Originally published October 31, 2014
One day your teenage son becomes convinced that someone is in his head. This person provides a running commentary on your son’s life and every move he makes. Your son can hear this voice as clearly as yours when you stand before him. Your son socially withdraws from you, his friends, and everyone else, and this voice becomes his only companion. When your son does speak to you, it seems disjointed and confused. Then one day reveals that the voice in his head belongs to a demon, and this demon has taken control.
Although this may sound like the first 30 min of the latest exorcism movie, psychiatrists would recognize these behaviors as symptoms of schizophrenia, a neurodevelopmental disease that affects approximately 1% of the world’s population. Hallucinations (e.g. hearing voices) and delusions (e.g. believing someone possesses control over a person’s actions) are perhaps most commonly associated with schizophrenia, but the symptoms of schizophrenia are diverse and complex. Other symptoms may be cognitive (e.g. disorganized thinking and speech) or negative (e.g. social withdrawal and depression). No two patients have exactly the same symptom profiles. Most patients first develop symptoms in their late teens or early 20s and battle this disease for their entire lives.
The Dark History of Schizophrenia and Mental Illness
According to a 2008 survey, 85% of people understand that schizophrenia is an illness with a physical basis, yet throughout history schizophrenia and other forms of mental illness were thought to be the result of demonic possession or witchcraft. During the Middle Ages and Renaissance, the Catholic Church promoted the view that people who suffered from mental illness should be treated through religious means: confession in the case of witchcraft or exorcism to remove the demon spirit. Perhaps consequently, those who suffered from mental illness were treated with fear and disgust.
The first asylums opened in the 14th century and used brutal means to control its mental patients. Patients were often chained to the walls or fastened to their beds. In extreme cases flaming pitch was applied to the patient’s head. Mental patients only began to experience more humane treatment in the 18th and 19th centuries. However, even these “humane” treatments included bloodletting, a prolonged withdrawal of blood that also sedated unruly patients by weakening them. Throughout history the horrors suffered by mental patients have been far more worthy of Hollywood’s horror film genre than the behaviors of the patients themselves.
Although schizophrenia patients receive more humane treatment today, the belief that their condition may be the result of demonic possession rather than a brain disorder still resurfaces. Any Google search for “demons and schizophrenia” will yield a variety of spiritual and occult websites claiming to be able to differentiate demonic possession from schizophrenia. In June of this year, the Journal of Religion and Health published an article by the Turkish researcher M Kemal Irmak. According to the author, demons reside in a parallel world, unseen by most humans, but they may also possess and control humans. He also claims that many modern cases of demonic possession have been misdiagnosed as schizophrenia and urges medical doctors to enlist the services of faith healers in such cases.
A Scientific Interpretation: Debunking the Demon Myth
Science is equipped to deal with exploration of physical phenomena within our own world––not that of demons. However, decades of research have shown that the symptoms of schizophrenia are due to physical changes within the brain, and they may be treated using medical rather than religious means.
The first antipsychotic medications were introduced during the 1950s. Early and modern antipsychotics alleviate positive symptoms as well as some of the cognitive symptoms of schizophrenia by blocking the activity of dopamine, a signaling molecule within the brain. No approved antipsychotics treat the negative symptoms, which are often debilitating. Fortunately, many schizophrenia patients are still able to lead productive, independent lives under a lifelong treatment regime.
The last few decades have also greatly expanded our understanding of the physical basis of this disease. Schizophrenia is highly heritable: if one identical twin is diagnosed with schizophrenia then the other twin has about a 50% chance of also developing the disease. The genetics of schizophrenia are highly complex, and thousands of different genes have been linked to schizophrenia, many of which have also been linked to autism, Tourette’s syndrome, or other cognitive disorders. Environmental factors, including early life stress and drug abuse, also appear to interact with genetic factors to further influence disease development.
Perpetuating the Stigma of Schizophrenia
Despite the advances made in our understanding and treatment of schizophrenia, the average patient experiences a nine year delay between their first symptoms and first diagnosis and treatment. Part of the problem is misdiagnosis: other mental diseases, including major depression, can have similar symptoms. Furthermore, many physicians are reluctant to diagnose a patient with schizophrenia due to the stigma that many patients experience following diagnosis.
Schizophrenia is one of the most highly stigmatized diseases in our society. Many patients are reluctant to tell others about their diagnosis because many people are afraid to work with, date, or admit that they are related to someone with schizophrenia. This stigma not only delays diagnosis but also means that at any given time more schizophrenia patients are homeless or imprisoned than in a mental hospital. Stigma also affects the allocation of research funds: schizophrenia receives less funding per person affected than other mental disorders, e.g. Alzheimer’s disease or depression, yet schizophrenia is one of the most costly diseases to society.
If most people recognize that schizophrenia is a physical illness, then why does this stigma still exist? After millennia of association with supernatural and often evil forces, our society has been slow to accept the mentally ill without fear or reservation. The news media reinforces this stigma by reporting on crimes committed by those suffering from untreated mental illness, though patients are far more likely to harm themselves than others. As you view The Exorcist and similar horror flicks this Halloween, ask yourself whether these films also perpetuate the stigma. The myth of demonic possession and the history of schizophrenia have been closely entwined for centuries, and science must continue its work to disentangle them within our society.