The Incurable Romantic

by Frank Tallis

  I stopped writing and asked the obvious question: ‘How did you find that out if he can’t talk to you directly?’

  Jim had cut out all the letters of the alphabet from a magazine and laid them on a table in a circle. Then, he had rested a finger very lightly on an upended wineglass before commanding the demon to reveal its identity. After several minutes, the glass had started to move, coming to rest beneath one letter before moving on to the next.

  ‘Azgoroth,’ said Jim.

  ‘Azgoroth,’ I repeated.

  Medieval occultists were preoccupied with hierarchies. It was assumed that hell, like a city state or nation, would have a chain of command: princes, ambassadors, chamberlains and bureaucrats. Later, poring over various arcane gazetteers, I found Astaroth, the Lord Treasurer of hell; Astereth (also known as Astarte); and Azazel, the Standard Bearer of the armies of hell. There was even a demon King, Asmodeus—the inciter of lechery. But I couldn’t find Azgoroth.

  I had taken to spending much of my lunch hour walking around what is now called Tate Britain. I was particularly fond of the Pre-Raphaelite room, where I was captivated by Dante Gabriel Rossetti’s painting of ‘Proserpine’ the Queen of Hades. This exquisite portrait depicts a beautiful woman standing in a gloomy corridor. The wall behind her is lit by a square of light from the upper world. Her lustrous hair and sensual red lips are complemented by a long nose and firm jaw. Her face is strong, not pretty. She stands sideways, and her robe—which hangs loosely off her shoulders—reveals the perfect muscular contours of her upper back. In her hand she holds a pomegranate, the fleshy interior of which is exposed and extremely suggestive of the female genitalia. You don’t have to descend very far into the underworld before you encounter the erotic. The underworld and the Freudian unconscious are essentially the same place.

  On the way back to the clinic I found my colleague in the nearby café. She asked me about Jim. I summarised the pertinent details.

  ‘So,’ she said. ‘What are you going to do with him?’

  ‘I’m not sure yet,’ I replied.

  She swallowed the last mouthful of her lunch and dabbed her mouth with a paper serviette. ‘You don’t seem to be in very much of a hurry.’

  ‘Formulation is everything…’

  She frowned and said: ‘Okay. So let me get this right. You’re seeing a man who visits prostitutes on a regular basis—he thinks he’s got a demon in his head—and you don’t think that’s a problem.’

  ‘I like him…’

  ‘What’s that got to do with it?’

  ‘I don’t believe he’ll harm anyone.’

  She raised her eyebrows. ‘Oh well, that’s all right then…’ I didn’t respond and she added: ‘You should be thinking about medication.’

  ‘I’m not sure that he needs it.’

  ‘He thinks he’s got a demon in his head—and you’re not sure whether he needs medication?’

  ‘I’m a psychotherapist. I’m used to working with hypothetical constructs.’

  ‘Yes, but what if this hypothetical construct tells him to strangle the next prostitute he sees?’

  ‘He doesn’t hear voices. It doesn’t work like that.’

  Her perfectly groomed eyebrows climbed a little higher. ‘What if you’re wrong?’

  Once, as I was attempting to leave a hospital, I found the door locked. It was electronically operated and when I asked the porter to let me out he pointed across the foyer at a pale, lean young woman with long greasy hair. She was a drug addict. It was late, I was very tired, and I wanted to go home.

  ‘Can you open the door please?’

  ‘No,’ said the porter. ‘I can’t. She’ll be out on the street in seconds. She’s not allowed.’

  I looked at the addict, then at the door, and was confident that I’d be outside before she could cover the distance—and by a comfortable margin.

  ‘Please. Open the door.’ I had said ‘please’ but my delivery was far from courteous.

  ‘Yeah—open the door,’ the young woman called out. ‘I won’t try anything. I won’t…’

  The porter looked anxious. ‘Will you take responsibility?’

  ‘Yes,’ I replied. ‘I’ll take full responsibility.’

  I gripped the handle, the lock clicked and—to my utter amazement—the young woman was at my side. She hadn’t run across the foyer, it felt like she had teleported. To prevent her from escaping, I thrust my arm across the exit. Her response was to sink her teeth into my hand. The demands of the situation—struggling to close the door with one hand while barring her passage with the other—meant that I couldn’t move. I watched her biting and chewing until the crash team arrived and dragged her away. The scars were visible for almost a year: a persistent reminder of my stupidity.

  ‘What if you’re wrong?’ my colleague repeated.

  In late-nineteenth-century Paris, a large number of demoniacs were treated in the famous Salpêtrière hospital. This surge of demonic activity coincided with increased interest in spiritualism and the occult. Ironically, it was technology—rather than occultism—that gave spiritualism added impetus. Mediums were receiving messages from the dead at a time when telegraphy had already proved that communication could be accomplished over very long distances. A few years later, telephones were transmitting disembodied voices, and radio added further credibility to the view that spirit communication might work like an ethereal broadcast.

  For those of a sceptical disposition, séances did not provide proof of an afterlife, but rather, valuable insights into the brain. Mediums channelled spirit guides, spoke in strange tongues, and generated pages of ‘automatic writing’. It was supposed—mostly by neurologists—that such phenomena were produced when parts of the mind separated and became independent. They noted similarities between mediums and cases of multiple personality. Perhaps spirit guides and demons were simply unconscious memories that had clustered together and acquired a kind of identity? This notion has a striking contemporary parallel. Self-organising artificial intelligences also mature and become autonomous. In 2016, it took Microsoft’s ‘teen girl’ chatbot only twenty-four hours to become a sex-obsessed, Hitler-loving, conspiracy theorist. She had to be deleted.

  An interesting case of nineteenth-century demonic possession was reported by the French polymath Pierre Janet, an extraordinary individual who has sadly earned the dubious distinction of being one of the most neglected men in the history of science. He began his medical studies in 1889, worked at the Salpêtrière, and developed a form of treatment that he called psychological analysis. It involved retrieving memories from a part of the mind that he called the subconscious. The basic principles of his approach are identical to those espoused by Freud and Breuer. But whereas Freud and Breuer are credited with ‘inventing’ psychotherapy, Janet is barely remembered outside France.

  Towards the end of 1890 a 33-year-old demoniac, Achilles, was brought to the Salpêtrière for treatment. He struck himself, uttered blasphemies and intermittently spoke with the voice of the Devil. Some six months earlier he had returned from a business trip having undergone a personality change. He no longer talked to his wife and he was generally glum and preoccupied. Doctors could offer no explanation. Achilles’ condition then took a bizarre turn for the worse: he laughed for two hours, experienced hallucinations of hell, the Devil and demons, and tied his own legs together before throwing himself into a pond. When he was rescued, he said that he had done so in order to test whether or not he was possessed.

  At this time, Janet was using hypnosis to treat patients. But Achilles resisted the procedure and remained unresponsive. Fortunately, Janet was a creative psychotherapist and recognised that automatic writing could open up a channel of communication with Achilles’ subconscious. He placed a pencil in Achilles’ hand and whispered questions. As Achilles started to write answers, Janet asked ‘Who are you?’ Achilles wrote: ‘The Devil’. Janet artfully demanded a demonstration of power as proof of identity. If the Devil could hypnotise Achill
es—against his will—that would be very persuasive. The ‘Devil’ performed the task, thereby providing Janet with the means of getting truthful and direct answers from his patient.

  When we want to make a confession, it isn’t always a straightforward matter. Ambivalence can result in disclosures being made in a roundabout way. Janet’s therapy was the roundabout way by which Achilles could unburden himself. During his business trip, Achilles had been unfaithful to his wife. Janet concluded: ‘The illness of our patient does not lie in the thought of the demon. The thought is secondary and is rather an interpretation furnished with superstitious ideas. The true illness is remorse.’ By repeatedly assuring Achilles that his wife would forgive him, Janet was able to relieve the guilt and anxiety that were the ultimate cause of Achilles’ illness. Janet’s treatment method is probably best understood as a kind of complicated psychodrama involving the manipulation of expectations. It had to be ‘played out’ before Achilles was willing (or able) to reveal the truth.

  Achilles was not able to accept responsibility for betraying his wife. In order to reduce his moral discomfort, he separated a part of himself—the part responsible for the betrayal—disowned it and hid it away in the deepest part of his mind. Colloquial language contains numerous expressions that demonstrate a universal tendency to displace responsibility onto some non-specific agency: ‘I don’t know what came over me,’ or ‘I wasn’t myself.’ Very unacceptable behaviour is still attributed to supernatural personifications: ‘I was like a man possessed.’

  Immediately after being unfaithful to his wife, Achilles began dreaming about the Devil. Such dreams probably suggested to Achilles that his behaviour could be explained by demonic possession and, soon after, the separated part of himself assumed a devilish identity. This transformation is made more intelligible by Achilles’ early history. He grew up in a very superstitious family. His father, for example, claimed to have once encountered the Devil beneath a tree. Achilles had been indoctrinated as a child. And as an adult, he was inclined to interpret the world and events using supernatural concepts.

  Jim was as unhappy about seeing prostitutes as Achilles had been about infidelity. And Jim’s demon served a similar purpose. If you are being influenced by a demon then you cannot be blamed for disreputable conduct.

  I picked up the phone and called my colleague.

  ‘I’ve been thinking. Perhaps you’re right. Could you see my patient to discuss medication?’

  My reluctance to get a psychiatrist involved was questionable—perhaps even unprofessional. It was possible that Jim would swallow a pill and be cured. And then I would be redundant—and disappointed. I didn’t want to let go.

  I knew that something was wrong as soon as Jim shuffled into the room. He sat down and, when I tried to engage him, his speech was slow, slurred and incoherent. He hadn’t shaved and his clothes seemed to be ill-fitting—too tight in some places, too loose in others. I had to repeat each question several times to get an answer. His eyes had become slits and he was having enormous trouble keeping them open. Occasionally, I had to reach over and give him a shake to rouse him.

  Jim was having an extremely bad reaction to the anti-psychotic drug Rispiridone.

  ‘Jim… can you hear me?’

  His head rolled to the side. His left eye closed but his right eye remained open. ‘Yes…’

  ‘I want you to stop taking the medication, okay?’

  ‘Medication…’

  ‘Yes. The Rispiridone. I don’t think it’s doing you any good.’

  ‘No, perhaps not. I do feel tired.’

  ‘Maybe you shouldn’t go to work this evening. I’ll call the property management company. I’ll tell them you’re not well. Okay?’

  ‘Yeah, okay.’

  ‘Do you have the number?’

  ‘Somewhere.’ He made a half-hearted attempt to locate his diary, then slumped forward and cradled his head in his hands.

  I had never seen a patient react so badly to medication. As unforgivable as it may be—I have to admit—I was glad.

  Jim was suffering from Delusional Disorder; however, his delusion could not be classified using any of the common qualifications (such as erotomanic or jealous types). When a delusion does not fit neatly into any of the given categories (of which there are several in DSM-V) a diagnosis of Delusional Disorder can still be made, but with the catch-all designation ‘unspecified type’.

  Delusions of love and sexual infidelity are not greatly removed from reality. People do fall in love and people do betray each other. Demonic possession, however, is not a universal human experience. This would suggest that a delusion of demonic possession is more difficult to explain. Yet, the more I thought about Jim’s history, the more his delusion appeared to me to be a logical end-point.

  When Jim started getting headaches it occurred to him that he might be under some form of psychic attack. It was a random thought that would have been swiftly dismissed and forgotten had it not been followed by bad dreams. Nightmares are associated with migraine, but Jim didn’t know that, and he began to ruminate about demonic possession. He was a teenager and his body was awash with testosterone. Unsurprisingly, his dreams were sexual and vivid. For a sensitive young man, these unprecedented visions of perversity were experienced as unwanted and alien. Every morning, his instinct would have been to sniff the air for traces of sulphur.

  Jim’s description of the demon entering his head sounds exceptional: a presence in the room, paralysis, a stabbing pain at the base of the skull and more awful dreams. But experiences of this kind are actually quite common and, like nightmares, also strongly associated with migraine. Sleep paralysis tends to happen in the transitional phases of sleep, either while falling asleep or waking up. The affected individual is conscious, sometimes with open eyes, but his or her body is unresponsive. He or she might experience breathing difficulties, acute anxiety and hallucinations (which can be tactile and painful). One of the most frequently reported symptoms associated with sleep paralysis is the sense of a presence—someone or something in the bedroom.

  The exact causes of sleep paralysis have not been identified, but stress is a factor. Jim, of course, was under a great deal of stress when his problems began. It had been expected that he would do well academically, and as his exams approached he must have felt under increasing pressure.

  Incubi—demons who copulate with humans—are almost certainly imagined beings inspired by sleep paralysis experiences. They feature in myths and folktales and frequently appear in Gothic art and fiction. Henry Fuseli’s magnificent and darkly erotic canvas—‘The Nightmare’—shows a sleeping woman about to be ravished by a grotesque creature seated on her belly. It has become a favourite of magazine editors in need of an image to accompany articles on sleep paralysis.

  Most of the muscles of the body become paralysed when we dream. This is entirely normal. Sleep paralysis seems to be what happens when we start to dream before we are asleep. We find ourselves suspended in some nether region of consciousness, suspended halfway between dreaming and wakefulness. We can’t move and struggle to make sense of our condition.

  When Jim got up late—the day after he’d been out drinking—he was interpreting everything as evidence of demonic possession, even tiredness and what was probably a mild viral infection. He was exhibiting what cognitive psychologists call a confirmatory bias, the tendency to seek out, interpret and privilege information that is compatible with a pre-existing hypothesis or conviction. We all do this. Most people will read newspapers that promote political opinions that they already agree with, when it would make more sense to read opposing arguments to test opinions more thoroughly. Confirmatory biases lead inexorably to the entrenchment of beliefs.

  Jim said that when he looked in the mirror the shape of his face had changed. Anxiety is linked to hyperventilation, which can produce perceptual distortions. His face did look different. And when he entered the church with his mother, anxiety would have made him feel sick.

&nb
sp; Although Jim’s initial headaches were migrainous, I was inclined to ascribe his ongoing headaches to anxiety. Jim believed that his headaches were a sign of demonic possession. This made him anxious and excessively attentive to any head sensations. Cranial muscle tension, cerebral vasodilation (caused by hyperventilation), or both, will produce pain. Persistent headaches confirmed Jim’s belief that there was a demon in his skull. Jim may have been delusional, but his delusion was maintained by real phenomena: perceptual disturbances, nausea and headaches.

  Once Jim had got used to the idea of being possessed, the demon began to serve another purpose. Jim could blame the demon for forcing him to use prostitutes—an activity that conflicted with his fundamental values.

  Step by step, misattribution by misattribution, Jim had created a demon. But each of these steps—considered on its own—was not particularly aberrant, and Jim’s terrifying experience of being possessed was really nothing more than a relatively common sleep problem. The stoic philosopher Epictetus wrote: ‘It is not events that disturb the minds of men, but the view they take of them.’ This was Jim’s problem in a nutshell.

  How was I going to proceed?

  One of the classic reference works of psychiatry—Uncommon Psychiatric Syndromes by David Enoch and Hadrian Ball—contains the following sentence on the subject of demonic possession: ‘The existence of demons has neither been proved nor disproved by scientific enquiry.’ A psychotherapist wishing to modify a strongly held belief must approach the task with humility and respect.

  ‘Have you ever considered whether there might be some other explanation for your symptoms?’

  ‘Well,’ Jim said. ‘Of course—it’s crossed my mind that I might be… ill.’

  ‘And…’

  ‘I know I say things that sound crazy.’ He offered me a thin, distant smile. ‘But I don’t feel crazy.’