Mass shootings: moral evil or mental illness?; 'True or False Possession?'

By Matt C. Abbott

"Jesus doesn't need an army to cast out the demons, He has no need of pride, no need of force, of arrogance. 'What is there about His word? For with authority and power He commands the unclean spirits, and they come out.' This is a humble word, meek, with so much love; it is a word that accompanies us in the moments of the Cross. Let us ask the Lord to give us today the grace of His Light, and to teach us to distinguish when the light is from Him, and when it is an artificial light, made by the enemy to deceive us."

– Pope Francis, Sept. 3

"You're looking at me as though I'm weird. My God! Are you so out of touch with most of America, most of which believes in the Devil? I mean, Jesus Christ believed in the Devil! It's in the Gospels! You travel in circles that are so, so removed from mainstream America that you are appalled that anybody would believe in the Devil! Most of mankind has believed in the Devil, for all of history. Many more intelligent people than you or me have believed in the Devil."

– U.S. Supreme Court Justice Antonin Scalia (interview with New York magazine)

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(An abridged version of this column originally appeared at Catholic Online.)

The following is a brief interview with Aaron Kheriaty, M.D., director of residency training and medical education; associate clinical professor, department of psychiatry; and director of program in medical ethics at the University of California Irvine School of Medicine.

Dr. Kheriaty, a practicing Catholic, is the author of The Catholic Guide to Depression: How the Saints, the Sacraments, and Psychiatry Can Help You Break Its Grip and Find Happiness Again, an excellent and informative book for Catholics who suffer from – or who are close with someone who suffers from – clinical depression. (Click here to order the book directly from the publisher, Sophia Institute Press.)

1. There were reports that the Washington Navy Yard shooter, Aaron Alexis, had received treatment for mental health issues, including "hearing voices." The shooters in the Sandy Hook and Aurora, Colorado tragedies also reportedly suffered from some form of mental illness. But can mental illness alone cause someone to commit such a heinous crime? Isn't there also a diabolical influence present in such cases?

Dr. Kheriaty: Severe mental illness, including various forms of psychotic disorders, can put a person at risk of engaging in behavior that he would never do when thinking more clearly. Treating hospitalized patients on a psychiatric ward, I have often seen agitated or aggressive behavior when the person's symptoms were severe. However, it is a myth that mentally ill individuals, even those suffering from severe psychotic disorders, are violent by nature.

If they do commit violent acts, they are much more likely to inflict harm on themselves than on others. It seems to me that the kinds of atrocious violence on a massive scale that we see in these shooters cannot be fully explained by mental illness alone. I've treated hundreds of people with severe schizophrenia, for example, and when the illness is poorly controlled, they may be liable to quite strange behaviors. But not violence, not evil, on the scale that we see in these tragedies.

Such acts seem to require something beyond just ordinary human frailty, or even typical human malice. I believe that wherever evil on this scale is committed, there must be some kind of diabolical influence present. The way in which this influence plays out is mysterious and varied – from temptation, to oppression, to outright possession. Mental illness alone, in my judgment, cannot account for these behaviors. Something else is involved.

The hypothesis of the devil – a personal spiritual being whose will is turned toward evil and who can exercise some sort of influence over man – may give rise to scorn from rationalists. I challenge the skeptics to find a better explanation for Sandy Hook or Aurora. As Baudelaire famously put it, the devil's greatest trick is convincing us that he does not exist.

2. What can we do as a society to promote good mental and spiritual health?

Dr. Kheriaty: Strengthen the family, where children can grow up with their mother and father. Welcome children into the world and treat them as ends in themselves, not as means to another end. Turn off the TV and get rid of your video games and pornography. Give young people hope, and a sense of meaning and purpose, so that they do not turn to drugs in despair. Reject the culture of narcissism and self-aggrandizement promoted in the media, and instead, learn to care for those who are marginalized and forgotten, the poor, the elderly and infirm, and those with mental illness. Go to church as a family on Sunday and pray together as a family during the week.

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Dr. Kheriaty also has written the preface to the book True or False Possession?:

How to Distinguish the Demonic from the Demented, by Jean Lhermitte. The preface can be read in its entirety below.

(Click here to read Catholic author and journalist Michael H. Brown's review of the book; click here to order a paperback copy via SpiritDaily.com. Click here to order the electronic version directly from the publisher, Sophia Institute Press, whose president, Charlie McKinney, graciously granted me permission to publish the following excerpt in this column.)

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Preface to True or False Possession?

Aaron Kheriaty, M.D.
The question about the devil was put to me directly by a patient who had come to see me for treatment of depression and recovery from a serious drug addiction. As a physician, he had gained access to the intravenous anesthetic drug propofol and had self-administered it in order to escape from refractory insomnia and unrelenting depression. Without carefully titrated dosing, gleaned from his medical knowledge, this patient would surely have overdosed long ago. Indeed, it was something of a miracle that he was still alive.

During an interview, he suddenly interrupted the narrative of his psychiatric history, paused, and looked me directly in the eye. With a sober seriousness, and without a trace of hysterics or dramatization, he asked simply, "Do you believe in the Devil?"

I stared back. "Yes. I do."

"Me too," he said.

Then after a pause, I inquired: "Why do you ask?"

"When I was injecting the propofol I felt something . . . enter into me. It was not the drug, but something else. The drug was just the gateway. It was . . . something . . . foreign."

At no point in his treatment did I suspect this patient to be possessed, in the strict sense of the term. Yet, neither did I doubt the reality of a malevolent influence on him that exceeded in power and scope the physiological effects of the anesthetic he was abusing. He later related to me how this evil spirit would mock and taunt him as he slipped deeper into the hell of drug addiction.

Most of my colleagues in psychiatry probably would have regarded this exchange between doctor and patient as rather puzzling, even ludicrous. They would likewise regard a book like the one you hold here as an oddity. A work purporting to distinguish between cases of true and false possession will seem to many a throwback to a bygone age of religious superstition. Yet a modern psychiatrist cannot help but be impressed by the author's perspicuous medical and psychological analysis of each case he examines in these pages. This is not the work of a premodern credulous dupe, but the work of a skilled and experienced neurologist, who knows his trade and sees his way clearly into the tangled workings of the human mind and heart.

The author, a physician and not a theologian, skillfully navigates the Scylla of credulity and the Charybdis of relentless skepticism. Inclined by training and clinical experience to search first for naturalistic medical or psychiatric explanations for the phenomena in question, he nevertheless leaves open the possibility of explanations that go beyond what science or medicine can assess, as well as the possibility that any given manifestation may have elements of both the natural and preternatural. Originally published over fifty years ago, the author's medical judgments and observations still hold true. While some clinical terminology may have changed in the interim, little could be brought to bear from modern neurology or psychiatry that would contradict his findings or conclusions. The clinical histories, fascinating in their own right aside from the author's clinical assessment, are presented with sober clarity and reserve.

Believers have sometimes made the mistake of finding supernatural possession where there was only a pathological personality, given to the grossest hysterics and deceptions. This book provides fascinating accounts of false-possession cases, for example, those of Marie-Thérèse Noblet and Sr. Jeanne of the Angels. Here the author astutely notes that the repeated misapplication of the Rite of Exorcism may have exacerbated the behavioral disorder, in this case, hysterical (what we now call conversion) symptoms that were encouraged by the excessive attention received from the exorcist and by the public or overly dramatized way in which the exorcist misapplied the rite, in defiance of the prescriptions of the Roman Ritual. The curious onlookers fell prey to the colorful and dramatic, while the sick individual was motivated by receiving such attention. The author observes: "Well known, too, were all the criteria which the Church holds to be decisive of genuine possession, but they were scarcely heeded" in such cases. The cautionary note here comes not from a belief that the rite or the prayers themselves would be harmful, but rather from a desire to avoid an overly theatrical application of a sacramental in situations where the hysterical person was taking on the sick role precisely in order to draw attention to herself. The author discerns that it was the excessive attention, not the prayers of the rite itself, that could have exacerbated the behavioral symptoms.

In a similar vein, the author then recounts well-documented historical cases of mass hysteria and pseudoseizures, which often become "contagious" among those living in close quarters through suggestion and mimesis. Such phenomena could be accounted for by psychological observations known as early as the sixteenth century and given more definitive form in the work of the great French neurologist Charcot in the nineteenth century. Today, one could add a wider knowledge of culture-bound syndromes worldwide, with characteristically wild behavioral, dissociative, and somatic manifestations – such as the clinical syndrome Amok found among the Malaysians. In such cases, as the author concludes, "the influence of the demon is to be sought in vain." Yet he also notes correctly that hysteria is not playacting and that those who manifested this behavioral disorder were not consciously feigning their symptoms or deliberately trying to deceive: "Hysterical patients, like all other sick people, deserve our understanding and our charity."

The author knows well that some historical cases, thought at the time to be demonic possession, can now be explained as having their origin in neurological or psychiatric disorders. Yet he displays none of the hubris of modern men who scoff at the superstitions of past ages, as though they had made such medical discoveries themselves. He writes with sympathy for the limited theories employed by men of the past, even while correcting their errors or misjudgments in particular cases. He is also careful to point out that there were contemporaneous skeptics, who, although they could not offer alternative explanations, nonetheless had the insight to doubt the presence of true demoniacal influence where there was none. In the case of false possessions where an exorcism was mistakenly employed, the author offers this psychologically penetrating insight, which rests upon the mechanism of projection: "It must be remembered that if one calls up the devil, one will see, not the devil himself, but a portrait composed according to the patient's idea of him."

By the time our author takes the reader through chapters 3 and 4, explaining in light of modern neurological and psychiatric concepts what were at the time riotously incomprehensible manifestations and behaviors, and disabusing the reader of any supernatural interpretation of these cases of pseudo-possession, one is left wondering whether all apparent demonic manifestations can be likewise explained away or accounted for by naturalistic explanations. With astute medical insight, the author describes a case of postpartum depression with psychotic features, including homicidal command-type auditory hallucinations: "One of my patients, for example, during a state of depression heard the devil in the middle of the night speaking to her and bidding her kill her child, then a few months old." After acting on this impulse and tragically tossing the poor child out the window (fortunately the baby was only bruised), she received medical treatment and made a good recovery: "As for the mother, when she had been given electric shock treatment, she was not long in recovering her mental equilibrium." Naturalistic explanations for such evil sensory perceptions and violent acts can often be found within the realm of well-described mental illnesses.

In light of such cases, a skeptical reader might wonder whether the Latin Rite of Major Exorcism should now be tossed into the dustbin? Is it the product of a bygone era, now known to be defunct and discredited by the findings of modern science and medicine? Have psychoanalytic concepts, or modern materialistic theories of the mind sufficiently disabused us of the need for supernatural explanations, for recourse to angels and demons? As our author poses the question, "If there can be no doubt of the existence of non-genuine possessions, are we in a position to distinguish them from the genuine?" But even while he goes about the work of debunking, he is also spiritually astute enough to avoid throwing the baby out with the bathwater. The misuse of something like the Rite of Exorcism does not negate its proper and sometimes necessary use.

We still face this question: How do we account for the manifestations documented in many cases that were thoroughly examined by competent psychiatrists, cases still seen today that evade the explanations of skilled physicians? Can modern psychiatry or neurology give an account of all such things – of preternatural knowledge, of superhuman strength, of xenoglossia, of inexplicable rage toward sacred objects – or will science ever discover a naturalistic cause here? I have observed firsthand several of these demonic manifestations during an exorcism, manifestations for which I can find no explanation within the realm of natural science.

This book needs to be framed in the context of profound cultural shifts that have occurred since it was first published in 1956, most notably the rise of a widespread philosophy of materialism that turns appreciation for science into an ideological scientism. Such secularizing cultural changes surely influence the book's readership. When the author wrote it, he could assume that most Catholic readers would, by and large, take for granted the necessity of exorcism in certain cases and not doubt its efficacy in instances of true possession. He was writing therefore with the prudent intent to avoid overzealous applications of the rite in cases that had not been sufficiently medically examined. But the background cultural assumptions today are radically different, even among many Catholics, including many clergy. Today the default assumption for many readers would be that naturalistic or medical explanations can always be found and can be taken as fully explanatory. The danger today is therefore precisely the opposite, namely, that the rite may now be under-applied rather than overused. Indeed, in many dioceses in the United States there is no available trained exorcist to deal with such cases, and afflicted individuals therefore suffer without recourse.

This author knows the permanent limitations of his science: this book does not attempt to detail cases of what may be considered true possession, for these by their nature would lie outside the scope of the author's explanatory powers or clinical expertise. That task is best left to the trained and experienced exorcist and to the theologian. Where the physician has reached the limits of his methods, where medical or psychological explanations simply cannot account for the phenomena, then the doctor must recognize the boundaries of his own craft and remain silent before the mystery of iniquity – the mystery of a real and effective evil personality that in rare cases may oppress and torment some few unfortunate souls.

In such cases the physician and the priest need to collaborate responsibly, and with respect for the insights of both science and theology. Fr. Gary Thomas, who is the subject of journalist Matt Baglio's book, The Rite: The Making of a Modern Exorcist, later adapted for the Hollywood film by the same name, starring Anthony Hopkins, recently recounted to me severe cases of demonic possession with extraordinary manifestations. Some of these I have since witnessed during an exorcism and can attest that such "symptoms" lie outside the scope of anything listed in the psychiatrist's Diagnostic and Statistical Manual of Mental Disorders.Fr. Gary also gave me an invaluable insight into his work when he explained that an exorcism is always an act of healing. And so, of course, the Church recognizes the urgent need for competent neurologists and psychiatrists to work with exorcists in the process of discernment, diagnostics, treatment, and healing. But such collaboration presumes that each person – both the medical doctor and the priest exorcist – have something indispensable to contribute to this work of discernment and healing. This is a work of mercy, patterned after our Lord's own acts of casting out demons and curing disease.

© Matt C. Abbott