Schilling

Possession Trance and Suicide in a Colombian tribe

Sergio Schilling Universidad Internacional SEK Santiago, Chile

INTRODUCTION
Between June 12 and 19, 2005, the film production team for Unknown Factor, a Discovery Channel documentary for its Latin America network, visited the Embera tribe to collect information about supposed possession trance episodes and suicides among the youth of that community. DSM-IV describes possession trance (PT) as the replacement of a customary sense of personal identity by a new identity, ascribed to the influence of a spirit, power or deity, and associated with stereotyped involuntary movements and amnesia (APA, 2000, p. 532). Possession trance is classified inside the category of dissociative disorder not otherwise specified (NOS)." Other authors have developed similar descriptions of this phenomenon (e.g., Bourguignon, 1976; Cardea, 1992), assuming that it has a psychological origin. The objective of this research was to gather data to determine if some other possible disorder exists that could provide an explanation of the symptoms displayed in the Embera tribe that would lead to additional information related to suicidal behavior.

The Community
Embera Union is a community of 350 people located in the northwest frontier of Colombia, near the Panama border. Since 2001, 28 suicides and 26 possession trance (PT) episodes have affected young persons in the village, especially women between the ages of 11 and 23 years. These events were painful and concerned the entire community. Until 2000, the Emberas had no history of suicide in their community, nor even an Embera word to describe it or any references to it in the legends of the community. Many of the villagers believed that the spirits of the deceased were taking possession of the young people, inviting them to death by throwing themselves into rivers or over precipices or simply kneeling down, tying a rope around their necks, and strangling themselves. For several weeks prior to the suicides, surviving victims reported feeling a strange force; they became aggressive, insulting the communitys wise persons, and changed their voices and suffered amnesia. They also entered into a state of melancholy and became passive. They felt themselves vulnerable, which was the time that they felt that the spirits impelled them to commit suicide. The community requested the services of Atensio Salazar, a spiritual guide or Jaibana (a word that comes from the expression jai, meaning spirit). Salazar told the villagers that "they are not killing themselves; those deaths do not originate from their own will. Bad spirits introduce themselves inside these weak and sad people, and they hang themselves. It originates with people who have been killed during war and who havent been buried (translated from Spanish). The war that Salazar referred to was a battle between the Colombian army and guerilla groups in December 2001, after which the villagers found bodies of 30 paramilitary troops hanging in trees and many other corpses near the river.

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METHOD
The methods of gathering data to support the initial hypothesis that the disorder was PT rather than a pathology of organic origin consisted of testing fecal samples from pigs,, interviewing survivors and their parents, making a community census, and performing a genetic analysis of community members.

Fecal Samples from Pigs

Fecal samples from 7 pigs were analyzed. The community had many sanitary risks that made possible the existence of neurocysticercosis, which is the encystment of larvae or eggs of the tenia solium in cerebral tissue. Infestation is acquired by egg ingestion, generally via fecal contamination of food. Infected people present seizures, intracranial hypertension and meningitis (Del Brutto, 1992). Neurocysticercosis is the most common cause of acquired epilepsy worldwide (Fayaca & Ibaez, 2002), and it is one of the major conditions that differentiates psychogenic non-epileptic seizures (PNES) from epileptic seizures (ES).

Interviews of Survivors and Their Parents

Qualitative data were obtained through observation of the community and a semi-structured diagnostic interview of 7 surviving girls, their parents and the communitys spiritual leader (Atensio Salazar).

Community Census
The sample of 308 people consisted of 48.4% men and 51.6% women, including 26 people affected by symptoms of PT; the average age was 18. There were 113 children under age 10, 81 normal men, 88 normal women, 4 men with PT and 22 women with PT. Supplementary data about diseases, nutrition and the history of village were also collected.

Genetic Analysis
Repetition of surnames in the community indicated that there are many consanguineous links, thus increasing the probability of homozygosis and consequent appearance of anomalies with a recessive autosomic genetic base. Among the most extensive lineages, endogamy is quite feasible. The Salazar lineage, for example, includes 77 members in the community, or 25% of the village. A genetic analysis was done in search of anomalies that could explain some of characteristic episodes. When an individual characteristic manifests in two ways within the population, it may correspond to a simple genetically based phenotype. To evaluate this possibility, we can estimate the probability that subjects belonging to family w have phenotype p, and that x have phenotype q. The order of birth is inconsequential. so (s! /w! x!) pwqx (Neel & Schull, 1954). Following these parameters, we can estimate expected phenotypic frequencies in a sample of families and statistically evaluate the distance or difference between the empirical sample and a theoretical sample. In all these calculations, we used the computer program Simple Segregation Analysis, implemented with Microsoft Quick BASIC4.5 language. A segregation analysis was applied to data of 5 nuclear families, where there was at least one case of PT in any one of their modalities.

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RESULTS Segregation Analysis

The 5 families, selected because they had the presence of the symptoms in at least one individual, included 12 young people expressing symptoms of PT. If we hypothesize a recessive autosomic genetic pattern, expected frequencies are 6 children with disturbances and 6 normal. With an assumption of a recessive autosomic genetic pattern, the differences in observed frequencies in the selected families were not statistically relevant (X=1,355; df=1). When the supposition is dominance, the expected frequency is 7 children with disturbances and 5 normal, and the differences in observed frequencies among the selected families were statistically relevant (X=4,082;df=1). Further, data from families N 29th and 59th are incompatible with a dominant gene distribution model (Figure 1). Thus, the result fits well with an autonomic recessive heritage model. Perhaps some of the symptoms were due to a genetic origin but, because it is a small sample, we could not accept the segregation analysis results as definitive.

Figure 1: Analyzed families genogram. (In boldface, people suffering PT). Probabilities of such a
pedigrees being associated with a dominant gene or a recessive gene disease are 4.3% and 24.4%, respectively. The Parapsychological Association Convention 2007 3

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Symptom Comparison among Men and Women

Table 1 compares the frequency of PT in young men and women. TABLE 1

No PT 81 Men 4

PT

85 [73.7] [11.3] 88 22 110 [95.3] [14.7]

Women

Total

169

26

195

Note: Observed frequencies are in boldface and expected frequencies are in brackets. Freedom degrees: 1. Chi-square=9.62. For significance at the .05 level, the Chi-square should be higher than or equal to 3.84. Distribution is significant, so there is adequate evidence to say that PT is not independent from sex.

DISCUSSION Physiological or Psychological Symptoms?

The PT cases in the Embera tribe appeared to have been related to genotype and sex. Women presented symptoms at rates 5 times higher than that of men, although there was no linkage to sex (inheritance of chromosome X), since there are families with healthy parents who have children with this disturbance. A recent review of research on gender and psychogenic non-epileptic seizures concluded that the female to male ratio in PNES is about 4:1 (Gales & Rowan, 2000, pp 111, cited in Litwin & Cardea, 2000). The much higher preponderance of women among PNES patients in our sample replicates previous studies about the relationship between gender and PNES. Women in the general population present much higher levels of somatoform disorders and a greater probability of developing post-traumatic stress 4 Proceedings of Presented Papers

Schilling disorder after traumatic events. The increased probability of somatoform disorders and dissociation in women might be partly explained by the greater rate of sexual abuse of women than of men (Litwin & Cardea, 2000). It also must be mentioned that in some reports (see Litwin & Cardea, op cit), PNES patients had a significantly later mean age of seizure onset (thirties for PNES, twenties for ES), fewer years of recurrent seizures, and more seizures per week (in PNES patients). The previous findings were reported in North American samples.However, the same authors points out that there could be differences in the onset and characteristics of seizures across cultures. Results are unfavorable for the neurocysticercosis hypothesis. Laboratory analysis was negative for the presence of tenia proglottis or larvae of strongyloides. It is possible that the villagers tales about PT misinterpreted Tourettes syndrome (characterized by presence of multiple physical and vocal tics) as a possession, although Tourettes syndrome has an autosomal dominant genetic trait and is four times as likely to occur in men as women. Temporal lobe epilepsy and/or catamenial epilepsy (seizure exacerbation in relation to menstrual cycle, related with temporal lobe disorders) could be the underlying disease; however, results obtained in the interview and our film record of PT in girls aims at PNES. PNES are paroxysmal changes in behavior that resemble epileptic seizures but are without organic cause. PNES symptoms include unresponsive staring, minor motor movements, bizarre behavior, and generalized movements. They are psychological in origin. (Bowman & Cons, 2000). We ruled out paranoid subtype schizophrenia, which has its onset at 25-40 years, and catatonic subtype schizophrenia, which has its onset in women in their 20s to early 30s. We did not find evidence supporting other differential diagnoses, like Sydenham's chorea, Wilson disease, Venezuelan Equine Encephalitis and Lyme disease. There was some evidence that data we received concerning the seizures and suicides were adjusted to the initial hypothesis of PT. The relationship between auto destructive behavior and suicides with syndromes of PT has also been reported in investigations of cultures in Southeast Asia (LewisFernandez, 1994). Those who reported experiences related to PT were often oppressed women with few options to protest who win social support and find a way to prosecute their demands through PT (LewisFernandez, 1994). While there was no sign of neurological illness that could explain the symptoms, theories related to some subjacent hereditary illness could not be discarded because of the results of genetic analysis.

Acknowledgements
The author acknowledges the kind and invaluable assistance of Waldo Mora, Stanley Krippner, and the Eileen J. Garrett Library Fellowship.
REFERENCES

American Psychiatric Association Committee. (2000). Diagnostic and statistical manual: DSM-IV-TR (4th Ed). Washington, D.C: American Psychiatric Association. Aminoff, M, Greenberg, D, and Simon, R. (2005). Clinical Neurology (6th Ed.). Norwalk, CT. Lange Publishers. Bourguignon, E. (1976). Possession. San Francisco: Chandler & Sharp. Bowman, E., & Coons, P. (2000). The different diagnosis of epilepsy, pseudoseizures, dissociative identity disorder and dissociative disorder not otherwise specified. Bulletin of the Menninger Clinic 64, 164-180.

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Cardea, E. (1992). Trance and possession as dissociative disorders. Transcultural Psychiatric Research Review, 29, 283-297. Del Bruto, O., Santibez, R., Noboa, C., Aguirre, R., Daz, E. and Alarcn, T. (1992). Epilepsy due to neurocysticercosis: Analysis of 203 patients. Neurology, 42,389-392. Foyaca S., Ibaez, V. (2002). Clinical trial of praziquantel and prednisone in rural patients with neurocysticercosis presenting recurrent epileptic attacks. The Internet Journal of Neurology, 1(2), 1-12. Lewis-Fernandez, R. (1994). Culture and dissociation: A comparison of nervous attacks among Puerto Ricans and possession syndrome in India. In D. Spiegel (Ed.), Dissociation: Culture, mind and body (pp.123-170). Washington, DC: American Psychiatric Press. Litwin, R., & Cardea, E. (2000). Demographic and seizure variables, but not hypnotizability or dissociation, differentiated psychogenic from organic seizures. Journal of Trauma and Dissociation, 1, 99-122. Neel, J.V. and Schull, W.J. (1954). Human heredity. Chicago: The University of Chicago Press.

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