Multimodal Hallucinations in Muslim Patients with Severe Psychotic Disorders: The Entity Experience Revisited.

Introduction: In biomedicine, entity experiences are conceptualised as compound hallucinations featuring living beings. The term "experience" suggests that these have an objective basis in reality, as those perceiving them may maintain. So-called jinn encounters, typically described by Muslims with and without a psychiatric diagnosis, involve the multimodal perception of a spirit that, as described in the Qur'an, was created by Allah.

Methods: We conducted a phenomenological investigation among Muslim patients residing at Parnassia Psychiatric Institute, The Hague, mostly diagnosed with a schizophrenia spectrum disorder. To enquire specifically into multimodal hallucinations featuring jinn or related entities, we used the Hallucination Attribution List, a tailor-made, semi-structured questionnaire.

Results: Of the 42 interviewees, 35 described multimodal hallucinations, of which 22 fulfilled the criteria of entity experiences involving 2 to 6 sensory modalities simultaneously. Twelve participants (54.5%) were fully convinced they were dealing with jinn; the others left some room for doubt. Although we did not quantitatively assess the levels of jinn-associated distress, all participants characterised their experiences as impressive and impactful.

Conclusion: Multimodal hallucinations may involve full-blown entity experiences, which in Muslim patients typically take the form of jinn encounters. The way in which these entity experiences are mediated is as yet uncertain. However, since visual, auditory, and tactile hallucinations in our sample were described substantially more frequently than somatic, olfactory, and gustatory ones, we hypothesise that the processes underlying the hallucinations may be driven by a stochastic mechanism in that the first three sensory modalities need to have been engaged before the latter three can be recruited. We highlight several biological models of potential underlying mechanisms as well as two overarching models that may help place the mechanisms in the wider context of personal, social, cultural, religious, philosophical, and evolutionary factors that, conceivably, all play a role in their mediation.