http://orcid.org/0000-0002-4942-8556
Abstract
The paper describes a case report of a 36-years old female patient suffering from an addiction to seeking fortune-telling services, which is a type of behavioral addiction, or non-substance addiction. This condition is characterized by the addiction to various “occult services”, fortune tellers and other representatives of nontraditional practices who are usually manipulative and self-serving. The authors reveal that this case report of fortune telling addiction possesses all of six components universal for addictions.
In light of the increasing prevalence of various behavioral addictions, clinical psychiatrists should be aware of this phenomenon.
Introduction
For the last decade, there has been significant growth in the research of behavioral addictions. It is currently well-known that several behaviors, besides psychoactive substances use, produce short-term reward that may cause persistent behavior despite knowledge of possible harmful consequences, which is called diminished control over the behavior.Citation1,Citation2 It has given rise to the concept of non-substance or “behavioral” addictions, which are similar to substance addiction but possess a behavioral focus outside of psychoactive substance consumption.
There is evidence of considerable overlap across various addictive disorders (both behavioral and substance-related ones). Authors such as CarnesCitation3 and BrownCitation4 have postulated that addictions consist of a number of common components. Brown’s components have been further developed and modified by Griffiths, whose model includes the following six components: salience, mood modification, tolerance, withdrawal, conflict, and relapse.Citation5 GriffithsCitation6 has argued that all the above-listed components need to be present for a behavior to be defined as addictive. However, it is clear that some individuals engage in behaviors having addictive elements without necessarily developing a full-blown addiction. Recent scientific publications suggest that a common feature of all addictions is the failure to resist an impulse, meaning the tendency to act rashly without forethought, leading to persistent engagement in the behavior despite recurring harms.Citation1 Compulsivity is an important symptom of both behavioralCitation7 and substance-related addictions.Citation8 Furthermore, emotional dysregulation (or low distress tolerance) has been associated with gambling,Citation9 compulsive shopping,Citation10 and binge eating,Citation11 increasing the severity of these addictive behaviors.Citation12
At the same time, addictions always result from an interaction between numerous factors including the individual’s genetic predisposition, psychological constitution (for instance, personality factors, unconscious motivations, attitudes, expectations, etc.), social environment (i.e. situational characteristics) and the nature of the activity itself (i.e. structural characteristics).Citation6 Thus, addictions are a part of a complex biopsychosocial process and they cannot be restricted to drug-consuming behaviors only.
Diagnostic models do not currently include the criteria necessary to identify behaviors as addictions in a clinical setting. Behavioral addictions have been proposed as a new class in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-V,Citation13 which now includes a section entitled “Substance-related and addictive disorders”, but it combines substance use disorders and gambling addiction only. Internet gaming addiction is included in the appendix as a condition for further study.Citation13 Along with gambling and internet gaming, empirical research has investigated other behaviors related to behavioral addictions. It turns out that constant social changes associate with new forms of behavior, which could lead to new forms of addictive disorders. They include, but are not limited to: sex addiction, shopping (compulsive buying disorder), food-related addictions (including binge eating), working addiction (“workaholism”), exercise-related addictions, adventure seeking (for instance, auto-racing, dangerous sports), and technology/communications-related addictions (smartphone, social media and texting addiction, etc.).Citation1,Citation14–21 A huge interest in behavioral addictions resulted in an increasing number of everyday activities proposed as addictive disorders, including tanning addiction,Citation22 tango addiction,Citation23 and fortune telling addiction.Citation24
Currently the concept of behavioral addictions remains a bit controversial, and the main question is – What makes a behavior (even a behavior in excess) qualify as an addiction? Many patients with behavioral addictions defend their actions with the claim that they are simply healthy enthusiasts who have been unfairly labeled by the physicians, parents, police, etc. This issue is further complicated by the fact that behavioral addictions involve “normal” drives, i.e. highly rewarding and reinforcing drives toward sex, food, love and money, which can be considered addictions only when such behaviors reach a certain degree of excess and self-harm. Thus, excessive (or in some cases, even embarrassing) behavior does not warrant the diagnosis of behavioral addiction, but rather the individual’s inability to curtail the activity despite the negative consequences is what stands as the hallmark of the addiction process.
Clairvoyance consulting, also known as “spiritual advisor” or fortune teller consulting, is a behavior that may seem harmless, but can also become excessive.Citation24 Common methods used for fortune telling are astromancy, horary astrology, pendulum reading, spirit board reading, tasseography (reading tea leaves in a cup), cartomancy (fortune telling with cards), tarot reading, crystallomancy (reading of a crystal sphere), and chiromancy (palmistry). Another form of fortune telling, sometimes called “reading” or “spiritual consultation”, does not rely on specific devices or methods, but rather the practitioner gives the client advice and predictions which are said to have come from spirits or in visions. Fortune telling has always been a time-honored tradition in Russia. Throughout the year, it was the custom to tell fortunes on the eve of all important Orthodox holidays. The most propitious time for fortune telling was believed to be yuletide (Christmastide, or “svyatki” in Russian) and the summer solstice. Although nowadays fortune telling is dismissed by the scientific community (since it is based on magical thinking and superstition) and despite the fact that psychics and the occult are officially anathemas to the Orthodox Church, such behavior continues to be widespread in Russia.
Case report
A 36-years old female admitted to an outpatient addiction psychiatry department with complaints about “having a fortune telling addiction”. The patient was born in Moscow, she is the only child in a family. There is no family history of any mental disorders. All developmental milestones were accomplished in time. In early childhood, she describes herself as a quiet and obedient child avoiding any conflicts. She was very attached to her father who was “strict but fair”. The girl attended secondary school since 7 years old, her progress was average. She continued her education at vocational school in the field of economics. Currently, the patient works as an economist and belongs to middle socioeconomic status. She had close interpersonal relations with several individuals of the opposite gender and had several male sexual partners. At the same time, she sometimes feels “regret that she is not married yet”. She describes herself as an active, communicative and vigilant person.
Since childhood, the patient was interested in fortune telling. When she was 12, a classmate brought her a book on astrology. She remembers that the book was very interesting, and they began to “practice fortune telling”, since “it seemed attractive and harmless”. The patient describes these “practices” as “innocent and childish”: for instance, they gathered with friends in her house and “used traditional Slavonic techniques” to predict their wedding day or to “see a future husband”. During adolescence, she liked to read different books on astrology, occultism and mystics.
When she was 30, her father died due to a heart attack. The patient experienced loss and grief since they have always been very close to each other and she “always felt support from him and appealed to him for advice”. After her father died, she felt orphaned, crying and hopeless. She describes this period as “a rough patch in life”. For several months she experienced sleep disorder, appetite loss and decreased mood. Once during a conversation with a colleague, the patient complained about her difficult life situation, and the coworker recommended her “a good and experienced clairvoyant who definitely could help her”. The patient called on the clairvoyant and described her problems in general terms. The clairvoyant agreed to help, “vaguely hinting that it would not be easy to do”. She asked the patient to bring her father’s photo with her and “revealed that someone put a whammy on her”. Furthermore, she demanded the patient to consistently perform certain rituals. The patient strictly followed the instructions, even such strange ones as “to buy a few candles in a certain place, visit the cemetery at night and burn them at the scheduled time saying spells”. After such rituals, the patient felt better: she noticed “a kind of emotional comfort” and experienced “calmness, lightness and liberation”. She kept a good memory of the consultations and consulted different fortune tellers episodically during the next few years, especially when she had doubts about making decisions.
At the age of 35, during the vacation at sea, she met a man and “fell in love madly”. They spent her vacation together enjoying the romantic relationship. However, when they returned to Moscow, he began to avoid her. The patient felt upset and rejected, but tried to console herself that he was “just a man who loves freedom”. Finally, she decided to consult a fortune teller who looked at the photo made during vacation and said that they’ll get married in two years. The patient remembers that during that consultation she had no doubts that a fortune teller really knows her future and tells the truth. She was inspired by the prediction and experienced mood improvement and heightened emotions. A few months later she met a girl by accident whose mother was a fortune teller. That woman confirmed that “a man in the photo was her destiny” and that all she had to do was to keep waiting for him to understand. As time went on, the patient consulted the fortune teller literally every day asking what to say and what to do. As a result, that man removed her contacts and didn’t take her calls. The patient felt disappointed with fortune telling and guilty.
A couple of weeks later she saw a dream with an empty coffin standing in a house. The patient felt anxiety and fear and therefore decided to consult a clairvoyant. Since she was disappointed with the few previous fortune tellers, she found “one of the best female clairvoyants” on the Internet who interpreted that dream as “a very unfavorable forecast”. This fortune teller was “extremely charismatic”, and the patient had no doubt that she will solve her problems. To “prevent” any unfavorable consequences, the clairvoyant demanded three significant sums of money. Prior to that, the patient had also transferred money to her. She even had to borrow money from friends and colleagues contributing to unforeseen expenses. Although the patient felt excitement before each fortune teller consultation, she recalls that during them she constantly felt an overpowering fear and “could not think about anything else”. At the same time, she felt a kind of euphoria when she transferred money to the clairvoyant because she was sure that “Now everything will be done and everything will end”. The clairvoyant gave her a kind of “home tasks”: for instance, she had to look closely at the angle of her left eye’s reflection in the mirror giving special spells. The patient followed all instructions strictly and even noticed some mood improvement after such rituals. After a couple of months, her friends and colleagues noticed some changes in her behavior: she could not focus on current affairs even for a short time, constantly catching herself not hearing or unable to understand what the employees were turning to her and what she had to do. She also experienced weight loss (more than 10 kg). Nevertheless, she continued to transfer the money to her clairvoyant who “was struggling with evil for her”. This resulted in accumulated debts for the total amount of more than a million rubles. Once her friend noticed the changes in her behavior and they had a frank conversation. This friend insisted on taking a vacation at work and isolating the patient from the clairvoyant by changing her phone number and restricting communication. The patient felt uncomfortable and resisted isolation. She was at home for several days under the supervision of her mother. Gradually she began to understand what was happening to her and to “rethink these events”. Finally, she decided to admit to an outpatient addiction psychiatry department due to a “fortune telling addiction”. The patient is still in the therapeutic program at the moment.
Discussion
This case report demonstrates how a patient with no history of mental disorders develops an anxiety-depressive disorder with a subjective sense of hopelessness against the background of several psychosocial stresses, which was skillfully used by charlatans. The use of various rituals and their unquestioned performance by the patient, despite their obvious absurdity, indicates a serious violation of critical abilities. This was also facilitated by the performance of “magical” tasks of the meditative nature (“to look closely at the angle of the left eye’s reflection in the mirror, giving special spells”), which undoubtedly partially transformed the patient’s consciousness hypnotically and contributed to the suppression of critical abilities.
As a result of psychological manipulations, the patient developed a pattern of dependent behavior. She felt relief when she performed another “magic ritual” by the task of “sorcerers” and euphoria when she sent money to mystifiers. Thus, we can find all components universal for addictions in this case report: salience, mood modification, tolerance (a growing need to consult fortune tellers, complication of the “magic rituals” and continuous uncritical money transfers for the “services”), withdrawal (feeling uncomfortable in case of isolation from the fortune teller), conflict, and relapse (repeated appeal to fortune tellers, even after the previous disappointing experience). It allows defining the patient’s behavior as addictive.
In this case report development of the addictive behavior has much in common with the process of becoming a cult member. It is a fact that not all people exposed to cultic processes within a cultic structure will become members of a cult. For a broad range of reasons, a significant number of potential recruits will never join or will join for a relatively brief amount of time and then leave.Citation25 Psychologist Michael Langone modified Farber, Harlow and West’sCitation26 description of the “DDD (Debility, Dependency, Dread) Syndrome” in brainwashing. According to Langone, the cultic relationship involves deception on the part of the cult hierarchy and the induction of dependency and dread in members.Citation27 The FBI’s report on “Project Megiddo” quoted Singer and Lalich: a cultic relationship refers to “one in which a person intentionally induces others to become totally or nearly totally dependent on him or her for almost all major life decisions, and inculcates in these followers a belief that he or she has some special talent, gift, or knowledge”.Citation28
Conclusion
Despite significant advances in research, behavioral addictions currently remain poorly understood. Our understanding of efficacious, well-tolerated pharmacological and behavioral strategies for such disorders lags significantly behind our understanding of treatments for other major neuropsychiatric disorders.Citation29 At the same time, increasingly, psychiatrists have to deal with various behavioral addictions in clinical practice. The description of clinical cases expands our knowledge in this area, leading to a better understanding of this modern challenge.
With an addiction to seeking fortune-telling services, as with other conditions, an accurate diagnosis and differential diagnosis are critical to an appropriate therapeutic plan. It is important to be aware of co-occurring disorders, especially if it is a mood/anxiety disorder, and both must be treated. The presence of other associated comorbid disorders (such as anxiety and depression) may serve to perpetuate a vicious cycle, thus potentially causing the person’s condition to deteriorate further. In such cases, therapy aimed at mood/anxiety disorders may also be necessary to treat the behavioral addiction effectively.
Ethics approval and consent to participate
Written informed consent was obtained from the patients following a detailed explanation of the objectives and protocol of the study, which was conducted in accordance with the ethical principles stated in the Declaration of Helsinki.
Disclosure statement
The author declares that there is no conflict of interest regarding the publication of this article.
Funding
The research received no external funding.
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