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Guide XIII-211

Exorcism (Rituale Romanum)

1999Holy See
A 35 · L 53 · M 1211 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Catholic Church's revised rite De exorcismis et supplicationibus quibusdam (Rituale Romanum, published by the Congregation for Divine Worship and the Discipline of the Sacraments, presented 26 January 1999), as described by the Holy See's 1999 presentation and by the US Conference of Catholic Bishops (USCCB) for its English edition, Exorcisms and Related Supplications (ERS; translation approved 2014, confirmed 2016, implemented in US dioceses 29 June 2017). The Latin editio typica itself is described here from these official summaries, not reproduced. [source: Catholic Culture, "Congregation Publishes New Rite of Exorcism"; USCCB, "Exorcism"] No ritual text or ritual procedure is given in this guide.

What it is, as the Church states it. The Church describes exorcism as a form of prayer "against the power of the devil" and classes it as a sacramental, not one of the seven sacraments. It distinguishes minor exorcisms (prayers within the baptismal rites for adults and children, and private supplications the faithful may use) from major or solemn exorcism, which is aimed at liberating a person from what the Church judges to be genuine demonic possession (Catechism of the Catholic Church, para. 1673). [source: USCCB, "Exorcism"; Vatican Catechism concordance] Possession, demons and deliverance are described here as the Church holds them, neither asserted nor dismissed.

Three published safeguards.

  • The bishop's permission. A major exorcism may be performed only by a priest with the special and express permission of the local ordinary (Code of Canon Law, can. 1172), granted for one case or to a priest appointed as a diocese's exorcist; the priest must be marked by piety, knowledge, prudence and integrity of life. [source: USCCB; Catholic Culture]
  • Distinguishing illness. The Catechism, as quoted in the 1999 presentation, says illness, "especially psychological illness, is a very different matter", whose treatment belongs to medical science; before an exorcism it must be established that the case is not illness. [source: Catholic Culture]
  • Medical and psychiatric consultation. The USCCB says diocesan protocols should include a "thorough medical and psychological/psychiatric evaluation" before the exorcist reaches a final judgement, and that the Church, not the person's self-diagnosis, decides. The ERS tells the exorcist to use "utmost circumspection and prudence" (ERS 14). [source: USCCB]

How change happens (the therapist's frame). For the client, the rite's meaning lies in the Church's teaching on evil, prayer and liberation. The psychotherapist does not perform, recommend or evaluate the rite. The therapist's own work is to understand what possession beliefs and a request for exorcism mean in the client's life, to make sure medical and psychiatric conditions are assessed and treated, to work alongside clergy when the client wishes, and to protect clients, especially children, from harmful unauthorised "exorcisms". [synthesis]

2. Framework

This is a rite, not a therapy; there are no therapy phases or session counts in the sources. The framework below sets the Church's published pathway beside the therapist's parallel tasks. [synthesis, built on USCCB and Catholic Culture]

A. The Church's published pathway (who leads and authorises)

  1. Pastoral contact. A person or family raises concerns with a parish priest; the USCCB notes pastors may recommend private supplications (ERS Appendix II) when someone reports spiritual attack in counselling, spiritual direction or confession. [source: USCCB]
  2. Diocesan referral and evaluation. Diocesan protocols include medical and psychological or psychiatric evaluation before any determination. [source: USCCB]
  3. Discernment by the appointed exorcist. The exorcist seeks moral certitude, avoiding both credulity and attributing everything to natural causes; the 1999 presentation lists the traditional signs the Ritual mentions (unknown languages, revealing hidden things, strength beyond one's condition, vehement aversion to sacred things). [source: USCCB; Catholic Culture] The USCCB adds that the person's consent should be sought if at all possible. [source: USCCB]
  4. Authorisation by the bishop. The diocesan bishop authorises each case or appoints a standing exorcist. [source: Catholic Culture; USCCB]
  5. Celebration under safeguards. The USCCB says the rite is to be held discreetly (normally not in the person's home), never by the exorcist alone, with a woman present when the person is female, confidentially, and exactly as the approved text allows. [source: USCCB]
  6. Ongoing pastoral care. The rite is linked to the sacramental life of the Church (the USCCB relates it to the Sacrament of Penance). [source: USCCB]

The International Association of Exorcists (founded 1990) was recognised by the Congregation for the Clergy in 2014; its 2020 Italian guidelines state that only priests with a specific mandate from their bishop may perform exorcisms and that an exorcist must not request payment. The association says the guidelines are not an official Church document. [source: Crux, 19 July 2020]

B. The therapist's parallel tasks

  • Engagement and meaning: hear the client's account and its religious and family context. Move on once the client feels understood and the explanatory model is clear.
  • Assessment: Cultural Formulation Interview with the spirituality module; medical and psychiatric differential; risk and safeguarding screen. Move on when medical review is arranged and risk is known.
  • Collaboration: with consent, liaise with the client's doctor and, if the client wishes, with the parish priest or diocesan contact.
  • Treatment: evidence-based treatment of any diagnosed condition, integrated with the client's faith where the client wants that.
  • Aftercare: meaning-making after any rite, grief, community and, where harm occurred, trauma-focused care. [synthesis]

Criteria to stop and act immediately [synthesis]: any child at risk; food or fluid refusal or restriction; restraint, beatings or confinement; suicidal or homicidal risk; acute psychosis; seizures; plans for an unauthorised "deliverance" or a ritual abroad. These override pacing (see Harm account).

3. Guiding principles

  • Attribute, do not adjudicate. Describe possession and demons as the client's tradition holds them; neither confirm nor debunk. Practically: say "in your Church's teaching" rather than "it's just your illness" or "the demon". [synthesis]
  • Medicine first, as the Church itself requires. The Church's own texts route illness to medical science and require evaluation. Practically: ensure a medical and psychiatric assessment happens; cite this to devout clients who fear a doctor implies lack of faith. [source: Catholic Culture; USCCB]
  • The bishop authorises; the therapist does not. Practically: never suggest, refer for or endorse an exorcism; if a client wants one, the route is the parish and diocese. [source: USCCB; synthesis]
  • Self-diagnosis is not the Church's verdict. Practically: when a client or relative is sure someone is possessed, note that the Church reserves this judgement to its process after medical evaluation. [source: USCCB]
  • Safety and safeguarding override belief. Practically: restraint, deprivation of food or water, beating or isolation are never acceptable, whoever performs them; follow local child and adult safeguarding procedures. [source: North East Lincolnshire safeguarding guidance; synthesis]
  • Consent and assent. The USCCB says consent should be sought if possible. Practically: in therapy, obtain informed consent for any religious content and for every contact with clergy; with children, seek the child's assent and the parents' consent, and never let parental belief override the child's safety. [source: USCCB; synthesis]
  • Client-led integration. Bring religious resources into therapy only at the client's request, in the client's own language and tradition. [synthesis]
  • Role clarity. The therapist is not an exorcist, confessor or spiritual director; keep dual relationships out; self-disclose one's own faith or lack of it only when it serves the client. The APA Ethics Code's principles on competence, respect for religion and multiple relationships apply [synthesis]. Spiritual and religious competencies for psychologists (Vieten et al. 2013) are relevant [uncertain: not verified].
  • Confidentiality both ways. The Church keeps exorcism confidential; therapy is confidential. Practically: share information with clergy only with written consent, limited to what the client agrees. [source: USCCB; synthesis]
  • Cultural humility. Possession and spirit beliefs occur across countries, cultures and religions. Practically: do not assume Catholic categories fit a client from another tradition (e.g. Pentecostal deliverance, ruqya, kindoki); ask. [source: North East Lincolnshire safeguarding guidance]

4. Intervention inventory

These are the psychotherapist's own interventions alongside the rite. None involves performing, simulating or advising on any part of the rite. Unless marked otherwise, the steps are [synthesis] built on the Church's published safeguards (USCCB; 1999 presentation), the DSM-5 Cultural Formulation Interview (CFI) supplementary modules, and UK local-authority safeguarding guidance on abuse linked to faith or belief.

4.1 Understanding the meaning of possession beliefs and the request in the client's life

  • Purpose / when: first sessions whenever a client (or relative) speaks of demons, possession, curses, "oppression" or wanting an exorcism. Clarifies whether this is a settled religious interpretation, a frightened question, family pressure, or a symptom.
  • Steps: (1) Ask for the story in the client's own words and terms. (2) Ask who first named it possession and what the parish or others have said. (3) Ask what the client hopes an exorcism, or the Church, would change. (4) Ask what the client fears if nothing is done. (5) Reflect back without endorsing or contesting the interpretation. (6) Note any urgency, family conflict or plans for action outside the Church's process.
  • Example language (illustrative): "You've described this as something spiritual attacking you. Tell me how you and your faith understand what's happening." / "What would it mean to you if the Church looked into this?"
  • Watch for: the client feeling judged (shrinking answers, "you'll think I'm mad"); fixed, unshakeable conviction alongside other psychotic features; relatives speaking for the client. Working: the client talks openly about both the spiritual and the practical sides of their distress.

4.2 Cultural Formulation Interview with the spirituality, religion and moral traditions module

  • Purpose / when: structured cultural assessment early in care, especially where possession beliefs are central. The core CFI covers the person's own definition of the problem, cause, help-seeking and identity; the supplementary modules include Explanatory Model (Module 1), Spirituality, Religion and Moral Traditions (Module 5), Coping and Help-Seeking (Module 7), and School-Age Children and Adolescents (Module 9). [source: APA CFI Supplementary Modules]
  • Steps: (1) Run the core CFI. (2) Use Module 5 to map: religious identity and community ties; the tradition's role in daily life and decisions; practices at home and in the community and their importance; whether the tradition, its leaders or practices help the person cope; whether religious matters contributed to the problem or brought conflict or discrimination. [source: APA CFI Supplementary Modules] (3) Add Module 1 for the explanatory model and Module 7 for help-seeking (priest, prayer group, healer, doctor). (4) If the client cannot answer (e.g. severe psychosis), the core CFI informant version can gather caregiver information. [source: APA CFI Supplementary Modules] (5) Write a short cultural formulation that places possession beliefs inside the client's tradition. Do not reproduce CFI items in client handouts; use the official forms.
  • Example language (illustrative): "Some people find their faith a strength in times like this, and some find it adds pressure. How has it been for you?"
  • Watch for: confusing religious belief that is shared by the client's community with delusion (ask whether co-religionists see it the same way); stress from conflict between family factions or between a prayer group and the parish. Working: you can state the client's explanatory model in terms the client agrees with.

4.3 Telling possession beliefs apart from mental illness (differential assessment)

  • Purpose / when: whenever possession is alleged. The Church itself requires that illness be excluded and treated by medicine. [source: Catholic Culture; USCCB]
  • Steps: (1) Screen for psychotic disorders (hallucinations, delusions beyond what the client's community shares, thought disorder), mania and severe depression (including psychotic depression, guilt about damnation). (2) Screen for dissociative presentations (amnesia, identity alteration, trance states); DSM-5-TR recognises culturally framed possession-form presentations within dissociative disorders [uncertain: not verified]. (3) Screen for neurological causes; in the Klingenberg case, doctors had diagnosed epilepsy (see Harm account). [source: Freethinker 1978; The Local 2013] (4) Screen for substance use and medical causes (delirium, endocrine, infection) via the doctor. (5) Screen for obsessive-compulsive fears of being possessed or of blasphemy (see 4.7). (6) Screen for trauma and abuse, including abuse inside religious settings. (7) Where no disorder is found, DSM-5-TR lists Religious or Spiritual Problem among conditions that may be a focus of clinical attention (code Z65.8). (8) Document both the client's religious account and the clinical findings, side by side.
  • Example language (illustrative): "Your Church asks for a full medical and psychiatric check before it reaches any view. Would you be willing for us to do that part properly?"
  • Watch for: missing illness because belief is sincere; pathologising ordinary belief because it is unfamiliar. Red flags needing urgent medical or psychiatric review: weight loss, not eating or drinking, seizures, confusion, command hallucinations, suicidal statements, violence. Working: a diagnosis (or clear absence of one) is reached with the client still engaged.

4.4 Routing health issues to the doctor and medical coordination

  • Purpose / when: whenever physical symptoms, seizures, eating or drinking problems, sleep loss or medication questions arise.
  • Steps: (1) With consent, contact the GP or physician and, where relevant, psychiatry. (2) Share your concerns factually (e.g. reduced intake, collapses, seizures). (3) Encourage the client to keep taking prescribed treatment; do not advise on medicines yourself. (4) If a family proposes stopping treatment because the problem is "spiritual", inform the prescriber and, if risk is significant, follow safeguarding. (5) Agree who monitors what.
  • Example language (illustrative): "Prayer and medical care aren't rivals in your Church's teaching. Let's make sure the medical side is covered."
  • Watch for: food or fluid refusal, which can become life-threatening (Klingenberg). Working: the client attends medical appointments and the doctor is aware of the religious context.

4.5 Collaboration with clergy (when the client wishes)

  • Purpose / when: the client wants their priest or diocese involved, is already in the Church's process, or wants reassurance that treatment is compatible with faith.
  • Steps: (1) Ask what role the client wants clergy to have. (2) Get specific written consent: whom, what information, for what purpose. (3) Contact the parish priest or the diocesan office the priest names; ask whether the diocese has a protocol for medical and psychological evaluation (the USCCB says protocols should include one). [source: USCCB] (4) Clarify roles: clergy for pastoral and sacramental care; therapist and doctor for assessment and treatment. (5) Share clinical findings only as consented. (6) If an individual claims to be an exorcist, the client may check with the diocese whether the person holds the bishop's mandate; the IAE's guidelines say only priests mandated by their bishop may perform exorcisms and none may ask for payment. [source: Crux 2020; USCCB] (7) Agree how you will both respond if risk rises.
  • Example language (illustrative): "Would it help if I spoke with Father ___, so we're not pulling you in different directions?"
  • Watch for: any helper (clergy or lay) who discourages medical care, demands payment, insists on secrecy from doctors, or uses restraint or deprivation; these are not features of the Church's published rite. Working: the client experiences faith and treatment as supporting each other.

4.6 Accommodation in scheduling and treatment

  • Purpose / when: a client attending Mass, confession, prayer groups or diocesan meetings, or who wants faith language in therapy.
  • Steps: (1) Schedule around important religious commitments where possible. (2) Ask whether religiously integrated techniques are wanted (e.g. drawing on the client's own prayers or scripture as coping resources) and use them only on request. (3) Keep the treatment's core intact.
  • Example language (illustrative): "Is there anything from your faith you'd like us to draw on, or would you rather keep that separate?"
  • Watch for: accommodation that becomes avoidance of needed treatment. Working: attendance is steady.

4.7 Scrupulosity and religious OCD presenting as fear of possession

  • Purpose / when: intrusive, unwanted thoughts of being possessed, of blasphemy or of having invited evil, with compulsive prayer, reassurance-seeking from priests, repeated confession or avoidance of sacred objects. [synthesis; for the IOCDF's Catholic scrupulosity and ERP material, see guide 202 (sacraments of reconciliation and anointing)]
  • Steps: (1) Distinguish ego-dystonic intrusive fears (the client wants them gone and sees them as excessive) from a settled religious interpretation or delusion. (2) Psychoeducation on OCD, respectfully of faith. (3) With consent, consult the client's priest so that a single, agreed position on what the faith actually requires (e.g. that reassurance rituals are not required) can be named. (4) Adapt ERP: build exposures that do not ask the client to violate their faith, and reduce reassurance-seeking, including repeated requests for blessings or exorcism, by agreement with the client and, if desired, clergy. (5) Track compulsions over time.
  • Example language (illustrative): "It sounds like the fear keeps asking for one more prayer to be sure. Could we look at what the fear wants, and what your faith actually asks of you?"
  • Watch for: exposures that feel sacrilegious to the client (stop and redesign); clergy and therapist giving conflicting messages. Working: less time spent on rituals and reassurance; the client describes their faith as less fearful.

4.8 Shame, moral injury and spiritual struggle

  • Purpose / when: a client who believes they caused their own "possession" through sin, occult practice or doubt, or who feels betrayed by the Church or family (e.g. after a harmful "deliverance").
  • Steps: (1) Name the shame or betrayal without debating doctrine. (2) Separate guilt about specific acts from global self-condemnation. (3) If the client wishes, involve a priest or spiritual director for sacramental or doctrinal questions. (4) Use evidence-based approaches for any trauma, depression or moral injury.
  • Example language (illustrative): "You've been carrying the belief that this happened because you're bad. Can we look at that belief together?"
  • Watch for: suicidal thinking linked to beliefs of damnation (assess risk using current standards). Working: self-blame softens; the client can hold faith and self-compassion together.

4.9 Grief, ritual and community support

  • Purpose / when: families after a death or serious harm linked to a ritual; clients estranged from a church community; communities stigmatised after a publicised case (the Klingenberg grave became a pilgrimage site and the town faced decades of attention). [source: The Local 2013]
  • Steps: (1) Support grief and anger, including complicated grief where relatives bear responsibility. (2) Help the client decide what relationship they want with their faith community. (3) Encourage healthy community supports and, if wished, pastoral care.
  • Example language (illustrative): "There may be grief here for the person and for the faith community you trusted."
  • Watch for: guilt in family members; media intrusion; isolation. Working: the client keeps or rebuilds supports.

4.10 Children: safeguarding, consent and assent

  • Purpose / when: any child or young person described by family or a church as possessed, "a witch", or needing deliverance. Safeguarding guidance says children labelled this way are often seen as "different" (disobedience, bed-wetting, nightmares, illness, disability), and that reported cases involved boys and girls aged 2 to 14. [source: North East Lincolnshire, Child abuse linked to faith or belief]
  • Steps: (1) Treat the label itself as a risk indicator. (2) Look for the published indicators: neglect including being "fasted", worse treatment than siblings, withdrawal, scars, restraint marks, unknown drinks, and the child's own talk of being possessed. [source: North East Lincolnshire] (3) Follow local child-protection procedures: in England, refer to children's social care (the guidance cites the National Action Plan to Tackle Child Abuse Linked to Faith or Belief, 2012, and Children Act 1989 s.47); elsewhere, the equivalent statutory agency and police where a child is in immediate danger. [source: North East Lincolnshire] (4) The guidance advises seeing the child alone, a full health assessment, considering siblings, identifying the faith leader and place of worship, and taking any plan to take a child abroad seriously. [source: North East Lincolnshire] (5) Consent and assent: parents consent to the child's treatment, but the child's assent is sought in age-appropriate words, and safeguarding duties apply whatever parents believe. (6) Use CFI Module 9 for school-age children. [source: APA CFI Supplementary Modules]
  • Example language (illustrative, to a child): "Sometimes grown-ups say a child has something bad inside them. It's never okay for anyone to hurt you because of that. Has anyone said that about you?"
  • Watch for: reassurance from carers that the matter is "spiritual only"; faith settings that treat repentance as ending risk or discourage contact with secular agencies. [source: North East Lincolnshire] Working: the child is safe and seen regularly by appropriate services.

4.11 Adult risk planning around unauthorised "exorcism" or "deliverance"

  • Purpose / when: an adult client or relative plans a ritual outside the Church's authorised process, or describes one involving restraint, confinement, deprivation, choking, forced fluids or beatings. These appear in the harmful cases (see Harm account).
  • Steps: (1) Ask specifically what will happen, who leads it, where, for how long, and whether food, water, sleep or medical care will be limited. (2) Assess capacity, coercion and vulnerability (psychosis, learning disability, dependence). (3) Share the Church's own requirement of medical evaluation and the bishop's authorisation. (4) Where the person lacks capacity or is at risk of serious harm, use adult safeguarding and emergency services. (5) Make a safety plan with the client.
  • Example language (illustrative): "I'm not here to judge your beliefs. I am worried about you not eating or being held down. Can we talk about what's safe?"
  • Watch for: secrecy; isolation from doctors; escalation over days. Working: the client chooses medical review and authorised pastoral routes.

5. Handling problems

All guidance in this section is [synthesis] unless a source is given; the sources on the rite do not address psychotherapy problems directly.

  • Client insists the therapist confirm or deny possession. Say plainly that this is not your role and that the Church reserves that judgement to its own process after medical evaluation. [source: USCCB] Illustrative: "That's a question for your Church, and it asks for a medical check first. My part is helping with the distress, whatever its cause."
  • Client refuses psychiatric assessment as "faithless". Point to the Church's own texts: illness is "a very different matter" for medical science, and the diocesan process includes psychiatric evaluation. [source: Catholic Culture; USCCB] Offer to coordinate with the priest if the client wishes.
  • Family pressure for a ritual; client ambivalent. See the client alone; explore the client's wishes; assess coercion; for adults lacking capacity or at risk, use adult safeguarding; for children, child protection (4.10).
  • Rupture: client feels the therapist is dismissive of faith. Acknowledge it, repair, return to the CFI framing, and offer clergy collaboration (4.5).
  • Rupture: client feels the therapist is too accepting of a frightening belief. Clarify that you take their faith seriously and also their health; reassert the medical pathway.
  • Non-adherence to medication "because it's spiritual". Do not advise on medicines; inform the prescriber with consent; involve clergy if the client wishes, since the Church's process presumes medical treatment of illness. [source: Catholic Culture]
  • Overwhelm or acute distress during sessions (e.g. dissociative or trance-like states, panic, perceived attack). Use grounding and orientation in the room; stay calm; do not engage with the content as if addressing a spirit; afterwards, assess for dissociative disorder or seizures and arrange medical review.
  • Stuck: recurrent requests for repeated blessings or exorcisms. Consider scrupulosity or OCD (4.7), health anxiety, or trauma; coordinate one consistent message with clergy.
  • A self-styled exorcist or prayer group is involved. Encourage the client to ask the diocese whether the person has the bishop's mandate; payment requests, secrecy from doctors, restraint or fasting demands are red flags. [source: USCCB; Crux 2020]
  • Therapist's own discomfort or beliefs. Seek supervision or consultation; refer if your beliefs (for or against) prevent neutral care.
  • Confidentiality conflicts. Clergy may ask for information; share only with written consent, except where safeguarding law requires disclosure.
  • Cross-tradition cases. For Islamic ruqya see entry 261 (Domain XI 049); for other churches' deliverance practices, apply the same safeguards: medical review, consent, no restraint or deprivation, safeguarding for children.

Harm account

This account concerns deaths and injuries during exorcisms or deliverance rituals as courts and news organisations have reported them. It does not describe the Church's current authorised rite as causing these harms; in several cases the harm came from rituals outside any Church authorisation. Victims are not named.

What was actually done

  • Klingenberg, Bavaria, Germany, 1975–1976 (Catholic). A young woman from Klingenberg, whom doctors had diagnosed with epilepsy and a "hyper-religious personality disorder" and treated in 1975 (she did not return to them), was taken by her parents to priests because of her fits. [source: Freethinker, May 1978; The Local, 13 June 2013] The diocesan bishop of Würzburg authorised an exorcism. [source: University of Würzburg press release 2007; The Local 2013; Freethinker 1978] Two priests performed the rite repeatedly over many months: the contemporary trial report says it was administered 67 times before her death. [source: Freethinker 1978] In the later stages she refused food and drink, and medical help was not sought. She died on 30 June 1976, aged 23, weighing about 31 kg (68 lb); the trial report gives the cause as hunger and exhaustion, consistent with malnutrition and dehydration. [source: Freethinker 1978; The Local 2013] One priest told the court possession "is not an illness"; the other described the death as one of atonement. [source: Freethinker 1978]
  • The verdict. In 1978 the court in Aschaffenburg found the parents and the two priests guilty of negligent homicide; the prosecution argued her life could have been saved with medical help. [source: Freethinker 1978; The Local, 21 May 2008] The sentences were suspended. [source: Freethinker 1978] The judge said she "needed a doctor more than prayers". [source: Freethinker 1978] The bishop was questioned but not charged. [source: Freethinker 1978] German bishops then did not use the rite for decades. [source: The Local 2008]
  • Tanacu, Romania, 2005 (Romanian Orthodox convent). A young woman was tied up for several days without food or water and chained to a cross during an exorcism ritual; she died in June 2005. In 2007 a court in Vaslui convicted the convent's monk-priest (14 years) and four nuns (5 to 8 years) of holding her captive resulting in her death. The Romanian Orthodox Church called the ritual "abominable", removed the priest, excommunicated the nuns, and promised psychological tests for those entering monasteries. [source: AP via Fox News, 19 February 2007]
  • New Zealand, 2007 (family ritual against makutu, a curse). Relatives, believing a young woman was possessed, poured water into her nose and mouth over several days; she drowned. The High Court convicted them of manslaughter in 2009; sentences were community service. Prosecutors said she may have been mentally ill and her symptoms mistaken for a curse. [source: AP via Fox News, 2009]
  • California, USA (Pentecostal church; reported charges). According to a news report of 23 May 2024, three relatives were charged with assault on a child causing death after a 3-year-old girl died during what was described as an "exorcism ritual" on a church altar lasting about 20 hours; the allegations are that she was repeatedly squeezed and choked and made to vomit, and experts cited in the report attributed the death to asphyxia and smothering. A judge ruled that the relatives must stand trial. These are charges as reported; no outcome is stated here. [source: The Independent, 23 May 2024; CBS News, April 2024]
  • Children labelled possessed (UK safeguarding experience). Safeguarding guidance describes exorcism or "deliverance" usually at home, with severe beating, burning, starvation, cutting or stabbing, isolation, and drinks of unknown content. [source: North East Lincolnshire]

How it caused harm

  • Medical care displaced. At Klingenberg, a diagnosed neurological condition and a psychiatric presentation were reinterpreted as possession, and treatment lapsed; the court's finding rested on the view that medical help could have saved her. [source: Freethinker 1978] Prosecutors in the New Zealand case made the same point about possible mental illness. [source: AP 2009]
  • Starvation and dehydration. Prolonged refusal of food and drink, interpreted spiritually, led to death by hunger and exhaustion (Klingenberg) and was imposed by others in Tanacu. [source: Freethinker 1978; AP 2007]
  • Restraint, confinement and asphyxia. Tying, chaining, holding down and forced fluids caused deaths in Tanacu and New Zealand; holding, squeezing and choking are among the allegations in the California charges. [source: AP 2007; AP 2009; The Independent 2024]
  • Repetition and escalation. Many sessions over months, with deterioration read as spiritual struggle rather than medical emergency. [source: Freethinker 1978; synthesis]
  • Authority and sincerity. Perpetrators often sincerely believed they were helping; a judge noted the New Zealand family "did what they genuinely thought was right". [source: AP 2009] Sincerity did not prevent conviction.
  • Who is most at risk: people with epilepsy, psychosis, eating disorders, dissociative or severe mood disorders; young women in closed religious settings (as in these cases); and children, especially those seen as "different", disabled, or in stressed or reconstituted families. [source: North East Lincolnshire; synthesis]
  • Psychological sequelae in survivors and families (trauma, religious trauma, guilt, stigma) are expected but are not documented in these sources [uncertain: not verified].

Recognising it today

  • Features of the Church's authorised rite as published: the diocesan bishop's specific permission; a priest appointed and prepared for the task; prior medical and psychological or psychiatric evaluation; consent sought where possible; never performed alone; confidentiality; no payment. [source: USCCB; Crux 2020] These are the markers clients and clinicians can check.
  • Red flags in any group or practitioner: no bishop's mandate or a self-appointed "exorcist"; payment; advice to stop medication or avoid doctors; fasting or withholding food, fluids or sleep; restraint, holding down, beating, burning, forced drinks or induced vomiting; rituals lasting many hours or repeated over weeks with the person getting worse; secrecy from family doctors or schools; labelling a child a witch or possessed. [source: North East Lincolnshire; cases above; synthesis]
  • Phrases and rationales: "it's spiritual, not medical"; "possession is not an illness" (said by a convicted priest at Klingenberg); "the worse it gets, the more the demon is fighting"; suffering framed as atonement. [source: Freethinker 1978; synthesis for the third phrase]
  • How the legitimate version differs: the Church's own texts require illness to be excluded and treated by medicine, and the bishop's authorisation; the 1999 revision states that the exorcist must judge with "utmost circumspection and prudence". [source: Catholic Culture; USCCB]
  • In a colleague's practice: a therapist who diagnoses possession, recommends or arranges exorcism, or uses "deliverance" techniques in therapy is acting outside professional competence; raise in supervision and with the relevant regulator if needed. [synthesis]

What to do instead and how to help those harmed

  • Instead: medical and psychiatric assessment and evidence-based treatment of any condition; pastoral care through the client's own parish, and, only if the client seeks it, the Church's authorised diocesan process; the therapist's role stays as in section 4. [source: USCCB; synthesis]
  • Immediate danger: call emergency services for any person who is restrained, not drinking, not eating, or medically unwell. Children: child-protection referral (in England, children's social care; police if in immediate danger). [source: North East Lincolnshire]
  • Assessing survivors: trauma history including the ritual; physical health review; screening for PTSD, depression, dissociation, and the condition originally mislabelled; religious or spiritual struggle and loss of community; shame and self-blame. [synthesis]
  • Treatment: trauma-focused evidence-based therapy at the client's pace; religiously integrated work only if wanted; support for re-engaging with or leaving the faith community by the client's own choice; family work where safe. [synthesis]
  • Families and bystanders: support for guilt, complicated grief and legal processes; avoid demonising communities. [synthesis]
  • Collaboration with clergy: with consent, involve trusted clergy who accept medical care, to restore safe pastoral support and to counter beliefs that the person failed spiritually. [synthesis]
  • Ethical, reporting and legal duties: follow mandatory child-protection reporting and local adult safeguarding duties; document carefully; breaches of confidentiality only as law and professional codes allow; seek legal or supervisory advice where a ritual abroad is planned. [source: North East Lincolnshire; synthesis]

Sources

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