Ninety years of multiple psychotic-like and spiritual experiences in a doctor honoris causa a case report and literature review

Abstract

Psychotic experiences are common experiences shared by a considerable part of the world's population. Moreover, most of the individuals who report these experiences also report those called spiritual and dissociative phenomena. In specific culture and religious backgrounds, these experiences are frequently seen as a part of normal human experiences, usually called mediumship. We report a case of a famous Brazilian medium with 90 years of experiencing psychotic-like, dissociative and/or spiritual experiences, but coped well with the experiences and never sought psychiatric or psychological assistance. The medium received several honorific prizes, such as doctor honoris causa from different institutions, published more than 200 books, and ran a nonprofit organization that takes care of 5000 people daily. Finally, we review the literature on this topic and stress the urge for more research aiming to distinguish pathological and nonpathological psychotic experiences to avoid overmedicalization and iatrogenic treatments. Dating back to 1983, the American psychiatrist Ian Stevenson wrote an article entitled “Do we need a new word to supplement ‘hallucination’?”, pointing to the need of a new term to define unshared sensorial experiences (Stevenson, 1983). He based his claim on the etymology and widespread understanding of the word “hallucination” as a perceptual disorder related to mental illness. However, the word “hallucination” does not encompass the totality of the unshared sensory experiences reported in the general population, given that a large part of the nonclinical population experiences such phenomena and does not have any mental illness (Linscott and van Os, 2013; Loch et al., 2011). In fact, the largest survey ever performed on psychotic experience (PE) in the general population involved more 250,000 subjects from nationally representative samples of 52 countries worldwide. A total of 12.5% of the sample reported at least one PE over the past 12 months, excluding those happening when the person was half asleep, dreaming, or under the influence of alcohol or drugs. However, most of them had no mental disorder, and only 1 out of 10 has had a diagnosis of schizophrenia (Nuevo et al., 2012). Other studies have replicated this finding (Loch et al., 2011, 2019; McGrath et al., 2015), and a recent meta-analysis yielded a median annual incidence of 2.5% and a prevalence of 7.2% (Linscott and van Os, 2013). It is noteworthy that several cohort studies have highlighted the relatively benign nature of PEs, what they called “subthreshold psychotic experiences” or “psychotic-like experiences” (Chapman et al., 1994; Dominguez et al., 2010, 2011; Hanssen et al., 2005; Mainieri et al., 2017; Poulton et al., 2000; Welham et al., 2009; Werbeloff et al., 2012), even though approximately 20% of people with PEs report persistent, rather than transient, experiences (Poulton et al., 2000). Important meta-analysis pointed out a 3.5 greater risk for conversion into a clinical psychotic outcome in individuals with subthreshold PEs; however, the risk remains low, with only 0.56% of individuals converting into any psychotic disorders (PDs) yearly (Kaymaz et al., 2012). Furthermore, in contrast to the totality of the population with PEs, a recent meta-analysis pointed out a lifetime prevalence of PDs in the general population of 0.74%, and a 12-month prevalence of only 0.40% (Moreno-Küstner et al., 2018). Although in a global population level the frequency of PE is related to higher distress and conversion rates to PD, there is wide heterogeneity in these findings. It is likely that people reporting PE in the general population are a highly heterogeneous group, ranging from prepsychotic patients to people having healthy spiritual experiences (SEs) (Moreira-Almeida and Cardeña, 2011b; Wüsten et al., 2018). A recent study involving 7141 adults from 13 countries found that PE is reported more often and is less related to distress in low- and middle-income countries compared with high-income countries (Wüsten et al., 2018). Studies with people who have high levels of PE fostered in a spiritual environment (spiritualist mediums) found that despite having high levels of PE, these are not related to distress and may even have healthy correlations (Moreira-Almeida et al., 2007; Peters et al., 2016). Historically, the impact of spirituality, religiosity, and SEs on PEs and PDs has gained much attention from studies around the world (Menezes and Moreira-Almeida, 2010). This is due to the fact that psychotic patients frequently present their symptoms with religious/spiritual contents (Koenig, 2009). At the same time, SEs, such as mystical experiences (Beauregard and Paquette, 2006), prayer (Newberg et al., 2003), glossolalia (Newberg et al., 2006), past-life memories (Daher et al., 2017), states of transcendence (Borg et al., 2003), dissociative states, and mediumistic-trance phenomena (Peres et al., 2012), not infrequently present with some kind of PEs (Menezes and Moreira-Almeida, 2009). Moreover, brain imaging studies have investigated functional and structural brain alterations during such SEs, finding different patterns than presented in psychotic patients (Mainieri et al., 2017; Peres et al., 2012), despite not being easy to differentiate in terms of clinical phenomenology (Parnas and Henriksen, 2016).Therefore, there is an urgent need to differentiate the phenomenological, clinical, and biological features of SEs, PEs, and PDs to better understand them and promote the best evidence-based care for patients, especially those with a high risk for psychosis. In addition to large quantitative studies, in-depth analysis of exemplary cases is also very useful in helping us have a better understanding of how these experiences manifest themselves in the actual life of a specific human being (Delmonte et al., 2016; James, 2002). To contribute to address in this gap, we will report the case of one of the world's most prolific and renowned living medium, who, for 90 years, has experienced continually (every day) multiple PEs/SEs and has remained mentally and socially well, being awarded doctor honoris causa from several universities (Landi, 2015; Publisher, 2020; Sinotti, 2009). The aim of this article was to present an in-depth case report of this spiritist medium who was submitted to a psychiatric interview to debrief his psychic phenomenology and social history, in order to discuss in light of the modern neuropsychiatry the clinical implications of this and multiple similar cases to the daily practice as well as to guide future research projects.