Chaudhary et al.

UJMDS 2013, 01 (01): Page 12-22

Unique Journal of Medical and Dental Sciences

Available online: www.ujconline.net
Review Article

DISSOCIATIVE TRANCE DISORDER: A CLINICAL ENIGMA

Chaudhury Suprakash1*, Subodh Kumar2, Santosh Kumar3, Chandra Kiran4
1
Prof & Head; Dept of Psychiatry, PIMS (DU) Loni
2
Senior Resident; Dept of Psychiatry, AIIMS, New Delhi
3
Asst. Professor, Resident; Dept of Psychiatry, Rohilkhand Medical College and Hospital, Bareilly.
4
Senior Resident; Dept of Psychiatry, RINPAS, Ranchi.

Received: 02-07-2013; Revised: 20-08-2013; Accepted: 11-09-2013

*Corresponding Author: Dr. S. Chaudhury
Prof & Head, Dept of Psychiatry, Pravara Institute of Medical Sciences (DU) Rural Medical College & Hospital, Loni,
Dist. Ahmednagar, Maharashtra, Email: suprakashch@gmail.com

ABSTRACT
Cultural influences give rise to challenges in the context of managing commonly presenting mental illnesses and dissociative trance or
possession states capture the essence of the problem. Trance is an altered state of consciousness and possession is a conviction that the
individual has been taken over by a spirit, power, deity, or other person. It remains an enigma for most of us. Unresolved stressful
events and socio-cultural background are the vulnerability factors. Various cortical area and neurotransmitters are blamed for this
condition. It can also be understood by religious perspective and psychoanalytic theory. A holistic view of paranormal experiences
should be developed to tackle these phenomena.
Keywords: Dissociative Trance Disorders; Dissociative Identity Disorder; Possession States

INTRODUCTION
India is a country with a diverse range of cultures, ethnicities, serve to keep stressful internal knowledge out of one’s
race, religions and languages. These cultural influences consciousness and prevent conscious awareness of stressful
sometimes give rise to challenges in the context of managing external stimuli. It is generally believed that dissociation
commonly presenting illnesses. Physicians are expected to comprises a continuum of experiences found cross-culturally
take account of psychological, social and environmental and, with some types, universally4-6.
factors that underlie some of the problems with which patients Dissociative trance or possession states capture the essence of
present, particularly where there are concerns about mental the problems and it remains enigma for most of us. It has been
health. In cases where physical manifestations seem to stem reported in Hong Kong, Singapore, Malaysia, India, Sri
from deep-seated influences relating to socio-cultural norms Lanka, Japan, and Haiti. Although there are several case
and expectations, some conditions can prove difficult to treat1. reports7-9, and few reviews 10-11 the largest series of possession
Belief systems and moral values are intrinsic to human life, cases was reported by Yap12. He described 50 women and 16
and for many people cultural and religious considerations men admitted to Hong Kong Mental Hospital during a two-
exert strong, positive influences on their lives. Norms bound year period with signs of the possession syndrome (i.e., either
by culture and belief can also negatively impact on people in believing that they were possessed or actually exhibiting
terms of mental and physical well-being. Culture-bound another ego state characteristic of possession) ; this
syndromes are not uncommon within primary care in India represented 2.4% of all first admissions. Although their ages
and Asian communities more generally, with cases arising that were not significantly different from the general population,
display psychiatric and associated somatic symptoms2. there was an overrepresentation of widowed and divorced
Recognizing that there is an element of controversy persons. Diagnoses included hysteria (48%), schizophrenia
surrounding the diagnosis, an example to consider is that of (24%), depression (12%), and mania (6%). Some degree of
dissociative trance or possession-like state, most commonly clouding of consciousness, skin anaesthesia, identity
encountered amongst young adult women3. Dissociation is alteration, and amnesia was exhibited by 38 patients. A
posited to be a psychological mechanism for coping with follow-up of 41 cases revealed that those with hysteria and
internal and external stress. It is conceptualized as a depression were well, but two-thirds of the schizophrenic
compartmentalization of consciousness that varies in strictness patients remained symptomatic. A review of 28 articles
of compartmental isolation and interaction. Compartments reporting 402 cases of patients with DTD worldwide showed
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 12
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

an equal proportion of female and male patients, with a subjects reported multiple possessions. The initial experience
predominance of possession (69%), compared with trance of possession typically came on acutely and often became a
(31%). Amnesia was reported by 20% of patients. Conversely, chronic relapsing illness. Almost all subjects manifested the
hallucinatory symptoms during possession episodes were two symptoms of loss of control over their actions and acting
found in 56% of patients and thus should feature as an differently. They frequently showed loss of awareness of
important criterion. Somatic complaints are found in 34% of surroundings, loss of personal identity, inability to distinguish
patients. Multiple explanatory models are simultaneously held reality from fantasy, change in tone of voice, and loss of
and appear to be complementary13. Recently a study to perceived sensitivity to pain.18 Similarly in 119 patients with
determine whether classical culture-bound syndromes occur spirit possession from Uganda had significantly higher number
among psychiatric inpatients with dissociative disorders in of reported potentially traumatizing events including lack of
North America reported a wide range of possession food or water, ill health, no access medical care, serious
experiences and exorcism rituals, as well as the classical injury, forced isolation, being close to death, forced separation
culture-bound syndromes of latah, bebainan, amok, and from family, murder of family member/friend, unnatural death
piblokto. The participants reported high rates of childhood of family member, murder of stranger, lost or kidnapped,
physical and/or sexual abuse (87%), dissociative disorders torture and frightening life situation19. Trance and possession
(73%), and membership in the dissociative taxon (78%) 14. states also occur as part of formal religious practice in all of
Trance the world's major religions. Ritual trance may be associated
Trance is a phenomenon underlying both ritual trance with numerous methods of induction including music and/or
possession and the dissociative disorders. It is an altered state drum beating, dancing, spinning, chanting, hyperventilation or
of consciousness characterized by the presence of alter ego hypoventilation and drug use. During such trance states it is
states15. Trance-like states occur during meditation, religious not uncommon to have helpers or guides who protect the
ritual, automatic writing, brain-washing/interrogation, sensory trancers from hurting themselves. Methods of terminating
deprivation, day-dreaming, and medium ship, a nineteenth trance possession include inhaling smoke, being shaken and
century phenomena, and channeling, its twentieth century slapped or being exposed to noise. Usually, however,
counterpart. Trance is commonly confused with hypnosis, mediums simply come out of trance through the use of
which is a type of a trance induced in a subject by a hypnotist. suggestion. Rituals have many functions. Ideological rituals,
Alterations may occur in memory, mood, perception, identity such as rites of passage, control individuals for the sake of the
and motor function during hypnosis. The matters revealed community. Salvation rituals, such as ritual possession or
during hypnosis may be contaminated by fantasy, exorcism, repair damaged self esteem. Finally, revitalization
confabulation, or lying. Persons cannot be hypnotized against rituals, such as religious revivals serve to create a better
their will, and it is doubtful that they can be induced to do culture. The belief in possession and exorcism serves more
something against their moral code. Susceptibility to hypnosis specialized functions, including identifying and dramatizing
occurs along a bell-shaped curve among the general unacceptable behavior, enabling social change to occur by
population16. isolative disruptive influences, reunifying deviant individuals
Possession with society when unacceptable behavior has ceased,
Possession is an age old concept with number of biblical reconfirming of a group's beliefs, resolving conflict, protecting
references. Central Asian shamans participate in ritual trance of the community against disintegration, reenacting of death or
possession. However, that possession phenomenon may be resurrection, and demonstrating that living beings have control
normal, and occur as an everyday part of cultural or religious over the spiritual world 20-21.
experience10. According to anthropologist Erika NOSOLOGY: ICD 10 & DSM V:
Bourguignon17 there are three types of possession: non-trance Classification of trance and possession states is somewhat
possession belief, trance possession, and ritual possession. In different in the two major classificatory systems. The ICD and
non-trance possession belief, either the individual or close the DSM present dissociative trance and possession disorder
observer believes that one is possessed, usually by the devil or as a transient involuntary state of dissociation causing distress
demons. In trance possession an altered state of consciousness or impairment. The divergence between the ICD and the DSM
usually of a god or spirit, alternates with the individual's is that in the latter classification the DTD is solely mentioned
normal identity. In ritual possession, trance possession occurs as an example of "Dissociative Disorder Not Otherwise
within a ritual, usually religious in nature. Trance possession Specified
and ritual trance possession occur on a worldwide basis and ICD 10 F44.3 Trance and possession disorders
have been observed in 90% of 437 cultures in America, Disorders in which there is a temporary loss of both the sense
Europe, Africa, Asia and the Caribbean and Pacific Islands17. of personal identity and full awareness of the surroundings; in
A study of 20 hospitalized Chinese psychiatric patients (mean some instances the individual acts as if taken over by another
age 37 years) who believed they were possessed revealed that personality, spirit, deity, or "force". Attention and awareness
most were women from rural areas with little education. Major may be limited to or concentrated upon only one or two
events reported to precede possession included interpersonal aspects of the immediate environment, and there is often a
conflicts, subjectively meaningful circumstances, illness, and limited but repeated set of movements, postures, and
death of an individual or dreaming of a deceased individual. utterances. Only trance disorders that are involuntary or
Possessing agents were thought to be spirits of deceased unwanted, and that intrude into ordinary activities by
individuals, deities, animals, and devils. Twenty percent of occurring outside (or being a prolongation of) religious or
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 13
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

other culturally accepted situations should be included here. also offers strong social bonds and group support within a
Trance disorders occurring during the course of schizophrenic well-defined subculture26. Another possible predisposing
or acute psychoses with hallucinations or delusions, or factor for possession is the individual’s personality.
multiple personality should not be included here, nor should Unfortunately, there are only a few studies investigating this
this category be used if the trance disorder is judged to be aspect.
closely associated with any physical disorder (such as Lower extraversion scores and higher psychoticism,
temporal lobe epilepsy or head injury) or with psychoactive neuroticism, and lie scores were found in 58 dissociative
substance intoxication22. trance disorder patients compared to the Singapore norms.
DSM V: DSM V has included the pathological possession Follow up of 47 subjects revealed that total episodes of trances
component into Dissociative Identity Disorder (DID). The that occurred over the 1-year period were positively correlated
pathological trance component remain in Other Specified with neuroticism and negatively with extraversion scores. The
Dissociative Disorder – Dissociative trance23. high lie scores in individuals with dissociative trance disorder
Diagnostic criteria of DID: could be a reflection of their concern of how others perceive
A. Disruption of identity characterized by two or more distinct them. The motivation could be that of restoration of self-
personality states, which may be described in some cultures as esteem or "face." The profiles in the EPQ could be used to
an expression of possession. The disruption in identity predict the individual's frequency of trance states. Subjects
involves marked discontinuity in sense of self and sense of with personality traits like nervousness, excitability, and
agency, accompanied by related alterations in affect, behavior, emotional instability were more likely to have a higher
consciousness, memory, perception, cognition, and /or frequency of trance states27. Ten people who had undergone
sensory-motor functioning. These signs and symptoms may be exorcisms for demonical possession were found to have many
observed by others or reported by the individual. traits in common with patients with dissociative identity
B. Recurrent gaps in the recall of everyday events, important disorder27. Furthermore, they were overwhelmed by
personal information, and/or traumatic events that are paranormal experiences. Despite claiming possession by a
inconsistent with ordinary forgetting. demon, most patients managed to maintain normal social
C. The symptoms cause clinically significant distress or functioning. Rorschach findings showed that these persons
impairment in social, occupational, or other important areas of had a complex personality organization. Some tended to
functioning. oversimplify stimulus perception whereas others seemed more
D. The disturbance is not a normal part of a broadly accepted committed to psychological complexity. Most had severe
cultural or religious practice. impairment of reality testing, and six had an extratensive
Note: In children, the symptoms are not better explained by coping style28.
imaginary playmates or other fantasy play. On the Thematic Apperception Test the stories of dissociative
E. The symptoms are not attributable to the physiological participants were characterized by greater interpersonal
effects of a substance (e.g. blackouts or chaotic behavior distance and more trauma and dissociation responses than
during alcohol intoxication) or another medical condition (e.g. those of the controls. No significant differences were found
complex partial seizures). regarding total number of emotional references, although
Dissociative Trance: This condition is characterized by an references to positive emotions were almost nonexistent for
acute narrowing or complete loss of awareness of immediate the dissociative group. A post hoc analysis of the data found
surroundings that manifests as profound unresponsiveness or the testing behaviors of dissociative participants to be
insensitivity to environmental stimuli. The unresponsiveness characterized by switching, trance states, intra-interview
may be accompanied by minor stereotyped behaviors (e.g. amnesias, and affectively loaded card rejections29.
finger movements) of which the individual is unaware of MECHANISM FOR DISSOCIATION
and/or that he/she cannot control, as well as transient paralysis If dissociation is triggered autonomically by stressors, then
or loss of consciousness. The dissociative trance is not a there must be a physiological basis for it. It is a biogenetic
normal part of a broadly accepted collective cultural or structure that exists for contending with an abundance of
religious practice. external stimuli too complex for cognitive processing. Brains
VULNERABILITY FACTORS simplify information by filtering to render it consistent with
All people facing unresolved stressful events will not enter a preexisting information and thereby maintain psychological
possession-trance. The social and cultural background of the equilibrium. With self-awareness and language, the role of
individual exerts a significant etiological effect. Possession dissociation expanded in higher primates and especially
occurs far more often in primitive tribes or societies with folk humans. It is now also used to filter an overabundance of
belief of spirits and evil. In India 75% of psychiatric patients internal information for use in contending with social
consulted religious healers about possession24. Similarly, in a situations in the same manner. The fundamental and adaptive
rural community of South Korea, 15 to 25% of psychotic nature of dissociation is best implicated by its integral role as a
patients were treated by shamanistic therapies, clearly facility of sleep and dreaming. While psychologist posited a
indicating that primitive societies are more ready to accept partial mechanism for dissociation, constituting alternative
possession as a kind of help-seeking behavior and spiritual neural pathways to those of normal consciousness, localization
intervention is a common and important alternative to standard of other social intelligence mechanisms enable completion of
medical treatment25. Being possessed will allow the individual the model. Studies have linked self-related operations,
to seek help in another identity, which is culturally accepted. It including self-awareness and mental-state attribution, to the
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 14
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

brain’s right prefrontal cortex. Dissociation is the third like those of modern shamanic trance cultures and may be a
primary aspect of social intelligence along with self-awareness part of the symbolic enactment of religious ceremony34-35.
and mental-state attribution, and it is directly correlated to the Furthermore, cultures differ in their manifestations of
same cognitive mechanisms as other self-related traits. shamanic dissociation. In the Himalayas, shamans make soul
Demonstrations of contra-lateral self-face recognition (quicker journeys, whereas in Korea they utilize trances but not soul
recognition and identification of photos of oneself with the left journeys per se. Hindu shamans achieve trance states by
hand than the right) have confirmed the localization of these in driving metal hooks into their bodies or walking on red-hot
the right prefrontal cortex, as have studies of the loss of self- coals. Among the Sora of Orissa, the shaman’s soul leaves her
recognition, self-awareness, and mental-state attribution in body while it is inhabited by a succession of dead ancestor
Alzheimer’s patients. Conjugated upward deviation of the “helper” spirits who speak to the living. Certain native peoples
eyes, as well as the so-called "rolling of the eyes", which are of North America are known for their dissociative “vision
present during trances, are suitable entry points for the study quests,” where they go into the wilderness for a number of
of the anatomic substrate underlying these experiences. The days to fast and seek the guidance of spirits who often take the
thalamus, posterior commissure, pretectal zone, and Cajal and form of animals. Similarly, the Mandan sweat-lodge may have
Darschewitsch nuclei are the anatomic zones related with the served a similar purpose. South American shamans are
upward gaze, "eye rolling" and trance type changes of renowned for their use of entheggenic plants such as
consciousness. Independently of these facts, at least three ayahuasca, San Pedro, and tobacco to induce dissociation and
different types of trance behavior can be differentiated: the visions, while peyote has been used in the U.S. Southwest.
form that we call passive is present in physiological sleep, and The Bushmen of the Kalahari were able to induce a trance and
consists of the eyes turning upwards spontaneously. In the “climb to the sky,” a practice reminiscent of the Sambia of the
form called active, the trance is linked clearly to the upward New Guinea Highlands35. Most of these descriptions imply a
stare and ocular rotation. Finally, a form that we call dissociation induction method—i.e., pain, exhaustion,
intermediate in this study accompanies personality changes in hypoglycemia, psychoactive drugs that can readily be defined
multiple personality disorder and some cases of psychogenic as stressors.
flight. The conjugated upward deviation of the eyes can be, in DISSOCIATIVE TRANCE AND POSSESSION: IS THE
the absence of another disorder, a first-order indicator of PERSON MENTALLY ILL?
disorder of consciousness of the type found in dissociative Shamans in the past were viewed as “mentally deranged”
disorders30. persons exploiting a cultural niche36, and possession cults
SHAMANISM AND POSSESSION TRANCE were labeled as refuges for the mentally ill37. However,
Anthropologists believe self-induced stress is used cross- culturally-mediated dissociation is now acknowledged in the
culturally as a form of healing31. In rituals and with medicinal current classificatory systems. This extreme behavior, viewed
plants, people push past normal limits in order to experience as mental illness if unsupported by the community at large, is
power, energy, and transformation. They do so through by contrast viewed as adaptive in supportive environments37-
38
exposure to excessive or extremely low levels of stimulation. . Despite this apparent social construction of mental health,
This can include many things, from the hyperkinetics of DID can be compared particularly to possession trance on a
prolonged dancing and music to drug use to chanting or silent psychological level. It is, in the face of severe trauma, an
meditation to the localized, induced pain of acupuncture. Such adaptive coping strategy for an individual. For example,
self-induced stress is thought to release endorphins, which are comparing DID to cross-cultural possession trance in respect
biochemically similar to opium or morphine and known to to childhood trauma, Ross33 states that in their culture, the
reduce pain and relieve depression32. These rituals and stress- traumatized girl creates a tough secular adolescent male
induction methods are part and parcel of cross-cultural protector personality, while in another culture the protector
shamanic and possession practices. Ross33 believes that the would be a deity, spirit guide, or mythological figure. There is
psychobiological basis is the same as “trance and possession variation at the level of content, but the structure is probably
states found in most cultures throughout history.” Indeed, a universal. In possession trance cultures in which spiritual
variety of such cultural rituals and behaviors are characterized leaders are taken over by spirits, the individual is absolved
by the dissociation. Foremost among them are shamanic from responsibility for behavior exhibited while possessed.
trances, often soul journeys, and ceremonial possession trance. This functionalist interpretation conceptualizes dissociation as
“Soul journey” describes an emic wherein the soul of the a ritualized valve for venting personal and social pressure in
individual has left the body to commune with the spirits, an acceptable context. Dissent toward authority figures
generally about matters related to the health of clients or otherwise considered inappropriate for an individual to
community issues. “Possession trance” involves the express is acceptable and even expected from a spirit. In this
displacement of one’s soul by an invading spirit that has come way, social problems can be voiced and changes implemented
for similar purposes. These are among the more extreme forms without individuals bearing the brunt of social disapproval37.
of dissociation but are nonetheless non-pathological due to Yet this model of dissociation does not posit a closed and
very structured cultural mediation. Culturally-mediated use of coherent system; rather it proposes that dissociation is a
dissociation is believed to have occurred at least as far back as biological adaptation to self-awareness and mental state
Paleolithic times. The prehistoric paintings depicting half- attribution (i.e., consciousness) that is culturally and
human, half-animal figures that populate caves around the psychologically malleable. To clarify this position, one can
world are believed to represent shamans in religious frenzies also point out that sexual intercourse and eating are biological
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 15
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

adaptations far more fundamental than dissociation, yet perspective suggests a slight revision31. Institutionalized forms
promiscuous intercourse can be used to selfishly or ignorantly of trance, such as those of yoga, create alternative neural
hurt others and spread diseases. Likewise, overeating or poor pathways of long-term potentiation through repeated use44. In
nutrition can lead to poor health and social dysfunction. this sense, dissociation is less an altered state of consciousness
Continued non-ritualized possession is viewed as aberrant, and than an alternative state of consciousness and not necessarily
may be seen within the culture as mental illness. Spirits appear “disconnected from the mainstream.” The dissociation
in ceremonial context to reinforce and maintain community phenomenon encompasses forms that are both culturally
needs, offering criticism with impunity directed toward social normal and abnormal42 and that can be short-term, infrequent
problems, government officials, or individuals. Possession aberrations or reinforced through long-term potentiation.
trance is believed to provide power to the powerless. As such, Sometimes information is rigidly separated and results in
it is more typical of developing than developed countries37,39. amnesia; sometimes it is only partially separated. Haitian
To distinguish demon possession from mental disorder is an Vodou and DID offer striking examples of the former,
interesting and important topic to religious people. Koch40, whereas hypnosis and meditation are good examples of the
stated that, in addition to the criteria used by the Catholic latter. A definition of such a generalized phenomenon must
Church, a true possession should also have the following also be broad and avoid stipulating what is normal or
features: internal conflict within an individual, sudden mainstream.
recovery after exorcism, and presence of the ‘transfer Lynn31 has revised Krippner’s definition to read as follows:
phenomenon’ — that is the transfer of the evil spirit from one “The word dissociative attempts to describe reported
person to another, or from a human being to an animal. experiences and observed behaviors that seem to have been
Cooper41 maintained that possession included features which partitioned from conscious awareness, behavioral repertoire,
are not characteristics of mental disorder. and/or self-identity; the word dissociation is an etic used to
These included: describe a person’s involvement in these reported dissociative
(a) history of previous involvement with the occult (b) experiences or observed dissociative behaviors, which
resistance to prayer (c) tendency to curse or blaspheme (d) encompass a variety of emics.” Healthy people dissociate
impaired consciousness so as to cut off spiritual help (e) every day of their lives. In fact, not only can excessive
clairvoyant powers (f) speaking in a different voice or dissociation be maladaptive, so can an inability to dissociate.
language. With the rapid growth of the Charismatic Movement Intermediate between these extremes is a range beginning with
during the past decade, the number of reported possessions few, very mild dissociative experiences and progressing
and successful exorcisms dramatically increased. It is not through many, severely dissociative experiences. Mild
surprising to see that despite advances in medical knowledge, experiences are those of focused attention (e.g., daydreaming)
there is an increasing tendency, in the religious field, to from which a person may easily be distracted. Severe
attribute abnormal experiences to a spiritual cause10. dissociation involves amnesia as a person passes from one
Anthropological Model of Dissociation dissociative state to another. A population mean of type and
Anthropology views dissociation as an adaptation that is only quantity should therefore equate positive well-being—i.e.,
psychopathological under extreme and often culturally-relative good mental health31.
circumstances 17,42. It does not presume the psychiatric ideal of Possession with Evidence of Paranormal Knowledge
integration being the norm31. When severe dissociation occurs Possession states occur widely in India45. Psychiatrists have
in an individual due to a history of traumatic experiences, a emphasized the similarities between cases of the possession
fine line between being personally adaptive and socially type and diagnostic entities such as DID and hysteria.
maladaptive exists. That line may be crossed when an Accordingly, they tend to use phrases such as "possession
individual’s dissociation is so severe as not to be confined to syndrome" and "hysterical possession." They also offer
culturally-condoned parameters and leads to social motivational explanations of the condition that depict it as
marginalization or institutionalization. It is therefore possible beneficial to the affected person in improving his status and
that a community that ceremonially practices a form of perhaps besolving internal and external conflicts. Lewis 46
dissociation, such as spirit possession, may provide a wrote: "Nothing after all is easier than leaping to conclusions
supportive, complementary environment for someone prone to and projecting our own psychological assumptions and
trauma induced, severe dissociation. The opposite could be interpretations onto exotic evidence which may correspond
true in Europe and U.S., where such people find themselves only in superficial detail with apparently similar data in our
labeled as outsiders or mentally ill 17. own culture".
A culturally and anthropologically-oriented definition of The question arises of whether some ostensibly possessed
dissociation was given by Krippner43: “Dissociative” is an persons show knowledge about the life of a deceased person
adjective that attempts to describe reported experiences and that they could not have obtained normally. In a small number
observed behaviors that seem to exist apart from, or appear to of cases the subjects do show such knowledge. Cases of this
have been disconnected from, the mainstream, or flow of kind are rare, and yet sufficiently well known in India so that
one’s conscious awareness, behavioral repertoire, and/or self- the Hindi word parakayapravesh ("entering into another
identity. “Dissociation” is a noun used to describe a person’s body") exists for designating them. The ostensibly possessing
involvement in these reported dissociative experiences or personalities (when not gods or godlings) are usually persons
observed dissociative behaviors. This is a sound assessment known to the subject or about whom the subject may easily
based on cross-cultural comparisons, yet a biocultural have learned normally. In cases of this type it is difficult to
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 16
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

obtain satisfactory evidence of the subject's having knowledge effects more broadly defined, such as financial misfortune,
paranormally acquired. and that (c) may persist indefinitely or until a diagnosis is
Dissociation and Trauma made and the agent is dispossessed of the host’s body. This
Dissociation is experienced as part of the normal cultural concept does not entail the displacement of the person’s
construction of self, local cosmology and society in many identity. It does not require, for example, that the person is
cultural settings. However, in Psychiatry, dissociation is addressed by a different name — the name of the possessing
treated as pathological and associated with traumatic agent — as is commonly the case in executive possession
experiences6. Although some have disputed the relationship episodes. The spirit’s name is often not known until steps are
between dissociative symptoms and traumatic experiences, taken to eliminate or mollify it. Indeed, ritual naming
others have confirmed the association47. Retrospective studies ceremonies frequently appear to concern the establishment of
in Western countries suggested a relationship between the possessing agent’s identity as a person, no longer an
manifestations of dissociation and recalled potentially unknown, unpredictable, and unbiddable thing or force53.
traumatizing events48-49. Retrospective studies in Turkey and Trauma is considered as a risk factor for spirit possession in
among Bhutanese refugees in Nepal also found that South Asia54-55. Common stressors for DTD in Singapore
individuals reporting overwhelming events had more include problems with military life, conflicts over religious
dissociative symptoms than controls. Several authors and cultural issues, domestic disharmony and marital woes56.
concluded that potentially traumatizing events can be Trauma, early loss and recent loss were predictors of attacks
predictors of dissociative symptomatology, particularly when of medically unexplained illness in a Bhutanese refugee camp.
the events are severe and recurrent, when they involve threats This involved alterations of consciousness, which were
to the body from a person or betrayal and when they involve attributed to possession by spirits, rather than to traumatic
an individual who is young or who was previously experiencesv57. A case-control study of 32 school girls aged 9-
traumatized45. Prospective and longitudinal studies have found 14 years afflicted with spirit possession and 34 matched
causal associations between documented traumatization and controls in Thailand showed that being first-born from a small
dissociative symptoms50. Historical connections are suggested family, individual vulnerability especially psychiatric
between the domination of one culture by another and disorders, anxious and fearful character traits, histrionic
dissociative spiritual and religious responses to that character traits and dissociative tendency (history of recurrent
oppression. Connections are drawn between colonial trance states) were significant risk factors in the development
oppression, trauma, and three examples of dissociation and of possession states in children58.
spirit possession: the Zar cult of Southern Sudan, "Puerto Partial Trance among the Mediums
Rican syndrome" or ataque, and the Balinese trance dance. Most of 18 New Age trance channels in Los Angeles, retained
The role and functions of spirit possession is postulated to be a partial memory of the channeling process during trance which
means of escape from unbearable reality, where it becomes a for many of them included a feeling of blending with the
form of the expression of needs and desires forbidden by channeled entity. For some group of mediums, partial
authorities, a way of entering an identity not subject to awareness of physical body sensations and sensory functions
traditional authorities, and reenactment of traumatic were also present. In other words, unlike the full trance
experience51. mediums, dissociation from the physical body process,
Spirit Possession and Trauma including such functions as hearing, speaking, and
Spirit possession, according to anthropologists, occurs more feeling/sensing was only partial, while the inner experience
frequently among marginal, subordinate and underprivileged seems often to have included the same richness of intuitive,
people and has been regarded as a response to intra-psychic emotional, and religious components described by the
tension, difficulties with relatives and situations associated conscious full trance mediums. In semi-trance mediums
with low expectations for aid and support or socioeconomic afterward remembered "being there" and listening to what was
change52. Spirit possession concepts fall into broadly two said, there was often less than normal recall of the content of
varieties: one that entails the transformation or replacement of the communication and the medium retains some awareness of
identity (executive possession) and one that envisages sensory input from the physical body and its surroundings
possessing spirits as (the cause of) illness and misfortune during trance. In full trance by contrast, there seems to be, in
(pathogenic possession). ‘Executive possession’ entails the both the conscious and unconscious varieties: no awareness of
following features: (a) the presence of an incorporeal the external world or the vocal or motor apparatus of the
intentional agent in or on a person’s body, that (b) temporarily physical body during trance, and except for an initial contact
affects the ousting, eclipsing or mediation of the person’s no memory of the process of spirit communication remaining
agency and control over behavior, such that (c) the host’s in the mind of the medium at the conclusion of the trance59.
actions are partly or wholly attributable to the intentions, Conscious Trance and Sensory Amnesia among the Yogis
beliefs, desires and dispositions of the possessing agent for the While the English word "dissociation" can apply in a variety
duration of the episode. In contrast, ‘pathogenic possession’ - of psychiatric contexts60, Yoga uses a specific Sanskrit term to
minimally entails the following set of conditions: (a) the denote trance-related dissociation. Dissociation (pratyahara)
presence of an agent in or on a person, that (b) either causes and trance (samadhi) are not emically equivalent terms in
no (perceived) effects (i.e. the spirit is ‘dormant’) or causes Yoga but the two processes commonly occur together.
physical effects, such as disease or illness, or psychological Samadhi refers to a deepening of engagement of one's
effects, such as depression or hallucinations, or existential awareness in the single aspect upon which the mind focuses.
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 17
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

The word pratyahara refers to the withdrawal of the conscious and trance experiences as well as intense mystical, religious,
awareness from the senses and the objects of their perceptions. and spiritual experiences, are distinct and mediated by several
Most yogic meditation practices are done with closed eyes to brain regions and systems. Increased activity in the frontal
encourage pratyahara, which makes meditation easier. cortex may reflect focused concentration during the altered
Pratyahara tends to occur partially in deep meditation and states of consciousness (ASC) experiences elicited by
more completely in samadhi. As samadhi deepens, meditation practices, while the correlation between the
dissociation increases. One of the older yogis in the dorsolateral prefrontal cortex and the superior parietal lobe
community enters so deeply into samadhi that she cannot hear may reflect a non-ordinary sense of space or time. Circuitries
the alarm clock next to her ringing. Yogic practitioners have involved in sustaining reflexive evaluation of thought were
all heard stories about Yogis who enter high stages of found in religious experience64-66. Although spiritual, mystical,
samadhi for a number of days during which their bodies are and religious experiences may be related to trance and
fed and daily carried by their disciples to the river to be mediumship manifestations, the actions of the main
washed, all without arousing the yogi back to body neurotransmitters during these practices remain poorly
consciousnes.~. While the word "amnesia" implies that the investigated and understood. Nevertheless, it has been
failure is one of memory; the emic term "pratyahara" suggests proposed that higher activity of the dopaminergic system
that the minds of deeply entranced individuals simply fail to (DRD4) and parallel lower activity of the serotonin (5-HT)
register certain types of sensory input; therefore they have no system may be involved in individuals who showed higher
memory of it afterwards. Informants who experienced lower measures of spirituality67 . The latter postulated that their
stages of samadhi reported no interruption of conscious results might be due to the higher concentration of dopamine
awareness, but they did note that they would lose body D4 receptor in the frontal cortex. However, it has been shown
awareness for a time, either partially or completely. Upon that the dopaminergic system is in part under the regulation of
completing practice, for example they would suddenly notice 5-HT projections. For instance, stimulating 5-HT1A or 5-
that their leg was asleep, or they would suddenly notice in HT2A receptors may elicit dopaminergic release68. Therefore,
meditation that their breath had comfortably suspended, but it is too early to postulate a role for neurotransmitters in trance
they would not remember when those sensations had begun. and religious experiences given the tiny number of studies
Trance and Mediumistic Investigation conducted so far. From a psychophysiological perspective of
Research on trance and mediumistic experiences has been trance and dissociation, dissociation involves the disengaging
seminal for understanding mind and its relationship with the of the cognitive processes from their executive, higher-order,
body61. Resuming a rigorous, open-minded and volitional faculties. Generalized psychophysiological
comprehensive investigation of trance and mediumship may correlates of what might be described as trance with
provide important evidence and many insights capable of dissociative aspects involve hemispheric lateralization that
advancing an alternative understanding of mind-brain favors (in right-handed people) the right hemisphere of the
relationships. brain (more closely associated with intuitive, emotive, non-
NEUROBIOLOGICAL STUDIES ON DISSOCIATION, logical, spatial, imaginative thought and perception) over the
POSSESSION, AND TRANCE ordinarily dominant left hemisphere (associated with linguistic
Penfield postulated that neural networks alone would be and rational processing). In shamans, a wide range of
incapable of producing consciousness and stated that the mind culturally-patterned induction techniques lead to generalized
had a distinct existence from the brain, although closely parasympathetic dominance in which the frontal cortex
related to it. He added that there was no place in the cerebral exhibits high-voltage, slow-wave, synchronous
cortex where electric stimulation could cause a patient to make electroencephalographic (EEG) patterns (e.g., theta rhythms)
a decision62. Neurofunctional findings in relation to that originate in the limbic system and proceed to frontal
psychotherapy, hypnosis and the placebo effect, taken as a regions via limbic-frontal innervations69. Some ASCs, such as
whole, can be interpreted to challenge the hypothesis that the some forms of meditation and hypnosis, exhibit small
mind is a by-product or epiphenomenon of the brain63. Studies variances in EEG patterning, and similar differences also exist
of cardiac-arrest survivors found that 11 to 20% of patients between voluntary and spontaneously induced states.
reported experiences that can be used to support the Involvement of the limbic system is an important part of the
hypothesis that the mind can express itself independently of neural architecture of dissociative trance69. For instance, it has
neural functioning. In line with these findings, some theories been implicated in the modulation of a variety of functions
associate the brain with the role of mediating concepts such as including basic survival drives and hypothalamic/pituitary
“spirits” 61. Thus, we should not be dogmatic in taking an a release of neurotransmitter and endogenous opiates. The
priori monist or dualist approach based on as-yet embryonic hypothalamic action, in turn, influences, among other things,
neurofunctional research. Moreover, elucidating the neural dissociation trance-related hallucinations, analgesia, and
circuits involved in subjective experiences such as prayer or amnesia. The hypothalamus also controls sympathetic
mystical experience does not diminish their significance. Most (excitatory) and parasympathetic (inhibitory) nervous systems;
studies in this field have focused on religious practices and the latter being associated with decreased cortical excitation
their underlying neural circuitries. Findings suggest higher and increased hemispheric synchronization. Evidence shows
activity of the frontal cortex, prefrontal cortex64-65, and the that parasympathetic dominance can be induced through
limbic system and decreased activity in the parietal lobes excessive sympathetic activation; such as through drumming,
during religious experiences66. This indicates that mediumistic dancing, and chanting, all of which are common features of
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 18
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

ritual practice and in which the homeostatic reciprocal action Exorcism

of the autonomic nervous system collapses. Rituals, such as During the Renaissance, a great reformation occurred in
those associated with shamanism and mediumship, therefore, Christianity. Protestants believed that every believer who
not only provide psychological relief from social and prayed would be granted the power of exorcism by God, while
environmental stressors, they are mechanisms that employ the Roman Catholics believed that Jesus Christ had given such
driving techniques that “tune” the nervous system through power to his apostles and then to the Church. Today the
hemispheric lateralization, parasympathetic dominance, and Catholic and Protestant Churches still have divided opinions
cortical synchronization. Topographic brain mapping at on the way to identify demon possession. The Catholic Church
midline scalp locations of healer-mediums revealed increased relies heavily on identifying features such as abnormal
brain activity when the healer-mediums reported being physical strength, rejection of sacred things, clairvoyant
incorporated by a “spirit,” compared to resting baseline powers, and ability to speak in a different voice or language,
conditions, suggesting the presence of a hyper-aroused brain together with the test by ‘Holy Water’ to ascertain a suspected
state associated with the possession trance behaviors of the possession. So the haunting spirit can be reliably tested for its
mediums70. In contrast, a small sample of psychiatric patients identity by directly asking it in the name of God10. The signs
monitored during involuntary possession trance revealed no of possession by a demon, suggested by Nevius, included
high frequency brain activity. change of personality with a different set of characteristics,
Rhythmic brain electrical oscillations as measured by EEG and possession of knowledge and intellectual power not
may also have functional implications for the dynamics belonging to the original person10,76.
associated with cortical networks. EEGs reflect changes in DIFFERENTIAL DIAGNOSIS
attention, sensory processing, and cognitive processes Although hysterical dissociation is often the diagnosis on
highlighting the different cortical network interactions71. A referral, different psychiatric disorders including
correlation of self-reported dissociative experiences and theta schizophrenia and depression have been cited to attempt to
power, a positive relation between dissociation and delta explain different possession symptoms. Descriptions of
activity, while cortical power within the alpha range was visions, voices, and ‘dreams’ in chronicles from the Middle
inversely related to dissociative symptoms was reported72. Ages, autobiographies and correspondence between France
Consequently, the combining of neurophysiological and and England, in 134 documents revealed that about half were
phenomenolkgical assessments in a qualitative investigation of descriptions of people in a twilight state and the other half
mediumistic experiences is essential to develop a more precise were associated with an organic confusional state as a result of
understandinc of the neurobiologicad substrate of its fever, starvation, or terminal illnesses74. It is interesting to note
manifestation and disruption of the integrated functions of that psychiatric disorder is not always diagnosed among
consciousness. Biological mechanisms common to all human possessed people. In a 4-5 year follow up study of 36 young
beings may well underlie possession and trance phenomena. men with possession-trance, none of the 26 who could be
Since trance and mediumship have so rarely been investigated contacted at the end of the study showed any evidence of
from a neurobiological perspective, these mechanisms are not psychiatric illness10,77.
clear73. TREATMENT
RELIGIOUS PERSPECTIVE OF POSSESSION Review of data relating to treatments for 114 patients in 19
Early descriptions of possession and exorcism can be found in articles, which can be organized in 6 major approaches:
the Old Testament of the Bible. Interestingly, although (1) Traditional medicine involving folk healers, faith healers,
insanity, epilepsy, and possession are commonly seen as a shamans, but not labeled as exorcism
result of sin, the Bible has distinct descriptions for each of (2) Exorcism
them. There are also stories about possessed persons who (3) Psychotherapy
suffered from epilepsy and after the demon was driven out, the (4) Medications
epilepsy was cured10. (5) ECT
Possession and sin (6) Hospitalization in a psychiatric ward.
In medieval times the relationship between sin, possession, Psychotherapy was the most commonly used treatment (59%)
and insanity was far more complicated10. A systematic review and seems to provide relief in all patients except for one who
of a sample of secular and religious texts, and chronicles chose to end the follow-up. Traditional medicine was used by
sources, successfully extracted every reference to mental 30% of patients of the sample and was reported as efficient for
illness. In 25 of the 57 episodes of mental illness, there were all but two. One patient benefited from an initiation to
roughly equal numbers of bouts of madness alone, possession becoming a shaman. Exorcism was performed in 7% of the
alone, and madness combined with possession. Only about patients, with variable reported efficiency. Medications were
one-sixth of these episodes were attributed directly to sin. Sin prescribed in 30% of patients. Nine patients were prescribed
was most commonly implicated as the cause of madness or antipsychotic medication, with five showing clinical
epilepsy combined with possession, while possession alone improvement, of whom two were receiving low doses. Of
was attributed to sin in only a single case. Madness without note, four patients showed no improvement. Two patients
possession was rarely attributed to sin74. This finding were prescribed antidepressants, showing clinical
contrasted with Zilboorg’s75 simple conclusion that all mental improvement. In contrast, one patient suffering from
illnesses were believed to be a result of sin in the middle ages. "dissociative epileptic disorder" was treated with the
The difference may be due to the different sources studied10. antidepressant nortryptiline, which interrupted the disorder
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 19
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

and resulted in the new onset of a DTD (possession type). Psychiatry and Clinical Neurosciences, 1996; 50(6):
Anxiolytics were prescribed to three patients and brought 313-316.
about some relief. In the 19 remaining patients, the authors do 10. Chiu SN. Historical, religious, and Medical
not specify the drug that was prescribed. ECT was used in one perspectives of Possession phenomenon. Hong Kong
patient without success. Six patients were hospitalized13. Journal of Psychiatry, 2000; 10(1):14-18.
CONCLUSION 11. Littlewood R. Possession states. Psychiatry, 2004;
Although there is a growing trend this century to attribute 3(8): 8-10.
possession phenomenon to mental disorder, controversial 12. Yap PM. The possession syndrome: a comparison of
opinions remain. We, as psychiatrists, should be able to Hong Kong and France findings. Journal of Mental
develop a holistic view of paranormal experiences so that we Science, 1960; 106:114-137.
are competent to give professional advice to patients troubled 13. During EH, Elahi FM, Taieb O, Moro M, Baubet T.
with apparent spiritual issues. We sincerely hope that there are A critical review of dissociative trance and
more psychiatric researches in this area and spiritual issues are possession disorders: etiological, diagnostic,
no longer taboo in medical science. It is in this context of therapeutic, and nosological issues. Canadian Journal
strong emotion that we study possession and dissociation. of Psychiatry, 2011; 56(4): 235-242.
Questions arise about who is qualified to discern possession, 14. Ross CA, Schroeder E, Ness L. Dissociation and
what professional works with what type of subject, what is an symptoms of culture-bound syndromes in North
effective working relationship and which technique are truly America: a preliminary study. Journal of Trauma and
effective. These are all good research questions which can Dissociation, 2013;14(2):224-35.
only be solved in an atmosphere of openness and collegiality 15. Coons PM. The differential diagnosis of possession
between diverse groups of professionals. Hopefully, increased states. Dissociation, 1993; 6(4): 213-221.
exposure to one another's work will enrich our experiences 16. Tart CT. Altered States of consciousness. 3rd edition.
and help those whom we wish to serve. San Francisco: Harper, 1990.
REFERENCES 17. Bourguignon E. Culture and the varieties of
1. Worthington RP, Gogne A. Cultural aspects of consciousness reading. Massachusetts: Addison-
primary healthcare in India: A case- based analysis. Wesley Publishing Company, 1974.
Asia Pacific Family Medicine, 2011; 10:8. 18. Gaw AC, Ding Q, Levine RE, Gaw H. The clinical
2. Pang KY. Hwabyung: the construction of a Korean characteristics of possession disorder among 20
popular illness among Korean elderly immigrant Chinese patients in the Hebei province of China.
women in the United States. Culture, Medicine and Psychiatric Services, 1998; 49:360-365.
Psychiatry, 1990;14(4): 1512 19. Duijl MV, Nijenhuis E, Komproe IH, Gernaat HBPE,
3. Chaturvedi SK, Desai G, Shaligram D. Dissociative Jong JTD. Dissociative symptoms and reported
disorders in a psychiatric institute in India: A trauma among patients with spirit possession and
selective review and patterns over a decade. matched healthy controls in Uganda. Culture,
International Journal of Social Psychology, 2010; Medicine and Psychiatry, 2010; 34(2):380-400
56(5): 19. 20. Pattison EM, Winthrob RM. Possession and exorcism
4. Ray WJ. Dissociation in Normal Populations. In in contemporary America. Journal of Operational
Handbook of Dissociation: Theoretical, Empirical, Psychiatry, 1981; 12: 13-20.
and Clinical Perspectives. Larry K. Michelson and 21. Prins H. Besieged by devils - thoughts on possesion
William J. Ray, eds. New York: Plenum Press. 1996, and possession states. Medical sciences and law,
pp. 51–66 1992; 32, 237-246
5. Ross CA. Possession experiences in dissociative 22. World Health Organization. The ICD-10 Classification
identity disorder: a preliminary study. Journal of of Mental and Behavioral Disorders Diagnostic Criteria
Trauma and Dissociation, 2011;12(4):393-400. for Research. Geneva: WHO, 1992.
6. Seligman R, Kirmayer LJ. Dissociative Experience 23. American Psychiatric Association. Diagnostic and
and Cultural Neuroscience: Narrative, Metaphor, and Statistical Manual of Mental Disorders. 5th Edition.
Mechanism. Culture, Medicine, and Psychiatry, Washington: APA, 2013.
2008; 32(1), 31–64 24. Campiol J, Bhugra D. Redigious healing in South
7. Basu S, Gupta SC, Akthar S. Trance and possession India. Paper presented at the World Association of
like symptoms in a case of CNS lesion: A case report. Social Psychiatry meeting. Germany, Hamburg,
Indian Journal of Psychiatry, 2002; 44(2): 65-67. 1994.
8. Peters, L.G. Karga Puja: A Transpersonal 25. Kim YS, Cho SC, Kim EY, Chung KC, Oh S, Choe
Ritual of Healing in Tamang Shamanism. TS, Cho DY, Rhi BY, Lee CK. The attitudes,
Alternative Therapies in Health and knowledge and opinions about the mental disorders
Medicine, 1995; 1(5):53-61. in the rural Koreans. Neuropsychiatry, 1975; 14: 365-
9. Satoh S, Obata S, Seno E, Okada T, Morita N, Saito 375
T, Yoshikawa M, Yamagami A. A case of possessive 26. Ward CA, Beaubrun MH. The psychodynamics of
state with onset influenced by 'door-to-door' sales. demon possession. Journal for Scientific Study of
Religion, 1980; 19: 201-207
Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 20
 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

27. Ng BY, Yap AK, Su A, Lim D, Ong SH. Personality Susan Marie Powers, eds. Washington, DC:
profiles of patients with dissociative trance disorder Brunner/Mazel, 1997, pp. 3–40.
in Singapore. Comprehensive Psychiatry, 2002; 44. Castillo, R. Culture, Trance, and the Mind-Brain.
43:121-126. Anthropology of Consciousness, 1995; 6(1):17–34.
28. Ferracuti S, Sacco R, Lazzari R. Dissociative trance 45. Carstairs M, Kapur R L. The great universe of Kota:
disorder: clinical and research findings in ten persons Stress, change and mental disorder in an Indian
reporting demon possession and treated by exorcism. village. London: The Hogarth Press. 1976.
Journal of Personality Assessment, 1996; 66: 525- 46. Lewis I M. Ecstatic religion: An anthropological
539 study of spirit possession and shamanism.
29. Pica M, Beere D, Lovinger S, Dush D.The responses Harmondsworth, Middlesex: Penguin Books. 1971.
of dissociative patients on the thematic apperception 47. Lewis-Ferna´ndez R, Martı´nez-Taboas A, Sar V,
test. Journal of Clinical Psychology, 2001;57(7): 847- Patel S, Boatin A. The Cross-Cultural Assessment of
864. Dissociation. In The Cross-Cultural Assessment of
30. Orengo-García F.On the anatomo-physiological basis Psychological Trauma and PTSD. J.P. Wilson and C.
of trance and dissociation. Actas Luso Esp Neurol Tang, eds., New York: Springer, 2007, pp 279–317.
Psiquiatr Cienc Afines, 1998; 26(4): 247-253. 48. Chu JA, Frey LM, Ganzel BL, Matthews JA.
31. Lynn CD. Adaptive and maladaptive dissociation: An Memories of Childhood Abuse: Dissociation,
epidemiological and anthropological comparison and Amnesia, and Corroboration. American Journal of
proposition for an expanded dissociation model. Psychiatry, 1999; 156: 749–755.
Anthropology of Consciousness, 2005; 16(2): 16–49. 49. Nijenhuis ERS, Van der Hart O, Kruger K, Steele K.
32. McElroy A, Patricia K. T. Medical Anthropology in Somatoform dissociation, reported abuse, and animal
Ecological Perspective, 4th Ed. Cambridge, MA: defence like reactions. Australian and New Zealand
Westview, 2004. Journal of Psychiatry, 2004; 38: 678–686.
33. Ross CA. History, Phenomenology, and 50. Diseth TH. Dissociation Following Traumatic
epidemiology of Dissociation. In Handbook of Medical Treatment Procedures in Childhood: A
Dissociation: Theoretical, empirical, and clinical Longitudinal Follow-up. Developmental
perspectives. Larry K. Michelson and William. J. Psychopathology, 2006; 18: 233–251
Ray, eds. New York; London: Plenum. 1996, pp. 3– 51. Hegeman E. Ethnic syndromes as disguise for protest
24 against colonialism: three ethnographic examples.
34. Clottes J, Lewis-Williams D. The Shamans of Journal of Trauma and Dissociation, 2013; 14(2):
Prehistory: Trance and Magic in the Painted Caves. 138-146.
New York: Harry N. Abrams. 1996. 52. Ward C. Spirit Possession and Mental Health: A
35. Winkelman M. Shamanism and Cognitive Evolution. Psycho-Anthropological Perspective. Human
Cambridge Archaeological Journal, 2002; 12(1): 71– Relations, 1980; 33(3): 149–163
101. 53. Cohen E. What is Spirit Possession? Defining,
36. Vitebsky P. The Shaman: Voyages of the Soul comparing, and explaining two possession forms.
Trance, Ecstasy and Healing from Siberia to the Ethnos, 2008; 73(1): 1-25.
Amazon. London: Macmillan. 1995. 54. Castillo RJ. Spirit Possession in South Asia,
37. Bourguignon E. Possession. Prospect Heights, IL: Dissociation or Hysteria? Culture, Medicine, and
Waveland Press. 1976. Psychiatry, 1994; 18: 1–21.
38. Goodman F. How about demons?: Possession and 55. Castillo RJ. Spirit Possession in South Asia,
exorcism in the modern world. Bloomington: Indiana Dissociation or Hysteria? Part 2: Case Histories.
University Press, 1988. Culture, Medicine, and Psychiatry, 1994; 18: 141–
39. Sharp L A. The Power of Possession in Northwest 162.
Madagascar: Contesting Colonial and National 56. Ng BY, Chan YH. Psychosocial stressors that
Hegemonies. In Spirit Possession: Modernity and precipitate dissociative trance disorder in Singapore.
Power in Africa. Madison: University of Wisconsin Australian and New Zealand Journal of Psychiatry,
Press. 1999, pp. 3–19. 2004;38(6): 426–432.
40. Koch KE. Demonology – past & present. Michigan: 57. Van Ommeren M, Sharma I, Komproe BN. Trauma
Kregel Publications, 1973. and loss as determinants of medically unexplained
41. Cooper A. The Scottish Baptist Magazine, 1975; epidemic illness in a Bhutanese Refugee Camp.
Nov:10. Psychological Medicine,2001;31(7): 1259–1267.
42. Walker, Sheila S. Ceremonial Spirit Possession in 58. Trangkasombat U, Su-Umpan U, Churujiporn V,
Africa and Afro-America. Leiden, Netherlands:E.J. Nukhew O, Haruhanpong V. Risk factors for spirit
Brill. 1972. possession among school girls in southern Thailand.
43. Krippner S. Dissociation in Many Times and Places. Journal of Medical Association of Thailand, 1998;
In Broken Images, Broken Selves: Dissociative 81(7): 541-546.
Narratives in Clinical Practice. Stanley Krippner and

Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 21

 Chaudhary et al. UJMDS 2013, 01 (01): Page 12-22

59. Hughes D. Blending with an Other: An Analysis of 68. Diaz-Mataix L, Scorza M C, Bortolozzi A, Toth M,
Trance Channeling in the United States. Ethos, Celada P, Artigas F. Involvement of 5-HT1A
1991;19: 160-184 receptors in prefrontal cortex modulation of
60. Hilgard E. Divided Consciousness New York: John dopaminergic activity. Journal of Neuroscience,
Wiley & Sons.1986. 2005; 25: 31-43
61. Kelly E F, Kelly E W, Crabtree A, Gauld A, Grosso 69. Winkelman M. Trance states: A theoretical model
M, Greyson B. Irreducible mind: Toward a and cross-cultural analysis. Ethos, 1986; 14: 174-203
psychology for the 21st century. Lanham: Rowman 70. Don N S, Moura G. Trance surgery in Brazil.
& Littlefield, 2007. Alternative Therapies, 2000; 6(4): 39- 48.
62. Penfield W. The mystery of mind: A critical study of 71. Lopes da Silva F. Neural mechanisms underlying
consciousness and the human brain. Princeton, NJ: brain waves: From neural membranes to networks.
Princeton University Press. 1978. Electroencephalography and Clinical
63. Beauregard M. Mind does really matter: Evidence Neurophysiology, 1991; 79: 81-93.
from neuroimaging studies of emotional self- 72. Giesbrecht T, Jongen E, Smulders F, Merckelbach H.
regulation, psychotherapy, and placebo effect. Dissociation, cortical activity and sleep. Journal of
Progress in Neurobiology, 2007; 81: 218–236. Nervous and Mental disease, 2006; 194,362-368.
64. Beauregard M, Paquette V. Neural correlates of a 73. Oohashi T, Kawai N, Honda M, Nakamura S,
mystical experience in Carmelite nuns. Neurorcience Morimoto M, Nishina E, Maekawa T.
Letters, 2006; 405: 186-190 Electroencephalographic measurement of possession
65. Newberg AB, Wintering N A, Morgan D, Waldman trance in the field. Clinical Neurophysiology, 2002;
MR. The measurement of regional cerebral blood 113: 435-445.
flow during glossolalia: A preliminary SPECT study. 74. Kroll J, Bachrach B. Visions and psychopathology in
Psychiatry Research, 2006; 148, 67-71. the Middle Ages. Journal of Nervous and Mental
66. Newberg A, Alavi A, Baime M, Pourdehnad M, Disease, 1982; 190: 41-49
Santanna J, d'Aquili E. The measurement of regional 75. Zilboorg G. A History of medical psychology. New
cerebral blood flow during the complex cognitive York: Norton, 1941.
task of meditation: A preliminary SPECT study. 76. Nevius JL. Demon possession. Michigan: Kregel
Psychiatry Research, 2001; 106, 113-122. Publications, 1968.
67. Previc F H. The role of extrapersonal brain systems 77. Ee HK, Li PS, Kuan TC. A cross-cultural study of the
in religious activity. Conciousness and Cognition, possession trance in Singapore. Australian and New
2006; 15: 500-539 Zealand Journal of Psychiatry, 1986; 20: 361-364.

Source of support: Nil, Conflict of interest: None Declared

Unique Journal of Medical and Dental Sciences 01(01), Jul-Sep 2013 22