Epilepsiu. 40(2).239-241, 1999 Lippincott Williams Kr Wilkin\, Inc., Philadelphia 0 International League Against Epilep~y

Brief Communication

Epilepsy and Religious Experiences: Voodoo Possession

E. Carrazana, J. DeToledo, W. Tatum, R. Rivas-Vasquez, G. Rey, and S. Wheeler

Neurologic Cenenter o;f South Florida, University of Miami School of Medicine, and University o j South Floi-idu-Tampa General HoJpitul, Miami, Floridu, U.S.A.

Summary: Epileptic seizures have a historical association with religion, primarily through the concept of spirit posses- sion. Five cases where epileptic seizures were initially attrib- uted to Voodoo spirit possession are presented. The attribution

is discussed within the context of the Voodoo belief system. Key Words: Epilepsy-Seizures-Religion-Voodoo- Possessions.

The concept of possession, “to be seized by spirits,” is central to the historic association of religion and the epilepsies. A common belief of ancient cultures was that mental disturbances were caused by supernatural inter- ference. The early Greeks viewed epilepsy as a visitation from the gods, and thus a sacred disease. Christians dur- ing medieval times followed the biblical belief of de- monic possessions (Matthew 17: 14-1 8). Persons with epilepsy themselves have often explained their seizures as religious experiences, particularly the feelings associ- ated with depersonalization, derealization, and autoscopy of temporal lobe epilepsy. Furthermore, most of the re- ports invoke elements of Christianity, thereby reflecting a Eurocentric view of the subject ( 1 ) .

Voodoo is the most popular religion in Haiti. It has preserved many of the characteristics of the Dahomean and Guinean cults from which it derives (2). Worship and possessions by spirits (loas) are the essence of Voo- doo; thus many illnesses are explained on that basis. Spirits incarnate themselves at will in the people they choose. The person possessed is a mere receptacle bor- rowed by the spirit for the purpose of revealing itself. In that sense, the experience is similar to an epileptic sei- zure in that the patient has no control over its timing nor expression. Voodoo faithfuls voluntarily place them- selves under the authority of some priest/priestess (hun- gun, mambo), with the interpretation of beliefs depend- ing on a great extent on their influence (3). We report a

Accepted July 17, 1998. Address correspondence and reprint requests to Dr. E. J. Carrazana

at Neurologic Center of South Florida, Baptist Hospital Outpatient Bldg., 802-E, 8940 N. Kendall Drive, Miami, FL 33176, U.S.A.

series of patients with epilepsy whose seizures were at- tributed to possession by Voodoo spirits. These cases demonstrate that beliefs and folklore are not always harmless in that, at times, they can adversely affect clini- cal management. In addition to being a source of great anxiety, they may delay appropriate diagnosis and treat- ment.

CASES

Case 1 This 24-year-old Haitian man had his first generalized

tonic-clonic seizure at the age of 17 years during the wake of an uncle. The patient had been sleep deprived during the vigil of the corpse. The seizure was attributed to possession by Ogu (the warrior god), the dead uncle’s protecting loa. Subsequent seizures and morning myoc- lonus were explained as harassment by the wandering soul of the uncle. The possession was interpreted as a punishment, for the patient had been disrespectful toward the deceased in the past. He was treated by the local mambo (priest) for 6 years and did not see a physician until coming to the United States. His EEG showed 3- to 4-Hz bursts of generalized spike-wave complex dis- charges occurring spontaneously and during photic stimulation. In retrospect, the patient had a history of waking myoclonus, which had been ignored. He re- mained seizure free after treatment with valproic acid (VPA). The likely diagnosis is juvenile myoclonic epi- lepsy.

Case 2 This 27-year-old Haitian woman, with a history of

complex partial and secondarily generalized seizures

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240 E. CARRAZANA ET AL.

since adolescence, was the product of a long and difficult delivery, which was attributed to a “grip” in the moth- er’s belly by a loa. At the age of 14 years, she fell in an open fire during a seizure and suffered extensive burns to her arm, leg, and parts of the face and trunk. Burns were treated at a local hospital, but the family brought the patient back to the mambo to treat the “possession.” This incident was interpreted by the mambo as posses- sion by ‘‘Marinnette.” Marinnette-bwa-chech is one of the most dreaded loas, an agent for underhand dealings and an expert sorceress. Those possessed by this loa are said to throw themselves in the fire and stamp about until they put the flames out. The patient had bitemporal in- dependent spikes on EEG. Treatment with antiepileptic drugs (AEDs) has decreased the frequency of seizures.

Case 3 This 36-year-old woman had several years of recurrent

complex partial seizures that manifested as a strong sense of fear and epigastric coldness, followed by loss of awareness, utterances of nonsensical phrases, and com- plex motor automatisms. The local mambo attributed the events to her being taken by “Melle Charlotte,” a french loa, with the nonsensical speech being interpreted as a foreign language. It is said that during the possession by this spirit, a person will speak perfect French or other languages, even though in life, the person has no knowl- edge of that language. She continued to have seizures despite the mambo’s attempts to conjure the spirit. He explained his failure to the fact that Melle Charlotte is a very particular loa who makes only sporadic appear- ances. She was not treated with AEDs until she left Haiti at the age of 34. An EEG revealed a right anterior tem- poral focus, and magnetic resonance imaging (MRI) showed right hippocampal atrophy. Seizures improved with carbamazepine (CBZ), although compliance with medication was a problem, largely because of family interference.

Case 4 This 44-year-old Dominican woman (of Haitian par-

ents) for years has been experiencing partial seizures which she refers to as “la cosa” (the thing). Her sei- zures, with a sudden overwhelming sensation of empti- ness, were attributed to her “good angel” leaving her as the spirit of the dead tried to take hold of her (“me mandaron un muerto”). The sending of the dead, l ’envois morts, is a feared Voodoo curse, which is said to affect health and prosperity. The mambo explained the failure of the attacks to respond to his exorcisms to the strong hold of the spirit. EEG showed a right temporal focus, and the MRI was normal. Seizures were controlled with phenytoin (PHT) monotherapy.

Case 5 This 47-year-old Jamaican woman of Haitian descent

with a history of Chiari I malformation, syringomyelia,

and arrested hydrocephalus, has a long-standing history of complex partial seizures with and without secondary generalization. The patient and her family attributed the seizures to Voodoo spirit possessions, being influenced by the olfactory hallucination of a burning smell, and a rising epigastric aura “taking over the body.” A pro- longed postictal psychosis would follow, in which the patient would alternate chanting and wooing with peri- ods of total unresponsiveness. EEG demonstrated inde- pendent bitemporal interictal epileptiform discharges. She denied her diagnosis of epilepsy, resisted diagnostic and therapeutic interventions, and insisted that she was possessed by spirits of the dead. On immigrating to the. United States, she ultimately became seizure free with PHT monotherapy.

DISCUSSION

Possession by spirits is part of many African cults. Their influence was spread to the New World by the slave trade. From the ports of Benin, Dahomey, and Guinea, natives were sold as slaves primarily to the colo- nies in the Caribbean basin and Brazil. Holds of slaves contained representatives of all social classes including “servants of the gods,” who knew the cults’ rites and kept them alive in exile. Many of their descendants have held onto these traditions to the present, because of either geographic isolation or sociocultural constraints and in- fluences or both. Attempts to eliminate slave cults in the colonies were not very successful because of a lax po- litical authority and resistance to Church interference in slave matters on the part of land owners. This influence is clear in the synchretic religions that developed there- after, such as Santeria in Cuba, Mayombe in Brazil, Espiritismo in Mexico, Obeah in the Bahamas, and Voo- doo in Haiti (2).

Many people in Haiti still adhere to the practice of Voodoo and believe implicitly in magic. Voodoo, as it is practiced today, is not substantially different from the Dahomean cults of the 17th and 18th century, except for human sacrifice, which was then widely practiced. In Dahomey, a voodoo is a “god,” a “spirit,” or a “sacred object” (2). The spirits, the worship of whom is the essence of Voodoo, are called loas, mysteries, saints, or angels. Not only do they range from known Catholic saints to the old gods from Africa, but minor local spirits also are worshiped. Voodoo is always enriching itself with new loas; some are revealed and imposed on mem- bers of a cult group when a devotee is suddenly pos- sessed by an unknown spirit who demands worship; oth- ers owe their existence to dreams, particularly of influ- ential mambos (2). This dynamism of Voodoo, as illustrated in cases 2 and 3, allows simple religious con- cepts to provide explanations for a range of life circum- stances,including health matters.

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In Voodoo circles, possession and trance are not re- garded as cause for shame or even anxiety; they are a mark of divine favor (4). Adepts of Voodoo, however, make a clear distinction between possession by a “radu” loa, which is sought after and desired, and pos- session by evil spirits from the “petro” family of loas, which is frightening and morbid (2). Possession by petro loas is often delivered by sorcerers as punishment, as in case 1. Voodoo tradition holds that humans have two souls, the “Big” and the “Little” good angels. A guard- ian role is attributed to the “Little Good Angel.” Serious illness takes hold only when the guardian has been over- whelmed by evil spirits stronger than itself or when, through weariness or any other reason, it finds itself un- able to cope. Possession by loas takes place when the loa drives out the “Big Good Angel.” The eviction of the soul is responsible for the tremblings and convulsions that characterize the trance. The trance is typically fol- lowed by a period of sleep or confusion, and the pos- sessed remembers nothing of what was said or done. The intensity of the crisis varies according to the character of the spirit seeking incarnation (2). The description of pseudoseizures in the literature is quite similar (5) . Thus we could appreciate how easily an epileptic seizure may be attributed to a spirit possession by a medically unso- phisticated mambo. As case 1 illustrates, the generalized tonic-clonic seizure’s timing and severity lead the mambo to incriminate the deceased’s protecting loa. The sleep deprivation and the flickering effect of the flames at the wake may have triggered the seizure in this patient with probable juvenile myoclonic epilepsy.

The symptoms accompanying epileptogenic dis- charges in the temporal lobe are fertile ground for mystic interpretations. Depersonalization, derealization, and double consciousness are common in patients with a temporal lobe focus (6) and have been elicited during intraoperative stimulation of the amygdala, hippocam- pus, and first temporal gyrus (7,8). Similar feelings also are described with religious conversions (1). Other fea- tures common to both conditions are the abruptness, the depth, the lack of control, and the perceptual changes occurring during the seizures. Autoscopy, or the sensa- tion of leaving the body and viewing it from above, can also be affiliated with religious experiences. It is a rela- tively common experience of those with temporal lobe epilepsy, either at the onset of the seizure or during the postictal phase (9). The mystical experiences of Saints Paul, Catherine of Ricci, Theresa of Avila, and Catherine of Genoa have been considered examples of ecstatic epi- lepsy (lo). Auditory and visual hallucinations, although less common features of temporal lobe partial seizures, are frequently interpreted as celestial voices and visions

as well (11). Patients 2 through 5 have temporal lobe epilepsy, with their complex partial seizures miscon- strued as possessions; the nature of the incarnated loa was identified by the mambo based on the clinical mani- festations of the epilepsy. The services of the mambo required periodic “contributions,” which can total hun- dreds of dollars in each case. The patients and relatives pursued treatments with mambos for many years despite the persistence of seizures. This failure was attributed to the uniqueness of the loa in one case and the unyielding grip of the loa in the other. Medical help was not sought until the patient moved away from the native town. The patients and families acknowledged that they feared go- ing against the lous or disobeying the mambos. Tradition has it that either act can be punished with revenge and deliverance of even worse ailments ( 2 ) .

Although we are in no position to deny a true Voodoo spirit possession, in likelihood, cases as these are more likely the application of cultural and religious beliefs to otherwise unexplainable occurrences by a medically un- sophisticated population. When treating patients, the physician must take into account the patient’s cultural background and system of beliefs, an important point particularly in areas with a high percentage of new im- migrants. Regardless of the faith, epileptic seizures should be considered in the differential diagnosis of atypical and episodic religious experiences.

Acknowledgment: We are indebted to Mrs. Esther Dominguez and Ms. Patricia de la Torre for their invaluable help in preparing the manuscript.

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Epilepsia. Vol. 40, No. 2, 1999