Exorcism as treatment for madness

1. Introduction

Version followed: the historical account of exorcism as a response to madness in sixteenth- to eighteenth-century German-speaking Europe as framed by the historian H. C. Erik Midelfort (A History of Madness in Sixteenth-Century Germany, Stanford University Press, 1999; Exorcism and Enlightenment, Yale University Press, 2005), with Johann Weyer's 1563 argument for natural causes and the Catholic Church's own published distinction between possession and psychological illness (Catechism of the Catholic Church, paragraph 1673; the revised rite of exorcism of 1998-1999). This guide is for the psychotherapist's own work. It does not describe how an exorcism is performed, and gives no rite, prayers or words.

What it is. In medieval and early-modern Europe some forms of disturbed behaviour and distress were understood, by the sufferer, the family and the clergy, as the work of demons, and were brought to priests, shrines and pilgrimage sites as well as, or instead of, to physicians. Midelfort's study of sixteenth-century Germany treats demonic possession alongside melancholy, mania and St Vitus's dance, in the terms Germans of the period used, and draws on records from pilgrimage shrines and newly founded hospitals for the disordered to recover the voices of the afflicted [source: Stanford University Press description of Midelfort 1999]. The theory of change, as its practitioners held it, was that the illness was caused or worsened by a spiritual agent and would lift when that agent was expelled in the name of a higher power [source: Catholic Encyclopedia entry on Gassner; Yale University Press description of Midelfort 2005].

In the eighteenth century the Catholic priest Johann Joseph Gassner (1727-1779) concluded that demons caused most human ailments and claimed to heal thousands of Catholics and Protestants, rich and poor, by exorcism; his campaign provoked official efforts to restrict him and a public controversy that Midelfort reads as a window on the German Enlightenment and Counter-Enlightenment and on the persistence of magic and belief in a scientific age [source: Yale University Press description of Midelfort 2005]. The physician Franz Anton Mesmer, called before a Bavarian inquiry in 1775, argued that such cures could be explained without the supernatural; the later history of animal magnetism and the 1784 Royal Commission is covered in the animal magnetism guides (Domain XIV 081; Domain XVI 035) [source: CHMC Dubai article on Gassner; Catholic Encyclopedia entry on Gassner].

What survives today. Exorcism and deliverance continue in several religious traditions. Current Catholic exorcism and its safeguards are covered in Domain XIII 211; abusive exorcism and deliverance today, including child abuse linked to faith or belief, are covered in Domain XVI 108. This guide does not repeat them; it gives the psychotherapist the history and the clinical work that history informs. The idea reaches clients through family and community explanations of illness, through a client's own faith, through films and popular culture, and through interest in family or local history [synthesis].

2. Framework

Historical phases (outline, attributed)

• Sixteenth century: madness, possession, melancholy and mania understood within a religious and moral world in which, as Midelfort describes the period, the sinful world itself could be called insane; Martin Luther and Paracelsus both treated madness as a basic part of human experience; afflicted people sought help at pilgrimage shrines and in new hospitals; physicians searched ancient Greek medicine for the right concepts, and the late century became an "age of melancholy"; courts asked physicians whether melancholic defendants were responsible for their acts [source: Stanford University Press description of Midelfort 1999].
• 1563: the physician Johann Weyer (1515-1588) published De praestigiis daemonum in Basel, arguing that the witchcraft accusations of his day were rooted in melancholy and other mental disorders rather than demons, and that such people needed a physician rather than an executioner. His views were widely rejected in his lifetime (Reginald Scot, 1584, was an exception); the historian George Mora later linked Weyer to the beginnings of psychiatric examination, the therapeutic relationship, legal psychiatry and diagnosis, while Thomas Schoeneman questioned that reading [source: University of Pittsburgh Health Sciences Library System, Fort, on De praestigiis daemonum]. Weyer's argument concerned accused witches; how far he applied it to the possessed is [uncertain: not verified].
• 1614: the Rituale Romanum issued a standard rite of exorcism for the Catholic Church; its prayers remained largely unchanged until the 1998-1999 revision [source: National Catholic Reporter, Allen, 2000]. Whether the 1614 text itself cautioned exorcists against mistaking melancholy or other illness for possession is [uncertain: not verified].
• 1774-1779: Gassner's public exorcisms, attended by large crowds and recorded before witnesses; he claimed to distinguish demonic from natural illness by a preliminary test and, by one account, sent those whose illness he judged natural to a physician [source: Catholic Encyclopedia entry on Gassner; CHMC Dubai article, uncertain: secondary]. Accounts of the official response differ. The Catholic Encyclopedia (early twentieth century) states that church authorities and commissions of the University of Ingolstadt and of the Imperial Government approved his procedure. A clinic's historical article states that the Prince-Elector Max Joseph of Bavaria set up an inquiry in 1775 at which Mesmer demonstrated his technique, that on Emperor Joseph II's orders Gassner had to leave Regensburg, and that a papal brief of Pope Pius VI dated 20 April 1776 rejected his teachings and prohibited sensational healing rituals [uncertain: secondary, unverified]. Midelfort's study, on its publisher's description, covers the official efforts to restrict him and the suffering of those he treated [source: Yale University Press]. Where these differ, this guide follows Midelfort's framing and marks the details [uncertain].
• Modern Catholic position: the Catechism states that before an exorcism one must ascertain that one is dealing with "the presence of the Evil One" and that "Illness, especially psychological illness, is a very different matter; treating this is the concern of medical science" (Catechism, paragraph 1673) [source: UCatholic text of CCC 1673; Catholic Culture, L'Osservatore Romano 1999]. The revised rite, presented in Rome on 26 January 1999 (the National Catholic Reporter dates its issue to 26 January 1998; sources differ), warns exorcists not to consider people vexed by demons when they suffer mainly from psychic illness or are "victims of imagination" [source: National Catholic Reporter, Allen, 2000].

Harms, qualitatively

Historians describe the suffering of people brought for exorcism, including public exposure, fear, and delay or replacement of other help [source: Yale University Press description of Midelfort 2005; synthesis for the general point]. Where an illness was attributed to a demon, the person could be held morally or spiritually suspect, and families could carry shame across generations [synthesis]. Present-day physical and psychological harms of abusive exorcism and deliverance are documented in Domain XVI 108 and are not repeated here.

Phases of the psychotherapist's work [synthesis]

Session number and length follow the client's needs and the setting [synthesis].

1. Recognition and assessment: notice when a spiritual explanation of illness, a family history of exorcism, or a client's interest in the history is clinically relevant; take a respectful spiritual and cultural history; screen for current risk. Move on when the meaning of the topic for the client is clear and any risk is known.
2. Safety and safeguarding: if anyone, especially a child, is at current risk from a deliverance or exorcism practice, safeguarding comes first (see Domain XVI 108). Move on when risk is managed or absent.
3. Meaning-making and processing: work with the client's explanatory model, family history, faith and any distress or shame; use the history to widen perspective, never to ridicule. Move on when the client can hold their own account with less distress.
4. Collaboration and repair: with consent, work with responsible faith leaders; support repair of family relationships or of the client's relationship to faith.
5. Advocacy and follow-up: support access to evidence-based mental health care, and to religious care where wanted, alongside rather than instead of it.

3. Guiding principles

• Ask about religion and spirituality respectfully and routinely: a spiritual history is part of assessment, not an intrusion [source: WPA Position Statement on Spirituality and Religion in Psychiatry, 2023 revision].
• Religious care supports, never replaces, physical, psychological and social care: help the client reach evidence-based care, including care with religious elements where wanted [source: WPA 2023].
• Do not promote any worldview, religious or secular: you neither endorse nor debunk the client's belief in spirits [source: WPA 2023].
• Work with faith leaders, chaplains and pastoral workers for the client's wellbeing, whatever your own beliefs, and with consent [source: WPA 2023].
• Know both the benefits and the harms of religious and secular practices: treatment refusal, intolerance and negative religious coping are documented harms; so are support and meaning [source: WPA 2023].
• Use the tradition's own distinction: the Catholic Church itself states that psychological illness is the concern of medical science; this can open, not close, dialogue with a devout client [source: CCC 1673].
• History as perspective, not verdict: describe past practice as historians describe it, attributed and in outline, and let the client draw meaning [synthesis].
• Never provide, supervise, recommend or refer to exorcism or deliverance; never give ritual details [synthesis; scope of this domain].
• Safeguarding overrides cultural deference: belief is respected, harm to a child or adult at risk is not [source: North East Lincolnshire Council guidance on child abuse linked to faith or belief].
• Name a spiritual problem accurately when it is the focus: the DSM-5-TR "Religious or Spiritual Problem" may be recorded as Z65.8; ICD-10-CM Z65.8, "Other specified problems related to psychosocial circumstances", lists religious or spiritual problem under Includes [source: ICD-10-CM Z65.8 (Unbound Medicine)]; DSM-5-TR wording [uncertain: not verified].
• Cultural humility: use the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions; draw on spiritual and religious competencies (Vieten et al. 2013) [uncertain: not verified].
• Avoid moralising language about the past or the client's community; the facts carry the weight [synthesis].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis]. None is a step of exorcism or deliverance.

4.1 Spiritual and religious history

• Purpose: to learn, as routine, what the client believes and practises and how it bears on the presenting problem; use at intake and whenever spiritual themes appear [source: WPA 2023, recommendation 1].
• Steps: (1) Introduce the topic as a standard part of assessment. (2) Ask open questions about tradition, practice, community and importance. (3) Ask how the client's faith or community understands their current difficulty. (4) Ask what helps and what has hurt. (5) Record in the client's own words. [synthesis]
• Example language (illustrative): "I ask everyone about faith or spiritual life, because for many people it matters a great deal. What part does it play for you, and does it have anything to say about what you've been going through?"
• Watch for: guardedness from a client who expects ridicule; mention of a spiritual diagnosis such as possession, curse or spirit attack; signs that the community is pressing a particular remedy. Working: the client volunteers more over time and uses their own vocabulary.

4.2 Eliciting the client's explanatory model

• Purpose: to understand what the client and family think is causing the problem and what they think will help, so that care fits their meaning; use when illness is attributed to spirits, demons or sin.
• Steps: (1) Use the Cultural Formulation Interview and its spirituality, religion and moral traditions module, without reproducing items [uncertain: not verified]. (2) Ask about cause, course, feared outcome and preferred help. (3) Ask who in the family or community holds which view. (4) Reflect the model back accurately before offering any other frame. [synthesis]
• Example language (illustrative): "In your family, what do people think is behind this? And what do you think yourself? Sometimes those aren't the same."
• Watch for: a gap between the client's view and the family's; fear of the illness as a spiritual danger to others. Working: the client feels understood rather than corrected.

4.3 Screening for current exorcism or deliverance and for risk

• Purpose: to find out whether a deliverance or exorcism is planned, happening or recently happened, and whether anyone is at risk; use when 4.1 or 4.2 raises possession.
• Steps: (1) Ask plainly whether anyone has tried, or plans, to remove a spirit from the client or a family member. (2) Ask about any injury, confinement, food or sleep deprivation, isolation, or pressure to stop medical treatment, without asking for ritual detail. (3) Ask whether children are involved. (4) If there is any current risk, move to 4.6. [source: North East Lincolnshire Council guidance on child abuse linked to faith or belief, for the indicators; synthesis for the steps]
• Example language (illustrative): "Has anyone tried to pray a spirit out of you, or someone in your family, in a way that frightened or hurt you? You don't need to describe what was said; I only need to know if anyone has been hurt or is at risk."
• Watch for: indicators the guidance lists for children, such as neglect relative to siblings, scapegoating, withdrawal, concealed marks or restraint marks, or unknown "magical" drinks [source: North East Lincolnshire Council]. Working: risk is known and, where present, acted on.

4.4 Collaborative differential assessment

• Purpose: to make sure a treatable mental or physical illness is not being left unassessed when the client or family sees a spiritual cause; the Catholic Church itself states that psychological illness "is the concern of medical science" [source: CCC 1673].
• Steps: (1) Assess mood, psychosis, dissociation, substance use, trauma and cognitive change within your competence. (2) Where symptoms suggest psychosis, severe depression, dissociative or neurological illness, arrange psychiatric or medical assessment with consent. (3) Treat the spiritual explanation as part of the person's meaning, not as a symptom in itself; belief that is shared and normative in the client's community is not a delusion on that basis alone. (4) Never advise starting, stopping or changing a medicine; route medication questions to the prescriber. [synthesis]
• Example language (illustrative): "Your priest and I may see this differently, but I think we'd both want to be sure nothing medical is being missed. Would you be willing to see a doctor as well?"
• Watch for: the client hearing referral as dismissal of their faith; urgent features (suicidal thinking, command hallucinations, inability to care for self). Working: the client accepts assessment without feeling their belief was attacked.

4.5 Recording a religious or spiritual problem

• Purpose: to name accurately a difficulty that centres on faith, possession fears or a past exorcism, without pathologising belief.
• Steps: (1) Decide whether the spiritual difficulty is a focus of clinical attention. (2) If so, it may be recorded with Z65.8; ICD-10-CM lists religious or spiritual problem under Z65.8 Includes [source: ICD-10-CM Z65.8 (Unbound Medicine)]. (3) Record any co-occurring disorder separately. (4) Explain the record to the client. [synthesis]
• Example language (illustrative): "I'd like to note that part of what we're working on is your relationship with your faith after what happened. It's not a diagnosis of illness; it's a way of saying it matters in your care."
• Watch for: the client fearing the record will be read by their community or a church. Working: the record is accurate and the client understands it.

4.6 Safeguarding a child or an adult at risk

• Purpose: to protect anyone at current risk from a practice based on belief in possession or witchcraft; use whenever 4.3 shows risk.
• Steps: (1) Take the concern seriously regardless of the family's sincerity. (2) In the UK, refer to children's social care through the local "report a concern about a child" route; local guidance also covers concerns where beliefs affect health treatment [source: North East Lincolnshire Council]. (3) Follow your jurisdiction's mandatory reporting and adult-safeguarding routes elsewhere [synthesis]. (4) Do not confront the family in a way that raises risk before the referral. (5) Note siblings, who may have witnessed or been drawn into harm, and treat any plan to take a child abroad seriously [source: North East Lincolnshire Council]. (6) Record facts, not ritual detail.
• Example language (illustrative): "I respect that your family is trying to help in the way your faith teaches. But I'm worried someone could be hurt, and when a child might be at risk I have to share that with the people whose job is to keep children safe."
• Watch for: escalation after disclosure; the child being moved; pressure on the client to retract. Working: the referral is made and acknowledged; the client remains in contact. See Domain XVI 108 for abusive exorcism today.

4.7 Duties when a colleague, service or faith setting uses exorcism with clients

• Purpose: to act when a clinician, service or religious setting is offering exorcism or deliverance to people with mental illness, or using it in place of care.
• Steps: (1) Do not take part, supervise or refer. (2) Raise the concern with the colleague or service lead, documenting facts. (3) If a client is at risk, safeguard first (4.6). (4) Report to the professional regulator or licensing board through its published route where a registered professional is involved [synthesis]. (5) Where you hold a role in the client's faith community as well as a therapeutic role, consider the multiple-relationship standard: APA Ethics Code Standard 3.05 (Multiple Relationships) [source: APA Ethics Code]; other ethics points here are [synthesis].
• Example language (illustrative): "I'm not able to be part of that, and I'm concerned about the client's safety. I'd like us to talk to the service lead together today."
• Watch for: pressure to keep it quiet out of respect for a community; your own wish to avoid conflict. Working: the practice stops or is escalated, and the client's care continues.

4.8 Historical psychoeducation, offered not imposed

• Purpose: to widen the client's perspective by showing that questions about madness and demons have a long history within religious traditions themselves; use when a client asks, or when shame is fuelled by a sense of being uniquely cursed.
• Steps: (1) Ask permission. (2) Offer short, attributed points: that sixteenth-century Germans sought help both at shrines and from physicians [source: Midelfort 1999, Stanford description]; that the physician Johann Weyer argued in 1563 that accused witches suffered from melancholy and needed a physician [source: Fort, HSLS]; that the Catholic Church today distinguishes psychological illness from possession [source: CCC 1673]. (3) Ask what the client makes of it. (4) Do not use history to argue the client out of belief. [synthesis]
• Example language (illustrative): "People have asked this question for centuries, and even within the church there's long been a view that some suffering is illness rather than a spirit. Would it help to hear a little of that history?"
• Watch for: the client feeling lectured or that their faith is under attack. Working: the client reports relief, curiosity or a sense of being less alone.

4.9 Working with a client's interest in the history

• Purpose: to support a client whose interest in the history of exorcism and madness is intellectual, artistic or tied to their own experience; use when the client brings reading, films or museum visits into sessions.
• Steps: (1) Ask what draws them to the topic and what it stirs. (2) Point to reputable sources (historians such as Midelfort; library and museum collections such as the Wellcome Collection) rather than sensational material. (3) Notice whether the interest soothes, fascinates or frightens. (4) Link the interest to the client's own story only if they wish. [synthesis]
• Example language (illustrative): "You've been reading a lot about Gassner and the exorcism controversies. What is it about that story that keeps pulling you back?"
• Watch for: rising fear of personal possession; intrusive images after films or reading; interest as a way of avoiding present pain. Working: the interest becomes a source of perspective rather than dread.

4.10 Family history work: an ancestor treated by exorcism

• Purpose: to help a client make sense of a relative, past or present, whose illness was treated as possession, and of what the family carried from it.
• Steps: (1) Build a genogram that includes illness, religious explanations and any exorcism or shrine visit, in outline. (2) Explore family stories, silences and shame. (3) Place the relative's experience in its historical setting, attributed (4.8). (4) Invite the client to separate their own identity from the label the relative bore. [synthesis]
• Example language (illustrative): "Your great-aunt was taken to a priest because the family thought she was possessed. Looking back with what we know now, what do you imagine she was going through? And what did the family learn to fear?"
• Watch for: fears that the client has inherited a curse or illness; anger at the family or church; grief for the relative. Working: the client tells the story with more compassion and less fear.

4.11 Working with shame and stigma from a possession label

• Purpose: to address the shame of having been, or fearing being, seen as possessed, sinful or spiritually dangerous.
• Steps: (1) Name the shame gently. (2) Explore who applied the label and with what authority. (3) Distinguish the person from the label. (4) Where the client wishes, draw on their own tradition's teaching of dignity and mercy, and on CCC 1673 for Catholic clients [source: CCC 1673]. (5) Use self-compassion work [synthesis].
• Example language (illustrative): "Being told something evil was in you is a heavy thing to carry. I don't see you that way. What would it be like to imagine your faith seeing you as someone who was suffering, not someone who was bad?"
• Watch for: self-punishment, isolation, or withdrawal from all religious life against the client's wishes. Working: the client's self-description softens.

4.12 Working with a client who was subjected to an exorcism

• Purpose: to support a client who underwent exorcism or deliverance, whether it felt helpful, neutral or harmful; full guidance on abusive exorcism today is in Domain XVI 108.
• Steps: (1) Let the client set the pace; do not ask for ritual detail. (2) Ask what it meant to them then and now. (3) Assess for trauma responses and treat with an evidence-based trauma approach where indicated. (4) If harm occurred and the client wishes, support reporting or complaint routes (4.6, 4.7). (5) Respect a client who found it meaningful. [synthesis]
• Example language (illustrative): "Some people find an experience like that comforting, and some find it frightening, and some both. What was it like for you?"
• Watch for: flashbacks, dissociation, terror of spiritual retaliation; ambivalence towards the people involved. Working: the client can speak of it without being overwhelmed.

4.13 Working with a client drawn to seeking exorcism now

• Purpose: to respond to a client who believes they are possessed and wants an exorcism, without endorsing or ridiculing the wish, and while making sure they receive medical and psychological care.
• Steps: (1) Explore the wish: what they hope it will change. (2) Assess risk and illness (4.3, 4.4). (3) Clarify your role: you will not arrange or recommend exorcism. (4) Note, for a Catholic client, that the Church itself requires that illness, especially psychological illness, be distinguished first [source: CCC 1673; National Catholic Reporter on the revised rite]. (5) Support access to pastoral care that works alongside treatment (4.14). [synthesis]
• Example language (illustrative): "I hear how much you want this to be lifted. I can't arrange an exorcism, and I'm not the person to judge the spiritual side. What I can do is make sure everything medical and psychological is properly looked at, and stay with you through it."
• Watch for: plans to stop treatment, to fast or to isolate; contact with unregulated deliverance groups (see Domain XVI 108). Working: the client stays in care and keeps talking about the wish.

4.14 Collaboration with responsible clergy and faith leaders

• Purpose: to work with a faith leader, chaplain or pastoral worker for the client's wellbeing, with the client's consent [source: WPA 2023, recommendation 6].
• Steps: (1) Ask the client whether and whom to contact; obtain written consent and agree what may be shared. (2) Explain your role and your concerns plainly. (3) Seek shared ground, such as the tradition's own teaching that psychological illness belongs to medicine [source: CCC 1673]. (4) Agree how each will support the client without either replacing the other. (5) If the faith leader proposes a harmful practice, return to 4.6 and 4.7. [synthesis]
• Example language (illustrative, to a chaplain): "Your support matters a lot to her. I'd like us to make sure she also keeps her medical appointments, and I wondered how we can each help with that."
• Watch for: breaches of confidentiality, pressure on the client from either side. Working: the client experiences the two forms of help as allies.

4.15 Integrating faith resources into care

• Purpose: to draw on the client's faith as a support where the client wants this; WPA recommends that religion and spirituality support, not replace, other care [source: WPA 2023, recommendation 2].
• Steps: (1) Identify practices the client finds sustaining (prayer, community, scripture, ritual). (2) Agree how these sit alongside therapy. (3) Notice negative religious coping (seeing illness as punishment) and explore it. (4) Never prescribe a religious practice. [synthesis]
• Example language (illustrative): "You said evening prayer steadies you. How might that fit with the breathing practice we've been trying, if at all?"
• Watch for: religious practice becoming a source of fear or scrupulosity. Working: faith becomes a source of steadiness.

4.16 Supporting access to evidence-based care

• Purpose: to make sure that a spiritual explanation does not delay or replace medical, psychiatric or psychological treatment.
• Steps: (1) Identify barriers (stigma, distrust, cost, community pressure). (2) Help the client plan appointments. (3) Coordinate with the GP or psychiatrist with consent. (4) Never advise starting, stopping or changing a medicine. [synthesis; WPA 2023 recommendation 2 for the principle]
• Example language (illustrative): "What gets in the way of seeing the doctor? Let's look at that together."
• Watch for: missed appointments around religious events; family pressure. Working: treatment continues.

4.17 Working with families holding different explanatory models

• Purpose: to reduce conflict when family members see the illness differently, some as spiritual, some as medical.
• Steps: (1) With consent, meet the family. (2) Map each person's view without ranking them. (3) Find shared goals (the person's safety and recovery). (4) Agree non-harmful supports from each view. (5) Safeguard if any proposal risks harm (4.6). [synthesis]
• Example language (illustrative): "Everyone here wants him to get better. You see the cause differently. Can we agree on what each of you can do that will help and won't hurt?"
• Watch for: scapegoating of the ill person; secrecy. Working: the family agrees a plan that keeps the person safe.

4.18 Suicide-risk assessment where despair is spiritualised

• Purpose: to assess and manage suicide risk in a client who believes they are possessed, damned or beyond help.
• Steps: (1) Ask directly about suicidal thoughts, plans and intent. (2) Explore spiritual hopelessness as a risk factor and protective faith beliefs as a resource. (3) Make a safety plan; lethal-means counselling covers safe storage and removal only. (4) Give crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). (5) Arrange urgent assessment when risk is high. [synthesis]
• Example language (illustrative): "When people feel there's something evil inside them, they sometimes think about ending their life. Have you had thoughts like that?"
• Watch for: statements that death would free others from the spirit; abrupt calm after distress. Working: the client engages with the safety plan.

4.19 Repair of the relationship with faith

• Purpose: to support a client whose faith was damaged by an exorcism or a possession label and who wishes to rebuild, change or leave their faith.
• Steps: (1) Follow the client's goal; do not steer towards or away from faith [source: WPA 2023, recommendation 5]. (2) Explore spiritual struggle, anger at God or church, and loss. (3) Where wanted, help the client find a faith community or leader experienced in pastoral care. [synthesis]
• Example language (illustrative): "You've said you miss your church and are also angry at it. Both can be true. What would you want your faith life to look like a year from now?"
• Watch for: guilt about doubt; loneliness after leaving a community. Working: the client chooses their path with less fear.

4.20 Reflective practice on the profession's history and one's own stance

• Purpose: to keep the clinician's own beliefs, secular or religious, from shaping care; WPA asks psychiatrists not to use their position to promote any worldview [source: WPA 2023, recommendation 5].
• Steps: (1) Notice your reactions (contempt, fascination, fear, zeal). (2) Bring them to supervision. (3) Read the history as historians present it, including the long debate between religious and medical accounts [synthesis].
• Example language (illustrative, in supervision): "I notice I want to talk her out of the idea of possession. I'd like to think about whose need that is."
• Watch for: subtle ridicule or over-identification. Working: you can stay curious with a client whose world differs from yours.

5. Handling problems

The responses below are [synthesis] unless a source is given.

• The client feels their faith is being dismissed. Name it, apologise for any slight, and restate that you are not judging the spiritual question; return to the client's own words (4.1, 4.2). For Catholic clients, the Church's own distinction between illness and possession (CCC 1673) can be offered as common ground, not as a correction [source: CCC 1673].
• The client insists on exorcism and refuses medical assessment. Keep the relationship; assess risk; explain your concern and your limits; offer to involve a trusted faith leader who supports medical care (4.14). If capacity or safety is in doubt, follow your jurisdiction's urgent assessment routes.
• Stuck: the client returns again and again to whether they are "really" possessed. Shift from proving to living: what would help today, whatever the cause? Notice if the question is a form of rumination or obsessional doubt and assess for it (4.4).
• Overwhelm when history or family stories are explored. Slow down; ground in the present; move from detail to meaning; postpone historical material (4.8, 4.10). Do not show images or sensational texts.
• A child or vulnerable adult may be at risk. Safeguarding comes first, even if it strains the alliance: refer through children's social care or your local route [source: North East Lincolnshire Council guidance]; see Domain XVI 108.
• The family pressures the client to stop therapy or medication. Meet the family with consent (4.17); never advise starting, stopping or changing a medicine; involve the prescriber; safeguard if needed.
• Rupture after a safeguarding referral. Acknowledge the hurt; explain why you acted; keep the door open; do not retract a referral to repair the alliance.
• A colleague, service or faith setting is offering exorcism to clients with mental illness. Do not take part; escalate and report (4.7). Consider APA Ethics Code Standard 3.05 if you hold more than one role [source: APA Ethics Code].
• Spiritualised hopelessness and suicide risk. Assess directly, safety-plan, give 988 (US) or Samaritans 116 123 (UK and Ireland), and arrange urgent help when risk is high (4.18). Follow safe-messaging principles: no method details, no glamorising.
• Fear triggered by films or online material on possession. Normalise the reaction, reduce exposure, and explore what the fear connects to (4.9).
• Clinician's own discomfort or zeal. Take it to supervision (4.20); WPA asks psychiatrists not to promote any worldview [source: WPA 2023].
• Contradictory historical claims (for example, whether the authorities approved or restricted Gassner). Present them as contested, attributed, and point to historians such as Midelfort rather than resolving them yourself [source: Yale University Press; Catholic Encyclopedia].

Sources

Web sources:

• Exorcism and Enlightenment (Yale University Press)
• A History of Madness in Sixteenth-Century Germany (Stanford University Press)
• Fort, "De praestigiis Daemonum" by Johann Weyer (Basil 1563), University of Pittsburgh HSLS Update
• Schaefer, "Johann Joseph Gassner", Catholic Encyclopedia (Catholic Answers)
• Joseph Gassner. From Exorcism to Dynamic Psychiatry (CHMC Dubai) [uncertain: secondary, unverified]
• Allen, "Exorcism - Revised rite", National Catholic Reporter, 1 September 2000
• Congregation Publishes New Rite of Exorcism (Catholic Culture; L'Osservatore Romano, 3 February 1999)
• Catechism of the Catholic Church 1673 (UCatholic)
• WPA Position Statement on Spirituality and Religion in Psychiatry, 2023 revision
• Child Abuse linked to Faith or Belief (North East Lincolnshire Council)
• ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances
• APA Ethical Principles of Psychologists and Code of Conduct (Standard 3.05)

Books and works cited:

• Midelfort, H. C. Erik (1999). A History of Madness in Sixteenth-Century Germany. Stanford University Press.
• Midelfort, H. C. Erik (2005). Exorcism and Enlightenment: Johann Joseph Gassner and the Demons of Eighteenth-Century Germany. Yale University Press.
• Weyer, Johann (1563). De praestigiis daemonum. Basel.
• Vieten, C., et al. (2013). Spiritual and religious competencies for psychologists [uncertain: not verified].

Cross-references: Domain XIII 211 (current Catholic exorcism); Domain XVI 108 (abusive exorcism and deliverance today); Domain XIV 081 and Domain XVI 035 (animal magnetism, Mesmer and the 1784 Commission).