Who Ya Gonna Call?

Here’s a short story about the evolution of modern science: we used to understand very little about the world, and lacked the means to understand it.  But we wanted to know how it worked, and we invented things like gods and demons to explain phenomena.  As we gradually learned more and more about the way the world works, the god-and-demon beliefs got ditched and replaced by better – that is, more truth-tracking – beliefs.  Some of these truth-tracking beliefs were actually true, too.  Sometimes this progress is halted or even temporarily reversed, perhaps as a result of poverty or trauma – think of the widespread belief in witches in parts of West Africa – but the trend is to abandon the supernatural; and the supernatural has no place in modern medicine.

The story is a bit simple, and a bit simplistic, but it’s the kind of thing that a lot of people accept as being, at least in essence, correct – and trivially correct.  Sophisticated people don’t do demons; we know there’re things we don’t know, but that’s why we have science; and the fact that we don’t know why x happened doesn’t warrant the belief that the spirits did it.

Why am I rehearsing all this?  Well, because Asleepius over at Religion versus Medicine has drawn my attention to a fairly remarkable document on the Christian Medical Fellowship’s website that appears to take seriously the idea that demons might well play a part in explaining some disorders, particularly in psychiatry.

No, really.  Look:

As Christians in psychiatry, then, we have an important responsibility. We need to be informed of the findings and limits of psychiatric research, so that we can offer rational scientific explanations and treatments for psychiatric illness, where these exist. We need to bring healing to, and show love and care for, patients with stigmarising [sic] mental illnesses, just as Jesus showed compassion for those who were stigmatised by physical illness (eg Mt 8:1-4). However, we also need to recognise that not all human problems will be explicable by medical science. The New Testament tells us that Jesus has commissioned us to ‘ drive out demons’ (Mk 16:17), and we must be ready to respond to this commission if and when we are called to do so.

Psychiatry, then, is not the only domain within which we need to be aware of demonic influence, and perhaps it is not even the most important such domain. Furthermore, we cannot expect to make a simple differential diagnosis according to certain signs or symptoms of demonisation. However, this does not exclude the need to consider other possible links between demonic activity and mental illness.

[…]

It would seem reasonable to argue that demon possession may be an aetiological factor in some cases of mental illness, but it may also be an aetiological factor in some non-psychiatric conditions, and in other cases it may be encountered in the absence of psychiatric or medical disorder. Furthermore, demon possession is essentially a spiritual problem, but mental illness is a multifactorial affair, in which spiritual, social, psychological and physical factors may all play an aetioIogical role. The relationship between these concepts is therefore complex. Differential diagnostic skills may have a part to play in offering help to those whose problems could be of demonic or medical/psychiatric origin. However, spiritual discernment is of at least equal, if not greater, importance in such matters. [emphasis mine]

This is problematic – and worrying – for a number of reasons.  First, there’s an obviously fallacious scientistic interpretation of medicine in the first paragraph: not all human problems are amenable to solution by medical science, therefore GOD.  But the idea that medicine is just about medical science is a minority view anyway – it’s widely accepted that medicine is – or at least has elements of – art to it as well.  It’s about applying science in an appropriate way, for sure: but at least some medicine – most obviously general practice, psychiatry, and so on, is clearly much richer.  (Or put it this way: applying science isn’t the same as science, any more than spreading jam is the same as jam.)  And let’s suppose that there’re some conditions that will never be understood by medical science – again, we might think that some kinds of psychological distress are candidates here: well, so what?  It doesn’t follow that there’s any room for spooky ghost stuff.

Moreover, the claims are not just non-scientific: they’re anti-scientific.  Look at the claim about differential diagnosis.  In effect, the claim is that the widely-recognised diagnostic tools will be of no help in respect of demonic possession – d’ya reckon? – with the clear implication that medics therefore really don’t have to worry about standard diagnostic practices.  In other words: don’t worry about there being no evidence for “spiritual” explanations of the patient’s condition; we don’t need evidence.  This is a message that’s reenforced in the last paragraph, in the bit I’ve highlighted.  It’s also implicit in the claims about the limits of psychiatric research – there aren’t unknowns, the message goes, so much as areas in which research cannot tread.  (Note the similarity here with the strategy adopted by IDers and creationists when they’re attacking evolutionary biology.  And, wouldn’t you know it, the CMF endorses creationism as well.)

Oh, by the way: there is (apparently) evidence that demon-talk is legitimate – after all, Jeebus did it:

Surely, He would not accede to erroneous views regarding the influence of evil in human lives? Furthermore. the Gospels provide evidence that Jesus actually saw the casting out of demons as a part of His mission on earth (eg Lk 13: 32), and that He made it a part of the mission of His disciples (eg Lk 9: 1). We must, therefore, be very hesitant to accept any idea that Jesus was simply acceding to, or actively colluding with, a primitive misconstruction of the nature of mental illness.

But why should an ethicist be bothered about this?  There’s a range of reasons.  The first is that morally good medical practice requires scientifically good medical practice – that is, a doctor seems to me to have an obligation to use the most up-to-date information, and to pare that information with Occam’s razor.  Novel treatments may require a small leap of faith on occasion – absolute certainty in diagnosis and treatment is, after all, not possible – but even here, there’ll be a requirement for a springboard of decent evidence.  The CMF, by associating itself with demon-nonsense, is therefore participating in the erosion of one of the things that underpins decent medical practice.

Second – and this follows – it’s hard to see how there could ever be evidence for the soundness of demon-based treatment.  The promotion of clinical methods for which there is no evidence, and for which the requirement for medical evidence is airily dismissed – remember, there are some things that are beyond medical science – is a recipe for reckless care.  Once you’ve abandoned evidence in one area, it’s hard to see why it remains important in any other.

Finally, it’s hard to see what the practical implications could be.  I don’t get the impression from the document that Christian doctors are being recommended to wear their science hat during the day and then pray privately for their patients at night.  That might be what’s actually meant, but I don’t see it.  Were that the case, there’d be no need to harp on about the limits of medical science.  It seems obvious to me that there’s at least a vague notion that some of this stuff should have a place in clinical practice.  That’s where daft becomes dangerous.  Frankly, it’s an invitation to neglect (why bother with the tried and trusted, if we’re dealing with demons?) and abuse (on the basis that it’s hard to see how any attempt to drive out demons from the vulnerable is anything other than abuse).

OK – I’ll admit that the document is old – it’s from 1997 – but it’s still hosted on the CMF’s site, and so it would seem to have the CMF’s approval.  And, while the CMF generally is a slightly batty organisation in my view, for it to be associated with this kind of garbage is simply jaw-dropping.

  • John O’Malley

    I think most if not all doctors would share your worries but I don’t think this is representative of doctors who do have beliefs in religion.
    As always with the Bible (and other tomes), people read what they want to read and whatever your views you can normally find something to back it up with. If Jesus was around today, the right wing evangelists and politicians would hate his guts and probably lock him away.Although not a believer, I have always thought of Jesus as being somewhat of a cool guy with political views left of most Marxist Today readers and all the better for it.
    What worries me most with all this is the singling out of mental illness. These ‘demons’ never seem to want to cause psoriasis or osteoarthritis but always mental illness and I think it demonstrates that we still have a long way to go before the stigmatisation of mental illness goes away. I know we now have far better information through PET scans etc as to some of the origins of many mental illnesses but the treatment of many psychiatric/ psychological problems still remains an art. To simply ascribe those aspects of mental illness that we cannot explain in scientific terms to demonisation, allows such doctors to atach blame and place unnecessary pressure on patients as, if their faith had been strong enough, why would the demon ‘ have got in’?
    However, they may have a point. With the recent White paper and the need to cut costs, we could reduce our drug budget by 99% by dousing everyone in holy water.
    Just time to prepare the car park with vultures blood and sacrifice a virgin before Mrs Jones has her appointment about her heartburn. Why Tesco don’t sell live vultures for sacrificial purposes escapes me? P.S. No jokes about finding a virgin in Greater Manchester.

  • Oh, I totally agree that the views here are probably unrepresentative. And I did worry about my claim concerning endorsement: after all, the editors of the JME don’t have positively to endorse the stuff I spew here. On the other hand, were I to write something libellous, they’d delete it, and I’d get (at best) a slap on the wrists – they can’t stand back completely while remaining editors in any meaningful sense. And the fact that a view is unrepresentative doesn’t make it any less worrisome. Even if only a tiny minority of psychiatrists or medics think this way, that’s still far too many.

  • Keith Tayler

    The casting out of demons is not this simple. Demons, as Jesus recognised (Ecclesiastes 3:1), cannot be cast out before the “appointed time”. Jesus permitted demons to enter the swine to avoid the “Abyss” which ‘caused‘ all 2000 of them to jump into a lake and drown. We all know that led to Jesus being asked to take his psychiatric treatment somewhere else by the locals. Not sure why Jews had a massive herd of pigs, but that aside, the casting out of demons has not always been welcomed because God, so we are told by Matthew 8:28-34, Mark 5:1-20, and Luke 8:26-33, has a cunning plan for the demons which even Jesus has difficulty in understanding. So, given all the ’evidence’, best not cast out demons and keep taking the tablets.

  • Keith Tayler

    The casting out of demons is not this simple. Demons, as Jesus recognised (Ecclesiastes 3:1), cannot be cast out before the “appointed time”. Jesus permitted demons to enter the swine to avoid the “Abyss” which ‘caused‘ all 2000 of them to jump into a lake and drown. We all know that led to Jesus being asked to take his psychiatric treatment somewhere else by the locals. Not sure why Jews had a massive herd of pigs, but that aside, the casting out of demons has not always been welcomed because God, so we are told by Matthew 8:28-34, Mark 5:1-20, and Luke 8:26-33, has a cunning plan for the demons which even Jesus has difficulty in understanding. So, given all the ’evidence’, best not cast out demons just keep taking the tablets.

  • asleepius

    The author of the demonic posession piece is now Chairman of The Royal College of Psychiatrists' Spirituality and Psychiatry Special Interest Group and a consultant psychiatrist who still works for Tees, Esk & Wear Valleys NHS Foundation Trust.

    It would be interesting to find out whether he still holds these views.

    http://www.dur.ac.uk/theology.religion/staff/?username=dth0ccc
    http://www.rcpsych.ac.uk/rollofhonour/specialinterestgroups/spirituality/aboutus/executivecommittee.aspx