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Exorcism-seekers: clinical and personality correlates Buch, Wes 1994

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EXORCISM-SEEKERS:CLINICAL AND PERSONALITY CORRELATESbyM. WESLEY BUCHB.A., The University of British Columbia, 1976M.A., The University of British Columbia, 1988A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFDOCTOR OF PHILOSOPHYinTHE FACULTY OF GRADUATE STUDIESInterdisciplinary StudiesWe accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAMay 1994© M. WESLEY BUCHIn presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives, It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)__________________________Department ofThe University of British ColumbiaVancouver, CanadaDate 3c2DE-6 (2188)AbstractThis study was a case control field investigation of a special population.The psychodiagnostic and personality correlates of 40 ChristianCharismatic exorcism-seekers were compared to the correlates of 40matched c2ntrols and 48 randomly selected controls. The study wasguided by a central research question: how do exorcism-seekers differfrom similar individuals who do not seek exorcism? Two theoretiäalapproaches to demonic possession and exorcism anticipated differentanswers. A mental illness approach anticipated the report of certainforms of clinical distress among exorcism-seekers. A social roleapproach anticipated the report of certain personality traits that wouldfacilitate the effective enactment of the demoniac role. Results supportedthe mental illness approach to demonic possession inasmuch asnumerous between-group diagnostic differences achieved statisticalsignificance, especially mood disturbance. The exorcism-seeker’s groupproduced a modal dependent-avoidant personality disorder profile,although schizoid features best distinguished between exorcism-seekersand control subjects. However, half of the sample did not reportsignificant psychological distress. A cognitive-behavioral model ofdemonic possession of relevance to both distressed and non-distressedexorcism-seekers was therefore proposed. Treatment implicationsincluded a discussion of special treatment problems and collaborationbetween members of the clergy and the health care professions.11Table of ContentsPageAbstract iiList of Tables viiList of Figures xiAcknowledgments xiiCHAPTER 1 INTRODUCTION 1The Central Research Question 2The Need for the Study 3Definition of Key Terms 3Summary of Method 4An Interdisciplinary Research Context 4Appropriateness of Research Topic for Scientific Study 5Organization of Chapters 6CHAPTER 2 LITERATURE REVIEW 8The Charismatic Movement, Exorcism and Demonic Possession 8Psychological Factors Regarding Charismatic Christians 26Psychological Approaches to Demonic Possession and Exorcism 37111Discussion of the Present State of Knowledge 86Objectives 88Hypotheses 89CHAPTER 3 METHODOLOGY 94Research Design 94Subjects 94Instrumentation 97Procedures 122Validity Issues 123Statistical Plan 125CHAPTER 4 RESULTS 127Sample 128Multivariate Analysis of Questionnaire Variables 142Univariate F-Test Results of Basic Personality Descriptors 151Univariate F-Test Results of Psychosocial Vulnerability Factors 152Univariate F-Test Results of Psychopathology Indicators 165Univariate F-Test Results of Social Role Variables 188Univariate F-Test Results of Religious Factors 189Statistical Results of Exorcism Readiness Factors 194Discriminant Analysis 196ivCHAPTER 5 DISCUSSION .209Sample Information 209Questionnaire Information 211Direction of Causality: An Interpretive Conundrum 229A Convergent Exorcism-Seeker Profile 230CHAPTER 6 IMPLICATIONS 232Implications for Theory Building 232Treatment Implications Regarding Exorcism-Seeker Distress 236Treatment Implications Regarding Religious Beliefs 242Treatment Implications for Pastoral Care 246Limitations of Study 252Future Directions 253Epilogue 257Bibliography 259Appendix A A Case Report of Co-existing Demonic Possession andPsychopathology 289Appendix B Proposed Diagnostic Criteria for DSM-III-RPossession/Trance Disorder 291Appendix C The Diagnostic Criteria for Transient DissociativeDisturbance 292Appendix D Diagnostic Criteria for Possession Disorder 293VTAJiBUUoflsnOdfl-MoJjo%!{Hxjpudd86aireuUOnSnO3UB..IATjOQqL0xjpuddy96STJ3JDq3uossssouomcjxipuddyt’6Jp.IOsJQSt3ATSSSSOdJOJBUT13DflSOUTcJxjpuddyList of TablesTable PageTable 1. Signs of Demonic Behavioral Displays 20Table 2. Item #24 and #490 Endorsement of MMPI & MMPI-2 24Table 3. Review of Demonic Possession Diagnostic Studies 58Table 4. Categories of Possession Syndrome (Yap, 1960) 64Table 5. List of Primary Hypotheses 90Table 6. List of Dependent Measures 98Table 7. Table of Theoretical Constructs Underlying MCMI-IIPersonality Disorder Scales 108Table 8. Table of MCMI-II Scales 109Table 9. Table of Response Set Group Means and Significance ofIndependent t Tests 124Table 10. Contingency Table of Demographic Variables with ChiSquare Significance 130Table 11. Table of Exorcism-Seeker Occupations According to theHollingshead Occupational Scale 135viiTable 12. Table of Medical Information, Substance Abuse andChildhood Abuse 140Table 13. Table of Past or Present Psychological Diagnosis 141Table 14. Maximum and Median Correlations Between Demographicand Questionnaire Variables 143Table 15. Table of Control Group and Exorcism-Seeker Skewness(Skew), Kurtosis (Kurt), Kolmogorov-Smirnov Goodness of Fit Values(K-S z) and Bartlett-Box Significance 145Table 16. Table of Questionnaire Group Means and Results ofMANOVA 153Table 17. Table of Openness to Experience (NEO-PI) Group Meansand Significance of Independent t Tests 157Table 18. Table of Life-Event Stress and Social Support GroupMeans and Significance of Independent t Tests 160Table 19. Intercorrelational Matrix of Dysphoria, Neuroticism, LifeEvent Stress, Self-Efficacy, Social Isolation and Social SupportVariables 163Table 20. ANOVA Table for Psychosocial Vulnerability MultipleRegression 164viiiTable 21. Table of Multiple Affect Adjective Check List-Revised(MAACL-R) Subscale Group Means and Significance of IndependenttTests 166Table 22. Table of Critical Item Scales Group Means andSignificance of Independent t Tests 170Table 23. Table of Leyton Obsessional Inventory (Modified) GroupMeans and Significance of Independent t Tests 171Table 24. Comparison of QED Exorcism-Seeker and Other ClinicalGroup Univariate Statistics 173Table 25. Factor Loadings on MCMI-II Personality Scales 175Table 26. Table of MCMI-II Personality Factor Means andSignificance of Univariate F Tests 177Table 27. Table of Frequency and Proportion of Highest MCMI-IIScale Elevations among Exorcism-Seekers 180Table 28. Table of Basic Personality Scale (Scales 1-8B) High-PointConfigural Combinations among Exorcism-Seekers 184Table 29. Number and Proportion of Exorcism-Seeker Scores Withinand Above the Average Range of Control Group Scores 187Table 30. Intercorrelational Matrix of Diabolical Experiences,Neuroticism, Dysphoria and Somatoform Variables 190ixTable 31. ANOVA Table for Multiple Regression of DiabolicalExperiences 192Table 32. Intercorrelational Matrix of Religious Orientation Scale(ROS) and Multiple Affect Adjective Check List-Revised (MAACL-R)Dysphoria Scales 193Table 33. Table of Attitudes Toward Exorcism and ExorcismCredibility Means and Significance of Independent t Tests 195Table 34. Wilks’ Lambda and Univariate F Results of QuestionnaireVariables for Exorcism-seekers and Matched Control Subjects.... 199Table 35. Summary of Steps in Discriminant Analysis 203Table 36. Canonical Discriminant Functions 205Table 37. Discriminant Function Coefficients 207Table 38. Classification Summary 208Table 39. Support for Primary Hypotheses 212xList of FiguresFigure PageFigure 1. Detail from “Procession of the Possessed of Molenbeek”(Veith, 1965) xiiiFigure 2. NEO-Five Factor Inventory T-Score Mean Profile of Maleand Female Exorcism-Seeker and Control Groups 158Figure 3. Multidimensional Scale of Perceived Social Support MeanProfile 161Figure 4. Multiple Affect Adjective Check List-Revised Mean T-ScoreProfile of Male and Female Exorcism-Seeker and Control Groups 168Figure 5. MCMI-II Median Base Rate Profile of Exorcism-Seekers,Patients Diagnosed With Dependent Personality Disorder, and theMCMI-II Normative Psychiatric Sample 179xiAcknowledgmentsI wish to thank my interdisciplinary committee for their guidanceand helpful suggestions during the preparation of this manuscript: Dr.John Friesen (Supervisor), Dr. Stanley Coren (Methodologist), Dr. CharlesAnderson, Dr. Ehor Boyanowsky and Dr. Jonathan Fleming. I also wishto acknowledge the helpfulness of Dr. Ernest Runions who served on thecommittee before his death.I am indebted to my parents, Rev. Mark and Hilda Buch, my sister,Ingrid Buch-Wagler, my Irish family, Robert, Martha and Lynn Gibson,my friends, Anne, Barbie, Cam, Jamie, Mike, Patty, Paul, and Ruth, andmy work friends in the Back Evaluation and Education Program andPsychology Department of the Worker’s Compensation Board for all theirencouragement and support. In particular, Mr. Cameron Graham wasindispensable as the creator of the computer scoring routines, and bothhe and Ms. Lynn Gibson proof-read several drafts of my dissertation andoffered helpful suggestions.I am grateful to the subjects, members of the clergy, and variousother church personnel for their participation in the study. Theexorcism-seekers, in particular, often expressed the hope that theirparticipation would result in better understanding and care of futureexorcism-seekers.Finally, I am deeply grateful to my wife and much lovedcompanion, Paula, who has been both encouraging and patient duringthe course of my studies. And to our little Kirsten, Daddy loves you.xiiFigure 1. Detail from “Procession of the Possessed of Molenbeek” (Veith,1965).xliiCHAPTER 1INTRODUCTION“I can’t believe that,” said Alice.“Can’t you?” the Queen said in apityirig tone.“Try again, draw a long breath, and shut your eyes.”(Through the Lookina Glass, Lewis Carroll)The healing of mental illness in Western culture is historicallyembedded in the Christian cure of souls tradition (Favazza, 1982). Thepast 150 years have witnessed the emergence of alternate, secularapproaches to the understanding and treatment of mental illness. Theseapproaches represent attempts to align the conception and treatment ofabnormal behavior with scientific theory and methodology. Christianand secular approaches to mental illness have co-existed uneasily(Campbell, 1975). At times, unease has turned to open antagonismregarding a group of symptoms historically associated in the Christiantradition with demonic possession and its religious cure, exorcism. In1975, for example, the Leeds Exorcism Trial prompted critical and evenhostile comments from the health care community regarding the practiceof exorcism (Pearson, 1977). The trial involved the prosecution of a 31-year-old man for the brutal murder of his wife following his unsuccessfulexorcism.12The Central Research QuestionThe present study is guided by a central research question: howdo exorcism-seekers differ from similar individuals who do not seekexorcism? Perhaps there are clinical differences that warrantcollaboration between members of the clergy and health care professions.For example, there is now a considerable literature suggesting thatdemonic possession may at times resemble mental illness and, as such,may require treatment by mental health professionals. In her case studyof the 1976 death of Anneliese Michel, a Bavarian college student whosestruggle with demonic possession culminated in the failure of a formalRoman Catholic rite of exorcism, Goodman (1981) asks: “Are we dealingwith the genuine religious experience of a clinically healthy person or isthis possibly some physical illness reflected in deranged behavior?” (p.209). Goodman’s question, while acknowledging a clinical interpretationof demonic possession, also entertains the possibility that demonicpossession belongs to the religious experience of normal individuals. Inthat case, intervention by mental health professionals would beunnecessary. Perhaps, then, personality traits rather than clinicalcharacteristics will better distinguish those who seek exorcism fromthose who do not. However, it is possible that psychological factors,whether normal or abnormal, are of little consequence to exorcismseeking. Perhaps another academic discipline would provide a moredefinitive response to the central research question of this study.3The Need for the StudyWhitwell and Barker (1980) suggest several reasons why patientswho believe that they are demon possessed are worth studying: (1)people continue to make this complaint; (2) their numbers, if anything,may be rising; (3) they show a common tendency to seek non-medicalhelp, such as exorcism, and (4) there are special difficulties in treatingthese patients. A fifth reason of interest to the mental health communityis that people who believe themselves to be demon possessed may besuffering from an undetected psychological or medical disorder and aretherefore potential treatment candidates.Definition of Key TermsThe study is concerned with Christian individuals of theCharismatic Movement who believe themselves to be demon possessedand in need of exorcism. The Charismatic Movement, aninterdenominational outgrowth of Pentecostalism, is a movement ofreform with regard to the role of the Holy Spirit and especially thesupernatural gifts or “charismata” of the Holy Spirit in the modemChristian church. Within the Charismatic Movement, demonicpossession is understood as an unwanted condition of variable durationcharacterized by the belief that one is under the influence of demonicspirits. Exorcism is the traditional religious cure for demonic possession.The nature of the Charismatic Movement and the definition of demonicpossession and exorcism are discussed in greater detail in Chapter 2.4Summary of MethodThe study is a controlled field investigation with three comparisongroups: Christian exorcism-seekers, matched control subjects, and arandomly-selected group of Christians from three large Charismaticchurches. The experimental variable is a behavioral one, exorcism-seeking, and the dependent variables are the self-report questionnaireresponses of the sample. A priori hypotheses regarding exorcism-seekerdifferences are derived from a comprehensive literature review and testedusing multivariate statistical procedures.An Interdisciplinary Research ContextThe study of possession and exorcism phenomena requires aresearch endeavor that is sensitive to an extensive, multidisciplinaryliterature, including the literature of Religious Sjudies, Anthropology,Sociology, Psychiatry, Psychology, and a variety of such hybriddisciplines as psychological Anthropology and Cultural Psychiatry. Inher review of ceremonial spirit possession, for example, Walker (1972)suggests that “possession, to be really understood, must be studied fromvarious points of view because no simple explanation appears adequateto explain it” (p. 1). The literature reviews of Pattison and Wintrob(1981), Bourguignon (1976), Ward (1980), Walker (1972), Goodman(1988), and Lewis (1989) point to the multidisciplinary nature ofpossession and exorcism research and the active scholarly andprofessional interest in the research topic of this proposal. In addition,there is related research regarding shamanism (e.g., Heinze, 1991; Noll,1989), witchcraft (e.g., Lewis, 1989), occultism (e.g., Singer & Benassi,51981), lycanthropy (e.g., Dening & West, 1989; Koehler, Ebel, &Vartzopoulos, 1990), paranormal phenomena (e.g., Perry, 1990; Teguis &Flynn, 1983), ritualistic child abuse (e.g., Cozolino, 1990), and positiveChristian spirit possession accompanied by glossolalia (e.g., Goodman,1972; Kildahl, 1972).Possession and exorcism phenomena require not onlymultidisciplinary research but also multiple levels of analysis.Crapanzano and Garrison (1977) criticize many possession studies asbeing restricted to the social and cultural level of analysis. Theseauthors therefore present case studies of spirit possession as ademonstration that such phenomena are intelligible at the individuallevel of analysis as well. The present study explores demonic possessionand exorcism from a psychological perspective and an aggregate or grouplevel of analysis.Appropriateness of Research Topic for Scientific StudyAre possession and exorcism phenomena appropriate candidatesfor scientific study? As paranormal phenomena, demonic possessionand exorcism enter a venerable academic debate in the social sciences(e.g., Alcock, 1990). This debate includes the philosophical issue ofwhether the legitimate scientific domain of psychology ought to be limitedto observable behavior or extended to hypothesized internal variables: isthere a “ghost in the machine,” a phrase taken literally by the subjects ofthis study? However, the scientific study of religious and paranormalphenomena does not require their g priori acceptance or denial. It issufficient to remain agnostic regarding the existence of demons, but6curious about the outcomes ascribed to demonic possession. Thisapproach is endorsed by the present author and summarized in the well-known dictum of W.I. Thomas: “If men define situations as real, they arereal in their consequences” (Thomas & Thomas, 1928, p. 572).Organization of ChaptersChapter 2 provides an introduction to the religious context of thestudy, the Christian Charismatic Movement, and a discussion ofpsychological factors among Charismatic Christians. However, the majorportion of the chapter is devoted to a literature review ofmultidisciplinary research regarding psychological factors in possessionand exorcism phenomena, especially within the Christian tradition. Theliterature review leads to several hypotheses concerning individualdifferences between those who seek exorcism and those who do not. Thechapter concludes with a summary of the present state of knowledgeregarding demonic possession and exorcism, a discussion of theobjectives of the study and, finally, a presentation of hypotheses andtheir rationales.Chapter 3 describes the design, the sample, the measures andtheir psychometric properties, the procedures, validity issues and thestatistical plan of the study.Chapter 4 reports the results of statistical hypothesis testing. Thechapter begins with results of relevance to control group equivalence andbetween-group sample differences. The results of an initial multivariateanalysis of variance are then discussed with regard to the existence ofoverall between-group differences when all questionnaire variables are7examined simultaneously. The univariate p-test results generated by themultivariate statistical procedure are organized into hypothesis-specificclusters for discussion purposes. Several other multivariate procedures,such as multiple regression analysis, factor analysis and discriminantanalysis, are used in order to address specific questions. The chapterconcludes with a discriminant analysis that identifies the questionnairevariables that best differentiate exorcism-seekers from control subjects.Chapter 5 provides a discussion of the results with the intent ofintegrating the substantial findings of the study into a coherentexorcism-seeker profile. Special consideration is also given to such focalinterpretative issues as state versus trait distress, confounding variablesand direction of causality.Chapter 6 presents implications for theory building and treatment,examines the limitations of the study and provides directions for futureresearch.CHAPTER 2LITERATURE REVIEWIt would be very simple for me and acceptable to others f Iwere to say that all these people were dupes, frauds, lunaticsand psychopaths, and to suggest that this constituted somesort of an explanation. Who forbids it? I am sitting in mystudy and have pen and paper and can write what I please.So I shall conclude by writing that the phenomena describedby Osterreich are very much in need of an explanation (AnitaKohsen Gregory, Forward, Possession Demoniacal and OtherAmong Primitive Races, in Antiquitzi, the Middle Ages, andModem Times).The Charismatic Movement, Exorcism and Demonic PossessionThe Charismatic movement represents the export of Pentecostalideology to mainstream Christianity (Harrell, 1975). In the 1950’s,Pentecostal beliefs and practices began to appear in mainstreamProtestant denominations (e.g., Ball, 1981), giving rise to the NeoPentecostal movement (Quebedeaux, 1976). In 1967 Pentecostalismemerged within the Roman Catholic church, marking the beginning ofthe Catholic Charismatic Renewal (Bord & Faulkner, 1983; Fichter,1975). Within a broader historical perspective, the Charismaticmovement may be identified as a resurgence of “enthusiasm” (Knox,1950). Scholarly attention within the academic community has beenespecially drawn to socio-cultural aspects of the Charismatic movement(e.g., Bradfield, 1979; Csordas, 1983, 1988; Lane, 1978; McGuire, 1982).89For example, the Charismatic movement has appealed not only to lowerincome groups, but to the middle-class as well, thereby defying theeconomic deprivation arguments typically applied to sects and cults ofthis type (McGuire, 1975).Within contemporary Christianity, demonic possession andexorcism phenomena are perhaps the most prominent in the Charismaticmovement (Hall, LeCann, & Gardner, 1982; Kemp & Williams, 1987), andfor good reason. A central ideological motif of the Charismatic movementis the recovery of the supernatural, especially the gifts or “charisms” ofthe Holy Spirit, such as glossolalia, prophecy and discernment of evilspirits. There is an appeal to the supernatural works of Jesus, and tothe promise of Jesus to his followers:I tell you the truth, anyone who has faith in me will do whatI have been doing. He will do even greater things than me...(John 14: 12, Bible, New International Version)ExorcismExorcism was an important, if not central, activity in the ministryof Jesus (Vermes, 1973). One summary description of the activity ofJesus from the Christian scriptures is as follows:So he travelled throughout Galilee, preaching in theirsynagogues and driving out demons (Mark 1:39, Bible, NewInternational Version)Within the Charismatic movement, exorcism or ‘Deliverance Prayer’ (Linn& Linn, 1981) is viewed as one component of the contemporary,supernatural healing ministry of Jesus through Charismatic believers. Asuccessful exorcism represents a dramatic re-enactment of the victory of10Jesus Christ over Satanic spirits. It is a parable of the continuedsubjection of the demonic world to the present rule of Christ through theChristian church. Charismatic Christians practice exorcism in a varietyof formats as prescribed by the prevailing belief system. Exorcism maybe liturgical or informal, an event or process phenomenon, spontaneousor planned.Christians from such liturgical church denominations as RomanCatholic, Greek Orthodox and Anglican practice liturgical exorcism.Liturgical exorcism is characterized by a preset sequence of specificprayers, Scripture verses and sacraments, and is administered only bydesignated church officials. Although informal exorcism does not followa prescribed ritual, there are core ingredients common to mostexorcisms, especially various kinds of prayer: prayers to invoke the HolySpirit; prayers of command for demons to manifest and/or identifythemselves; prayers of command for demons to depart; and prayers ofrepentance, forgiveness to others, praise, physical healing andintercession. Furthermore, there are the recitation of certain Scriptureverses or creeds, the singing of hymns or choruses, the administration ofthe Eucharist, the laying on of hands, teaching or counseling, and theuse of special aids (e.g., a crucifix, blessed water or oil).Event exorcism typically occurs on a single occasion, such as achurch service, whereas process exorcism occurs over a period of time inmultiple exorcism sessions. Process exorcism is a form of religioustherapy that may occur on a weekly basis. Often exorcism of this kind isembedded in a broader counseling context that may also include history-11taking, the healing of hurtful memories (“inner healing”), teaching andbehavioral prescriptions. The similarities with Western psychotherapyare obvious and unlikely to be accidental.Spontaneous exorcism occurs suddenly, often in the context of achurch worship service, a mid-week small group meeting or pastoralcounseling session. The recipient may begin to shake, shriek, or fall onthe floor in convulsions. Subsequently, with and sometimes without theaid of other church personnel, the recipient becomes quiet and peaceful.Spontaneous exorcism is therefore an instance of event exorcism,whereas planned or intentional exorcism can be either event or processexorcism.The practice of exorcism, though common among CharismaticChristians, is far from universal among all Christian groups. Manychurch groups have curtailed the practice of exorcism due to the reinterpretation of demonic phenomena as symptoms of mental illness inneed of psychiatric care or because of fears concerning the abuse ofexorcism. However, Charismatic theologians and church leaders wouldtend to attribute the paucity of possession and exorcism among manytraditional church groups to a worldview that discredits both theunderlying theology and the contemporary practice of exorcism. Forexample, in the stormy aftermath of the Leed’s Exorcism Trial, BishopHanson (cited in Trethowan, 1976) asks if,• . .ever since the earliest days of the Church the use ofexorcism has always depended on a belief in the Devil, and ifearly Christian exorcists were not attempting to cast outneuroses, but devils: how can we still continue to exorcisedevils if we no longer believe in them?12In Roman Catholic theology, deliverance prayer and exorcism aredistinguished: the former is reserved for the relief of individuals who areharassed by demons, whereas the latter is for those who are completelydominated by the demonic (Linn & Linn, 1981). Deliverance prayer, apopular synonym and possible euphemism for exorcism in Charismaticchurch groups, is therefore a kind of ‘mini-exorcism’ for less severe casesof demonic possession, and may be conducted by either a priest or alayperson.Demonic PossessionDefinitions of Spirit PossessionMany religions, both literary and non-literary, subscribe to someform of spirit possession. Spirit possession may be differentiated alongritual/non-ritual, good/evil, and voluntary/involuntary dimensions. Onemay be possessed by benevolent or malevolent spirits; consequently,possession may produce either socially desirable or undesirablebehavior. Definitions of possession vary in their level of abstraction: at aconcrete level, the individual is possessed by the “spirit” of a specificperson, animal or spiritual being, whereas, at a more abstract level, oneis possessed by thoughts, impulses, memories or images (Pattison &Wintrob, 1981). In the broadest sense, spirit possession may be definedas “a cultural evaluation of a person’s condition” (Lewis, 1989, p. 40).Lewis (1989) has proposed a polar classification of possessionphenomena as central or peripheral. Central possession is regarded as apositive experience, often accompanied by ritual, and a part of theinstitutional apparatus supporting a society’s moral order. On the other13hand, peripheral possession is usually regarded as a form of illness,occurring spontaneously, and requiring treatment of some kind. It is arefuge of those who are marginal, of low-status, and lacking in socialintegration. As such, peripheral possession may serve as “an obliqueaggressive strategy,” an expression of protest or distress for a sociallyoppressed group (e.g., women in a male-dominated society) to obtainlimited redress (e.g., practical aid, protection, or status enhancement) asa ‘secondary gain’ of spirit-induced illness (Lewis, 1989). Peripheralpossession has also been referred to as diabolical mysticism, involuntarypossession, sickness possession, negative possession trance,bewitchment, and cacodemonomania (Ward, 1989; Salmons & Clarke,1987). Csordas (1987) points to the increasing anthropological attentionto peripheral possession as a development in the medicalized discourseof spirit possession.Geographical differences in possession have been recognized. Forexample, Goodman (1988) distinguishes between African and Eurasiandemonic possession, the latter found in India, China and ChristianEurope. Similarities between the two types of possession include beinginvaded by an unwelcome, noxious spirit, recognized as such by outwardsigns (e.g., illness), at times accompanied by trance during which thespirits identify themselves, and healed by exorcism. However, there arealso differences. African possession is both simpler and more sinisterthan its Eurasian variant. In African possession, the invading entitiesare always ghosts of an undifferentiated nature, as opposed to theEurasian host of varied and distinct demonic beings, at times14hierarchically arranged and orchestrated by an arch demon (e.g., Satan).The onset of African possession is signaled by a single, acute, anddevastating illness, whereas in Eurasian possession, there is typically achronic phase of depression and frightening visions, punctuated withepisodic attacks of violent possession and accompanied by intractableraging and other symptoms.Many writers distinguish between types of demonic possession onthe basis of the presence and degree of trance and other dissociativefeatures. For example, Oesterreich (1966) speaks of lucid andsomnambulist demonic possession: in the former, the demoniac is fullyconscious and aware of his or her condition, whereas in the latter, thedemoniac performs a variety of complicated actions without consciousawareness of doing so and has amnesia for the performance. Lucidpossession tends to occur less often than somnambulistic possessionand is associated with insidious onset and poor prognosis. Oesterreich’scategories correspond to Bourguignon’s (1973) possession andpossession trance categories, and Lhermitte’s (1963) lucid andparoxysmal hysterical or mythomaniacal possession, respectively.Jaspers (1963) and Lewis (1989) also differentiate between states ofpossession presenting with and without an alteration of consciousness.Yap (1960) has distinguished among three kinds of possession accordingto degree of dissociation: first degree, involving complete dissociationwith amnesia; second degree or partial dissociation with partial amnesia;and, third degree with no dissociation or amnesia, associated withhistrionic presentation.15Finally, Pattison and Wintrob (1981) propose four types ofpossession phenomena that they differentiate from trance: possessiontrance, possession behavior (neurotic), possession behavior (psychotic),and possession explanation. Trance refers to an altered state ofconsciousness that is culturally prescribed, learned and practiced, andinterpreted by the culture as an acceptable normal behavior and not apossession state. Possession trance also refers to an altered state ofconsciousness, but, unlike trance, is interpreted by the culture as apossession state of symbolic significance to the witnessing community.it is regarded by the culture as normal only within the context of specialcommunal activity. Possession behavior (neurotic) does not involve analtered state of consciousness, and is regarded by the culture on acontinuum from unique to pathological behavior. It constitutes a set ofculturally symbolized behaviors that may serve as a socially sanctionedexpression of personal or interpersonal conflict. Possession behavior(psychotic) is characterized by “stereotyped behavior, usually of psychoticproportion, which the culture recognizes as clearly pathological” (p. 14)but not necessarily identical with behavioral syndromes associated withbipolar disorder or schizophrenia. In this regard, possession behavior(psychotic) resembles a culture-bound reactive syndrome. Possessionexplanation invokes possession as an explanation for a variety of natural,social and personal misfortunes. At a personal level, possession may beinvoked to explain psychosis or organic illness.To date, there is no broadly accepted taxonomy of possession(Enoch & Trethowan, 1979; Pattison & Wintrob, 1981; Ward, 1980). This16is largely because possession is a variable phenomenon, occurring on aglobal basis with culture-bound interpretations of its etiology, purpose,and consequences (Bourguignon, 1968, 1973). The present study isconcerned with demonic possession within the context of the ChristianCharismatic movement.Demonic possession among the Canadian Charismatic Christiansof this study corresponds to Goodman’s Eurasian possession, Lewis’peripheral possession, Oesterreich’s lucid or somnambulist possession,Bourguignon’s possession and negative possession trance, and Pattisonand Wintrob’s possession behavior (neurotic), possession behavior(psychotic) and possession explanation.Issues in the Christian Definition of Demonic PossessionWard and Beaubrun (1981) define demonic possession as “arelatively long-term condition in which the individual believes that he isunwillingly possessed by one or more intruding spirits and exhibitscontingent behavioral responses which he attributes to the spirits’influence” (p. 295). This definition highlights several important issues inthe definition of demonic possession: religious belief, behavioralexpression, voluntariness, and duration.Demonic possession as belief. Bourguignon (1976) emphasizes thecentrality of belief to spirit possession when she defines possession as“an idea, a concept, a belief, which serves to interpret behavior” (p. 7).She distinguishes possession belief from sensations and behaviorascribed to possession:17Thus, possession is a term which refers to belief of a group ofpeople under study, or, perhaps, to the belief held by a givenauthor. On the other hand, at least some of the outwardmanifestations which are ascribed to ‘possession’ in somesocieties may be ascribed to other causes elsewhere (p. 6).Pattison and Wintrob (1981) speak of the “culture of belief’ associatedwith possession and exorcism phenomena. Oesterreich (1966),Bourguignon (1976) and others maintain that belief in the demonic is anecessary condition for the occurrence of demonic possession. Forexample, Tippett (1976) concludes that “there can be no possessionwithout a cultural situation that makes it credible and possible andrenders the human spirit vulnerable to possession” (p. 168).The “demon” in demonic possession points to the profoundlyreligious nature of this phenomenon. Demonic possession is rooted inthe language, symbols and cosmology of religion and cannot beadequately understood apart from its religious context. The belief indemons and demonic possession is common to a variety of religionsbesides Christianity, including such major religions as Buddhism, Islam,and Judaism.Within Christianity, demonic possession refers to a belief in evilspirits which ‘possess’ people, inflicting suffering (‘torment’) and areduced sense of personal control (‘bondage’). Some have attempted todistinguish between types of possession along continua of severity andduration such as demonic attachment, oppression, infestation andpossession (Peck, 1983). There has also been a long-standingcontroversy regarding the possibility of demonic possession amongChristians (Dickason, 1987). Christians, it is argued, are ‘filled with the18Holy Spirit’, and may therefore be demon obsessed but never demonpossessed. Accordingly, the transliterated New Testament word fordemonic possession, “demonization,” has become increasingly popular inCharismatic circles, and has the advantage of circumventing theaforementioned controversy by leaving open the question of the extent ordegree of demonic possession. Dickason (1987) has defineddemonization as “demon-caused passivity’ or control by one or moredemons with various results in the life of the person, including thephysical and the psychological” (p. 40).Demonic possession behavioral displays. The host of self-reportsymptomatology ascribed to the demonic may be accompanied byobservable behavioral displays. These are generally displays of humandistress and therefore point to the abnormal and undesirable nature ofdemonic possession. Within Christianity, demonic possession displaysmay include a variety of characteristic behaviors (see Table 1), as listedby Cramer (1980) and Goodman (1988).Unfortunately, the search for a definitive core of demonicbehavioral signs appears futile, as is indicated by the sheer number andvariation of associated signs and symptoms that have been proposed(Cortes & Gatti, 1975; Enoch & Trethowan, 1979). For example, in 1608,Francesco Guazzo (cited in Trethowan, 1976) was able to list no less than47 indicators of demonic possession in his Compendium Maleficarum. Amodem Christian exorcist asks exorcism-seekers to complete a checklistof 145 indications of demonic possession (see Appendix F), includingdisco dancing! Cortes and Gatti (1975) helpfully remind their readers19that current understanding of the signs of demonic possession may notaccurately represent the biblical record; indeed, the same issue could beraised at a more general level regarding the equivalence of current andbiblical conceptions of demonic possession and exorcism. In addition,Virkler and Virkier (1977) suggest that the relatively brief descriptions ofdemonically-caused symptomatology found in the New Testament are notnecessarily intended to be normative examples of possession across timeand cultures.Voluntariness. Demonic possession behavioral displays arebelieved to be of an involuntary nature. The demoniac is “unwillingly”possessed by an evil spirit(s). Oesterreich (1966) distinguishes betweenvoluntary and spontaneous possession, the former being artificial andthe product of conscious desire.Duration. Regarding the duration of demonic possession, Wardand Beaubrun (1981) point to demonic possession as a “relatively long-term condition.” Among contemporary Christian Charismatics, however,the duration of demonic possession varies on a continuum from thetemporary or seasonal to the chronic.Definition of Christian demonic possession. For the purposes ofthis study, Christian demonic possession is defined as an unwantedcondition of variable duration characterized by the self-perception ofbeing under the influence of demonic spirits as indicated by (1) selfreport and, perhaps, (2) the occurrence of demonic possession behavioraldisplays.20Table 1. Signs of Demonic Behavioral DisplaysCramer’s List (1980) Goodman’s List (1988)Convulsions or SeizuresBlasphemies and scatologyUse of a “different” voiceDisplays of great strength or violenceMarked aversion to religious objectsVomiting of putrescent matterBizarre behavior (mfrnicldng animals)SimilaritiesTrembling, convulsionsCorprolaliaUnnatural, rasping, low demonic voiceSuperhuman strengthViolent aversion to everything sacredRepulsive stench; copious foaming salivaRigidity of muscles; catatonic-like state(table continues)21Cramer’s List (1980) Goodman’s List (1988)DifferencesDeclaration of demonic personage(s) Screaming fitsTemporary deafness or muteness Grinding of teethTemporary blindness Uncontrollable weepingClairvoyance RoamingAmnesia AgitationGlossolalia InsomniaFeverA near-total change in facial featuresAggression towards self & othersSevere abdominal painCompulsive ingestion of strange orrepulsive substances, or refusal of allfood, resulting in anorexia.22Epidemiology of Demonic PossessionPattison and Wintrob (1981) maintain that there are a wide varietyof religious subcultures in contemporary America that subscribe tosupernaturalistic beliefs and practices, leading them to conclude thatpossession and exorcism phenomena are more pervasive in pluralisticAmerican culture than supposed (see also Bourguignon, 1976; Goodman,1988; Lewis, 1989; Walker, 1972). For example, Gallup and Castelli(1989) estimate that 37% of the American population believe in “Devils”,a belief that varies with education and geography. The persistence ofsupernatural beliefs in America is likely to be true of Canada as well. Ina recent survey, for example, Bibby (1987) found that 30% of hisCanadian sample claimed to have encountered an evil presence.Bourguignon (1973) estimates that 25% of North American culturalgroups has possession trance.Although possession and exorcism belief may be widespread, theactual prevalence of demonic possession complaint is probably low in thegeneral population (Kemp & Williams, 1987; Pattison & Wintrob, 1981;Sevensky, 1984; Ward & Beaubrun, 1980a). In fact, the prevalence ratemay be as low as 2-4%, an estimate derived from the endorsement ofitem #24 (“Evil spirits possess me at times”) of the Minnesota MultiphasicPersonality Inventory (MMPI) in two normative samples: the normativesample of the original MMPI, and the recent national U.S. sample of thesecond edition, MMPI-2 (Hathaway & McKinley, 1989; see Table 2). Itemendorsements ranged from 2-6% of female respondents and 4-8% ofmale respondents, the lower percentages deriving from the more recent23sample. These indications of the prevalence of possession complaint inNorth America are roughly similar to those reported in epidemiologicalstudies of possession syndrome in India (Chandra shekar, 1989).Although the prevalence of possession complaint may be low in thegeneral population, this is likely not the case among specific sub-populations, such as Christian Charismatic groups. Furthermore, theprevalence rate is likely to vary with religious ideology and certaindemographic variables, such as gender, minority status and perhapssocio-economic status.Conservative Christian ideologies are characterized by a strongadherence to biblical authority (e.g., Protestant Charismatics) andchurch tradition (e.g., Roman Catholic Charismatics), and often by aliteral biblical hermeneutic. Consequently, conservative Christians,whether Charismatic or not, tend to believe in or at least entertain thepossibility of the existence of contemporary demonic possession and thepractice of exorcism (Page, 1989). Furthermore, the prevalence ofdemonic possession complaint is likely to be greater among Christiangroups which are committed to the recovery and demonstration ofsupernatural religious experiences (e.g., possession by the Holy Spiritand demonic possession), such as Pentecostal and Charismatic groups.This commitment is explicitly stated in documents of church ideology,such as doctrinal statements.Demonic possession and exorcism are traditionally associated withwomen, the previous table notwithstanding, or minorities as a protest ofthe oppressed and economically disadvantaged. This deprivation24Table 2. Item #24 and #490 Endorsement of MMPI & MMPI-2Gender MMPI MMPI-2 U. S. Normative MMPI-2Normative Sample PsychiatricSample SampleItem #24 n % Retest %a ilFemale 315 6 1462 2 97 191 20Male 225 8 1138 4 97 232 22Item #490Female 1462 10 90 191 34Male 1138 12 92 232 92aRetest % = the percentage of the MMPI-2 normative sample answeringin the same direction on retest (average retest interval of 8 ‘/2 days).25hypothesis of spirit possession is eloquently articulated by Lewis (1989),and remains a popular interpretation of possession phenomena amonganthropologists and sociologists. For example, Walker (1972) argues thatwomen are more likely to become possessed than men in male-dominated societies as a protest against their exclusion from positions ofauthority and reduced opportunity to gain esteem through personalachievement. In her examination of Trinidadian Pentecostal demonicpossession, Ward (1982) conceptualizes demonic possession as apsychological stress reaction to oppressive socio-cultural conditions andthe nature of the female role. The form of the reaction is shaped bycultural beliefs and superstitions. In his sample of 66 Hong Kong casesof “possession syndrome,” Yap (1960) found a greater preponderance ofdivorced women or widows who were illiterate or from a low socioeconomic background.Some minorities have prior allegiances to supernaturalistic beliefsystems embedded in their ethnic sub-culture, such as Latin AmericanPentecostalists. Alternatively, lower education may render certainminorities more open to supernaturalistic belief systems and lesschallenged by dissonant scientific reasoning, such as the snake-handlersof the South-Eastern U.S.A. (LaBarre, 1962).DiscussionThe foregoing attempted to locate Christian Charismatic demonicpossession and exorcism within the larger framework of amultidisciplinary possession literature. First, demonic possession theoryand phenomena are not unique to Christendom, but share certain26similarities with the possession of other religions and cultures. Forexample, Charismatic demonic possession assumes a worldviewenchanted by the supernatural. Demonic entities are believed to exist, tohave malevolent intentions, and to cause human suffering. The presenceand nature of such beliefs warrant careful consideration in an adequatestudy of demonic possession. Second, Charismatic demonic possessionis regarded as negative and undesirable. It is a “peripheral” possession,a condition recognized by the cultural group as deviant, abnormal and inneed of cure (Lewis, 1989). Accordingly, a link between demonicpossession and illness is anticipated. Third, Charismatic demonicpossession cannot be extricated from its social context. Both itsemergence and cure are typically part of a social drama thick withinterpretive possibilities. It is this social aspect of demonic possessionand exorcism that provides an opportunity for socio-cultural analyses.Finally, Charismatic demonic possession is a variable phenomenon, andtherefore likely to be an unstable or “wobbly” experimental criterionvariable. Accordingly, behavioral anchors are needed in definingdemonic possession. A behavioral correlate of demonic possession, suchas exorcism-seeking, is likely to be a more reliable experimental criterionvariable.Psychological Factors Regarding Charismatic ChristiansAs exorcism-seekers are likely to be affiliated with CharismaticChristian groups, an exploration of psychological factors amongCharismatic Christians will establish a psychosocial context for thepresent study. The following overview of psychological factors will be27limited to diagnostic and personality trait correlates of religion and, inparticular, Charismatic Christianity.Religion, Mental Health and PsychoDathologvThe relations between religion and mental health are not yet clearlyunderstood (Bergin, Masters, & Richards, 1987). They have beenarticulated in three ways: religion is positively associated with mentalhealth, religion is positively associated with psychopathology, and therelation between religion and mental health is ambiguous. The results ofempirical studies have been inconsistent, prompting some to doubt theexistence of any relationship between religion and mental health andothers to emphasize methodological complexities (Gartner & Larson,1991). In their recent literature review, Payne and Bergin (1991)conclude that religious affiliation is neither damaging to nor predictive ofmental health (e.g., Bergin, 1983). Likewise, in a literature review ofreligion and mental disorder, Wenegrat (1990) concludes as follows:Although the mentally ill often have religiouspreoccupations, numerous studies contradict the notion thatreligion is strongly pathogenic. It may not be pathogenic atall. Therefore, religious preoccupations of the insane aremost likely secondary: They reflect an enhancement ofreligious interest resulting from abnormal experiences,feelings, or thought patterns (p. 165).Meissner (1991) suggests that religious belief systems may be misused asvehicles for the expression of neurotic tendencies and needs. Sevensky(1984) is not surprised that religion may, at times, contribute topsychopathology since religion is a part of psychic life and, as such, canbe distorted. However, he argues that such distortions of religion do not28preclude the possibility of “healthy” religion. In their review of religiousideas in psychiatric disorders, Beit-Hallahmi and Argyle (1977) concludethat “the occurrence of religious ideas as part of the content of individualdelusional systems in psychiatric patients can be explained on the basisof exposure to religious ideas through the social environment” (pp. 28-29). Finally, Runions (1979) warns of two fallacies when assessingpatients who report extraordinary religious experiences: reductionism--the fallacy of assuming that such experiences are “nothing but” apathological manifestation, and the fallacy of speculation withoutadequate philosophical or theological tools.Two religious variables may help to clarify the relationship betweenreligion and mental health. First, Bergin Ct al. (1987) found that anintrinsic religious orientation (Ailport & Ross, 1967) is positivelycorrelated with “normality” and “better” personality functioning.Extrinsic (E) religious orientation refers to utilitarian religious belief andbehavior. For the person with a high extrinsic religious orientation,religion is expedient, a means to an end. By contrast, intrinsic (I)religious orientation refers to religious belief and practice as the basis orcentral focus for life. For the person with a high intrinsic religiousorientation, religion tends to determine the consistent parameters ofappropriate behavior (Wiebe & Fleck, 1980).Second, Spanos and Moretti (1988) developed the DiabolicalExperiences Scale in order to assess the extent to which people reportcontact with demonic beings, experience demonic revelations, and feeloverwhelmed by evil forces. In their study of 124 female university29undergraduates, they found a positive correlation between diabolicalexperiences and emotional distress (i.e., psychosomatic symptoms anddepressive affect). They reasoned that individuals who believe insupernatural good and evil forces and who are psychologically distressedmay tend to attribute their distress to evil forces. Such attributionswould permit these individuals to cope with their distress in a mannercongruent with their religious beliefs. Furthermore, these individuals, ifhigh in trait absorption, might also tend to personify their troublesimagistically in terms of demonic influences.Diagnostic Correlates of Charismatic ChristiansAlthough adherence to religion in general is not necessarilyindicative of emotional disturbance, perhaps there is an associationbetween particular religious affiliations and specific psychologicaldisorders (MacDonald & Luckett, 1983).One specific Christian group, Pentecostals, share many beliefs andpractices in common with Charismatic Christian groups, and thereforewarrant special mention. Gritzmacher, Bolton, and Dana (1988) dividetheir review of psychological studies of Pentecostals into two parts,psychometric and nonpsychometric studies. Nonpsychometric studiesdo not show an association between Pentecostal affiliation and mentaldisorder. Psychometric studies indicate mixed results regardingpsychological adjustment, although the most consistent and stablefindings are of less depression and hostility among Pentecostals thancontrol groups or normative samples. In addition to evidence of anegative relationship between frequency of participation in Pentecostal30church activity and self-reported psychological symptomatology (e.g.,Ness, 1980; Ness & Wintrob, 1980), there are indications of positivetherapeutic effects as well (Gritzmacher et a!., 1988).However, in his review of charismatic religious sects, Gallanter(1982) suggests that certain sects attract adherents with considerablepsychopathology, although he provides no information regardingCharismatic Christian groups. By contrast, a study of 52 psychiatricinpatients (Kroll & Sheehan, 1989) did not find the beliefs and practicesof charismatic and cultic movements disproportionately represented.Only two studies of Charismatic Christians using psychometricmeasures of psychopathology were located in the literature. In a surveyof 65 Catholic Charismatics and 65 non-Charismatic Catholicparishioners, Buechele (1989) found that Charismatic parishioners,especially those attending prayer groups, showed significant elevationson the Minnesota Multiphasic Personality Inventory-168 (MMPI- 168)Paranoia scale (mean T score = 62.40). Again, in a survey of 154Charismatic and non-Charismatic Christians, Olsen (1983) found thatCharismatic subjects had more disturbed personal histories andachieved higher anxiety and hostility MMPI scores than their nonCharismatic counterparts. These studies suggest that CharismaticChristians may constitute a special population with a greater prevalenceof psychopathology than other Christian groups, including theirPentecostal counterparts.31Religion and PersonalityNumerous studies have examined the normal personalitycorrelates of religious individuals, but to date there is no clear consensusregarding the location of religion within fundamental dimensions ofpersonality (Brown, 1987). Caird (1987) outlines three primaryapproaches to the study of religion:The cognitive approach attempts to scale responses toquestionnaires about attitudes or beliefs; the behavioralapproach assesses the frequency of practices such as churchattendance or private prayer; the experiential approach isrepresented mainly by investigation of mysticalexperiences...(p. 345).Regarding the cognitive approach, a promising line of recentresearch has provided preliminary support for an hypothesis regardingthe location of religion within Eysenck’s three-dimensional model ofpersonality. The Eysenckian hypothesis has three postulates:1. Religion belongs to the domain of tenderminded socialattitudes.2. Tenderminded social attitudes are the product ofsocialization and conditioning.3. Within Eysenck’s model of personality, it isPsychoticism rather than Extraversion which issignificantly related to conditioning andtendermindedness (Francis, 1991).This hypothesis, which anticipates a negative relationship betweenreligion and Psychoticism and no relationship with Extraversion, wassupported in a recent study of 165 regular church-attending adults(Francis, 1991) using a measure of attitude towards Christianity and the32Revised Eysenck Personality Questionnaire (EPQ). However, Francis alsofound a significant negative correlation with Neuroticism after controllingfor sex differences, thereby contradicting his previous findings of norelationship between religion and Neuroticism. Francis warns againstthe generalizability of research findings among the general population tospecialist groups, and recommends further research into the relationshipbetween religion and personality among specific religious samples (e.g.,Magaro & Ashbrook, 1985; Neanon & Hair, 1990).Within the experientialist approach, Caird (1987) examined therelationship between mystical experience and the personality dimensionsof the EPQ using a university sample ( = 115). A null hypothesis wassupported for all EPQ scales, thereby challenging the association ofreligious experience, especially mysticism, with introvert, neurotic orpsychotic characteristics.However, Calrd used Hood’s (1975) Mysticism scale which does notassess negative, frightening or “diabolical mysticism” (James, 1963).Perhaps it is only diabolical religious experience that is associated withneuroticism. Spanos and Moretti’s (1988) study, discussed earlier, founda positive correlation between the Diabolical Experiences Scale andEysenck’s Neuroticism scale. Furthermore, their multiple regressionanalysis revealed that only neuroticism was a significant predictor ofdiabolical experience, although it accounted for only a meager proportion(5%) of the variance.33Personality Trait Correlates of Charismatic ChristiansNeanon and Hair (1990) conducted a study of 91 Charismatic and24 non-Charismatic Christians using the EPQ, an imaginativeinvolvement scale and a religious beliefs questionnaire. The study is ofimportance not only because it contributed to EPQ personality researchin a specific religious sample (see also Francis, 1991), but also because itexplores an additional hypothesis regarding personality and unusualreligious experience: Charismatics who actively participate in suchpractices as glossolalia and other unusual religious experiences have agreater aptitude for imaginative involvement than non-Charismatics.Neanon and Hair found that religious belief was negatively correlatedwith Psychoticism and had no relationship with either Extraversion orNeuroticism. In addition, they found that Charismatics were not moreimaginatively involved than non-Charismatics. Their findings may becontrasted with the result of an earlier study of paranormal experienceand imaginative involvement. In this study, Nelson (1989) divided 120subjects into five groups of 24 according to the total number of lifetimeparanormal experiences. He found that capacity for imaginativeinvolvement, as measured by the Absorption scale (Tellegen & Atkinson,1974), was highly discriminative of frequency of paranormal experience.This study, however, did not use a Christian Charismatic sample.Finally, studies by Radtke (1990), Buechele (1989), and Rarick(1982) have shown that Catholic and Protestant Charismatic Christianshave a greater intrinsic religious orientation than their non-Charismaticcounterparts. However, these findings seem contradictory to diagnostic34findings of a positive association between Charismatic affiliation andpsychopathology since measures of psychopathology have typically beennegatively correlated with intrinsic religious orientation. Indeed, it issurprising to find within the same study (Buechele, 1989) elevated scoreson measures of both psychopathology and intrinsic religious orientation.Perhaps psychometric measures of psychopathologic personality styletend to overestimate the presence of psychopathology in this religiouspopulation. Alternatively, perhaps religious affiliation is a weakerpredictor of psychopathology than specific kinds of religious experience,such as demonic possession. If so, the association between churchaffiliation and psychopathology would be mediated by the nature andextent of diabolical experiences in the religious sample.Personality Trait Correlates of Demon Possessed Charismatic ChristiansThere has been only one controlled psychometric study of a normalpersonality correlate of demon possessed individuals. Ward andBeaubrun (1981) found that their Trinidadian sample of 10 demonpossessed Pentecostals achieved a significantly higher score on theNeuroticism scale of the Eysenck Personality Inventory than a matchedcontrol group of non-possessed Pentecostal church attenders (see moredetailed discussion below). Ward (1982) has described these TrinidadianPentecostals as “similar to the charismatic movement in North America,but services appear even more dynamic and emotionally charged”(p. 414). Their study, though cross-cultural in nature and limited in sizeand scope, supports a traditional association between demonicpossession and neuroticism. Their finding of greater neuroticism is35contrary to Neanon and Hair’s (1990) study of Charismatic Christiansand to Francis’ (1991) study of regular church-attending adults, but issupportive of Spanos and Moretti’s (1988) finding of a correlationbetween diabolical experiences and neuroticism. Ward and Beaubrun’sstudy also supports the author’s proposal that Charismatic exorcism-seekers who report considerable diabolical experiences may represent aspecial religious population of neurotic individuals.The past decade has witnessed a renewed interest in fundamentaldimensions of personality, and in particular, a five factor model ofpersonality. The model proposes that the “big five” personality factorsare both necessary and reasonably sufficient for describing at a globallevel the major dimensions of personality (McCrae, 1989; McCrae &Costa, 1987; McCrae & John, 1992). One of the “big five” factors, inaddition to neuroticism, has been described by McCrae and Costa (1985)as openness to experience, and defined as “a broad dimension ofpersonality manifested in a rich fantasy life, aesthetic sensitivity,awareness of inner feelings, need for variety in actions, intellectualcuriosity, and liberal value system” (p. 145). Although Neanon and Hair(1990) did not find significant differences in imaginative involvementbetween Charismatic and non-Charismatic Christians, perhaps suchdifferences would be found among Christians who seek exorcism. Forexample, perhaps exorcism-seekers might be more open to the possibilityof demonic influence in their personal lives. Their aptitude forimaginative and fantasy involvement might render them more likely tobecome preoccupied by demonic ideation during times of personal36distress. Finally, as individuals who tend to actively seek out and engagein new experiences, especially religious experiences, they might be moreinclined to seek the drama of exorcism to expunge their inner demonsthan others.DiscussionThe association between religion and psychopathology is uncertain.Several recommendations have been made to clarify their relationship.For example, variables such as religious orientation and diabolicalexperiences have been successful in this regard. In addition, the studyof specific religious affiliations has been similarly successful, such as thefinding of elevated MMPI distress in two Christian Charismatic samples.The association between religion and basic personality dimensions alsoremains uncertain. The same recommendations have been proposed,and promising initial results obtained using measures of neuroticismand diabolical experiences. Openness to experience has also beeninvestigated using a Charismatic sample, albeit with disappointingresults.Perhaps Charismatic Christians who report diabolical experiences,such as demonic possession, and a low intrinsic religious orientationconstitute a special population of Christians that is distinguished bysignificant neuroticism, openness to experience and psychologicaldistress.37Psychological Approaches to Demonic Possession and ExorcismPhysicians in our time call disorganizations of the mindneuroses or psychoses; the ancients called the samephenomena demon possession (McCasland, 1951, P. 26).We cannot regard the mentally ill as being possessed, nor thepossessed as being mentally ill. The continual errors made inthis respect are found to a frightening extent not only amongpsychiatrists, but also among ministers. And such errors leadto both incorrect and extremely inappropriate treatments (Koch,1970).Human personality and temperament seem to me to be sodependent on surrounding culture, ideals, and prejudices, andmental illnesses (at least the rionorganic varieties) seem to beshaped so by class, expectation, labeling, and experience, thathistorians will need to regard both personality and mentaldisease as social artzfacts (Midelfort, 1981, p. 12).Many analyses of possession phenomena may be organized aroundtwo broad theoretical frameworks: special state and non-state views.The special state view suggests that possession behavior is, in certainimportant respects, discontinuous from other behavior, and therefore anadequate account of possession behavior must propose specialpsychological or physiological processes. The special state approach maybe subdivided into normal and abnormal (pathological) views of demonicpossession. An example of the former is possession trance which iscommonly found in ritual possession. Here, demonic possession isconceptualized as an altered state of consciousness. An example of theabnormal view is the attempt to subsume demonic possession as either anew dissociative disorder or a variant of an existing dissociative disorder.Here, demonic possession is conceptualized as a mental illness withreligious elaborations.38Conversely, the non-state view suggests that possessionphenomena, despite external appearances, are similar to other forms ofsocial behavior. Accordingly, an adequate and parsimonious explanationof demonic possession does not require recourse to special or abnormalmental processes, but rather an understanding of well known andmundane social processes with particular attention to the social context.An example of a non-state view of demonic possession is the social roletheory of Nicholas Spanos (1978, 1983, 1989) which is rooted incognitive social psychology. Spanos conceptualizes demonic possessionas a strategic social role enactment.The following discussion of demonic possession as mental disorderand social role enactment will facilitate the development of hypothesesand the identification of diagnostic and personality correlates ofexorcism-seekers.Demonic Possession as Mental IllnessThe states ofpossession correspond to our neuroses...(Freud, 192.3/1961,p. 72)The relationship between demonic possession and psychopathologyhas been articulated in three ways.First, demonic possession is a form of psychopathology withreligious elaborations. Phenomenological similarities between demonicpossession and certain mental disorders, such as Multiple PersonalityDisorder, support the view that demonic possession and mental illnessare in fact identical but have been discussed in different forms ofexplanatory discourse, one psychological and the other religious; that is,39both may be phenocopies of the same psychological genotype. Forexample, some researchers view Multiple Personality Disorder as themodern secular successor to the demonic possession of religiousantiquity (e.g., Coons, 1986; Ross, 1989; Spanos & Gottlieb, 1979), thereligious form of the symptoms being attributed to the pathoplasticinfluence of the religious context within which the symptoms firstemerged (Whitwell & Barker, 1980).Second, demonic possession is a spiritual condition and not a formof psychopathology. Tippet (1976) warns of a “cross-cultural scientificanalysis which merely inflicts an agnostic world view upon what is afterall a religious experience” (p. 161). Lhermitte (1963) distinguishedbetween genuine possession, a spiritual phenomenon, and“pseudopossession”, a psychological phenomenon. This strict dichotomyenabled him to offer psychiatric treatment to individuals who claimed tobe demon possessed without the censure of Roman Catholic theologiansor recourse to exorcism. Sail (1976) attempts to distinguish betweendemonic possession and mental illness, especially psychotic illness, onfour grounds: individuals who believe themselves to be demon possesseddisplay a specific and marked aversion to Jesus Christ, an absence ofsocial isolation, coherent and rational communication, and intact objectrelationships. However, Sail’s grounds for differentiation betweendemonic and psychopathic conditions have been effectively challenged byBach (1979).Third, demonic possession and psychopathology may at times coexist. This mediating view, cogently argued by Songer (1967) and40Southard and Southard (1985), retains the distinctiveness ofpsychological and religious aspects of demonic possession. Forexample, Ehrenwald (1975) has submitted a case report (see Appendix A)regarding a patient who reported bizarre hallucinations and delusions ofpossession by assorted animal “introjects.” These symptoms suggestedto Ehrenwald a combination of organic damage and hysterical behavior.He subsequently made a psychodynamic interpretation of thesymptomatology, but felt that such an interpretation was limited since “itleaves the demon out of demoniacal possession” (p. 109). He thereforebegan to explore an additional paranormal interpretation of the case.A neglected source of information pertaining to the relationbetween demonic possession belief and psychological disorder is theendorsement of two MMPI-2 items in normative and psychiatric samples(Hathaway & McKinley, 1989; see Table 2): “Evil spirits possess me attimes” (Item 24) and “Ghosts or spirits can influence people for good orbad” (Item 490).The contrast in item endorsements between normative andpsychiatric samples is evident, with one fifth of the psychiatricpopulation endorsing the possession item (Item 24) and one thirdendorsing the item concerning a belief in spirit influence (Item 490).These endorsements support a general link between demonic possessionand mental illness. The possession item is used in the Paranoia clinicalscale, the Bizarre Mentation content scale, and the Mental Confusioncritical item scale.41Demonic possession has been identified with a variety ofpsychological disorders, including such organic disorders as Tourette’ssyndrome and temporal lobe epilepsy (e.g., Beyerstein, 1988; Jilek,1979). This study will be concerned only with those disorders that maybe subsumed under three broad diagnostic categories: psychoticpsychological disorders, non-psychotic psychological disorders, andpersonality disorders. Before reviewing the similarities between certainof these disorders and demonic possession, it is appropriate to consideran alternative: no diagnosis.Spiegel and Cardena (1991) propose that “neither the merepresence of unusual phenomena nor the apparent strangeness ofbehavior are sufficient for a diagnosis” (p. 375), and “trance states arenot necessarily pathological as may be observed in some highly focusednonpathological experiences of fantasy-prone persons, traditionalhealers, and so on” (p. 374). Chandra shekar (1981) suggests that“possession syndrome” is a culturally believed and socially expectedphenomenon that occurs in individuals who are otherwise well adjusted.Sargant (1974) agrees and offers an arousal-suggestibility model ofunusual religious phenomena such as demonic possession and faithhealing. Spanos (1983, 1989; see below) offers a cognitive socialpsychological model.Non-Psychotic Psychological DisordersIn the introduction to his analysis of the seventeenth centurypainter Christoph Haizmann, Freud (1923/1961) associates demonic42possession with the neuroses (non-psychotic psychological conditions) asfollows:The states of possession correspond to our neuroses, for theexplanation of which we once more have recourse topsychical powers. In our eyes, the demons are bad andreprehensible wishes, derivatives of instinctual impulses thathave been repudiated and repressed. We merely eliminatethe projection of these mental entities into the external worldwhich the middle ages carried out; instead, we regard themas having arisen in the patient’s internal life, where theyhave their abode (p. 72).Demonic possession has been discussed in the literature in relation to avariety of non-psychotic psychological disorders.Obsessive-Compulsive Disorder (OCD1. Oesterreich (1966)describes lucid possession as an obsessional form of possession. Thedemoniac, although aware of his or her possessed status, is like apassive spectator, helpless to curtail the compulsion to behave in agrossly distorted and unwanted manner. Whitwell and Barker (1980)found that two of their possessed patients corresponded closely toOesterreich’s lucid possession. These patients were ruminatingindividuals who, under tension, had difficulty in resisting apreoccupation with being possessed. Furthermore, their obsessionaltendencies had been persistent for many years, but became particularlytroublesome during periods of depression. Sargant (1974) andTrethowan (1976) point to other obsessive-compulsive features, such asthe blurting of obscenities, blasphemies or glossolalic phenomena, and apersistent preoccupation with the sexual life of Jesus Christ. Regularlyrepeated exorcisms may be construed as cathartic rituals which43ameliorate the accumulating anxieties ascribed to demonic possession.This interpretation of demonic possession and exorcism is in keepingwith diagnostic discussions of obsessional tendencies among Christiansin general (Gibson, 1983; Higgins, Pollard, and Merkel, 1992; Mora,1969).Depression. In his case study of “demonological neurosis”, Freud(1923/1961) discusses the motive for Haizmann’s pact with the devil:relief from “melancholic depression” related to the death of Haizmann’sfather and the search for a substitute father figure. Trethowan (1976)points to other features of depression, such as relentless guilt leading tothe development of delusions, and the way in which the melancholic“will, on account of his wretchedness, wish upon himself, as it were,some fearful malignant disorder as a form of self punishment by whichhe seeks to expiate his sins” (p. 129). Trethowan offers two case studiesof demonic possession as depression, a seventeenth century exampledescribed by Reginald Scot and a contemporary example. In the formerexample, he suggests that “the agitations, the self reproach, the selfaccusations of wickedness, the sleeplessness, the delusions of imminentpunishment, were all present as indeed they commonly are today in suchcases” (p. 129). Scot’s observation of “sleeplessness” raises thepossibility of sleep disturbance among exorcism-seekers, a frequent covariant of mood disturbance and also a primary presenting complaint.Taylor (1978) offers a case study of a demon possessed woman whoentered psychiatric treatment for a depression with obsessive features:44specifically, she believed that “a small devil with an icepick was trappedinside her heart and he would kill her if she misbehaved sexually” (p. 56).Demonic possession as hysteria. Demonic possession is commonlyassociated with hysteria in the literature, a view that became prominentin the mid-eighteenth century and was epitomized in the writings ofCharcot (Spanos & Gottlieb, 1979). Bizarre convulsions and contortions,including violent hammering movements and shakings of the head,glossolalia, attacks of paralysis and blindness, strange pains or swellings(e.g., swellings of the belly without pregnancy), spots of anesthesia, andtrance phenomena were ascribed to the demonic (for case studies, seeArbman, 1970, Oesterreich, 1966, and Veith, 1965). Oesterreich (1966)describes his somnambulist possession as an hysterical form ofpossession in that the demoniac’s complex and dramatic enactment isperformed without apparent awareness, like a sleep walker. Thecentrality of belief in hysteria has been highlighted by Taylor (1989), animportant consideration given the importance of belief to demonicpossession: “... such people have a belief about how they are, and theyare prepared to go to great lengths to make the world congruent withthat belief’ (pp. 39 1-392).The view of demonic possession as hysteria continues to enjoypopularity, and has received modest empirical support. Yap (1960) wasable to make the diagnosis of hysteria for almost half of his 66psychiatric subjects (see Table 3). He identified possession as a“pseudopsychotic hysterical reaction” involving a split in the self anddevelopment of subpersonalities which may at times dominate the self.45Ward and Beaubrun (1981) found a statistically significant elevation onthe Hysteria scale of the MMPI in their sample of demon possessedTrinidadian Pentecostal subjects (see Table 3).However, the validity of hysteria as a diagnostic category has beenstrongly criticized. For example, Slater (1982) characterizes thediagnosis of hysteria as “a way of avoiding a confrontation with our ownignorance,” as in the case of an undetected organic pathology (Gould,Miller, Goldberg, & Benson, 1986; Marsden, 1986), and “a disorder of thedoctor-patient relationship” (p. 40). Feminist scholars consider the entireconcept of hysteria as an outstanding example of psychiatric malechauvinism (Smith-Rosenberg, 1972).Nevertheless, hysteria continues its hegemony as a favoreddiagnosis of demonic possession under the rubric of dissociation.Current expressions of hysteria in contemporary psychological nosology,such as the Diagnostic and Statistical Manual, Third Edition, Revised(DSM-III-R; APA, 1987), are Conversion Disorder (or Hysterical Neurosis,Conversion Type), the dissociative disorders (especially MultiplePersonality Disorder), Brief Reactive Psychosis, Factitious Disorder withpsychological symptoms, and Histrionic Personality Disorder.Demonic possession as dissociative disorder. The appearance oftrance phenomena in demonic possession, and particularly, theemergence of diabolical personalities followed at times by amnesia-somnambulist possession--suggest that demonic possession is adissociative condition. Dissociation has been defined in the DSM-III-R(APA, 1987) as “a mechanism in which the person sustains a temporary46alteration in the integrative functions of consciousness or identity”(p. 394). In fact, dissociation may be the central psychologicalmechanism underlying demonic possession as well as other dissociativeconditions, such as conversion symptoms, fugue states and multiplepersonality disorder. The various forms of dissociative experience havebeen traditionally conceptualized as lying along a continuum from theminor dissociations experienced by many in the general population to themajor or pathological dissociative experiences prevalent among thosewith dissociative disorders (Bernstein & Putnam, 1986). A vulnerabilitymodel of dissociative disorder has become increasingly popular,according to which the development of dissociative symptoms ordisorders is understood as the adaptive response of individuals of highdissociative capacity to sustained traumatic experiences (Putnam, 1985).This model is of special interest to the present study as a high proportionof exorcism-seekers reported childhood abuse.Distinctions have been made between positive-desirable possessiontrance states (ritual possession) and negative-undesirable possessiontrance states. In her taxonomy of trance and possession behavior,Bourguignon (1968) classifies demonic possession as a negative andundesirable trance state that requires exorcism. This classification iscongruent with attempts to subsume demonic possession as adissociative disorder in the DSM-III-R (APA, 1987), most notably MultiplePersonality Disorder, or Dissociative Disorder Not Otherwise Specified.Multiple Personality Disorder (MPD) warrants special attention due toseveral phenomenological similarities with demonic possession.47Demonic possession as MultiDle Personality Disorder. Thehistorical connection between multiple personality disorder and demonicpossession has been made explicit in several recent books (Crabtree,1985; Friesen, 1991; Hilgard, 1986; Putnam, 1989; Ross, 1989),historical treatises (e.g., Veith, 1965; Ellenberger, 1970), theoreticaldiscussions (e.g., Allison, 1985; Carlson, 1986; Coons, 1984, 1986;Kenny, 1981; Knowles, Haan, and Rimlinger, 1986; Krippner, 1986;Putnam, 1986; Spanos, 1989; Spanos & Gottlieb, 1979; Stern, 1984),and in the DSM-III-R (APA, 1987) as follows:The belief that one is possessed by another person, spirit, orentity may occur as a symptom of Multiple PersonalityDisorder. In such cases the complaint of being “possessed”is actually the experience of the alternate personality’sinfluence on the person’s behavior and mood (pp. 27 1-272).The most notable phenomenological feature shared by both MPDand demonic possession is the emergence of one or more alternatepersonalities marked by distinct changes in facial expression, vocalintonation, speech content and body movement, and followed at times byamnesia (Coons, 1984; Kemp & Williams, 1987; Kenny, 1981; Ross,1989). Brendsma and Ludwig (1974) describe alters that are cold,belligerent, sullen, frightening and violent. These alters may be“persecutors” who inflict punishment, such as self-mutilation or suicide,and are readily associated with the demonic. In the famous case of MissBeauchamp, for example, Morton Prince (1905) reported that his patient“regarded herself as ‘possessed’ in much the same sense as it is said inthe Bible that a person is ‘possessed” (p. 119). Ross, Norton, andWozney (1989) found demon alters in 28.6% of their MPD sample. The48alternate personalities in both MPD and demonic possession are oftenantinomic in character to the host personality; thus, a devout Christianis possessed by a hostile and blasphemous personality.There have been recent attempts to distinguish MPD from demonicpossession (e.g., Craig, 1987, 1988a, 1988b, 1988c; Friesen, 1989,1991). For example, Knowles et al. (1986) suggest that the alternation(or “switching”) of identities does not occur as frequently in demonicpossession as in MPD. Alternation does not occur at all in Oesterreich’s(1966) lucid possession. Furthermore, supernatural phenomena areascribed to demonic possession, such as mediumistic abilities, feats ofunusual strength and the knowledge of languages, future events, andsecrets which the possessed person does not have access to in his or hernormal state (Cramer, 1980; Spanos, 1983; Virkier & Virkler, 1977).Unfortunately, the successful diagnosis of MPD in a specific case ofdemonic possession may not be helpful as the diagnostic validity of MPDremains hotly debated. For example, Skodal (1989) points to the “relativeabsence of external validity standards for the diagnosis of multiplepersonality” (p. 476).Demonic possession as Dissociative Disorder Not OtherwiseSpecified (DDNOS). In their discussion of dissociative disorders in theforthcoming Diagnostic and Statistical Manual, Fourth Edition (DSM-IV),Spiegel and Cardena (1991) discuss one of six proposed examples ofDDNOS of relevance to demonic possession, as follows:Dissociative and trance phenomena in which the specificcharacteristics of the disorders are indigenous to particularlocations axid cultures, lead to dysfunction, and whose49predominant features involve a disturbance of the normallyintegrative functions of memory, identity, or consciousness.Entry in undesirable altered states of consciousness beyondthe control of cultural or religious ritual, for example,amnesic episodes, the assumption of another identity, or thesense of being possessed by some entity, are commonfeatures of some of these indigenous conditions (p. 375).This example is proposed in order to bring attention to culturallypatterned dissociative syndromes, some of which could be mistakenlydiagnosed as psychotic. Furthermore, it is necessary that the conditionis considered pathological by members of the individual*s culture andleads to marked dysfunction. Among Charismatic Christians, demonicpossession is always considered pathological and is often accompaniedby marked dysfunction.Demonic possession as a new dissociative disorder: Someproposals. There have been recent attempts to classify possessionphenomena as a discrete diagnostic category among the dissociativedisorders. In his discussion of possession states, Skodal (1989) disclosesthat a new category of Possession/Trance Disorder was to be added tothe dissociative disorders (see Appendix 13 for a preliminary draft of thediagnostic criteria). This disorder would require nonpsychotic possessionphenomena, not substance-induced or of organic etiology, that occursoutside a culturally sanctioned context, such as religious ritual.In their discussion of dissociative disorders and the forthcomingDSM-IV, Spiegel and Cardena (1991) propose the inclusion of a newdiagnostic category, Transient Dissociative Disturbance, as an alternativeto identifying specific culture-bound dissociative syndromes, such as50“unwilled and uncontrolled possession,” as Dissociative Disorder NotOtherwise Specified (See Appendix C for proposed diagnostic criteria).Akhtar (1988) offers the term “Possession Syndrome” to describe apsychological condition with sudden onset that occurs in India almostexclusively among women and generally in the lower levels of literacy andsocio-economic class. He refers to this condition as a culture-boundsyndrome (for reviews of culture-bound syndromes, see Simon & Hughes,1985; Hahn, 1985). Akhtar maintains that the symptoms of thissyndrome are independent of schizophrenic and manic states and mayconstitute a hysterical dissociative state.Saxena and Prasad (1989) conducted an archival study in Indiathat lends support to the classification of possession phenomena as adissociative state. However, these researchers recommend the inclusionof Akhtar’s culture-bound Possession Syndrome in the DSM as a sub-category of the Dissociative Disorders with the designation, PossessionDisorder. In their study, Saxena and Prasad screened the case records ofall of the 2,651 patients seen in the adult psychiatric outpatient clinic ofthe All-India Institute of Medical Sciences Hospital during 1986 for thepresence of dissociative symptoms. Sixty-two cases (2.3% of the total)were found to conform to DSM-III (APA, 1987) criteria for the followingdissociative disorders: psychogenic fugue ( = 4), depersonalizationdisorder (n = 2) and atypical dissociative disorder (n = 56). Saxena andPrasad were able to further subdivide the large atypical category intoSimple Dissociative Disorder (, = 50), using criteria suggested by Saxena51(1987), and Possession Disorder (n = 6), using criteria proposed by Yap(1960)(see Appendix D for diagnostic criteria).Isaacs (1987) collected 14 cases of demonic possession from fourpracticing exorcists, two Episcopal priests and two Episcopal laypersons.These cases were, in turn, submitted to five experiencedpsychodiagnosticians (four psychologists and one psychiatrist) for aDSM-III (APA, 1980) diagnosis and an expert opinion regarding a newlycreated diagnostic category, Possessive States Disorder (see Appendix E).The panel of psychodiagnosticians favored the new diagnostic categoryand pointed to the inadequacy of DSM-III categories in such cases.Factitious Disorder and Malingering. Skodal (1989) discusses theimportance of determining the voluntariness of symptoms: the voluntaryor intentional production of symptoms points to the diagnosis ofFactitious Disorder with psychological symptoms or Malingering,depending upon whether symptoms are feigned to achieve some obviousobjective or to fulfill a psychological need (e.g., the sick role). However,determining matters of voluntariness and intentionality, especially in theface of intentional denial and purposeful deception, is a tenuous clinicaltask as it requires high levels of clinician inference and subjectivejudgment (Skodal, 1989).Psychotic Psychological DisordersJaspers (1963) suggests that possession states without alteredconsciousness are usually indicative of schizophrenia. Demonicpossession states may include a variety of features associated withpsychotic disorders: marked distress, signs of prodromal deterioration,52social isolation, mental confusion, extreme negativity and agitated ordepressed mood, bizarre behavior and ideation, incoherent speech(glossolalia), and, of course, the conviction of being helpless and underthe control or influence of a demonic power.The belief that one is controlled by demonic spirits may beinterpreted as a delusion and therefore a symptom of a psychoticdisorder, as opposed to a dissociative disorder. Individuals withdelusions of control have Schneiderian first rank symptoms and wouldmeet one of the criteria for Schizophrenia or Schizophreniform Disorder.However, many authors (e.g., Jaspers, 1963; Pattison, 1980; Whitwell &Barker, 1980) point to the importance of subcultural relativity inevaluating patients who speak of possession, although Lopez andHernandez (1986) point to the false negative risk in doing so. The DSMIII-R (APA, 1987) also addresses the issue of subcultural relativity:Beliefs or experiences of members of religious or othercultural groups may be difficult to distinguish fromdelusions or hallucinations. When such experiences areshared and accepted by a cultural group, they should not beconsidered evidence of psychosis (p. 193).Andrade and Srinath (1988) emphasize the importance of subculturalrelativity in their case report of true hallucinations occurring as aculturally sanctioned experience in a non-psychotic adult. They identifyIndia as a cultural context within which paranormal phenomena such asdemonic possession are accepted by the majority of the population:In this cultural context, especially when the gross behaviorchanges of psychosis are absent, hearing voices or seeingvisions easily finds cultural explanations, thus biasing thepercipient towards ascribing veridicality and objectivity to53false perceptions. Such false perceptions therefore, by virtueof cultural sanction, may be regarded as true perceptions bythe subject (p. 838). -Andrade and Srinath also suggest that cultural sanction might underliethe psychodynamic genesis of such perceptual disturbances in non-psychotic psychiatric patients. Jaspers (1963) points to the prevailingviews and values of the cultural milieu as important in that “they fostercertain psychic abnormalities and prevent others from developing”(p. 733). Myers (1988) speaks of a paranoid pseudocommunity beliefsystem that contributes to and maintains individual delusional beliefs.In his discussion of the cultural relativity of delusions andhallucinations, Leff (1988) suggests that “minority religious sects notonly provide a potential haven for the paranoid, but may encouragebeliefs and behavior that are close to those exhibited by psychoticpatients” (p. 6). He points to the similarity between Pentecostalglossolalia and the extremely disjointed speech exhibited by someschizophrenic patients.Westermeyer (1987) provides several criteria for differentiatingpsychotic perceptual experiences from religious preternaturalexperiences: (1) lack of support from social network, (2) persistencebeyond a few weeks, accompanied by psychological, behavioral, or socialdeterioration, (3) the presence of other psychopathological signs andsymptoms, and (4) culturally incongruent or unfamiliar perceptions.Skodal (1989) and Spitzer et al. (1980) helpfully comment on issues ofdifferential diagnosis with regard to hysterical psychosis, brief reactive54psychosis and factitious disorder in a case study of bizarre behavior andreligious ideation.The presence of marked precipitant stress and the absence ofprodromal symptomatology is important to the differentiation of demonicpossession as a Brief Reactive Psychosis from Schizophrenia,Schizophreniform Disorder and Delusional Disorder, whereas thepresence of significant mood disturbance is important to thedifferentiation of demonic possession as a Schizoaffective Disorder,Bipolar Disorder or Major Depressive Episode with psychotic features.Hall et al. (1982) present three case studies of demonic possessionand psychotic illness. Kiraly (1975) and Schendel and Kourany (1980)present cases of demonic possession in adults and children in relation tofolie a deux. There has also been discussion of demonic possession ashysterical psychosis (e.g., Spiegel & Fink, 1979), a diagnostic category ofquestionable validity and roughly equivalent in the DSM-III-R (APA,1987) to Brief Reactive Psychosis or Factitious Disorder withpsychological symptoms (Spitzer et al., 1980). Finally, several archivalstudies of demonic possession (discussed below) found a predominanceof psychotic symptoms.Personality DisordersPerhaps there is a prototypical personality template that underliesthe variable symptom presentation of demonic possession. Personalitydisorders are defined in the DSM-III-R (APA, 1987) as behaviors or traitsthat are characteristic of an individual’s recent and long-term55functioning and cause either significant psychological distress orimpairment in social or occupational functioning.Histrionic Personality Disorder. In keeping with the previousdiscussion of hysteria and possession, histrionic personality disorderseems especially suitable as a diagnostic candidate for demonicpossession. In particular, the essential feature of this disorder--”apervasive pattern of excessive emotionality and attention seeking” (DSMIII-R, APA, 1987, p. 348)--corresponds well to the theatrical requirementsof the demoniac presentation. In addition, the tendency to formdependent relationships with the opposite sex, to be overly trusting andsuggestible, and to positively respond to authority figures who areperceived to offer magical solutions is all too familiar to the stereotypicalexorcism spectacle of a male church authority figure and his troubledfemale supplicant surrounded by a chorus of supportive on-lookers.Regarding the issue of dependency, Yap (1960) lists a dependent andconforming character as one of several preconditions necessary forpossession to occur.Obsessive Compulsive Personality Disorder. The obsessionalsymptoms ascribed to lucid possession (Oesterreich, 1966) and observedin possessed individuals (e.g., Sargant, 1974; Trethowan, 1976; Whitwell& Barker, 1980) may reflect an underlying obsessive compulsivepersonality disorder. For example, Whitwell and Barker (1980) reportedthat two of their possessed patients had obsessional tendencies of severalyears duration. It was only during periods of tension and depressedmood that obsessional symptoms emerged. In such individuals, a56morbid preoccupation with the possibility of personal possession may beencouraged by repeated failure to control unacceptable feelings orbehavior, thereby leading to rumination concerning demonic causation.Outbursts of accumulating inner tension, resentment or despair in theotherwise self-restrained individual further encourage such rumination.Borderline Personality Disorder. Peters (1988) has recentlyidentified demonic possession states as cross-cultural variants ofBorderline Personality Disorder (BPD). He defines a cluster of core BPDsymptoms which he considers “eminently applicable to the ‘possessionsyndromes’ which occur in societies and individuals where possession isused to explain the psychological states characteristic of BPD” (p. 6). Hiscore symptoms of BPD are:• . .transient reactive psychotic episodes; little or nodeterioration between these episodes, and a relatively quickreturn to former levels of ego functioning; a tendency to act-out internal conflicts in dissociative states; lack of impulsecontrol with ego syntonicity during acting-out episodes;unstable interpersonal relationships; and prominent splittingand repression leading to multiple identities (p. 6).Schizotypal Personality Disorder. Bufford (1989) points toschizotypal personality disorder as one of several likely diagnosticcorrelates of demonic possession. In particular, the peculiarities ofideation (e.g., paranoid ideation, ideas of reference, odd beliefs, magicalthinking), unusual perceptual experiences (e.g., sensing the presence of aforce not actually present), and odd behaviors (e.g., unkemptappearance, strange mannerisms, talking to self) are likely to be ascribedto the demonic.57Diagnostic Studies of Christian Demonic PossessionDiagnostic studies of demonic possession within a Christianreligious framework are composed of four archival studies, one casereport series, and one controlled psychometric study (see Table 3). Inaddition, Yap’s (1960) classic archival study of Hong Kong psychiatricpatients continues to be the most extensive and thorough archivalinvestigation of possession to date. However, his study is not specific toChristian demonic possession per se, but to a more general “possessionsyndrome” within a primarily Taoist-Buddhist-Confucianist religiouscontext. His study is included for comparative purposes.Yap’s diagnostic study. Yap (1960) collected an archival sample of66 first admissions to the Hong Kong Mental Hospital who presentedwith a “possession syndrome” (see Table 3). The sample comprised 2.4%of all admissions over two years (1954- 1956). The patients were poorlyeducated (41% illiterate, 45% had primary school education only) and oflow socio-economic status (97%). Half of the patients were married, and42% were single, widowed or divorced. Regarding religious affiliation, thepatients were primarily Taoist, Buddhist or Confucian (80%), and 9%were Christian. With regard to a demographic profile, therefore, Yap’spossessed patients were predominantly poorly educated Chinese womenof low socio-economic status.58Table3.ReviewofDemonicPossessionDiagnosticStudiesAuthorGroupnSexAgeDiagnosisCommentsFMYap166501616-60Hysteria(48%),Theclassicarchival(1960)schizophrenia(24%),studyof“possessiondepression(12%),maniasyndrome”among(6%),generalparesis(3%),HongKongsenileconfusion(1.5%),psychiatricpatients.lactationalconfusion(1.5%),febriledelirium(1.5%),postepilepticconfusion(1.5%)(tablecontinues)59AuthorGroupSexAgeDiagnosisCommentsFMWhitwell &11697M=26.4Manic-depressivepsychosisABritisharchivalBarker(25%),mixedaffectivestudyofpsychiatric(1980)psychosis(12%),hypomanicadmissionswhose(6%),depression(12%),chiefcomplaintwasschizophrenia(31%),acutedemonicpossession.hystericaldissociativestate(6%),severechronicanxietystate(6%)(tablecontinues)60AuthorGroupiSexAgeDiagnosisCommentsFMWard&1561244Md=23.5Schizophrenia(64.3%),AnarchivalstudyofBeaubrun(Females)otherpsychoticconditionspsychiatricpatients(1980a)=35.5(17.9%),acuteconfusionalinTrinidad,West(Males)state(1.8%),depressionIndies.(3.6%),inadequatepersonality(3.6%),behaviordisorder(3.6%),alcoholism(1.8%),chronicbrainsyndrome(1.8%),psychoneuroticreaction(1.8%)(tablecontinues)61AuthorGroup,SexAgeDiagnosisCommentsFMWard&1108215-54PossessedTrinidadianThefirstandonlyBeaubrun21082Pentecostalsscoredcontrolledpsycho-(1981)significantlyhigherthanthemetricstudyofmatchedcontrolgroupindemonicpossession.MMPIHysteria(1=3.45,p<.005)andEPIaNeuroticism=1.86,p<.05).NostatisticallysignificantdifferenceinExtraversion.(tablecontinues)62AuthorGroupnSexAgeDiagnosisCommentsFMAchaintre12520520-40Classicalpsychoses(50%).Aseriesofpsychiatric(1988)Atypicalclinicalcasestudiesofcharacteristics(50%):referralsfromanatypicaldelusionaldisorder,exorcistinLyons,schizo-affectivedisorder,France.andschizotypalpersonalitydisorderaEpI=EysenckPersonalityInventory.63Yap (1960) defines three types or degrees of “possession syndrome”based on degree of dissociative symptoms (see Table 4). Only 11% of theentire sample exhibited the complete possession syndrome with markeddissociative features. However, over half the sample (58%) displayedsome measure of dissociative symptomatology. The specific content ofthe possession varied, with the more severe cases acting in a mannersuggested by the kind of possessing spirit or personality: for example,there were spirits of dead relatives (22), deities (18), both dead relativesand deities (17), deities of the Taoist-Buddhist Pantheon (2), Jesus Christ(1), the Virgin Mary (1), the Christian God (1), an Indian Prince (1), afortune-teller (1), a fox spirit (1) and a snake spirit (1).Although Yap found that possession phenomena were manifestedin varying degrees of completeness and distributed among discretepsychiatric syndromes, 73% (48/66) of the cases of possession weregiven a diagnosis of either hysteria (48%) or schizophrenia (24%). Thediagnosis of depression was made in 12% of the cases. Yap thereforesuggested that the task of differential diagnosis would be to distinguishbetween these three disorders.Whitwell and Barker’s archival study. Whitwell and Barker (1980)examined the diagnoses of 16 psychiatric admissions to Barrow Hospital(Bristol, Great Britain) between 1973-1977 (see Table 3). The patientstended to have an above average education and an upper socio-economicstatus. Most patients were single (only three were married) and ofBritish origin (15). The patients neither identified with nor wereestablished members of particular groups, religious or otherwise.64Table 4. Categories of Possession Syndrome (YaD, 1960)Type Sample Characteristics%Degree 1 11 Characterized by clouding of consciousness,(Complete) skin anesthesia to pain, a changed demeanorand tone of voice, the impossibility of recallingthe patient to reality, and subsequentamnesia.Degree 2 47 Characterized by mild clouding, partial(Partial) anesthesia, no change in voice and demeanor,the possibility of recall to reality, and partialamnesia subsequently.Degree 3 42 Marked by the absence of clouding, or(Histrionic) anesthesia, and of change in voice anddemeanor, the possibility of immediate recallto reality and the gaining of attention, togetherwith (in females) mannerisms like giggling,belching and other attention-seeking devices(Yap, 1960, p. 120).65However, at least 63% (10) described a Christian background and a highproportion had been in contact with Pentecostal or Charismatic churchgroups from whom six had sought exorcism.Patients were selected from hospital records only if possession wasone of their primary complaints. This selection criterion resulted in 13patients who believed themselves to be possessed by a “demon” or “thedevil”, one patient by an “evil spirit”, and two women by a man’s spirit.Surprisingly, aside from self-reported possession, very few showed any ofthe features either of traditional demonic possession or of Yap’s moregeneral “possession syndrome.” However, most patients presented withsevere psychopathology. Common symptoms included depression,suicidal impulses, hallucinations, insomnia, anxiety, restlessness, anddelusions. Nine patients reported psychiatric illness in a parent. Theresults of psychiatric intervention were mixed. A three year follow-upcould only presume that half the patients were psychologically well; theother half were either day patients or outpatients. Whitwell and Barkersuggest that cases of demonic possession are likely to vary according to(1) the relative contribution of psychopathology and (2) contact with aculture that includes possession and exorcism belief and practice. Themost difficult cases have both characteristics to a marked degree.Ward and Beaubrun’s archival study. Ward and Beaubrun(1980a) examined 87% (1063 cases; 225 women, 808 men) of the 1978first admissions to St. Ann’s Hospital, Trinidad, and identified 56 (5.3%)patients who believed themselves to be suffering from spirit possession(see Table 3). Although the specific nature of this possession is unclear,66Ward has indicated elsewhere that the possession was peripheral anddemonic (Ward, 1980, 1989; Ward & Beaubrun, 1980b). Ward andBeaubrun (1980a, 1980b) described the religious context of Trinidadianspirit possession as a complex and syncretic Caribbean supernaturalism,informed by African polytheism and ancestor worship, Asian mysticism,and European demonology. The sample of subjects consisted primarilyof single men in their later thirties, of African or East Indian descent, andof low socio-economic status. The women were primarily young adults,married, unemployed and of African descent. Regarding religiousaffiliation, Christians were heavily represented (76%), followed by Hindus(17.2%) and Muslims (6.8%).In this sample, Ward and Beaubrun (1980a) found the possessionexperience primarily associated with psychotic disorders (82.2%),especially schizophrenia (64.3%), although various neuroses, personalitydisorders and organic brain syndromes were also found. Given thecorrespondence of their diagnostic findings with regard to both hospitaladmission trends and general population patterns, Ward and Beaubrunconclude that Trinidadian spirit possession does not represent anindependent psychiatric syndrome but rather a culturally endorsedinterpretation of mental illness.Of particular interest is Ward and Beaubrun’s (1980a) suggestionthat spirit possession will vary in its associations with the type of samplestudied. For example, in a psychiatric hospital sample possession will beassociated with severe mental disorder, whereas in other samples, it maybe associated with less severe and less chronic conditions. In fact, this is67precisely what Ward and Beaubrun (1981) found in a study of demonicpossession in a Trinidadian Pentecostal community.Ward and Beaubrun’s psychometric study. Ward and Beaubrun(1981) verbally administered the Eysenck Personality Inventory(Neuroticism and Extraversion scales only) and the Hysteria scale of theMMPI to 10 demon possessed Trinidadian Pentecostal subjects and 10non-possessed church attenders (see Table 3). Ward (1982) describedher Pentecostal subjects as similar to adherents of the CharismaticMovement in North America. The non-possessed control subjects werematched “roughly” on age, gender, race and educational/occupationalstatus (see Table 3). No subjects reported a history of psychiatric care.The sample was composed primarily of poorly educated women, rangingin age from 12 to 75, of lower to middle class background, and of eitherAfrican or East Indian descent.The possessed subjects scored significantly higher in both hysteriaand neuroticism than the control group, and there was no significantdifference in extraversion. Ward and Beaubrun interpreted these resultsas supportive of their hypothesis that demonic possession is a culture-bound form of neurosis, and offered the following psychologicalexplanation:.it is likely that individuals socialized in communitiespervaded by supernatural and animistic beliefs employpossession as a psychological defense to cope withfrustration and conflict. Despite its maladaptive features,such as accompanying anxiety and psychosomaticcomplaints, the reaction does afford some advantages interms of temporary escape from unpleasant reality,absolution of guilt and responsibility by attributing the68reaction to supernatural causes, and evocation of sympathyand affection from family and friends (p. 296).Achaintre’s case report series. In the most recent study to date,Achaintre (1988) offers a series of 25 case reports of demonic possession(see Table 3). These cases were referred for a psychiatric consultation byan exorcist associated with the Diocese of Lyon, France. The casesconsisted primarily of French Catholic women from rural backgrounds(70%). Half of the sample had consulted with a psychiatrist in the pastbut without positive results. Achaintre had from one to tenconsultations with each subject.Approximately half of the sample was psychotic, whereas the otherhalf displayed atypical clinical characteristics that roughly correspondedto delusional disorder, schizo-affective disorder, and schizotypalpersonality disorder. Given the frequency of atypical diagnostic findings,Achaintre wondered whether his demon possessed subjects constituted asubpopulation of patients who expressed their psychological difficultiesin an unusual manner when compared to other patients, or alternatively,whether psychological explanations were insufficient to adequatelyaccount for their symptoms.The Psychosocial Context of Demonic Possession: Vulnerability FactorsExorcism-seekers may be rendered more vulnerable to thedevelopment of psychological distress associated with demonicpossession than those who do not seek exorcism due to suchpsychosocial factors as life-event stress, social isolation, impoverishedsocial support, weak personal self-efficacy and high neuroticism.69A common finding among investigators is that stress precipitatespossession behavior. For example, in their discussion of demonicpossession among Trinidadian Pentecostals, Ward and Beaubrun (1980b)conceptualize demonic possession as a psychological defense thatenables the individual to cope with psychosocial stress factors, such assexual conflicts and domestic troubles..possession is a basic condition in response to anindividual’s intrapsychic tension and a precipitatingsituation due to an event involving unusual stress oremotion (Ward & Beaubrun, 1980b, p. 206).Alternatively, Sargant (1974) offers a neurophysiological view, rooted inPavlovian theory, that also attributes a central role to stress in thedevelopment of possession states. According to Sargant,psychophysiological stress associated with possession or exorcism ritualsprecipitates a sudden and complete inhibitory collapse that suppressespreviously learned responses and increases susceptibility to suggestion.Demonic possession behavior is then shaped by others in the vulnerableindividual, and finally extinguished.The stress-illness paradigm proposes a link between life-eventstress and psychological distress (e.g., Harder, Strauss, Greenwald,Kokes, Ritzier, & Gift, 1989; Rahe, 1979; Waring, Patton, & Wister,1990). The relationship, however, appears to be modest (Nezu, 1986)and controversial (e.g., Grant, Patterson, Olshen, & Yager, 1987;Lazarus, DeLongis, Folman, & Gruen, 1985; Schroeder & Costa, 1984).Consequently, attempts have been made to refine stress-illness theory(Nezu, 1986). For example, personality and social variables have been70advanced as mediators of the stress-distress relationship. Regardingsocial variables, for example, social support has been identified as abuffer against the harmful effects of stress--the buffering hypothesis(Cohen & McKay, 1984; Cohen & Wills, 1985; Thoits, 1982). Socialisolation and loneliness have been implicated as vulnerability factors inthe development of depression and other forms of distress (Peplau,1985). Regarding personality variables, self-efficacy has both a directeffect and an indirect effect via social support on psychological distress(e.g., Kahn & Long, 1988; Holahan & Holahan, 1987; Major & Cozzarelli,1990; Murphy, 1988). Trait neuroticism has demonstrated greaterexplanatory power than either life-events or social support in accountingfor the variance of nonpsychotic symptoms (Henderson, Byrne, DuncanJones, Scott, & Adcock, 1980; Waring et al. 1990). Within a stress-illness model of psychopathology, demonic possession may beconceptualized as a stress reaction among religious individuals who,during periods of high life-event stress, are rendered vulnerable to thedevelopment of psychological distress via social isolation, poor socialsupport, low self-efficacy and high neuroticism.DiscussionThe literature review has identified an association betweendemonic possession and psychopathology. This association supports theauthor’s proposal that Charismatic Christians who report diabolicalexperiences may constitute a special Christian subpopulation withconsiderable psychological distress.71However, the variable presentation of demonic possession hasfrustrated the search for any invariant diagnostic correlate (for a decisiontree regarding the differentiation of trance states, possession syndromesand psychopathology, see Augsburger, 1986). The failure to identify anysingle diagnostic correlate of demonic possession has been noted byother researchers. For example, Salmons and Clarke (1987) presented acase study of demonic possession in which “the profusion of symptomswas difficult to combine in a single diagnosis” (p. 53). Likewise, Wardand Beaubrun (1980b) presented four case studies of TrinidadianPentecostal demonic possession and concluded that “a single psychiatricdiagnosis was not readily apparent” (p. 207). Ludwig (1965) submittedfive cases of spirit possession in Spanish American clients and, far fromestablishing a single correlate of possession, his diagnoses includedvarious neuroses (e.g., hysteria), psychoses (e.g., schizophrenia) andpersonality disorders (e.g., sociopathy). Furthermore, the possessionphenomena appeared in a variety of forms as minor symptoms, acomplex of symptoms, a syndrome, or a major feature of a psychiatricdisorder. Achaintre (1988) also highlighted the atypical nature of manyclinical presentations of demonic possession. Finally, in their review of“possession states and allied syndromes”, Enoch and Trethowan (1979)concluded as follows:What clearly emerges from a study of the literature is thatthe phenomena of demoniacal possession are soheterogeneous as to disallow the possibility of any unitarytheory of origin... (p. 169).72One plausible interpretation of this uncertain diagnostic state ofaffairs is that “rather than representing a determinant of a specificpsychological disorder, this type of possession provides a culturalexplanation for a variety of mental problems” (Ward, 1980, p. 158).Others question the adequacy of current diagnostic nosologies to accountfor demonic possession, and have proposed new nosological categories(e.g., Craig, 1987, 1988a, 1988b, 1988c).Spanos (1978) questions the value of diagnostic categoriesaltogether. He suggests that labeling possession phenomena as hysteriaor some other form of psychopathology does little more than re-state thefact that possession behavior appears deviant and unusual. He arguesthat such labeling reveals nothing about the variables that produce ormaintain unusual behavior. As an example, Spanos rejects hysteria as auseful explanatory concept as follows:Historically, it [hysteria] has been associated with a vasthodgepodge of unusual and dramatic behavior includingspontaneous amnesia, fugue states, convulsions, sensoryand motor deficits occurring in the absence of demonstrableorganic pathology, heightened suggestibility, hallucinations,anorexia, a host of sexual disturbances, various languagedysfunctions, and a personality configuration variouslydescribed as vain, coquettish, frigid, and so on (Spanos,1978, p. 418).Diagnostic studies of demonic possession within a Christianreligious framework are few and limited in methodology. Nevertheless,they clearly support an association between mental illness and demonicpossession. For example, psychotic disorders were over-represented incomparison to their prevalence in the general populations studied. Once73again, however, the association between mental illness and demonicpossession was neither simple nor direct as no single psychologicaldisorder was invariably identified.Regarding implications for hypothesis-testing, the specificassociation between psychotic disorders and demonic possessionanticipates indications of formal thought disorder among exorcism-seekers. The display of an alternate, diabolical personality in theabsence of psychotic symptoms suggests the likelihood of a dissociativedisorder, especially Multiple Personality Disorder or Dissociative DisorderNot Otherwise Specified. Other plausible diagnostic candidates includeDepression and Obsessive-Compulsive Disorder. Favored candidatesamong the personality disorders are Histrionic, Obsessive Compulsive,Borderline, or Schizotypal Personality Disorders.The distress associated with demonic possession may be fosteredby certain psychosocial conditions. Perhaps exorcism-seekers areindividuals who are experiencing a period of unusual life-event stressand are rendered vulnerable to the development of psychological distressvia social isolation, poor social support, weak self-efficacy and highneuroticism.An invariant demographic profile does not emerge from the studies.Regarding gender, for example, three studies reported a 4:1 ratio ofwomen to men, one study reported a 4:1 ration of men to women, andthe remaining study reported a roughly similar number of both men andwomen. Support for the hypothesis that demonic possession is a genderspecific condition was therefore equivocal. There were, however, several74demographic similarities across studies of relevance to theoreticalanalyses. For example, of the four studies reporting socio-economicinformation, three studies found that a high proportion of subjects wereof low socio-economic status. In addition, most subjects across studiescould be given a religious identification, although degree of religiousinvolvement was not well specified. The studies therefore suggest thatdemonic possession is a condition of the poor and devout.Demonic Possession as Social Role Enactmentft is the easiest thing, sir, to be doneAs plain as fizzling: roll but with your eyesAndfoam at the mouth. A little castle soap will do it.(Ben Jonson, The Devil is an Ass)Several investigators (Jones, 1979; Nisbitt and Ross, 1980; Ross,1977) have proposed that, in everyday life, people tend to function asimplicit trait theorists; that is, they typically explain the behavior ofothers by attributing stable, internal dispositions to them. In so doing,people minimize potent and often obvious situational determinants ofhuman behavior. This tendency is especially likely when the behaviorbeing observed is deviant or unusual, as is the case with demonicpossession. Stark (1965) points to the critical importance of socialcontext to religious experience, and in so doing, represents a commonassumption among sociologists and anthropologists: possessionphenomena as social product.If we adopt a cross-cultural view of human affairs for amoment, it is apparent that the vast majority of instanceswhen human beings have thought themselves confrontedwith supernatural agencies occurred in social situationswhere, far from being unusual, such experiences were75considered normal. Indeed, in many such situations failureto manifest religious experience would be deemed atypical,perhaps even bizarre (p. 17).Social accounts of deviant behavior resist the popular notion thatthe occurrence of unusual or dramatic behavior requires that there beequally unusual or dramatic explanatory causes (Nisbitt & Ross, 1980).Instead, the causes of such behavior are often mundane and similar tothe causes of everyday social behavior (Spanos, 1983). For example,recipients of exorcism may learn to enact the role of “being demonpossessed” in much the same way that others learn to enact the role ofuniversity student, experimental subject or psychotherapy patient.Social role theory highlights change, novelty and the salience of thesocial context in accounting for human behavior. It is rooted in themetaphor of the theater: “All the world’s a stage...” and those upon it are“merely players,” actors in a complex social drama that involves adynamic interplay between actor and audience. Human beings are notpassive participants following a mechanical script, but are viewed ashaving intentions, of choosing roles to meet the exigencies of social life,and of using strategic actions to achieve personal or interpersonal goals(Sarbin, 1954, 1982; Sarbin & Allen, 1968). The assignment of agency tothe social actor is contained in the recognition that the self becomesinvolved in role enactment. It is a caricature of social role theory toregard human beings as basically “con artists” who employ interactionalstrategies to maximize gains and to minimize losses. Spanos andGottlieb (1979) explain:Role enactment or role playing may involve prescribedpatterns of subjective experience as well as overt behavior.76This notion implies neither that enactments involve a lack ofpersonal conviction nor that they involve a superficial goingthrough the motions without a subjective involvement. Onthe other hand, role playing perspectives do not precludeanalysis of such phenomena as faking or disinterestedenactment (p. 528).Demonic possession may be conceptualized as a strategic socialrole enactment that is inextricably linked to the specific requirements ofcertain social contexts often found in Christian Charismatic groups,rather than as a symptom of diseased mental processes.The Theoretical Contribution of Nicholas SanosFor over two decades, Nicholas Spanos has conducted empiricalinvestigations of phenomena associated with hypnosis (Spanos, 1982a,1982b; Spanos & Radtke, 1982), multiple personality disorder (Spanos,1986; Spanos, Weekes, & Bertrand, 1985; Spanos, Weekes, Menary, &Bertrand, 1986) and demonic possession (Spanos, 1978, 1983, 1989;Spanos & Gottlieb, 1979) from a social role perspective. Spanos (1983,1983) argues that such Charismatic phenomena as glossolalia anddemonic possession are, despite strange and dramatic externalappearances, essentially similar to other forms of complex socialbehavior insofar as they involve purposeful, goal-directed action. Assuch, demonic possession behavior can best be understood by examiningthe interpretations that people hold about their situation, the selfimpressions they attempt to convey and legitimate through their roleenactments, and the shaping and validation of their behavior bysignificant others. The conceptualization of demonic possession as role77enactment is a dominant explanation among anthropologists, asillustrated by Bourguignon (1976) with regard to Haitian voodoo:.Possession offers alternative roles, which satisfy certainindividual needs, and it does so by providing the alibi thatthe behavior is that of the spirits and not of the humanbeings themselves (p. 40).Possession beliefs and socialization into the demonic role. It isdifficult to conceive of demonic possession behavior apart from a socialgroup that believes in demonic possession. Indeed, demonic possessionmay be interpreted as a socially constructed condition with a social cure(exorcism). Kemp and Williams (1987) comment as follows:It is generally believed that a key factor in producing a caseof possession syndrome is a culture or subculture whichbelieves in the reality of possession (p. 21).People who are demon possessed are actively engaged in enacting asocially structured self-presentation that conforms to implicitly andexplicitly held beliefs about what constitutes “being possessed” (Spanos,1989). Membership and participation in a religious group that espousessuch beliefs provide the learning environment in which socialization intothe demonic role can occur.Demonic enactments as strategic: social learning and socialreward. Spanos (1989) suggests that the major components of thedemonic role have historically been well known, and that exposure topossession experts defines the more subtle aspects of the role in greaterdetail. The possibility of learning to persuasively enact unusual religiousbehavior typically ascribed to the supernatural, such as glossolalia (anexample of positive spirit possession), has already been demonstrated78(Cohn, 1968; Spanos & Cross, 1986. See also Zuk, 1989). Currentsources of information about the demon possessed role are biblicalstories of demon possessed people, verbal or published personaltestimonies from those who have experienced demonic possession orfrom the case reports of exorcists, workshops concerning demonpossession and exorcism, and the modeling of those exhibiting demonicmanifestations in public church meetings (either seen directly or viatelevision) and in movies.Spanos (1983) recommends against taking reports of suchpossession phenomena as convulsions, increased intelligence,clairvoyance, amnesia, superhuman strength, various extraordinarysensory experiences, and experienced involuntariness at face value, butas strategic aspects of goal-directed role enactments. For example, acentral feature of the demonic role involves conveying the impressionthat behaviors are no longer under personal control. However, conveyingthis impression convincingly requires the actor to retain precisebehavioral control in order to appropriately gear demonic enactments tocontextual demands in a manner consistent with the prevailingconception of what it means to be demon possessed. Hence, responsivedemoniacs may act as if their possession behavior occurs involuntarilybecause their preconceptions about exorcism define involuntary behavioras an integral and authenticating aspect of the demon possession role.Their reports of involuntariness, like those of hypnotic subjects, reflect acontextually fostered interpretation employed by them to explain theirown responses. Such reports, however, are not believed to reflect a79transformation from purposeful actions into involuntary behavioralevents (Spanos, 1986, 1989).The convincing enactment of the demonic possession role usuallyresults in various social rewards, such as increases in social position orstatus (e.g., becoming the star attraction in a cosmic battle between theforces of Heaven and Hell; or perhaps being offered a new and valuedministry position), sympathetic attention (especially from higher-statusindividuals such as the clergy), practical help and respect or awe(Mischel & Mischel, 1958; Spanos, 1983, 1989). These social rewardsmay be particularly attractive to the socially powerless, an important linkto the deprivation hypothesis regarding demonic possession.There are also institutional rewards associated with demonicpossession and exorcism; that is, social groups perpetuate possessionbeliefs because of certain vested interests (Spanos, 1983, 1989). Forexample, Spanos suggests that the Christian church has maintained thedemoniac role because the role may be associated with a number ofimportant social functions: a culturally consistent explanation forvarious physical disorders and for otherwise inexplicable propriety normviolations, a means of re-integrating deviants into the social community,an ideological tool used to reinforce certain religious and moral valuesincluding the authority of the church while denigrating the values ofreligious competitors, a proselytizing device, a religiously sanctionedchannel for allowing (while simultaneously controlling) some expressionsof social and personal dissatisfaction and, finally, a means of controllingpersonal, political, or ideological enemies by having the demoniac identify80them as witches. Additional vested interests may include the following:(1) the role of possession beliefs in maintaining a male-dominated,hierarchical view of power and authority in the church (e.g., the necessityfor women to stay under the protective covering of a man’s spiritualauthority or else become vulnerable to the demonic); (2) the role ofdemonic possession and exorcism in affirming a Pentecostal andCharismatic supernaturalistic world view; (3) the use of demonicpossession and exorcism as a way of regulating unacceptable behavior orsocial deviance; and, (4) the function of possession beliefs in promotingan awe-inspired cohesion in the life of the church group threatened bydisunity.Social role theory and personality traits. Spanos (1983) arguesthat “.. .an adequate theoretical account of deviant social behaviors isunlikely to be facilitated by the straightforward application ofdispositional concepts...” but by “...scrutiny of the social context in whichthe behavior occurs and examination of the understandings held by theparticipants in the social interaction” (pp. 187-188). However, heacknowledges that certain personality variables may enable someindividuals to enact a particular social role more effectively than others(Spanos & Gottlieb, 1979). For example, in a discussion of the historicalinterrelations between the demon possessed, hysterical and magnetizedroles, Spanos and Gottlieb comment on the suitability of certainpersonality traits to the hysterical role enactment:Nineteenth century investigators regularly describedhysterics as highly imaginative, attention seeking,suggestible females with a strong flair for the dramatic.81When stripped of pejorative connotations, such a descriptionseems to refer to individuals who enjoy and are highly skilledat becoming absorbed in a variety of “make-believe” role-playing endeavors. Given the appropriate definition of thesituation along with the requisite interpersonal cueing andreinforcement, it is not surprising that such individualswould be particularly adept at enacting both the hystericaland the magnetized role (p. 541).Bourguignon (1976) suggests that people enact demonic roles and theirassociated experiences “not only because cultural learning of thisbehavior is available but also because they have the personalitystructures, resulting from their particular upbringing and lifeexperiences, that make them apt to engage in such behavior and to findit personally as well as socially rewarding” (p. 41).Individuals who “enjoy and are highly skilled at becoming absorbedin a variety of ‘make-believe’ role-playing endeavors” (Spanos & Gottlieb,1979, p. 541) may more fully immerse themselves in the demoniac rolethan others, thereby giving a more compelling role performance. Suchcharacteristics are associated with trait absorption. The rich imageryand symbolism of the demonic may also tend to capture the imaginationof such individuals more completely and subtly attract them to thedemoniac role. A related but more comprehensive construct in socialrole theory is organismic involvement (Sarbin, 1982). Another relatedconstruct is openness to experience, one of five basic personalitydimensions postulated by McCrae and Costa (1985).The demoniac role might be more effectively enacted by theindividual with high acting aptitude. Perhaps such an individual wouldalso be more inclined to become engaged in the demoniac role.82Spanos (1983, 1989) maintains that compelling demoniac roleenactment requires sensitivity to the subtle nuances, behavioral cuesand demand characteristics of the social situation. Individuals who tendto be especially sensitive to the expressive behavior of others in socialsituations and who use such behavior as situational cues to guide themanagement of their own social behavior would be more likely tosuccessfully enact the demoniac role than others. Such individuals havebeen described as high self-monitors.In an ironic twist, Spanos (1989) argues that the convincingenactment of involuntary demonic behavior requires the demoniac toretain precise behavioral control. The expectancy of such control insocial situations is a central feature of high internal interpersonal locusof control.Finally, Spanos (1989) suggests that information regarding themajor components of the demonic role are readily available throughvarious media and the modeling of possession experts. Individuals whohave greater demoniac role knowledge are likely to be better prepared tosuccessfully enact the demoniac role than others.DiscussionDemonic possession may be conceptualized as a socially createdand legitimized role enactment that fulfills certain social functions andgoals (Berger & Luckmann, 1966; Spanos, 1983, 1989; Spanos &Gottlieb, 1979). As a role enactment, demonic possession is a learnedand socially rewarded pattern of interpersonal behavior aimed atconveying and sustaining the impression that one is possessed by evil83spirits in order to obtain certain social rewards. Demonic possessiondisplays are shaped by contextual factors that lead actors to interprettheir goal-directed actions as involuntary happenings.Certain personality variables may facilitate a more persuasiveenactment of the demonic role, such as openness to experience,absorption, role-playing aptitude, self-monitoring and interpersonal locusof control.Although Spanos’ theoretical account of demonic possession isconceptually rich, it is neither as parsimonious as other non-statealternatives (e.g., see Kirsch, 1986, regarding expectancy theory) nor ascomprehensive as the many varied expressions of demonic possessionphenomena demand. Furthermore, Spanos clearly underplays the role offunctional psychopathology, although he allows for the role of organicpathology in demonic possession displays; in fact, he seems prepared tore-interpret functional psychopathology altogether as social psychologicalphenomena. Is the demonic possession display of the exorcism-seekerwho presents with chronic psychotic pathology to be interpreted as astrategic role enactment? Is all functional psychopathology to beinterpreted in this way? Perhaps Spanos’ approach is best suited fortransient displays of demonic possession in the absence of prominentpsychopathology and a history of chronic psychological disorder.Spanos has not offered a specific model of demonic possession pSe, but rather a cognitive social psychological approach to unusualphenomena in general. Direct empirical testing of his theoretical ideas84regarding demonic possession awaits the specification of a possessionmodel.A more troubling matter is the incongruence between the self-report of demonic possession by people who have experienced demonicpossession and Spanos’ social psychological explanation of demonicpossession. For example, exorcism-seekers tend to insist that theirdemonic possession displays are quite involuntary, not strategicenactments for interpersonal gain, and some report amnesic episodes.However, Spanos (1983, 1989), in a striking irony, argues for the veryopposite: exquisite behavioral control is necessary in order toconvincingly enact the demonic role requirement of involuntariness andin some cases amnesia.Only by maintaining the behavioral control necessary toguide their actions in terms of culturally defined roleprescriptions can they convincingly present themselves asthe victims rather than the perpetrators of their own actions(Spanos, 1989, p. 97).Of clinical concern in this regard is the use of Spanos’ approach as alegitimization of countertransference reactions that minimize or evendeny painful reports of trauma, particularly child abuse. Thesecountertransference reactions can arrest the difficult task ofacknowledging painful memories and foster instead a collusion ofavoidance (Fleming, 1989; for an alternative view, see Ganaway, 1989).Finally, social role and mental illness views of demonic possession,though contrasting, are not necessarily incompatible. The formeraddresses abnormal intrapsychic processes, whereas the latter addresses85socio-cultural considerations, such as situational, interpersonal, societal,demographic and economic variables.Psychological Approaches to ExorcismExorcism, like demonic possession, varies in form, practice,experience and meaning as a function of the culture within which it isembedded. Various underlying psychological processes have beenadvanced to explain exorcism phenomena: abreaction (Sargant, 1957,1974; Davis, 1979), a placebo effect for those with high expectations ofchange (Blatty, 1971; Ward & Beaubrun, 1979; Ross & Stalstrom, 1979),the induction of an altered state of consciousness and heightenedsuggestibility (Ludwig, 1966; see also Prince, 1969; Berwick & Douglas,1977), perceptual shift through mysterious, ritualized experiences(Herscovici, 1986; Waters, 1986; n.b., O’Connor & Hoorwitz, 1984), aprojective identification process (Frederickson, 1983), and a roletransition phenomenon facilitated by self-identity change (Boyanowsky,1982).Regarding the efficacy of exorcism, there is no outcome research ofany consequence. A case report by Barlow, Abel, and Blanchard (1977)documenting a successful gender identity change in a transsexualthrough exorcism represents the best study of the effects of exorcism todate. The paucity of outcome research regarding exorcism represents anunfortunate state of affairs since the practice of exorcism raises an ageold dilemma: the conflict between religiously approved treatment andthe conventional treatments of the helping professions. Larson andLarson (1991) suggest that outcome research of religious treatment86would help to foster collaboration between pastoral counselors andhealth professionals.Exorcism Readiness FactorsExorcism-seekers may report certain attributes and expectationsthat facilitate their readiness to benefit from exorcism and offer supportfor a placebo model of exorcism. In the psychotherapy outcomeliterature there are numerous studies of the correlation of positivetreatment attitudes, treatment credibility, and outcome expectancies totreatment outcome (e.g., Garfield & Bergin, 1986).Implications for Hypothesis TestingIt is anticipated that the exorcism-seekers will show elevations inindices of positive attitudes, outcome expectancies and treatmentcredibility regarding exorcism. In this regard, it is incorrect to assumethat help-seekers will invariably have high expectations of theirtreatment or helper of choice. For example, help-seekers may bepursuing a particular treatment out of sheer desperation for any help atall or because alternative treatments have been exhausted.Discussion of the Present State of KnowledgeThe literature review identified several kinds of individualdifferences that may distinguish exorcism-seekers from those who do notseek exorcism: basic personality descriptors, psychosocial vulnerabilityfactors, psychopathological conditions, dispositional variables that mayfacilitate the persuasive enactment of the demoniac social role, religiousfactors and exorcism readiness factors.87Studies of relevance to the diagnostic and personality correlates ofexorcism-seekers have serious methodological limitations, especially theabsence of control groups. The association between demonic possessionand psychopathology in the archival studies is virtually guaranteed bythe use of a psychiatric sample. The diagnostic reliability and validity ofthese studies is uncertain. The specific nature and religious frameworkof the demonic possession appears to vary both within and betweenstudies, thereby introducing undesirable criterion variance. In Whitwelland Barker’s (1980) study, for example, two of the female subjectsclaimed to be possessed by a man’s spirit and the majority of the othersubjects were not affiliated with a particular religious organization.Furthermore, as two of the studies used Trinidadian samples and one ofthe studies used a French sample, cultural variation makes comparisonacross samples tentative.Ward and Beaubrun’s (1981) study is an exception to most of theaforementioned criticisms. For example, their study uses a matchedcontrol group and a specific, non-psychiatric religious population fromwhich the entire sample is drawn. The study employs only establishedpsychometric measures and uses appropriate statistical tests todetermine between-group differences. However, Ward and Beaubrun’sresearch is limited in size and scope (i.e., only two dependent variables),and its cultural setting makes comparison to North American samplesuncertain.88ObjectivesThe literature review has identified multiple clinical andpersonality correlates of demonic possession observed and discussed forover 400 years. However, empirical studies have only been undertakenin the past 30 years. These studies have been of an exploratory natureand almost entirely limited to psychiatric populations. The noteworthycontribution of Ward and Beaubrun (1981) notwithstanding, there hasbeen no systematic and comprehensive attempt to empirically investigateclinical and personality correlates of exorcism-seekers from a generalpopulation.While the present study incorporates the strengths of Ward andBeaubrun’s (1981) work by using a matched control group and a specificreligious sample, the study also expands and moves beyond their work inseveral ways. A larger sample and two control groups are used.Numerous church groups of the same religious conviction, as opposed toa single church group, supply subjects, thereby enhancing therepresentativeness of the sample. A greater number of dependentvariables derived from a more comprehensive review of the literature areused. For example, the study explores differences between exorcismseekers and control subjects regarding psychosocial vulnerability factors,social role variables, religious variables and exorcism readiness factors.Multivariate statistical analyses determine between group differences andidentify variables that best distinguish between exorcism-seekers andcontrol subjects. The use of a North American sample will move thestudy of demonic possession and exorcism to a larger North American89population, thereby permitting cross-cultural comparisons of interestand the appropriate application of treatment implications.Finally, the study attempts to replicate Spanos and Moretti’s(1988) study of diagnostic and personality correlates of diabolicalexperiences. Spanos and Moretti’s sample was limited to females whoreported low levels of diabolical experience (jyl = 24.2; = 20.8). Areplication of their study will be attempted using a religious sample ofroughly equal size consisting of both female and male subjects.HypothesesThe hypotheses are presented (see Table 5) and their individualrationales summarize the relevant research from the literature review.The Basic Personality Hypothesis: RationaleThe literature review yielded only one controlled psychometricattempt to determine the normal personality correlates of demonicpossession. Ward and Beaubrun (1981) found significantly greaterneuroticism in their sample of 10 demon possessed TrinidadianPentecostals than a matched control group of non-possessed Pentecostalchurch attenders. Their finding of greater neuroticism, although inkeeping with a traditional association between demonic possession andemotional instability and a positive association between diabolicalexperiences and Eysenck’s Neuroticism scale (Spanos & Moretti, 1988),is contrary to the results of Neanon and Hair’s (1990) study ofEysenckian personality correlates of Charismatic and non-Charismatic90Table 5. List of Primary HypothesesThe Basic Personality HypothesisThere will be significant differences between exorcism-seekers andcontrol subjects in major dimensions of normal personality.The Psychosocial Vulnerability HypothesisExorcism-seekers will report significantly greater psychosocialvulnerability than control subjects.The Psychopathology HypothesisExorcism-seekers will report significantly greater psychopathologythan control subjects.The Social Role HypothesisExorcism-seekers will report significantly greater personalitydifferences of relevance to their effective enactment of the demoniacrole than control subjects.The Religious Factors HypothesisThere will be significantly higher diabolical experience and lowerintrinsic religious orientation in the exorcism-seekers group than inthe control group.The Exorcism Readiness HypothesisThere will be significant differences in variables related to exorcismpreparedness between exorcism-seekers and control subjects.91Christians. However, following Francis’ (1991) recommendation offurther research into the relationship between religion and personalityamong specific religious samples, the author has proposed thatCharismatic Christians who report diabolical experiences, such asdemonic possession, may constitute a special population of Christianswho are distinguished by high neuroticism; that is, exorcism-seekers areindividuals who are more susceptible to psychological distress, moreprone to unrealistic ideas, and less able to cope under stress than otherchurch attenders.Perhaps exorcism-seekers may also be distinguished by anaptitude for imaginative and fantasy involvement that renders them morelikely to be open to the very notion of demonic influence, to becomepreoccupied by demonic ideation during times of personal distress and toseek the drama of exorcism to expunge their inner demons than others.In support of this proposal, the literature review pointed to a venerableassociation between hysteria and demonic possession which Ward andBeaubrun (1981) empirically verified. It is assumed here thatimaginative involvement is positively correlated with traditional hysteria,a correlation suggested by Spanos and Gottlieb (1979). Furthermore,Nelson (1989) found that capacity for imaginative involvement was highlydiscriminative of frequency of paranormal experience in a generalpopulation sample. However, a study using a special population sampleof Charismatic and non-Charismatic Christians (Neanon & Hair, 1990)did not find statistically significant differences in imaginativeinvolvement.92The Psychosocial Vulnerability Hypothesis: RationaleThe literature review indicated a long-standing association betweendemonic possession and psychopathology. Perhaps this psychopathologyis fostered by certain psychosocial conditions, such as significant life-event stress. Personality and social variables have been advanced asmediators of the stress-distress relationship, such as social isolation,poor social support, weak self-efficacy and neuroticism.The Psychopathology Hypothesis: RationaleThe literature review identified multiple psychopathologiccorrelates of demonic possession. These correlates may be organized intothe following categories: mood disturbance, obsessionality, dissociativeexperiences, formal thought disorder and personality disorder.The Social Role Hypothesis: RationaleThe literature review pointed to certain personality variables thatmay facilitate a more persuasive enactment of the demoniac role;specifically, role-playing aptitude, absorption, self-monitoring andinterpersonal locus of control. In addition, Spanos (1989) has discusseddemoniac role knowledge in relation to effective demoniac roleenactment.The Religious Factors Hypothesis: RationaleThe literature review identified intrinsic religious orientation anddiabolical experiences as two religious factors that may distinguishexorcism-seekers as a special religious population and help to clarify therelationship between religion and mental health. Given the traditionalassociation between demonic possession and psychopathology and the93positive correlation between intrinsic religious orientation and mentalhealth, it is anticipated that the exorcism-seekers of the present studywill report a weak intrinsic religious orientation. It is also expected thatexorcism-seekers will report considerable diabolical experiencesassociated with the demonic possession for which they are seeking acure.The Exorcism Readiness Hypothesis: RationaleThe literature review suggested that certain cognitive factors, suchas positive attitudes, outcome expectancies and treatment credibilityregarding exorcism, may play a role in the preparedness of individuals tobenefit from exorcism and offer support for a placebo model of exorcismefficacy.CHAPTER 3METHODOLOGYResearch DesignThe research design is a case control field investigation of a specialpopulation. The design was chosen for its appropriateness to theprimary research question: how do exorcism-seekers differ from similarindividuals who do not seek exorcism? In addition, the design requiresminimal experimental control, a prerequisite of participation demandedby the clergy, exorcists and exorcism-seekers involved in the study. Theexperimental variable was a behavioral one, exorcism-seeking. Thedependent variables were the self-report questionnaire responses of threegroups of volunteer subjects: a group of exorcism-seekers, a matchedcontrol group and a randomly-selected control group.SubjectsThree groups of subjects were recruited: exorcism-seekers,matched control subjects, and randomly selected control subjects.The Exorcism-SeekersA convenience sample of 40 exorcism-seekers was obtained withthe help of participating clergy. Typically, members of the clergy or other9495church personnel informed exorcism-seekers about the present study,asked whether there was interest in pursuing the matter further, and ifso, obtained consent for contact from the author. If the exorcism-seekerconsented, the author contacted the person and, after a briefpresentation regarding the study, asked questions related to the selectioncriteria. If the person fulfilled the selection criteria, consent toparticipate in the study was requested.Selection criteria are as follows:1. Possession belief, as determined by an affirmativeresponse to the question, “Do you currently haveproblems that you attribute, at least in part, to thedeñionic?” (cognitive marker).2. Is currently seeking or in the process of receivingexorcism (behavioral marker).3. At least an elementary school education.The Matched Control SubiectsForty volunteer control subjects, matched for gender, age,education, socio-economic status, race and church affiliation were askedto participate. Selection criteria were as follows:1. No possession belief, as determined by a negativeresponse to the question, “Do you currently haveproblems that you attribute, at least in part, to thedemonic?”2. Is not currently seeking or in the process of receivingexorcism.3. At least an elementary school education.As each exorcism-seeker entered the study, his or her churchaffiliation was identified. A member of the clergy from a church with the96identified affiliation was contacted and asked for help with the study. Achurch member who met the matching criteria was contacted by churchpersonnel, informed of the present study, asked whether there wasinterest in pursuing the matter further, and if so, obtained consent forcontact from the author. This potential control subject was contactedand, after a brief presentation regarding the study, was asked questionsrelated to the selection criteria. If the person was appropriate for thestudy, consent to participate in the study was requested.The Randomly-Selected Control SubjectsA second unmatched control group ( = 48) was randomly selectedfrom three major Charismatic churches located in three different sectorsof the Vancouver Lower Mainland. The purpose of this control group wasto provide information of relevance to the representativeness of thematched control group and the effects of selection bias.The respective church pastors were contacted and asked for theirendorsement of the study and cooperation. A random sample of 60names was obtained from each church membership list, for a total of 180church members. Letters of invitation were sent that containedinformation regarding the nature of the study and questionnaires andthe conditions of their participation. Selection criteria are as follows:1. A current church attender.2. At least an elementary school education.97InstrumentationThe instrumentation consisted of a battery of self-reportquestionnaires that operationalized various constructs of theoreticalrelevance to demonic possession and exorcism (see Table 6). Thequestionnaires were published in the literature and had demonstratedacceptable psychometric properties. One experimental questionnairewas devised by the author for the study.Measures of Basic PersonalityOne questionnaire was chosen of relevance to the basic personalityhypothesis, the NEO Five-Factor Inventory (NEO-FFI; Costa & McCrae,1989). The NEO-FFI, a shortened version (60 items) of the NEOPersonality Inventory (NEO-PI), measures the “big five” personalityfactors: neuroticism (N), extraversion (E), openness to experience (0),agreeableness (A), and conscientiousness (C). The inventory requires asixth-grade reading level, takes 10 to 15 minutes to complete, and uses a5-point rating scale (I strongly disagree (1), I strongly agree (5)). Anormative sample ( = 983 adults; Costa & McCrae, 1988) yieldedinternal consistency coefficient alpha values of .89, .79, .76, .74, and .84for N, E, 0, A, and C, respectively. Test-retest reliability has not yet beenassessed, although the stability of the full NEO-PI scales is sufficientlyhigh to anticipate adequate NEO-FFI stability. Correlations between theNEO-FFI and the NEO-PI range from .75 for C to .89 for N.98Table 6. List of Dependent MeasuresQuestionnaire Constructs MeasuredMeasures of Relevance to the Basic Personality HypothesisNEO-Five Factor Inventory (NEO- The “Big Five” personality traits:FF1) neuroticism, extraversion,openness to experience,agreeableness, conscientiousnessMeasures of Relevance to the Psychosocial Vulnerability HypothesisLife Events Scale (LES) Three and six month perceivedlife-event stressFamily, friend and significantother perceived social supportSocial isolationSelf-efficacyMeasures of Relevance to the Psychopathology HypothesisMultiple Affect Adjective Check Dysphoric mood, positive affect,List-Revised (MAACL-R) sensation-seekingSleep Questionnaire Sleep disturbanceLeyton Obsessional Inventory- Obsessive-compulsive traits andModified symptomsMultidimensional Scale of PerceivedSocial SupportUCLA Loneliness Scale, RevisedSpheres of Control Scale: PersonalControl(table continues)99Questionnaire,.a —lConstructs MeasuredQuestionnaire of Experiences ofDissociation (QED)Millon Clinical MultiaxialInventory-IT (MCMI-II)Measures of Relevance toDeliverance Prayer QuestionnaireRole-Playing ScaleAbsorption ScaleRevised Self-Monitoring ScaleSpheres of Control Scale:Interpersonal ControlMea11rs of Re1e’ to theDiabolical ExperiencesQuestionnaireDissociative symptomatologyDSM-III-R-like pathology: clinicalsyndromes & personality scales.the Social Role HypothesisDemoniac role knowledge.Role-playing aptitudeAbsorptionImpression management,interpersonal sensitivityInterpersonal locus of controlReligious Orientation Scale____Religious Factors HypothesisDiabolical experiences of demonicpresence, influence, assault,revelation, controlIntrinsic and extrinsic religiousorientationMeasures of Relevance to the Exorcism Readiness HypothesisDeliverance Prayer Questionnaire Exorcism attitudes, expectancy &credibility; religious beliefs100On average, convergent correlations between the NEO-FFI scales andadjective factors, NEO-PI spouse ratings and NEO-PI mean peer ratingssuggest that the NEO-FFI scales account for approximately 75% as muchvariance in the convergent criteria as do the full NEO-PI scales. Genderdifferences have been found: women score higher on the NEO-FFI N andA scales than men, a finding that mirrors NEO-PI results.In addition to the NEO-FFI scales, the full NEO-PI Openness toExperience scale with its six facet subscales was also used. Internalconsistency alpha coefficients for this scale are high: for men (n = 360),.86, and for women (n = 290), .88. The six month test-retest correlationis .86 (n = 30 men and women). Internal consistency coefficients for theindividual facets range from .60 to .86. Adequate construct validity hasbeen demonstrated by convergent coefficients with related measures(e.g., Absorption scale, .56, = 48, p < .00 1), external ratings, andvariables outside the domain of personality (Costa & McCrae, 1985).Measures of Psychosocial VulnerabilityLife Events ScaleLife-event stress was measured by the Life Events Scale, a versionof the Social Readjustment Rating Scale (Holmes & Rahe, 1967) alteredto incorporate three and six month ratings (for a recent critical review ofchecklist methods of measuring stressful life events, see Raphael, Cloitre,& Dohrenwend, 1991).The Multidimensional Scale of Perceived Social SupportPerceived social support was measured by the MultidimensionalScale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, &101Farley, 1988). The MSPSS is a 12-item measure of subjectively assessedsocial support with three factor-derived subscales: family, friends andsignificant others support. Scale items were rated on a 7-point Likerttype scale ranging from very strongly disagree (1) to very strongly agree(7). The MSPSS demonstrated adequate reliability in a sample of 275male and female university undergraduates. Internal consistencycoefficients (Cronbach’s alpha) ranged from .85 to .91 for the total scaleand the three subscales (Zimet et al., 1988). Test-retest values rangedfrom .72 to .85. A subsequent study using three samples obtainedcomparable reliability estimates (Zimet, Powell, Farley, Werkman, &Berkoff, 1990). The factorial structure of family, friends and significantothers support remained stable across the four samples of Zimet et al.’stwo studies. Moderate construct validity was also demonstrated in thetwo studies. Gender differences were found: women reportedsignificantly greater overall social support than men, and greater specificsupport from friends and significant others. Finally, Zimet et al. (1990)criticized the MSPSS for a tendency to elicit socially desirable responsesand for ambiguity regarding what is constitutive of “family” in the Familysubscale and of “special person” in the Significant Other subscale.The UCLA Loneliness Scale, RevisedSocial isolation was measured by a short form of the UCLALoneliness Scale, Revised (ULS-8). In their factor analysis of the revisedUCLA Loneliness Scale (20-item version), Hays and DiMatteo (1987)found that eight of 20 scale items loaded substantially on the firstunrotated factor which accounted for 67.44% of common variance.102Hays and DiMatteo described these items as indicators of perceivedsocial isolation, as representative of the essence of loneliness (i.e., thedifference between desired and actual social contact), and as constitutinga new short form of the UCLA Loneliness scale. The ULS-8 has beenfound to be highly correlated with the 20-item version (r = .91). Internalreliability of the ULS-8 was high (alpha reliability coefficient = .84;n = 192). Furthermore, item discrimant validity was established in astringent test involving conceptually related constructs.Spheres of Control Scale: Personal Control SubscaleSelf-efficacy was measured by the Personal Control (PC) subscaleof the Spheres of Control Scale, version three (SOC-3; Paulhus, 1983;Paulhus & Christie, 1981; Paulhus & Van Selst, 1990). The SOC-3 is a30-item, multidimensional measure of locus of control. The conceptualsystem underlying the SOC-3 involves the systematic partitioning of theindividual’s control expectancy in terms of three independent, behavioralspheres: personal efficacy, interpersonal control, and sociopoliticalcontrol (Paulhus, 1983). Consequently, the individual may becharacterized by a control profile, “a pattern of expectancies that he orshe brings into play in confronting the world” (Paulhus, 1983, p. 1254).The 10-item PC scale measures the individual’s expectancy of being incontrol of the nonsocial environment in situations of personalachievement. The scale has been found to have reasonable convergentand discriminant validity. For example, the scale demonstratesmoderate positive correlations with other established measures of suchconstructs as generalized expectancy for success, achievement103internality, academic self-efficacy, and especially general self-efficacy(Paulhus & Van Selst, 1990).The PC scale of the SOC-3 represents a revision of previousversions in order to strengthen internal consistency and constructvalidity. The PC scale had been criticized for heterogeneity of itemcontent. Specifically, it was argued that the PC scale included itemstapping two separate facets of perceived control: perceived competence(self-efficacy) and locus of control (contingency). The scale was thereforerevised in order to focus on one facet of perceived control, perceivedcompetence or self-efficacy. As a consequence, the PC scale now has animproved internal consistency: the alpha reliability coefficient of thescale is now .80, compared to a median reliability of .59 for the originalscale.Measures of PsychopathologyThe Multiple Affect Adjective Check List-RevisedDysphoric mood, an unpleasant, pervasive and persistent emotion,such as anxiety, depression or irritability, was measured by the MultipleAffect Adjective Check List-Revised (MAACL-R; Zuckerman & Lubin,1985; Zuckerman, Lubin, & Rinck, 1983), Trait (General) form. TheMAACL-R is a 132 item, self-report checklist list with five scales:Anxiety, Depression, Hostility, Positive Affect and Sensation-Seeking.The first three scales may be combined to form a Dysphoria scale (Dys),and the remaining two scales, a Positive Affect/Sensation-Seeking scale(PASS). The trait form asks the respondent to check those adjectiveswhich “generally apply.” A state form is also available. All adjectives are104at or below an eighth-grade reading level. The checklist is untimed andtypically requires approximately five minutes to complete. Responsesheets are considered invalid if no items are checked or more than 92items are checked. Raw scores are converted to male or female standard(T) scores which control for an acquiescence response set and genderdifferences, and reduce intercorrelations between the Dys subscales.Normative data for the MAACL-R trait form was obtained from aU.S. national area probability sample ( = 1,491) designed to produce anapproximation of the American adult civilian population, 18 years andolder, with proportional representation for sex, racial, regional,educational, and income distributions (Lubin, Zuckerman, Breytspraak,Bull, Gumbhir, & Rinck, 1988). Internal (alpha) reliability coefficientswere obtained from seven samples in addition to the normative sample(Lubin, Zuckerman, Hanson, Armstrong, Rinck, & Seever, 1986). Allscales showed satisfactory internal consistency with the exception of theSensation-Seeking scale. The Positive Affect, Dys and PASS scalesdemonstrated the best internal reliability as most of their alphacoefficients were greater than or equal to .90. In addition, most test-retest reliabilities (2-8 week retest intervals) derived from college studentsamples were satisfactory, with the exception of Positive Affect and PASSscales. Finally, validity studies based on a variety of general and clinicalsamples support the convergent validity of all the scales, butdiscriminant validity for only some of the scales (Zuckerman & Lubin,1985). In particular, high negative correlations between MMPI clinicalscales and the Positive Affect scale suggest that the latter may be as105useful in predicting clinical depression as the MAACL-R Depression scaleor the other Dys scales. Furthermore, in their diagnostic study of 200psychiatric patients and 200 matched control subjects, Zuckerman,Lubin, Rinck, Soliday, Albott and Carison (1986) found that a simplelinear combination score, D-PA, was highly efficient in discriminatingdepressed patients from schizophrenics, other types of patients andnormal subjects.Sleep Disturbance ScaleSleep disturbance was measured by the Sleep Disturbance Scale(Coren, 1988; 1993). The 6-item scale has demonstrated high reliabilityin terms of both internal consistency (alpha = .87) and stability (onemonth test-retest correlation = .89).Leyton Obsessional InventoryObsessive symptoms and traits were measured by a modified formof the Leyton Obsessional Inventory (LOl; Cooper, 1970). Althoughreliability information is sparse, Cooper (1970) reported a test-retestcorrelation of r = .87 for symptom scores and r = .91 for trait scores(n = 30). The LOl was originally developed as a measure of obsessionalityamong houseproud and normal housewives. However, subsequentstudies have confirmed a reasonably stable factorial structure amongboth normal (Cooper & Kelleher, 1973; Kazarian, Evans, & Lefave, 1977)and obsessive-compulsive samples (Murray, Cooper, & Smith, 1979), andsupported the discriminant validity of the LOl with such samples. Theseresults are in keeping with a view of obsessionality as a continuum alongwhich individuals differ quantitatively rather than qualitatively, as106opposed to an obsessional patient/non-patient dichotomy (n.h., thecontinuum view of obsessionality has been criticized by Pollak (1987).The modified form of the LOl used in the present study consisted of22 items representing four factors: Counting-Checking-Repetition,Clean-Tidy, Dissatisfaction-Incompleteness, Methodical-Careful. Thefirst three of these factors consistently emerged across normal andclinical samples, whereas the Methodical-Careful factor has only emergedin factor analyses of normal samples (Cooper & Kelleher, 1973).Responses to the 22 items were elicited using a five-point Likert scalewith the following anchor words: never, seldom, occasionally, frequently,and always.Questionnaire of Experiences of DissociationDissociation was measured by the Questionnaire of Experiences ofDissociation (QED; Riley, 1988). The QED consists of 26 true/false items“drawn from the clinical literature describing experiences reported by‘classical’ hysterics, patients with dissociative and multiple personalitydisorders, and the dissociative experiences associated with temporal lobeepilepsy” (Riley, 1988, p. 449). The internal reliability of the QED issatisfactory (Cronbach’s alpha coefficient = .77). The performance of theQED in both normal and clinical samples is presented in the Resultschapter (see Table 24).The Millon Clinical Multiaxial Inventory. Second EditionSeveral scales of the Millon Clinical Multiaxial Inventory, SecondEdition (MCMI-II; Millon, 1987) were used in the testing of thepsychopathology hypothesis of demonic possession. In addition, the107MCMI-Il provided a multidimensional assessment of exorcism-seekersand control subjects.Theoretical derivation of the MCMI-II. The development of theMCMI-II was guided by Millon’s biopsychosocial model of personalitypathology (Millon, 1986a, 1986b, 1987, 1990; see Table 7). The modelproposes a social learning formulation of Freud’s “three great polaritiesthat govern mental life” (cited in Millon, 1986a): positive-negative(reinforcement nature), self-other (reinforcement source), and active-passive (instrumental behavior). The first polar dimension refers to theprimary source from which individuals gain comfort and satisfaction(positive reinforcement) or attempt to avoid emotional pain and distress(negative reinforcement), and consists of five types: detached,discordant, dependent, independent and ambivalent. The remaining twopolar dimensions, self-other and active-passive, are coping strategies ofmaximizing comfort or minimizing pain. The self-other dimension refersto the direction an individual turns in order to experience pleasure oravoid pain. The active-passive dimension refers to an initiating oracquiescent orientation to maximizing comfort or minimizing pain (seeTable 7). Normal personality functioning is defined, in part, by balancein each of the dimensions (Millon, 1990). The three polar dimensions,variously combined, result in 10 basic pathological personality stylesthat are intended to be comparable to DSM-III-R (APA, 1987) Axis IIdisorders and viewed as quantitatively pathological variants of a normalpersonality pattern (see Table 8).108Table 7. Table of Theoretical Constructs Underlying MCMI-II PersonalityDisorder ScalesReinforcement Nature Reinforcement SourceOther + Self + Self <-> Pain <-> Pleasure -Self - Other- Other Pleasure Pain ±Instrumental Dependent Independent Ambivalent Discordant DetachedBehavior/TypePassive Dependent Narcissistic Compulsive Self-Defeat SchizoidActive Histrionic Antisocial Pass.-Aggr. Aggressive AvoidantDysfunctional Borderline Paranoid Borderline Schizotypalor ParanoidNote. Table adapted from Millon (1986a).Table 8. Table of MCMI-II Scales109Personality Scales Clinical Scales Other Scales1.2.3.4.5.6.7.8.9.10.11.12.13.SchizoidAvoidantDependentHistrionicNarcissisticAntisocialAggressive!SadisticCompulsivePassive-AggressiveSelf-DefeatingSchizotypalBorderlineParanoid14. Anxiety15. Somatoform16. Hypomanic17. Dysthymic18. Alcohol Dependence19. Drug Dependence20. Thought Disorder21. Major Depression22. Delusional Disorder23. Disclosure24. Desirability25. DebasementCritical Item Scales26. Emotional Dyscontrol27. Health Preoccupation28. Interpersonal Alienation29. Self-Destructive Potential110Milon (1987) proposes three additional personality styles that aredistinguished from the other styles by such characteristics as deficientsocial competence and frequent episodes of psychotic behavior. Thesethree pathological personality styles are viewed as severe variants of theother styles that tend to appear under conditions of continuous stress.Indeed, Millon (1986a) distinguishes severity of personality pathologyalong a continuum of three categories: mild (e.g., dependent, histrionic,narcissistic, and antisocial personality disorders), moderate (e.g.,compulsive, passive-aggressive, aggressive, self-defeating, schizoid andavoidant personality disorders), and severe (e.g., borderline, paranoid,and schizotypal personality disorders).Millon (1987) also proposes nine clinical syndromes that areconceptualized as transient, stress-related reflections of the pathologicalpersonality styles, and as such, are interpreted only within the context ofthe personality disorders (see Table 8).The 13 personality disorders and nine clinical syndromes arerepresented by 22 scales that parallel the DSM-III-R (APA, 1987)nosology. In addition, there are three response set scales: disclosure(degree respondent is frank versus reticent), desirability (degree ofrespondent attempts to create a psychologically healthy and sociallyattractive impression), and debasement (degree respondent belittles selfand emphasizes psychological problems).Ouestionnaire items. The 25 MCMI-II scales consist of 175true/false items (Millon, 1987). The items were developed through athree-stage validation process: theoretical-substantive, internal-111structural, and external-criterion. The items require at least an eighthgrade reading level. Some scale scores are adjusted for a tendency ofcertain personality types to either deny or exaggerate emotionaldiscomfort (e.g., histrionic, narcissistic, compulsive versus avoidant, self-defeating).Scoring. Three types of scores can be calculated from the MCMI-IIitems: weighted raw scores, base rate (BR) scores, and prototypicalscores. Weighted raw scores have weights of one to three points that arecalculated in accordance with substantive, structural and externalvalidity requirements for each item (Hsu & Maruish, 1992). The greatestitem weight (three points) was assigned to those scale items that wereconsidered to be prototypical of the theory- and DSM- defined disorderthe scale was designed to measure. Two-point weights were assigned toitems if they met certain conditions. For example, item-scale correlationcoefficients must be greater than the lower 25% of the correlations of theprototypical items with the scale; and, the item’s endorsement frequencymust be greater than the lower 25% of the endorsement frequencies ofthe scale’s prototypical items. One-point weights were assigned to thoseitems that met either of the aforementioned two conditions and wereconsistent with theoretically expected co-variations. Weighted raw scoresare converted to base rate scores according to the prevalence data for thedisorder corresponding to each scale. Prototypical scores are calculatedby the summation of unadjusted three-point items for each scale.Normative data. Normative data were obtained from two patientsamples (Millon, 1987). Data from the first group of patients ( = 825)112consisted of MCMI-I and MCMI-II results and clinician-assigned Axis Iand Axis II diagnoses based on preliminary DSM-III-R (APA, 1987)criteria. Similar data was obtained from the second group of patients(n = 467) and their clinicians. In addition, the clinicians also provided asmany as three or more Axis I and Axis II diagnoses for each patient. Thetotal sample consisted of 1,292 patients, 643 males and 649 females,mostly outpatients (82%), of Caucasian ethnicity (88.7%), of Protestant(44.7%) or Catholic (28%) religion, and almost half married or remarried.The lower age limit was 18 years.Reliability. The MCMI-II has demonstrated satisfactory reliability.For example, Millon (1987) reported stability coefficients (three to fiveweek test-retest intervals) for a variety of populations. Coefficients for 91nonclinical respondents were at least .79 or higher across scales. Thelowest stability coefficients reported by Millon were obtained from asample of 47 heterogeneous psychiatric inpatients. The coefficientsranged from .59 to .75 for the 10 basic personality scales, from .49 to .64for the three severe personality disorder scales, and from .43 to .66 forthe clinical syndrome scales. The findings were supported by Piersma(1989). Stability data for the two scale, high-point profiles of the MCMI-IIwere obtained from a sample of 168 heterogeneous psychiatric inpatientsand outpatients who were tested at three to five week intervals (Millon,1987). Approximately 65% of respondents had the same first or secondhighest MCMI-II scale on both administrations, and 45% had the samehighest two-scale profiles in the same or reverse order. Internal113consistency coefficients (Kuder-Richardson) ranged from .81 to .95across all personality and clinical scales, with a median coefficient of .90.Validity. The internal structure of the MCMI-II has been examinedin several factor analytic studies (Millon, 1987; Choca, 1992). To date,scale- and item-based factor analyses of the MCMI-II have not produceda consistent set of factorial solutions. The search for a stable factorialstructure has been hindered by considerable item overlap and evidenceof an acquiescence response bias. Lorr, Strack, Campbell, and Lamnin(1990) point to the problem of linear dependence when two or morescales share items, a condition that results in an intercorrelation matrixwith a degree of structure not provided by the subject responses alone.Item-based factor analyses have been utilized to circumvent the problemof item overlap. For example, Retzlaff, Lorr, and Hyer (1989) found eightpersonality and nine clinical factors in a sample of 207 male Veteran’sAffairs patients, and Lorr et al. (1990) found seven personality and fiveclinical factors in a sample of 248 male psychiatric patients.Satisfactory convergent validity of the MCMI-II has been foundtypically by comparing MCMI results with those from other instrumentsor procedures, the most common of which have been the MMPI andclinician-assigned diagnoses (Millon, 1987; Hsu & Maruish, 1992).Satisfactory discriminant validity has yet to be convincingly established,although early indications (e.g., Millon, 1987) are promising.Description of hypothesis-relevant personality scales. Thehistrionic personality is conceptualized according to Millon’s (1987)model of psychopathology as an active-dependent, other-oriented114personality disorder (see Table 7). Histrionic individuals tend to turn toothers as their source of affection, nurturance, security and guidance,and have this tendency in common with passive-dependents (e.g.,Dependent Personality Disorder). However, they differ from passive-dependent individuals in their creative and enterprising socialmanipulation, through which they maximize social attention, favor andstimulation while minimizing disinterest and disapproval. Their publicpersona exudes inner confidence and self-assurance, but is motivated bya fear of genuine autonomy and a need for repeated indications ofacceptance and approval.Reliability estimates of the Histrionic Personality Scale aresatisfactory to excellent (Millon, 1987). Stability coefficients (three to fiveweek retest intervals) ranged from .74 to .93 among heterogeneouspsychiatric inpatient and outpatient samples. A heterogeneous sampleof 825 psychiatric patients has demonstrated an internal consistencycoefficient (Kuder-Richardson) of .90.The compulsive personality disorder, according to Millon’s (1987)theory-based framework, is characterized by a passive-ambivalentinterpersonal orientation. Compulsive individuals tend to exhibit apublic impression of prudence, control, and perfectionism that disguisesan internal conflict between hostility for others and a fear of socialdisapproval. They resolve this ambivalence by suppressing resentment,overconforming, and placing high demands on themselves and others.An outer disciplined self-restraint serves to control intense inner angerand oppositional feelings.115Reliability estimates of the Compulsive Personality Scale areadequate (Millon, 1987). Stability coefficients (three to five week retestintervals) ranged from .70 to .85 among heterogeneous psychiatricinpatient and outpatient samples. The scale has demonstrated aninternal consistency coefficient (Kuder-Richardson;,= 825) of .91.The DSM-III-R (APA, 1987) Borderline Personality Disorder isassociated with several of Millon’s (1987) interpersonal orientations:dependent, discordant, independent, and ambivalent. As one of threesevere personality variants, Millon’s borderline personality ischaracterized by the experience of intense endogenous moods withrecurring periods of dejection and apathy interspersed with periods ofanger, anxiety or euphoria. Associated features include self-mutilatingand suicidal thoughts, preoccupations with the securing of affection,identity confusion, and a cognitive-affective ambivalence experienced assimultaneous feelings of rage, love, and guilt towards others.Regarding the reliability of the Borderline Personality Scale,stability coefficients (three to five week retest intervals) ranged from .49to .78 among heterogeneous psychiatric inpatient and outpatientsamples (Millon, 1987). The scale has demonstrated an internalconsistency coefficient (n = 825) of .92.Another of Millon’s (1987) severe personality variants, schizotypalpersonality, is characterized by a dysfunctional-detached orientation.Schizotypal individuals tend to be socially isolated and have minimalsocial attachments and obligations. Associated features includecognitive confusion, tangential thinking, self-absorption and rumination,116and behavioral eccentricity. Depending on whether their basicorientation is active or passive, schizotypal individuals display either ananxious wariness and hypersensitivity or an emotional flattening.The Schizotypal Personality Scale has shown satisfactory toexcellent reliability (Millon, 1987). Stability coefficients (three to fiveweek retest intervals) ranged from .64 to .84 among heterogeneouspsychiatric inpatient and outpatient samples. The scale hasdemonstrated an internal consistency coefficient (Kuder-Richardson;825) of .93.Problems. As normative data and transformation scores for theMCMI-II are based entirely on clinical samples, the MCMI-II isappropriately used only for “persons who evidence psychologicalsymptoms or are engaged in a program of psychotherapy orpsychodiagnostic evaluation” (Millon, 1987). Furthermore, Strack (1993)points to the extreme endorsement frequencies, low item-scalecorrelations and low internal consistency estimates as additionalcontraindications for the use of the MCMI-II in normal samples. As thecontrol subjects of the present study constitute a normal sample, it isassumed that their scale scores will likely be inflated as an artifact ofadjustment for the influence of response set biases and distress.Although item overlap is problematic for multivariate statisticalmethods, a certain amount of scale covariation is nevertheless consistentwith Millon’s (1987) “polythetic” model of psychopathology. A polytheticview of psychological disorders anticipates that prototypical features of adisorder will not be exhibited equally or uniquely by those who have been117diagnosed with that disorder, and therefore factorial purity was notexpected. Accordingly, Millon maintains that “the clinical scales of theMCMI-II overlap, intercorrelate, and cluster in a variety of ways, themajority of which accord well with the theoretical model” (p. 128).Regarding the problem of acquiescence, Strack, Lorr, and Campbell(1990) maintain that the tendency to endorse few or many test itemsirrespective of content can add unwanted variance to test scores,resulting in artificial scale intercorrelations.Measures of Social Role VariablesRole-Playing ScaleRole-playing ability was measured by a short form of the Role-Playing Scale (Hensley & Waggenspack, 1986). A study of the factorialstructure of the original 32-item Role-Playing Scale (Fletcher & Averill,1984) yielded six primary factors: ability to imitate, fantasy involvement,memory and attention, ability to fake, ability to play unusual roles, andstorytelling ability. The scale demonstrated reasonable reliability andvalidity (Fletcher & Averill, 1984). Hensley and Waggenspack (1986)administered the Role-Playing Scale to a university student sample(n = 204) and selected the two items that exhibited the highest itemfactor correlations for inclusion in their 12-item short version. Theyobtained an internal reliability estimate (Cronbach’s alpha) of .75. Afactor analysis of the short form confirmed a stable factor structure aseach of the 12 items loaded on their predicted factor.118Differential Personality Questionnaire: Absorption SubscaleAbsorption was measured by the Absorption subscale of theDifferential Personality Questionnaire (Tellegen, 1982). The Absorptionscale is a 34-item, true/false scale that measures a “disposition forhaving episodes of ‘total’ attention that fully engage one’srepresentational (i.e., perceptual, enactive, imaginative, and ideational)resources” (Tellegen & Atkinson, 1974). The scale consists of eightcontent clusters: imaginative and oblivious involvement, affectiveresponsiveness to engaging stimuli, responsiveness to highly “inductive”stimuli, vivid re-experiencing of the past, expansion of awareness,powerful, “inductive” imaging, imaginal thinking, and cross-modalexperiencing (Tellegen, 1981). The construct of absorption appears to besimilar to organismic involvement (Sarbin, 1950, 1982), imaginativeinvolvement (Hilgard, 1970), depth of role-taking involvement (Shor,1962), goal-motivated fantasy (Spanos, 1971), fantasy proneness (Lynn &Rhue, 1988), and openness to experience (McCrae, 1987; McCrae &Costa, 1985). The absorption scale demonstrated high reliability interms of both internal consistency (alpha = .88) and stability (one monthtest-retest correlation = .91) in a normative sample of 800 collegestudents (Tellegen, 1982).Revised Self-Monitoring ScaleSelf-monitoring was measured by the Lennox and Wolfe (1984)Revised Self-Monitoring Scale (RSMS). Self-monitoring refers to the selfobservation and self-control of expressive behavior and self-presentationguided by situational cues to social appropriateness (Snyder, 1974).119High self-monitors are individuals who are especially sensitive to theexpressive behavior of others in social situations and use such behavioras situational cues to guide the management of their own socialbehavior. Low self-monitors, by contrast, use personal dispositions,internally held beliefs, opinions, or attitudes to guide their socialbehavior. The 13-item RSMS measures two factors: sensitivity to theexpressive behavior of others and ability to modify self-presentation. Theresponse format is a 6-point Likert-like scale from certainly always false(0) to certainly always true (5). Reliability data obtained from 201 collegestudents indicates that the RSMS has adequate internal consistency(coefficient alpha = .75). Discriminant validity is indicated by theabsence of significant positive correlations of the RSMS with socialanxiety or public self-consciousness, an important improvement over theoriginal Self-Monitoring Scale (Briggs, Cheek, & Buss, 1980; Lennox &Wolfe, 1984). The factorial stability and internal consistency of theRSMS has been recently confirmed (Shuptrine, Bearden, & Teel, 1990).Spheres of Control Scale: Interpersonal Control SubscaleInterpersonal locus of control was measured by the InterpersonalControl (IC) subscale of the Spheres of Control Scale, version three,described earlier (Paulhus, 1983; Paulhus & Van Selst, 1990). The 10-item IP scale measures the individual’s expectancy of being in control insocial interactions using a 7-point Likert scale. The median alphareliability coefficient of 12 samples is .71, with a range of .55 - .85(Paulhus & Van Selst, 1990). Convergent validity is demonstrated bymoderate positive correlations with measures of such related constructs120as interpersonal competence and social self-efficacy. The constructvalidity of IP scale is further strengthened by positive correlations withestablished scales that measure empathic concern and extraversion(Paulhus & Van Selst, 1990), and variables from a telephone interviewstudy such as Thinks He Would be a Good Salesman, Personally Involvedin Student Politics and Rated Assertiveness During Interview. Paulhus(1983) describes the high IP as successful in interpersonal engagements,such as social influence on another’s behavior:The high-IP person has built up a strong expectancy forsuccess over an extended reinforcement history. His or hersuccess may be attributable to some combination ofintelligence, verbal skills, social skills, physicalattractiveness, and social status (p. 1263).Deliverance Prayer Ouestionnaire: Demoniac Role Knowledge SubscaleThe 35-item Deliverance Prayer Questionnaire (see Appendix 0) isan experimental scale that was developed to measure several constructsof interest to the study of exorcism, such as attitudes toward exorcism,the credibility of exorcism as a treatment, outcome expectanciesregarding exorcism, demoniac role knowledge, andEvangelical/Charismatic beliefs. Respondents use a 7-point Likert-likescale that ranges from disagree (1) to agree (7).The 5-item Attitudes Toward Exorcism scale was based on ameasure of attitudes toward hypnosis (Spanos, Brett, Menary, & Cross,1987). Selected items from the Positive Beliefs and Fearlessnesssubscales were re-written for use with exorcism.The exorcism and exorcist credibility and outcome expectancyscales were based, in part, on the credibility scale of Borkovec and Nau121(1972). Control data were obtained for the four-item Exorcism Credibilityscale only.Demoniac role knowledge was measured by the Demoniac RoleKnowledge subscale of the Deliverance Prayer Questionnaire (seeAppendix 0). The scale does not measure a trait, but the frequency withwhich individuals have either observed or enacted the demoniac role andthe degree to which individuals perceive themselves to be knowledgeableabout the demoniac role.Measures of Religious FactorsDiabolical Experiences ScaleDiabolical experiences were measured by the DiabolicalExperiences Scale (DES; Spanos & Moretti, 1988). The DES is a 26-itemscale that measures four content categories of diabolical experience:sensing the presence of an evil spirit, the sense of being acted upon byan evil presence, the sense of being intimately assaulted and terrorizedby an evil spirit, and receiving messages from Satan, being overtaken byhim or being used as his agent. Subjects respond on a 4-point scale thatranges from strongly disagree (-2) to strongly agree (+2). Factor analyticdata indicated that the DES is unidimensional. Reliability datademonstrated high internal consistency (Cronbach’s alpha = .92).Religious Orientation ScaleReligious orientation was measured by a version of the ReligiousOrientation scale (ROS; Aliport & Ross, 1967) using a 5-point Likertcontinuum (disagree (1), agree (5)). Gorsuch and Venable (1983) re-wrotethe 20 items of the ROS in order to lower reading level requirements.122Statistical analyses of ROS responses from a sample of 101 adultProtestant Christian volunteers yielded alpha coefficients of .66 for E and.73 for I. The E and I scales were highly correlated with the original ROSscales: .79 for E, and .90 for I. Gorsuch and Venable (1983) concludedthat their version of the ROS was a reliable and valid alternate form ofthe original ROS with the advantage of reduced reading levelrequirements.ProceduresExorcism-seekers and control group subjects who fulfilled theselection criteria and consented to participate received a package ofquestionnaires by mail. In addition to the questionnaires and returnpostage, the questionnaire package contained a covering letter ofinformation regarding the voluntary and confidential nature ofparticipation in the study, and instructions for completing thequestionnaires.Randomly-selected subjects received questionnaires through theirrespective churches. Church members from the randomly-selected listwho consented to participate and conformed to the selection criteriareceived and returned their questionnaires to their church office. A totalof 48 questionnaire packages was returned from the three churches, fora return rate of 27%.With respect to research ethics, it is important to note that theexorcism seekers had already elected exorcism as a religious treatment.The study simply required their responses to diagnostic and personality123trait questionnaires, and should not have either increased or decreasedany risks or benefits normally associated with exorcism.Validity IssuesIdentification of Invalid QuestionnairesThe MCMI-II validity screen was used to identify invalidquestionnaires. Subjects who failed the validity screen were droppedentirely from the study with their matched counterparts. MCMI-II resultswere considered invalid if any of the following conditions were found: (1)two or more of the four validity items received “True” endorsements, (2)12 or more items were omitted or double-marked, and (3) the sum of theraw scores of the Disclosure subscale was less than 145 or greater than590 (Millon, 1987). One exorcism-seeker failed the validity screen andwas excluded from the study and his matched control subject.Response Set BiasThe presence of response sets was measured by the three MCMI-IIresponse set scales: the Disclosure, Desirability and Debasement scales(see Table 9). Independent tests (two-tailed) revealed statisticallysignificant between-group differences in disclosure and debasement, butnot desirability. Specifically, exorcism-seekers responded to the MCMI-IIitems in a more frank and self-revealing manner than the controlsubjects. The exorcism-seeker group median base rate score was 72. Abase rate score of 75 “suggests an unusually open and self-revealingattitude, not only while completing the inventory, but also in discussingemotional difficulties with others” (Millon, 1987, p. 196).124Table 9. Table of Response Set Group Means and Significance ofIndependent t TestsResponse Set Scales Controls Exorcism- t(df)aSeekersDisclosure 305.60 384.13 4.63 (60)*Desirability 12.23 11.45 -1.16(71)Debasement 5.94 16.35 5.98(57)*at values with significance levels of p < .05 are marked with anasterisk (*)125Although exorcism-seekers reported significantly greater tendencyto devalue and depreciate themselves than control subjects, theexorcism-seeker group median base rate score (60) is not clinicallysignificant; that is, it does not indicate a pathological level ofdebasement.Statistical PlanA preliminary statistical analysis consisting of a series of Pearsonpartial correlations and a multivariate analysis of variance (MANOVA)will determine the equivalence of the matched and randomly-selectedcontrol groups with regard to demographic and questionnaire variables.If the control groups are roughly equivalent, they will be combined inorder to acquire greater statistical power by increasing the degrees offreedom associated with the statistical tests used in the study.Independent t tests and chi-square analyses will determinewhether there are significant demographic differences between theexorcism-seekers and control groups.A MANOVA will determine whether statistically significantdifferences exist on questionnaire variables between exorcism-seekersand control subjects. If the omnibus statistic reveals significantbetween-group differences, a series of univariate tests generated by theMANOVA procedure will determine acceptance or rejection of a priorihypotheses.Certain additional multivariate statistical techniques ofappropriateness to specific problems will be used. For example, factoranalysis will be used to examine communalities underlying MCMI-II126personality disorder scales. MANOVA will determine the statisticalsignificance of between-group factor score differences. Multipleregression analysis will be used to explore the explanatory power ofcertain psychosocial variables in accounting for hypothesized exorcism-seeker distress. A second multiple regression analysis will build on theresearch of Spanos and Moretti (1988) by examining the effectiveness ofcertain diagnostic and personality variables in accounting for diabolicalexperiences. Finally, a post-hoc discriminant analysis will be conductedin order to determine which variables best distinguish exorcism-seekersfrom control subjects.CHAPTER 4RESULTSThe results of statistical hypothesis-testing are here presented.First, control group equivalence is examined, followed by an analysis ofbetween-group demographic differences. The remainder of the chapter isdevoted to a presentation of multivariate analyses beginning with amultivariate analysis of variance (MANOVA) and ending with adiscriminant analysis.The MANOVA examined whether significant diagnostic and/personality differences existed between exorcism-seekers and controlsubjects. Univariate F tests proceeding from the MANOVA permitted ascale-level analysis of any specific between-group differences, therebyresponding to the central research question of the study: how doexorcism-seekers differ from those who do not seek exorcism? In theinterest of clarity, the F-test results were organized into hypothesis-specific clusters for discussion purposes. The final discriminant analysisdetermined which questionnaire variables best differentiated exorcismseekers from control subjects and thus represented the most effectivepredictors of group membership.127128SampleControl Group EquivalenceThe equivalence of the matched and randomly-selected controlgroups was tested in order to explore the possibility of combining them,thereby acquiring greater statistical power by increasing the degrees offreedom associated with the statistical tests used in the study. A seriesof Pearson partial correlations of all variables by group revealed that thematched and randomly-selected control groups were roughly equivalent.This result was confirmed by a MANOVA of all forty-four questionnairevariables, excluding subscales and the scales of the experimentalexorcism scale (The Deliverance Prayer Questionnaire). The MANOVAfailed to find an overall statistically significant difference between the twocontrol groups: E(1, 44) = 1.53, p> .05. The control groups weretherefore combined (n = 88).Sample Characteristics and Between-Group DifferencesThe nature of the sample is described with regard to the followingvariables: gender, age, education, occupation, employment status, socioeconomic status, socio-economic class, race, marital status, treatmentstatus, religious affiliation, church attendance, Christian selfidentification, and evangelical belief. These variables are discussedindividually or in clusters, and between-group differences are examinedthrough chi-square analysis. Additional information concerning theexorcism-seeker sample is presented: specifically, medical, diagnostic,substance abuse, and childhood abuse information.129Independent tests and chi-square analyses were performed inorder to determine whether there were significant demographicdifferences between the exorcism-seekers and control groups.GenderChi-square analysis of between-group gender differences did notachieve statistical significance (see Table 10). Female subjects accountedfor roughly two-thirds of both groups. This finding is not surprisingsince demonic possession has traditionally been a woman’s affliction.However, women also tend to have higher population base-line levels inChristian churches (Mol, 1976).An independent t test (two-tailed) of between-group mean age didnot achieve statistical significance: t(95) = -.11, ns. In fact, the meanage of both exorcism-seekers and control groups was identical--38 yearsold. In the exorcism-seekers group, the range was 42, the youngestbeing 21 years of age and the eldest being 63. In the control group, therange was 56, the youngest being 20 years of age and the eldest being76.EducationChi-square analysis of between-group differences in educationalachievement was statistically significant (see Table 10). These differencesare primarily the result of several subjects from the random controlgroup with graduate degrees. Exorcism-seekers tend to be high-schoolgraduates, whereas the control group tends to have partial collegetraining.130Table 10. Contingency Table of DemograDhic Variables with Chi-SciuareSignificanceVariable Control Exorcism- X2daSubjects SeekersCount % Count %1. GenderMale 29 33 12 30 .11(1)Female 59 67 28 702. EducationGraduate Degree 8 9.1 0 0 14.0 1(6)*Standard College 20 22.7 5 12.5Partial College 12 13.6 9 22.5High School 45 51.1 20 50Partial High School 3 3.4 3 7.5Elementary School 0 0 2 5Less than 7 years. 0 0 1 2.53. Employment StatusWorking 56 63.6 20 50 4.32(2)Unemployed 26 29.5 19 47.5Part Time Work 6 6.8 1 2.5(table continues)131Variable Control Exorcism- X2(dl)aSubjects SeekersCount % Count %4. Socio-EconomicClassClass 1 3 3.4 1 2.5 2.41(4)Class 2 13 14.8 3 7.5Class 3 18 20.5 9 22.5Class 4 24 27.3 9 22.5Class 5 30 34.1 18 455. RaceCaucasian 80 90.9 39 97.5 2.47(3)Oriental 3 3.4 1 2.5Asian 4 4.5 0 0Afro-Canadian 1 1.1 0 0(table continues)132Variable Control Exorcism- X2(dfaSubjects SeekersCount % Count %6. Marital StatusSingle 23 26.1 12 30 10.99(4)*Separated 2 2.3 4 10Divorced 11 12.5 7 17.5Common-Law 0 0 2 5Married 52 59.1 15 37.57. Treatment StatusbYes 14 15.9 17 43.6 11.22(1)*No 74 84.1 22 56.48. Religious AffiliationEvangelical 4 4.5 4 10 1.40(1)Charismatic 84 95.5 36 909. Church AttendanceYes 88 100 38 97.4 2.27(1)No 0 0 1 2.6(table continues)133Variable Control Exorcism- X2daSubjects SeekersCount % Count %10. ChristianIdentificationYes 86 97.7 40 100 .92(1)No 0 0 0 0Unsure 2 2.3 0 02 values with significance levels of p < .05 are marked with anasterisk (*)• bTreatment status refers to whether individuals arecurrently receiving either medical or psychological treatment.134OccuDationOccupations were categorized according to the Hollingshead’s TwoFactor Index of Social Position (Miller, 1991). Chi-square analysis ofbetween-group occupational differences was not statistically significant(see Table 11). Half of the subjects from both groups were eitherunskilled or unemployed.Employment StatusChi-square analysis of employment status differences between thetwo groups did not achieve statistical significance (see Table 10). Almosthalf of the exorcism-seekers were unemployed at the time of testing.Socio-economic StatusSocio-economic status (SES) was determined by the HollingsheadTwo Factor Index of Social Position (Miller, 1991). The two-factor indexconsists of an occupational scale and an educational scale. An SESscore is determined by summing partial scores derived from the productsof scale scores and their factor weights.An independent t test (two-talled) of socio-economic score groupmeans did not achieve statistical significance: (79) = 1.44, ns. Over60% of the subjects from both groups was from the lowest two socioeconomic classes (see Table 10).RaceA chi-square analysis of racial differences between the two groupsdid not achieve statistical significance (see Table 10). At least 90% of thesubjects from both groups was Caucasian.135Table 11. Table of Exorcism-Seeker Occupations According to theHollinshead Occupational ScaleScale Occupation Controls Exorcism- X2(daSeekersCount % Count %Higher executives of 4 4.5 2 5 3.25(6)large concerns,proprietors, andmajor professionals2 Business managers, 9 10.2 1 2.5proprietors ofmedium-sizedbusinesses, andlesser professionals.3 Administrative 12 13.6 6 15personnel, owners ofsmall businesses,and minorprofessionals.(table continues)136Scale Occupation Controls Exorcism- X2(dl)aSeekersCount % Count %4 Clerical and sales 10 11.4 4 10workers, technicians,and owners of smallbusinesses (<$6,000).5 Skilled Manual 4 4.5 2 5Employees.6 Machine operators 6 6.8 5 12.5and semiskilledemployees.7 Unskilled employees, 43 48.9 20 50unemployed.b2 values with significance levels of p < .05 are marked with anasterisk (*). bThis category includes individuals collecting welfare,unemployment insurance and medical disability as their sole source ofincome.137Marital StatusChi-square analysis of between-group marital status differenceswas not statistically significant (see Table 10). The categories with thegreatest proportion of subjects were married and single, respectively.Treatment StatusChi-square analysis of between-group differences in treatmentstatus was statistically significant (see Table 10). Almost three times asmany exorcism-seekers as control subjects were receiving either medicalor psychological treatment at the time of testing.Religious Affiliation. Church Attendance and Christian IdentificationChi-square analyses of between-group differences regardingreligious affiliation and church attendance did not achieve statisticalsignificance (see Table 10). At least 90% of the subjects of both groupsidentified their religious affiliation as Charismatic, the remainder asEvangelical. These two designations are largely synonymous with regardto basic religious ideology. Charismatic Christians generally adhere tothe same basic statements of faith and practice as evangelical Christians,although there has often been controversy regarding the gifts or charismsof the Holy Spirit, their availability today, and their appropriateexpression in the modem church. All subjects described themselves aschurch attenders, with the exception of one exorcism-seeker who wassearching for a new church. Finally, subjects of both groups identifiedthemselves as Christian, although two control subjects were unsure.138Evangelical BeliefEvangelical belief was measured by the Evangelical Beliefssubscale of the Deliverance Prayer Questionnaire (see Appendix 0). TheDeliverance Prayer Questionnaire is an experimental questionnaire thatwas developed for the present study in order to measure variousattitudes and beliefs about exorcism. The Evangelical Beliefs scaleconsists of the 4-item Traditional Religious Belief subscale of Tobacykand Milford’s (1983) Paranormal Belief Scale and 5 additional itemsdeveloped by the author in order to measure specific Evangelical,Charismatic beliefs.An independent t test (two-tailed) of Evangelical Belief groupmeans did not achieve statistical significance: ( 103) = 1.13, ns. StrongEvangelical beliefs (i.e., endorsement of 6 or 7 on a 7-point Likert scale)were endorsed by 87.5% of the exorcism-seekers group and 78.4% of thecontrol group.Additional Characteristics of Exorcism-Seeker SampleAdditional information was obtained from follow-up questionnairesfrom the exorcism-seekers group only ( = 39; test interval M = ninemonths; see Appendix H) and is included here for descriptive purposes.Medical InformationSeveral medical conditions, such as organic brain syndrome,epileptic seizures, Tourette’s Syndrome and Multiple Sclerosis havesymptom presentations that may account for some, if not all, demonicpossession behavior. All medical information categories were endorsedby at least one exorcism-seeker with the exception of Tourettes139Syndrome, although response frequency was low (see Table 12).However, 18% of exorcism-seekers reported a history of blackouts ormemory loss, a history associated with such conditions as brain injury,substance abuse and dissociative disorders.Substance AbuseHalf of exorcism-seekers reported previous substance abuse andparental substance abuse (see Table 12). Only one exorcism-seekeradmitted to current substance abuse.Child AbuseThree-quarters of exorcism-seekers reported childhood physical orsexual abuse (see Table 12). This finding is significantly higher thancurrent estimations of childhood abuse incidence in the generalpopulation.Information Regarding Psychiatric HistoryAlmost half of the exorcism-seekers reported a psychiatric history(see Table 13). One quarter of the sample reported a non-psychoticpsychological disorder, and 15% reported a psychotic disorder. Thespecific diagnoses recalled have all been implicated in demonicpossession (see Chapter 2). The findings regarding psychiatric historysupport the mental illness view of demonic possession.140Table 12. Table of Medical Information. Substance Abuse and ChildhoodAbuseMedical Information n Exorcism-SeekersYes% No%Brain injury or lesion 39 8 92History of blackouts or memory loss 39 18 82History of seizures 39 8 92Tourette’s Syndrome 38 0 100M. S. or other neurological disorder 38 3 97Past Substance Abuse 38 50 50Current Substance Abuse 39 3 97Substance Abuse in Parent(s) 38 55 45Physical or sexual childhood abuse 37 76 24141Table 13. Table of Past or Present Psychological DiagnosisPast or Present Psychological Diagnosis ( = 39) Exorcism-SeekersCount %Psychotic Disorders 6 151. Schizophrenia 2 52. Manic Depression 3 7.63. Auditory hallucinations (diagnosis unknown) 1 2.5Non-Psychotic Disorders 10 25.64. Depression 6 155. Obsessive Compulsive Disorder 2 56. Multiple Personality Disorder 2 5Personality Disorders7. Borderline Personality Disorder 1 2.5Hospitalized (diagnosis unknown) 1 2.5Total Diagnoses 18 46Note. Each diagnosis represents a separate subject. No multiplediagnoses were reported.142Demographic EffectsAn assumption of the study is that questionnaire variability can bereasonably attributed to group membership rather than extraneousfactors such as demographic effects. In order to explore the plausibilityof this assumption, an intercorrelational analysis of demographic andquestionnaire variables for both the entire combined sample and forexorcism-seekers only was conducted (see Table 14). Both median andmaximum correlations were calculated. The magnitude of the mediancorrelations was insignificant, and maximum correlations were modest toinsignificant.Multivariate Analysis of Questionnaire VariablesA MANOVA of all questionnaire variables (n = 44), excludingsubscales and the experimental exorcism scale, was performed in orderto determine whether overall between-group differences existed.MANOVA is a method of statistical inference that evaluates theprobability of systematic (i.e., nonrandom) differences between the groupmeans of two or more dependent variables. Glass and Hopkins (1984)present three advantages of MANOVA over a series of independenttests:(1) It yields an accurate and known type-I error probability,whereas the actual c for the set of several separate t-tests ishigh yet undetermined; (2) It is more powerful (when cx isheld constant)--that is, if the null hypothesis is false, it ismore likely to be rejected; (3) It can assess the effects of twoor more independent variables simultaneously (p. 325).143Table 14. Maximum and Median Correlations Between DemoraDhic andOuestionnaire VariablesVariable All Groups Exorcism-SeekersMaximum Median Maximum MedianGender .30 .02 .39 -.06Age -.32 -.08 -.41 -.09Education .30 .06 -.31 -.01Occupation .27 .06 .40 -.07Socio-economic Status -.29 .08 .40 -.06Marital Status -.31 -.09 .38 .00Employment Status -.23 .03 .47 .00Religious Affiliation .21- .02 - .34 .01Church Attendance -.18 .00 -.36 -.05144The following assumptions are required for the proper applicationof MANOVA: (1) the groups must be random samples; (2) the dependentvariables must have a multivariate normal distribution; (3) thedependent variables must have the same variance-covariance matrix ineach group; and (4) the observations (i.e., the questionnaire responses) ineach group must be independent; that is, they must not be influenced byeach other (Glass & Hopkins, 1984).Data ExaminationThe questionnaire data was examined in order to identifydepartures from normality. First, a Kolmogorov-Smirnov (K-S) goodnessof fit test was conducted for each questionnaire variable (see Table 15) asa test of normal distribution. A necessary, though insufficient,requirement of multivariate normality is that both the exorcism-seekerand control groups must individually achieve a normal distribution oneach questionnaire variable. The K-S test, compares the observedcumulative distribution function of a variable with its normal theoreticaldistribution. A K-S score is computed from the largest differencebetween the observed and theoretical distribution functions (SPSS Inc.,1993). As the mean of a z distribution is zero and the standard deviationis one (i.e., M = 0; SD = 1), a K-S z score of plus or minus one with aprobability value equal to or greater than .05 indicated a statisticallysignificant departure from the theoretical normal distribution of aparticular scale, and warranted an examination of how the normalityassumption had been violated. In such instances, two kinds of145Table15.TableofControl GroupandExorcism-SeekerSkewness(Skew). Kurtosis(Kurt),KolmogorovSmirnovGoodnessofFitValues(K-Sz)andBartlett-BoxSignificanceScalesControlGroupExorcism-SeekersBartlett-BoxFBasicPersonalityDescriptorsSkewKurt.K-SSkewKurt.K-SSignificancebNEO-FFINeuroticism.13-.60.94-.831.91.48nsNEO-FFIExtraversion-.28.31.60-.03-.78.68nsNEO-FFIOpennesstoExperience.65.18.881.383.01.85nsNEO-FFIAgreeableness.22.67.63.21-.46.59<.001NEO-FFIConscientiousness-.20-.31.58-.26-.31.71nsPsychosocialVulnerabilityFactorsTotalLife-EventStress1.644.591.231.021.12.72.054TotalSocialSupport-.95.961.03-.10-.79.58nsUCLALonelinessScale.61.20.74.42.13.57nsPersonalControl Scale-.08-.30.95-.08-.30.74ns(tablecontinues)146ScalesControl GroupExorcism-SeekersBartlett-BoxFPsychopatho1oyIndicatorsSkewKurtK-SgSkewKurtK-SE’SignificancebMAACL-RDysphoria1.843.661.74*.24-.67.55.006MAACL-RTotalPositiveAffect-.05-1.051.05.09-.78.77nsSleepDisturbanceScale.23-.121.07-.36.311.04nsTotalObsessiveness-.11-.41.78.952.66.94flsDissociation(QED).00-.471.01.16-.91.63.011MCMI PersonalityDisorderScales1.Schizoid.41-.501.70*.651.06.99ns2.Avoidant1.752.972.61*.13-1.011.15ns3.Dependent.31-.431.09.15-.93.86ns4.Histrionic.30-.571.03.55.12.98ns(tablecontinues)147ScalesControlGroupExorcism-SeekersBartlett-BoxFSkewKurtK-SSkewKurtK-SSignificanceb5.Narcissistic.29-.812.27*.921.041.03<.0016.Antisocial1.14.602.23*1.422.171.42*ns7.Aggressive/Sadistic.46-.441.32.11-.50.88ns8.Compulsive-.10-.421.31.33-.57.95ns9.Passive-Aggressive.20-.851.31.19-1.071.08ns10.Self-Defeating.99-.032.48*.34-1.351.14.00111.Schizotypal2.548.312.73*1.05.491.23.01312.Borderline1.08.821.99*.40-.551.06ns13.Paranoid1.502.442.49*1.01.821.10<.001MCMIClinicalSyndromes14.Anxiety2.184.394.12*.95-.281.65*<.00115.Somatoform1.671.983.51*.21-1.191.06ns(tablecontinues)148ScalesControl GroupExorcism-SeekersBartlett-BoxFSkewKurtK-SSkewKurtK-SSignificanceb16.Hypomanic.86.392.36*.99.781.60*ns17.Dysthymic1.671.872.86*-.18-1.05.80ns18.AlcoholDependence2.968.784.88*2.769.562.78*<.00119.DrugDependence2.253.284.40*1.832.182.06*ns20.ThoughtDisorder1.693.692.54*.80-.091.22<.00121.MajorDepression2.7310.023.51*.83-.041.01<.00122.Delusional Disorder.96-.403.42*.75-.802.05*.019SocialRoleFactorsRole-PlayingScale.16-.43.85.91-.011.02nsAbsorptionScale.27-.14.57.24-1.14.71nsImpressionManager-.53.141.21-.84.421.74nsSocialSensitivity-.84.941.23.27-.32.49ns(tablecontinues)149ScalesControlGroupExorcism-SeekersBartlett-BoxFSkewKurtK-SSkewKurtK-S‘SignificancebInterpersonalControl-.36.08.54-.18-.86.40nsReligiousFactorsDiabolicalExperiences.07-.73.64-.35-.05.71nsExtrinsicReligion.42-.301.05.59.74.73nsIntrinsicReligion-.91.941.13-.60-.78.95nsNote.Non-overlappingMCMI-IIscalescomprisedof prototypicalitemswereused.aKolmogorovSmimovGoodnessofFitvaluesachievingsignificance(p.05)willbemarkedbyanasterisk(*).bonlysignificance.05willbeindicated.150departures from normality were noted, skewness and kurtosis (see Table15).In addition, a necessary, though insufficient, requirement of thehomogeneity of variance-covariance matrix assumption is that theexorcism-seeker and control groups must have equal variances on eachquestionnaire variable. In order to test this assumption, a Bartlett Box Fvalue and associated probability was calculated for each of thedependent variables.The results indicate that significant departures from normalitywere almost exclusively associated with MCMI-II scales. The controlgroup achieved significant K-S scores for 17 of the 22 MCMI-II scales,and the exorcism-seeker group for six scales. This outcome was notunexpected as the control group tended to show positively skewed,leptokurtic distributions on the pathology-oriented MCMI-II scales; thatis, the control subject scores tended to ‘bunch up” on the lowernumerical values of each scale as one would expect of normal controlsubjects. In contrast, significant departures from normality in theexorcism-seeker MCMI-II scales tended to be bimodal in nature, therebyindicating the existence of two groups of exorcism-seekers, distressedand non-distressed.The equality of variance assumption was violated in 13 of the 44questionnaire variables. Once again, the MCMI-II scales accounted fornine of these violations.The MANOVA statistical test is robust to violations of normalityand homogeneity of variance assumptions (Glass & Hopkins, 1984).151Nevertheless, some departures from normality were found, especiallyamong the MCMI-II scales. Furthermore, the approximation of univariatenormality does not guarantee the MANOVA assumption of multivariatenormality. Therefore, the MANOVA results, particularly those involvingMCMI-II scales, must be viewed with caution.Results of Overall MANOVAThe MANOVA yielded a highly significant result: E(1, 44) = 2.64,p < .00 1. The omnibus null hypothesis (i.e., no significant between-group differences) was therefore rejected.As the MANOVA procedure has supported the existence ofsignificant overall between-group differences, the univariate F-testresults will be examined in order to determine which questionnairevariables contributed to the between-group variance (see Table 16).Univariate F-Test Results of Basic Personality DescriptorsThe hypothesis pertaining to exorcism-seeker basic personalitydifferences was accepted as univariate F tests revealed that NEO-FFINeuroticism, Extraversion and Agreeableness mean differences achievedstatistical significance (see Table 16). Specifically, exorcism-seekersreported significantly greater NEO-FFI Neuroticism but less Extraversionand Agreeableness than control subjects.Contrary to expectations, no statistically significant differenceswere found with regard to NEO-PPI Openness to Experience. In order todetermine if between-group differences in specific facets of Openness toExperience existed, independent tests (two-tailed) of the NEOPersonality Inventory (NEO-PI) full version of the Openness to Experience152scale and its six facet subscales were conducted (see Table 17). Onestatistically significant mean difference was found for the Actionssubscale. However, the group mean elevations for this subscale were inreverse of expectations; that is, exorcism-seekers were less inclined toexperiment with new behavior than control subjects.In order to compare the aforementioned results to those of thenormative NEO-FFI sample, raw summed scale scores for both groups ofmale and female subjects were calculated and converted to T scoresbased on data from a normative sample of 983 adults (Costa & McCrae,1988; see Figure 2). The T-score profiles for men and women of bothgroups were elevated by at least one standard deviation above thenormative mean across scales. Neuroticism and Agreeableness T-scoregroup means were highest among male and female exorcism-seekers; onboth scales, T scores were over two standard deviations above the mean.Univariate F-Test Results of Psychosocial Vulnerability FactorsThe hypothesis pertaining to between-group differences inpsychosocial vulnerability factors is accepted as univariate F testsrevealed that exorcism-seekers reported significantly more life-eventstress and social isolation and significantly less social support but notpersonal control than control subjects.153Table 16. Table of questionnaire Group Means and Results of MANOVAControls Exorcism- MANOVASeekersScales M MBasic Personality DescriptorsNeuroticism 34.65 42.43 <.00 1Extraversion 40.28 36.95 .015Openness to Experience 37.92 36.75 nsAgreeableness 46.16 43.58 .006Conscientiousness 44.00 41.80 nsPsychosocial VulnerabilityFactorsTotal Life-Event Stress 389.26 587.75 .005Total Social Support 64.41 54.40 <.00 1UCLA Loneliness Scale 26.94 31.20 .001Personal Control Scale 47.91 47.20 ns(table continues)154Controls Exorcism- MANOVASeekersScales M MPsychopathology IndicatorsMAACL-R Dysphoria 6.23 15.95 <.00 1MAACL-R Total Positive Affect 17.56 15.63 nsSleep Disturbance Scale 16.89 21.30 <.00 1Total Obsessiveness 61.17 68.25 .003Dissociation (QED) 8.23 12.48 <.001MCMI-II Personality DisorderScales1. Schizoid 2.14 3.00 .0022. Avoidant 1.16 2.63 <.0013. Dependent 3.87 4.10 ns4. Histrionic 4.26 3.40 ns5. Narcissistic 1.75 2.40 .0386. Antisocial 1.60 2.33 ns7. Aggressive/Sadistic 2.69 3.05 ns8. Compulsive 5.53 5.55 ns9. Passive-Aggressive 3.19 4.60 .001(table continues)155Controls Exorcism- MANOVA, SeekersScales M M Fa10. Self-Defeating 1.09 2.38 <.00111.Schizotypal .80 1.98 <.00112. Borderline 2.15 4.60 <.00 113. Paranoid 1.24 2.68 <.001MCMI Clinical Syndromes14. Anxiety .45 1.58 <.00115. Somatoform .77 2.05 <.00116. Hypomanic .86 1.08 ns17. Dysthymic 1.30 4.03 <.00 118. Alcohol Dependence .13 .33 ns19. Drug Dependence .56 1.00 ns20. Thought Disorder .77 1.93 <.00121. Major Depression .63 2.38 <.00 122. Delusional Disorder .53 .83 ns(table continues)156Controls Exorcism- MANOVASeekersScales M M FaSocial FactorsRole-Playing Scale 24.49 23.6 nsAbsorption Scale 14.39 16.30 nsImpression Manager 20.27 19.05 nsSocial Sensitivity 19.73 20.15 nsInterpersonal Control 46.47 39.95 <.00 1Religious FactorsDiabolical Experiences Scale 46.24 69.97 <.00 1Extrinsic Religious Orientation 26.01 27.51 nsIntrinsic Religious Orientation 34.90 35.13 nsNote. Overall F(1, 44) for the MANOVA = 2.62, p < .00 1. Nonoverlapping MCMI-II scales comprised of prototypical items were used.aOnly significance levels with p < .05 are listed.157Table 17. Table of Openness to Experience (NEO-PI) Group Means andSignificance of Independent t TestsScales Controls Exorcism-Seekers t(df)aOpenness to Experience 151.61 149.63 -.58(72)Facet 1. Aesthetics 25.26 26.00 .71(72)Facet 2. Ideas 24.70 23.30 -1.32(79)Facet 3. Actions 24.30 22.23 2.53(64)*Facet 4. Fantasy 22.76 23.65 .84(67)Facet 5. Feelings 30.45 30.60 .18(70)Facet 6. Values 24.14 23.85 -.46(102)at values with significance levels of p < .05 are marked with anasterisk (*)158Figure 2. NEO-Five Factor Inventory T-Score Mean Profile of Male andFemale Exorcism-Seeker and Control GroupsN EQ A111• Male Exorcism- Female Male Controls LI Female ControlsSeekers (N=1 2) Exorcism- (N=29) (N=59)Seekers (N=28)Note. N = Neuroticism; E = Extraversion; 0 = Openness to Experience;A = Agreeableness; C = Conscientiousness.159Life-Event Stress.In addition to significant E-test results regarding total life-eventstress, independent t tests (two-tailed) revealed significant differences onthe two LES subscales; that is, exorcism-seekers reported significantlymore life-event stress in the past three months and six months thancontrol subjects (see Table 18).Perceived Social SuDportIn addition to significant E-test results regarding total perceivedsocial support, independent tests (two-tailed) of MSPSS subscale meanswere all statistically significant. Exorcism-seekers reported significantlyless family, friends and significant other support than control subjects(see Table 18). Exorcism-seekers also reported less social support than anormative MSPSS sample of 275 university students (see Figure 3).Perceived Social IsolationA univariate F test of between-group ULS-8 means was statisticallysignificant. Exorcism-seekers were experiencing greater isolation thancontrol subjects at the time of testing (see Table 16).Personal ControlThe univariate F test of between-group SOC-3 PC mean differenceswas not statistically significant. The elevations of the scale means werecomparable to those reported by Paulhus and Van Selst (1990) in variousuniversity samples.160Table 18. Table of Life-Event Stress and Social Support Group Meansand Significance of Independent t TestsScales Controls Exorcism-Seekers t(df) aLife-Event Stress Scale1. Three Month Stress 129.30 188.65 2.11(63)*2. Six Month Stress 259.97 399.10 2.60(54)*MSPSSb Social Support1. Family Support 18.28 13.55 3.47(70)*2. Friend Support 22.11 19.53 2.30(56)*3. Significant Other 24.01 21.33 2.18(61)*Supportat values with significance levels of p < .05 are marked with anasterisk (*)• bMultidimensional Scale of Perceived Social Support.Figure 3. Multidimensional Scale of Perceived Social Support MeanProfile161V.C‘UV‘U0ci,Exorcism Combined • NormativeI Seekers (N40) Contnl Groups Sample (N=275)L (N=88)6543210Total Significant Fanily FilendsSocal Other Support SupportSupport Support162Multiple Regression Analysis of Psychosocial Vulnerability FactorsA multiple regression analysis was conducted in order to determinethe contribution of the psychosocial vulnerability factors and neuroticismto exorcism-seeker distress. This post-hoc analysis is not central to thestudy and has certain limitations, especially a low sample size ( = 40).The low sample size may yield false negative but not false positivefindings due to a lack of statistical power. In addition, positive results,though not spurious, are best interpreted as suggestive.First, an intercorrelational matrix of Pearson Product-Momentcorrelations (two-tailed significance) was generated (see Table 19). Thecorrelations between exorcism-seeker distress and the psychosocialvariables ranged in magnitude from .32 (life-event stress, p = .044) to-.05 (social support, ns). However, neuroticism achieved the highestcorrelation with exorcism-seeker distress (.47, p = .002).The multiple regression analysis provided a simultaneousexamination of the effectiveness of the psychosocial vulnerabilityvariables and neuroticism, including their inter-relationships, inaccounting for exorcism-seeker dysphoria (see Table 20). The MAACL-RDysphoria scale was entered into the regression equation as the criterionvariable, and the following social and personality variables were enteredas predictors: life-event stress, total social support, social isolation, selfefficacy and neuroticism. The magnitude of the beta163Table19.IntercorrelationalMatrixof Dysphoria,Neuroticism,Life-EventStress.Self-Efficacy.SocialIsolationandSocialSupportVariablesDysphoriaNeuroticismLife-EventSelf-SocialSocialStressEfficacyIsolationSupportDysphoria1.00Neuroticism47*1.00Life-EventStress.32*.221.00Self-Efficacy-.25-.22.001.00SocialIsolation.13.29.11-.271.00SocialSupport-.05-.24-.29.28.38*1.00Note.Onlytheexorcism-seekersamplewasused(=40).Statisticallysignificantcorrelationalcoefficients(p<.05,two-tailed)aremarkedwithanasterisk(*).164Table 20. ANOVA Table for Psychosocial Vulnerability MultipleRegressionMethod & f Sum of Mean Sig. 1?Source Squares Square1. ForcedEntryRegression 5 1306.4 261.3 3.28 .016 .57 .33Residual 34 2705.5 79.62. StepwiseEntryRegression 1 883.1 883.1 10.72 .002 .47 .22Residual 38 3128.8 82.3165coefficients followed the same pattern as the correlational coefficientsregardless of entry method. Using the forced entry method, the predictorvariables combined accounted for 33% of the variance in exorcism-seekerdysphoria. Using the stepwise method, neuroticism was the single bestpredictor and accounted for 22% of the variance. None of the remainingvariables added significantly to the prediction of exorcism-seekerdysphoria.Univariate £-Test Results of Psychopathology IndicatorsThe hypothesis pertaining to between-group differences inpsychopathology is accepted as univariate tests revealed significantlygreater exorcism-seeker mood and sleep disturbance, obsessionality,dissociative experiences, formal thought disorder and personalitydisorder (see Table 16).Mood DisturbanceMood disturbance was measured by the MAACL-R Dysphoria scaleand three MCMI-II scales: Dysthymic, Major Depression and Hypomanic.MAACL-R dysphoria. In addition to a statistically significantunivariate F test, independent tests (two-tailed) of the Dysphoriasubscale means (Anxiety, Depression and Hostility) were also statisticallysignificant (see Table 21), whereas independent tests (two-tailed) of theTotal Positive Affect scale and its two subscales, Positive Affect andSensation-Seeking, did not achieve significance.166Table 21. Table of Multiple Affect Adjective Check List-Revised (MAACL-R)Subscale Group Means and Significance of Independent t TestsScales Controls Exorcism- t(df)aSeekersMAACL-R Dysphoria1. Anxiety 2.35 5.48 5.43(60)*2. Depression 1.75 5.45 5.61(56)*3. Hostility 2.13 5.03 3.80(54)*MAACL-R Total Positive Affect1. Positive Affect 11.74 10.53 -1.09(74)2. Sensation Seeking 5.82 5.10 -1.64(85)at values with significance levels of p < .05 are marked with anasterisk (*)167Exorcism-seeker MAACL-R results were compared with anormative sample. Mean scale scores for men and women wereconverted to standard T scores (see Figure 4). The mean profile shows asharp contrast between exorcism-seeker negative and positive affectscales. Furthermore, the exorcism-seeker T-score means of theDysphoria scale and its three subscales were all at least two standarddeviations above the mean for both males and females. Male exorcism-seekers showed higher elevations on the negative affect scales thanfemale exorcism-seekers, contrary to typical gender-specific findings, andthese elevations are higher than reported in clinical samples. Forexample, Zuckerman et al. (1986) found that the T-score means of threepsychiatric samples, a schizophrenic group ( = 25), a depressed group(, = 46) and a heterogeneous group ( = 48), all had Dysphoria T-scoremean elevations of 60 or greater. The depressed group, composedprimarily of dysthymic patients, achieved a Dysphoria T-score mean of77. The male and female exorcism-seeker Dysphoria T-score means were109 and 86, respectively.In addition, Zuckerman et al. (1986) found that a D-PA index wasparticularly effective in discriminating between their depressed group,other diagnostic groups and general population subjects. When thedepressed group was subdivided by DSM-III (APA, 1980) diagnosis, theDysthymic Disorder group ( = 41) achieved a D-PA index T-score meanof 58.01 and the Major Affective Disorder group ( = 5) achieved 69.16.Male and female exorcism-seekers achieved D-PA index T-score means of58 and 34, respectively.Figure 4. Multiple Affect Adjective Check List-Revised Mean T-ScoreProfile of Male and Female Exorcism-Seeker and Control Groups130120110100908 8070605040168• Male Exorcism-Seekers El Female Exorcism- Male Controls (N 29) El Female Controls(N= 12) Seekers (N= 28) (N= 59)Dysphoria Anxiety Depression Hostility Total Positive Sensation-Positive Affect SeekingAffect169MCMI-II mood disturbance. The significant exorcism-seekerelevations in MAACL-R Dysphoria were supported by significant meanelevations in two of the three MCMI-II mood disturbance scales:Dysthymia and Major Depression.Suicide potential. Suicide Potential was measured by one of fourMCMI-II Critical Item Scales, Self-Destructive Potential. An independenttest (two-tailed) yielded highly significant results (see Table 22). TheMCMI-II Critical Item Scales consist of eight or nine items each and werederived on the basis of a rational and empirical validation process (seeMillon, 1987, p. 113).ObsessionalityLOl univariate F-test results indicate significant between-groupobsessionality. In addition, independent tests (two-tailed) of LOlsubscale mean differences were statistically significant for two of foursubscales: Dissatisfaction-Incompleteness and Methodical-Careful (seeTable 23). Dissatisfaction-Incompleteness obsessionality was measuredby such questions as the following:Even when you have done something carefully do you oftenfeel that it is somehow not quite right or complete?Do you feel unsettled or guilty if you haven’t been able to dosomething exactly as you would like?Methodical-Careful obsessionality was measured by such questions asthe following:Are you very systematic and methodical in your daily life?Do you pride yourself on thinking things over very carefullybefore making decisions?170Table 22. Table of Critical Item Scales GrouD Means and Significance ofIndependent t TestsCritical Item Scalesa Controls Exorcism-Seekers (df)bEmotional Dyscontrol .81 2.48 4.67(54)*Health Preoccupation .81 2.25 4.61(62)*Interpersonal Alienation .89 2.13 3.53(62)*Self-Destructive .76 2.88 6.05(55)*PotentialaBased on selected raw scores. bt values with significance levels ofp < .05 are marked with an asterisk (*).171Table 23. Table of Leyton Obsessional Inventory (Modified) Group Meansand Significance of Independent t TestsLeyton Obsessional Inventory Controls Exorcism-(Modified) SeekersTotal Obsessiveness1. Counting & Checking 14.76 16.43 1.96(76)2. Clean&Tidy 20.20 22.13 1.87(71)3. Dissatisfaction & 13.81 15.75 3.37(78)*Incompleteness4. Methodical & Careful 12.40 13.95 2.91(81)*at values with significance levels of < .05 are marked with anasterisk (*)172Dissociative ExperiencesDissociative experiences were measured by the Questionnaire ofDissociative Experiences (QED). The univariate test of QED groupmeans was statistically significant. However, the mean differences donot appear to be clinically noteworthy. For example, independent tests(two-tailed) of the exorcism-seeker QED group mean and a mixeddissociative sample mean ( = 2.42, f = 45, p < .05) as well as an MPDsample mean ( = 4.81, jf = 56, p < .05) were statistically significant,thereby indicating that the exorcism-seeker QED group scores belong toa population of lesser dissociative severity than that of the mixeddissociative and MPD samples (see Table 24).Formal Thought DisorderIndications of formal thought disorder were measured by twoMCMI-II severe clinical syndrome scales: Thought Disorder andDelusional Disorder. Only the former achieved a statistically significantunivariate (see Table 16). The prototypical items of the ThoughtDisorder scale describe confused and ruminative thinking, visual andauditory disorientation, loss of contact with reality and mentalbreakdown (Millon, 1987).Personality DisordersIndications of personality disorder were measured by the MCMI-IIpersonality scales. Statistically significant univariate E tests were foundfor the Borderline and Schizotypal personality scales, but not for theHistrionic or Compulsive personality scales. In addition, statistically173Table 24. Comparison of OED Exorcism-Seeker and Other Clinical GroupUnivariate StatisticsQED Samples fl MExorcism-Seeker Group 40 12 5.3Mixed Dissociative Sample 7 17 3.5MPD Sample 18 21 3.6Heterogeneous Psychiatric Sample 131 13 5.1Drug & Alcohol Treatment Sample 210 10 5.2Normative College Sample 1,210 10 4.3174significant between-group mean differences were found for Schizoid,Avoidant, Narcissistic, Passive-Aggressive, Self-Defeating and Paranoidscales (see Table 16).Princrnal Components Factor Analysis of MCMI-II Personality ScalesThe 13 MCMI-II personality scales were entered in a principalcomponents factor analysis for data reduction purposes. Threecomponents were retained based on the scree test that accounted for61.1% of the variance. Eigenvalues for the first seven components were4.64, 2.05, 1.25, .88, .81, .64, and .56. Varimax rotation converged infive iterations and produced two unipolar and one bipolar factors withintercorrelations of .00 between factors. See Table 25 for factor loadingsby scale.Factor 1 was characterized by severe personality pathology(positive loadings on all three MCMI-II severe personality pathologyscales--Schizotypal, Borderline, Paranoid), aggression (Aggression,Passive-Aggression, Antisocial), self-absorption (Narcissistic) andmasochism (Self-Defeating). The factor was therefore interpreted asSevere Trait Pathology. Factor 2 was a bipolar factor with a positiveloading on the Histrionic scale, and negative loadings on the Schizoidand Avoidant scales. The factor was interpreted as Extraversion Vs.Introversion. The same factor was found by Lorr et al. (1990) in theiritem-based factor analysis, and a similar one by Strack, Lorr, Campbell,and Lamnin (1992) in their scale-based factor analysis. Factor 3 hadpositive loadings on the Compulsive and Dependent scales. According toMillon’s (1987) theoretical framework these scales share a passive style175Table 25. Factor Loadings on MCMI-!! Personality ScalesScales Factor 1 Factor 2 Factor 3Borderline .28 -.06Passive-Aggressive .11 .02Paranoid .08 .13Self-Defeating .22 .15Schizotypal .33 .08Narcissistic -.31 -.02Aggressive (Sadistic) -.28 .22Antisocial___________-.15 -.09Histrionic .20 .09Schizoid .13 .17Avoidant .52 .24Compulsive -.07 -.08Dependent .18 .33.86.70Note. Exorcism-Seekers and Combined Controls (n = 128) werecombined for this analysis. Prototypical raw scores were used.Correlations among these varimax factors were: 1-2, .00; 1-3, .00; and2-3, .00..83.73.73.72.71.65.65.63-.83.70.62176in maximizing social favor and attention and minimizing socialdisinterest and disapproval. The two scales differ in that the formerrefers to a dependent and the latter to an ambivalent or conflictedinterpersonal orientation. The factor was interpreted as Restrained andDependent. In their cluster analysis of MCMI-II personality scales, Lorrand Strack (1990) found a cluster similar to this factor consisting ofCompulsive, Dependent and Schizotypal scales.Group differences between the three MCMI-II personality factormeans were analyzed by a Multivariate Analysis of Variance (MANOVA).The MANOVA for the MCMI-II personality factor scores yielded an overallF(3, 126) = 13.67, p < .00 1. Univariate tests revealed statisticallysignificant differences between exorcism-seekers and control subjects onSevere Trait Pathology and Extraversion Vs. Introversion factors (seeTable 26). These results support the scale-based analysis in findingsignificantly greater exorcism-seeker trait distress than control subjects.MCMI-II Profile ResultsMCMI-II personality and clinical syndrome scale raw scores weretransformed into base rate scores and compared to prevalence data frompsychiatric samples in order to estimate the clinical significance ofexorcism-seeker results. Noteworthy elevations are associated with abase rate greater than or equal to 75 (%), thereby indicating the presenceand magnitude of a disorder. Among basic personality scales, a baserate of greater than or equal to 75 signifies the rate at which a scalerelated disorder was found to be among the two most prominentclinician-assigned Axis II diagnosis. Profile interpretation will be177Table 26. Table of MCMI-II Personality Factor Means and Significance ofUnivariate F TestsMeasures and Factors Controls Exorcism- Sig.aSeekersMCMI-II Personality ScalesI: Severe Trait Pathology- .27 .60 <.001II: Extraversion Vs. Introversion -.19 .43 .001III: Restrained & Dependent .03- .06 nsNote. Overall F(3, 126) for the MANOVA = 13.67, p < .00 1.aSig.= Significance. Only significance levels with p < .05 are listed.178determined by following the interpretive process outlined by Millon(1987): first, the overall median base rate profile will be examined and,second, high-point single scale and configural combinations (BR 75)will be analyzed.The exorcism-seeker group median base rate profile. Median baserate scores of the exorcism-seeker group were calculated for allpersonality and clinical syndrome scales (see Figure 5). The overallmedian base rate profile closely approximated the MCMI-II profile of asample of 162 psychiatric patients diagnosed with Dependent PersonalityDisorder according to the DSM-III-R (APA, 1987). The secondaryelevations on the Avoidant and Self-Defeating personality scales and theDysthymic clinical syndrome scale point to a Dependent-Avoidant profile.None of the four hypothesized personality scales achieved scaleelevations of clinical significance (i.e., BR 75).Exorcism-seeker high-point configural interpretations. Milon(1987) has emphasized the importance of configural analysis in MCMI-IIinterpretation; that is, test interpretation is most validly done in thecontext of profile patterns rather than single scale elevations. Inaddition, median or mean scale scores tend to obscure differences amongindividuals.Eighty-three percent of exorcism seekers had at least one clinicallysignificant (BR 75) basic personality scale elevation; 28% had at leastone clinically significant severe personality scale elevation; and 53% hadat least one clinically significant clinical syndrome scale elevation (seeTable 27).179Figure 5. MCMI-II Median Base Rate Profile of Exorcism-Seekers,Patients Diagnosed With Dependent Personality Disorder, and the MCMIII Normative Psychiatric Sample9080(0a)70Coa)60504030Exorcism-Seekers [::::.:::::.:j Dependent(N= 40) Personality Sample(N= 162)Psychiatric Sample(N= 1,292)180Table 27. Table of Frequency and ProDortion of Highest MCMI-II ScaleElevations among Exorcism-SeekersScale Code Frequency %1. Basic Personality ScalesaDependent 3 9 27Compulsive 7 5 15Passive-Aggressive 8A 5 15Self-Defeating 8B 5 15Avoidant 2 3 8Narcissistic 5 3 8Schizoid 1 1 3Histrionic 4 1 3Aggressive-sadistic 6B 1 32. Severe Personality PathologybBorderline Personality C 9 82Schizotypal Personality S 1 9Paranoid P 1 9(table continues)181Scaie Code Frequency %3. Clinical Syndrome ScalesCDysthymic Disorder D 9 43Anxiety Disorder A 6 29Somatoform Disorder H 1 5Bipolar Disorder N 1 5Alcohol Dependence B 1 5Thought Disorder SS 1 5Anxiety-Dysthymic Tie A/D 1 5Dysthymic-Delusional Tie D/PP 1 5aOnly for individuals having a basic personality scale score 75. Thirtythree exorcism-seekers (82.5%) qualified. bOnly for individuals having asevere personality scale score 75. Eleven exorcism-seekers (27.5%)qualified. conly for individuals having a clinical syndrome scale score75. Twenty-one exorcism-seekers (52.5%) qualified.182Among the basic personality scales, the Dependent personalityscale attained clinical significance more frequently than any other. Thescale achieved clinical significance in 22% of the 33 exorcism-seekerprofiles that had at least one clinically significant basic personality scalescore, and was the highest scale elevation in 23% of those profiles.Of the 11 exorcism-seeker profiles achieving a clinically significantsevere personality scale score, the Borderline scale attained the highestfrequency (82%) of clinical significance.Among the clinical syndrome scales, the Dysthymic scale attainedclinical significance more frequently than any other: 43% of exorcism-seeker profiles had clinically significant elevations on the Dysthymicscale, and in approximately half (23%) of those profiles the highest scaleelevation was Dysthymic. When the Dysthymic scale has the highestelevation among the clinical syndrome scales, it is associated withclinician’s judgments of Dysthymic Disorder (DSM-III-R; APA, 1987) in82% of those so diagnosed in the same sample. Millon (1987) describesthe high-scoring Dysthymia respondent as follows:The high-scoring patient remains involved in everyday lifebut has been preoccupied over a period of two or more yearswith feelings of discouragement or guilt, a lack of initiativeand behavioral apathy, low self-esteem, and frequentlyvoiced futility and self-deprecatory comments. Duringperiods of dejection, there may be tearfulness, suicidalideation, a pessimistic outlook toward the future, socialwithdrawal, poor appetite or overeating, chronic fatigue, poorconcentration, a marked loss of interest in pleasurableactivities, and decreased effectiveness in fulfilling ordinaryand routine life tasks (p. 32).183High-point configural combinations of personality scales use thehighest two (primary and secondary) personality scale elevations as theinterpretive key to a profile. Table 28 displays the basic personality two-point configural combinations and their frequency among exorcism-seeker profiles that had at least one clinically significant basicpersonality scale elevation (ri = 33).The Dependent-Avoidant configural combination was the mostprominent among clinically significant exorcism-seeker profiles: 18% ofexorcism-seeker profiles displayed the Dependent-Avoidantconfiguration. When Dependent and Avoidant personality scales werethe two highest personality scales in an exorcism-seeker profile, a BRscore of 75 or greater on the Dependent personality scale was associatedwith clinician judgments of Dependent Personality Disorder (DSM-III-R;APA, 1987) in 88% of those so diagnosed in a heterogeneous sample of703 psychiatric patients (Millon, 1987). A BR score of 75 or greater onthe Avoidant personality scale was associated with clinician’s judgmentsof Avoidant Personality Disorder (DSM-III-R) in 91% of those sodiagnosed in the same sample.Were All Exorcism-Seekers Distressed?The statistically significant differences between exorcism-seekersand control subjects required an averaging of scores (the mean) acrossthe exorcism-seeker sample for each variable examined.184Table 28. Table of Basic Personality Scale (Scales 1-8B) High-PointConfigural Combinations among Exorcism-SeekersCodea Frequency %32,23 7 188B2, 28B 4 108B3,38B 3 870 3 873 2 556A 2 518A 1 331 1 334 1 340 1 354 1 36B5 1 3(table continues)185Codea Frequency %8A2 1 38A3 1 38A6B 1 38A7 1 38A8B 1 38B1 1 3Note. Only exorcism-seekers who have at least one BR score greaterthan BR 75 are included (n = 33).aThe first digit represents the highest scale. The second digit representsthe second highest scale. Two-point codes having 0 as the second digitindicates that the second scale did not achieve BR 75 or greater.186Table 29 presents the number and proportion of exorcism-seekers whosescale scores were (1) less than or equal to the first standard deviation,(2) between the first and second standard deviations, and (3) greater thanthe second standard deviation above the control group mean. Distressscales were selected that had yielded highly significant between-groupdifferences; specifically, life-event stress, MAACL-R Dysphoria, MCMI-IIDysthymia, Suicide Potential, Severe Personality Pathology, PathologicIntroversion and NEO-FFI Neuroticism.The results indicate that not all exorcism-seekers were distressed.On average, half of the exorcism-seekers scored at or below the firststandard deviation of control group scale scores; that is, they did notreport life-event stress, psychopathic traits and symptoms, or traitneuroticism any greater than the average reported by the controlsubjects. A similar result was obtained regarding the MCMI-IIDependency Personality base rate scores of exorcism-seekers: separateanalysis revealed that 50% of exorcism-seekers did not achieve clinicallysignificant Dependency scale elevations. This outcome is in keeping withthe exorcism-seeker bimodal distributions on certain MCMI-II scalesdiscussed earlier with regard to MANOVA assumptions.187Table 29. Number and Proportion of Exorcism-Seeker Scores Within andAbove the Average Range of Control Group Scores.Scale ÷1ja >+i -‘-25D+2SDfl % ii % IiTotal Life-Event Stress 27 67.5 8 20 5 12.5MAACL-R Dysphoria 18 45 8 20 14 35MCMI-II Dysthymia 15 37.5 8 20 17 42.5MCMI-II Suicidal Potential 16 40 9 22.5 15 37.5MCMI-II Severe 20 50 10 25 10 25Personality PathologyMCMI-II Introversion 22 55 13 32.5 5 12.5NEO-FFI Neuroticism 22 55 16 40 2 5M: 20 50 10 26 10 24aExorcismseeker scores equal to or less than one standard deviation() above the Control Group mean.188Univariate F-Test Results of Social Role VariablesThe hypothesis pertaining to between-group differences in socialrole variables of relevance to Spanos’ (1983) theory of demonicpossession was rejected.Dispositional VariablesFour of the five dispositional variables of relevance to a social roleview of demonic possession failed to achieve statistical significance;specifically, exorcism-seekers did not perceive themselves to have betteracting ability than the control subjects (i.e., role-playing aptitude) orgreater tendencies toward fantasy activities (i.e., absorption), impressionmanagement (i.e., self-monitoring) and social sensitivity (i.e., self-monitoring). The fifth dispositional variable, interpersonal controlachieved statistical significance, but in reverse of expectations; that is,exorcism-seekers perceived themselves to have significantly less internaland greater external interpersonal locus of control than control subjects(see Table 16).Demoniac Role KnowledgeAn independent t test (two-tailed) of between-group Demoniac RoleKnowledge mean differences was statistically significant: (73) = 2.97, p= .004. Exorcism-seekers perceived themselves to have had significantlymore demoniac role knowledge than control subjects. Extensivedemoniac role knowledge (i.e., an endorsement of 6 or 7 on a 7-itemLikert scale) was reported by 25% of exorcism-seekers as opposed to 8%of control subjects.189Univariate p-Test Results of Religious FactorsThe hypothesis pertaining to between-group differences in religiousfactors is accepted as univariate tests revealed significantly greaterexorcism-seeker diabolical experiences. However, contrary toexpectations, the univariate tests of the two religious orientationscales, Intrinsic and Extrinsic Religious Orientation, did not achievestatistical significance.Diabolical ExperiencesExorcism-seekers perceived themselves to have had significantlygreater diabolical experiences than control subjects. Furthermore, themean scale elevations of both groups were much higher than the meanscale elevation reported by Spanos and Moretti’s (1988) female collegesample.Multiple Regression Analysis of Diabolical Experiences.Building upon Spanos and Moretti’s (1988) analysis of diabolicalexperiences, a multiple regression analysis was conducted in order totest the explanatory power of absorption, neuroticism, somatoformsymptoms, and dysphoria in accounting for exorcism-seeker diabolicalexperiences. First, an intercorrelational matrix of Pearson ProductMoment correlations (two-tailed significance) was generated (see Table.30). The correlational coefficients were all positive and all but one werestatistically significant. The magnitude of the correlations were greaterthan those reported by Spanos and Moretti (1988).190Table 30. Intercorrelational Matrix of Diabolical Experiences.Neuroticism, Dysphoria and Somatoform VariablesDiabolical Neuroticism Dysphoria SomatoformExperiencesDiabolical 1.00ExperiencesNeuroticism .32* 1.00Dysphoria •35* .60* 1.00Somatoform .29* .67* .63* 1.00Absorption .41* .21* .10 .21*Note. Only the exorcism-seeker sample was used (N = 40). Statisticallysignificant correlational coefficients (p < .05, two-tailed) are marked withan asterisk (*)191The multiple regression analysis was then conducted withexorcism-seeker diabolical experiences as the criterion variable and thefollowing four predictor variables: absorption, neuroticism, somatoformsymptoms, and dysphoria (see Table 31). Using the forced entry method,the predictor variables combined accounted for 27% of the variance inexorcism-seeker diabolical experiences. Using the stepwise method,absorption was the single best predictor and accounted for 18% of thevariance. None of the remaining variables added significantly to theprediction of exorcism-seeker diabolical experiences.Religious OrientationThe univariate tests of Religious Orientation Scale (ROS) groupmeans were not statistically significant (see Table 16). Exorcism-seekerswere neither significantly more intrinsic nor extrinsic in their religiousorientation than control subjects. The first hypothesis is therefore notsupported. In fact, 97% of exorcism-seekers and 93% of control subjectsclearly endorsed an intrinsic religious orientation (i. e., endorsed a 4 or 5on a 5-point Likert scale).The Relationship of Religious Orientation to DistressAn intercorrelational matrix of Pearson product-momentcorrelations between the religious orientation scales and the MAACL-RDysphoria scale is presented in Table 32. As expected, intrinsic religiousorientation and dysphoria were negatively correlated in both exorcismseeker and control groups. The magnitude of the correlations wasmodest.192Table 31. ANOVA Table for Multiple Regression of Diabolical ExperiencesMethod & f Sum of Mean E Sig.Source Squares Square1. ForcedEntryRegression 4 3861.4 965.4 3.11 .028 .52 .27Residual 34 10569.5 310.872. StepwiseEntryRegression 1 2621.8 26218 8.21 .007 .43 .18Residual 37 11809.2 319.2193Table 32. Intercorrelational Matrix of Religious Orientation Scale (ROS)and Multiple Affect Adjective Check List-Revised (MAACL-R) DysphoriaScalesScales Ia E Dys.Intrinsic ROS 1.00 .28* 27*Extrinsic ROS -.22 1.00 .00MAACL- R Dysphoria -.29 .06 1.00Note. Exorcism-seeker (n = 39) correlational coefficients are below thediagonal; control subject ( = 88) coefficients are above the diagonal.aj= Intrinsic ROS; E = Extrinsic ROS; Dys. = MAACL-R Dysphoria Scale.*Statistically significant correlational coefficient, p < .05, two-tailed.194Statistical Results of Exorcism Readiness FactorsThe experimental exorcism scale provided data of relevance toexorcism readiness.Attitudes Toward ExorcismIndependent tests (two-tailed) of Attitudes Towards Exorcismgroup means and one of two subscales, Positive Beliefs, were statisticallysignificant (see Table 33). Exorcism-seekers reported more favorableattitudes toward exorcism overall than control subjects. In particular,87.5% of exorcism-seekers strongly endorsed positive beliefs aboutexorcism in comparison to 55.7% of the control subjects. In addition,only a low percentage of both exorcism-seekers and control subjects,20% and 22.7% respectively, were highly apprehensive about receivingexorcism themselves.Exorcism CredibilityAn independent t test (two-tailed) of Exorcism Credibility groupmeans was statistically significant (see Table 33). Furthermore, 85% ofexorcism-seekers strongly endorsed the credibility of exorcism as areligious treatment modality (i.e., they circled 6 or 7 on a 7-point Likertlike scale) in comparison to 61.4% of control subjects who did likewise.Outcome Expectancy and Credibility VariablesThree scales, Exorcism Outcome Expectancy (3 items), ExorcistCredibility (2 items) and Exorcist Outcome Expectancy (2 items), werecompleted by exorcism-seekers only. A substantial proportion ofexorcism-seekers strongly endorsed all three scales. For example, 72.5%of exorcism-seekers reported high outcome expectancy regarding195Table 33. Table of Attitudes Toward Exorcism and Exorcism CredibilityMeans and Significance of Independent t TestsExorcism Scales Controls Exorcism- (df)aSeekersAttitudes Toward Exorcism 43.43 39.52 2.77(93)*1. Positive Beliefs 11.14 13.3 5.86(125)*2. Fearlessness 13.80 13.95 .20(81)Exorcism Credibility 23.35 26.03 3.89(120)*at values with significance levels of p < .05 are marked with anasterisk (*)196exorcism (i.e., circled 6 or 7 on a 7-point Likert-like scale), 75% reportedhigh expectancy regarding the ability of their exorcist to perform effectiveexorcisms, and 72.5% considered their exorcist to be a highly crediblehelper.Discriminant AnalysisThe MANOVA procedure has identified numerous between-groupdifferences related to basic personality descriptors, psychosocialvulnerability factors, psychopathology indicators, social role variablesand religious factors. But which of these variables best accounts forbetween-group differences found thus far? It would be useful to reducethe number of variables discussed to a simple set of components thatwould be of assistance in identifying those scales that best predictexorcism-seekers and non-exorcism-seekers. A common statisticalmethod for accomplishing this task is discriminant analysis.Discriminant analysis belongs to a family of statistical procedureswhich includes analysis of variance, multiple regression analysis andcanonical analysis. The particular contribution of discriminant analysisis to identify variables that are important for distinguishing amongmutually exclusive groups. The discriminant analysis proceduregenerates a linear combination of predictor variables that is summarizedin a single index, the discriminant function, and used to assign cases togroups (SPSS Inc., 1993). A linear combination of variables is chosenthat best accounts for the total between-group variance. Theassumptions required by discriminant analysis have already been197examined in relation to the present study in the previous discussion ofthe MANOVA procedure.The discriminant analysis procedure required a sequence of severalsteps. First, a decision was made to use the matched control groupinstead of the combined control group for two reasons: (1) to sharpenthe sensitivity of the experiment to the influence of questionnairevariables upon exorcism-seeking by removing any demographic variationattributable to the randomly-selected control group, and (2) when groupsizes are equal, violation of the homogeneity of variance assumption hasnegligible consequences on the probability of type-I error (Glass &Hopkins, 1984).Second, the same questionnaire variables used in the previousMANOVA were entered into the discriminant analysis, and a Wilk’slambda and univariate F ratio were generated for each variable (see Table34). Wilk& lambda is the ratio of the within-groups sum of squares tothe total sum of squares. Large lambda values (the largest obtainablevalue is one) would indicate that exorcism-seeker and control groupmeans appear to be equal, whereas small values would indicate that thegroups appear to be different (SPSS Inc., 1993). Regarding the univariateF ratios and their significance, the effect of using only matched controlsubjects is negligible. Of the 44 variables entered, only seven of theunivariate ratios changed: four of the E ratios became statisticallyinsignificant (total life-event stress, NEO-FFI Agreeableness and MCMI-IINarcissistic and Hypomanic scales), and three became significant (NEOFF1 Openness to Experience and MCMI-II Histrionic and Self-Defeating198scales). None of the changes offered support for the hypotheses of theliterature review.Third, a series of stepwise variable selections identified the bestpredictor variables of membership in the two groups. The selectioncriteria were as follows: the largest Mahalanobis distance (D2) betweenthe two groups, a minimum tolerance level of .00 1, a minimum entrycriterion ( = 3.84), a maximum removal criterion (F = 2.71), a maximumof four steps (twice the number of independent variables), a maximum ofone discriminant function and a prior probability for each group of .5.Each entry or removal of a variable constituted a step. As the stepwiseprocess proceeded, only those variables which fit the specified tolerancelimits and contribute to the predictiveness of group membership wereused. The stepwise process of variable selection terminates whentolerances were no longer met.As a result of the stepwise process, three predictor variables wereselected: the variables, in step order, are the Diabolical ExperiencesScale, the MCMI-II Schizoid personality scale and the MCMI-II MajorDepression clinical syndrome scale. Table 35 lists the action taken(variable entry or removal) for each step, the Wilks’ lambda andassociated significance level, and the minimum Mahalanobis distance(D2) and associated significance level. As the steps progressed, theWilks’ lambda decreased and the minimum Mahalanobis distanceincreased due to the successive removal of variables that powerfullyaccounted for between-group differences.199Table 34. Wilks’ Lambda and Univariate F Results of OuestionnaireVariables for Exorcism-seekers and Matched Control SubjectsScales Wilks’ Sig.aLambda RatioBasic Personality DescriptorsNeuroticism .913 7.27 .009Extraversion .941 4.73 .033Openness to Experience .935 5.30 .024Agreeableness .977 1.78 nsConscientiousness .989 .82 nsPsychosocial VulnerabilityFactorsTotal Life-Event Stress .967 2.57 .113Total Social Support .908 7.71 .007UCLA Loneliness Scale .914 7.17 .009Personal Control Scale .995 .38 ns(table continues)200Scales Wilks’ Sig.aLambda RatioPsychopatholov IndicatorsMAACL-R Dysphoria .818 16.96 <.00 1MAACL-R Total Positive Affect .990 .80 .373Sleep Disturbance Scale .764 23.46 <.00 1Total Obsessiveness .923 6.33 .014Dissociation (QED) .827 15.87 <.001MCMI-II Personality DisorderScales1. Schizoid .774 22.20 <.00 12. Avoidant .838 14.68 <.0013. Dependent .988 .89 ns4. Histrionic .922 6.44 .0135. Narcissistic .969 2.42 ns6. Antisocial .972 2.18 ns7. Aggressive/Sadistic .994 .49 ns8. Compulsive .995 .39 ns9. Passive-Aggressive .960 3.16 ns(table continues)201Wilks’Lambda Ratio10. Self-Defeating11. Schizotypal12. Borderline13. ParanoidMCMI Clinical Syndromes14. Anxiety15. Somatoform16. Hypomanic17. Dysthymic18. Alcohol Dependence19. Drug Dependence20. Thought Disorder21. Major Depression22. Delusional Disorder.812.853.813.842Scales Sig.a17.59 <.00113.05 <.00117.51 <.00114.26 <.001.849.897.992.754.961.996.813.787.98413.538.76.6524.823.05.3217.5320.591.20<.00 1.004ns<.00 1nsns<.00 1<.00 1ns(table continues)202Scaies Wilks’ Sig.aLambda RatioSocial FactorsRole-Playing Scale .990 .74 nsAbsorption Scale .985 1.16 nsImpression Manager .962 3.04 nsSocial Sensitivity .999 .04 nsInterpersonal Control .962 3.04 nsReligious FactorsDiabolical Experiences Scale .741 26.52 <.001Extrinsic Religious Orientation .997 .23 nsIntrinsic Religious Orientation .962 3.04 nsNote. Non-overlapping MCMI-II scales comprised of prototypical itemswere used.asig.= Significance. Only significance levels with p < .05 are listed.203Table35.Summaryof SteDsinDiscriminant AnalysisStepAction:VariableEnteredVariablesWilks’Sig.aMinimumSig.aInLambdaMahalanobisDistance1DiabolicalExperiencesScale(DES)1.741<.0011.36<.0012MCMI-IISchizoidScale(MCMI1)2.594<.0012.66<.0013MCMI-IIMajorDepressionScale3.517<.0013.64<.001(MCMICC)asig.=Significance.204Table 36 presents two statistics, the canonical correlation andWilks’ lambda, that yield information about the proportion of the totalvariability between the exorcism-seeker and control groups that isattributable to between-group differences and within-group differences,respectively. In a two-group situation, the canonical correlation is simplythe Pearson correlation coefficient between the discriminant score andthe grouping variable (coded 0 and 1). The square of this coefficient(.69472= .48) results in a value that represents the proportion of thetotal variance attributable to between-group differences (48%). Again, inthe two-group situation, Wilks’ lambda (.52) may be understood as theproportion of the total variance not attributable to between-groupdifferences (52%). Therefore, the sum of the canonical correlationsquared and the value of Wilks’ lambda should equal one (.48 plus .52 =1). Wilks’ lambda, when transformed to a variable which has a chisquare distribution, may be further used as a test of the null hypothesisthat there are no significant differences between group means from theexorcism-seeker and control group populations. If this null hypothesiscannot be rejected, discrimination between the two groups is notpossible. The observed significance level (p < .001) strongly rejected thishypothesis.Fourth, a linear combination of the three predictor variables andassociated coefficient weights was used to generate a set of discriminantscores. The discriminant scores, in turn, were used to obtain a rule forclassifying cases into one of the two groups.205Table36.CanonicalDiscriminantFunctionsFunctionCanonicalWilks’LambdaChi-SquareCorrelation1.6947.51749.0843<.001fSig.aasig.=Significance.206Table 37 displays the standardized canonical discriminant functioncoefficients and Fisher’s linear discriminant function coefficients for thethree predictor variables. These coefficients represent two methods ofclassification; that is, they may both be used as the basis for assigningcases to groups. The former coefficients are those that maximize theratio of between-groups to within-groups sums of squares and thereforeresult in the best separation between the two groups. They are used asweights in the linear discriminant equation which ultimately yields a setof discriminant scores. The Fisher’s linear discriminant functioncoefficients may be used directly for classification purposes. The set ofFisher coefficients presented in Table 37 is used to assign each case tothe group for which it has the largest discriminant score.Finally, classification output is generated in which known groupmembership is compared to that predicted using the discriminantfunction. Cases that are misclassified using the discriminant functionare flagged. The results of the classification output is summarized inTable 38. The number of correct and incorrect classifications is shownfor the three groups of exorcism-seekers, matched controls andrandomly-selected controls. The three predictor variables were moreefficient in predicting membership in the control group (87.5%) than inthe exorcism-seeker group (77.5%). The overall percentage of casesclassified correctly was 82.5%.207Table 37. Discriminant Function CoefficientsVariable Canonical Fisher’s FunctionFunction 1Matched ExorcismControls SeekersDiabolical Experiences .643 .13 .19MCMI Schizoid .585 1.22 2.12MCMI Major Depression .518 .19 .80Constant-4.91 -11.64208Table 38. Classification SummaryGroup Predicted Group MembershipControl Group Exorcism-SeekersMatched Controls 40 35 587.5% 12.5%Exorcism-Seekers 40 9 3122.5% 77.5%Randomly-Selected Controls 48 38 1079.2% 20.8%Note. Percent of “grouped” cases correctly classified: 82.5%CHAPTER 5DISCUSSIONThere are more things in heaven arid earth, HoratioThan are dreamt of in ourphilosophy (Hamlet 1.5)Sample InformationThe exorcism-seekers of the present study were composedpredominately of Caucasian women who were, on average, 38 years ofage, high school graduates, largely unskilled or unemployed and of lowsocio-economic status. Regarding psychological information, almost halfof the sample had a psychiatric history and were currently receivingmedical or psychological treatment, one-half admitted previous personaland parental substance abuse, and three-quarters reported childhoodphysical or sexual abuse. Regarding religious variables, the sample wascomposed of Evangelical, predominantly Charismatic (94%), churchattenders who strongly endorsed Evangelical beliefs.There were few significant demographic differences between theexorcism-seeker and control groups. Exorcism-seeker educationalachievement was, on average, somewhat lower. For example, exorcismseekers tended to have a high school education as opposed to the controlsubjects’ partial college education. Finally, 84% of exorcism-seekers, as209210opposed to only 16% of control subjects, was currently receiving medicalor psychological treatment.The demographic profile of the exorcism-seekers group is rich inpossibilities for socio-cultural analyses. For example, the profile is inkeeping with a deprivation hypothesis regarding demonic possession.The demon possessed of the present study are mainly socio-economicallydisadvantaged women who have a history of emotional distress andchildhood abuse. These women are also likely to be disadvantaged intheir male-dominated churches with regard to positions of power andauthority. Their demonic behavior may have wider significance than theenactment of a religious idiom of distress: for some, it may also be an“oblique aggressive strategy” (Lewis, 1989) to circumvent genderinequities and obtain greater respect, a more favorable status, or even aministry position of considerable influence.The high proportion of childhood abuse among exorcism-seekers isstriking and may have important etiological and treatment implications.For example, demonic possession may be conceptualized as a chronicpost-traumatic syndrome, as has been suggested of multiple personalitydisorder (Braun, 1990; Kluft, 1984, 1987). Certainly the symbolism ofdemonic possession--physical and psychological violation by an evilbeing--represents a striking portrayal of the sexual abuse act. Indeed,some exorcism-seekers reported sexual assault by demonic spirits. Anytreatment, religious or otherwise, of individuals who believe themselvesto be demon possessed would be enriched by a sensitivity to childhoodabuse issues (e.g., Vargo, Stavrakaki, Ellis, & Williams, 1988).211Questionnaire InformationNumerous statistically significant differences between exorcism-seekers and control subjects were found in support of hypotheses (seeTable 39). These differences, so essential to the central researchquestion of the study, are best interpreted within the context of overallprofile patterns based on normative research with normal and clinicalpopulations. For example, there were between-group differences that didnot achieve statistical significance and yet both groups producedsignificantly elevated scale elevations above normative sample means.Conversely, there were between-group differences that achievedstatistical significance but their scale elevations were not particularlynoteworthy in comparison to normative data.Basic Personality DescriptorsExorcism-seekers and control subjects produced a similar T-scoreprofile pattern: all five NEO-FFI scale means were significantly elevatedabove normative sample means. Based on research with a large generalpopulation sample, a basic personality Christian Charismatic profile ofrelevance to both exorcism-seekers and their controls may be sketchedas follows.Overall, the subjects of the study are prone to experienceemotional distress and to become impaired by stressfulcircumstances. They are extraverted: they tend to besociable, proactive, talkative, and enjoy excitement andstimulation. They are open to experience: they tend to havean active imagination and a vivid fantasy life, aestheticsensitivity, preference for variety, curiosity about both inner212Table 39. Support for Primary HypothesesThe Basic Personality Hypothesis SupportThe Basic Personality Hypothesis YesThere will be significant differences between exorcism-seeker and control groups in major dimensions ofnormal personality.The Psychosocial Vulnerability Hypothesis YesExorcism-seekers will report significantly greaterpsychosocial vulnerability than control subjects.The Psychopathology Hypothesis YesExorcism-seekers will report significantly greaterpsychopathology than control subjects.The Social Role Hypothesis NoExorcism-seekers will report significantly greaterpersonality differences of relevance to their effectiveenactment of the demoniac role than control subjects.The Religious Factors Hypothesis PartialThere will be significantly higher diabolical experienceand lower intrinsic religious orientation in the exorcismseekers group than in the control group.The Exorcism Readiness Hypothesis YesThere will be significant differences in variables relatedto exorcism preparedness between exorcism-seekers andcontrol subjects.213and outer worlds, and a willingness to experiment with theunconventional. They are agreeable: they tend to betrusting, altruistic, sympathetic to others and eager to help.Finally, they are conscientious: they tend to be reliable,persistent, scrupulous, self-controlled and achievementoriented.This profile pattern is consistent with the choice of CharismaticChristianity as a religion and of exorcism as a cure. For example, hightrait agreeableness is not only in keeping with Christian altruism, butalso with a central feature of the exorcist-demoniac encounter: thecomplementarity of exorcist authority and demoniac compliance. Hightrait conscientiousness is congruent with Christian scrupulosity, self-denial and the achievement of good works. When devilish impulsesbecome unmanageable, the conscientious Charismatic may becomepreoccupied with guilty rumination and self-abasement; such anindividual may eventually find a measure of relief in attributing thoseimpulses to the demonic and seeking the cathartic discharge of exorcism.The openness to experience trait is in keeping with the choice of an nontraditional, experience-centered religious movement. In addition,openness to experience tendencies toward a vivid imagination and anactive fantasy life supports associations with the following:(1) participation in unusual religious experiences common toCharismatic religious life, such as glossolalia, paranormal revelationsand exorcism phenomena; (2) the personification of troubles imagisticallyin terms of demonic influences (Spanos & Moretti, 1988); and (3) a moreeffective enactment of the demoniac role (Spanos & Gottlieb, 1979). Theextraversion tendencies may account in part for an attraction to the214social excitement of Charismatic religious sentiment in general andexorcism in particular. Finally, high trait neuroticism is in keeping withthe choice of a movement that advocates contemporary miraculous faithhealing and deliverance from evil spirits.Although exorcism-seekers and control subjects produced a similarpersonality profile, there were statistically significant between-groupdifferences as anticipated by the basic personality hypothesis: exorcism-seekers reported significantly higher trait neuroticism and lowerextraversion and agreeableness than control subjects. This pattern ofresults is both supportive of, and contrary to, previous research. Forexample, the significant neuroticism differences replicate Ward andBeaubrun’s (1981) finding of greater neuroticism in a small sample ofdemon possessed Trinidadian Pentecostalists. However, the significantextraversion differences are contrary to the null findings of two previouspersonality studies of Christian church attenders (Francis, 1991) andCharismatic vs. non-Charismatic Christians (Neanon & Hair, 1990).Basic personality differences portray exorcism-seekers asespecially troubled extraverts with fewer agreeableness andconscientiousness tendencies than other Charismatics. However, thesedifferences must be interpreted within the context of a significantlyelevated T-score profile across scales and groups based on normativedata.Psychosocial Vulnerability FactorsIn keeping with the psychosocial vulnerability hypothesis, thepsychosocial context of exorcism-seekers was considerably more215vulnerable to psychological distress than control subjects. For example,exorcism-seekers reported significantly more life-event stress and socialisolation, and less social support than control subjects. However,multiple regression results did not support a stress-vulnerability modelof exorcism-seeker distress or a buffering role for social support: thestress, isolation and social support variables did not significantlyaccount for exorcism-seeker distress.In addition to social variables, self-efficacy and neuroticism werealso examined as psychosocial vulnerability factors. Only neuroticismachieved statistical significance. Indeed, neuroticism was the strongestpredictor of dysphoric mood and accounted for two-thirds of the variancein dysphoria symptoms in the multiple regression analysis. Theseresults are similar to the findings of Waring et al. (1990) and Hendersonet al. (1980) in that neuroticism explained more of the variance of non-psychotic symptoms than either life-event stress or social support.PsychoDathology’ IndicatorsThe literature review examined two views of demonic possession--the mental illness (state) and social role (non-state) views, and generatedtwo corresponding hypotheses--the psychopathology and social rolehypotheses, respectively. The results of the present study offer greatersupport for the mental illness view than the social role view of demonicpossession; specifically, demonic possession is a mood disorder withreligious elaborations and underlying dependent-avoidant features ofpersonality disorder.216State Vs. Trait DistressThe state versus trait distinction has been an important andcontroversial one in the clinical and personologic psychology of the pastthree decades. Fridhandler (1986) proposes four overlapping but distinctdimensions as underlying current professional uses of this distinction:temporal duration, continuous versus reactive manifestation,concreteness versus abstractness, and situational causality versuspersonal causality. For example, state distress as compared to traitdistress is of temporary duration, of continuous manifestation inreaction to relevant circumstances (e.g., depressed mood), of directdetection as opposed to an inferred quality, and of situational etiology asopposed to the result of distant and complex causal factors.State distress. The finding of significant exorcism-seeker statedistress is not surprising in view of the entrance criteria: volunteerswere asked whether they had problems which they were attributing to thedemonic. Clearly in excess of expectations, however, were the severalindications of statistically significant and clinically severe mooddisturbance as measured by the MAACL-R and the MCMI-II. Theseindications were anticipated by diagnostic discussions of demonicpossession as a mood disorder with religious elaborations as discussedin the literature review. For example, exorcism-seekers reported acuteMAACL-R dysphoria when compared to both normative and clinicalsamples. In addition, the discriminant analysis identified MCMI-II MajorDepression as one of three variables that best differentiated exorcismseekers from control subjects. The item endorsements most associated217with the exorcism-seeker group in order of correlation magnitude are asfollows:Item 76. I feel terribly depressed and sad much of the timenow (r = .38, p < .00 1).Item 136. In the last few years, I have felt so guilty that Imay do something terrible to myself ( = .36, p = .001).Item 59. I have given serious thought recently to doing awaywith myself (r = .35, p = .001).Item 76 was endorsed as true by 48% of exorcism-seekers as opposed to12% of the matched control subjects; Item 136 was endorsed by 23% ofexorcism-seekers and none of the matched control subjects; and Item 59was endorsed by 33% of exorcism-seekers and 5% of the matchedcontrol subjects. In addition, there were several statistically significantexorcism-seeker findings that represent common sequelae of mooddisturbance, such as significant sleep disturbance, social isolation, lessperceived social support and suicidal ideation.The previous MANOVA findings of statistically significant meandifferences on MCMI-II Schizotypal, Paranoid and Thought Disorderscales suggest the possibility of a mood disorder with psychotic features.In addition there were two exorcism-seekers who reported a pastdiagnosis of schizophrenia, and three of manic depression. However, theconverted MCMI-II base rate means of exorcism-seekers did not indicatethe likelihood of a formal thought disorder of noteworthy magnitude.This result does not offer support for a long-standing association betweendemonic possession and psychotic disorders discussed in the literaturereview. The presence of a thought disorder among exorcism-seekers is218most likely to be validly diagnosed when, in addition to disorganizedbehavior and abnormality of rate and association of thought, the contentof thought regarding diabolical experiences is clearly incongruent withthe typical form and content of diabolical stories from the individual’sreligious group.Several other indicators of state distress achieved statisticalsignificance in keeping with expectations but, unlike the basicpersonality profile, their magnitude was not clinically noteworthy whencompared to normative clinical samples. For example, exorcism-seekersreported significantly greater obsessiveness than control subjects,including Incompleteness-Dissatisfaction and Methodical-Carefulobsessionality. The symptom of Incompleteness is regarded by someclinical researchers as a central experience of obsessional individuals(Cooper & Kelleher, 1973). However, the clinical significance of thisfinding is unlikely to be important as exorcism-seekers only endorsed, onaverage, the “occasional” option on the questionnaire response scale.Again, the dissociation scale results offered modest support for thevenerable association between dissociation and demonic possession(Bourguignon, 1973; Jaspers, 1963; Lewis, 1989; Lhermitte, 1963;Oesterreich, 1966; Yap, 1960). However, the exorcism-seekerdissociative scale elevation did not appear to be clinically significantwhen compared to the scale elevations of several groups of subjects withvarious dissociative disorders. This pattern of results for obsessionalityand dissociative experiences--statistical but not clinical significance--failsto support a traditional division of demonic possession into lucid219(obsessional) and somnambulist (dissociative) categories. Finally, thesame pattern of results was observed for MCMI-II indications of formalthought disorder. As previously discussed, however, these indicationsdid not achieve noteworthy severity.Trait distress. In addition to state distress, there were clearindications of marked and enduring patterns of exorcism-seeker distressas measured by the MCMI-II personality disorder scales. For example,33 exorcism-seekers (82.5%) achieved significant base rate scoreelevations on at least one personality scale. In addition, the initialMANOVA identified 8 of 13 exorcism-seeker personality disorder meansas significantly higher than those of the control subjects.There were two exorcism-seeker trait distress findings of primaryimportance. The first was an MCMI-II Dependent-Avoidant median baserate profile with secondary Self-Defeating and Schizoid scale elevations.The second was the identification of the MCMI-II Schizoid scale as one ofthree variables that best differentiated exorcism-seekers from controlsubjects.The MCMI-II Dependent-Avoidant ProfileChoca (1992) describes the Dependent-Avoidant profile as follows:High scores on these scales indicate a personality style withhigh cooperative and avoidant components. Theseindividuals tend to have low self-esteem and see others asbeing more capable or more worthwhile. They tend to befollowers rather than leaders, often taking passive roles.They would like to seek emotional support and the protectionof others but, together with these wishes, they experience acertain amount of discomfort. The discomfort comes fromthe assumption that if others get to know them as well asthey know themselves, people would develop the same220uncomplimentary views that they have of themselves. As aresult, these patients probably tend to be guarded andapprehensive when relating to others. Similar people try to“put their best foot forward” and tend to hide their truefeelings, especially when the feelings are aggressive orotherwise objectionable. These individuals may seem tense,nervous, and distant. Because they feel ill at ease in socialsituations, they often avoid them, resulting in loneliness andisolation (p. 84).The dominant dependency features of this profile are in keeping with atendency to form dependent relationships with authority figures of theopposite sex who are perceived to offer magical solutions; that is, theprofile is well suited to the requirements of exorcist-demoniac rolecomplementarity. Indeed, Yap (1960) lists a dependent and conformingcharacter as one of several preconditions necessary for possession tooccur. The dependency profile may also render the exorcism-seekerespecially vulnerable to abusive exorcism.Given the venerable association between hysteria and demonicpossession, it is surprising that the MCMI-II Histrionic scale did notdominate the trait distress results. The failure to find group differencesof statistical significance may be due, in part, to the nature of theHistrionic scale, as suggested by Millon:It is possible that the MCMI-II represents the acutely upsetHistrionic well but cannot elicit their premorbid personalitypicture at this point of their disorder (p. 144).Furthermore, the MCMI-II Dependent-Avoidant profile provided indirectsupport for an association between demonic possession and histrionicpersonality: dependency tendencies are a shared core feature of both221Dependent and Histrionic personality disorder according to Millon’s(1987) model of personality pathology.However, there were various findings that described a moresubdued and reclusive demoniac than the pattern of excessiveemotionality and attention-seeking so commonly ascribed to thepossessed histrionic of the literature. For example, the MCMI-II Avoidantand Schizoid elevations suggest the presence of considerable exorcism-seeker social discomfort and withdrawal. The MCMI-II factor analysisrevealed that exorcism-seekers reported significantly greater pathologicintroversion than control subjects. Similarly, other statistical analysesfound significantly less exorcism-seeker NEO-FFI Extraversion andsignificantly more ULS-8 Social Isolation.The MCMI-II Schizoid PredictorThe strongest support for a significant exorcism-seeker tendencytowards greater social withdrawal and discomfort was provided by thediscriminant analysis: one of three variables that best differentiatedexorcism-seekers from control subjects was the MCMI-II Schizoid scale.The Schizoid item endorsements most associated with the exorcism-seeker group in order of correlation magnitude were as follows:Item 2. I’ve always found it more comfortable to do thingsquietly alone instead of with others (r = .40, p < .00 1).Item 19. I have always wanted to stay in the backgroundduring social activities (r = .35, p < .001).Item 2 was endorsed as true by 68% of exorcism-seekers as opposed to29% of the matched control subjects, and Item 19 was endorsed by 60%of exorcism-seekers as opposed to 24% of the matched control subjects.222How are these results to be interpreted in light of the basicpersonality results that indicate the probability of extraverted exorcism-seeker tendencies?A Response Set InterpretationThe indications of exorcism-seeker social withdrawal anddiscomfort as reflected in significant Schizoid and Avoidant scaleelevations may be an artifact of mood disturbance. Millon (1987) advisesthat in spite of methodologic and psychometric procedures to tease stateand trait distress apart, every scale reflects a mix of both enduring andsituational attributes. His warning that an elevated Dysthymia scalemay contribute to elevations obtained on the Avoidant and Self-Defeatingscales is of particular relevance to the present study. The ubiquitousinfluence of a marked dysphoric mood state may also account for thesignificant differences in neuroticism, extraversion, agreeableness andpsychosocial vulnerability factors.This interpretation points to attributes other than normal orabnormal personality variables in distinguishing those who seekexorcism from those who do not; and yet, it is unlikely that the influenceof mood state alone can account for MCMI-II base rate profile indicationsof social discomfort and withdrawal. First, Millon (1987) has includedmodifier and correction indices in the MCMI-II base rate profile in orderto compensate for a complaint response style and the effects of adepressed or anxious mood state. Second, the debasement scale, ameasure of respondents’ tendency “to demean or denigrate themselves, toaccentuate their psychological anguish, and to play up their emotional223vulnerabilities” (Millon, 1987, P. 119), was not significantly elevatedamong exorcism-seekers (M = 56).A Personality Disorder InterpretationThe Dependent-Avoidant median base rate profile and the Schizoidpredictor of the discriminant analysis suggest that the exorcism-seekersof the present study are troubled dependents with tendencies towardsocial discomfort and self-defeat. These features of personality disordermay render exorcism-seekers vulnerable to state distress, such asrecurrent mood disturbance.The relationship between the exorcism-seeker MCMI-II and NEOFF1 profiles is in keeping with a previous study of the intercorrelationsbetween these two instruments in a sample of 297 adult volunteers(Costa & McCrae, 1990). For example, MCMI-II dependent features wereassociated with NEO Agreeableness. Costa and McCrae (1985) describedependency as a pathological form of agreeableness. In addition,Avoidant and Self-Defeating features were positively correlated withNeuroticism.There are divergences as well. For example, in the aforementionedstudy, Schizoid tendencies were negatively correlated with NEOExtraversion, whereas exorcism-seekers reported both schizoid andextraversion tendencies. Rather than interpreting the schizoidtendencies as an artifact of mood disturbance, both tendencies can beaccepted as valid and attributed to personality complexity. Perhapsexorcism-seekers are troubled ambiverts; that is, they show acombination of extraverted and introverted tendencies as a function of224such variables as situation and mood. However one interprets thesepersonality findings, it is the tendencies toward social discomfort andwithdrawal, not extraversion, that best distinguish exorcism-seekersfrom Charismatic control subjects as indicated by the discriminantanalysis.An account of the role of distress variables in the development ofdemonic possession is offered as follows. When otherwise sociableCharismatic Christians become emotionally overwhelmed and sociallywithdrawn, they may entertain a demonic etiology for their troubles inaccordance with their religious belief. They may report tormentingreligious experiences of a diabolical nature. They may present signs andsymptoms of a recurrent depression which they attribute to the demonic.They may be troubled by distal or proximal events, such as therecollection of early memory fragments of childhood abuse or thesequelae of unemployment, respectively. In their search for help, theywill be reassured by the Charismatic promise of personal change, healingand spiritual renewal. Furthermore, their tendencies towarddependency, social discomfort and self-defeat, and their experience ofmood disturbance and the diabolical may predispose them to passivelyaccept and subordinate themselves to an exorcist--a stronger, nurturingfigure who provides protection, cure and direction during a time ofdiabolical danger and demoralization. Exorcism will offer its specialrewards: a cathartic religious experience in which emotional turmoil isexternalized and disowned, and a rite of transition (Boyanowsky, 1982)from peripheral possession (Lewis, 1989) to social integration.225Social Role VariablesContrary to expectations, social role variables yielded only onestatistically significant result in keeping with Spanos’ theoreticalframework: exorcism-seekers reported significantly greater demoniacrole knowledge. Presumably, a greater knowledge of the demoniac socialrole would facilitate a more effective and convincing demonic roleenactment. However, four of five dispositional variables (role-actingaptitude, absorption, impression management and social sensitivity)failed to attain statistical significance. The remaining variable,interpersonal control, achieved statistical significance, but in reverse ofexpectations.The failure of dispositional variables to distinguish exorcism-seekers does not constitute a direct challenge of Spanos’ social roletheory of demonic possession. First, although NEO-FFI basic personalitytraits of relevance to Spanos’ theory did not achieve statisticalsignificance, they were elevated in comparison to normative data. Inparticular, the elevations in extraversion and openness to experiencemay contribute to a more compelling demoniac role performance.Second, a study with a design and methodology that could enable themanipulation of some aspect of the social situation in which demonicpossession behavioral displays occur would provide a more appropriatetest of Spanos’ theory. Such a study would be helpfully guided by a clearpsychological model of demonic possession derived from Spanos’ingenious theoretical ideas. Finally, Spanos (1983) points to the226limitations of personality variables in explaining unusual social behavioras follows:• . . an adequate theoretical account of deviant social behaviorsis unlikely to be facilitated by the straightforward applicationof dispositional concepts... (p. 187).Religious FactorsThe religious factors hypothesis was partially supported by theresults of the study as exorcism-seekers reported significantly greaterdiabolical experiences but not intrinsic religious orientation.Diabolical ExDeriencesThe Diabolical Experiences Scale (DES) yielded not only between-group differences of statistical significance but emerged from thediscriminant analysis as the variable that best distinguished exorcism-seekers from control subjects. The DES item endorsements mostassociated with the exorcism-seeker group in order of correlationmagnitude were as follows:Item 26. At times, I believe that an evil spiritual power ispunishing me for my refusal to go along with its wishes(r = .48, p < .001).Item 14. I have had an experience in which an evil presenceseemed to absorb and take hold of me (r = .43, p < .001).Item 7. I have had an experience in which I felt that all wasevil at the time (r = .40, p < .001).Item 26 was endorsed as probably or definitely true by 72% of exorcismseekers as opposed to 34% of the matched control subjects; Item 14 wasendorsed by 69% of exorcism-seekers as opposed to 29% of the matched227control subjects; and Item 7 was endorsed by 54% of exorcism-seekersand only 12% of the matched control subjects.The results of the present study represent a partial replication ofSpanos and Moretti’s (1988) study. Diabolical experiences werepositively correlated with neuroticism, dysphoria, somatoform symptomsand absorption. However, in contrast to Spanos and Moretti’s study, themultiple regression model of diabolical experiences identified absorptionas a major explanatory variable, a finding that offers greater support forSpanos and Moretti’s explanation of diabolical experiences than theirown results. The following account of the role of absorption in thedevelopment of demonic possession is heavily indebted to Spanos andMoretti.Among church groups there will be Christian adherents, such asthe exorcism-seekers of the present study, who are prone topsychological distress. The greater their tendency toward imaginativeand fantasy involvement, the more likely is their interweaving of inneremotional turmoil, accompanying somatic arousal, and attributions ofdiabolical influence into vivid auditory and visual diabolical experiences.Such diabolical experiences, in turn, may be enacted in demonicpossession behavioral displays. The combination of inner diabolicalexperiences, accompanied at times by demonic behavioral displays, islikely to reinforce psychological distress as in a feedback loop.Eventually, the search for exorcism begins.228Reliious OrientationCharismatic exorcism-seekers and Charismatic control subjectsdid not differ in religious orientation. Both clearly endorsed an intrinsicreligious orientation, as anticipated by previous research withCharismatic samples but contrary to an empirically established negativecorrelation between intrinsic religious orientation and psychopathology.In keeping with Scobie (1975), Charismatic Christians, whether seekingexorcism or not, may have an intrinsic religious orientation because of“inner feelings” associated with their often dramatic religiousexperiences. Ironically, the very preoccupation with inner religiousexperience, whether positive or diabolical, that characterizes theirintrinsic religious orientation may be contributing to their psychologicaldistress. This line of reasoning may help to explain the co-existence ofboth intrinsic religious orientation and psychopathology amongexorcism-seekers.Exorcism-Readiness FactorsExorcism-seekers appear to be cognitively prepared to benefit fromexorcism as anticipated by the exorcism readiness hypothesis. Thestrong endorsement of such cognitive variables as positive attitudestoward exorcism, exorcism credibility and outcome expectancy offerssupport for a placebo model of exorcism efficacy. As outcome data werenot collected it is impossible to directly test a placebo model of exorcism.229Direction of Causality: An Interpretive ConundrumThe discriminant analysis identified one religious experiencevariable and two distress variables as the most effective predictors ofmembership in the exorcism-seeker’s group. These discriminant resultsbring into clear focus a central interpretive conundrum regardingdirection of causality in a correlational study: are exorcism-seekersdistressed because of diabolical experiences, are diabolical experiences aproduct of psychological distress, or is there a third variable thataccounts for their relationship? Again, in interpreting the neuroticismresults, are exorcism-seekers highly distress-prone individuals who, inkeeping with their religious belief system, interpret periodic fluctuationsof emotional distress as demonic? An alternative paranormalinterpretation might suggest that a veridical diabolical experience or ahistory of such experiences leads to profound psychological disturbance.Unfortunately, a correlational design cannot address the directionof causality. However, the long-standing patterns of exorcism-seekerdistress indicated by MCMI-II personality disorder scale analysesconverge to suggest that the distress has the temporal priority and iseventually interpreted in a manner congruent with a dualistic religiousbelief system.Perhaps diabolical experiences and psychopathology should not bejuxtaposed in a cause-effect dichotomy. Perhaps both are descriptions ofhuman distress that are appropriate to different levels of explanatorydiscourse and social context, the one religious, the other scientific. Butthis analysis evades the issue of etiological inference. For many230Charismatic Christians, the relationship of demonic possession topsychopathology is linear and causative, although arguments aresometimes advanced for a reciprocal determinism. The root cause ofpsychopathology is paranormal, and therefore exorcism is required.The psychological models of demonic possession used in thepresent study do not address the existence of the demonic, but only theself-reported and observed effects of a belief that one is demonpossessed. Serious consideration of the paranormal is precluded by asearch for the most parsimonious account of demonic possession.Inevitably, Ockham’s razor deftly cuts the demon out of demonicpossession.A Convergent Exorcism-Seeker ProfileThe study has identified numerous demographic and psychosocialfindings regarding exorcism-seekers. There remains the task oforganizing these findings into a coherent exorcism-seeker profile.The modal exorcism-seeker of the present study is a CaucasianChristian woman nearing mid-life who strongly endorses Evangelical-Charismatic beliefs. She has a high-school education, but is largelyunskilled or unemployed and of low socio-economic status. Her familyhistory includes physical or sexual abuse and perhaps alcoholism. Shemay also have a psychiatric history for which she is currently intreatment.She shares certain personality attributes in common with otherCharismatics. She tends to be sociable, attracted by new andunconventional experiences, altruistic, conscientious and prone to231emotional distress. She can also exhibit marked features of dependencyand self-abasement.She may differ from other Charismatics by acute mood disturbanceand an underlying personality pattern of social discomfort andwithdrawal. She may perceive herself as socially isolated andunsupported. She may admit to suicidal ideation, intent or behavior;however, suicidal symptomatology is likely to be under-reported due tostrong religious sanctions regarding suicide.She will report strange diabolical experiences, such as punishmentor control by an evil presence. She will be knowledgeable regardingexorcism phenomena and have favorable attitudes and expectationsregarding the appropriateness and effectiveness of exorcism as areligious cure.CHAPTER 6IMPLICATIONSImplications for Theory BuildingExorcism-seekers were better distinguished from Charismaticcontrol subjects by psychopathology variables than by social rolevariables. Specifically, the results of the study point to the importance ofmood disturbance and features of dependent and avoidant personalitydisorders to theory building concerning demonic possession. On theother hand, social role theory regarding demonic possession was notadvanced by the findings of the study, except to underline the limitedusefulness of dispositional variables to a social role account ofpossession phenomena. The proper empirical testing of Spanos’ (1983,1989) intriguing theoretical ideas awaits a clear social role model ofdemonic possession and an appropriate social-psychological design.Although the results of the study support psychopathology theoryregarding demonic possession, psychopathology constructs are clearlyinappropriate for approximately half of the exorcism-seekers who did notreport any significant psychological distress when compared to controlsubjects. Therefore, an alternative cognitive-behavioral explanation ofdemonic possession of relevance to both distressed and non-distressed232233exorcism-seekers is offered in which belief, attribution, expectancy andsocial reinforcement comprise the primary components.A Cognitive-Behavioral Theory of Demonic PossessionIndividuals who describe themselves as demon possessed arecognitively prepared for possession experiences and behavior when theyespouse an Evangelical-Charismatic belief system and associatedattributions and expectancies. Demonic possession typically begins witha religious attribution for abnormal events, behavior or experience. Forexample, when Christian adherents experience physical illness orpsychological distress, they may eventually attribute their physical orpsychological problems to demonic influence, as suggested by Spanosand Moretti (1988):persons who view the world in terms of supernatural goodand evil forces and who are psychologically troubled maytend to attribute their personal difficulties to evil forces.Such attributions would allow them to understand andreflect upon their troubling experiences in a mannerconsistent with their world view (p. 107).This religious illness attribution is more likely among Charismaticchurch groups who teach that Christians may become demon possessedthan among other church groups who strongly denounce such teaching.The importance of religious belief to the development of demonicpossession points to a striking irony: demonic possession is an afflictionof the devout. The more convinced one becomes regarding the existenceand involvement of demonic spirits in human affairs, the more likely oneis to entertain demonic causation.234Physical illness or psychological distress are unlikely to be the onlyproblems attributed to the demonic among exorcism-seekers. Otherproblems may include financial, social, or religious problems (seeAppendix F), although such problems may have consequences forphysical and mental health. Demonic possession may also be inferredfrom deviant behaviors (e.g., violence, habits in violation of religiousmorality, impulsive behavior) or somatic experiences (e.g., swooning,shaking) during church services or healing prayer.Exorcism-seekers may develop a perception of demonic possessionon the basis of external as well as internal referents. For example, theymay accept the advice or even persuasion of others regarding theirpossession status, and may receive substantial social reward for theircompliance in this regard, such as “a temporary escape from unpleasantreality, absolution of guilt and responsibility by attributing the reactionto supernatural causes, and evocation of sympathy and affection fromfamily and friends” (Ward & Beaubrun, 1981). The dependent tendenciesof exorcism-seekers may render them especially susceptible to socialinfluence processes regarding possession attribution.Once a possession attribution has been made, possessionbehavioral displays occur in accordance with situationally-inducedexpectancies, especially during exorcism. People behave in a demonpossessed manner to the extent that they believe their behavior to beconsistent with the demoniac role and judge the situation to be one inwhich demonic behavior should occur (Council, Kirsch, & Hafner, 1986).235The development of diabolical experiences as a product of theinterplay between absorptive fantasy and chronic distress has alreadybeen discussed (see previous chapter). In addition, survivor guilt andlearned helplessness hold promise as important factors in thedevelopment of both diabolical experiences and depressed mood.The Implication of Gender Differences to Theory-BuildingThe results of the study require the consideration of genderdifferences in explaining demonic possession. The traditional associationof demonic possession with women is supported by the greaterproportion of women in the exorcism-seeker sample. Furthermore,these women were largely unskilled or unemployed and of low socioeconomic status. This pattern of results is in keeping with Ward’s (1982)view that demonic possession is not only a cultural explanation foremotional problems, but “almost specifically a feminine pathology” (p.416). In this regard, Ward points to the powerlessness inherent in theuniversal nature of the female role:Social subordination may induce psychologicalcomplications in women, and narrowly defined stereotypicroles limit the availability of adjustive coping mechanisms(p. 416).Ward extends the generalizability of her analysis of TrinidadianPentecostal women to Western women.Ward’s (1982) analysis is clearly relevant to gender-based roleinequities in many Evangelical-Charismatic churches. A male-dominatedhierarchical view of ecclesiastical authority encourages women to valuesubordination to male leadership in the church and home. To suggest,236however, that role inequities regarding power and control are perceivedas a major source of stress by Charismatic women is dubious andultimately an empirical question. Ward’s analysis becomes even moredifficult to apply to Charismatic women when she suggests that demonicpossession is chosen as a coping strategy due to the paucity orunavailability of other more adaptive coping strategies. This does notappear to be the case in the Charismatic movement as a variety ofservices are typically available to distressed individuals, from personaland group healing modalities to the provision of food, clothing andshelter. Demonic possession among Charismatic women is thereforeunlikely to be “a feeble social protest against oppressive socio-economicconditions” (Ward, 1982, p. 417). Nevertheless, the possibility that, forsome Charismatic women, demonic possession is a covert strategy tocircumvent gender restrictions and obtain greater respect, status, orpositions of influence points to an important social motive for possessionattribution and behavior and must therefore remain as a plausibleinterpretive aspect of demonic possession.Treatment Implications Regarding Exorcism-Seeker DistressA central finding in the study is that the exorcism-seeker samplereported statistically significant personality and clinical psychopathology.Treatment implications include the need for collaboration with clergy, aconservative diagnostic approach, intervention for mood disturbance andawareness of personality disorder tendencies.237The Need for Collaboration with ClervThe clear indications of exorcism-seeker distress including self-destructive potential warrant the collaboration of health careprofessionals with the clergy. The need for cultural sensitivity andrapprochement between health care providers and cultural healers isespecially recommended in the literature when providing treatment forpatients who are deeply involved in ethnic or religious sub-cultures thatoffer alternative healing modalities (e.g., Jilek & Jilek-Aall, 1978;Wintrob, 1977; Pattison & Wintrob, 1981). The Leeds Exorcism Trialunderlines the need for collaboration, especially when alternativetreatment can result in harmful iatrogenic effects and negligence.According to Pattison and Wintrob (1981), “many mental health servicepersonnel are unaware of those alternative systems of healing that agreat number of people utilize instead of, or in addition to, those forms oftreatment offered by mental health professionals and psychiatricfacilities” (p. 17). Furthermore, when relations between practitionersfrom differing healing systems are marked by mutual distrust and evendisdain, help-seekers may become confused by conflictingconceptualizations and advice regarding their distress. The distress ofsome exorcism-seekers may be exacerbated by covert competition amongsuch practitioners for primary allegiance and treatment hegemony. Hallet al. (1982), in their discussion of the “therapist’s dilemma” in treatingmentally ill exorcism-seekers, speak of “role tensions between religiousexorcists and psychiatrists” that can become “fertile grounds forpolarization between two healers” and a “conflicting framework” for the238enactment of family ambivalence, “leaving the patient immersed inuncertainty and turmoil” (p. 520).Several types of collaboration between health care professionalsand members of the Christian clergy have been suggested (Augsburger,1986; Gorsuch & Meylink, 1988; Meylink & Gorsuch, 1986, 1988;Pattison, 1977). Various suggestions have been made regarding thespecific treatment of Christians (e.g., Lantz, 1979; Worthington, 1988)and help-seekers from charismatic religious sects (e.g., Galanter, 1982).Several authors have suggested collaboration with the clergy in cases ofdemonic possession (Barlow et aL, 1977; Cappannari, Rau, & Abram,1975; Edwards & Gill, 1981; Hall et al., 1982; MacKarness, 1974;Pattison, 1977; Salmons & Clarke, 1987; Schendel & Kourany, 1980;Whitwell & Barker, 1980). In their study of 36 members of the clergyand 29 mental health professionals, O’Malley and Gearhart (1984) foundreason to be hopeful regarding collaboration. In their survey of 102Christian clergy, Wright, Moreau, and Haley (1982) found the clergy to be“a highly promising resource for the community mental health movementand its workers (p. 71):”As pastors and mental health professionals learn some moreabout their respective roles in providing care incommunities, and as they are able to support one anotherwithout attempting to alter or deny each other’s world view,we can expect better community care and a renewedaffirmation of the importance of religious values andcommunal religious experience in mental health (p. 79).There are, in fact, several benefits of collaboration for the healthcare professional. First, the clergy can legitimize the work of the239treatment provider, resulting in increased valuing of non-religioustreatment and improved rapport. Second, members of the clergy canoften provide useful collateral information regarding a patient since theymay have known the patient and his or her family over an extendedperiod of time. Also, the clergy is a source of expert opinion about thepatient’s belief system. Third, the clergy can often coordinate andmobilize considerable social and practical support, an important servicein view of the indications of marked mood disturbance and suicidalideation in the exorcism-seeker sample.A Conservative Diagnostic ADproachA conservative approach to diagnosis, in spite of the risk of Type IIdiagnostic error (i.e., failure to make a diagnosis when a disorder exists),is recommended in view of the transience of some demonic possessiondisplays and the plausible consideration of such possession reactions associal artifacts, especially when possession behavior occurs only in thecontext of exorcism.Intervention for Mood DisturbanceThe findings of marked MAACL-R dysphoria, MCMI-II dysthymiaand an MCMI-II major depression predictor variable point to the need forpharmacological and/or psychological treatment for mood disturbance.Indeed, there may be a need for emergency treatment: the residualvulnerabilities of previous substance abuse by half of the exorcismseeker’s group and of childhood abuse by two-thirds of the group, whencombined with depression, constitute a particularly lethal admixture, asis indicated by significantly greater MCMI-II Self-Destructive Potential240among exorcism-seekers. Treatment for mood disturbance mightaddress the impact of unemployment upon mood and a discussion ofvocational issues as almost half of the exàrcism-seeker sample wasunemployed. In view of the dependency tendencies of the exorcism-seeker’s group, treatment might also address relationship issues,especially when a primary relationship is threatened. The relevance ofexorcism-seeker survivor issues to depressed mood represents anothertreatment focus. Finally, the mean age of the exorcism-seeker’s group(i.e., 38 years old) raises the possibility of mid-life developmental issues.Special sensitivity to religious illness attributions is required asnon-religious treatment rationales may be resisted by exorcism-seekersand rapport may be compromised if religious beliefs are notacknowledged and discussed (see below). The report of recent demonicpossession behavioral displays may constitute a religious ‘cry for help’during an episode of acute mood disturbance and suicidal ideation. Insuch cases, a collaborative approach to crisis management involvingrelevant clergy would be especially appropriate.The self-perception of demonic possession and its link to mooddisturbance may need to be addressed directly. For some, a biochemicalor psychological explanation for mood disturbance may be sufficient,whereas for others, such explanations may lack credibility as they fail toaddress ‘the root cause’--malevolent demonic activity. A single exorcismattempt by the appropriate clergy may circumvent resistance to nonreligious treatment. If exorcism is successful in removing the selfperception of demonic possession and clinical symptoms persist, non-241religious treatment can proceed with greater cooperation. If exorcism isunsuccessful, it may be suggested that an attributional error was madeand other explanations may prove more helpful.Awareness of Personality Disorder TendenciesThe report of demonic possession may represent an acute statemanifestation of an underlying personality disorder. A carefulpsychological history may reveal a waxing and waning of clinicalsymptoms that tend to coincide with possession episodes; if so, such apattern may be helpful in educating exorcism-seekers regarding thepsychological aspects of their distress and in formulating preventativetreatment plans. However, while providing differential treatment forsituation-based clinical symptoms, the effective health care professionalwill also attend to the ramifications of underlying personality pathologyand the treatment of such pathology where appropriate.The finding of primary dependency features accompanied byavoidant and self-defeating tendencies suggests the need for training inassertiveness, problem-solving and decision-making skills in an effort tofoster greater independent functioning and initiative. If an exorcismseeker describes a constricted social network in which there is an overreliance on the approval and support of a very few people, a helpfultreatment goal will be to expand social contacts, thereby dilutingexclusive dependencies. The possibility of ‘multiple doctoring’--thesimultaneous engagement of several health care professionals for thesame problem--or a history of perpetual health care utilization may alsobe helpfully discussed in relation to dependency issues. A similar242dependency pattern may also be found regarding clergy care. Theimmediacy of the therapeutic relationship can be used to foster anawareness of interpersonal dependency strategies. In addition, someclinicians may wish to include cognitive restructuring strategies in theirtreatment plan in order to address such cognitive phenomena ashandicapping rumination and frightening religious imagery. Finally, therecommendation of relevant reading material from the immenseliterature of pastoral psychology and pastoral care, and theacknowledgment and discussion of religious beliefs and childhood abuseexperiences in the presentation of treatment rationales and goals arelikely to facilitate rapport-building and treatment adherence.Treatment Implications Regarding Religious BeliefsThe strong evangelical Christian belief, generally, and demonicpossession belief, specifically, among exorcism-seekers has implicationsfor help-seeking and psychological assessment and treatment.Furthermore, it is assumed that therapists also espouse a system ofbelief, whether explicit or implicit, religious or otherwise. Therefore, thetreatment implications of therapist beliefs will also be examined.Christian Beliefs and Help-SeekingChristian beliefs have been shown to be associated with helpseeking behavior; specifically, Christians may prefer to receiveprofessional help from those with similar religious beliefs and values(e.g., Dougherty & Worthington, 1982; McLatchie & Draguns, 1985;Worthington & Gascoyne, 1985). Demonic possession beliefs, inparticular, are likely to have important consequences for help-seeking243behavior governed by religious illness attributions. For example, ifdepression is believed to be primarily demonic, then help is more likely tobe sought from exorcism ministries than from mental health services, atleast until exorcism proves ineffective. In this regard, Pattison & Wintrob(1981) describe how “both supernaturalistic and scientific systems ofhealing are utilized preferentially at different times by the same people,”a phenomenon which they term “etiological and therapeuticparticularism” (p. 17).Demonic Possession Belief and Psychological ServicesSeveral authors point to the importance of religious beliefs inproviding psychological services to Christians (e.g., DiBlasio, 1988; King,1978; Worthington, 1988). For example, Salmons and Clarke (1987)recommend that, when assessing individuals who believe themselves tobe demon possessed,.psychiatrists should not be waylaid into always viewingthem within the narrow confines of psychiatric diagnosis. Abroader perspective is required, which takes account notonly of the patient’s interpersonal difficulties but also of theindividual’s subculture and spiritual life (p. 54).An attempt to fully understand relevant religious beliefs is animportant part of the empathic process, and dismissing them asprimitive or unimportant may be detrimental to rapport and underminingto treatment adherence. For example, in a survey of 81 evangelicalChristians and 41 evangelical clergy, King (1978) found that 89% ofevangelical Christians who indicated dissatisfaction with professionalcounseling services in their local communities anticipated that theirChristian faith would be misunderstood or unappreciated, even ridiculed.244McLatchie and Draguns (1985), in their survey of 152 members of liberaland traditional Protestant churches, found that Evangelicals areprepared to use professional help, but express fears that mental healthprofessionals will attempt to alter their Christian beliefs and values.DiBlasio (1988) warns that peripheral treatment of the religious beliefs ofevangelical Christians is likely to meet with conflict and resistance.On the other hand, Begley (1984) has found that CharismaticChristians who frequent religious healing services may have unusual andconfused expectations of therapists and therapy. Ehrenwald (1975)points to the clinical challenge of communicating within a client’s ownframe of reference without reinforcing client pathology. He also arguesfor “an open mind to. the possibility that genuine pj elements may beinvolved in the clinical picture” (pp. 1 17-1 18). The occasional therapisthas even undertaken the strategic use of exorcism (Prince, 1969),although this is surely an example of role blurring. By contrast, Murphyand Brantley (1982), in their operant behavior treatment of demonicpossession, bluntly informed the mother that her daughter was notdemon possessed, her house was not haunted, and that her daughters’possession behavior was not of supernatural origin. Treatmentproceeded successfully despite the mother’s disagreement with thetreatment rationale and the reinforcement of her belief by her ministerand neighbors. However, Murphy and Brantley’s approach is unlikely tobe successful in adult cases of demonic possession in which demonicpossession belief and attribution are entrenched. In such cases,collaboration with clergy in directly addressing and altering the245possession belief through religious means or the legitimization of apsychological treatment rationale by clergy may expedite therapeuticprogress.The Influence of Therapist BeliefsBergin (1980) has expressed concern that clinicians may routinelyperceive religious individuals as more disturbed; if true, this is especiallylikely in cases of demonic possession. However, Bergin’s concern has notbeen empirically supported (Houts & Graham, 1986; Lewis, 1983;Wadworth & Checketts, 1980). Furthermore, the previously observeddisparity between the religious beliefs of mental health professionals andthe general public (Larson, Pattison, Blazer, Omran, & Kaplan, 1986)appears to have lessened in recent years (Bergin, 1991). Nevertheless,the possible influence of both religious and non-religious therapist beliefson clinical judgment (Houts & Graham, 1986), treatment goalpreferences (Worthington & Scott, 1983), referral practices and rates ofservice delivery (Larson et al., 1986) suggests the ongoing need for acritical self-awareness of personal beliefs, religious or otherwise, amongmental health professionals. Wallace (1991), upon reviewing two recentpublications regarding psychoanalysis and religion, is hopeful thatclinicians can fully explore religious aspects of a patient’s psychical lifewithout either supporting or rejecting the value of the patient’s faith.DiBlasio (1988) seems less hopeful. He recommends that therapistsaddress their own philosophical or religious ideologies as a prerequisiteto addressing the religious issues of evangelical Christians.246Treatment Implications for Pastoral CareThe pastoral care of exorcism-seekers often presents specialproblems for religious care-givers. The following pastoral care issues arediscussed: the need for collaboration with health-care professionals, theneed for an awareness of strategic aspects of demonic possession, theiatrogenic affects of past or present exorcism treatment, the problem ofdisavowed responsibility, and the special treatment problems ofexorcism-seekers who report a history of childhood abuse or dissociativedisorder.The Need for Collaboration with Health-Care ProfessionalsCollaboration with the health care community is indicated by thefinding of significant exorcism-seeker distress and the admission of apsychiatric history by almost half of the exorcism-seeker’s group. Peoplewho attribute their distress to the demonic and seek exorcism maybenefit from such a collaborative stance in several ways. First, acutedistress and suicidal ideation require an immediate and broad base ofsocial and professional support. Second, the presence of an unidentifiedpsychological disorder may be better treated by a medical and/orpsychological intervention, especially in the absence of exorcism outcomestudies. For example, a course of appropriate medication or short-termtherapy might at least bring a temporary relief of symptoms, and thiswas indeed the case for one subject in the present study with bipolardisorder. Trethowan (1976), in the aftermath of the Leed’s ExorcismTrial, warns that “the misguided application of such procedures[exorcism] may amount to frank mismanagement and can have dire247results” (p. 127). Alternatively, concomitant pastoral care andpsychological help may have a greater combined trçatment effect thaneither form of help alone. Third, a collaborative approach is prudent inview of the rise of litigation involving members of the clergy and thegreater public demand for clergy accountability. Unfortunately, it is stillconceivable in situations in which a lingering distrust persists betweenchurch leadership and mental health professionals that a troubledperson could be subjected to repeated exorcism without success and yetstrongly discouraged from obtaining help from a psychiatrist,psychologist or even a Christian counselor (Favazza, 1982; Hall et al.,1982; Whitwell & Barker, 1980).Whitwell and Barker (1980) differentiate between two demonicpossession presentations with referral implications. One presentationsuggests the strong influence of the cultural setting; that is,interpersonal contact and specific religious beliefs and rituals lead anindividual to consider a supernatural, demonic illness attribution.Psychological disturbance, especially of a chronic nature, is not evidentand there may be a positive response to exorcism. This kind of demonicpossession presentation is likely to correspond well to a socialpsychological explanatory model. In contrast, the other demonicpresentation is characterized by peripheral involvement in the religioussubculture, indications of major psychological conflict and prominentpsychological symptomatology, and a poor response to exorcism. Thiskind of possession presentation requires collaboration with the mentalhealth community.248Strategic Aspects of Demonic PossessionIt is important to explore the possibility that some of themotivation for believing oneself to be possessed is rooted in the hope thatcertain social needs will be fulfilled through the exorcism process, suchas the need for attention, friendship, nurturance, encouragement andthe mobilization of practical help. To others who may be sensation-seekers looking for excitement, a dramatic religious experience may bevery appealing.latrogenesisThe possibility that some demonic possession behavior is a socialartifact of the exorcism process has already been raised. The creation ofan emotionally charged social situation through musical and/orinterpersonal means and such common procedures as staring into aperson’s eyes and commanding demons to manifest and even reveal theirnames may well trigger a variety of emotional reactions in the vulnerable,suggestible or compliant individual. These emotional reactions are thenpromptly interpreted as demonic manifestations warranting exorcism.The literature on simulated MPD is of relevance here. There areseveral simulation studies that have experimentally producedphenomena analogous to MPD (e.g., Coons, 1988; Harriman, 1942a,1942b; Kampman, 1976; Kiuft, 1982, 1985; Leavitt, 1947; Spanos et al.,1985, 1986). Furthermore, a keen desire to have one’s own ministryvalidated by “signs and wonders” can easily result in much striving tomake something extraordinary happen. Persistence is likely to berewarded by ministry phenomena that are neither the product of hell nor249heaven but of personal ambition. The possibility of iatrogenesis raisesthe pressing need for accountability in pastoral ministries that practiceexorcism.Demonic Possession as Disavowal of Personal ResponsibilityDemonic possession may represent a socially sanctioned disavowalof personal responsibility for one’s own actions. Human action is robbedof its intentional character when it is interpreted as an involuntaryhappening rather than a goal-directed strategy. Under the rubric ofdemonic possession, negative emotional states and morally unacceptablebehavior are disowned; the devil is to blame. Greenson (1974) commentsas follows:I believe most psychoanalysts would explain the feeling ofbeing possessed by the devil as a state of mind that aims todeny the fact that “devilish” impulses are always inside us.By reacting to this situation as if one were taken possessionof by the devil, the person attempts by externalization todeny his responsibifity for his internal devilishness.. .Thoughexorcism is frightening, it is also very appealing because it issimple and quick, and we can delude ourselves into believingthat we are only innocent victims, without a sense ofresponsibility or guilt (p. 828).Treatment Implications of Childhood AbuseThere is a need for sensitivity to child abuse in the pastoral care ofindividuals who seek exorcism as two-thirds of the exorcism-seekers inthe present study reported physical or sexual childhood abuse. The useof a sudden and often dramatic helping process, such as exorcism, forthe emotionally traumatized is clinically questionable; if used at all insuch cases, exorcism would require skill and experience in the clinical250management of decompensation and regression, and adequate emotionalsupport during and after treatment.Also worrisome is the common insistence on the immediateconversion of the distressed person to Christ and the forgiveness of theabuser before exorcism can successfully proceed. Whatever thetheological rationales may be of these treatment conditions, suchconditions may only result in a short-lived conversion and a compliantforgiveness that strangulates emotional issues of importance totherapeutic insight and behavioral change.Unfortunately, there have been some notorious instances ofbungled exorcisms, however well-intentioned, that neverthelessconstitute a re-victimization of victims (e.g., Pearson, 1977). Edwardsand Gill (1981) point to three instances receiving media attention inwhich tragedies occurred as a consequence of exorcism. The cautionexpressed by Page (1989) in his recent defense of the practice of exorcismis salutary and timely.Treatment ImDlications of Dissociative PhenomenaAlthough the identification of specific dissociative disorders wasnot attempted in the present study, exorcism-seekers reportedstatistically significant trait dissociation, and two exorcism-seekersdescribed a past diagnosis of Multiple Personality Disorder.Furthermore, the venerable association between demonic possession andMultiple Personality Disorder (MPD) due to shared phenomenologysuggests that individuals who believe themselves to be demon possessedconstitute a special population in which an elevated incidence of MPD, or251at least MPD diagnoses, is likely to occur. For example, two exorcism-seekers in the present study sought professional confirmation of MPDwhen exorcism began to wane in its effectiveness. Since symptomspersisted, they concluded that there must be an additional cause of theirdistress for which exorcism was ineffective. Their history of childhoodabuse suggested a trauma-induced dissociative disorder, a well-knownconnection among most of the exorcists and many of the exorcism-seekers of the present study (n.b., Chu & Dill, 1990). In such cases, asuccessful diagnosis would provide a rationale and legitimacy forcontinuing symptomatology despite exorcism.Current psychotherapeutic approaches to MPD, at least those frominsight-oriented traditions, advocate an understanding of the function ofalter personalities (demonic or otherwise) and their overall role in thepersonality system and then a negotiation towards their integration(Braun, 1986; Kluft, 1985). Hence, Ross (1989) argues as follows:It doesn’t make sense to exorcise dissociative states, notbecause there are no demons, but because dissociativestates are part of the whole person (p. 26).Indeed, Ross reports that, prior to integration, demon alters evolve into“unhappy secular persecutors” and then therapeutic allies. It is surelyhere that exorcism approaches and current psychotherapeuticapproaches diverge irreconcilably (Goodwin & Hill, 1990). If demonicmanifestations are in fact the product of early attempts to cope withtrauma through dissociation, then their casting out during exorcism, asopposed to a gradual process of understanding and grieving, may meetwith considerable resistance. In this case, the cosmic victory of God over252the Devil, symbolized in exorcism, may turn out to be the rathermundane and questionable victory of a persistent helper over thedesperate evasive attempts of someone who is suddenly becoming aware,perhaps for the first time, of highly threatening memory fragmentsrelated to early trauma.Limitations of StudyInternal ValidityThe internal validity of the study is limited by the use of a batteryof self-report questionnaires under unknown testing conditions and inthe absence of collaborative information. Such influences as variablemood, recall, psychological insightfulness, fatigue and distractingenvironmental conditions may have contributed to unwanted methoderror variance in test responses.Internal validity is further limited due to unknown biasesintroduced by a sample of convenience and the lack of randomlyassigned experimental and control groups. The problems of a nonequivalent group-matching design have been discussed in the literature(Boneau & Pennypacker, 1961; Cook & Campbell, 1979; Huesmann,1982; Kirk, 1990). For example, exorcism-seekers and control subjectsmay be expected to systematically differ on a number of unmatchednuisance variables which account for an unknown proportion of thevariance in test scores.Finally, the assistance of the clergy in collecting data, thoughclearly helpful in obtaining volunteers, raises the possibility ofexperimenter effects and a socially desirable response set--other sources253of unwanted test response variance (Hunsberger & Ennis, 1982; Walker,Davis & Firetto, 1968). Fortunately, this does not appear to be the caseas the results of the MCMI-II Social Desirability response set scale werenot statistically or clinically significant.External ValidityThe representativeness of the exorcism-seeker control group isquestionable due to the use of a volunteer sample. Consequently, theresults should be generalized to other Evangelical-Charismatic Protestantexorcism-seekers with caution. The same is true of the matched controlgroup. Furthermore, the low return rate among the randomly-selectedcontrol subjects raises doubts about their representativeness of average,church-attending Charismatic Christians.SamDle SizeThe sample size was small for some analyses, the two multipleregression analyses in particular. The small sample size is likely toresult in the loss of significant findings which might exist (i.e., falsenegative findings) rather than the identification of significant findingswhich might not exist (i.e., false positive findings). Given the difficultiesin obtaining a sample, the results of the study should be taken as a firststep in the understanding of the special and not readily accessiblepopulation of exorcism-seekers.Future DirectionsThe results of the study are in need of replication. Carefulattention to entrance criteria will reduce sample heterogeneity. Forexample, future attempts to replicate the present study should enlist not254only individuals who identify themselves as Charismatic Christians andattend a Charismatic Protestant church, but also those who stronglyendorse Evangelical-Charismatic Christian beliefs.Future research may focus on exorcism-seekers from other sectorsof the Christian faith, such as Catholic Charismatics. Alternatively, if asufficiently large sample is obtained, it may be possible to makestatistical comparisons between exorcism-seekers who are distressed andnon-distressed, or obsessional (lucid) and dissociative (somnambulist).Exorcism-seekers may be selected for study prior, during or followingtheir exorcism treatment. Future research may also limit the scope ofstudy to demonic possession behavioral displays. The consequences ofaccepting a demonic illness attribution and of being labeled asdemonically possessed or “demonized” would provide another avenue offruitful research as would an investigation of attributional style betweendistressed individuals who accept or do not accept a demonic illnessattribution.Longitudinal research is needed in order to confirm the presence ofenduring patterns of psychopathology among some• exorcism-seekers.Exorcism outcome research is required to establish the efficacy ofexorcism as a treatment modality for the kind of state and trait distressfound in the present study, and to investigate psychological changeprocesses (e.g., exorcism as placebo). Is exorcism effective at all inreducing distress, and if so, for what kinds of distress is exorcism mosteffective? Alternatively, is exorcism harmful for some exorcism-seekers?Is exorcism an effective form of cognitive restructuring in that it removes255a demonic illness attribution? Does exorcism produce self-identitychange (Boyanowsky, 1982)? Ideally, exorcism-seekers could berandomly assigned to treatment and delayed treatment conditions inorder to control for the confounding effects of distress. Alternatively, adistressed control group could be used.Unfortunately, such questions will prove difficult to answer for thefollowing reasons. First, those who practice exorcism are unlikely toconsent to the imposition of experimental controls on the exorcismprocess. Among Protestant Charismatics, non-liturgical exorcism ispracticed; maximum freedom to respond to the Holy Spirit is highlyvalued. Consequently, exorcism is a very dynamic and variable process,thereby introducing the problem of considerable treatment variance. Theprospect of manual-driven treatment is unlikely. Second, there is theproblem of demarcating when treatment ends since many exorcism-seekers return for further exorcism sessions. For these repeaters, thereseems to be no treatment termination. One period of exorcism sessionsfades into another. Third, many exorcism-seekers are secretive abouttheir need for exorcism on the one hand, and wary of psychology on theother. Some report unhappy past experiences with psychologists orpsychiatrists. Others fear interference with their exorcism, or dislikebecoming “guinea pigs” for experimental purposes. In fact, for manyCharismatic Christians, psychology and faith are mutually incompatibleor even antagonistic; therefore, the opportunity to contribute to apsychological understanding of demonic possession and exorcism isneither valued nor desirable. Those who do consent to the scrutiny of99;SZflSjJTJBtppuBwpJO3UflJJUJupunojuooupnpoiiu£qaIqT‘A’.ipiosp3uoTssJoidm3ndisOwSpJOxJOSSUAJPJJAOJdo&iuni.ioddotiesApnsmoanotieaid.iuAemuowjuwjdxjeoooqoAsdEpilogueIn every man of course a demon lies hidden--the demon ofrage, the demon of lustful heat at the screams of the torturedvictim, the demon of lawlessness let off the chain, the demonof diseases that follow on vice, gout, kidney disease and soon... (Dostoyevsky, The Brothers Karamazov)The study has reviewed diagnostic and personality correlates ofcontemporary exorcism-seekers. Many of these correlates were derivedfrom two approaches to demonic possession, the mental illness andsocial role approaches. These approaches offer alternative views ofdemonic possession rooted in the social sciences that do not requirebelief in supernatural phenomena such as demons. According to themental illness view, demons are the personification of human fear andmental anguish, whereas, according to Spanos’ social role view, demonsare an imaginative tribute to the drama of complex social life. Theseapproaches contribute toward a multidimensional understanding ofdemonic possession that can enrich collaboration between clergy andhealth care professionals.Greater collaboration between clergy and health care professionals,however, will require mutual forbearance as demonic possession andexorcism phenomena highlight old tensions between science and religionthat derive from a fundamental clash of epistemology. Zilboorg andHenry (1941), for example, speak of the “restless surrender todemonology” in the Middle Ages as precipitating the “darkest ages ofpsychiatry” and resulting in the misdiagnosis and maltreatment of thementally insane. 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Contemporary FamilyTherapy, 11(2), 89-100.Appendix AA Case Report of Co-existing Demonic Possession and PsychopathologyThe following case report was submitted by Ehrenwald (1975) asan example of a natural psychopathological state and supernaturaldemonic entities co-existing within the same person.Mrs. H., age fifty-one, is the wife of a high-poweredArgentinean business executive two years her junior.Childless and neglected by her husband, she becameaddicted to alcohol eight or ten years ago. For a while shehad dabbled with the Ouija Board and had taken part inspiritualistic seances. She was referred to me when shebecame subject to bizarre attacks of what she and herhusband described as possession by some sinister power.While in my office, she spontaneously lapsed into such acondition. She fell back in the easy chair, rolled up her eyesand moaned and groaned as if in the throes of severe painand anguish. This was followed by a phase of convulsiveand jerky movements of her entire body, accompanied byhowling, barking, yelping and grunting noises which soonturned into an unmistakable take-off of canine antics andposturings. Reversing the biblical story of the swine ofGadara who were invaded by the demons cast out by Christ,she was “possessed” by dogs, if not by a herd of farmanimals, and acted out their parts. This bizarre behaviorcontinued for the better part of our first session and couldnot be interrupted by my attempts to establishcommunication with her, On coming to, she was slightlydazed, vaguely apologetic for her conduct and asked for thewhereabouts of her husband, who had been waiting outsidemy soundproof office. When restored to her usual self, shehad a spotty memory of what had transpired, was fully289oriented and capable of observing social amenities, buttearful and plainly asking for sympathy. Her neurologicalexamination revealed a halting, slightly slurred speech,tremors of the hands, an uncertain gait and a coated tongue.Previous consultants had put her on tranquilizers andvitamins, and diagnosed her condition as chronic alcoholismwith episodic confusional states. Significantly, her EEGshowed evidence of diffuse cortical damage in the parietooccipital region of both hemispheres. The changes wereattributed to her years of alcohol abuse (Ehrenwald, 1975,pp. 107-108).290Appendix BProposed Diagnostic Criteria for DSM-III-R Possession/Trance DisorderA. The predominant disturbance is either (1) or (2):(1) a trance, i.e., an altered state of consciousness withmarkedly diminished or selectively focused responsivityto environmental stimuli(2) possession, i.e., the belief that one has been taken overby some spirit of person (usually associated with trance).B. The disturbance occurs outside a culturally sanctioned context,such as a religious ritual or ceremony.C. The occurrence is not solely during the course of multiplepersonality disorder, brief reactive psychosis, or a psychoticdisorder.D. The disturbance is not due to a physical disorder, e.g., temporal lobeepilepsy, or a psychoactive-induced organic mental disorder, e.g.,intoxication from peyote or mescaline (Skodal, 1989, p. 516.291Appendix CThe Diagnostic Criteria for Transient Dissociative Disturbance(Spiegel & Cardena, 1991, p. 375)A. A significant social or physical stressor that would be markedlydistressing to almost anyone in that culture.B. One or more of the following dissociative symptoms:1. An alteration between customary and atypical heldidentity, such as involuntary possession states.2. An alteration between customary and atypical behavior,such as fleeing, running, or falling out.3. An alteration in state of consciousness coupled withcomplaints of impairment in sensation or motor functionnot explainable on the basis of organic disease, such asataciue de nervious.C. The syndrome leads to distress and dysfunction.292Appendix DDiagnostic Criteria for Possession Disorder(Saxena & Prasad, 1989, PP. 26 1-262)A. Short periods (a few minutes to a few hours) of change in theperson’s identity manifested by change in voice, mannerisms andbehavior--the new identity may be of a known person already deador of a culturally accepted spirit, demon, god, or mythical figure.B. Sudden onset and termination.C. Partial or complete amnesia for the new identity and events thatoccurred during the possession episode.D. Disturbance not due to an organic mental disorder.E. Associated features: attention seeking and dramatizing behaviorduring the possession episode--may occur during religiousceremonies.293Appendix EDiagnostic Criteria for Possessive States Disorder(Isaacs, 1987, P. 272)A, B, and C must be present.A. The experience of being controlled by someone, or something, otherthan oneself, with a subsequent loss of self-control in one of fourareas: thinking, anger or profanity, impulsivity, or physicalfunctioning.B. A sense of self which fluctuates between periods of emptiness andperiods of inflation, though one period may predominate. Thisfluctuation is riot due to external circumstances, but corresponds towhether the person is feeling in control of him or herself, or isfeeling out-of-control.C. At least one of the following is present:1. The person experiences visions of dark figures orapparitions and/or the person hears coherent voiceswhich have a real, and not a dream-like quality.2. Trances, or the presence of more than one personality. Ifmore than one personality, these are either observedonly during a trance, or if present in normal• consciousness, the person is able to maintain anindependent sense of reality respective to the otherpersonality. Also there may be variations in voice or theability to speak or understand a previously unknownlanguage.294295Diagnostic Criteria for Possessive States Disorder--Continued3. Revulsive religious reactions, such as extreme negativereactions to prayer, or to religious objects. The inabilityto articulate the name Jesus, or the destruction ofreligious objects.4. Some form of paranormal phenomena, such aspoltergeist-type phenomena, telepathy, levitation, orstrength out of proportion to age or situation.5. There is an impact on others: Paranormal phenomena,stench, coldness or the feeling of an alien presence orthat the patient has lost a human quality, is experiencedby someone other than the patient.Appendix FDemonic Possession Checklist1. Sexual Impurity: pornography, fornication, adultery,homosexuality, lesbianism, perversion,exposure, bestiality, molestation,masturbation, incest, rape, lust, harlotry,abortion, venereal, disease.2. False Religion: Mormonism, Christian Science, Buddhism,Hinduism, Masonic Lodges, RomanCatholicism.3. Addictions: drugs, alcohol, tobacco, gluttony, rock music,disco dancing, prayer, church attendance,witnessing, speaking in tongues, being slain inthe spirit, suspect gifts of the spirit.4. Occult: fortune told, tarot cards, palm read, seance,Satan worship, occult healing, levitation, ouijaboard, e.s.p., yoga, transcendental meditation,“inner healing,” automatic writing, automaticdrawing, charms and fetishes, hypnotism.5. Marital Problems: spiritual, emotional, sexual, frigidity,impotence, financial, parental.6. Areas of Sin: bitterness, resentment, unforgiveness,jealousy, violent acts, cruelty, criticism,fighting, quarreling, disobedience, rebellion,arrogance, self-righteousness, cursing, lyingand deceitfulness, covetousness, stealing,backbiting, belittling, impatience, irritability,laziness, daydreaming, fantasizing.2962977. Nightmares: discouraged, insecurity, depression, suicidalthoughts, self-pity, voices within, envy, pride,gossip, anger, rage, anxiety, worry, doubts,fears.8. Physical Problems: stress and tension, tiredness, exhaustion,hypoglycemia, diabetes, headaches, insomnia,allergies, asthma, infirmities, anorexia,bulimia, seizures, epilepsy, blackouts,dizziness.9. Pain: menstrual problems, narcolepsy, sinustrouble, arthritis, eyes, nose, ears, throat,venereal.10. Mental Problems: confusion, concentration, procrastination,delusions, hallucinations, schizophrenia,paranoia, persecution complex, trances,accident prone, past traumas, inferiority,prescription drugs.Appendix GThe Deliverance Prayer QuestionnaireThe following 35 statements describe beliefs and attitudes aboutDeliverance Prayer or Exorcism. Do not be concerned if some of thestatements are similar. Each statement is rated according to a seven-point scale:1 2 3 4 5 6 7Disagree AgreeCircle the number on the scale that best describes your response to eachstatement.1. I find the whole idea of Deliverance Prayer a positive one.1 2 3 4 5 6 7Disagree Agree2. The person who will be praying for me has a reputable prayerministry.1 2 3 4 5 6 7Disagree Agree3. I have personally witnessed another person receiving DeliverancePrayer in the past.1 2 3 4 5 6 7Never Very Often2982994. Deliverance Prayer is a legitimate, biblical ministry.1 2 3 4 5 6 7Disagree Agree5. Demonic activity is adversely affecting my life at present.1 2 3 4 5 6 7Disagree Agree6. I expect to be satisfied with the results of Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree7. I believe in God.1 2 3 4 5 6 7Disagree Agree8. I am totally open to receiving Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree9. I have confidence that the person who will be praying for me will behelpful and effective.1 2 3 4 5 6 7Disagree Agree10. Those who receive Deliverance Prayer are as normal and welladjusted as anyone.1 2 3 4 5 6 7Disagree Agree11. I have personally experienced Deliverance Prayer for myself in the•past.1 2 3 4 5 6 7Never Very Often30012. There is a devil.1 2 3 4 5 6 7Disagree Agree13. I#m not afraid of receiving Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree14. I do not expect to be disappointed by the ministry of the personwho will be praying for me.1 2 3 4 5 6 7Disagree Agree15. I believe in the existence of demonic spirits that can possess peopleand cause many kinds of medical and emotional problems.1 2 3 4 5 6 7Disagree Agree16. I am knowledgeable about procedures used in Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree17. I would not mind being known as someone who has receivedDeliverance Prayer. -1 2 3 4 5 6 7Disagree Agree18. There is a heaven and hell.1 2 3 4 5 6 7Disagree Agree19. There is little doubt in my mind that the results of DeliverancePrayer will be positive.1 2 3 4 5 6 7Disagree Agree30120. Intelligent people are the least likely to seek Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree21. If someone attempted to pray over me for deliverance from thedemonic, I would tend to hold myself back rather than get carriedaway by the process.1 2 3 4 5 6 7Disagree Agree22. The Bible is God’s inspired Word and is true in every detail.1 2 3 4 5 6 7Disagree Agree23. I ant knowledgeable about the kinds of actions and behaviors thatpeople may display during Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree24. I would recommend Deliverance Prayer to a friend.1 2 3 4 5 6 7Disagree Agree25. I believe that Christians can be possessed by demonic spirits.1 2 3 4 5 6 7Disagree Agree26. Deliverance Prayer is an effective Christian ministry.1 2 3 4 5 6 7Disagree Agree27. The soul continues to exist though the body may die.1 2 3 4 5 6 7Disagree Agree30228. I’m being bothered by demonic activity at present.1 2 3 4 5 6 7Never Very Often29. The only way to become a Christian is to be born again.1 2 3 4 5 6 7Disagree Agree30. I wonder about the mental stability of those who receiveDeliverance Prayer.1 2 3 4 5 6 7Disagree Agree31. I would recommend the person who will be praying for me to afriend.1 2 3 4 5 6 7Never Very Often32. I have some apprehensions about receiving Deliverance Prayer.1 2 3 4 5 6 7Disagree Agree33. I believe that Deliverance Prayer will be effective in my situation.1 2 3 4 5 6 7Disagree Agree34. The best way to understand the Bible is to take it at face value anduse your common sense.1 2 3 4 5 6 7Disagree Agree30335. Demonic activity has been adversely affecting my life.1 2 3 4 5 6 7Not Just This This Past Past PastAt All Today Week Month Six Year SeveralMonths YearsScale ItemsAttitudes About Deliverance PrayerPositive Beliefs About Deliverance Prayer: Items 1, 8.Mental Stability Attribution: Items 10, 20, 30.Fearlessness: Items 13, 21, 32.Outcome Expectancy: Items 6, 19, 33.Treatment Credibility: Items 4, 17, 24, 26.Possession BeliefPositive Possession Belief: Items 5, 28.Chronicity of Possession Belief: Item 35.Demoniac Role Knowledge: Items 3, 11, 16, 23.Therapist Expectancy: Items 9, 14.Therapist Credibility: Items 2, 31.Evangelical Beliefs: Items 7, 12, 15, 18, 22, 25, 27, 29, 34.Appendix HFollow-Up QuestionnaireThis questionnaire consists primarily of open-ended questions aboutDeliverance Prayer or exorcism that allow you to express yourself inwhatever way you wish. When you have finished the questionnaire, pleasereturn it by mail in the postage-paid envelope provided.questions About Your Condition When Seeking Deliverance Prayer1. Put a check mark beside one or more of the terms that best describethe spiritual condition that led you to seek deliverance prayer.Demonic possession— Explain:Demonic oppression Explain:Demonic bondage Explain:Demonic affliction— Explain:Demonic stronghold Explain:Demonization— Explain:Another term?— Explain:2. What led you to believe that your condition involved the demonic?3. What role did other people play (pastors, counsellors, friends,family) in leading you to believe that your condition involved thedemonic?3043054. People often try to find one or more causes for their problems.Regarding the cause(s) of the problem(s) that brought you to prayerministry, how much of the problem(s) was:4.1. Demonic in nature0% 10 20 30 40 50 60 70 80 90 100%4.2. Emotional/psychological in nature:0% 10 20 30 40 50 60 70 80 90 100%4.3. Physical/medical in nature0% 10 20 30 40 50 60 70 80 90 100%4.4. Another cause?______________0% 10 20 30 40 50 60 70 80 90 100%Comments?Ouestions About Unusual ExDeriences5. Have you ever had the experience of leaving your body? That is,have you ever experienced yourself as actually being outside of yourphysical body? Yes — No —5.1. How old were you at the time?5.2. How frequently did you have this experience?6. Have you ever actually seen a spiritual being? Yes — No —6.1. How old were you at the time?3066.2. Was the vision divine/holy, definitely evil, or neither clearlydivine or evil?6.3. Did the being in your vision communicate with you?Yes NoHow?What was communicated?7. Have you ever actually heard the voice of a spiritual presence?Yes No7.1. How old were you?7.2. Was the voice divine/holy, definitely evil, or neither clearlydivine nor evil?7.3. What did the voice tell you?Medical questions8. Have you ever had a serious bump on the head so that you lostconsciousness? Yes — No—9. Have you ever been told by a doctor that you have a head injury orbrain lesion? Yes No10. Have you had a history of blackouts or memory losses?11. Have you ever had seizures of any kind, such as epileptic seizures?Yes No12. Have you ever been diagnosed with:Tourette’s Syndrome: Yes — No—Multiple Sclerosis or a related neurological disorder: Yes — No—A psychiatric condition: Yes — No Diagnosis:30713. Have you abused drugs or alcohol in the past? Yes — No —Do you abuse drugs or alcohol now? Yes — No —Did your father or mother abuse drugs or alcohol?14. You may find the following questions too painful or too private toanswer, so please feel free to decline.Were you sexually or physically abused as a child? Yes — No —At what age did the abuse start?How long did the abuse last?How frequent was the abuse?Have you experienced other traumatic events since that time?

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