Cultural Presentations of Dissociation: The Case of Possession Trance Experiences

Summary

Pathological possession experiences, defined as involuntary and unwanted alterations of consciousness attributed to spiritual forces, are currently classified in the DSM-5 as a form of dissociative identity disorder (DID). However, researchers contest this link and note that it remains unclear how pathological possession differs from possession delusions in psychosis or cultural syndromes like ataque de nervios. Nonpathological dissociative experiences, such as spiritual experiences during religious practices, are also poorly understood.

Study at a glance

Abstract

We read with great interest the editorial by Krüger (2020) in which she provides a review of some of the cultural aspects of dissociation and trauma. We especially appreciate her call for the study of the “entire spectrum of dissociation” (p. 1) from normal to pathological. We have been working along similar lines (e.g., Maraldi et al., 2017; Maraldi et al., 2019) and would like to take the opportunity offered by Krüger to explore further the literature on possession experiences, which she mentions only briefly in her paper. Cardeña et al. (2009, p. 173) define possession trance as “a temporary alteration of consciousness, identity, and/or behavior, attributed to possession by a spiritual force or another person”. When involuntary, unwanted and incompatible with cultural or religious norms and practices, such experiences might be classified as pathological. The diagnosis of “possession trance disorder” was first proposed in the DSM-IV (APA, 1994) as a condition for further study, but in the DSM-5 (APA, 2013) pathological experiences of possession were subsumed under the dissociative identity disorder (DID) category. Pathological possession is now thought in terms of a “possession-form presentation” of DID. But the link between DID and possession trance has been contested by researchers from different countries (e.g., Delmonte et al., 2015; Maraldi et al., 2017; Van Duijl et al., 2013). Also, it is still unclear to what extent pathological possession differs from other pathological phenomena, such as possession delusions in psychosis and some of the so-called cultural syndromes (e.g., ataque de nervios, LewisFernández, 1994), which are considered by some authors as instances of dissociative phenomena (Hegeman, 2013; Ross et al., 2018). On the other hand, there are many nonpathological dissociative experiences about which we know very little, including spiritual experiences reported during religious or ritualistic practices (Alvarado, 2005; Queiroz, 2017). The DSM

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