The Journal of Religion and Health is an allegedly peer-reviewed journal that claims to “explores the most contemporary modes of religious and spiritual thought with particular emphasis on their relevance to current medical and psychological research.” In addition to clinical and statistical papers, they also make room for papers that are “impressionistic” or “anecdotal”. With an impact factor of around 0.8, it barely gets more citations than the average crank journal.

A recent paper published in this publication cements this views. Without any scientific evidence whatsoever, Irmak (2014) makes the assertion that hallucinations associated to schizophrenia are really the result of demonic agency. Demons, according to Irmak, creates real sensory images which the individual misinterprets as an hallucinations. This paper is so blatantly absurd and anti-scientific that it is hard to take seriously. Does this person really believe the stuff he is writing? Why did the journal publish such an obvious piece of nonsense? How on earth did it get past peer-review? There are many questions that demand answers. This post will go through the claims in the paper and then discuss the responsibility of editors and publishing companies.

Characteristics of alleged “demons”

After an introductory section on schizophrenia, Irmak suggests that demonic causation is one way to approach the etiology of hallucinations:

We thought that many so-called hallucinations in schizophrenia are really illusions related to a real environmental stimulus. Illusions are transformations of perceptions, with a mixing of the reproduced perceptions of the subject’s fantasy with the real perceptions. One approach to this hallucination problem is to consider the possibility of a demonic world.

“We thought”? Really? The idea of demonic possession as an explanation for hallucinations in schizophrenia is taken out of thin air. No argument, no evidence and no justification. Instead, Irmak treats us to a folkloric description of demons. They are “intelligent and unseen creatures that occupy a parallel world to that of mankind”. Parallel world? What exactly does he mean by “parallel world”? We get no explanation. Demons apparently have a considerably longer lifespan than ordinary humans. They can fly, make themselves invisible and “take over” people. Neither evidence nor explanation for how this is done is provided. Instead, Irmak just asserts that “most scholars” believe in demonic possession. It does not take long until the bait-and-switch tactic is deployed:

Demonic possession can manifest with a range of bizarre behaviors which could be interpreted as a number of different psychotic disorders (Al-Habeeb 2003; Boddy 1989). On many occasions, the person has within him more than one demon, and often they talk from their voices. They therefore cause symptoms such as hearing voices and certain delusions (Littlewood 2004; Al-Ashqar and Umar 2003; Pereira et al. 1995).

Irmak has not provided any evidence for the existence of demonic possessions in the first place. Thus, he cannot begin to talk about the alleged clinical presentations of demonic possessions. In reality, it is psychotic conditions that have been misinterpreted as demonic possessions, not the other way around. This is especially clear because of the ad ho rationalization provided for psychotic symptoms. With this realization in mind, his convoluted ruminations collapses.

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Dogmatic religious beliefs masquerading as disinterested analysis

The next section of the paper provides additional details:

As seen above, there exist similarities between the clinical symptoms of schizophrenia and

demonic possession

An assertion is not an argument. Irmak has not shown that there are similarities between schizophrenia and being possessed by demons. He has merely asserted it. He has provided no evidence for the existence of demonic possessions or that they have similar clinical symptoms.

Common symptoms in schizophrenia and demonic possession such as hallucinations and delusions may be a result of the fact that demons in the vicinity of the brain may form the symptoms of schizophrenia.

Why should we propose an extremely unlikely explanation (“demonic possession”) when the scientific model (schizophrenia) can explain the existing evidence? If you come home and see a broken window and a baseball on the living room floor, why should we jump to the most unreasonable explanation instead of the obvious one? Saying that it “may” be an extremely unlikely explanation does not cut it. Hypothetically possible does not imply probable or plausible.

Delusions of schizophrenia such as ‘‘My feelings and movements are controlled by others in a certain way’’ and ‘‘They put thoughts in my head that are not mine’’ may be thoughts that stem from the effects of demons on the brain.

Why should it? Irmak provides no evidence or argument.

On the other hand, auditory hallucinations expressed as voices arguing with one another and talking to the patient in the third person may be a result of the presence of more than one demon in the body.

So, in other words, we need to postulate multiple demons to be able to explain hallucinations on the demon model. Just one isn’t enough. The plausibility of his ideas has just dropped from zero to minus infinity.

Faith healing is not effective for schizophrenia

As if the multiple-demons-cause-auditory-hallucinations idea was not absurd enough, Irmak goes one step further in the last section of the paper. In a cloud of anecdotes and evidence-free assertions, he wants to promote the cooperation between medical authorities and faith healers:

It has been shown by World Health Organization (WHO) studies that faith healers may help patients with psychiatric disorders (Gater et al. 1991).

The reference provided is a 23-year-old paper that investigates the delays in various treatment facilities for psychiatric conditions in eleven different countries. It has nothing about the efficacy of exorcism performed by faith healers:

The variation in treatments offered by native or religious healers reflects the heterogeneity of centres studied (see Table 11). Almost all the patients who saw native or religious healers in Ujung Pandang and Bangalore say they received some form of treatment from them. In Ujung Pandang this is usually native medicine, but in over a third it is practical help; a main treatment rarely found in any other setting. In Bangalore and Aden a ritual cure is most common followed by herbal remedies, while in Rawalpindi prayer or other spiritual forms of support are common.

In other words, religious “healers” provide patients with herbs, prayer and practical help. It has nothing to do with “demons”. After this obvious false characterization was not enough, Irmak provides a single anecdote for his efficacy claim.

Similarly, B. Erdem is a local faith healer in Ankara who expels the evil demons from many psychiatric patients with the help of good ones. B. Erdem contends that on occasions, the manifestation of psychiatric symptoms may be due to demonic possession. An important indicator of his primary suspicions about the possession is that, if someone has auditory hallucinations, he would remain alert to the possibility that he might be demonically possessed. His method of treatment seems to be successful because his patients become symptom free after 3 months.

So this faith healer “treats” patients by evicting evils demons “with the help of good ones”?! Just when you thought it could not get more absurd. No evidence is provided that patients stop having symptoms.

Above considerations have led to the suggestion that it is time for medical professions to consider the possibility of demonic possession in the etiology of schizophrenia, especially in the cases with hallucinations and delusions. Therefore, it would be useful for medical professions to work together with faith healers to define better treatment pathways for schizophrenia.

“Above considerations?” You mean implausible assertions and a single anecdote? This is by no means sufficient evidence for the suggestion that “demonic possession” should be part of the etiology of schizophrenia or that we should pollute science-based medicine with fraudulent faith healers.

Who is M. Kemal Irmak?

The author contact information states that he is part of the High Council of Science at the Gulhane Military Medical Academy in Ankara, Turkey. At first I thought this paper was a hoax, written by someone who wants to reveal bad quality control in smaller journals. A quick PubMed search shows that he has published around 30 papers, including one about a hypothetical scenario where a woman gives birth to a child without a father. Naturally, this was published in another crank journal (Medical Hypothesis).

How could this paper get published?!

The journal in question claims to apply peer-review. Who reviewed this paper and how on earth could it avoid getting rejected? Did it even go though the peer-review pipeline? Was Curtis W. Hart, the editor-in-chief, aware of this paper being published? Why did he not step in? Taking a larger perspective, we also need to ask ourself why Springer keeps a journal like this afloat.

Publishing a paper denying the biological basis of schizophrenia, proposing the causative effects of demonic possession and recommending “treatments” by fraudulent faith healers is a threat to vulnerable patients who may refuse science-based medical treatments and instead seek out these kind of quack providers.

It is clear that this paper should be retracted and that the peer-review protocols for the journal should be reevaluated.