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ORIGINAL ARTICLE
Abstract
In some cultures, mental illness and its treatment may be closely linked to beliefs relating to sin, suffering, and separation
from the divine, or even possession by evil. The aim of this study was to explore whether there was an association
between receiving spiritual healing and the occurrence of schizophrenic relapses in a sample of elderly Egyptian patients.
The method used was a case-control study, comparing patients with an ICD 10 diagnosis of schizophrenia who received
spiritual healing and those without spiritual healing, in terms of the occurrence of relapses during a specified period.
Patients who received spiritual healing relapsed more frequently than those who did not (adjusted OR 3.5 p < 0.05).
Relapse was also associated with age and certain methods of healing. The risk of relapse was independent of gender,
duration of illness and type of religion. The study found spiritual healing to be positively associated with relapse of
schizophrenia in a sample of elderly Egyptian patients. It is however difficult to ascertain that the relapse actually started
after the process of spiritual healing and not before it. The study findings may suggest that religious history, at least in
some cases, should be taken into consideration when planning future management.
Correspondence to: Emad Salib, 18 Broughton Close, Grappenhall Heys, Appleton, Warrington WA4 3DR, UK
Received for publication 28th June 2000. Accepted 12th February 2001.
The aim of this study was to explore whether or not Data collection
there was a link between the occurrence of
schizophrenic relapses and receiving spiritual healing Information about cases and controls were extracted
in a sample of Egyptian patients. from case notes by a qualified psychiatrist, using a
standard format. Data was collected on all patients
prospectively to confirm whether or not they were
Methods reported to have used any form of spiritual healing
before readmission following an acute relapse during
The study sample of 40 elderly schizophrenic patients an 18-month period starting from January 1996
was drawn from the Register of Behman Hospital—an (Figure 1). Details about spiritual healing in the study
established private psychiatric hospital on the outskirts were restricted because of various constraints,
of Cairo, Egypt. The hospital accepts referrals from including attitudes of patients and relatives towards
various counties in Egypt as well as some Arab expressing their religious beliefs at the time of
countries and is renowned for its high standards of admission to hospital.
care and record keeping, and is also recognized by the There was a large diversity in types of religion,
Royal College of Psychiatrists for professional and the nature of spiritual healing itself. In almost all
training. cases spiritual healing was carried out through
reading verses from the Koran or the Bible i.e. some
form of psychotherapy based on religious relevance.
Selection of subjects For homogeneity of data collection in the report,
extremes of religious healing such as Zar and
In this case-control study, 20 schizophrenic patients spiritual possession were included under exorcism.
(cases) who were known from their previous history to Information included: socio-demographic variables,
have received spiritual healing prior to the study and illness history including age of onset, duration of
were confirmed to receive some form of spiritual condition and length of last remission. A detailed
healing after the follow up point in January 1996 were account of religious beliefs and their use of spiritual
compared to 20 controls—schizophrenic patients who healing prior to relapse was also collected. The
were not known to have received any form spiritual reliability of the data collection questionnaire was
healing prior to or after the follow up point in January tested prior to its formal use by comparing
1996. For each group the occurrence of relapses information collected by two independent doctors
during an 18-month period was documented (Figure and was shown to be reliable (Kappa = 0.6, P <
1). All subjects, cases and controls, were schizophrenic 0.05).
patients over the age of 60, on the Behman Hospital
Register, who required readmission after a period of
Statistical analysis
remission. All patients selected in the study had been
receiving maintenance antipsychotic medication prior
In view of the small number of cases and skewed
to readmission. Cases and controls were matched for
distribution for most variables, logistic regression was
age, sex, and duration of illness. In this study a relapse
used to assess the association between relapse and
was included when a patient developed an acute
spiritual healing as a well as other variables,
episode of schizophrenia that required hospital
simultaneously controlling for potential confounders.
admission following a stable remission period for
From the logistic regression equation, probability of a
cases and controls. The clinical diagnosis of
binary outcome:
schizophrenic disorder satisfied the ICD 10 criteria.
Cases included all patients aged 60 and above, who Log odds (OR) Schizophrenic relapse
= Constant + B 1X1 +
reported any form of religious healing, regardless of B2X2 + ... BnXn
its nature, method or religious affiliation of patients.
where X is the variable to be explored and B is its
Spiritual healing included: excessive use of prayers;
regression coefficient. The odds ratio were computed
reading verses of the Koran or the Bible as a form of
as exp (B), where B is the regression coefficient for
counselling based on religious relevance (for at least
the variable of interest, adjusted for age, sex, duration
an hour a day); excessive attendance at Mosques or
of illness, education, marital state, length of remission
Churches for solitary or group meditations (more
prior to relapse and depth of religious beliefs.
than 5 times a week); attending sessions that included
Statistical analysis was carried out using SPSS
the use of witchcraft or related methods (ever) and
(version 5).
attending rituals including exorcism and Zar
processions (ever). Cases were excluded if:
· Relapse was due to stopping medication. Results
· Physical illness or organic brain disease prior and
related to relapse. Of the total sample of 40, 67% were male, 65%
· Religious delusions occurred prior to relapse. married, 25% single, and 10% widowed. The mean
368 E. Salib & S.Youakim
age was 61 (SD 10) with a minimum of 60 and a differences between cases and controls in the reported
maximum of 72 years. There was no significant depth of religious beliefs (p > 0.05).
difference between mean age of male and female Of the 20 cases who reported to have received
patients in cases and controls (P > 0.05). Mean some form of spiritual healing while in remission
duration of illness for the entire study population was prior to hospital admission or other active
21 years (SD 8) with a minimum < one year and a psychiatric intervention, 50% received spiritual
maximum of 40 years. healing in the form of prayers, reading verses of the
The duration of illness did not differ significantly Koran or the Bible as a form of counselling based
between patients who used spiritual healing and on religious relevance, 90% attended Mosques or
those who did not (p > 0.05). Four patients had no Churches to an excessive degree, 75% attended for
medication (drug holidays) prior to the relapse, solitary or individual meditations, and 25%
while 40% received phenothiazines, 20% attended sessions that included the use of witchcraft
butyrophenones, 21% thioxanthines, and 13% or related methods including exorcism and Zar
received atypical antipsychotics. There were no processions.
significant differences in antipsychotic use between Seventeen patients (85%) of those who reported
cases and controls. receiving any form of spiritual healing relapsed
Table 1 summarises the characteristics of the cases compared to 12 (60%) of those who did not receive
and the controls. Four patients (10%) reported to similar spiritual support ( c 2 3.8, p < 0.05). Table 2
have no religious beliefs compared to 73% who shows the odds ratio of relapse after controlling for all
reported moderate religious beliefs (belief and other variables and potential confounders in the study.
occasional practice i.e. attendance to religious places The risk of relapse appeared higher at 4.3 (p = 0.01)
or events at least once a month) and 23% who were in cases that reported use of Zar, exorcism, and related
said to harbour deep religious beliefs (belief and methods. Depth of religious belief did not appear to
regular practice i.e. attendance to religious places or have a statistically significant association with the
events at least once a week). There were no significant probability of relapsing (p > 0.05).
Spiritual healing in elderly psychiatric patients 369
Cases Controls
Spiritual healing No spiritual healing
Sex:
Male 14 (70%) 13 (65%)
Mean age 61 (SD 10) 62 (SD 10)
60–71 60–72
Mean duration of illness 24 years 20 years
Marital status:
Married 12 (60%) 14 (70%)
Clinical relapse:
Yes 17 (85%) 12 (60%)
No 3 (15%) 8 (40%)
Religious beliefs:
None 0 2 (10%)
Moderate 15 (75%) 14 (70%)
Deep 5 (25%) 4 (20%)
Methods of religious healing:
Prayers 10 (50%)
Solitary meditation 8 (40%)
Excessive attendance 18 (90%)
Zar & exorcism 5 (25%)
R: reference category
patient may have gone to seek religious intervention as The study found that spiritual healing was positively
a result of being unwell and not that the spiritual associated with relapse of schizophrenia in elderly
healing process precipitated the relapse. Also it is Egyptian patients. The association appeared to be
possible that some of the behaviours that appeared to independent of type of religion and depth of religious
be a form of spiritual healing, such as solitary belief, but could be modified by age and method of
meditation and excessive praying, might have been healing. The possibility that some of the behaviours
symptoms of more severe psychosis. which appeared to be a form of spiritual healing could
The two main experiences that may occur during have been symptoms of more severe psychosis seems
spiritual healing process and could explain, at least to suggest that, at least in some cases, the association
partly, the observed association are: [1] mystical and may have been an effect rather than a cause of relapse.
contemplative states which involve a feeling of It is suggested that for some, patients’ religious history
communion with the divine and [2] ecstatic states with should be taken into consideration when planning
psychomotor over-activity, and heightened feelings of future management.
excitement as seen in Zar processions. Ecstasies include
possessions and trances, glossolalia and feelings of
being moved by the spirit. Both states involve the Acknowledgements
rejection feelings of alienation and disappointment in
interpersonal relationships, and the construction of a The authors are most grateful to Dr Naser Laza,
more gratifying reality. In schizophrenia, there is a Director of Behman Hospital and Drs Wagdi Salib
breakdown in the way the patient thinks of the and Sherif Atalla, consultant psychiatrists, for their
boundary between himself and the outside world so that invaluable help and support of the second author in
he can no longer accurately discriminate between the the process of collecting and validating the study data.
two. Crossing the line between the ego experience of
“self ” and failure to identify inner experiences could
possibly be explained by “thought dwelling” whether References
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