Polish Catholics Attribute Trauma-related Symptoms to Possession: Qualitative Analysis of Two Childhood Sexual Abuse Survivors

ABSTRACT

In many cultures, people use the concept of spirit possession to explain abrupt changes in behavior and identity or problems with affect regulation. High incidence of traumatic experiences are also found among “possession” victims but there are few studies exploring in detail their clinical presentations. This study reports the symptoms of two women with a history of sexual abuse, labeled in their religious communities as possessed, and subjected to exorcisms. Following a thorough clinical assessment, interpretative phenomenological analysis was used to explore their meaning-making and help-seeking behavior. Accepting the demonic reappraisal of trauma-related symptoms and interventions offered by clergy contributed to receiving social support but discouraged them from seeking diagnostic consultations and trauma-focused therapy, leading to their continued symptoms. This justifies the need for educating religious leaders in recognizing and understanding basic psychopathological symptoms.

KEYWORDS:

• Child sexual abuse
• diagnostic assessment
• cPTSD
• partial DID
• possession
• exorcism

Introduction

Psychotraumatology literature elaborates on how adverse childhood experiences, especially repeated child sexual abuse (CSA), can lead to personality fragmentation and post-traumatic symptoms (Nijenhuis, 2015; Sar et al., 2014; Steele et al., 2016; Van der Hart et al., 2006). It is common for trauma survivors not to see links between their flashbacks, nightmares, or somatoform symptoms, and horrific past events. They would rather perceive symptoms as strange, unexplainable, and feel reluctant to use clinical assessment, for the shame and fear of being labeled as insane and sent to a psychiatric hospital (ISSTD, 2011). Being phobic of inner experiences, survivors often strive to cope with everyday life and avoid thinking about or discussing their trauma and symptoms. However, parts of them (i.e., dissociative parts) remain stuck in traumatic memories and, when triggered by inner or outer cues, reexperience them in the here and now. This can be associated with non-realization, meaning that trauma survivors find it difficult to recognize these experiences as their own (Howell, 2011). In some cases, dissociative parts become fairly autonomous, obtain the first person perspective and take executive control. These parts can represent different aspects of mental reality; for example, a helpless child or an internalized perpetrator. If these symptoms occur in religious environments they may be interpreted as demonic possession (Hecker et al., 2015; Schaffler et al., 2016; Van der Hart et al., 1996).

Studies show that in many cultures people share folk beliefs about spiritual influence to explain a wide range of phenomena. Beliefs in possession have been widely studied by anthropologists for decades and are found common not only in developing countries but also in modern societies (Bourguignon, 1979; Hecker et al., 2015; Kianpoor & Rhoades, 2006; Kua et al., 1986; Ross, 2011; Somer, 2004). Possession is often linked with alterations in behavior and consciousness (possession-form presentations) marked by: talking in a different voice, sensation of paralysis, shaking, glossolalia or making animal sounds, fugues, or “night dances” (Van Duijl et al., 2013). Beliefs in possession can also affect people’s help-seeking behavior and pathways. If people perceive symptoms as the expression of demonic influence, they are likely to employ religious coping strategies and ignore other potentially valid explanations for illness (Pietkiewicz, Kłosińska et al., 2021; Somer, 1997; Tajima-Pozo et al., 2011). They may also be encouraged by family or friends to use exorcisms, which are practiced in many communities as a culturally legitimate way to appease or exort evil spirits (Boddy, 1994; Hanwella et al., 2012).

People reporting possession and subjected to exorcisms can be a diagnostically heterogeneous group (During et al., 2011; Pfeifer, 1999; Somer, 1997). DSM-5 indicates a link between possession-form presentations and dissociative identity disorder: “Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession” (American Psychiatric Association, 2013). This view is strengthened by studies comparing dissociative symptoms with the emic accounts of possession trance (Castillo, 1994; Duijl et al., 2014) and cases suggestive of a dissociative disorder but lacking through diagnostic assessment (Pietkiewicz & Lecoq-Bamboche, 2017; Van der Hart et al., 1996). Clinicians treating people with complex dissociative disorders observe that, depending on the cultural context, the angry and hostile parts of the patient or perpetrator-imitating parts may be named Satan, Lucifer, devil, demon, etc. (Howell, 2011). However, in many cases, behaviors observed as “disruptions of identity” can also express psychological conflicts and problems with affect regulation characteristic of personality disorders (Pietkiewicz, Kłosińska et al., 2021). They draw upon this concept of possession to explain unaccepted aggressive or sexual impulses. Others justify in this way difficulties in spiritual practice, or even family problems (Hale & Pinninti, 1994; Pietkiewicz & Lecoq-Bamboche, 2017; Pietkiewicz et al., 2019; Somer, 1997). In some religious groups, even exposure to inappropriate music or films, using substances, masturbation, homosexuality or extra-marital sex are perceived as spiritual threats or indicators of being possessed (Hanwella et al., 2012; Pietkiewicz, Kłosińska et al., 2021). Thus clinical presentations should be carefully examined in people reporting possession. Unfortunately, most studies focus on how people experience possession and very few of them are preceded by a careful diagnostic assessment. A few case studies we found used the Structured Clinical Interview for DSM (Delmonte et al., 2016; Sar et al., 2014) or a general psychiatric interview (Dein, 2021; Hale & Pinninti, 1994), but the majority of research relied on self-report tools or did not explain diagnostic procedures at all.

The use of exorcism was reported by people from North America (Ross et al., 2013), Italy (Ferracuti & Sacco, 1996; Giordan & Possamai, 2016), and Poland (Dein, 2021; Pietkiewicz, Kłosińska et al., 2021, 2021). Stobart (2006) also describes cases from the UK, where parents tried to “expel evil spirits” from their children using severe physical abuse (including beating and burning) or depriving them of food. Unfortunately, there are no statistics about exorcisms frequency, nor data from other European countries, especially the more secularized ones. In Poland, where this study was carried out, about 33,728,000 people (more than 87% of citizens) declare themselves as Roman Catholics (GUS, 2019). According to informal sources, there may be approximately 120–150 priests appointed by bishops to act as exorcists. According to Dall’Olio (2012) the reluctance of the Church authorities to supervise and report the use of exorcism may result from their caution not to empower exorcists and perhaps create a negative public image. In Poland, for instance, the Church became the target of severe criticism in the media for supporting such practices. In Germany, on the other hand, exorcisms became infamous and socially unacceptable after the death of Anneliese Michel, a psychiatric patient who was subjected to exorcism rites for a year (Goodman, 2005).

There is also no research about the incidence of CSA and ongoing abuse in people who are subjected to this ritual. Statistics about CSA can be inaccurate because victims rarely report such incidents and, if they do, authorities are not always informed. Sajkowska (2017) reviews different Polish studies according to which 0.2–18% of men and 2–16% of women reported being a victim of CSA in the past. Discrepancies were based on methodology and how CSA was defined. About 6.4% of Polish teenagers experienced physical sexual abuse with an adult before they were 15. According to police and court records, between 1158 and 2186 cases of sexual intercourse with a minor under 15 were investigated per year, and between 596 and 808 people were annually sentenced for that crime in the years 2005–2015. Unfortunately, there is no data about prevalence of CSA perpetrated by family members or other people (including priests) among exorcism users.

Participation in exorcisms satisfies some individuals’ need for attention and emotional support, enabling them to express forbidden and shameful impulses in a culturally acceptable manner. Such rituals can strengthen people’s faith and ontological presuppositions, reinforce the traditional social ties, values, and hierarchy (Geertz, 1957; De Munck, 1990). On the other hand, using the concept of possession and concentrating on rituals may cover up traumatic history or ongoing abuse. There are also some disadvantages associated with relying on this form of religious coping. For example, such participation can delay diagnostic assessment and prevent people from using psychotherapy to address problems with attachment, affect regulation, and self-image. They can externalize conflicts rather than consciously work on the disowned, feared and despised aggressive or sexual impulses. As a result, they cannot embrace them as different aspects of their own personality (Pietkiewicz, Kłosińska et al., 2021). While labeling individuals as possessed and using power to “liberate them” can be a form of abuse (Stobart, 2006), there are also risks of re-traumatizing people with a history of physical or sexual violence during exorcisms. Different authors postulate that using force or restraint during the ritual can lead to reactivation and reliving traumatic memories (Bowman, 1993; Fraser, 1993; Pietkiewicz & Lecoq-Bamboche, 2017).

The aim of this study is to explore how two women with a history of CSA experienced and interpreted their post-traumatic symptoms and how they used help. Their clinical presentations will be described in detail. One of them met ICD-11 criteria for partial dissociative identity disorder, and the other had complex post-traumatic stress disorder with comorbid dissociative neurological symptom disorder. Interpretative phenomenological analysis was used to examine their experience of post-traumatic symptoms, meaning ascribed to them, and help-seeking pathways.

Method

This study was carried out in Poland between 2016 and 2021. Qualitative data included clinical interviews and psychiatric mental health assessment. Their transcripts were subjected to Interpretative Phenomenological Analysis (IPA), which is based on the principles of phenomenology, hermeneutics, and idiography (Smith & Osborn, 2008). IPA explores participants’ experiences and interpretations, followed by researchers making sense of and commenting on these interpretations. Samples in IPA studies are small, homogenous, and purposefully selected. Qualitative material is analyzed in detail case-by-case (Pietkiewicz & Smith, 2014; Smith & Osborn, 2008). IPA was chosen for this research to analyze how patients with post-traumatic symptoms developed the concept of being possessed and how this influenced their help-seeking behavior and pathways.

Procedure

This study is part of a larger project examining phenomena and symptoms reported by people using exorcisms. This project was held at the Research Center for Trauma and Dissociation, financed by the National Science Center Poland, and approved by the Ethical Review Board at the SWPS University of Social Sciences and Humanities. Potential candidates enrolled themselves via an application integrated with a dedicated website, or were registered by healthcare providers and pastoral counselors. They filled in demographic information and completed online tests, including: Somatoform Dissociation Questionnaire (SDQ-20, Pietkiewicz et al., 2018), Dissociative Experiences Scale – Revised (DESR, I. Pietkiewicz et al., 2019). Elevated scores in these tests, SDQ-20 ≥ 30 and DESR ≥72, are suggestive of dissociative disorders. They then participated in semi-structured interviews exploring their biography, family situation, religious socialization and spiritual involvement, and motives for enrolling in the study, followed by a diagnostic consultation using Trauma and Dissociative Symptoms Interview (TADS-I, Boon & Matthess, 2017). The TADS-I is a semi-structured interview intended to identify DSM-5 and ICD-11 dissociative disorders, and differs from other semi-structured interviews used for this purpose. Firstly, it includes a significant section on somatoform dissociative symptoms. Secondly, it includes a section about other trauma-related symptoms for several reasons: (1) to obtain a more comprehensive clinical picture of possible comorbidities, including symptoms of PTSD and cPTSD, (2) to gain a better insight into the (possible) dissociative organization of the personality, and (3) to better distinguish between complex dissociative disorders and false positive DID. Finally, the TADS-I also aims to identify symptoms indicating a division of the personality and alterations in consciousness. Interview recordings were assessed by three healthcare professionals experienced in the dissociation field, who discussed each case and agreed with a diagnosis based on ICD-11. This interview was followed by an additional mental state assessment performed by the third author who is a psychiatrist. He collected medical data, double-checked the most important symptoms, confirmed and communicated the diagnosis and discussed available coping strategies. All interviews and medical consultations were divided into 60 minute sessions. The total length of interviews with participants in this study was 6 hours (Matilda) and 9.5 hours (Jane).

Among 23 participants who enrolled in the project, 12 had features of a personality disorder, five had a schizophrenia spectrum disorder, two met ICD-11 criteria for partial DID, two had complex PTSD, one had a dissociative neurological symptom disorder, and one had possession trance disorder. Only two participants reported evident post-traumatic symptoms so were selected for this analysis. They both had a history of CSA and were subjected to exorcisms because members of their religious communities interpreted their symptoms as signs of possession.

Participants

The two women who participated in this study were Roman Catholics aged 32 and 34 years. Both were labeled as “possessed” by families or local religious communities due to hearing voices, suicidal acts, and rapid changes in personality and behavior. Both had children, secondary education, remained unemployed, lived with family members and were supported financially by social welfare. They regularly participated in religious activities and used spiritual counseling and exorcisms. In their childhood, both women suffered from emotional neglect, physical and sexual abuse, and both had symptoms of complex post-traumatic disorders. Both had elevated levels of dissociation (measured with SDQ-20 or DESR-PL).

Matilda had participated in one exorcism alongside using psychiatric treatment and psychotherapy. She was referred for a diagnostic re-assessment by her psychiatrist. She reported symptoms of the complex post-traumatic stress disorder and many dissociative sensorimotor symptoms which qualified for a comorbid dissociative neurological symptom disorder. Jane had never used psychiatric treatment. For nine years, she had been regularly subjected to exorcisms, and used counseling based on Gestalt techniques. During the assessment, she presented symptoms indicating distinct personality states associated with marked discontinuities in the sense of self and agency, affective, perceptual and motor intrusions leading to impairment in personal and social functioning. However, she had no amnesia for daily activities. Her overall clinical presentation qualified for the diagnosis of the partial dissociative identity disorder. More information about the participants and their symptoms is provided in supplementary Table 1 and 2. Their names have been changed to protect their confidentiality.

Data analysis

Recordings of all interviews were transcribed verbatim and analyzed together with researchers’ notes using qualitative data-analysis software (MaxQDA 2020 ver. 20.4.0). Consecutive IPA procedures were employed in the study (Pietkiewicz & Smith, 2014). Researchers watched the interview and read their transcripts carefully. They individually made notes about body language, facial expressions, the content and language used, reported symptoms, and wrote down their interpretative comments using the annotation feature in MaxQDA 2020. Next, they categorized their notes into emergent themes by allocating descriptive labels. Then, they compared and discussed their diagnostic insights, coding and interpretations. They analyzed connections between themes in each interview and between cases, and grouped themes according to conceptual similarities into main themes.

Credibility checks

During each interview, participants were encouraged to illustrate reported symptoms or experiences with specific examples. Interviewers asked clarification questions to negotiate the meaning participants wanted to convey. At the end of the interview, they were also asked questions to check that their responses were thorough. The researchers discussed each case thoroughly, including the diagnoses and interpretative notes to compare their understanding of the content and its meaning (the second hermeneutics).

Results

Participants shared their life histories, symptoms, and their interpretations. Four salient themes were identified during the analysis: 1) reexperiencing sexual abuse in daily life, 2) Betrayal of trust, 3) Symptoms seen as the manifestation of evil, and 4) reenacted relationship patterns with authority figures. Each of them is discussed and illustrated with verbatim excerpts from the interviews, in accordance with IPA principles.

Theme 1. Reexperiencing sexual abuse in daily life

Both women reported symptoms directly or indirectly related to a traumatic past, but they could not always see these links clearly. They experienced full flashbacks during the day and recurrent nightmares in which they relieved trauma. Jane frequently “switched off,” and had auditory hallucinations and unpleasant somatic sensations. These episodes were sometimes covered with amnesia, and her friend (Emily) said she behaved as if threatened by a perpetrator.

It started with the experience of being cut off. For example, when carrying my baby I would suddenly fall on the ground, unaware of what was happening, unable to move. This lasted for a few years, two or three times a day. I also heard voices then, and could feel someone touching me. I couldn’t move and often had problems catching my breath. I felt sick and had headaches. […] Once I visited Emily and she said I lost contact with reality. I looked terrified, huddled on the couch and she said it was as if I could see someone. She said I was in great pain, crying and grabbing my … [perineum]. She said it was like watching me being raped, but I did not remember that. (Jane)

During the interview, Jane also exhibited signs of anxiety and conflicts to disclose her symptoms. She admitted having frequent dreams about being touched and sexually abused. For this reason, she tried to postpone going to bed and only slept about four hours per night.

I have these nightmares every night. I don’t really know if these are nightmares because they feel partially real. I have dreams about being brutally raped, strangled, and I cannot move. Sometimes I wake up terrified, all in tears. The sheet and duvet cover are ruffled. (Jane)

She recalled being lured to participate in a quasi-religious group at age 16, where she was groomed and sexually abused by a group of men. With that memory, grimaces crossed her face, she would suddenly grab her underbelly and moan, fighting the pain.

Matilda was tormented by intrusive memories and dreams of sexual abuse in childhood or escaping from her abusive, alcoholic ex-husband. Although she ran away from him to a shelter for abused mothers, and started a new life, she constantly felt threatened, agitated, and easily triggered by situations or objects which she associated with traumatic events. During these episodes, like Jane, she sometimes felt detached from her body and unable to move, or experienced convulsions.

I have these nightmares when I am seven again and he does that [sexual abuse] or I am trying to run away from my ex who is chasing me. I’m also afraid to go out. I’m afraid that someone may come and hurt me. Seeing something which resembles the original situation is enough for these flashes to come back. I recently saw an axe next to a tree, which terrified me. I have to run away and hide. Sometimes I feel stiff, and can’t move my arms and legs. My mouth becomes dry, I’m always thirsty; it is like epilepsy. Then it calms down but after a while the convulsions start again. My whole body is limp. I am usually aware, I feel stuffy and have a hard time breathing. (Matilda)

Theme 2: Betrayal of trust

Forbidden relationships became the leitmotif in Jane’s life and she was reluctant to talk about sexuality, because it always evoked feelings of guilt, shame, and pain. She remembered her mother blaming her for having sexual contacts with two of her elder brothers. Although she classified their actions in terms of abuse, she had conflicted feelings and tried to justify their behavior.

I had eight brothers but had no support from them. They formed groups and I was always an outsider. There was also physical and sexual abuse. I was 10 and my brother was two years older. The other one was six years older. It lasted until I was 17 […] I can’t say my brother forced me. I think he wanted to introduce me to sexuality so that I am not afraid of it. I wanted to feel loved, accepted, and have an ally at home. When I told my mother what was happening, she called me a whore. She said it was my fault because I wanted it and for some time I really believed it was true. (Jane)

At age 18 she was thrown out of home and offered shelter from her confessor. Unfortunately, this priest expected a sexual relationship and gave her money in return. This situation lasted for months until she gave birth to his child, which led to conflict with church authorities.

I had a relationship … a sick one. He was my confessor for six months. When my parents said I couldn’t stay at home overnight unless I paid them, he offered to help … and he actually supported me for a short time. But he wanted … I got pregnant and he still supported me financially. I knew I couldn’t live with him anymore when the baby came, but he wanted to keep dating. I didn’t have any alimony, so when I visited him, we had a quickie and then he paid me. (Jane)

She also felt betrayed by a younger brother, who moved in to live with her and her child. During one episode, when she was paralyzed in bed and unable to respond, he was touching her intimate parts. It is possible that this situation evoked similar feelings she experienced as a child.

I currently live with my younger brother. I thought we had a good relationship. I helped him move out from my parents. It is true that he helps me with the baby. However, two years ago he crossed some boundaries. For two years I had episodes when I felt detached from my body during the day or night. I lost consciousness. I mean, I knew what was happening to me, but couldn’t react. He knew about that and once he was touching me all over … but he didn’t abuse me. Then I lost my trust in him. (Jane)

Matilda was sexually abused by two uncles as a child and threatened by them to keep it secret. She did not tell anyone for years, also afraid of how her mother would respond. She knew about her mother’s affair with one of these perpetrators, who later left his family and moved in. Matilda was angry and apparently jealous. When she revealed her secret, leading to a fight between her mother and uncle, and her uncle’s departure, she was content for a while. However, she felt betrayed again when she found out her mother had reconnected with him.

I was maybe 5 years old when my uncle visited us and wanted to go for a walk. He touched me in private places and forbade me from speaking to anyone, so I shut up. Nobody knew about it … When I was 7, my father’s second brother came to help with the harvest. At home, we all always slept in twos. When my uncle came, it was normal for him to sleep with me. He started hugging and touching me. I felt weird, I didn’t think he would hurt me because he was my uncle … I was sent to his house once. He was drunk, and his wife and children were out. In the evening, he told me to take a bath, wash well, he told me where to wash. We slept together and then he did something more … The next day he bought me a swimsuit and wanted to take me to a beach, but I didn’t want to go. My mother was so grateful for such a gift and I didn’t tell anyone for a long time … Later, he visited us, helped my mother and had sex with her. I hated him for that. Finally, he moved in. My mother often witnessed him insulting me and my siblings. In high school, he once called me a whore and I yelled to him: “You’ve got a reason to say that, since you were doing this with me!” My mother got upset, they quarreled, he broke a jar on her head and ran away … She didn’t even report it. After two years, he called her and said he had a spare washing machine to hand over. My mother was overjoyed and took it, and I felt as if she had betrayed me again. (Matilda)

Theme 3: Symptoms seen as the manifestation of evil

Both participants were highly involved with a religious community and practices. They grew up in an environment saturated with traditional Catholic norms and beliefs. When post-traumatic symptoms were experienced in the religious setting, during group gatherings and rituals, they were perceived by community members as the expression of demonic influence. This strengthened group beliefs about spiritual warfare and the need to seek refuge in religious practices. During holy masses, Jane regularly depersonalized and experienced intrusions of traumatic memories: as if threatened by someone’s presence, felt touched all over her body, had physical pain and heard hostile male voices and child’s sobs. She said she was often accompanied by a friend, who received instruction from an exorcist on how to assist her.

At every mass, I drift off and I don’t know what’s happening to me. I can’t hear the sermon, but something else … voices around me threaten and curse me. My whole body hurts, especially … [points to perineum]. My friend later tells me that she is trying to gently touch me and calm me down, because I’m agitated … or I’m drifting away completely; my body becomes limp, as if I were lifeless. The exorcist advised her to call on me in the name of Jesus, but I do not always regain consciousness. (Jane)

Jane earlier mentioned having similar symptoms at her friend’s home (see: Theme 1). Depersonalization and somatoform dissociation also appeared to a lesser degree during the interview, because she was constantly fighting with pain, involuntary movements and grimaces on her face. Letting the priest put Holy Communion into her mouth usually led to nausea or vomiting, which could have been associated with activation of traumatic memories associated with fellatio. However, people thought it expressed the aversion to the sacred and was proof that she was truly possessed. After the ceremony, she sometimes had dissociative seizures and hysterical arcs. All these episodes were usually completely covered with amnesia.

I don’t know if I take communion. My friend sometimes says I did, because she tells me to open my mouth and I comply. I can’t remember that at all. Sometimes she says I get sick or vomit, or have some kind of epilepsy, seizures. My whole body is in such convulsions that I fall off the bench. She says my legs tremble … sometimes I stiffen and bend back into the letter C. She and the priest put me on the bench and protect me so that I do not get hurt. (Jane)

For this reason, Jane was being exorcised twice a month for about nine years. Because the rituals did not reduce her symptoms, her exorcist grew discouraged and considered alternative psychological uses and referred her for a diagnostic assessment.

The priest said my problems were purely spiritual. He was very disturbed by the fact that I vomited during the Eucharist which he took to mean I was possessed. But because exorcisms weren’t effective, he assumed it is both spiritual and psychological. He knows about the crap I went through and encouraged me to come here [for diagnostic assessment]. (Jane)

Matilda did not exhibit such dramatic symptoms in the religious setting but, like Jane, she felt tormented by intrusive male voices. They evoked fear and told her to hurt or kill herself; subsequently she tried to commit suicide twice. The content of these auditory hallucinations evoked memories of what she heard from her abusers. However, priests from whom she sought support strengthened her conviction that these were manifestations of evil.

I am having these thoughts and voices. One voice is especially loud, clear, associated with suicidal thoughts. It is such a clear male voice. It ordered me to take medication […] Once I was lying in bed and suddenly I felt a sudden surge of energy, such compulsion to swallow these pills. And the voice said, “Is that all you can do? Take more!” It was all real, sure, strong actions […] I know this is how Satan tries to communicate. I spoke to a priest about that and he referred me to the exorcist. He said it was 100% possession and that I should have faith and seek liberation through an exorcism. (Matilda)

She endorsed the interpretation offered by the exorcist and agreed to participate in rituals. During exorcisms she experienced anxiety, uncontrollable shivering or inertia. Sometimes she tried to resist the men who tried to immobilize her, but she finally gave up and passed out. According to priests, it only confirmed their theory about her possession.

I finally believed them and was so scared. I remember everything. They prayed and I was weakening more and more, my hands were shaking and I couldn’t control it. They poured holy water on me and I wanted to get away, I screamed and scratched my skin where they sprinkled water. They were holding me tight so I couldn’t move until I fainted. They later told me this was the manifestation of the devil who could not stand holy water. It took three days to recover, during which I had no energy. (Matilda)

Theme 4: Reenacted relationship patterns with authority figures

Earlier attachment difficulties apparently left the participants with some unmet dependency needs, mistrust and conflicts about receiving attention and care, or developing autonomy. Jane always sought protection and support from men, but was convinced she should satisfy their expectations, even at the cost of doing things which were harmful for her or fueled her conflicts (see: Theme 2). She hardly ever opposed or sought alternate solutions, even when she failed to receive what was promised to her (protection, safety, reducing symptoms). She seemed to enact a similar dynamic with authority figures in her adult life: confessor, exorcist, and priest-psychologist. Referred for exorcisms by her confessor, she used them for nine years but, because there was no symptomatic improvement, he directed her to another priest. This priest, who was also a psychologist, offered her counseling based on Gestalt modality parallel to exorcisms. While his psychological interventions did not cause improvement either, Jane declared being satisfied with receiving exorcisms and therapy and refused seeking alternative solutions. Perhaps she felt it was the only way to receive priests’ assistance and support.

I have been seeing the same psychologist twice a month for nine years. The priest-psychologist. He thinks the origin of my problems is spiritual [metaphysical], but working with emotions is also necessary. So he makes me write letters to different people who have hurt me and I have to say these things, imagining that they are sitting in front of me. I am also happy with his therapy. He gives me support. (Jane)

In time, these men grew confused and hopeless about her symptoms and referred her for diagnostic assessment. Subsequently, Jane realized that her symptoms were both metaphysical and psychological, resulting from trauma and other experiences evoking conflicting feelings (e.g., sexual relationships with brothers or her confessor). She emphasized the complex nature of her symptoms which may justify her longtime ineffective interventions of priests.

These experiences are surely influenced by the spiritual world and they are also linked to my past. There was also a lot of anxiety, insecurity in my life … and I made choices … I did things and for this reason I sometimes don’t want to go to church. So, I had to use both spiritual and psychological methods. I think I do have psychological problems with emotions, but I also think there is something spiritual that disturbs me. (Jane)

Her explanatory models for trauma-related symptoms led to her continued dependence on priests for their acceptance, love and support. She had similar expectations toward her elder brothers or the confessor (her child’s father) but kept feeling guilty for crossing the taboo (see: Theme 2). She also felt blamed by her parents for having forbidden sexual experiences and had problems with church authorities for getting pregnant with a priest.

I feel very hurt by the church. I don’t understand why … I think no one believes me … My child’s father said I was crazy and that people should not listen to me. He caused me trouble because I wanted to arrange everything legally and he refused to recognize his child. (Jane)

Talking about that during diagnostic assessment triggered a switch into a dissociative child part, who was ashamed and scared of punishment. She revealed her longing for love and understanding from father figures, saying: “I would like my dad to hug me … Only my dad!” Emphasizing her father could indicate she had strong resentment toward her mother, who was described as critical and abandoning.

Matilda felt disappointed and betrayed by her mother for bringing back home the perpetrator and maintaining contact with him, despite learning about the sexual abuse (see: Theme 2). In her adult life, Matilda had no close friends but maintained relationships with a priest and a nun. These two could have represented parental figures for her and evoke complex feelings. She once told them about a suicide attempt, making the nun helpless and desperate by not allowing her to help. Underneath her conscious motive to express gratitude, she may have experienced hostile feelings toward the nun, of which Matilda did not seem to be aware. On the other hand, she was obedient toward her spiritual father and followed his instructions without resistance.

I overdosed my pills and went to bed after saying goodbye to them. I wrote a text message to the priest, thanking him for everything. I sent the same text to the nun and I also wrote: “I hope we meet on the other side”. She kept trying to call me but I did not feel like talking. It was my final decision and I was 100% sure of it. She rang non-stop. I picked up once and she begged me to say where I was. But I knew what the risk was if I told her, so I hung up. She still tried to get through, but I didn’t answer. Then the priest called and asked me if there was anyone to help me. I told him what I had done and he made me crawl into the kitchen and drink a glass of water with two tablespoons of salt. I drank it and vomited. Then I fell on the couch and slept.

There was a similarity in how she dealt with her internal experiences currently and in the past. When she heard hostile male voices threatening her life (similar to how her father abused and threatened her mother, or how her uncle and ex-husband treated her), the nun suggested that she put her trust in God. Matilda thought it was ineffective and was angry with the nun for not being able to provide real protection and help. It seems that she experienced similar feelings toward her mother, who had failed to protect her.

The nun said that [when I hear voices] I should call in my mind: “God help me!” … but it is so difficult, then. I am in such despair that I cannot breathe. Recently, I sighed to God that I no longer have any strength. He was my last resort but I felt there was no one who could help me. (Matilda)

Her image of God was not clear. It seemed to be of a benevolent (perhaps idealized) figure who could soothe her pain. On the other hand, it could also be distant and abandoning.

Discussion

This study explored the experience and meaning attributed to trauma-related symptoms by two Roman Catholic women who were survivors of CSA. Our purpose was to examine how they came up to the conclusion that they were possessed and agreed to undergo exorcisms. Members of the Catholic Church may explain unacceptable aggressive or sexual impulses and incomprehensible symptoms in terms of supernatural causation (Pietkiewicz, Kłosińska et al., 2021, 2021). The symptoms of reexperiencing traumatic memories, in the form of emotional and somatosensory intrusions or full flashbacks, can also be perceived as the manifestations of evil or a sign of aversion toward sacred objects. Subsequently, CSA was ignored as a meaningful explanation for panic attacks, aggressive voices and visions, pains, sensations of being choked or groped etc. While “being touched by evil” was a justified metaphor for the memories of CSA, it was understood by participants and their friends literally and not symbolically.

Participants have endorsed and identified with the concept of possession for different reasons. Firstly, the concept of possession could have been used in the service of avoidance. It is common for trauma survivors to be reluctant to think about or discuss horrific experiences because they are overwhelming and it has been difficult to integrate different aspects of these experiences (feelings, sensations, cognitions) into autobiographical memory (Steele et al., 2016). This may be accompanied by negation or questioning whether trauma has really happened to them, which is described as the syndrome of nonrealization (Van der Hart et al., 2006). Attributing post-traumatic symptoms to spiritual influence and involvement with rituals could allow people to divert their attention from traumatic past (or ongoing abuse). Secondly, people who are labeled as “possessed” can receive emotional, instrumental and sometimes financial support from community members. Thus, being “possessed” legitimates the need for special attention and help, despite the fact that it can delay diagnostic assessment and professional treatment (Pietkiewicz, Kłosińska et al., 2021, 2021).

This study also shows how influential the religious community is in shaping people’s interpretations and help-seeking. Only after Jane’s spiritual advisor had doubts about the demonic causation of her symptoms and the appropriateness of exorcisms she experienced for nine years, did he insist that she have a clinical consultation. This shows that priests can be important gatekeepers to mental healthcare, as they can encourage or discourage from using non-religious coping strategies. It is thus important to understand how clergy develop their explanatory models of symptoms reported to them, which religious community members sometimes ascribe to possession. There have been no studies exploring that but the need for educating healers and clergy about how trauma-related conditions can resemble their conceptualizations of possession was already stressed decades ago (Somer, 1997).

Although Polish bishops recommend referring people for diagnostic assessments before subjecting them to exorcisms, there is limited evidence how often these guidelines are followed. Consultations are often done by doctors or psychologists collaborating with the Church, who are expected to “differentiate between religious and psychiatric problems by using proper Catholic anthropology.” No matter if they are affiliated with religious institutions or not, training in recognizing post-traumatic conditions, especially differential diagnosis and treatment of complex dissociation, is still poorly developed in Poland.

There are also reasons why religious communities may support the concept of possession. By justifying threatening aggressive or sexual impulses with it, communities can participate in the above-mentioned avoidance and use “possession victims” for their own ends. Group members may project their own weaknesses, vulnerability or powerlessness on the victims, while temptations, aggression or sexual impulses can be ascribed to the possessive agent. By cheering for and engaging in exorcisms, their intrapsychic conflicts and struggles can be played out on the ritual stage where the expulsion of evil takes place. In this way, community members can gain a sense of control over their own threatening impulses or other mental content. This also strengthens social axioms about the existence of the supernatural world and higher power, group hierarchy and authority, sanctity (Graham & Haidt, 2010). Unfortunately, this may be at the cost of the victim who has, once again, been used to satisfy the needs of others. By overemphasizing exorcisms, families and community can also deny or neglect exploring problems such as ongoing emotional, physical or sexual abuse at home. Although the participants in this study were adult women, media reports indicate that minors are also subjected to exorcisms and there is a risk of masking abuse and perpetrators by families and priests.

The lack of awareness (nonrealization) of traumatic underpinnings of possession-form presentations inevitably leads to re-enactments of traumatic scenarios. In the study of a Mauritian woman who had been sexually abused as a child and subjected to an exorcism, Pietkiewicz and Lecoq-Bamboche (2017) emphasize the likelihood of activating traumatic memories and reexperiencing abuse in the “here and now.” Thus, they recommend extreme caution in using force or immobilizing trauma survivors. Apart from her flashbacks, the participant in this study (Jane) talked about getting depersonalized and obediently following orders, e.g., to open her mouth and let the priest put something inside, which led to feeling nauseous or vomiting. There are other examples of how traumatic memories can be triggered along with bodily sensations. In this study, using religious coping did not bring either participant closer to understanding why she had her symptoms or to reprocessing traumatic memories. Certain attempts to work with Jane’s trauma by the priest, who used an empty chair technique, were apparently unsuccessful because it was not guided by adequate clinical assessment and a treatment plan which recommends starting with a stabilization phase, including the reduction of PTSD symptoms, improving self-care and the therapeutic alliance, before confronting a patient with traumatic memories (ISSTD, 2011).

The concept of possession is also used in DSM-5 in relation to DID. According to the manual, people with DID report a “disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession” (American Psychiatric Association, 2013, p. 292). Interestingly, being influenced by this DSM-5 suggestion, we started this project with a naive expectation to find cases of DID among people reporting possession. However, when we clinically assessed 23 participants who reported possession and used exorcisms, none of them met the diagnostic criteria for DID. The majority had features of personality disorders and justified in this way their problems with affect regulation or unacceptable, conflicting impulses (Pietkiewicz, Kłosińska et al., 2021). Only one man and one woman who enrolled in the project had Other specified dissociative disorder/partial DID. This supports the potential link between complex dissociation and this folk category in some individuals mentioned in DSM-5. However, it should also be expanded beyond the DID category.

Lastly, a comment should be made about amnesia in the clinical presentation of people with possession-form presentations. Amnesia for daily activities (including neutral or pleasant experiences) which can be indicative of autonomous dissociative parts taking executive control, is a criterion sine qua non for DID. However, this symptom should not be confused with problems recalling events happening under intense stress or associated with behavior evoking guilt, shame or fear of punishment. Such examples were found in people with personality disorders who tried to justify conflicting sexual or aggressive impulses in terms of demonic possession (Pietkiewicz, Kłosińska et al., 2021) or influence of multiple personalities (Pietkiewicz, Bańbura et al., 2021). Considering the above, localized amnesia for events that happen during a flashback or rage attack is not necessarily a direct indication of DID.

Limitations and further directions

IPA studies concentrate on people’s individual experiences and meaning-making, and they are, by nature, limited to small samples. Care should be taken in drawing conclusions from qualitative studies and further quantitative research is recommended to investigate how clergy and other members of religious communities interpret different trauma-related symptoms. Exploring the prevalence of CSA in people using exorcisms, and their help-seeking pathways, is also important for planning interventions and social campaigns.

Conclusions

Symptoms of post-traumatic stress and dissociation are common in CSA survivors. This study shows that members of the Roman Catholic Church can attribute them to demonic influence and use exorcisms instead of trauma-focused psychotherapy. Endorsement of the possession concept can help CSA survivors avoid confrontation with traumatic past and receive support from community members. However, labeling people as “possessed” can also cover up ongoing abuse and subjecting them to coercive exorcism is abusive in itself. This study also supports observations that participation in group rituals can trigger traumatic memories in CSA survivors and being subjected to exorcisms is likely to re-traumatize them. Because reluctance of trauma survivors to use diagnostic assessment and professional treatment can maintain symptoms, screening exorcism users for trauma and dissociation is highly recommended.

Ethics

The study procedures were carried out in accordance with the Declaration of Helsinki. The Ethical Review Board of the SWPS University of Social Sciences & Humanities approved the study. All subjects were informed about the study and all provided informed consent.

Supplemental data

Supplemental data for this article can be accessed on the publisher’s website.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by a research grant from the National Science Centre, Poland: Narodowe Centrum Nauki 2017/25/B/HS6/01025. Open access of this article was financed by the Ministry of Science and Higher Education in Poland under the 2019-2022 program “Regional Initiative of Excellence,” project number 012/RID/2018/19

Notes on contributors

Igor J. Pietkiewicz

Igor Jacob Pietkiewicz PhD is an associate professor in psychology, head of Research Centre for Trauma & Dissociation, psychotherapist and psychotherapy supervisor, mentor and president-elect of the European Society for Trauma and Dissociation (www.estd.org), Katowice, Poland

Urszula Kłosińska

Urszula Kłosińska MSc is a psychologist, doctoral student at the SWPS University of Social Sciences & Humanities, psychotherapist in training, Katowice, Poland

Radosław Tomalski

Radosław Tomalski MD, PhD is a psychiatrist, psychotherapist and psychotherapy supervisor, mentor of the European Society for Trauma and Dissociation (www.estd.org), Katowice, Poland.