On Satan, Demons and Psychiatry | Ragy Girgis

On Satan, Demons and Psychiatry

The following is an excerpt from On Satan, Demons and Psychiatry by Ragy Girgis. It’s a featured Speakeasy selection, and there are still limited review copies available for qualified reviewers.

Jesus and the (Dis)possesed: The Miracle of the (Gadarene) Demoniac
In one of the most well-known stories of the New Testament, told in all three Synoptic Gospels, Jesus had just stepped ashore along the Sea of Galilee when he was met by one or two “demon-possessed” men (v. 27). [In Luke and Mark, he heals one man. In Matthew he heals two men. Henceforth, I will use Luke 8 as the primary source for this account and will refer to one man, although the discussion and points do not change whether there were one or two men]. Examining this story from the perspective of serious mental illness could provide a great deal of understanding about serious mental illness. As stated above, it is important to iterate that my goal in this chapter is not to change the readers’ view that the Miracle of the Gadarene Demoniac is about serious mental illness per se, but rather to use this great miracle to enhance what we understand about serious mental illness by examining it from a post-Enlightenment perspective. I will undertake to do so now.

According to the Gospels, the man was disheveled and “. . . had not worn clothes or lived in a house, but had lived in the tombs.” (v. 27). It is possible that his “demon-possessed” man was also suffering from an untreated serious mental illness, such as schizophrenia or a severe form of bipolar disorder. In this context, this story underscores the clear pattern in which individuals in the Bible with symptoms of serious mental illness are disheveled, transient / homeless, and live away from society, similar to the story of Nebuchadnezzar in Daniel 4. As mentioned previously, this type of behavior, namely, inattention to hygiene, as well as chosen homelessness, are very unfortunate traits of especially untreated serious mental illness.

The Gospels go on to describe the man as being hyperactive and disorganized, so much so that he had “. . . broken his chains and had been driven by the demon into the solitary places.” (v. 29). These behaviors are unfortunately very typical of untreated severe and acute mental illness. For example, when patients with severe manic or psychotic episodes are in the emergency room, they frequently become severely agitated, loud, and hyperactive, to the point that they become unable to control themselves. They often have persecutory delusions, such as that people in the emergency room or elsewhere want to kill them, or that devils or other spirits are trying to control them. They may also experience auditory hallucinations that seem very real to them and command them to kill themselves or other people. In these cases, patients will sometimes try to harm or kill themselves or someone else, in order to protect themselves. These situations are considered among the most dangerous and acute in psychiatry and require emergency and extreme management. The first step in the management of such situations would be for these patients to be offered medications that they can choose to take by mouth. If they refuse to do so, which is often the case due to their agitation, disorganization, and impaired insight, and if they are still severely agitated and dangerous, approximately five or six very large, football lineman-sized security guards will hold the patient down (one for each limb and one for the head, at the minimum) for an injection of medication. The striking reality is that, while in a state of agitation and untreated severe psychosis, many times compounded by illicit substance use, people lose their inhibitions and become inordinately strong, so that even smaller people, men or women, become so enormously strong and difficult to manage that at least five or six 250 plus pound people are required to restrain the patients. Many times, formal restraint devices are used. The description of the “demon-possessed man” in Luke 8 is therefore a very dramatic, though unfortunately very accurate, description of an individual suffering from acute and serious mental illness. The account of the man possessed by an ”evil spirit” in Acts 19 (v. 15) is similar in that it describes a man who, because of his condition, was so powerful as to be able to overpower seven sons of Sceva. [This latter account came after the famous verses (v. 11-2): “God did extraordinary miracles through Paul, so that even handkerchiefs and aprons that had touched him were taken to the sick, and their illnesses were cured and the evil spirits left them.” In this case as with others described in this book, though described as “evil spirits,” the description is consistent with untreated serious mental illness, although few details are provided].

Even without the severe agitation described in this account, cutting, or much worse, is very common. In Mark 5 v.5, the man was described as someone who would “. . . cry out and cut himself with stones.” Psychotic people do not uncommonly self-injure, such as my recent twenty-seven year-old patient who would routinely essentially perform surgery on himself to remove the parasites that he thought were placed in his stomach by aliens, or my thirty year-old patient who carves symbols into his legs as signs of the occult. These behaviors are typical of serious mental illness.

The middle part of the story is very interesting for a number of reasons, including that Jesus began to have a discussion with the man’s “demons,” named “Legion” (v. 30), and only healed the man after transferring the illness to a large herd of pigs, which rushed into the lake. Several questions that people often have about this exchange are: 1) Why did Jesus have a discussion with Legion and transfer Legion to the pigs? Why did he not just cure the man and leave it at that? 2) Does this discussion, and the aftermath in which Legion was transferred to the pigs, not provide evidence that Legion was actually a demon or the devil rather than a mental illness? Regarding the second question, before setting out to write this book I never considered that this story was anything other than the curing of a demon-possessed man. However, what if we were to try to understand this story from the perspective of mental illness? That this man was speaking as Legion is actually wholly consistent with mental illness. Many individuals with severe psychosis develop delusions of having a false identity – for example, that they are kings, presidents, famous actors, rock stars, other political or military leaders, Satan, God, aliens, or the undead. The proper way of interacting with people with these delusions is almost exactly as described in this passage. In fact, Jesus responded to Legion as any psychiatrist would interact with a delusional person. Namely, to understand who they think they are and their purpose, and to try to empathize with and understand them, not challenging their delusion, and not reinforcing it. For example, even first-year psychiatry residents know that the wrong thing to do would be to dismiss a patient’s delusion and tell this person that he is not Legion but actually a person, say “Mr. G,” with a delusion. Similarly, it would be inappropriate to reinforce their delusion, for example by telling Legion that he has additional information about his identification, such as by appearance or report, in order to gain his trust. In addition, this would serve to help one understand the psychotic person’s delusions. As one of my supervisors would often tell me when I was in residency, it is not that delusional people are illogical. Rather, their thinking is very logical once you understand the premises for their beliefs. For example, I had one patient who would wear a winter hat that covered his ears wherever he went. It did not matter the time of year nor whether he was inside or outside, he always wore this hat. It was odd and seemingly illogical, especially in summer when it would have been very uncomfortable to wear a winter cap. Therefore, nobody understood why he was doing this. Everyone just attributed this behavior to his psychotic illness. When I began seeing this patient I noticed the same behavior and figured that there must have been a reason for it. It was during our second session when I learned that this patient thought that all human beings were actually impostors, with their bodies being taken over by an alien race from Jupiter. According to the patient, the way that this alien race took control of peoples’ bodies was by sending electronic signals through their ears into their brains. The patient had to cover his ears at all time in order to prevent being taken over by this alien race. Therefore, although at first view this patient’s behavior was seemingly illogical, I eventually understood the reason for why he was wearing a cap even in the summer and indoors. It was completely logical, based on what this patient believed. I used this understanding in the treatment and was better able to understand and ally with the patient with this new understanding. Therefore, Jesus simply and appropriately communicated with, and obtained information from, the man.

About the Author

Ragy Girgis

Ragy Girgis is an associate professor of clinical psychiatry at the Columbia University Department of Psychiatry. He is an academic researcher, focusing on serious mental illness, and in particular schizophrenia, with a focus on brain imaging as well as the development of experimental treatments. He has published approximately seventy peer-reviewed journal articles and several scientific book chapters pertaining to treatment and the neurobiology of schizophrenia. Girgis is also a practicing Christian.

One Response to On Satan, Demons and Psychiatry | Ragy Girgis

  1. JOHN T. SHEA April 22, 2020 at 1:18 pm #

    Thanks for this very interesting article! Though C. S. Lewis is often thought of as a conservative supernaturalist Christian, and wrote “The Screwtape Letters”, one of the most famous books about demons, he too viewed the “possessions” Jesus healed as probably mental illnesses rather than literal demons. Nonetheless, Lewis pointed out that Jesus’ sudden healing of severe and long-standing mental illnesses remained miraculous.

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