J R Soc Med 2005;98:351-353
doi:10.1258/jrsm.98.8.351
© 2005 Royal Society of Medicine
Possession and jinn
Najat Khalifa MRCPsych 1
Tim Hardie MRCPsych 2
1 Leicestershire Partnership NHS Trust, Leicester LE5 0LE, UK
2 East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester LE5
0LE, UK
Correspondence to: Dr Tim Hardie E-mail:
tim.hardie{at}nottshc.nhs.uk
 |
INTRODUCTION
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Religion remains a powerful influence on notions of health and
disease.
1 One
Islamic concept that has entered into western mythology
is that of the jinn or
genies, as in the story of Aladdin. However,
according to Islamic belief, jinn
are real creatures that form
a world other than that of mankind, capable of
causing physical
and mental harm to human beings. An example of such harm is
possession.
2,3
As
defined by
Littlewood,
4
possession is the belief that an individual
has been entered by an alien
spirit or other parahuman force,
which then controls the person or alters that
person's actions
and identity. To the observer, this would be manifested
as an
altered state of consciousness. In the UK, jinn possession is
most
likely to be seen among people from Pakistan, Bangladesh,
the Middle East or
North Africa.
4
Some commentators claim that possession is a culture-bound syndrome but
others argue that, although the manifestations may differ according to
culture, the underlying theme is always the
same.5 According to
Whitwell and
Barker,6 the word
possession is used in two different ways. The first refers to 'true'
possession invoking the supernatural. The second, which makes no such
assumptions, has been applied to several different states. One example of the
second is a syndrome consisting of clouding of consciousness, changed
demeanour and tone of voice and subsequent amnesia. Another is a trance that
may be induced deliberately in a certain cult setting. According to
Prins,7 true
possession consists of occult experience, invitation and unknown influences.
Very little has appeared on jinn possession in medical publications. Here we
describe cultural and religious and psychiatric aspects and offer guidance on
management in clinical practice.
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CULTURAL AND RELIGIOUS PERSPECTIVES
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There are numerous references to jinn in the
Qur'an and
Hadith (sayings of Prophet Mohammed). According to Islamic writings,
jinn
live alongside other creatures but form a world other than that
of
mankind. Though they see us they cannot be seen. Characteristics
they share
with human beings are intellect and freedom to choose
between right and wrong
and between good and
bad,
3 but according
to
the
Qur'an8
their origin is different from that of man: 'And
indeed, we created man
from dried clay of altered mud and the
Jinn we created aforetime from the
smokeless flame of
fire'.
8 Jinn
tempt and seduce mankind to stray from Allah (God); Satan
(shaytan, devil) is
thought to be from their realm.
Jinn are said to inhabit caves, deserted places, graveyards and
darkness.3 According
to Sakr2 they marry,
produce children, eat, drink and die but unlike human beings have the power to
take on different shapes and are capable of moving heavy objects almost
instantly from one place to another. The
Qur'an8
mentions how the Prophet Solomon contrived to subjugate the jinn and get them
to perform tasks that required strength, intelligence and skill.
In Islamic writings true jinn possession can cause a person to have
seizures and to speak in an incomprehensible
language.3 The
possessed is unable to think or speak from his own will. However, according to
Aziz9 such cases are
greatly outnumbered by those of physical or psychological origin, and he
castigates faith healers for taking money for treatment of the latter.
Attempts have been made by the church to establish criteria for distinguishing
real possession from
'pseudopossession'.6
In cases of real possession the task of the therapist, who must have strong
faith in Allah, is to expel the jinn. This is usually done in one of three
ways—remembrance of God and recitation of the Qur'an
(dhikr); blowing into the person's mouth, cursing and commanding
the jinn to leave; and seeking refuge with Allah by calling upon Allah,
remembering him, and addressing his creatures (ruqyah). Some faith
healers strike the possessed person, claiming that it is the jinn that suffer
the pain. This practice, however, is deplored by Muslim scholars as being far
from the principles of Islam and the instructions of the Prophet.
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PSYCHOLOGICAL AND PSYCHIATRIC PERSPECTIVES
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Possession states can be understood only through a combination
of
biological, anthropological, sociological, psychopathological
and experimental
perspectives. The patient's own interpretation
must be taken into
consideration. This will promote
collaboration
10
even
if it has little bearing on the treatment
given.
11
Instruments
that have been developed to elicit patients' explanatory
models
include the illness perception
questionnaire
12 and
the short
explanatory model
interview.
13
Chandrasheker
14 has
suggested
that possession is best understood by reference to three theoretical
frameworks.
According to
dissociation theory it is a hysterical state
in
which the Id wishes to overwhelm the Ego in a state of dissociation.
Communication theory holds that possession is exhibited by oppressed
individuals
who assume a sick role in an attempt to gain attention.
Sociocultural theory maintains that possession is a culturally
sanctioned
phenomenon to which people are exposed from an early age in
the
expectation that they may experience it later. The most
typical psychodynamic
conflicts identified by Whitwell and
Barker
6 in their
study of 16 cases were those of adolescence. The patients
were often in close
but confused relationships with their families,
having difficulties asserting
their independence and identity
and experiencing sexual anxieties. Some
workers, including
Oesterreich,
15 have
stressed the concept of 'suggestion', as an explanation
for
possession states; indeed Whitwell and
Barker
6 found that
the
idea of possession had been directly suggested to some of their
patients.
Nonetheless, jinn possession is characteristically
involuntary (in contrast to
voodoo possession, which is sought
by the person
concerned).
4 Some
Western practitioners may be
surprised to find possession state as a
diagnostic entity within
the
Diagnostic Statistical Manual
IV16 and the
International Classification of Disease, version
10.
17 The criteria
in these
two documents are similar, apart from the marked distress and
impairment
in social or occupational functioning included in DSM-IV. In
ICD
10
17 trance or
possession disorders are classified under
dissociative (conversion)
disorders—disorders in which
there is a temporary loss of the sense of
personal identity
and full awareness of the surroundings. Possession or trance
has
to be involuntary and to occur outside religious or culturally
accepted
situations. This classification excludes states associated
with psychotic
disorders, affective disorders, organic personality
disorder,
post-concussional syndrome and psychoactive substance
intoxication.
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ILLUSTRATIVE CASES
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The following two case histories illustrate typical presentations
and some
of the dilemmas faced by clinicians.
Case 1
A 25-year-old woman from Iraq with no previous psychiatric history
gradually withdrew from other people, became uncommunicative and stopped
eating and drinking. Investigations revealed no organic disease and severe
depressive illness was diagnosed. She underwent electro-convulsive therapy
without much improvement. Her family, believing her to be possessed by jinn
but not wanting to say so to the doctors for fear of being labelled as
superstitious, took her to a local faith healer, who offered to treat her in
the traditional Islamic way. After a few sessions of combined dhikr
and ruqyah her condition improved and she resumed eating and
drinking. On recovery she had no explanation for what had happened, though she
remembered the sequence of events. She stated that she had been aware of her
surrounding, but had been unable to initiate anything. She denied feeling low
in mood at the time. 5 years later she remains well and without
medication.
Case 2
A woman of 35 experienced episodes of high fever and confusion during which
her speech became incomprehensible. A local general practitioner diagnosed
typhoid fever and prescribed antibiotics. The patient and her family, however,
thought that she was possessed by jinn so she did not adhere to the treatment.
She was taken to a local faith healer, who reinforced their views and treated
her in the traditional Islamic way. However, her condition deteriorated over
the next few weeks and she started to have generalized epileptic seizures. One
of the authors (NK) was then asked to see her. On physical examination she was
jaundiced with hepatomegaly and splenomegaly. On admission to hospital she was
found to have cerebral malaria, for which she was treated successfully.
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MANAGEMENT
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The above cases illustrate the difficult interactions between
cultural
beliefs and conventional medicine. Clearly, in any
case of alleged jinn
possession, underlying organic disorders
should be excluded by physical
examination and by such investigations
as are necessary. Any underlying mental
disorder should be treated
by usual psychiatric methods, but the clinician
should respect
the cultural issues and avoid directly contradicting statements
from
the patient or relatives about the reality of possession. When
medicine
invites conflict with culture and religion, the therapeutic
alliance suffers.
Most people are content to utilize biomedical
treatments without giving up
traditional explanations of
illness;
11
therefore
there may be a strong case for involving an Imam or religious
leader
in the management of these cases.
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CONCLUSION
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Muslims form Britain's largest ethnic minority group—nearly
3%
of the UK
population
18—and
in this community there
is widespread belief in jinn possession. The
prevalence of jinn
possession states remains unknown. When medical and
psychiatric
services become involved, an inclusive, culturally sensitive
approach
is good medical practice. In future research, it would be useful
to
clarify the relationship between explanatory models generated
by the medical
profession, Muslim religious leaders, the Muslim
population and faith healers,
with a view to defining better
treatment pathways.
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Acknowledgments
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We thank Professor Kamaldeep Bhui and Shaykh Ibrahim Mogra for
valuable
comments.
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INTRODUCTION
CULTURAL AND RELIGIOUS...
