A recent article by Emily Korstanje details the story of Nadia, an 18 year old girl from Saudi Arabia who suffered from depression. Her religious parents took her to a faith healer who, through dubious methods involving choking her until she passed out, concluded that her symptoms were the result of demonic possession.

Fortunately Nadia was able to break away from that healer and defy her parents, but she still faces a more difficult challenge – her society.

“They need to separate religion from psychology, especially for us women, who suffer from depression because of our shitty circumstances, or we cannot—and will not—get help,” Nadia sad. “Society also needs to be rid of this of shame toward mental illness and stop saying that people are weak or not perfect believers, or possessed! Spirituality is important but it doesn’t mean that you deny what is really going on because it will only get worse.”

In the past, before science helped us understand things like psychology and neuroscience, it is understandable that prescientific cultures would reach for superstition to explain mental illness and neurological disorders. They had no way of understanding what a seizure was, let alone schizophrenia. So they used what explanations they had at hand and decided that such individuals were possessed by evil spirits, or cursed, or were being punished by god or the gods.

It amazes me, however, that in the 21st century this still occurs. Now, with all the knowledge of modern neuroscience, there is no excuse for confusing a brain disorder with spiritual possession. Further, we do not need to look to third world countries to find example – this is still happening in modern industrialized nations.

In 1991 ABC’s 20/20  aired an exorcism of a girl who was allegedly possessed. While the narrator is desperately trying to convince us that what we are seeing is amazing and defies ordinary explanation, what I see is a patient suffering from mental illness who is being abused. Her “acting” of possession is mundane and not compelling. Nothing supernatural, or even mildly interesting, happens.

Amazing, they declared success when after a couple hours she apparently just became exhausted. The audience is told that she later “relapsed” however and eventually had to be treated with standard antipsychotic medication. So the exorcism completely failed, and the case proceeded exactly as if she had schizophrenia which responded to conventional therapy.

Unfortunately exorcisms are not always as benign as what was seen on 20/20. Every year there are deaths from exorcism. Victims are beaten and suffocated. Many more suffer this abuse and survive.

The psychological harm is more difficult to measure. It is generally accepted by mental health professionals that it is harmful and counterproductive to play into a patient’s delusions. You would never tell a schizophrenic that the CIA actually is listening to their thoughts though the fillings in their teeth. But this is the same as telling them they actually are possessed by a demon.

There may be a temporary reduction in acting on their delusions if you perform an exorcism, just as there may be a short term effect from removing the fillings from the teeth in the example above. But neither intervention addresses the underlying problem and has no true or long term benefit.

Nadia’s story highlights that the superstitious belief in possession and barbaric abuse of exorcism is just part of a larger spectrum. We still have a pervasive problem of “demonizing” mental illness, sometime literally. There is a tendency to see mental illness not as an illness, but as a personal failing, or a choice. There are some who even deny the existence of mental illness at all.

I think this largely stems from an assumption that most people make without realizing and which is pervasive in our society. People tend to assume that our brains are blank slates. Problems with the “hardware” affect things like movement and sensation. They are, essentially, neurological disorders. The connection between the brain and our mood, thoughts, and behavior, however, is less intuitive. Perhaps this results from the very fact that our brains function in such a way as to create the seamless illusion of consciousness and free will. We are, by definition, unaware of all the subconscious processing that occurs.

We tend to assume that people’s behavior is deliberate and the result solely of a conscious choice. Even something as fundamentally hardwired as sexual orientation will be explained by some as being a free and conscious choice.

The fact is that our mood, thoughts, and behavior are just as much a manifestation of the firing of the neurons in our brains as is the movement of your hand or the processing of visual information. The neurological correlates of mental function can operate sufficiently far away from a functional range as to be considered a disorder. A certain amount of anxiety and depression is normal and healthy, part of how we deal with the world and our lives. But if you have a crushing depression every day, to the point that you cannot get out of bed, for no apparent external reason, it is perfectly reasonable to conclude that this level of depression is a brain disorder of some kind.

Because we don’t tend to see mood, thoughts, and behavior as brain functions we also don’t see disorders of these things as illness. We tend to stigmatize them, to blame the patient, or to blame an external agent like a demon or a god. This false assumption just adds to the burden that those who deal with mental illness must face. It also can deprive them of a meaningful chance to deal with their disorder in an effective way.

We still have a lot to learn, and psychiatry is still in its infancy in many ways. Psychiatry has a troubled history as well, and it is perhaps only in the latter half of the 20th century that it turned a corner to become a reasonably modern medical profession that can identify and effectively treat many disorders. It still struggles to understand the basic nature of many illnesses, to categorize them meaningfully, and treat them effectively.

Mental health treatment, however, can have a dramatic effect, and there are some illnesses which respond very well to treatment. The biggest barrier to treatment remains the unfair stigma attached to mental illness, and persistent primitive superstitions.

Belief in demonic possession and exorcism is literally a medieval practice that has no place in the modern world. It doubly victimizes people, both physically and mentally, while depriving them often of the modern help they need.