Based on having read the (mostly) horrific reviews for the new low-budget horror flick The Devil Inside (2012), I won't be sprinting to the theatre to see it any time soon. Make that ever. But, despite its reported pure stupidity and total lack of originality or redeeming artistic value, movie fans (especially those under twenty-five) are nonetheless flocking to it in droves. And dishing out good money to do so. It is a true, record-breaking phenomenon, so far surprisingly raking in more money (over 34 million dollars), dethroning from number one in the standings and doing almost twice the box office business as its closest competitor (Tom Cruise's Mission: Impossible--Ghost Protocol). What's the intense ? Is it all about cheap thrills and a temporary respite from recession's harsh reality? Or could there be something deeper going on here?

From what I gather, The Devil Inside tells the story, "inspired by true events," of a woman who, in 1989, brutally butchered three people (two priests and a nun), was found not guilty by reason of insanity and committed to a Roman hospital for the criminally insane for twenty years. Her daughter, now grown, understandably wants to make sense of what happened. She discovers that the killings occurred during a failed exorcism, and that her mother, despite decades of intensive psychiatric treatment, is still possessed by several demons. And clearly in serious need of another (hopefully, this time more successful) exorcism tout de suite.

She enlists the help of two rogue and rookie Catholic priests who are involved in performing unauthorized exorcisms on people who they believe may be both mentally ill and demonically possessed, but don't meet the Vatican's strict criteria for receiving this rare and sacred ritual. You get the picture.

What does the astounding and unexpected popularity of this movie say about us and our culture? Why are high-tech, scientifically-minded, religiously secular twenty-first-century cynics so fascinated with a (bad) film about exorcism, Satan and his demons? What many critics have called the worst movie they've seen in quite some time? While the level of filmmaking ranges wildly, there seems to be a trend toward this supernatural (i.e., religious) subject these days. (2007) and its sequels deal with the subject of evil demons. Last year, The Rite (2011), starring Sir Anthony Hopkins as a Jesuit priest and professional exorcist somewhat reminiscent of Father Merrin (Max von Sydow) in The Exorcist (an excellent film), was released to tepid if not terrible reviews. Nonetheless, the topic of exorcism and demonic possession evidently still touches a nerve in the movie-going audience, perhaps especially in horror fans, true believers and so-called recovering Catholics still not sure what to believe about such matters.

Films about possession and exorcism, like The Last Exorcism (2010) and 2005's The Exorcism of Emily Rose, strive in part to convince their audience of the objective existence of the Devil, and, in turn, of God. But in dogmatically pursuing this fundamentalist agenda, the filmmakers are missing a golden opportunity to examine and explore the many important parallels between exorcism and modern , and to possibly reach and educate a far wider secular, and psychologically sophisticated segment of the public about this intensive treatment for what I term the possession syndrome

Some of these movies make reference to the apparent actual growing demand for exorcisms and the need to train more priests to perform this archaic religious rite. This widespread explosion of interest in exorcism was confirmed by a Washington Post article (Feb. 10, 2008) titled "Exorcism makes a comeback in Europe: Citing modern ills, hundreds of priests have trained to expel the devil." In that legitimate news report, a Catholic priest in Poland routinely conducting twenty exorcisms per week explains, " ' there is a group of people who cannot get relief through any other practices and who need peace.' "

Another priest who holds a doctorate in theology and serves as the resident exorcist at a psychological center outside Warsaw, states that "the institute realized they needed an exorcist on staff after encountering an increase in people plagued by evil.' " The article notes that, in keeping with current Vatican policy, exorcists regularly consult with psychologists and psychiatrists in an effort to differentiate mental disorders from bona fide demonic possession. But according to one busy practitioner, " 'My remedy is based on spiritual means, which cannot be replaced by any pharmaceutical remedies. . . .I do not stop at the level of just treating symptoms. I'm very much interested in the soul of a person. As a priest, I keep asking questions a doctor will never ask.' "

Perhaps it's time psychologists start asking some of those same questions. What is exorcism? How does it heal? Can we learn something valuable about psychotherapy from exorcism? Are there certain techniques employed by exorcists that psychotherapists should consider when treating angry, psychotic or violent patients? Are there vital existential or spiritual questions addressed by exorcism--for example, the archetypal riddle of evil--that psychotherapy detrimentally avoids or neglects?

Exorcism--the ritualistic expulsion of evil spirits inhabiting body, brain or place--has been practiced in some form throughout history, and is probably the first primitive type of psychotherapy. Hippocrates, the father of western medicine, was originally a trained exorcist. Jesus of Nazareth is reputed to have healed individuals suffering from mental and physical symptoms by casting out demons.

Now, more than two millennia later, the Roman Catholic Church is reported to be secretly educating a new crop of exorcists to meet a rapidly rising demand for exorcisms in Italy, Australia, America and elsewhere around the globe. Here in the U.S., where there is evidently an acute shortage of formally trained exorcists, burgeoning numbers of suffering souls--some deeply disillusioned with or wary of what mainstream psychology and psychiatry have to offer today--are desperately turning to exorcism to deal with their debilitating "devils" and "demons."

Exorcism can be said to be the prototype of modern psychotherapy. (See my prior post.) Despite the secular scientific persona of most mental health professionals today, simply scratching the surface of rationality and objectivity reveals a secret exorcist: Like exorcists, psychotherapists speak in the name of a "higher being," be it medical science, rationality or some psychological, metaphysical or spiritual belief system. They firmly (and, in the case of biological psychiatry in particular) literally believe in the physical reality of the pathological problem manifested in the patient's symptoms and suffering, and dispense drugs and/or encouragement while joining with the patient in a sacred "therapeutic alliance" against the wicked and debilitating forces bedeviling them.

Notwithstanding today's economically-driven, superficial, simplistic trend toward brief psychotherapies such as , (see my prior post) and myriad psychopharmacological treatments, sooner or later one inevitably is confronted in clinical practice with strikingly similar phenomena and principles to those educed by traditional exorcists.

Psychotherapy, like exorcism, commonly consists of a prolonged, pitched, demanding, soul-wrenching, sometimes tedious bitter battle royale with the patient's diabolically obdurate emotional "demons," at times waged over the course of years or even decades rather than weeks or months, and not necessarily always with consummate success.

And there is now growing recognition--not only by practitioners--of the very real risks and dangers of psychic infection inherent also in the practice of psychotherapy. (This psychic susceptibility is almost universally depicted in these films, starting with The Exorcist and most recently by The Devil Inside.) is what clinicians technically call this treacherous psychological phenomenon, which can cause the psychotherapist (or exorcist) to suffer disturbing, subjective symptoms during the treatment process--sometimes even as the patient progresses!

Hence the ever-present importance for psychotherapists, like exorcists, to perform their sacred work within a formally ritualized structure, making full use of collegial support, and consultation, and to maintain inviolable personal boundaries. (Dr. Marsha Linehan's DBT, for instance, structures this support and consultation into the treatment program.) T

o paraphrase Sigmund , no one wrestles with the emotional demons of others all day without themselves being affected. This is an unavoidable occupational hazard of both exorcism and psychotherapy.

Of course, the main difference between psychotherapy and exorcism is that modern psychotherapy is typically a secular treatment for figurative, metaphorical "demons"--mental, emotional or psychological , memories or "complexes,"-- whereas exorcism takes the existence of demons quite literally. Doing so can have certain advantages in treating patients who believe in the Devil, demons and exorcism, if for no other reason than the extremely impressive power of suggestion. (This is also the power behind the so-called .) Someone in the midst of an acute , for example, is confused, disoriented and hyper-suggestible. They desperately seek some meaning to hang on to.

Unless we can seriously offer a more or at least equally satisfying explanation of the patient's disturbing experience, it is, as clinicians well know from working with patients, exceedingly difficult if not impossible to rationally dissuade someone of the fervent conviction that they are victims of demonic possession. Sometimes the best approach can be to go with where they are and use the patient's belief system to the treatment's advantage

Psychiatrist M. Scott Peck, who believed in and sometimes practiced exorcism, drew a distinction (like the Catholic Church, but mistaken in my view) between demonic possession and mental illness. Peck (1983) correctly pointed out that, unlike individual psychotherapy, exorcism makes more use of power in waging war against the patient's sickness, and is usually conducted by a team of exorcists who attempt to overpower the patient's efforts to resist treatment.

He further notes that, unlike time-limited psychotherapy sessions, exorcisms can extend far beyond forty-five minutes, and often involve forcible physical restraint of the patient during these intense and typically angry confrontations. In religious exorcism, as opposed to psychotherapy, the team invokes the healing power of God via prayer and ritual, and attributes any success directly to God rather than themselves or even the exorcism process itself. Whereas in psychotherapy, success is typically attributed primarily to some combination of the doctor-patient relationship and the treatment process itself.

Exorcism is based on a theological, spiritual or metaphysical model, unlike psychotherapy, which is generally rooted in a psychiatrically-based biopsychosocial or medical paradigm. But both methods address similar symptoms or syndromes, especially as seen in the most severely disturbed patients. The Catholic Church is careful today to rule out or demonstrable mental illness when considering candidates for exorcism, using medical doctors and mental health professionals to help distinguish between so-called genuine possession and pseudo-possession. But can such a distinction truly be drawn? And, if so, on what basis.

The Roman Catholic Church's official diagnostic criteria for discerning genuine demonic possession (something mentioned in many of these movies) includes speaking in tongues or languages formerly unfamiliar to the possessed person, supernatural physical strength, and visibly negative reactions of the victim to prayers, holy water, priests, etc. But for the modern Church, physical and/or psychiatric disorders must first be excluded. From a psychiatric perspective, the problem with such criteria is that these phenomena can be found in many mental disorders, including dissociative and psychotic disorders of various sorts.

According to Dr. Peck, a born-again Christian, the distinction between "human evil" and "demonic evil" is crucial: He distinguishes "satanic possession" from mental illness, stating that though in such cases some emotional problem predisposes the patient to satanic or demonic possession, "the proper question to pose diagnostically would be: ‘Is the patient just mentally ill or is he or she mentally ill and possessed?' " This is a clearly religious conceptualization. But another way of looking at this same possession syndrome is that in such cases what we are seeing are the most extreme and treatment resistant states of mind manifested in patients who may truly believe themselves to be demonically possessed.

The pertinent question then for psychologists and psychiatrists is how best to treat such severely disturbed and intensely suffering individuals? It seems that at least some familiarity with their religious beliefs and meaningful integration of these beliefs into their psychotherapy is essential. These patients have usually tried traditional psychiatric treatment, with its banal neurobiological , to no avail. Providing some way to help such frustrated patients make sense of their frightening and bewildering subjective experiences and integrate them meaningfully into a deeper psychological and spiritual understanding of themselves and the world is what real psychotherapy should, really must, strive toward. Without such a meaning-centered, spiritually sensitive secular psychotherapy (see my prior post), exorcism is seen by some bedeviled individuals as their only hope.

This question as to the true nature of what I call the "possession syndrome" is at the very crux of the matter regarding exorcism: Exorcism is the traditional treatment for possession. What is possession? Is so-called demonic possession a psychological phenomenon, a form of psychosis or another as yet ill-defined mental disorder? Or is it the work of the Devil, and irrefutable proof of Satan's powerful reality? In one of my previous posts, I discussed the infamous Andrea Yates filicide case. By the time she deliberately drowned her five children in 2001, Yates was convinced she was possessed.

Satan himself, claimed Yates, compelled her to carry out her evil deeds. In her second trial, Yates was found not guilty by reason of insanity and committed to a mental institution. How can we make sense of her delusions and diabolically destructive behavior? ? ? ? Or was Yates, as she fervently believed, a hapless victim of "possession"? And if so, what exactly is that? Do demons really exist? What is evil? Where does it come from? What is our relationship to it? Is it a proper subject of study for psychology and psychiatry? And how can we better deal with it?

The idea of demonic possession is a metaphysical, theological or spiritual explanation for human evil. The Exorcist (1973), a film based on William Peter Blattey's book about a supposedly "real" case, provides a highly dramatized depiction of evil, possession and exorcism, and stimulated renewed public fascination with what I call the "possession syndrome" (1996). The Exorcism of Emily Rose, also loosely based on an actual case, had a similar effect, raising legitimate ethical, legal and psychiatric questions regarding the practice of exorcism. As does The Devil Inside to some degree.

Possession has been a well-documented phenomenon occurring across cultures in virtually every era. But the term possession is seldom mentioned in the psychiatric and psychological literature. Instead, we speak of obsession, which has similar intrusive, involuntary, egodystonic qualities. Or we refer to "multiple personality disorder" (Dissociative Identity Disorder), in which one or more sub-personalities temporarily take possession of the person against his or her will. Or we diagnose bipolar disorder in those possessed by , irritability or melancholy, and Intermittent Explosive Disorder to describe someone repeatedly possessed or overtaken by uncontrollable rage. It must be admitted that the archetypal phenomenon known historically as "possession" persists today in differing forms and varying degrees. The only difference is the way in which we now attempt to explain and treat it

Phenomenologically, the subjective experience of possession--feeling influenced by some foreign, alien force beyond the ego's control-- is, to some extent, an aspect of most mental disorders. Patients frequently speak of symptoms, unacceptable impulses, thoughts or emotions as ego-alien, and uncharacteristic moods or destructive behaviors as "not being myself," commonly exclaiming "I don't know what got into me," or wondering "What possessed me to do that?" Presently, such disturbing symptoms are hypothesized by psychiatry to be due primarily to some underlying neurological or biochemical aberration.

Biochemistry, in the form of the tiny neurotransmitter, has become our postmodern demon du jour for which all manner of evils are blamed. Depth psychologists C. . Jung (in his concept of the shadow) and Rollo May (1969) provide psychologically sophisticated, secular theories of human evil and daimonic (as opposed to demonic) possession which do not demand literal belief in the devil or demons. (I discuss these matters in detail in my book Anger, Madness, and the Daimonic.) But, tragically, most psychotherapy today does not adequately comprehend or treat the possession syndrome. For some bedeviled individuals, the traditional ritual of exorcism or myth of "demonic possession" serve to make more sense of their suffering than the scientific, secular, biochemical explanations and theories proffered these days by mainstream psychiatry and psychology. If psychotherapy as a healing of the soul (not just the mind) is to survive and thrive into the future, our current overemphasis on , behavior, , neurology and biochemistry must be counterbalanced by the inclusion of the spiritual and depth psychological dimension of human existence. It must become, as Freud intimated and C.G. Jung courageously recognized, psychotherapy for the soul. (See my prior post.)

The truth is, most psychotherapy patients need far more than what pharmaceutical intervention and/or cognitive therapy--the two most popular so-called "evidence-based" or empirically supported modalities today--can provide. They need and deserve support and accompaniment through their painful, frightening, disorienting, perilous spiritual or existential crises, their "dark night of the soul." They need a psychologically meaningful method to confront their metaphorical devils and demons, their repressed or rage, and the existential reality of evil. They need a secular spiritual psychotherapy willing to ask the right questions. In a time where so many have lost faith in God, rejected organized religion, yet still seek something to believe in, something spiritual, something transcendental or supernatural, the notion of demonic possession has diabolically tempting appeal.

For to believe that the Devil and his demons can take possession of one's body, mind and soul is to find evidence also of God's existence. And to make meaning from meaninglessness. This "will to meaning," as existential psychiatrist Viktor Frankl called it, is a fundamental human drive, one which abhors a meaningless "existential vacuum." For those who have lost faith, the myth of "demonic possession" can--in addition to providing a possibility of attributing responsibility for our darkest, most despicable or spiritually unacceptable emotions, impulses and evil deeds to something or someone other than ourselves-- paradoxically provide a path back to God, since God and the Devil are but two opposite sides of the same spiritual coin. Unless psychology can provide a better or at least equally satisfying, meaningful alternate explanation of the possession syndrome--and a more effective way to deal with it-- belief in demonic possession and the practice of exorcism are bound to persist.