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Epilepsiu. 40(2).239-241, 1999Lippincott Williams Kr Wilkin\, Inc., Philadelphia0 nternational League Against E p i l e p ~ y

Brief CommunicationEpilepsy and Religious Experiences: Voodoo Possession

E. Carrazana, J. DeToledo, W. Tatum, R. Rivas-Vasquez, G. Rey, and S . WheelerNeurologic Cenenter o;f South Florida, University o Miami School o Medicine, and University o j South Floi-idu-Tampa General

HoJpitul, Miami, Floridu, U.S.A.

Summary: Epileptic seizures have a historical associationwith 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.K ey Words: Epilepsy-Seizures-Religion-Voodoo-Possessions.

The conc ept of possession, to be seized by spirits,is central to the historic association of religion and theepilepsies. A com mon belief of ancie nt culture s was thatmental disturbances were caused by supernatural inter-ference. The early Gree ks viewed epilepsy as a visitationfrom 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 withepilepsy themselves have often explained their seizuresas religious experiences, particularly the feeling s associ-ated with depersonalization, derealization, and autoscopyof temporal lobe epilepsy. Furthermore, most of the re-ports invoke elements of Christianity, thereby reflectinga Eurocentric view of the subject ( 1 ) .

Voodoo is the most popular religion in Haiti. It haspreserved ma ny of the characteris tics of the Dahom eanand Guinean cults from which it derives (2). Worshipand 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 theychoose. The person possessed is a mere receptacle bor-rowed by the spirit for the purpo se of revealing itself. Inthat sense, the experience is similar to an epileptic sei-zure in that the patient has no control over its timing norexpression. Voodoo faithfuls voluntarily place them-selves under the authority of so me 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. Carrazanaat Neurologic Center of South Florida, Baptist Hospital OutpatientBldg., 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 casesdemonstrate that beliefs and folklore are not alwaysharmless in that, a t times, they can adversely affec t clini-cal management. In addition to being a source of greatanxiety, they may delay appropriate diagnosis and treat-ment.

CASESCase 1

This 24-year-old H aitian man had his first generalizedtonic-clonic seizure at the age of 17 years during thewake of an uncle. The patient had been sleep deprivedduring the vigil of the corpse. T he seiz ure was attributedto possession by Ogu (the warrior god ), the dead unclesprotecting loa. Subsequent seizures and m orning myoc-lonus were explained as harassment by the wanderingsoul of the uncle. The possession was interpreted as apunishment, fo r the patient had been disrespectful towardthe deceased in the past. He was treated by the localmambo (priest) for 6 years and did not see a physicianuntil coming to the United States. His EEG show ed 3- to4-Hz bursts of generalized spike-wave complex dis-charges occurring spontaneously and during photicstimulation. In retrospect, the patient had a history ofwaking 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 2This 27-year-old Haitian woman, with a history ofcomplex partial and secondarily generalized seizures

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since adolescence, was the p roduct of a long and difficultdelivery, which was attributed to a grip in the moth-ers belly by a loa. At the ag e of 1 4 years, she fell in anopen fire during a seizur e and suffered extensive burns toher arm, leg, and parts of the face and trunk. Burns weretreated at a local hospital, but the family brought thepatient 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 ofthe most dreaded loas, an agent for underhand dealingsand an expert sorceress. Those possessed by this loa aresaid to throw themselves in the fire and stam p about untilthey put the flames out. The patient had bitemporal in-dependent spikes on EEG. Treatment with antiepilepticdrugs (AED s) has decreased the frequency of seizures.Case 3

This 36-year-old wom an had several years of recurrentcomplex partial seizures that manifested as a strongsense of fear and epigastric co ldness, followed by loss ofawa rene ss, utterances of nonsensical phrases, and com-plex motor automatisms. The local mambo attributed theevents to her being taken by Melle Charlotte, a frenchloa, with the nonsensical speech being interpreted as aforeign langua ge. It is said that during the possession bythis spirit, a person will speak perfect French or otherlanguages, even though in life, the person h as no know l-edge of that language. She continued to have seizuresdespite the mambos attempts to conjure the spirit. Heexplained his failure to the fact that Melle Charlotte is avery particular loa who makes only sporadic appear-ance s. She was not treated w ith AED s until sh e left Haitiat the age of 34. An EEG revealed a right anterior tem-poral focus, and magnetic resonance imaging (MRI)showed right hippocampal atrophy. Seizures improvedwith carbamazepine (CBZ), although compliance withmedication was a problem, largely because of familyinterference.Case 4This 44-year-old Dominican woman (of Haitian par-ents) for years has been experiencing partial seizureswhich she refers to as la cosa (the thing). Her sei-zures, with a sudden overwhe lming sensation of empti-ness, were attributed to her good angel leaving her asthe spirit of the dead tried to take hold of her (memandaron un muerto). The sending of the dead ,l envoismorts, is a feared V oodo o curse, which is said toaffect health and prosperity. The mambo explained thefailure of the attacks to respond to his exorcisms to thestrong hold of the spirit. EEG showed a right temporalfocus, and the MRI was normal. Seizures w ere controlledwith phenytoin (PHT) monotherapy .Case 5

This 47-year-old Jamaican wom an of Haitian descentwith a history of Chiari I malformation, syringomyelia,

and arrested hydrocephalus, has a long-standing historyof complex partial seizures with and without secondarygeneralization. Th e patient and h er family attributed theseizures to Voodoo spirit possessions, being influencedby the olfactory hallucination of a burning smell, and arising epigastric aura taking over the body. A pro-longed postictal psychosis would follow, in which thepatient 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 diagnosticand therapeutic interventions, and insisted that she waspossessed by spirits of the dead. On immigrating to the.United States, she ultimately became seizure free withPH T m onotherapy.

DISCUSSIONPossession by spirits is part of many African cults.

Their influence was spread to the New World by theslave trade. From the ports of Benin, Dahomey, andGuinea, natives were sold as slavesprimarily t o the colo-nies in the Caribbean basin and Brazil. Holds of slavescontained representatives of all social classes includingservants of the gods, who knew the cults rites andkept them alive in exile. Many of the ir descendants haveheld on to these traditions to the present, because of eithergeographic isolation or sociocultural constraints and in-fluences or both. Attempts to elimin ate slave cults in thecolonies were not very successful because of a lax po-litical authority and resistance to C hurch interference inslave matters on the part of land owners. This influenceis clear in the synchretic religions that developed there-after, such as Santeria in Cuba, Mayombe in Brazil,Espiritismo in Mexico, Obea h in the Bahamas, and Voo-doo in Haiti (2).

Many people in Haiti still adhere to the practice ofVoodoo and believe implicitly in magic. Voodoo, as it ispracticed today, is not substantially different from theDahomean cults of the 17th and 18th centu ry, except forhuman sacrifice, which was then widely practiced. InDahomey, a voodoo is a god, a spirit , or a sacredobject (2). The spirits, the worship of whom is theessence of Voodoo, are called loas, mysteries, saints, orangels. Not only do they range from known Catholicsaints to the old go ds from A frica, but minor local spiritsalso are worshiped. Voodoo is always enriching itselfwith 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-ent ial mambos (2) . This dynamism of Voodoo, asillustrated in cases 2 an d 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 amark of divine favor (4). Adepts of Voodoo, however,make a clear dis t inct ion between possession by aradu loa, which is sought after and desired, and pos-session by e vil spirits from the petro family of loas,which is frightening and m orbid (2). Possession by pe t r oloas is often delivered by sorcerers as punishment, as incase 1. Voodoo tradition holds that humans have twosouls, the Big and the L ittle good angels. A guard-ia n role is attributed to the L ittle Good Angel. Seriousillness takes hold only when the guardian has been over-whelmed by evil spirits stronger than itself or when,through weariness o r any oth er reason, it finds itself un-able to cope. P ossession by loas takes place when the loadrives out the Big Goo d Angel. The eviction of thesoul is responsible for the tremblings and convulsionsthat characterize the trance. The trance is typically fol-lowed by a period of sleep or confusion, and the pos-sessed remembers n othing of what was said or done. Theintensity of the c risis varies according to the character ofthe spirit seeking incarnation (2). The description ofpseudoseizures in the literature is quite similar ( 5 ) . Thuswe could appreciate how easily an epileptic seizure maybe attributed to a spirit possession by a medically unso-phisticated mambo. As case 1 illustrates, the generalizedtonic-clonic seizures t iming and severi ty lead themambo to incriminate the deceaseds protecting loa. T hesleep deprivation and the flickering effect of the flamesat the wake may have triggered th e seizure in this patientwith probable juvenile myoclonic epilepsy.

The symptoms accompanying ep i lep togenic d i s -charges in the tempora l lobe are fertile ground f or mysticinterpretations. Depersonalization, derealization, anddouble consciousness are common in patients with atemporal lobe focus (6) and have been elicited duringintraoperative stimulation of the amygdala, hippocam-pus, and first temporal gyrus (7,8). Similar feelings alsoare described with religious conversions (1). Other fea-tures common to both conditions are the abruptness, thedepth, the lack of control, and the perceptual changesoccurring during the seizures. Autoscopy, or the sensa-tion of leaving the body and viewing it from above, canalso be affiliated with religious experiences. It is a rela-tively common experience of those with temporal lobeepilepsy, either at the onset of the seizure or during thepostictal phase (9). The mystical experiences of SaintsPaul, Catherine of Ricci, Theresa of Avila, and Catherineof Genoa have been considered examples of ecstatic epi-lepsy (lo). Auditory and visual hallucinations, althoughless common features of temporal lobe partial seizures,are frequently interpreted as celestial voices and visions

as well (11). Patients 2 through 5 have temporal lobeepilepsy, with their complex partial seizures miscon-strued as possessions; the nature of the incarnated loawas identified by the mambo based on the clinical mani-festations of the epilepsy. The services of the mamborequired periodic contributions, which can total hun-dreds of dollars in each case. The patients and relativespursued treatments with mambos for many years despitethe persistence of seizures. This failure was attributed tothe uniqueness of the loa in one case and the unyieldinggrip of the loa in the other. Medical help was not soughtuntil the patient moved away from the native town. Thepatients and families acknowledged that they feared go-ing against the lous or disobeying the mambos. Traditionhas it that either act can be punished with revenge anddeliverance of even worse ailments ( 2 ) .

Although w e are in no position to deny a true Voodoospirit possession, in likelihood, cases as these are morelikely the application of cultural and religious beliefs tootherwise unexplainable occurrences by a medically un-sophisticated population. When treating patients, thephysician must take into account the patients culturalbackground and system of beliefs, an important pointparticularly in areas with a high percentage of new im-migrants . Regardless of the fai th, epi lept ic seizuresshould be considered in the differential diagnosis ofatypical and episodic religious experiences.Acknowledgment: We are indebted to Mrs. EstherDominguez an d Ms. Patricia de la Torre for their invaluablehelp in preparing the manuscript.

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Epileps ia. Vol. 40,No . 2, 1999