I have worked with hundreds and been near thousands of mentally ill patients over the years. Not once did I ever feel one of them was possessed by an evil spirit.
Mentally ill people have enough stigmas without having to carry the label of “possessed by the devil” on top of it all. In Medieval times schizophrenic patients were chained. Some had their heads drilled to “let out the evil spirits.” These patients were treated in the most horrible of ways.
Mentally impaired individuals deserve to be treated with respect, like anyone else.
The strange behavior associated with mental illness is due to chemicals of the brain that are out of balance, and/or brain cells that have been damaged.
Any Church leader from time to time is going to run across members of the Church who suffer from major psychiatric illness. Schizophrenia, for example, exists in 1% of the population. The disease usually occurs between the ages of 18 and 30. This means that a typical LDS Ward easily could have a member struggling with schizophrenia or a related disorder.
Medical scientists now know that schizophrenia is a brain disease involving the emotional centers of the brain (the limbic system, temporal lobes, frontal lobes, etc.). Since the disease attacks the auditory and language centers of the brain in the superior (top) portions of the temporal lobe, these patients hear hallucinatory voices. They hear conversations among multiple voices, which are often derogatory conversations telling the patient to “Go kill the pregnant woman,” as just one example. (They do NOT act upon these hallucinatory commands).
Although there are acute cases of schizophrenia lasting only a few weeks, most schizophrenic patients have a chronic brain disease.
These patients often talk funny, saying things like: “Quick ancestors pin my sleep.” Their language is bizarre and often without meaning. As they speak, they show a flight of ideas, often jumping from topic to topic without any logical threads.
Although the patients typically are not violent, they are often accusatory and paranoid. They often believe that others are out to get them, talking about them, and poisoning their food. They often believe that others (or TV sets) are inserting thoughts into their heads. They often have bizarre delusions, like “A flying saucer just flew out of my head.”
They often make up new words (neologisms): “The police are trying to figoriate me.” If you ask, “What does “figoriate” mean? The patient might define the term with other neologisms.
The schizophrenic patient is often withdrawn from others and incapable of maintaining relationships with family members and close friends. They often prefer to just be alone.
Suppose a LDS Bishop encountered a faithful member of the Church who was suddenly acting bizarre. It would be a good idea for that Bishop to interview the member in the presence of other family members. The Bishop should keep in mind that the family members may think of the disorder as a possession by evil spirits.
The Bishop should try to determine the answers to such questions as: Does the affected person hear voices in his or her head? What do the voices say? Are the voices derogatory? Are there any bizarre actions and beliefs? Does the person have excessive suspicions? Is the person’s language difficult to interpret? Is the person withdrawn from loved ones? How long have the symptoms been present?
Naturally, a priesthood blessing is appropriate. If the symptoms resemble that of schizophrenia or if the behavior concerns the family and the Bishop, then an appropriate referral should be made to a psychiatrist (an MD) or a psychologist (a PhD). Hospitalization may be an important consideration.
Mentally ill individuals need our love and compassion. They need our prayers, but they also need the best of medical science. Most schizophrenic patients need drug therapies, using medicines like clozapine or thorazine. Such drugs block the effects of a neurotransmitter in the brain called dopamine.
Finally, it is inappropriate to baptize any individual who is suffering from a psychotic mental illness. They are in NO CONDITION to make big life decisions. Such individuals should be treated with love and kindness, but they should NOT be issued religious challenges.
Mental illnesses are characterized by extreme confusion, and a confused brain should have minimal stress, religious or otherwise.
It is fine to remind a patient that God loves him or her, especially if there are feelings of deep-seated guilt. However, such patients do NOT need complex religious messages, because such messages, even if given with good intentions, are too often extremely disturbing.
Conclusion: The scriptures describe how Jesus dealt with the ill. He was an exemplar of care and concern. We should follow his footsteps.
When dealing with the mentally ill, it is useful to remember the story of the man born blind in John 9: 1-3. Jesus was asked, "[W]ho did sin, this man or his parents, that he was born blind?" Jesus set the standard: "Neither."
That simple answer generalizes to mental illness as well.
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18 comments:
Thorazine?!!
Shame on you. There are much better medications than that these days--Abilify and Risperdal for example.
Prodromal symptoms start typically by late adolescence, and schizophrenia is typically manifest in the early 20s. I have many stories of seeing MTC folk at Utah Valley Regional Med Center's psych unit who had their first psychotic break--stress will do that to a person....
So, if a person has otherwise been functioning reasonably well into adulthood (say 25-30 years old and they're all the sudden showing symptoms), it may be there is something organic going on. For example, schizophrenics rarely have olfactory hallucinations but smelling weird smells is associated with trauma, tumors, or infections.
Or, the person may have been sitting on the depressive end of the bipolar spectrum and is having their first venture into the realm of mania.
Schizophrenics are most likely to harm themselves, not others. Those are the commands they are most likely to act on.
Would you like to clarify that someone who suffers from schizophrenia should be allowed to be baptized, just not while in an psychotic state, rather than "suffering from a psychotic mental illness"? The medications available today are tons better than they were 20 or even 10 years ago.
Just had to get that out there :)
There definitely needs to be more compassion for people with mental illnesses in the world. Thank heavens, as the commenter said, we have much better treatments than at any other time.
Elizabeth-W:
Wow, what a reaction. Good for you.
As you know there are a wide range of neuroleptic drugs that can be prescribed in schizophrenia. I was just providing some examples, newer and older. Yes, there have been improvements since thorazine. (Science is good).
Yes, schizophrenia usually shows up between 18-23 or so, but can occur at later ages, even if "atypical."
I am unsure of your point about olfactory hallucinations. Schizophrenic patients almost always have auditory (voices) hallucinations. But, the schizophrenic brain is in a state of decay, and I am sure the lateral olfactory tracts are somewhat affected.
Agreed: schizophrenics are more likely to harm themselves than others. My experience suggests that they rarely harm others. (Behavioral problems are dramatically reduced with medications).
Priesthood authorities have to decide whether a person is prepared for baptism, but care must be taken to make sure a person with a psychotic illness is even capable of making a sincere decision, such as a change in religion. Many chronic schizophrenic patients are NOT capable of such a decision.
Did I calm you down?
Okay, I'll say that I personally have only known a handful of persons with schizophrenia to have olfactory hallucinations. But, I have seen persons with olfactory hallucinations present to the ER and then they are found to have epilepsy, or in another case, a brain tumor. Maybe I haven't seen enough geriatric schizophrenics and that's why I haven't seen enough tactile/olfactory hallucinations.
To your point about baptism, I can think of only 2 schizophrenics I have known who weren't baptized at 8 (long before symptoms are usually noticed) but joined the church in adulthood. So, I suppose you could argue for caution. But seriously, Dr F, I know schizophrenics who are well-medicated and have been psychosis-free. (See http://ajp.psychiatryonline.org/cgi/reprint/162/3/441) If they are clear, why deny them baptism?
Let's see...depression can have psychotic features, so we better no baptize them. Or how about the borderlines? They're notorious for unstable self-image and identity. Or how about anyone with an IQ under 70? I guess my tolerance/cut-off for treating these individuals with respect is perhaps more liberal than yours.
:D
For the past several years most of my practice is with addictions. You want to talk about possessed? Ugh. The things a person will do to obtain opiates....sigh. It's painful.
Elizabeth-W:
I agree that any psychiatric patient that is capable of making an honest and sincere decision about baptism should be able to apply for that ordinance. Still, care needs to be taken, as the Church does NOT need to be in the business of taking advantage of vulnerable populations.
Vulnerability and competency are key issues.
One of my long-term projects involves the history of my great-grandmother's sister, a woman who, at the time of a very traumatic incident, began displaying many of the symptoms you describe here. This was at the beginning of the 20th century when not only did some church members -- in her case, the stake president -- diagnose demonic possession, but also in the state mental hospital where she was confined for a few years there was no adequate treatment. Both conditions are understandable, given the time.
It became quite a celebrated case, reaching from the First Presidency's office to the Utah Supreme Court to the Smoot hearings in Washington.
Anyway, it has caused me to think a lot about mental illness, and about mental illness and the gospel.
Thanks for another thoughtful essay about a topic that doesn't get much attention on the blogs.
Ardis:
Your project on your relative sounds most fascinating. I hope it gets finished sooner rather than later.
As usual, you went straight to the main point. Illnesses, whether mental or physical, need to be treated with utmost care -- both spiritually and medically. Misperceptions about "cause" will lead to mistreatment and possibly maltreatment.
I think the Lord is especially merciful in judgement for those who have mental illness. I think as wickedness increases in the world, the stress will cause an increase in mental illness.
I agree with the points made in this post, but I think they would have greater impact coming from a different source - a general authority.
The reason some of the general membership of the church attribute psychotic behavior to demonic possession is that this interpretation is supported by scriptural examples. I may be wrong, but I believe that in these accounts Jesus does not discredit the idea that demons are the causes of the atypical behavior.
While most (all?) mental health professionals agree that psychotic behavior is the result of a disease, most church members are not familiar with the research this conclusion is based on. They are familiar with the biblical accounts that support the demon possession theory. Without clarification by a general authority, I would expect most church members to side with their scriptural understanding over an unknown professional.
I would love to be proven wrong on my belief that the general authorities have not addressed the demonic possession and mental health question. I can safely say that my undergraduate education at BYU in Psychology did not address the issue.
Don Yorgason:
You have made a great comment.
While I can claim to be an authority on mental illness, I am certainly NOT a General Authority or even an authority on spirit possession. I do not understand what Jesus encountered, and I am not commenting on that.
My essay is an editorial based in experience and science, NOT in scriptures.
In the context of mental illness the concept of "spirit possession" functions merely to further stigmatize the patient, causing further harm.
Please note, however, that as with any form of ill health, priesthood blessings are appropriate and needed, supplemented with medical science.
I urge theologians to learn more deeply about mental disorders and their underlying causes. Latter-day Saints believe in continuing expansion of truth -- in all realms of knowledge.
Wonderful post.
A couple of questions: First, is there an accepted spectrum going from mild to severe when diagnosing schizophrenia? And second, in milder cases what precautions should be taken when dealing with the kinds of stresses you mention in your post -- those that would be difficult in extreme cases such as baptism, etc?
Jack
Jack:
Thanks for your questions. Here is an attempt at an answer:
1. Schizophrenia should be viewed as a syndrome. Thus, not all patients with that diagnosis necessarily have the same disease, but they do carry similar symptoms. So, it is not surprising that such patients can vary widely in severity. Some schizophrenic patients with medication can be quite functional, but others may need continued hospitalization.
2. Patients with an active psychosis should be treated with care under the direction of a physician or psychologist. Patients with severe illnesses of this nature are NOT capable of making significant life decisions. LDS missionaries need to be careful in dealing with vulnerable populations where competence is in question.
I am confident that missionaries working closely with their Mission President, the local Bishop, and the Ward Council will make proper decisions about how to proceed with difficult individual cases.
Thanks for the response. I've wondered a lot about mental illness and accountability as it relates to the gospel. And it's only recently that I've learned that not all those "voices" are coming from above. ;>)
Jack
Jack:
It may be worth noting that NOT all individuals who "hear" voices have schizophrenia, but are quite normal. Concerning the latter, I recommend the following book: "Muses, Madmen, & Prophets" by Daniel B. Smith. It is a fascinating read.
How do you think the church should address diagnoses such as anti-social personality disorder? Such disorders have no known treatment of any kind and neither are their causes understood. I think such disorders create the hairiest issues because they are guaranteed to produce "sinful" conduct.
Anonymous:
Personality disorders are not as clear cut as psychotic disorders. Missionaries are NOT likely to be aware of the diagnostic history of investigators with personality disorders. Thus, I am unsure how often this issue even gets raised in the Church.
In such cases we especially need to rely upon the inspiration of the priesthood leaders involved, especially the Mission President and the local Bishop.
Just as children under age 8 cannot competently decide to get baptized, there are many adult psychiatric patients who are just as incompetent. Priesthood leaders are faced with a judgement. My experience suggests that priesthood leaders make this judgment quite well.
However, I am very confident that the atonement of Christ covers any mistakes.
God loves us all, regardless of any mental difficulties we are having. This is the basic message of my blog essay.
I'd like to add a couple of comments from the perspective of a Father of a Schizophrenic son. He is on medication, but as many know, the damage done to the brain can be arrested but not restored, and breaks prevented through medication. I have given many people blessings over the years, and on one occasion definitely felt the presence of a demonic spirit when giving a blessing as a missionary. I gave the appropriate blessing and command and there was a response. So I definitely believe in demonic spirits. But I have also given my son numerous blessing and have not felt that. Instead, I was made aware that my son was suffering from a medical condition that was rendering him debilitated and had halted his progression. I also take comfort in the fact that he will be whole in the resurrection.
It is still challenging though, dealing with a 24 year old who has Schizophrenia....
Anthony:
Thanks for commenting. No one knows what a parent goes through except parents. Thus, your addition here is very helpful.
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