus’ friends and family
viewed him as mad or “beside himself.” It is intrinsic to
his narrative that the people of his hometown (Mark 6:1–
6) and the religious authorities of the day also did not
accept his message. St Paul’s contemporary Festus, the
local Roman governor of Judea, in Acts 26:24 exclaimed
that Paul appeared “mad” or not sane. These events are
closest in time to our subjects and might suggest psychotic
type thought processes.
A third point speaks to the concern that religious and
cultural factors of the day need to be taken into account.
DSM-IV-TR recognizes that visual and auditory halluci-
nations with a religious content may be a part of normal
religious experience in some cultures.5 Rediger observes
that there is a tendency of the Western mind-set to
pathologize spiritual experiences and that there may
be an overdependence of psychological interpretation
on material existence.78 He suggests that there is an
anosognosia for experiential phenomena that exist out-
side the narrow band of consciousness that psychology
apprehends and that there is a great deal to learn from
Eastern traditions in this regard.78 He recommends an
approach that correlates phenomena falling outside the
psychological paradigm with medical science rather
than pathology. In harmony with this perspective is the
recognition that some spiritual experiences can have
very beneficial effects for transforming the lives of some
individuals, allowing them to surmount obstacles and
change destructive behaviors. In response to these
thoughts, we emphasize that our intent is not to prove
that the experiences of our subjects could not have
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
resulted from normal religious experiences in the con-
text of cultural factors; it is to apply a modern neuro-
behavioral paradigm to the experiences of our subjects
and thereby advance a dialogue about the rational limits
of perceptual experience. Toward this, we point out that
their experiences, if they occurred as narrated, might
also be conceptualized as psychotic spectrum because
of their resemblances, by way of their recurrent nature,
intensity, subject matter, grandiose-like qualities, and
similarity to psychotic auditory-visual phenomena.
It is recognized that the content of schizophrenic de-
lusions and hallucinations is significantly influenced by
sociocultural background. Different cultural experiences
can result in different delusional form and content.79,80
The DSM-IV-TR criteria presume our ability to distin-
guish psychotic phenomena from other normal experi-
ences in the context of a given culture. Unfortunately,
evidence-based algorithms for accomplishing this are
not available. Further complicating our task is the gulf
of time over which we must work. Overcoming these
obstacles in some measure might again be accomplished
through drawing on the perspectives of persons closer in
time and culture to our subjects.
The earliest believers found the experiences of the
subjects sufficiently removed from the sphere of normal
life so as to be understood as a product of a highly un-
usual relationship with a divine force.66 Those who did
not believe may have had various reasons, some of
which would have been that the message was too far
from their reality to be accepted.
From today’s vantage-point, if our subjects’ experi-
ences had resulted only from a convergence of normal in-
dividual and community religious experiences, we should
have expected numerous such stories and therefore no
reason to take notice of these now because of their mun-
dane nature. Surviving literature, whether of Classical
Greek, Roman period, or biblical origin, does not provide
support that it was commonplace in the ancient world for
the general population to have recurrent auditory-visual
experiences as grand in scope as those of our subjects. The
populations of the earliest followers of such new belief-
systems, as those of our subjects, would constitute small
groups able to accept the beliefs before the emergence of
social pressures related to larger group dynamics. How do
we explain the existence of the earliest followers? Their
presence would not be expected from an association with
individuals having a highly distorted view of reality.
Social models of psychopathology may be useful
for understanding how this might have happened.
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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY
Social-distance theory and communications-disorder the-
ory suggest that differentiating sanity from psychosis can
be achieved, based on the degree to which beliefs hamper
or facilitate communication and acceptance by society.
Those who deviate excessively from the societal norms do
not relate to the populace, are not understood, become
socially isolated and stigmatized, and may be identified
as not sane.81 This point of view might define as sane any
person who is able to maintain acceptance and commu-
nication with a social group. Not accounted for by this
theory are individuals who appear to demonstrate sus-
tained paranoid, grandiose, messianic-type delusions,
who, in more modern times, have drawn numbers of
adherents. Two such individuals are David Koresh, of the
Branch Dravidians,82 and Marshall Applewhite, of the
Heaven’s Gate cult.83 There are others in recent times who
have claimed to be prophet, messiah,84 Jesus,85 Buddha,86
avatar,87 or madhi,88 who have acquired followings. If
David Koresh and Marshall Applewhite are appreciated
as having psychotic-spectrum beliefs, then the premise
becomes untenable that the diagnosis of psychosis must
rigidly rely upon an inability to maintain a social group. A
subset of individuals with psychotic symptoms appears
able to form intense social bonds and communities
despite having an extremely distorted view of reality.
The existence of a better socially functioning subset
of individuals with psychotic-type symptoms is cor-
roborated by research indicating that psychotic-like
experiences, including both bizarre and non-bizarre
delusion-like beliefs, are frequently found in the general
population. This supports the idea that psychotic symp-
toms likely lie on a continuum.89–92
Political-psychology models of leader–follower relation-
ships may provide useful insights as to how early fol-
lowers could have coalesced around our subjects. Wilner93
surveyed the literature on the topic of charismatic leader-
ship and defined it as a relationship between a leader and
a group of followers, having the following properties:
1. The leader is perceived by the followers as somehow
superhuman.
2. The followers blindly believe the leader’s statements.
3. The followers unconditionally comply with the leader’s
directives for action.
4. The followers give the leader unqualified emotional
support.
Also, Wilner identifies four “catalytic factors” that are
shared by charismatic leaders. The first factor is the
assimilation of a leader to one or more of the dominant
422 http://neuro.psychiatryonline.org
myths of his society or culture. The second is the per-
formance of what appears to be an extraordinary or
heroic feat. The third is the projection of the possession
of qualities with an uncanny or a powerful aura. Finally,
there is outstanding rhetorical ability”93.
It is reasonable to speculate that a charismatic leadership–
follower group dynamic was present between our sub-
jects and their followers. Little further comment can be
made about Abraham in this regard since so little in-
formation is available about him. Moses felt himself not
to be a good speaker, and his brother Aaron was ap-
pointed to speak on his behalf to the community (Exodus
4:10–16). This raises interesting questions about what
roles community members might contribute to the
functioning of a leadership–follower dynamic in order
to supplement the leader’s deficiencies. The narratives
of Jesus and Paul have details which could fit into
a charismatic leader–follower paradigm of group
behavior.
Creating and sustaining groups would be dependent
on additional mechanisms:
Wilfred Bion94 observed three patterns of group
behavior that occur in healthy, mature adults, wherein
group members act as if they are dominated: the de-
pendency group, the pairing group, and the fight–flight
group. The dependency group turns to an omnipotent
leader for security, behaving as if they do not have in-
dependent minds of their own. Members blindly seek
directions and follow orders unquestioningly. They tend
to idealize and place the leader on a pedestal. When the
leader fails to meet the standards of omnipotence and
omniscience, a period of denial, then anger, and dis-
appointment result. In the pairing group, the members
act as if the goal of the group is to bring forth a messiah,
someone who will save them. There is an air of optimism
and hope that a new world is around the corner. The
fight–flight group organizes itself in relationship to a
perceived outside threat. The group itself is idealized
as part of a polarizing mechanism, while the outside
population is regularly seen as malevolent in motivation.
The threatening outside world is at once a threat to
the existence of the group and the justification for its
existence. Each of these group types regularly character-
izes the followers in charismatic leader–follower rela-
tionships.95 It is reasonable to propose that one or more
of these types of group dynamics were present to
varying degrees, whether simultaneously or in various
sequences, in our subjects’ groups as they developed
their beliefs over time.
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012

How do individuals with mental illness rise to
positions of leadership? Ghaemi96 sets forth a hypothesis
that there are key elements associated with mental
illness that may be beneficial for leadership abilities:
realism, resilience, empathy, and creativity.96 His anal-
ysis of several notable political, military and business
leaders and review of psychological research leads to his
proposal that depression can be associated with an
increase in each of these qualities, and mania can be
associated with an enhancement of creativity and re-
silience. Depression promotes leaders’ being more re-
alistic and empathic, whereas mania promotes their
being more creative and resilient.96 He adds that when
depression and mania occur together in bipolar disorder,
it may result in a further increase in leadership skills.
Such individuals, he proposes, benefit indirectly from
entering and leaving these mood states in addition to
being in their well state between episodes.96 If this were
to hold true, then our subjects might be more likely to
have affective disorder-associated psychotic conditions
and thereby could have benefitted from spending periods
in various mood states, including their well states. The
quality of realism would be expected to be most adversely
affected in a psychotic state, especially when judged from
the standpoint of modern sensibilities. With respect to
religious beliefs arising during historical periods pre-
ceding the advent of increased understanding about the
natural world, there might have been less by which to
judge this quality and, therefore, more cultural tolerance
or acceptance of a wider range of ideas.
A shared psychotic disorder5,60 is another means by
which the earliest followers may have received their
beliefs, with each of our subjects being a primary case.
Although occurring primarily in the form of a dyadic
relationship, paranoid delusions have been reported to
occasionally occur in larger sect-like groups whose
members become infused with the paranoid ideation of
a dominant member. Norman Cameron termed this a
“paranoid pseudocommunity.”97–99 This term is used to
denote an imagined persecutorial conspiracy directed at
the group member. Once separated from the group’s
social fabric, many members have been observed to re-
gain the ability to view others without undue levels of
suspicion.100 This pattern of group behavior may lie along
a continuum with that of the fight–flight group described
by Wilfred Bion. Much more speculatively, each of our
subjects and their followers could have been either an
initiator or recipient in a chain of persons who transmit
delusional-like beliefs. Each recipient would then act as
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
the primary case to another individual. No reported cases
of such a chain of transmission of delusion-like beliefs are
known to the authors, and, therefore, this possibility is
highly speculative. Generally speaking, it is an individu-
al’s insight and amenability to reason that are important
means by which sane and psychotic thought processes are
distinguished. A significant limitation of this analysis is
that we cannot now know to what degree the beliefs of our
subjects were fostered and maintained within a cultural
“microbubble,” and to what degree their beliefs were
amenable to being changed through reasonable processes.
Last, in response to the proposal that a non-literal
interpretation of religious writings is most advisable, it is
observed that, since the earliest of times, believers have
understood our subjects’ experiences as having occurred
literally as described. As such, a great many of these ex-
periences bear a striking resemblance to well-characterized
psychiatric phenomena. This raises the prospect of an
unusual degree of accuracy in the sources with regard to
these details.
Discussion about a potential role for the supernatural
is outside the scope of our article and is reserved for
the communities of faithful, religious scholars, and
theologians, with one exception. It is our opinion
that a neuropsychiatric accounting of behavior need not
be viewed as excluding a role for the supernatural.
Herein, neuropsychiatric mechanisms have been pro-
posed through which behaviors and actions might be
understood. For those who believe in omnipotent and
omniscient supernatural forces, this should pose no ob-
stacle, but might rather serve as a mechanistic explana-
tion of how events may have happened. No disrespect is
intended toward anyone’s beliefs or these venerable
figures.
If such is perceived after reading this analysis it might
be asked whether there is a stigma in the reader’s mind
about mental illness. Any stigma toward persons with
mental illness is rejected by the authors.
FUTURE DIRECTIONS
Research into this postulated form of psychiatric pre-
sentation might be facilitated by development of a new
DSM diagnostic subcategory of schizophrenia or psy-
chosis and an improved recognition that a continuum of
psychotic symptomatology likely exists.
This subcategory might be referred to as a grandiose or
supraphrenic (supra [above or beyond] phrenic [mind])
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PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY
variant. It would encompass those who are symptomatic
for 6 months or more, with an organized and relatively
nonbizarre delusional system, grandiosity, often delu-
sional narcissism, possible hallucinations, and an ex-
tremely intense feeling of being supernaturally selected
for a mission. It would recognize that when this occurs in
individuals with generally average-or-higher intelligence,
strong communication skills, a high degree of magnetic
charisma, and the ability to effectively engender empathy,
these individuals may be capable of convincing or
psychologically enthralling groups or populations of
individuals to follow their directives for undefined
periods of time. Their goals are partly or wholly based
on or inspired by psychotic thought processes. These
thought processes may yield beliefs that are closely
related to other common societal beliefs, but they are not
very amenable to reason. Affected individuals may de-
monstrate a preserved ability to maintain a social group,
be very persuasive, and become socially elevated in a
group and exercise inordinate influence over others in
the group. Their beliefs may result in the sponsorship of
activities that are lethal to self and others and are outside
the norms for their society. Disorganization, negative
psychiatric symptoms, and cognitive dysfunction are not
significantly present. Affective features may be present,
but are not usually debilitating. Hyperreligiosity would
be a frequent accompaniment, but is not necessarily
required, since extreme devotion to other socio-political
belief systems or perceived extraterrestrial or supernat-
ural forces might serve as surrogates. These individuals
References
1. Hazlett SB, McCarthy ML, Londner MS, et al: Epidemiology
of adult psychiatric visits to U.S. emergency departments.
Acad Emerg Med 2004; 11:193–195
2. Baillargeon J, Thomas CR, Williams B, et al: Medical emergency
department utilization patterns among uninsured patients
with psychiatric disorders. Psychiatr Serv 2008; 59:808–811
3. Rudaleviciene P, Stompe T, Narbekovas A, et al: Are religious
delusions related to religiosity in schizophrenia? Medicina
(Kaunas) 2008; 44:529–535
4. Baier M: Insight in schizophrenia: a review. Curr Psychiatry
Rep 2010; 12:356–361
5. American Psychiatric Association: Diagnostic and Statistical
Manual of Mental Disorders, 4th Edition, Text Revision. Wash-
ington, DC, American Psychiatric Association, 2000, pp 297–343
6. Shannon B: Biblical entheogens: a speculative hypothesis.
Time and Mind 2008; 1:51–74
7. Elliott B, Joyce E, Shorvon S: Delusions, illusions, and hal-
lucinations in epilepsy, 2: complex phenomena and psychosis.
Epilepsy Res 2009; 85:172–186
424 http://neuro.psychiatryonline.org
are capable of having extraordinary influence on
individuals and society.
CONCLUSION
We suggest that some of civilization’s most significant
religious figures may have had psychotic symptoms that
contributed inspiration for their revelations. It is hoped
that this analysis will engender scholarly dialogue about
the rational limits of human experience and serve to
educate the general public, persons living with mental
illness, and healthcare providers about the possibility
that persons with primary and mood disorder-associated
psychotic-spectrum disorders have had a monumental
influence on civilization.
Figure Credits: Figure 1: Wikipedia: http://en.wikipedia.org/
wiki/File:Abraham.jpg; Figure 2: Wikipedia: http://yo.wikipedia.
org/wiki/F%C3%A1%C3%ACl%C3%AC:Domenico_Fetti_
004.jpg; Figure 3: Wikipedia: http://en.wikipedia.org/wiki/
File:Rembrandt_Christ_in_the_Storm_on_the_Lake_of_Galilee.
jpg; Figure 4: Wikipedia Commons: http://commons.wikimedia.
org/wiki/File:4paul1.jpg.
Written with financial support from the Sidney R. Baer, Jr.
Foundation, St Louis, MO.
We thank Steven Schachter, M.D., Professor of Neurology,
Harvard Medical School; and Jeffrey Rediger, M.D., M.Div.,
Assistant Professor of Psychiatry, Harvard Medical School;
and The Center for Brain, Law, and Behavior at the
Massachusetts General Hospital, Boston, MA.
8. Nadkarni S, Arnedo V, Devinsky O: Psychosis in epilepsy
patients. Epilepsia 2007; 48(Suppl 9):17–19
9. de Araújo Filho GM, da Silva JM, Mazetto L, et al: Psychoses of
epilepsy: a study comparing the clinical features of patients with
focal versus generalized epilepsies. Epilepsy Behav 2011; 20:655–658
10. Ogata A, Miyakawa T: Religious experiences in epileptic
patients with a focus on ictus-related episodes. Psychiatry
Clin Neurosci 1998; 52:321–325
11. Kanemoto K, Kawasaki J, Kawai I: Postictal psychoses: in
comparison with acute interictal psychoses. Jpn J Psychiatry
Neurol 1994; 48:209–211
12. Brewerton TD: Hyperreligiosity in psychotic disorders. J Nerv
Ment Dis 1994; 182:302–304
13. Landtblom AM, Lindehammar H, Karlsson H, et al: Insular
cortex activation in a patient with “sensed presence”/ecstatic
seizures. Epilepsy Behav 2011; 20:714–718
14. Picard F, Craig AD: Ecstatic epileptic seizures: a potential
window on the neural basis for human self-awareness. Epilepsy
Behav 2009; 16:539–546
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012

15. Asheim Hansen B, Brodtkorb E: Partial epilepsy with
“ecstatic” seizures. Epilepsy Behav 2003; 4:667–673
16. Naito H, Matsui N: Temporal lobe epilepsy with ictal ecstatic
state and interictal behavior of hypergraphia. J Nerv Ment Dis
1988; 176:123–124
17. Cirignotta F, Todesco CV, Lugaresi E: Temporal lobe epilepsy
with ecstatic seizures (so-called Dostoevsky epilepsy). Epi-
lepsia 1980; 21:705–710
18. Prendergast J, Spira P, Schnieden V: Post-ictal psychosis: an
unusual clinical entity. Aust N Z J Psychiatry 1999; 33:
433–435
19. Dongier S: Statistical study of clinical and electroencephalo-
graphic manifestations of 536 psychotic episodes occurring in
516 epileptics between clinical seizures. Epilepsia 1959/1960;
1:117–142
20. Kanemoto K: Postictal psychoses, in Progress in Epileptic
Disorders: Neuropsychiatric Issues in Epilepsy. Montrouge,
France. Edited by Inoue Y, Matsuura M. John Libbey Eurotext,
2010, pp 27–34
21. Umbricht D, Degreef G, Barr WB, et al: Postictal and chronic
psychoses in patients with temporal lobe epilepsy. Am J
Psychiatry 1995; 152:224–231
22. Kanner AM, Stagno S, Kotagal P, et al: Postictal psychiatric
events during prolonged video-electroencephalographic mon-
itoring studies. Arch Neurol 1996; 53:258–263
23. Trimble M, Kanner A, Schmitz B: Postictal psychosis. Epilepsy
Behav 2010; 19:159–161
24. Kanemoto K: Postictal psychoses, revisited, in The Neuro-
psychiatry of Epilepsy. Edited by Trimble MR, Schmitz B.
Cambridge, U.K., New York, Cambridge Univ. Press, 2002,
pp 117–131
25. Devinsky O: Epilepsy: Patient and Family Guide, 3rd Edition.
Demos Health, 2007, pp 20
26. Holmes GL: Epilepsy.com. Temporal Lobe Epilepsy. http://www.
epilepsy.com/epilepsy/epilepsy_temporallobe; last accessed 05/
28/2011)
27. Professional Advisory Board: EpilepsyFoundation.org. Temporal
Lobe Epilepsy. http://www.epilepsyfoundation.org/about/types/syn-
dromes/temporallobe.cfm; last accessed June 4, 2011)
28. Dolgoff-Kaspar R, Ettinger AB, Golub SA, et al: Numinous-
like auras and spirituality in persons with partial sei-
zures. Epilepsia 2011; 52:640–644 10.1111/j.1528- PubMed
1167.2010.02957.x. Epub 2011 Feb 5.
29. Cavanna AE, Cavanna S, Cavanna A: Epileptic seizures and
spirit possession in Haitian culture: report of four cases and
review of the literature. Epilepsy Behav 2010; 19:89–91
30. Bortz JJ: Neuropsychiatric and memory issues in epilepsy.
Mayo Clin Proc 2003; 78:781–787
31. Patrikelis P, Angelakis E, Gatzonis S: Neurocognitive and
behavioral functioning in frontal lobe epilepsy: a review.
Epilepsy Behav 2009; 14:19–26
32. Hoffmeier, James K: Israel in Egypt: The Evidence for the
Authenticity of the Exodus Tradition. Oxford University
Press, 1999
33. Schultze-Lutter F, Ruhrmann S, Hoyer C, et al: The initial
prodrome of schizophrenia: different duration, different
underlying deficits? Compr Psychiatry 2007; 48:479–488
34. Yung AR, McGorry PD: The prodromal phase of first-episode
psychosis: past and current conceptualizations. Schizophr
Bull 1996; 22:353–370
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012
MURRAY et al.
35. Flaherty AW: Frontotemporal and dopaminergic control of
idea-generation and creative drive. J Comp Neurol 2005;
493:147–153
36. Flaherty A: The Midnight Disease: The Drive to Write,
Writer’s Block, and the Creative Brain. New York, Mariner
Books, 2005, p 41
37. Trimble MR. The Soul in the Brain: The Cerebral Basis of
Language, Art, and Belief. Baltimore, MD, Johns Hopkins,
2007, p 101–114
38. Nestor PG: Mental disorder and violence: personality
dimensions and clinical features. Am J Psychiatry 2002;
159:1973–1978
39. Hor K, Taylor M: Suicide and schizophrenia: a systematic
review of rates and risk factors. J Psychopharmacol 2010;
24(Suppl):81–90
40. Meltzer HY: Suicidality in schizophrenia: a review of the
evidence for risk factors and treatment options. Curr
Psychiatry Rep 2002; 4:279–283
41. Lord V: Suicide by Cop: Inducing Officers to Shoot. New
York, Loose Leaf Law Publications, 2004
42. Keram E, Farrell B: Suicide by Cop: Issues in Outcome and
Analysis. Suicide and Law Enforcement, 2001, pp 587–599
43. Landsborough D: St Paul and temporal lobe epilepsy. J
Neurol Neurosurg Psychiatry 1987; 50:659–664
44. Rieu CH: Introduction, notes, in The Acts of the Apostles.
Translated by Rieu CH. New York, Penguin Classics, 1957,
pp 9–39, 133–136, 170–171
45. Pfleiderer O: Lectures on the influence of the Apostle Paul on
the development of Christianity, delivered in London and
Oxford, April and May, 1885. Williams and Norgate, 1897,
p 43
46. The New Oxford Annotated Bible with the Apocrypha:
Revised Standard Version. Edited by May HG, Metzger BM.
New York, Oxford University Press, 1977, pp 1408
47. The Reformation Study Bible New King James Version Sproul
RC. Nashville, TN, Thomas Nelson Publishers, 1995, p 1408
48. Geschwind N: Behavioural changes in temporal lobe epilepsy.
Psychol Med 1979; 9:217–219
49. Geschwind N: Interictal behavioral changes in epilepsy.
Epilepsia 1983; 24(Suppl 1):S23–S30
50. Waxman SG, Geschwind N: The interictal behavior syndrome of
temporal lobe epilepsy. Arch Gen Psychiatry 1975; 32:1580–1586
51. Benson DF: The Geschwind syndrome. Adv Neurol 1991;
55:411–421
52. Schachter S: Religion and the Brain: Evidence from Temporal
Lobe Epilepsy, in Where God and Science Meet: How Brain
and Evolutionary Studies Alter Our Understanding of Re-
ligion, Vol 2. Edited by McNamara P. Westport, CT, Praeger,
2006, pp 171–188
53. Devinsky O, Najjar S: Evidence against the existence of
a temporal lobe epilepsy personality syndrome. Neurology
1999; 53(Suppl 2):S13–S25
54. Mungas D: Interictal behavior abnormality in temporal lobe
epilepsy: a specific syndrome or nonspecific psychopathol-
ogy? Arch Gen Psychiatry 1982; 39:108–111
55. Rodin E, Schmaltz S: The Bear-Fedio personality inventory
and temporal lobe epilepsy. Neurology 1984; 34:591–596
56. Stark-Adamec C, Adamec RE, Graham JM, et al: Complexities
in the complex partial seizures personality controversy.
Psychiatr J (Univ Ott) 1985; 10:231–236
http://neuro.psychiatryonline.org 425
PSYCHOTIC DISORDERS IN RELIGIOUS HISTORY
57. Stevens JR: Interictal clinical manifestations of complex partial
seizures, in Advances in Neurology. Edited by Penry JK, Daly
DD. New York, Raven, 1975, pp 85–107
58. Stern A: [The problem of St. Paul’s epilepsy]. Psychiatr Neurol
(Basel) 1957; 133:276–284
59. Brorson JR, Brewer K: St Paul and temporal lobe epilepsy. J
Neurol Neurosurg Psychiatry 1988; 51:886–887
60. Shimizu M, Kubota Y, Toichi M, et al: Folie à deux and shared
psychotic disorder. Curr Psychiatry Rep 2007; 9:200–205
61. James W: The Varieties of Religious Experience. New York,
Barnes & Noble Classics, 1902, 2004, pp 416–417
62. Karenberg A: Retrospective diagnosis: use and abuse in
medical historiography. Prague Med Rep 2009; 110:140–145
63. Price BH, Richardson EP Jr: The neurologic illness of Eugene
O’Neill: a clinicopathological report. N Engl J Med 2000;
342:1126–1133
64. Kahn CR, King GL, Moses AC, (eds): Joslin’s Diabetes
Mellitus, 14th Ed. Philadelphia, PA, Lippincott, Williams &
Wilkins, 2005, p 2
65. Friedman RE. Who Wrote the Bible? HarperOne, January 1,
1987, pp 15–33
66. Erhman BD. The New Testament: A Historical Introduction to
the Early Christian Writings, 5th Ed. New York, Oxford Univ.
Press, 2011
67. Murray ED, Price BH: The neurological examination, in
Comprehensive Clinical Psychiatry, 1st Ed. Edited by Stern
TA, Rosenbaum JF, Fava M, et al. Philadelphia, PA, Mosby/
Elsevier, 2008
68. Ovsiew F, Murray ED, Price BH: Neuropsychiatric approach
to the psychiatric inpatient, in Principles of Inpatient Psy-
chiatry, 1st Edition. Edited by Ovsiew F, Munich R. Baltimore,
MD, Lippincott Williams & Wilkins, 2008
69. Legesse B, Price BH, Murray ED: Brain–behavior relations, in
Encyclopedia of Human Behavior, 2nd Edition. Edited by
Ramachandran VS. New York, Academic Press, 2012
70. Murray ED, Buttner N, Price BH: Depression and psychosis in
neurological practice, in Neurology in Clinical Practice, 6th
Ed. Edited by Bradley WG, Daroff RB, Fenichel GM, et al.
London, UK, Butterworth Heinemann, 2012
71. Zubin J, Spring B: Vulnerability: a new view of schizophrenia.
J Abnorm Psychol 1977; 86:103–126
72. Russo J, Vitaliano PP, Brewer DD, et al: Psychiatric dis-
orders in spouse caregivers of care recipients with Alz-
heimer’s disease and matched controls: a diathesis-stress
model of psychopathology. J Abnorm Psychol 1995; 104:
197–204
73. Portin P, Alanen YO: A critical review of genetic studies of
schizophrenia, II: molecular genetic studies. Acta Psychiatr
Scand 1997; 95:73–80
74. U.S. Department of Health and Human Services (USDHHS):
Mental Health: Culture, Race, and Ethnicity, A Supplement
to Mental Health: A Report of the Surgeon General. Rock-
ville, MD, U.S. Department of Health and Human Services,
Public Health Service, Office of the Surgeon General, 2001,
p 26
75. U.S. Department of Health and Human Services (USDHHS):
Mental Health: A Report of the Surgeon General. Rockville,
MD, U.S. Department of Health and Human Services, Public
Health Service, Office of the Surgeon General, 1999, pp
269–284
426 http://neuro.psychiatryonline.org
76. van Os J, Kapur S: Schizophrenia. Lancet 2009; 374:635–645
77. Smith MS: The Origins of Biblical Monotheism: Israel’s
Polytheistic Background and the Ugaritic Texts. New York,
Oxford Univ. Press, 2001, pp 135–157
78. Rediger J: Bipolar disorder and western anosognosia, in The
Psychospiritual Clinician’s Handbook: Alternative Methods
for Understanding and Treating Mental Disorders. Edited by
Mijares S, Khalsa G. Binghamton, NY, Haworth Reference
Press, 2005, pp 205–231
79. Mohr S, Huguelet P: The relationship between schizophrenia
and religion and its implications for care. Swiss Med Wkly
2004; 134:369–376
80. Kim K, Hwu H, Zhang LD, et al: Schizophrenic delusions in
Seoul, Shanghai, and Taipei: a transcultural study. J Korean
Med Sci 2001; 16:88–94
81. Vardy MM, Kaplan BM: Christ/messiah delusions revisited:
toward an anthropological definition of religious delusions.
Psychoanal Rev 2008; 95:473–487
82. Reavis DJ: The Ashes of Waco: An Investigation. Syracuse
Univ Press, 1998
83. Snow RL: Deadly Cults: The Crimes of True Believers.
Westport, CT, Praeger, 2003
84. The MI5 Messiah: Why David Shayler Believes He’s the Son of
God; Mail Online. London, UK, Dailymail.co.uk; 2007
85. The Argus, Visit from the “Siberian Jesus” November 9, 2002
86. Akimoto H: The Aum Cult leader Asahara’s mental
deviation and its social relations. Psychiatry Clin Neurosci
2006; 60:3–8
87. Kalchuri B: Meher Prabhu: Lord Meher, The Biography of the
Avatar of the Age, Meher Baba Manifestation, Inc., 1986
88. Hardy R: Confusion surrounds Najaf battle. BBC News,
January 31, 2007
89. Pechey R, Halligan P: The prevalence of delusion-like beliefs
relative to sociocultural beliefs in the general population.
Psychopathology 2011; 44:106–115
90. Strauss JS: Hallucinations and delusions as points on continua
function: rating scale evidence. Arch Gen Psychiatry 1969;
21:581–586
91. Ellett L, Lopes B, Chadwick P: Paranoia in a nonclinical
population of college students. J Nerv Ment Dis 2003; 191:425–430
92. Kelleher I, Cannon M: Psychotic-like experiences in the
general population: characterizing a high-risk group for
psychosis. Psychol Med 2011; 41:1–6
93. Wilner AR: The Spellbinders: Charismatic Political Leader-
ship. New Haven, CT, Yale University Press, 1984
94. Bion WR: Experiences in Groups and Other Papers. London,
UK, Tavistock, 1961
95. Post JM: Leaders and Their Followers in a Dangerous World:
The Psychology of Political Behavior. Ithaca, NY, Cornell
University Press, 2004, pp 187–199
96. Ghaemi N: A First-Rate Madness: Uncovering the Links Between
Leadership and Mental Illness. New York, Penguin, 2011
97. Cameron N: The paranoid pseudocommunity. Am J Sociol
1943; 49:37–38
98. Cameron N: Paranoid conditions and paranoia: American
Handbook of Psychiatry, Vol I. New York, Basic Books, 1959a
99. Cameron N: The paranoid pseudocommunity revisited. Am J
Sociol 1959b; 65:57–61
100. Myers PL: Paranoid pseudocommunity beliefs in a sect
milieu. Soc Psychiatry Psychiatr Epidemiol 1988; 23:252–255
J Neuropsychiatry Clin Neurosci 24:4, Fall 2012