Resting stated-tractography-fMRI in initial phase of spiritual possession - A case report

Abstract

Objective: A cortical and subcortical area involved in a Functional Magnetic Resonance in a young woman in the first phase of a spiritual possession induced by an exorcism is presented.Background: Female 29 years of age, university student, from dysfunctional family.She began her suffering 11 years ago with personality dissociation, characterized by aversion to sacred objects and images, and psychomotor agitation with transient states of loss of consciousness with manifestations of spiritual possession that required psychiatric, and psychological treatment, and 5 exorcisms without improvement over a period of ten years.She is currently taking and has taken, clonazepam for ten years.Laboratory studies, EEG, brain scans (Computed tomography CT-scan) and Functional Magnetic Resonance (fMRI) reveal no evidence of organic or functional diseases. Methodology:The patient was initially evaluated by a psychologist, psychiatrist, neurosurgeon, and GI endoscopist, who excluded brain and gastrointestinal disorders, with complete medical record, blood tests, upper gastrointestinal endoscopy with biopsies and neuroimaging.With informed consent, a fMRI was accomplished before and in the beginning of a possession induced by exorcism performed by a Catholic priest.Results: Cortex, midbrain, brain stem and cerebellum anatomy were normal on the brain scans and MRI.Tractography performed by diffusion tension imaging was determined before performing the exorcism and a resting state in the initial phase of possession because the patient progressively presented with psychomotor agitation.Tractography corresponding to the left brain of the corticospinal tract, uncinate fasciculum and superior longitudinal fasciculum was tangled out compared to the right hemispheres.The morphology of the corpus callosum was symmetrical.The resting state presented greater temporal and parietal lobe activity at the cortical level with subcortical areas with less activity such as the amygdala, the, basal ganglia, and the brain peduncle.The corpus callosum showed no activity other than the minor forceps or rostrum.Bradycardia and increased respiratory rate were the most important manifestation during possession.The neurovegetative response subsequent to gastric content vomiting occurred during the recovery state.30 days after the exorcism, the patient had 3 spiritual possessions.The agent´s (possessor) name is Estencaster.Conclusions: fMRI is the most effective method to measure the cortical and subcortical activations areas involved in religious experience and patients possessed.The involved cortical and subcortical areas described make note that the temporal and parietal lobe are the brain lobes mainly involved in the present case of possession.However, due to the involuntary motor activity and the patient's loss of consciousness, it is not possible to perform the analysis completely in this case.The patient presented a generalized catatonic state at the beginning of the possession and psychomotor agitation of the head in a progressive way which permitted us to only perform the recording of Blood Oxygen Level Dependent (BOLD) for 6 minutes, thus allowing us to interpret part of the sensory-motor and verbal behavior and the low frontal response induced by the "possessor".Exorcism is an effective but invasive method to induce a possession state if other options or conditions are not available to provide patient safety, to protect against an increased neurovegetative response, where there is a risk of bronchospasm, aspiration, severe bradycardias, hypothermia, and even injuries induced by a possessor with greater aggressiveness.The use of Virtual Reality with images or sacred objects may prove a useful (and perhaps safer) for the induction of less aggressive agents.In agents such as the Demon, sedatives are an alternative for a corporal and behavioral control to perform a complete fMRI.