Since the demonic is a metaphysical belief without any empirical proof or external verification according to the norms of the empirical method, obviously there is no psychological diagnosis for demonic possession or demonic influence upon mental health within the DSM-V-TR. This does not mean within the history of pastoral care there has not been cases that were considered demonic in origin and required deliverance or exorcism. Universally, all human cultures have rituals, as well as theological commentary, on dark forces. While their etiology and origin stories may differ, the unexplainable belief in the evil and dark forces remains a constant even in the modern world. It is true many cases of mental defect in the past were attributed to the demonic influence due to lack of scientific explanation and that these beliefs led to further psychological damage to the person, as well as causing social turmoil but the opposite extreme of modern psychology to reject all spiritual and demonic causes is equally dangerous. Modern psychology has separated body and mind from soul and has restricted all mental defect to the realm of the scientific method. This stems from a atheistic and humanistic philosophy.
A proper balance is needed that respects the scientific method but does not become intoxicated with atheistic and humanistic rejection of spiritual realities. It also involves realizing that all reality is not measured or observed but there remains other sciences of theology and philosophy that have recorded human experiences that point to deeper realities than merely natural cause and effect within empirically observable phenomenon. Phenomenology is a type of science that looks to judge realities via the experience of the human person. Within these experiences are numerous other realities that escape the narrow and restricted lens of the empirical method.
So while it is important within psychology and diagnosis not to be caught up in superstition, it is also important to not necessarily neglect the spiritual aspect of humanity from a total atheistic outlook. Instead, it is important to recognize unexplainable situations, to measure them with reason, rule out all possible explanations and remain open to the person’s spiritual wellbeing. This involves having resources and referral capability to help clients find the individuals who are able and better equipped to help an individual within these rare and odd cases.
This blog will help clinical as well as non clinical professionals identify rare cases of unexplainable phenomenon and then the proper steps in addressing these issues within a professional and ethical framework that is both beneficial for the client as well as licensed counselor.
Please also review AIHCP’s Christian Spiritual Direction Certification, as well as AIHCP’s Christian Counseling Certification.
A Balance Between Science and Superstition
One could contend that if one believes a demon is behind every rock, then one may have serious issues. One could also contend that those who feel God is talking to them may need a serious mental health assessment to rule out psychosis. Simply put, if one were to meet a modern day Moses, or Abraham, who said God has spoken to them, then that bold statement would require sufficient proof and evidence. One can only imagine what neighbors thought of Noah, or for that matter Abraham. If a person today, like Noah, started to build a large boat in the middle of dry land, most would consider this individual quite mentally ill. And for that matter, one who would lead their son to the top of a mountain to be sacrificed based upon the voices in his head would immediately be arrested and kept for psychological evaluation! Yet all these bold claims were verified with bold miracles. However, these extraordinary events are rare in human history and usually when individuals hear voices or think they are seeing demons, there are natural explanations. Unlike the pre-scientific world and its understanding of mental illness, modern science has afforded humanity with numerous explanations that were once considered demonic or metaphysical.
This does not mean though that with the dawn of the scientific era that all spiritual occurrences remained explainable. The opposite error in thinking is to purge all spiritual and metaphysical realities simply because some cases have natural origin. The fact remains that numerous unexplainable experiences that are have no natural explanation continue to occur. Individuals continue to experience spiritual revelations, apparitions, as well as, evil encounters with the demonic despite the modern era of science. Many of these experiences are witnessed and testified by sane individuals and professionals, as well as healthcare professionals who have no explanation for the phenomenon. Hence, it is important to balance an over superstitious mindset with an agnostic or atheistic mindset. Science and metaphysics can work together to properly balance care of the body, mind and soul and identify afflictions that are beyond comprehension.
Professionals in healthcare as well as mental health can offer spiritual care in certain settings, as well, in particular cases with willing clients. Christian and spiritual counselors obviously have more freedom in pastoral settings to identify these issues, but when spiritual experts and mental health experts work together, then a proper balance of care is given that avoids sick spirituality and superstitious thought with the opposite extreme of a psychology that has become blatantly hijacked and poisoned by atheistic humanism.
Differential Diagnosis
Within the Catholic Church, prior to any exorcism, a full medical and mental health evaluation is required. This prevents not only a mockery of the rite, but also protects further damaging the person who is experiencing possible mental health issues. What may appear as possession could be more so a host of various mental and physiological issues. These differential diagnoses must be ruled out before any suspicion of a demonic possession or presence is even considered. The mental and clinical health professional plays a key role in these cases. The professional counselor may have a person referred by the Church exhibiting certain characteristics and the counselor’s professional diagnosis may be required to rule out all natural explanations, or discover an overlooked mental defect with natural causes. Some counselors, whether clinical or pastoral, as well. may have clients or patients arrive without referral with stories of demons or even God speaking to them, in which the counselor must deduce if the person is in a state of psychosis, or other mental defect, or truly being spiritually afflicted. The counselor, whether spiritual or atheistic, must carefully tread these ethical waters as not to impose one’s one religious or lack of religious faith, as well as to respect the cultural and spiritual beliefs of the person. This does not mean, the counselor should ignore present pathology, but instead should carefully with empathy and compassion work with the person to discover the underlying issue and if without closure, refer the client to someone who can deal with these issues.
Among the possible natural explanations for spiritual voices or demonic affliction can be a host of mental issues that must be diagnosed or ruled out.
Psychosis or any type of hallucinations due to natural explanation or mental defect first need addressed. In addition to psychosis diagnosis that includes seeing things or hearing things, the counselor needs to investigate if any psychosis may be due to drugs, substances or medications. Obviously certain hallucination type drugs need to be ruled out such as PCP or others. Within Schizophrenia, multiple symptoms that were once considered in the pre-scientific times as demonic have mental origins. Schizophrenia manifests not only hallucinations but also delirium, disorganized speech, catatonic behavior, numbness and stupor as well as negative symptoms including affective flattening, alogia or avolition (DSM-V-TR, 2022). In addition, Dissociative Disorder or formerly Multiple Personality Disorder presents the existence of different personalities within the same person. This manifestation is due to early childhood traumatic experience which cuts away from reality and terror to protect the self by a new identity (DSM-V-TR, 2022). It is easy to understand how the pre-scientific mind could misconstrue this as a demonic presence. In addition, physical ailments can also cause hallucinations. This includes tumors and brain injury. It is imperative that scans, as well as blood work is conducted to rule out these basic explanations for possible interpretation of demonic manifestations. Finally, one needs to rule out possible malingering. Some individuals may fake, lie or try to fabricate symptoms for attention (DSM-V-TR, 2022). Others may want attention or have a weak sense of the spiritual or their faith. They mistake what is demonic for natural. Some may have a fanatic view of faith and indeed look to use supernatural activity as a way to gather praise or sympathy from others. Only until this due diligence of ruling out natural explanations is completed, can one begin to contemplate a spiritual issue.
This not to say a seasoned exorcist can sense the demonic far sooner, or for that matter, present individuals who face various mental disorders with also spiritual origins attached, but it is extremely important for the mental and physical safety of the person to ascertain with clarity the etiology and source of the manifestations.
Signs of the Metaphysical
So what is an exorcism? An exorcism is liberation from a diabolical entity or force that is controlling the host person (posession). Exorcism is scripturally based and is a power given by Christ to His apostles to cast out demons in His name. Exorcism throughout the ages has taken on the form of a rite within the Catholic Church with detailed prayers, rituals and preparations. It involves a fasting and a holy priest who receives authorization from the local bishop to perform the rite. In Protestant churches, it is referred to as deliverance ministry. Deliverance ministry does not have the same prayers or rituals found in the rite of exorcism within the Catholic Church.
An exorcist or deliverance minister with experience can sense the signs usually quickly but there are some manifestations or oddities that point to something far more nefarious than only mental defect. While the demonic can thrive within mental defect and use it, outward signs usually manifest in cases of demonic infestation, oppression, obsession or possession (Amoth, 2016). Among these signs include unnatural strength of the possessed, unnatural contortions beyond natural explanation, fear of Christ’s name or holy objects, unknown knowledge, utilization of ancient languages, levitation, temperature within room, and supernatural occurrences such as flying objects (Ripperger, 2022). Another sign from a clinical standpoint is a person’s inability to heal from a potential diagnosis. Despite multiple medications, the issues remain. When these things manifest, it is ultimately the person’s choice for deliverance or exorcism.
Etiology of the Demonic Possession
All demonic activity is limited in scope and practice. God allows it to exist due to free will but the actions of the demonic can only go as far as His authority permits it. Any possession or time of liberation is based upon the time appointed by God. Possession can occur for the greater glory of God, or occur because of one’s own mishaps and missteps. While all mental defect and suffering is correlated with sin and the continued presence of the demonic in the fallen world, not all mental defect is directly caused by supernatural forces, but behind many forms of suffering exist multiple demonic forces. Scripture speaks of demons of suffering and the associated temporal pain with it, as well as the demonic and its association with various vices. Due to actual sin, the human soul weakens its union with God and opens itself to demonic influence. Demonic influence cannot breach freewill but it can become more persuasive to the soul that walks away from God and grace. Sinful practices that become habitual and more extreme weaken the soul to demonic influences. Souls that wander farther from God have less spiritual defenses. Their natural spiritual immune system weakens and as their spiritual hygiene deteriorates the more easily cracks open for spiritual and demonic infection. Bear in mind, not all extraordinary manifestations of the demonic such as infestation, oppression, obsession and possession are always due to spiritual decline. In the case of the saints, many times, spiritual oppression occurred where God permitted the saints to heroically battle the demonic for His greater glory.
Demonic influence is not always a long process, but sometimes can happen quickly or in the moment. Individuals who dabble within the occult or witchcraft can become victims of diabolical possession. Some may ignorantly fall under such influence through ouija boards, divinization, astral projection, spells, or occult ceremonies and then unknowingly and unwittingly become subjugated to the demonic. Others can face daily difficulties through generational curses (Amorth, 2016). Some voluntarily enter into demonic contracts through witchcraft and Satanism. Through unclean rituals, they allow themselves to be possessed or overtaken for special powers or gifts. It is important to note in any such contracts, they is not binding upon acceptance of Christ but the consequences of liberation can be difficult, not just from a supernatural element but also within the occult community which may seek vengeance. In addition, contracts for success and power always end sourly for the individual for the demons are princes of lies (Ripperger, 2022).
Professional Standards and Approaches when Confronted with Demonic Possession
Again, there is no manual for demonic possession within the DSM-V-TR. For many it is considered outside the scope of professional practice. This is why it is very important, if as a believer, a mental health professional adheres to standards and protocol. Professional ethics prevents discussions of spiritual matters unless the client addresses or asks about spiritual aspects. Spirituality is obviously very critical to mental health. Since it is so important, spirituality on numerous occasions filters into the counseling session. It is important that this aspect of counseling is introduced only at the interest of the client. Furthermore, if as a counselor, sharing in different theological views, it is important sometimes to set boundaries or refer clients to other counselors who may be better equipped to discuss spirituality. For those of faith, these conversations are not as difficult. Most of faith integrate spirituality at an implicit level of practice. They quietly pray to the Holy Spirit for guidance and healing of patients, while others can have a more explicit integration with clients who openly profess faith. Obviously this is far more easy a practice for Christian Counselors, faith based ministries, or counseling organizations with a Christian mission.
Yet, there still can be many pitfalls. First, many spiritual people can sometimes have distortions of faith. While faith experiences are exempt from delusionary behavior in the DSM-V-TR, many can experience spiritual events that need to be properly discerned for their authenticity. Some counselors are better equipped to handle these situations, while others should refer a client to a Christian or faith based counselor or a minister or spiritual director or priest. These individuals can help clients better discern spiritual communication from God, or for that matter, spiritual discernment regarding demonic manifestations. In addition, deliverance prayers, or pray healing can present serious issues for purposes of billing. Since they are not a recognized medical therapy (Note: prayer needs to be carefully integrated into any session for those who desire it) Finally, deliverance and exorcism is far different than mere prayers but involves deep emotional, psychological, mental and spiritual goals and aims. Only trained professionals who are approved should ever pursue these types of spiritual exercises. First, it is extremely dangerous for the person if mishandled both mentally and spiritually. Secondly, the possibility of malpractice sky rockets. Third, it is not recognized within norms of care. And finally, it is extremely dangerous for the counselor to perform exorcism or deliverance. Exorcism not only involves intense training, but it also requires spiritual preparation dictated in Scripture. It involves faith and it involves a calling. Thus, anyone manifesting symptoms of diabolical possession should be referred to the appropriate religious professional. Counselors should have a list of adjunct professionals they can contact regarding these extraordinary issues. Obviously, before anything can be referred or conducted, the person must grant full consent and give permission.
Christian Counselors can help an individual discern spiritual experiences, help lead in prayers, advise and offer solutions. Spiritual cleaning and spiritual direction can help the soul face issues, but if diabolical presence is more than temptation and simple obsession or infestation, a trained exorcist will be required for more serious matters. When matters are more serious, they seem to keep returning, especially if the person is unwilling to change certain life styles that have attracted the presence, or refuses to take the proper spiritual care at home, protecting it and self.
Christian Counselors can offer binding prayers, sacramentals of protection, moral guidance and references, but sometimes, a soul needs liberation at the hands of a qualified religious professional. Again under no circumstance, should a counselor, or even a Christian Counselor attempt to exorcize a person.
Conclusion
Demonic possession is a reality that many deny. Understanding the the presence of Satan in the world and its many levels is important because it affects all levels of humanity. Mental health and spiritual health are integrated realities and many times both affect each other. While not every issue is demonic or directly correlated, it is very dangerous to dismiss this reality. Mental health professionals play a key role in diagnosing mental disorders and helping religious professionals dismiss fake possession for true mental defect, or by ruling out all natural differential diagnoses. This helps the religious professional or exorcist understand if he is dealing with a true demonic case. Many Christian counselors or even clinical counselors may come across cases of the supernatural and must follow their own ethical standards. In cases of possession, clients should be referred to the appropriate religious and pastoral professionals. Clinical counselors or even Christian counselors should never attempt to perform an exorcism.
Please also review AIHCP’s Christian Counseling Certification.
Additional Blogs
Types of Demonic Activity. Access here
References
Amorth, G. (2016). “An Exorcist Explains the Demonic. Sophia Institute Press.
DSM-V-TR, 2022
Rippeger, C. (2022). “Dominion: The Nature of Diabolic Warfare”. Independently published.
Additional Resources
Fragomeni, R. (2023). “What is an exorcism?”. U.S. Catholic. Access here
Somers, J. (2023). “What Actually Happens When You Request An Exorcism” G. Access here
“What is deliverance ministry, and is it biblical?” Got Questions. Access here