Where mental illness is blamed on spirits, we need to be human to reach people,Manmeet Kaur,The Skeptic

On 23rd August 2008, 16-year-olds Ku Witaya and Sia Chan Hong jumped from a ninth-floor window to their deaths, in what was known in Singapore then as the “slayer suicide pact”. The coroner’s inquiry discovered that Witaya had his group of friends convinced he was able to talk to spirits, and that he had a dream whereby they had been chosen to fight demons. However, he claimed, they had to die in order to be “resurrected” as “slayers”. This led to the ultimate loss of two young lives. While tragic, the incident serves as a grim reminder of the fatal consequences of believing in spirit possessions for an individual who could have benefited from professional help.

Belief in the supernatural among sufferers of mental illnesses can have detrimental effects, such as delayed treatment-seeking and lower likelihood of treatment success. These consequences may be even more prevalent in Singapore, given that 68% of Singaporeans still believe in ghosts. This is a much higher percentage than in Britain, where only a third of Brits endorse such beliefs.

Madeeha Shahnaaz, a 22-year-old Indian Singaporean, is all too familiar with such a situation:

I have an aunt who had become depressed after her husband passed away. I do not know why but my family thought that my grandma had possessed her… honestly it felt like it was more of her grief of her husband passing away that explained her symptoms, rather than a supernatural cause.

The stigmatisation and isolation Madeeha’s aunt faced from her family members had a significant toll on her aunt:

She did not feel like herself and felt very angry… she is also quite traditional so when people around her were saying that it was ghost possession, she thought that maybe there really was a supernatural reason. She started tackling it by going to a mosque instead of seeking professional help. I think it worsened her symptoms because when people isolated her even more, she became worse.

When I asked Madeeha what she thought was the main reason for her family’s treatment towards her aunt, her answer was simple: “It’s just an Indian thing lor.”

Despite the potential detrimental effects of attributing mental illnesses to spirit possession, shunning people for their beliefs is no solution. Rather, it is important to understand the mechanisms underlying such beliefs. Understanding why people attribute psychiatric symptoms to the supernatural can allow us to view believers from a different perspective, when a knee-jerk response of ridiculing believers for their beliefs can do more harm than good.

Let’s start with the most obvious factor: culture. I had the privilege of interviewing Jonathan Kuek, a doctoral student from the University of Sydney, who had been close friends with the boys that had died on that fateful August in 2008. Jonathan told me:

At that time, I had already graduated from secondary school. However, after the incident happened, I had gotten a text from a close circle of friends saying that Witaya had ended his life. Everyone was saying that he was pushed off a block by some kind of spirit.

Jonathan went on to explain why many at the time had attributed this incident to supernatural causes:

To me, the explanation that they were pushed off the building made more sense, than [the explanation that] they had committed suicide. This had happened during the seventh month period. In Chinese culture, we were always told that we don’t mess around during the seventh month. We were told not to do certain things like whistle or swim, if not the spirits will follow you home.

The seventh month Jonathan was referring to is the Hungry Ghost Festival, a month in which the Chinese believe that the gates of hell are opened for spirits to roam the earth.

What he shared is not surprising, as there have been a plethora of studies attributing cultural influences as a significant factor underlying the belief in ghost possessions over mental illnesses. Semi-structured interviews conducted in Malaysia and Saudi Arabia found a greater likelihood of individuals attributing the supernatural to psychiatric symptoms, and of seeking help from spiritual healers. This could be due to religious reasons whereby, in Islam, jinn-possession is seen as a possible factor explaining psychiatric symptoms.

However, a study found that nearly 66% of individuals that had claimed to be possessed by a jinn were actually suffering from a mental illness. This attribution of mental illnesses to possession can also be seen in eastern cultures and traditions, such as in China and Japan.

But when we look closer, we can see that family background matters as well. Chad Yip, a clinical psychologist working in Singapore, recounted a time when he had worked with a 13-year-old boy that he thought might be autistic:

Halfway through our session he would point over to the toilet and say that he saw shadows there. If you look at his family background history, he grew up with such beliefs. For example, his father would tell him that the noises you heard at midnight were due to a ghost, so the boy from young was bombarded with messages that ghosts do exist. This resulted in him attributing unusual sounds or sights to ghosts.

For some, their belief in the supernatural serves as a coping mechanism. Jonathan shared how he had used his beliefs in spirits as a way to cope with the loss of his friend:

It was more comforting to think that something else had intervened and ended their life for them, and the seventh month thing really helped us buy into that supernatural narrative and provided closure. We didn’t have to follow up and think of why it happened, which helped us move on much more easily.

Jonathan’s experience highlights how the finding an alternative explanation provided some sense of solace for him and his friends, regardless of whether it was true or not.

Jonathan was not alone in this. Past research has found a positive association between traumatic experiences and the development of paranormal beliefs as a coping mechanism. One-on-one semi-structured interviews have also found that participants used supernatural beliefs as a form of problem-focused coping strategy, and that such beliefs play an integral role in the recovery process for some due to the feeling of belongingness they experience when they are part of a spiritual community.

However, for others, seeking spiritual aid could be a desperate cry for help, after countless unsuccessful attempts in seeking psychiatric treatments. This is not to say that psychiatric treatments do not work, but rather it exposes the low quality of care in some mental health institutions.

Dr. Andrea De Antoni, an anthropologist and associate professor at Kyoto University in Japan, explained:

Here in Japan, psychiatric care is extremely institutionalised. There is a high reliance on drugs, which becomes problematic as there is no counselling involved. Medical practitioners here are sort of tied up in a very strict system; they are understaffed and cannot afford to give a lot of time to patients. Even if they want to, they are unable to treat patients in a humane way. People then end up at the exorcist as their last resort.

But sometimes, the issue might not be just about the quality of care, but also about the affordability of and access to psychiatric treatment. In Singapore, there are just 2.6 psychiatrists per 100,000 people, compared western countries such as the UK and USA that have 11 and 13.7 psychiatrists for every 100,000 individuals respectively.

Furthermore, a recent study has shown that 66% of Singaporeans believe that the cost of mental healthcare is too high, with some disclosing that they had to stop seeking treatment due to the financial strain of going for regular sessions. This shows how the high barriers of entry to psychiatric care might lead to individuals seeking alternative treatments for their symptoms.

As we have seen thus far, the reasons underlying beliefs in possession over mental illnesses are many. However, merely knowing about these underlying mechanisms is not enough. In my quest to better understand the relationship between ghost possessions and mental illnesses, I had wondered how we could change the beliefs of those suffering from mental illnesses in order to improve their treatment-seeking behaviour. To my surprise, it seems that the solution may not lie in changing beliefs at all.

In fact, past research has highlighted the importance of integrating cultural mindfulness into psychiatric practices to promote treatment seeking behaviours and treatment success in those that believe in religion and spirituality. Studies recommend that clinicians should take into account cultural factors that shape the individual, instead of automatically attributing possession beliefs to delusion. This would also allow them to be able to better differentiate between what is just a commonly held cultural belief and what is a genuine delusion that requires psychiatric aid.

The importance of being sensitive is well encapsulated by Chad:

When patients come to me with such beliefs, I don’t affirm or deny the existence of supernatural sources; I am open and curious to what other people have experienced for a variety of reasons. To them, their experiences are real; it’s like their reality.

With regards to the implications of trying to change their beliefs, he said:

Shunning them for their beliefs will invalidate them; so, it is not a matter of changing their thinking, but rather it is more important to focus on which area the patient is experiencing most difficulty in, be it a relationship or work setting, and to come up with interventions that would help adapt to this particular situation. If patients can manage their behaviour in a healthier manner, then they can still function with such beliefs.

It seems that listening to patients, regardless of how unbelievable their concerns are, is very important. Plenty of evidence highlights the negative effects on patient care when healthcare professionals lack the time and empathy to listen and understand their patients’ concerns.

When I asked Dr. De Anthoni about the importance of why we should listen to patients that endorse such beliefs, he said:

Because everything is not about you, it’s about them. If the person is suffering, the least you can do is listen and try to interact with this person. The matter of fact is that they are suffering, and whether it is due to the devil or not is absolutely irrelevant.

Chad had similar thoughts:

At the end of the day, it is important to be curious as, to them, this is their existence. To invalidate them we are only pushing them away and destroying any opportunity to help them. Even though the normal reaction is to be shocked and to pull back, we should take the time and patience to listen a bit more before judging.

Speaking of being sensitive to cultural contexts, I am well aware that this article is going to be read by a British audience. I had asked my interviewees what were some parting messages that they would like their British audience to leave with. Surprisingly, most of them had the same thing to say: they all highlighted the importance of reading up and understanding the origins of such beliefs, and accepting the diversity of cultures that exist in Asia.

Perhaps Dr. De Anthoni summed up these points the best:

It is important to understand things from the natives’ point of view and not from a universal truth. Listening to others is an important starting point, and then you can do whatever you want with their knowledge.

It seems that regardless of the beliefs individuals endorse, it is important to understand, be culturally sensitive and to listen. It is only when we lose the judgments do individuals with such beliefs become more receptive towards listening to valid advice and receiving the psychiatric help they need. As a society, this is the least we owe to them.

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Some religious cultures misattribute mental health issues to spiritual possession – they won’t seek help if care directly challenges their faith
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