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Monday, January 05, 2009


Exorcism isn't a game

I should warn readers at the outset that this is going to be a long post - but there's a lot to say on this subject. The other night, the movie The Exorcism of Emily Rose was on television. And it bothered me a lot more than I expected.

To summarise for those who aren't familiar: the film is an Americanised and sensationalised account of a real case, that of a young German woman named Annaliese Michel, who died tragically at the age of twenty-three following a set of exorcism rituals which led to the two priests who 'exorcised' her and her parents being convicted of negligent homicide. Suffering from both epilepsy and depression, Annaliese became convinced she was possessed and, being devoutly Catholic, appealed to the Church to exorcise her. Following her death, the Church changed its position and declared her to have been mentally ill rather than possessed, but two priests did attempt to exorcise her - not once, as The Exorcism of Emily Rose suggests, but sixty-seven times. Giving up medical treatment with the support of the priests, Annaliese and her family put themselves entirely in their hands; she took to refusing all food, which, along with dehydration, eventually caused her death.

The Exorcism of Emily Rose isn't the only film made about this lamentable case. There's also Requiem, a German film I'd highly recommend: a moving, intelligent and naturalistic examination of the incident that takes an entirely different line. Rather than being about the exorcisms and their aftermath, the scariness of showing the audience demonic visions, it follows the young woman (called Michaela in this version) from the time she begins to believe she may be possessed up until the time she consents to the series of exorcisms, asking the really interesting question: why would a bright, modern young woman possibly submit to such a process? The presentation is a great deal sadder than The Exorcism of Emily Rose - Michaela's personality is much more of a factor, and she's presented as an exceptionally nice girl - and the 'possessions' are filmed from the outside. We see her collapsing or finding herself unable to touch a crucifix, but with no special effects or melodramatic music whether the cause is medical or spiritual is entirely up to the viewer.

The film's interpretation tends towards a psychological explanation: Michaela, accurately, is described as having suffered a debilitating form of epilepsy that's proved resistant to treatment for some years prior to possession ever becoming a factor (The Exorcism of Emily Rose suggests that the onset of fits and demonic visions occurred simultaneously, lending support to the idea that she might not have had epilepsy at all, which is not how it was). Michaela is aware she has epilepsy and so is her family - in fact, that's part of the problem. Requiem presents a family not just devout but tired and sceptical of doctors. Medicine hasn't cured Michaela, who's been sick for years, and her family are unwilling to trust doctors again; Michaela in particular is unwilling to accept medical treatment because the amount of freedom her family allows her has always been heavily dependent on her seeming well - for her, a medical diagnosis has long been associated with a punitive consequence. Similarly, her family is rather fraught: her mother is presented as a negative and disapproving woman who constantly treats Michaela as if there was something bad about her, even though Michaela's a nice and responsible girl; accepting the exorcisms is a way of reconciling herself with this difficult parent. There's also the issue of her relationship with the priests (two of them, again accurately, rather than the single priest of The Exorcism of Emily Rose), which has another influence: one is an ordinary, elderly parish priest, sceptical of the idea but without the strength or certainty to resist the escalating events, the other a young and idealistic man driven by good but dangerous intentions - possibly a sense of chivalry towards this beautiful young woman, and certainly a sense of personal spiritual crisis. While it's not discussed in detail, he remarks, 'The world makes our souls sick. I was close to despair' in their first meeting, talking of the world's over-reliance on science and the fact that an answered prayer doesn't necessarily prove the existence of God - suggesting that his own faith is less secure than he would wish it to be. Later on he tells Michaela, 'I have to see it as a trial or there is only despair left to me,' more or less acknowledging that his own emotional needs are driving him. He insists that Michaela is being 'tested' because she's 'special', perhaps seeing what he wants to see: a real spiritual drama, far removed from his regular round of giving sermons to small congregations and being asked to bless cows - a proper professional challenge to revive his own faith.

The personalities of the five people involved, in short, mesh together: Michaela's exhaustion with her own illness and the doctors' failure to cure it, her desire to be at peace with her mother, and perhaps the sense that it's easier to slip into being a martyr than to fight both her illness and the world for independence; her father's desire to see her better; her mother's sense that there's something wrong with her; the older priest's failure of certainty; the younger priest's need for something extreme to make his priesthood seem worthwhile to him. Five basically decent people influence each other into a terrible mistake. Michaela's fits, which are not the main focus of the film, seem a combination of her epilepsy and an expression of the stress she lives under, perhaps an opportunity to act out her desperation, her submerged anger towards her family and her fear that it's all hopeless; the slide into 'possession' seems as much an emotional breakdown as a case of epilepsy.

So Requiem is a plausible account of events, but one that doesn't pretend to precise accuracy. The beginning credit reads: 'Requiem is based on real events but the characters and situations portrayed in the film are fictional.' (Or 'freely imagined', in another translation.) It's a sensitive consideration of how such a tragedy might have happened, and as such, is an admirable film.

The Exorcism of Emily Rose, on the other hand, is problematic. Set up as a courtroom drama, it begins with the girl's death and follows the trial of 'Father Moore' (not the parents; 'the priest admits he ran the show' someone explains, which apparently acquits them) for negligent homicide, interspersed with flashbacks to the 'possession' and the exorcism. On the one hand, the movie strays much further from the real events than Requiem - but on the other, it's much less clear that it's fictionalising. At times, it comes uncomfortably close to suggesting that it's preaching the truth.

To begin with, the opening credit reads: 'This film is based on a true story.' Just that. 'Based on' is a phrase open to interpretation - you can diverge a long way from a story you're based on - but without Requiem's careful acknowledgement that a film version isn't, can't be, an accurate account, there's already more of a claim to verisimilitude in the first few seconds. And it's not just in the title card that truth is vaunted. The priest on trial returns again and again to the importance of 'telling Emily Rose's story', 'what really happened and why': structurally, the movie is of course 'telling Emily Rose's story', but by bit, in the same way and in the same order that the priest wants it told - which, it's later implied, is also following Emily's dying wish of spreading the 'truth'. The set-up of the story thus carries a heavy implication that, in spreading her 'true story' to a wider audience, it's following the fictitious Emily's request.

But a lot has been changed - important things. The film makers aren't interested in the psychological dymanics that preceded the 'possession'; we hear from the mother that 'Before she went away to university, my Emily was so very happy,' and, as I've said, there's no suggestion of epilepsy before the demonic visions began. 'We never had any problems like that before,' the father declares. Emily was 'completely normal' in between demonic episodes, someone explains, which proves that she wasn't mentally ill or epileptic, presumably because ill or epileptic people never, ever have moments of clarity - which will come as something of a surprise to anyone who actually knows a person with mental illness or epilepsy, because in reality almost everyone with such a condition is lucid a fair proportion of the time. In this version of events, it's possible to conclude, as some characters do, that she never suffered from epilepsy at all; there's certainly nothing in the story to suggest that there might have been problems within the family that allowed their daughter to die.

The trial, instead, is set up as a conflict between faith and science. 'We're going after a holy man,' remarks one lawyer, and the prosecuting lawyer's belief that a priest should be held to higher standards than the average person, and thus punished more severely is dismissed by the defense lawyer as a lack of the 'forgiveness' and 'compassion' that the prosecutor's religion dictates. In fact, religion isn't given much more of a context than this. Requiem paints a detailed portrait of a Catholic life in the 1970s, but we don't see the details of Emily Rose and her family's belief in anything other than demonic possession; the priest's teachings to his lawyer consist largely in warning her against demons. The prosecutor closes his case by calling the priest's beliefs 'superstition', the defender with the statement, 'I cannot deny that it's possible', as if the issue was about the existence of demons rather than about neglect of care - care you'd expect a priest to take seriously, demons or not. The issue the film is really interested in is not 'How could this happen?', as with Requiem; it's interested in asking whether 'Emily Rose' was really possessed. And it tends towards the answer 'yes' - because, after all, that makes for a more exciting horror movie.

In an interview, the makers commented quite correctly that they had taken 'certain dramatic license', remarking thus: 'My angle is, even if I don't believe necessarily in demonic forces, I think it's cavalier to dismiss people's beliefs when they have real credibility about what they feel and what they believe.'

Just from an artistic position, I do agree that even-handedness when portraying religion can be a worthy aim; my upcoming book, In Great Waters, attempts to do just that, revolving around two central characters, one deeply religious and the other unshakeably atheist. People being what they are, I suspect that Christian readers will consider it to be proselystising atheism and atheist readers will think it's preaching Christianity, which should be fun, but I'm doubtful when it comes to The Exorcism of Emily Rose. The apparent confusion over the word 'credibility' in that sentence - someone can't have 'credibility' about what they believe; credibility is about track record and actions, not beliefs and feelings - is not, I think, just me being a grammar snob. The word seems to imply a conflation of two different things: belief and believability. Believing something deeply doesn't make it credible to anyone but you - and ascribing someone credibility purely on the basis of their strong faith is a dangerous business. You can respect someone's right to believe without having to endorse what they believe.

So trying not to dismiss deep faith out of hand is fine as long as you don't start pretending to agree just to be polite - but adding more and more to the story to weight it in favour of those beliefs is more than just showing respect. (It's worth pointing out that the makers of The Exorcism of Emily Rose had no contact with the Michel family, while the director of Requiem met one of Annaliese's younger sisters several times; interest in the real people, which is an important element of respect, is on Requiem's side.) But leaving aside issues of who consulted who, it's perfectly possible to depict people as sincere in their beliefs, entitled to their beliefs, motivated by the best of intentions - yet still misguided or irresponsible in how they carry them out. One neutrally-presented exorcism after which the daughter dies, which is not what we get, would look like an ambiguous tragedy. One wildly dramatised exorcism in which lightning flashes and snakes and cockroaches swarm from all sides, which is what The Exorcism of Emily Rose gives us, looks like Satan killed your daughter. But sixty-seven exorcism rituals in which the daughter's knees ruptured from the genuflections, which is what actually happened, looks like a reckless disregard for her safety - and to rewrite that with added creepy-crawlies isn't what the film makers call 'some kind of even-handedness', it's taking sides. We see a few moments of 'possession' revisited, staged as if they were ordinary fits, but nothing like as many, and nothing like as compelling: the drama is all on the possession side. The film makers' addition of a doctor who attended the exorcism - no doctor attended the real exorcisms, which may be one reason why Annaliese died - is whitewashing. Add to that the 'based on a true story' premise and we have a highly slanted film pretending verisimilitude.

What's particularly troubling is the change in the girl's motivation. In the movie, Emily accepts her suffering because it will prove to others that demons are genuine. 'Through you, many will come to see the realm of the spirit is real,' the Virgin Mary tells Emily in a vision, and Emily herself adds, 'Through my experience, people will know that demons are real. People say that God is dead, but how can they think that if I show them the devil?' Watching this, I felt an instant, reflexive scepticism, though it took me a moment to work out why - and later on, to discover that my instinct was correct. Annaliese Michel was Catholic, and suffering to prove the reality of your faith isn't a Catholic thing. It's an old joke that Protestants believe and Catholics know; Catholicism isn't concerned with proving its truth. That might be the motivation of an American Evangelical Protestant girl, perhaps, but not a German Catholic - and in fact, my reaction was correct: Annaliese fasted herself to death because she believed it would atone for the sins of apostate priests and sinful youth. 'Offer it up': that's a Catholic motivation; it's what the nuns told my mother to do if she complained about something. Possibly this is just cultural misunderstanding - the subtleties of a faith are not necessarily clear to someone who isn't used to it - but it also feels disturbingly like a shout-out to the audience. I suffered torments to prove demons are real, and now this film is spreading the word! You have to believe! The girl's sufferings are undoubtedly distressing, and if an audience member accepts the 'based on a true story' motif, continuing in the belief that demons aren't real feels uncomfortably close to turning one's back on a young woman in pain. It puts a certain emotional pressure on the audience to believe in demons - one that your average viewer is more than capable of resisting, no doubt, but still a rather odd change on the part of the film makers. Emily is presented, in fact, as someone we should believe in if we want to enter a richer spiritual world: 'I never knew how dead I was until I met her,' her boyfriend declares, with the strong implication that the audience are equally dead if they don't believe in her story. The closing credits conclude, 'As Emily predicted, her story has affected many people' - citing a prediction that Annaliese Michel didn't actually make, and again supporting the sense that the film is a continuation of the fictional Emily's need to get the story out to as many people as possible.

So the film makers' claims of neutrality don't hold up when you compare the film with the real case. If you change a lot of facts, and everything you add or subtract is a change that favours one side, you're being about as fair and balanced as Fox News.

Let's be fair ourselves. Based on interviews with them, I actually wouldn't assume that the film makers are trying to proselytise a belief in demons. It's easy to get swept up in a story and end on the most dramatic note, even if it doesn't express what you really think: Stephen King concluded Gerald's Game by having the heroine declare forthrightly that 'the only reason a man sticks a ring on your finger is because the law no longer allows him to put one through your nose.' If a happily married male writer can get sufficiently caught up in his story to go with the rousing conclusion that all men are domestic abusers, it's reasonable to conclude that secular film-makers can get sufficiently caught up to go with the idea that demons are real just because it makes things more exciting - especially as both King and the makers of The Exorcism of Emily Rose are working in the same genre, horror, a class of story where drama and shock are supposed to prevail over reason and balance.

If anything, I'd interpret their favouring of the possession idea as a writer's argument for freedom of the imagination - one of those little manifesto thoughts that can slip unconsciously into a narrative. 'Facts leave no room for possibilities,' declares the defence lawyer in what's almost a pre-emptive strike to anyone who points out that the film is factually inaccurate; talking to the jury, she speaks of Emily Rose's story as a chance to believe in 'a more magical world'. Writers need freedom to imagine whatever they wish, and sometimes they can get caught up in expressing that need. I would interpret the film's bias as an expression of the film makers' desire to picture and create something 'magical', rather than necessarily an attempt to convince the audience about demons: an attempt to assume an intellectual position they wouldn't ordinarily hold, in the same way a dancer might strike an unfamiliar pose to see how it felt.

But if you're selling it as a true story, and changing things to make the film evangelical in its tone if not in its intentions, you're being profoundly irresponsible. Because people believe in demons in the real world. And not just mentally ill people.

A while ago I solicted donations on this blog following a documentary called Saving Africa's Witch Children, which you can see here: parts one, two, three, four, five and six. The documentary is extremely upsetting, be warned; if it's any consolation, it would appear that following the documentary, steps are being taken to arrest the murderers and stamp out the practice, which is a fine thing. The situation is this: in Nigeria, a moral panic has built up around the idea that witch children are causing havoc in their villages. A child so accused, who can be a mere baby, is liable to be ostracised, starved, beaten, burned, cut, tortured and either murdered outright or 'exorcised' to death.

Now, according to the documentary, there was a terrible upswing in such cases following the widespread release of various movies describing how 'witch' children can wreak evil, particularly a film called End of the Wicked, produced by Liberty Films, a branch of Liberty Foundation Gospel Ministries. The documentary quotes the minstry founder Helen Ukpabio's website, which boasts that 'Liberty Films delivers the truth in a fresh and exciting way, and has led to the deliverance and salvation of many. Our books and publications also enhance the message of deliverance and hope to all those in the clutches of Satan.' The documentary makers went to interview Helen Ukpabio herself, a quick-tempered woman with a lot of blood on her hands whose main response to the suggestion that innocent children were being murdered by people who believed in her message was to turn on the interviewer (a white woman) and accuse her of racism - demanding, among other things, why she wasn't also challenging a white woman like J.K. Rowling ('Do you go to ask her? Is it because it is Africa?'), a challenge so ridiculous in so many ways that I'm not even going to bother dismantling it. (If you don't have time to watch the whole documentary, you can see the interview at the beginning of part 5.)

In the light of this, a fairly throwaway line in The Exorcism of Emily Rose assumes a rather horrifying undertone: an academic expert witness is called to defend possession, being a specialist in 'contemporary cases of possession, mostly in the Third World.' Like, perhaps, Nigeria, where they pour acid on five-year-olds? It's at this point that the film's quest to prove 'a more magical world' starts to seem really questionable. This expert witness is described as one who studies possession 'from a scientific perspective and doesn't try to debunk it' - which seems an odd understanding of what 'scientific' means, given that the whole scientific method depends on trying to disprove things and considering theories valid only if they can withstand people 'trying to debunk' them with great energy: the implication, bizarrely, is that scepticism is unscientific. But it goes beyond that. One man dismisses the idea of citing such possessions on the grounds that the Third World is 'primitive and superstitious', which neatly implies that it's only racism and cultural prejudice that would make you doubt such beliefs - rather similar to the line Helen Ukpabio takes, in fact - but I would argue that actually, by making a vague gesture at 'the Third World' to back up the fictional story is rather closer to the cultural prejudice Chinua Achebe describes as 'reducing Africa to the role of props', 'Africa as setting and backdrop which eliminates the African as human factor.' People die of exorcisms in Africa as well as in the West, and they all matter equally; casually nodding at 'the Third World' shows a certain disrespect for the fact that ideas about possession are a real problem for real people there, not just a generic cultural background.

The situation in Nigeria only one example, though a particularly recent and heartbreaking one; people's courses of action are often influenced by fictional representations of real, or purportedly real, phenomena. The psychologists who tried to treat Genie, a girl rescued from a home so abusive that she had been denied any kind of conversation and had a vocabulary of about two words ('stopit' and 'nomore'), watched Francois Truffaut's L'Enfant Sauvage, an account of the similarly languageless Victor 'the Wild Boy of Aveyron' for inspiration.* That's a mostly benign example, though Michael Newton points out that it may have been problematic - 'More negatively, the misleadingly upbeat ending of Truffaut's film (in which Victor appears to be heading for a full place in the human community) may also have subtly influenced the scientists' expectations about the possible outcome of their work ... More than this, Victor's story might have helped to create for the Genie team a narrative in which the role of heroic educator was uncast. Perhaps it was now the subtle and in many ways understandable conflicts began in which each sought to assume the part of Genie's saviour.' (Conflict between her potential parent figures led to her life being disrupted in various damaging ways.) And the scientists themselves acknowledged potential issues: 'All of us saw in the movie what we were prepared to see to confirm our own biases,' remarked one of them. ** Intentions were honourable, but Genie's life went downhill nonetheless, and while it would be silly to blame Truffaut for this, his influence is acknowledged to have at least been felt in the tragedy.

There are more dangerous examples. A lot of the thinking behind the 'Satanic Panic' of the 1980s, in which daycare attendants were accused of grotesque and implausible abuses, traces back to the book Michelle Remembers, a supposed personal account of ritual abuse based on the 'recovered memories' of a woman known as Michelle Smith - 'memories' that there's a lot of evidence against, such as yearbook photographs of her taken at a time when she claimed to have been locked in a basement round the clock, and that are most probably the result of false memory syndrome induced by her psychiatrist, who co-wrote the book.*** A lot of people went to prison over those years.

It's worth noting that, leaving aside the Genie example on the grounds that it was a secular attempt to help someone rather than a moral panic, these things crop up in different continents, and they bear a fair resemblance to each other, people being people wherever you go. Daniel Radosh's Rapture Ready!, for instance, refers to an American kids' show called Bibleman (a superhero for the Lord) where one villain zaps children with something called a neuroiconoclasticskepticizer, 'which causes them to go glassy-eyed and say horrible things like "I don't wanna go to Vacation Bible School." Because there's no way a child would say that unless he was under some evil influence.' Similarly, also cited by Radosh, the novels of Frank Peretti discuss people being latched on to by demons who infect them with lust, or greed, or whatever. Of course, that's fiction taking some artistic license - Peretti, according to Radosh, 'stresses that he doesn't have any theological expertise, much less personal experience of demons; that all he does is take concepts he finds in the Bible and invent fantasies about them. And yet many people refuse to believe him. Terri was one of them. "With how vivid he puts everything, I honestly think that's something he doesn't just come up with. I think it's got to be something he experiences and walks in. I do feel like he's experienced those things."' And, again, of course, the idea that people can't possibly just be inventing stuff is by no means confined to the religious - but there is, at least, a theological consistency between these American tales and the African ones. In End of the Wicked, the child heading the coven tells a member, 'I invoke upon you the spirit of stubbornness ... lack of interest in school, waywardness, unsteadiness, bad company...', which sounds pretty neuroiconoclasticscepticizing. The idea that ordinary annoying qualities or vices are imposed from without by bad spirits is not confined to one culture. Of course, these American examples are just pop culture and nothing like as gruesome in their consequences as Ukpabio's film - but possession is a real idea in the West as well as elsewhere. Consider 'exorcism therapy' - there's an abstract for a study of it here, which comments 'Although many patients subjectively experienced the rituals as positive, outcome in psychiatric symptomatology was not improved. Negative outcome, such as psychotic decompensation, is associated with the exclusion of medical treatment and coercive forms of exorcism.' - and those two examples took me about ten seconds to pull of the Net. Now imagine your community pressing you to accept exorcism rather than medication while your brain was slowly crumbling from within. Which is why it's serious no matter what the country if people start believing that physical abuse or neglect, and withdrawal of medical help, is the answer to 'demons'. Exorcism and possession may sound weird to many of us, but they aren't quaint or obscure. They're real beliefs having a real effect on real people suffering from real illnesses - and it's happening today.

Here's an article in the Guardian about the phenomenon, described as 'a form of spiritual abuse' by a reverend - who points out that 'sexual abuse, homosexuality and unwanted pregnancy were often seen as routes for demonic possession.' The idea that religion might step in declaring 'More needs she the divine than the physician' is not confined to fiction: it's happening in the world around us. Even if people don't die in the exorcisms - and of course, most don't; Annaliese's case became famous because it was extreme, not because it was unique - they're still at risk. One of my friends who's suffered from mental illness made the following important point: while it's not uncommon to personify your illness to some extent - I Don't Want To Talk About It by Terence Real gives examples of men identifying their depression as a gorilla, a shark or Hitler; Churchill famously called his 'the Black Dog', Antonia White referred to hers as 'the Beast' and so on - there's a real danger in personifying it and then putting control of it in somebody else's hands. If you decide your illness is a demon and then try to cope with it yourself - ignoring thoughts that seem characteristic of the illness because that's the 'demon' talking, trying to build on the positives in your life to reduce the 'demon's' influence over you and so on - then you're really not doing much more than a religiously-toned version of CBT. But if you put yourself in the hands of an exorcist, you're setting up a situation where you can't control the illness/demon, where it has to be removed by an external force. It's an extremely good way to reinforce a sense of helplessness - and the thing is, controlling a mental illness has to be done by the patient. Nothing else works. The patient may use resources to fight the good fight - medication, CBT, therapy, exercise - but they're only effective if they patient is deliberated and self-determinedly using them as weapons against the disease. A priest who says, 'Your illness is a demon trying to distract you from God; you can overcome it if you try' may be being unscientific - and irresponsible if they also discourage their parishioner from taking necessary medication - but they are at least granting the parishioner some of the autonomy and dignity that are so vital if someone is to fight the sickness. A priest who insists 'You're possessed by devils, and you must put yourself in my hands' isn't just blocking a medical path, they're convincing their parishioner to believe themselves unable to control their own disease. They've usurped the role of General that should be occupied by the patient and demoted them into disputed territory - and territory can't fight for itself. It's one of the world's nastiest self-fulfilling prophecies.

And the numbers are surprising. According to the Washington Post, 'Exorcism is far more widespread today than most people imagine. According to Richter, there are about 70 practicing exorcists in France and just as many employed in Italy. In July this year, a congress in Poland was reportedly attended by about 350 practicing exorcists.' It's a minority activity, but it's not a one-off. It's seriously practised.

Prayer and medicine together are fine, but mental illness is a horrible scourge that desperately needs proper treatment. Considering the case of Annaliese Michel, I'll have to acknowledge my own limited expertise: she suffered from epilepsy and depression, and possibly more besides. I'm not a psychiatrist. I know one person with petit mal, which is nothing like as drastic as Annaliese's condition - but which definitely needed medication: epilepsy creates electrical storms in the brain which can cause permanent damage there, and it's crucial to keep fits to a minimum; encouraging someone with epilepsy to do otherwise is encouraging them to court injury. I know a lot of people with depression, though. The frightening thing is, it can look a bit like demonic possession; I've said elsewhere that when dealing with fiction, at least, the idea of depression as a possessing force - 'parasite personality' is the phrase I used - is grimly convincing. I've seen people I love lose it when their depression overwhelmed them, and it's a scary thing to watch. Body language changes. The face contorts into a different and worrying expression. The voice changes tone. Empathy breaks, emotion overwhelms the sufferer and isolates them from their normal selves and from those around them, leaving an observer to feel as if there are two different realities in the room, one normal and one malign. At its most severe, depression is a very frightening sight, and considering it a possessing force, metaphorically at least, is not as wild an idea as it might sound if you haven't seen it. And that's just depression on its own, never mind depression combined with epilepsy and who knows what else.

So if I had a child who was this sick and acting this alarmingly, and if I was deeply religious and believed in demons, and if medication wasn't working - because while it usually helps, it can take time to act, it can take time to find the right prescription, and some diseases are distressingly resistant to treatment - what would I think? Wouldn't I want my lovely child back? Wouldn't I be frightened of the thing that was destroying them? And if I was encouraged to think so, mightn't I be inclined to believe that it was the devil's work? I'm an agnostic and sceptical about any tales of the devil, but after seeing mental illness I have a vivid mental image of him nonetheless: having known mental illness, I feel like I've met the devil. And I'm secular. How hard would it be for someone who did believe in the devil not to feel his presence if your child seemed to be losing herself?

And if I was a member of a faith that believed in demons theoretically, but had never expected to meet one myself - and my child started acting desperately sick - and I'd seen a film I believed to be based on a true story that supported the idea of exorcism - mightn't I factor that film into my thinking when deciding what to do? I don't believe any one film ever converted anyone to a course of action - End of the Wicked would have done little harm in Nigeria if people there weren't ready to believe in spirits and demons to begin with - but there's such a thing as a push in the wrong direction. Nigeria had a combination of traditional beliefs and Pentecostal Christianity that laid the groundwork for 'witch children', and the West has a combination of Christianity and hostility to psychiatry that lays plenty of groundwork for negligent exorcisms.

Because it's not just cases of terrifying acting-out that are a cause for concern here. Mental illness is plenty stigmatised as it is, even in its less extreme forms. The world is full of people eager for some other explanation, any other explanation, than 'mind diseased'. One of the many lousy things about mental illness is that from the outside it looks, well, completely irrational. There's nothing physically wrong with the patient - or at least, nothing you can detect. (Actually there probably is something physically wrong in their brain tissue; recent findings suggest that depression is neurodegenerative, for instance, but the lesions of a mental illness are tiny and delicate, and hidden inside a skull, so the naked eye can't pick them up.) As a result, there's always a massive temptation to assume that the patient has nothing really wrong with them except their behaviour, that if they just pulled themselves together, or prayed themselves clean, they'd be fine. There's a lot of hostility to medication when it comes to mental illness; people love to talk about us being an 'overmedicated society', even when many mentally ill people actually don't get the treatment they need. Yes, doubtless some doctors overprescribe things like Prozac - you can find doctors who overprescribe most things. But mental illness is extremely common; a doctor friend of mine estimates that three out of four people will suffer at least one depressive episode in their lives - so even if the majority of people were being prescribed a drug for mental illness, it would actually be a case of sick people getting what they need rather than a sign of a degenerating culture - and sick people getting treatment is a sign of a culture being healthy and well-run, not of degeneration. It's when sick people aren't being treated that a culture's in trouble.

This 'overmedication' scare doesn't attach to non-psychiatric medication. Close to a hundred per cent of people in the West have taken aspirin at some point in their lives, but I don't hear much outcry about us being an overmedicated society because of that; it's assumed that people take it when they need it. It's generally agreed that antibiotics, which most people have taken at some point, genuinely are overprescribed, with measurable bad consequences for humanity (I've never heard of SSRIs creating a 'superdepression' or anticonvulsants creating a 'superepilepsy'), but people are nothing like as eager to point to antibiotics as the sign of decadence. It's agreed that they're very valuable when prescribed correctly, misused when prescribed unnecessarily, and should therefore be used appropriately. Tell someone you think you need antibiotics for your sore throat, and they're most likely to suggest that you consult a doctor to see if you're right - but try telling someone you think you need antidepressants, and watch how uncomfortable they get ... and how likely to suggest that you try other alternatives first. Taking antibiotics for a chest infection is considered an appropriate use of medication, but for far too many people, antidepressants are considered a lack of spine and independence, a flabby failure of will, a desire to medicate yourself out of normal emotions you're too weak to deal with. (Rather than what they are, which is a treatment for organic brain dysfunction in which abnormal emotional pain is one of many symptoms.) In situations like this, a religious person is all the more likely to reach for prayer as a first resort: after all, God is supposed to deal with matters of the spirit. (Plus, of course, medication can take a while to work, and we want instant results. Not even because we're an 'instant gratification culture', but because if you or a someone you love is in pain, you want that pain stopped as fast as possible. The Exorcism of Emily Rose blames 'Gambutrol' - a fictitious anticonvulsant - for failing to cure Emily's fits immediately, but plenty of drugs take a while to have an effect. Patients prescribed SSRIs are generally warned that their symptoms will actually get worse before they get better.) To suggest that it's all right to support a mentally ill girl in her refusal of medication is tantamount to suggesting it's all right to encourage a cancer patient to reject surgery because they believe a trip to Lourdes will fix them right up - only more so, because we live in a society that puts up a lot of resistance to medical care for the mentally ill as it is, whether religious or secular. You don't have to be religious to feel that not taking medication that would very likely cure a terrible disease has a certain moral cachet to it. The Guardian article I cited earlier quotes the Mental Health Foundation: 'The charity warned that the notion of demonic possession could be extremely damaging when linked to people with a label of mental illness and "risked conflating notions of evil and ill health."' In a culture where even secular people are unwilling to accept the idea that mental illness isn't somehow the patient's fault, such notions can be incredibly dangerous.

Mental illness rips people up in every country in the world. In many of those countries, there's resistance to getting it properly treated - even in technologically developed countries where decent treatment is available. The anger I feel at the harm such illnesses cause people is hard to express without sounding unstable myself, so I'll confine myself to saying that one reason why I'll accept a personified version of someone's illness in real life is that it allows me to fantasise about finding that personification and torturing it to death. But I know, more than that, that it's never okay to torture the person in the name of getting at the disease.

The thing is, when making a horror movie, mental illness is a rather convenient toy to play with. 'I'm not crazy!', character after character cries; the monster's real, and the psychiatrist who tries to treat them is an obstacle to solving the problem, an ignorant know-it-all trying to force someone to give up their truth. It's an issue such stories have to address, because someone insisting the boogyman is after them probably would run into questions about their mental health pretty fast, but that doesn't make it okay to be cavalier. Like Africa, mental illness shouldn't be treated as a prop.

Dealing with serious matters like this, the artistic duty of honesty becomes more sacred than ever. It's always important to be truthful, whether you're producing the next arthouse masterpiece or a mass-market popcorn fest: art expresses, and has to reach for something worth expressing. Simplifying a story to make it fit into a two-hour film is fine; the amalgamation of the two priests who exorcised Annaliese Michel into one priest who exorcises Emily Rose, for example, is fair enough. Unless the relationship between the two priests was a crucial factor, it doesn't change the essentials of the story. (Though Requiem kept the two priests, of course, and it's still a better film.) The story of Annaliese Michel is a complicated one: unlike the young victims in Nigeria, she actively participated in the belief that she was possessed, so the withdrawal of medical treatment and exorcisms were done with her consent. In such cases, new questions arise: if someone's not in sound mind, at what point can their consent be trusted or overridden? These questions are serious because they stray, even without religion, into dangerous territory where the dignity and autonomy of the patient can be violated, where their rights and their best interests may seem to conflict, and there are no easy answers. In such situations, in fact, easy answers must be resisted, because they'll probably end up damaging the patient. The case of Annaliese Michel seems largely like a failure of pastoral care on the part of the Church; an ordinary family can't be expected to be experts either on psychiatry or on theology, and it should have been the duty of the priests to ensure that she got proper medical treatment as well as prayers, even just on a common sense, belt and braces principle. They succumbed instead to a common failing: viewing medicine not as an ally but as a competitor - to the point where it doesn't seem to have occurred to them to do what The Exorcism of Emily Rose pretends they did, and brought in a doctor to make sure she wasn't injured in the exorcism process. Such a situation involves a complex diffusion of blame, and anyone trying to depict it owes it a lot of care and thought.

As it stands, though, The Exorcism of Emily Rose seems to have struck truth a double whammy. On the one hand, the laudable aim of being understanding towards those whose beliefs or actions are abhorrent to you - a fine thing for art to do - has overshot: so much time and emotional energy is spent presenting their perspective that the alternative, you-shouldn't-let-people-die perspective fades into the background. On the other hand, the film makers have gone for sensational scenes with bugs and thunder galore, plus creepy manifestations affecting other characters to add to the spookiness, which in terms of spectacle and the evidence of our own eyes seems to provide tremendous evidence for the idea that there really were demons in the girl. Broad-mindedness and a desire to be spectacular have forged a strange alliance.

If it didn't make an issue of being based on a true story, and lay so much emphasis on the 'true' girl's desire to have her story told, this wouldn't be so much of a problem. But as it is, the result is a film that comes uncomfortably close to suggesting that letting a sick girl starve to death is really not a big deal, morally speaking, just as long as you're convinced you're acting for God - which, according to the film's visuals and the characters we get to hear from properly, you actually are.

Morality, as a result, winds up oddly constrained. We never hear very much from the Christian prosecuting attorney, for example, who believes in God but believes the priest sinned nonetheless. Such a position, which you'd think would be a perfectly sound one, is treated only as an antagonist's stance, there to be defeated. Not only do we see compelling portraits of Emily's visions, but the supernatural effects bleed out into the rest of the story: as early as fifteen minutes in, our lawyer heroine finds her watch stopping at 3am, the witching hour, and she too is plagued by night terrors. She finds a gold locket with her initials on the street, and takes it as a sign from God, wearing it on the priest's advice. This looks more like stealing than faith - you'd think she should have at least tried to find out if the valuable trinket had a rightful owner, not to mention the fact that it's rather materialistic of faith to provide her with such a flattering accessory - but the film does have some moral stumbles like this. Oddly, for instance, the priest decides at the end not to go back to his parish, because he's 'seen the darkness' and feels affected by it - apparently uninterested in sharing his experiences with the souls he's supposed to be saving from said darkness. You'd think that if demons were real, people might need to hear about it, but Father Moore seems more inclined to retreat into splendid isolation than to carry on the good fight. Similarly, the lawyer turns down a partnership at her firm at the end, having previously been threatened with the sack for pursuing the trial as she thought right, apparently uninterested in the greater freedom to follow her conscience that this professional security would provide. The film makers' love of gestures sometimes overrides the sense that characters might have responsibilities that extend beyond the moment of the gesture itself, which is at the root of what's really wrong with the film.

In short, there are a lot of problems with The Exorcism of Emily Rose. It purports to be a true story while slanting both the facts and the language to favour an interpretation that justifies allowing the death of a sick young woman. Other continents and dangerous illnesses are treated as mere props to a fairly splashy horror story, and grand gestures carry more weight than serious assumption of duties and responsibilities. Its flaws wouldn't be very serious if it didn't purport to be a true story. Some horror films are inspired by real events, but if they don't claim to be actual depictions of them, it hardly matters; nobody thinks Psycho or The Texas Chainsaw Massacre are accurate portraits of Ed Gein. If The Exorcism of Emily Rose had contented itself with being one of those, it would just be a descendant of The Exorcist with a courtroom twist - but the fact that it lays emphasis on telling a 'true' story invites, demands, that the audience consider it in the light of reality. And in the light of reality, it's misleading in a worrying way.

I'm not saying that people will undoubtedly start starving their children to death because of this movie; that would be a wild prediction that I have no evidence to back up, probably alarmist and certainly nothing more than ill-informed speculation about the actions of people I've never met. My aim is to talk about the film and the decisions of its makers, not to forecast the reactions of its audience. What I am saying is this: there is a history of people taking works of fiction that purport to be true - End of the Wicked, Michelle Remembers - and letting the new 'information' have a profound effect on how they behave towards their fellow human beings. Fiction does influence how we think; my impressions of Ayn Rand and Queen Elizabeth are heavily bound up with Helen Mirren nowadays, for instance, because things that strike our emotions tend to stay in our memories more than things that only touch our reason. When handling an real event - and setting out to present it as dramatically as possible - an artist ought to be very, very careful in how they portray dangerous subjects like mental illness and exorcism. People die of them. We should always try to be honest, particularly when we're creating art, and claiming greater accuracy than we should is always a questionable business. When it comes to claiming accuracy about real events that involve real dangers, that honesty becomes crucial. I'm not saying that The Exorcism of Emily Rose will influence people to start 'exorcising' people they should treat; I'm saying that if there's a chance that it might, the makers ought to have been very careful with their claims of honesty - and I don't think they were. It seems more like they tried to have it both ways: the authority of a 'true story' with the freedom to invent of a fictional one. I can't predict the consequences, but I do believe this carelessness is irresponsible.

In conclusion, I'd like to address the point that supporting exorcism is not a question of faith versus unbelief. To say that exorcisms are an irresponsible way of dealing with physical illnesses is not to attack the idea of faith. One doesn't have to support abuse to support respect for religion - and for the Christians in the audience, there's Scriptural precedent for this. I'd refer to Matthew 7 23-24: 'Many will say to Me in that Day, "Lord, Lord, have we not prophesied in Thy name, and in Thy name have cast out devils, and in Thy name done many wonderful works?" And then will I profess unto them, "I never knew you: depart from Me, ye that work iniquity."'

*See Savage Boys and Wild Girls: a history of feral children by Michael Newton.
** See Genie: a scientific tragedy by Russ Rymer.
*** See Satan's Silence: ritual abuse and the making of a modern American witch hunt by Debbie Nathan and Michael Snedeker.

[...] nobody thinks Psycho or The Texas Chainsaw Massacre are accurate portraits of Ed Gein.

I would almost be willing to wager that someone out there does. ;-)

Wonderful entry, and worth every word. I haven't seen Emily Rose myself, even though a favorite actress (read: crush) of mine is in it; maybe I'll add it to my list of Things to Rent.
Another penetrating article, Kit.

I took particular interest in your distinction between psychiatric medication (antidepressants, anticonvulsants, &c.) and antibiotics.
I haven't seen either movie, so I can't comment. But I tend to avoid movies "based on a true story," because I know they're not really "true," but with the power of the visual medium, you can't help accepting them as true, to some extent anyway.

On the other hand, some of my favorite novelists have been known to base their plots on real incidents that I've read about in the paper. But somehow that's different; those books are quite clearly works of imagination. A writer hears or sees something that causes her to think about what might have bought about that situation, or what might have been a consequence, and takes it from there. Well, you'd know about that better than I would, but that kind of thing is still "truer," in its way, than any sensationalized piece of moviemaking.

Does it make a difference, I wonder, if the persons involved are still alive, or were within living memory? Is "based on history" more defensible than "based on a true story"?

I agree that exorcism is not a game. Mental illness isn't a game either. I get tired of the sensationalized stories, and the long-distance diagnoses, and the reducing any behavior that someone disapproves of, to a mental problem. The kid who doesn't want to go to Vacation Bible School may not be possessed by demons, but he probably isn't suffering from "Oppositional Defiance Disorder" either.

This piece hit home personally, too. My sister, in her teens, developed what in retrospect must have been a neurological disorder. It didn't show up on scans as one of the diagnosible (if that's a word) varieties of epilepsy, and nobody quite knew what it was or how to treat it. For years, she traveled between neurologist, psychiatrists, psychologists, counselors...from everyone she saw, she got a different diagnosis: seizures, agoraphobia, anxiety, depression, bulimia, on and on. Well, anyone would be anxious, depressed and agoraphobic if she couldn't leave the house without bringing on a panic attach, and was spending her youth in hospitals and clinics instead of high schools, colleges and jobs.

We were Catholic, and my mother said a lot a prayers and lit a lot of candles, but it never occurred to anyone to call in an exorcist! But in a different time and place, I can see how that might have happened.

Forgive the rambling; lots to think about in this piece, and lots of memories.

Word is "olathil" which sound quite pharmaceutical: when all else fails, try Olathil before calling Father Exorcist!
This isn't the first time you've described depression that way, and I always find it interesting because it doesn't match my experience with depression at all. I'm not saying you're wrong or anything, obviously 1) depression will look different from the outside than how it feels from the inside, 2) different people have different experiences anyway, and 3) we live is (slightly) different cultural contexts, which will affect how we view that sort of thing, but it's really interesting to me just how different our ideas of it are. I never thought to personify my depression or treat it as somehow independent or separate from my self.
Well, no one has the final word on depression, so if it was different for you then I won't contradict you! And that may well be the best way to treat it in some cases; after all, identifying it as an outsider isn't always accurate. Multiple viewpoints are always important in learning about something, so thanks for sharing your own experience. :-)

It does tend to look different from the outside, and mercifully I've never been depressed myself so I can only comment as an observer. An interesting thing, actually - a much-recommended book for friends and families of people with depression is Anne Sheffield's 'Depression Fallout', and if you look at the Amazon reviews here...


... you'll notice that almost everyone gave it 4 or 5 stars, with two people who gave it a bad review - both of whom were depressed. Basically, people who weren't depressed but had a depressed partner or relation all thought it was good, and people who were depressed thought it was horrible. (Largely because it acknowledges that a depressed person can be very hard on those around them; someone who's feeling terrible is probably not ready to hear that.) So a difference of perspective seems to be par for the course!

the reducing any behavior that someone disapproves of, to a mental problem.

It may be different in the States, but I certainly don't see much evidence of it here. I wonder sometimes if such situations are over-reported because people are very uncomfortable with the mental illness diagnosis. Do you know cases where that's happened?

Is your sister any better now? I hope so, anyway.
I think that part of the reason that Americans tend to over-medicalize mental illness has to do with insurance companies and their discomfort with mental illness. The companies need to get some sort of diagnosis that confirms there's a "real disease" if there's going to be even a slim chance of reimbursement. Hence "Oppositional Defiance Disorder" and other such terms.
Yes, thanks, my sister has done fairly well since the worst of those days. I'm not sure how much the doctors or medicines had to do with that, though; it just seems that the worst symptoms eventually subsided on their own. She still takes an anti-convulsant occasionally, if it seems like the symptoms are starting again. And it left her very "sensitized," if that's the word I want: she totally avoids alcohol and caffeine; if a medicine has potential side effects, she'll probably suffer them. And while we're all told to be conscientious about things like exercise, fresh air and sunlight, good nutrition, enough sleep, managing stress, and the like, she'll suffer immediate consequences if she neglects any of that. Mind and body are linked in all of us; some people learn that earlier and harder than others.

As for overmedicalizing behavior, I was thinking more of the kinds of things that got said about politicians on all sides during our recent elections. "She said that? He did what? sounds like Alzheimers'/paranoia/narcissism/antisocial personality disorder to me!"

In real life, so to speak, I agree that mental illness is more likely to be under-diagnosed and under-treated than the other way around.

people's courses of action are often influenced by fictional representations of real, or purportedly real, phenomena.
To go from the tragic to the ridiculous, I'm noticing a spate of movies, books, magazine articles about the supposed "Bridezilla" phenomenon: the bride as monster of selfishness, or the wedding as all-devouring juggernaut, a trial by ordeal. It's been a while since I've been personally involved in a wedding, but it all seems kind of unlikely to me. Are brides really behaving this way? If they are, is it because they think that's how they're expected to act? And is this just an American thing, or are you running into those kinds of cultural tropes over on your side, as you plan your own wedding? (The last time you mentioned your plans, I remember thinking, "well, that sounds like a nice party," so I doubt you've been personally infected. )

Word of the day: sconeymp, a particularly delicious breakfast pastry.
I was thinking more of the kinds of things that got said about politicians on all sides during our recent elections.

Oh, it drives me crazy when people do that! Thing is, it's actually offensive to people who really have suffered from mental illnesses; it's throwing around words like they have no real meaning, plus also implying that there's no difference between being sick and just being a dishonest prat. I always end up glaring at the screen muttering 'Don't use big words you don't understand...'

Re Brides. I've recently read Rebecca Mead's excellent One Perfect Day: the selling of the American wedding, which makes the interesting point that stories tend to circulate when there's a certain level of discomfort in society - the razor-blades-in-Halloween-apples story could be seen to express discomfort with the commercialisation of holidays, for instance, or a fear that strangers can't be trusted with our children. Her theory is that 'Bridezilla' stories are on the rise because we feel that the wedding industry has got out of control, that the amount of money and effort it's now expected we spend on a wedding has become ridiculous, and we're all feeling the pressure. Also, of course, if you've been pressed into spending a year's salary on a day's festivities, you probably are rather stressed out and more likely to act unreasonably if it looks like you might not get your money's worth.

The weddings I've been involved with haven't been like that, so I can't really comment on whether it's an American thing except to say that America often seems to get a worse dose of whatever's going round. The weddings I've most enjoyed have tended to be fairly relaxed affairs - the one where the bride decided she didn't need a wedding dress but bought a nice white coat because it was winter; the one where the couple brought in their favourite curry restaurant to do the catering and had us all decorate with a handful of white balloons shortly before dinner... Generic weddings never seem as much fun, somehow. But I've certainly never seen bridal tantrums, or anything like that (or at least, nothing worse than the brief snappishness that everyone sometimes gets when they're about to do something major and important).

I'm certainly unwilling to get involved with the full-on wedding industry - anything that considers a thousand quid a sensible starting price for a dress can count me out. That's why we like the farm so much - they do weddings, but they don't care what we wear or how we celebrate. I fear it's still going to be quite a business, though!

Word: bationes. Attendants to a traditional parade still held in some rural areas of Spain, who beat an effigy symbolising evil.
And wi' makin' the arrangements, faith, I'm just aboot deranged
For marriage is an awfa' undertakin'

"Mary Mack"
(thought of you while quoting this song over at slacktivist)

Word: escless. What you are when there's no escape key, clause, or hatch.
I suppose you've heard about Bobby Jindal? The 37-year-old governor of Louisiana has made a name for himself in some circles for being young and of minority stock – "The Republican Obama," some have called him. But to many of us on the left he became notorious for performing an exorcism on his then-girlfriend while they were in college. If it weren't for that, he might be getting more traction as a possible Presidential candidate. (Here is a link to that story: http://tpmelectioncentral.talkingpointsmemo.com/2008/06/bobby_jindals_dance_with_the_d.php/)

The safest route for the GOP to take might be to treat the whole thing as a youthful indiscretion. (Hey, it worked for Dubya.) Otherwise you open a whole barrel of worms; how do you criticize exorcism without seeming anti-religious? (And yes, I know that Jindal wasn't authorized to perform exorcisms, and that Left Behind readers are not the Vatican's biggest fans; but such subtleties are likely to be lost in a Presidential campaign.)

I'm just saying that we might be hearing a lot more about exorcism come 2011.
That's interesting, isn't it? I didn't know that, so thanks for pointing it out. I guess The Exorcism of Emily Rose was picking up on something in the air by reviving a thirty-year old case. Very worrying, too. Not to mention the fact that even if you believe in exorcism, it surely shouldn't be done on a girlfriend - that's like psychoanalysing her; the power relations are too easy to disrupt and exploit. (Of course, it would be male-female exploitation, which hardliners tend to get less worked up about...)

Word: 'spluber'. A sailor from the days of tall ships performing various minor tasks near the helm; usually a spluber would be a middle-aged midshipman who had never gained promotion.
Tried twice to leave a fairly lengthy comment on this post, and in each case was properly chastised by having my laptop seize up.

This time I shall try to be more concise.

In re exorcising a "demon of epilepsy", I should immediately think that said priests fail at basic Bible literacy -- one of the stories common to all three synoptic Gospels is Jesus rebuking his disciples for their efforts to exorcise an epileptic boy (Mk 9, Mt 17, Lk 9) In each case the cause of their failure is slightly different, but it is clear that violent and aggressive techniques are a sign of LACK of faith, not greater faith.
Continuing on to a second thought -- that being said, I've never participated in an exorcism, but I know priests who have done them. I *have* been the recipient of the Sacrament of Healing.

By my experience and by these priests' reports, the sacrament is not intended to replace or supersede medical treatment. It is meant to *supplement*; to bring strength, relief, and release to a suffering spirit.

If you accept the Christian anthropology that body, soul, and spirit are inextricably linked and interwoven, it makes sense that ailments that affect one part of your being will inevitably have repercussions upon the others. Anyone suffering from depression, for example, will tell you how mental disorders will have repercussions in lack of energy, low grade pain, etc.; and there is no question that serious or chronic illness can create depression in its turn.

If one accepts a supernatural / spiritual component in our basic human makeup, it would be unlikely to think it is immune from this effect.

Tunnelling in and treating only ONE aspect (perhaps because it's your specialty?) is almost always going to be ineffective and perhaps ultimately harmful, whether it's the therapist who cavalierly hands out "happy pills" without addressing destructive patterns of thought, or the preacher who calls upon Jesus and shouts "Be healed!" without recommending a follow-up visit to the physician.

(verification word: "rettori", a specialist in eloquence native to the Italian Alps)
Interesting refs, thanks.

On a point of pickyness - but accuracy is good with these issues - I don't think we'd see a therapist prescribing pills without addressing thought patterns. They wouldn't be licensed to prescribe, and thought patterns would be what they'd be trained to address. It's more likely to be a doctor who hands out pills without therapy, though doctors seem to get less societal hostility than therapists. (And 'happy pills' really isn't an accurate description.) But yes, pills without therapy or CBT are less likely to be useful. I'd expect them to bring some symptomatic relief that would fade away once the patient went off the pills again.

The one difference, I'd say, is that it's probably rare for a doctor or therapist to discourage the patient from seeking other forms of treatment as well. A friend of mine went to get a repeat prescription of anti-depressants, and the doctor asked, 'So, have you been doing other things as well?' My friend explained that they'd been seeing a therapist and also exercising several times a week, and the doctor gave a big grin, stuck both thumbs up and said 'Great!'

I have the impression that a doctor with the attitude of a really hardline exorcist - who are undoubtedly the extreme fringe, unlike the moderates you describe - would instead have said, 'Get out of my surgery! You have no faith in the pills!'

There is a difference between just doing your speciality while neglecting to recommend the patient seek out other specialists and actively discouraging the patient from seeking help anywhere but with you. The one is careless, the other's malign.

Gentle prayers, on the other hand, sound nice. Spiritual support is an excellent thing to have, and as long as the priests are seeing medicine as an ally, that could be great. Hit it with whatever you've got, is my attitude to mental illness, and certainly the people I know who've recovered best have been the ones who adopted as many-pronged an attack as possible.
Congratulations! Yes, that cover art is very good. I like the way the patterns of the water swirling allow you to *almost* think you see something recognizable behind or around the human figure (or at least the figure with what seem to be fingers and feet). And the colors and lighting suggest the famous picture of the iceberg with the underside lit up, which always gives me a feeling of breathlessness, i.e., a desire to surface, NOW!--whenever I see it.

Alas, it is not yet available in the U.S., so I shall be exorcising--or at least exercising--the Demon of Covetousness.
Ooooooohhhh. Pretty iceberg! I've never seen that picture before; thank you! It's preeeettty...

If you want a copy, you could always order a UK one. The exchange rate is horribly in your favour right now...

Word: sembaral. A small piece of armour worn around the chest; only used on ceremonial occasions as its purpose was largely decorative.
I don't think there's a conflict between "We're overmedicated" and "anti depressants are underprescribed" any more than "antibiotics are overused" and "pain medication is underprescribed." Running on Ritalin is good book on the "overprescribed" side, by a child psychologist. -Fraser
I don't think there's a conflict...

In science, probably not. In the popular understanding of science, which is where stigmas are formed, I fear so.
An incredibly interesting post.

And thank you so much for addressing the stigma on mental health problems. As a former depressive, I get *angry* when I hear people express knee-jerk skepticism against psychiatric medication ("They should treat the problems!" "You should try alternative treatments first!"), in a way they never would about other medication. How many times do you hear someone say "You should try alternative treatments first" about a physiological disease?
A really awesome post. Thanks.

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