Articles & Thesis

DISSOCIATIVE AND PSYCHOTIC EXPERIENCES IN BRAZILIAN SPIRITIST MEDIUMS

Alexander Moreira de Almeida, MD, PhD 1, 2, 3

Bruce Greyson, PhD 4

Francisco Lotufo Neto, MD, PhD 1

1 NEPER - Center for the Study of Religious and Spiritual Problems, Department of Psychiatry, University of São Paulo, Brazil; 2Hospital João Evangelista, Brazil; 3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; 4Division of Perceptual Studies, Department of Psychiatry, University of Virginia Health System, USA Increasing attention is being given to the study of the high prevalence of psychotic and dissociative experiences in the general population and how these differ from symptoms experienced by people with mental disorders (MD) [1,2]. Many spiritual experiences involve dissociative and psychotic-like phenomena, which often create difficulties in the differentiating between a non-pathological spiritual experience and a MD [3-5]. These difficulties have generated many conflicts between spiritualists and physicians in the 19th and 20th centuries in Europe and Americas [6]. Currently, it is recognized that dissociative or hallucinatory experiences should not be considered pathological if they occur in a cultural context (usually religious rituals) [5]. Nevertheless, such criteria were not validated methodologically by rigorous studies, neither are the nature and impact of these experiences on the health of those who have them well known. Some of the most interesting spiritual experiences are those considered mediumistic, in which an individual, called a medium, is purported to be in communication with the personality of someone deceased or a non material entity.
Experiences taken as mediumistic have enormous influence over the people who have them, and are found in the Greek, Jewish and Christian roots of western society and even nowadays in religions such as Spiritism, Afro-Brazilians, Pentecostalism and Charismatic movement. In a broad study involving 488 societies throughout the world, institutionalized forms of trance possession states were identified in 251 (52%) of these societies [7].
Mediums are an especially useful population for the study of dissociative and psychotic experiences in a non-clinical population. We found no work with a sufficiently large sample or standardized tools of evaluation that investigated the psychopathological profile of mediums along with the characteristics which would help to differentiate non-pathological mediumistic experiences from those that are manifestations of MD.
Spiritism is a French offshoot of the spiritualistic movement that developed in the 19th century. It is, in Brazil, the fourth largest religion and its practices are deeply connected to mediumistic activity, that are not reimbursed, being understood as charitable voluntary work [8].
This study examines the socio-demographic profile, social adjustment and mental health in Spiritst mediums, as well as the clinical and socio-demographic characteristics that help distinguish the dissociative and psychotic experiences of a pathological character from those of a non-pathological character.
115 mediums were randomly selected from different Kardecist Spiritist centers in São Paulo, Brazil. In the early phase of the study, all participants signed a consent form, completed socio-demographic and mediumistic activity questionnaires, SRQ (Self-Report Psychiatric Screening Questionnaire) [9] and SAS (Social Adjustment Scale) [10]. Those mediums identified by the SRQ as probably having MD (n = 12) and a control group (12 subjects randomically selected among the remaining 103 mediums) were interviewed using the DDIS (Dissociative Disorders Interview Schedule) [11] and SCAN (Schedules for Clinical Assessment in Neuropsychiatry) [12].
The types of mediumship were coded according to the Spiritist classification: embodiment/incorporation (the medium says that the spirit controls his/her whole body), psychophony (a feeling that the medium's speech has an external origin, considered to be a disembodied spirit), hearing (hear the spirits), seeing (seeing the spirits) and psychography (the spirit writes through the medium’s hand) [13].
The t-test for independent samples, Chi-squared for categorical variables and the Pearson test for correlation coefficients were used.
The main results are presented in table 1. The sample had a high educational level, low unemployment rate and was predominantly female; a profile similar to other samples of
mediums [14,15]. Average SAS score was in the range of general population and better than psychiatric patients [10]. SRQ results suggest a low prevalence of common mental disorders in the sample, lower than other Brazilian studies using SRQ in non-clinical populations [16,17]. Unlike patients with dissociative and psychotic disorders patients[2,18], these mediums did not show high prevalence of childhood abuse.
The activity of incorporation was linked to better scores of social adjustment and fewer psychiatric symptoms. Hearing and psychography were also associated with better social adjustment. Surveys performed over the last decade have shown that dissociative,
hallucinatory and purported extrasensory experiences are common in the general population and often not associated with MD [2,3,4,15].
The high level of mediumistic experiences was reflected in the high frequency of Schneiderian First Rank Symptoms for Schizophrenia. However, these classic symptoms, in the present sample, had no statistical correlation with other markers of MD: social adjustment, SRQ scores, and physical or sexual abuse.
Even considering only the experiences occurring outside spiritist centers, 12 of the 23 mediums interviewed with the SCAN were diagnosed with schizophrenia by ICD 10 criteria.
Diagnosis based only on fulfilling objective diagnostic criteria has a series of limitations, especially when dealing with a non-clinical population [19], mainly regarding spiritual experiences [3]. Presence of co-morbidities and additional impairment have been proposed as additional criteria [19]. Based on that, we tested if the mediums who were diagnosed with schizophrenia differed from those that did not receive this diagnosis with regard to other indicators of MD (SRQ and SAS scores), they did not. These considerations make the diagnosis of schizophrenia unlikely in this sample.
In summary, mediums included in this study showed high socio-educational level, low prevalence of MD and a sound level of social adjustment. The mediumistic process was
characterized by dissociative and psychotic experiences that were not related to MD. These results may not be generalizable to mediums as a whole. A bias may have occurred in selecting healthier mediums, because in order to participate as medium in Spiritist centers, candidates are required to attend a two-year course. Other possible explanations to our findings include the fact that high educational level and religious involvement have been associated with better mental health [17,20]. Finally, it might be postulated that the mediumistic experiences have functions such as the relief of emotional problems and ascribing meaning to existence [21]. This hypothesis is reinforced by the correlation found between the frequency of mediumistic activities and better scores in SRQ and SAS. Our findings do not corroborate the view that the mediumistic experiences are less severe symptoms in a continuum with dissociative or psychotic disorders. If this was the case, a directly proportional correlation between the intensity of the mediumistic experiences and psychiatric symptoms or social maladjustment would have be found.
Future prospective and transcultural studies will be fundamental for the advance in the understanding of spiritual, dissociative and hallucinatory experiences in non-clinical populations, as well as the differential diagnosis of these and MD.

Acknowledgments
Alexander Moreira-Almeida was supported by grant (no.01/02298-0) from the FAPESP (The State of São Paulo Research Foundation), and from HOJE-Hospital Joao Evangelista. We thank Drs. Alexandre Zanini and Clarice Gorenstein for valuable help with statistical analyses, and Drs. Harold G. Koenig, Mario Peres, and Roberto J. Carvalho Filho, for comments on an earlier draft of the paper.
 

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Alexander Moreira-Almeida, MD, PhD
2748 Campus Walk Ave. Apt.18b
27705 – Durham – NC - USA

In press at the Journal: Psychotherapy and Psychosomatics