Summoning a punishing angel: "Treatment of a depressed patient with dissociative features" Academic Article uri icon


  • The authors describe their treatment of a 24-year-old repentant, extremely observant Jewish man with major depressive disorder who complained of persecution by a personal angel. The therapists initiated a culturally sensitive psychotherapy of the patient, enacting a ritual summoning of the angel that resulted in the angel's transformation into an ally. The authors discuss the relationship of the patient's symptomatology to pathological mourning, trance, and dissociation. They advocate the use of a strategic combination of culturespecific concepts with modern psychiatric approaches in similar cases. (Bulletin of the Menninger Clinic, 54, 524-537) Both traditional healing practices and modern psychotherapeutic approaches are based on a rationale or a healing myth that includes an explanation of illness and health, deviancy and normality (Frank, 1973). In traditional societies, the myth is compatible with the world view (usually religious) shared by the patient and the therapist. The traditional healer-a shaman, for example-makes a diagnosis by performing certain acts, and then offers a remedy that may involve drugs or the performance of specific symbolic acts and incantations. According to Frank (1973), the healing efficacy of these procedures lies in the patient's expectation of help and in the perception that the healer possesses a special healing power. Not only in traditional healing practices, but in all health care systems, including modern psychotherapy, explanatory models accepted by patients and practitioners alike guide the choice among therapies and therapists and cast personal and social meaning on the experience of sickness (Kleinman, 1980). A potential conflict exists when the patient belongs to a subculture or religious group with beliefs and explanatory models that differ substantially from those employed by practitioners in the mental health establishment. Psychotherapists can solve this conflict strategically by adjusting to the world view of the patient (cf. Van der Hart, 1978/1983, 1988; Van der Hart, Witztum & de Voogt, 1988). Within the context of cross-cultural therapy, these therapists endeavor to help patients articulate their symptoms and solve their problems in the mold of the prevailing idiom and with metaphors from their unique cultural background (cf. Crapanzano, 1975; Good & Good, 1986; Obeyesekere, 1970). Elsewhere, we (Bilu, Witztum, & Van der Hart, 1990) have described the successful treatment, based on this approach, of an ultraorthodox Jewish patient by two secular therapists in a mental health clinic in Jerusalem. After being exposed t0 a terrorist attack, this patient developed posttraumatic symptomatology; including hallucinations of a demon who threatened to kill him. These hallucinations appeared related to the patient's traumatic grief about his father's death in a traffic accident when the patient was 8 years old. Treatment included instructing the patient to use traditional incantations intended to keep the demon at a distance and metaphoric imagery work in which the patient moved from the desert (where the demon and his aides were threatening him) to an oasis called the "Lower Paradise" where he reunited himself with his father, a mystical experience that successfully concluded therapy for him. Here we report a comparable cross-cultural therapy from the same clinic. This patient also expressed unresolved mourning regarding his father's death in the idiom of his subculture: A personal angel appeared and ordered him to perform self-afflictive behavior. The two therapists (one an observant Jew) were equally able to join the patient's cosmology. Treatment combined a standard psychiatric approach, consisting of the prescription of psychotropic medication and supportive therapy, with a culturally sensitive approach in

publication date

  • January 1, 1990