Epilepsiu. 40(2).
239-241, 1999
Lippincott Williams Kr Wilkin\, Inc., Philadelphia
0 International League Against Epilep~y
Brief Communication
Epilepsy and Religious Experiences: Voodoo Possession
E. Carrazana, J. DeToledo, W. Tatum, R. Rivas-Vasquez, G. Rey, and S. Wheeler
Neurologic Cenenter o;f South Florida, University of Miami School of Medicine, and University o j South Floi-idu-Tampa General
HoJpitul, Miami, Floridu, U.S.A.
Summary: Epileptic seizures have a historical association
with religion, primarily through the concept of spirit posses-
sion. Five cases where epileptic seizures were initially attrib-
uted to Voodoo spirit possession are presented. The attribution
The concept of possession, “to be seized by spirits,”
is central to the historic association of religion and the
epilepsies. A common belief of ancient cultures was that
mental disturbances were caused by supernatural inter-
ference. The early Greeks viewed epilepsy as a visitation
from the gods, and thus a sacred disease. Christians dur-
ing medieval times followed the biblical belief of de-
monic possessions (Matthew 17:14-1 8). Persons with
epilepsy themselves have often explained their seizures
as religious experiences, particularly the feelings associ-
ated with depersonalization, derealization, and autoscopy
of temporal lobe epilepsy. Furthermore, most of the re-
ports invoke elements of Christianity, thereby reflecting
a Eurocentric view of the subject (1).
Voodoo is the most popular religion in Haiti. It has
preserved many of the characteristics of the Dahomean
and Guinean cults from which it derives (2). Worship
and possessions by spirits (loas) are the essence of Voo-
doo; thus many illnesses are explained on that basis.
Spirits incarnate themselves at will in the people they
choose. The person possessed is a mere receptacle bor-
rowed by the spirit for the purpose of revealing itself. In
that sense, the experience is similar to an epileptic sei-
zure in that the patient has no control over its timing nor
expression. Voodoo faithfuls voluntarily place them-
selves under the authority of some priest/priestess (hun-
gun, mambo), with the interpretation of beliefs depend-
ing on a great extent on their influence (3). We report a
Accepted July 17, 1998.
Address correspondence and reprint requests to Dr. E. J. Carrazana
at Neurologic Center of South Florida, Baptist Hospital Outpatient
Bldg., 802-E, 8940 N. Kendall Drive, Miami, FL 33176, U.S.A.
239
is discussed within the context of the Voodoo belief system.
Key Words: Epilepsy-Seizures-Religion-Voodoo-
Possessions.
series of patients with epilepsy whose seizures were at-
tributed to possession by Voodoo spirits. These cases
demonstrate that beliefs and folklore are not always
harmless in that, at times, they can adversely affect clini-
cal management. In addition to being a source of great
anxiety, they may delay appropriate diagnosis and treat-
ment.
CASES
Case 1
This 24-year-old Haitian man had his first generalized
tonic-clonic seizure at the age of 17 years during the
wake of an uncle. The patient had been sleep deprived
during the vigil of the corpse. The seizure was attributed
to possession by Ogu (the warrior god), the dead uncle’s
protecting loa. Subsequent seizures and morning myoc-
lonus were explained as harassment by the wandering
soul of the uncle. The possession was interpreted as a
punishment, for the patient had been disrespectful toward
the deceased in the past. He was treated by the local
mambo (priest) for 6 years and did not see a physician
until coming to the United States. His EEG showed 3- to
4-Hz bursts of generalized spike-wave complex dis-
charges occurring spontaneously and during photic
stimulation. In retrospect, the patient had a history of
waking myoclonus, which had been ignored. He re-
mained seizure free after treatment with valproic acid
(VPA). The likely diagnosis is juvenile myoclonic epi-
lepsy.
Case 2
This 27-year-old Haitian woman, with a history of
complex partial and secondarily generalized seizures
240 E. CARRAZANA ET AL.
since adolescence, was the product of a long and difficult
delivery, which was attributed to a “grip” in the moth-
er’s belly by a loa. At the age of 14 years, she fell in an
open fire during a seizure and suffered extensive burns to
her arm, leg, and parts of the face and trunk. Burns were
treated at a local hospital, but the family brought the
patient back to the mambo to treat the “possession.”
This incident was interpreted by the mambo as posses-
sion by ‘‘Marinnette.” Marinnette-bwa-chech is one of
the most dreaded loas, an agent for underhand dealings
and an expert sorceress. Those possessed by this loa are
said to throw themselves in the fire and stamp about until
they put the flames out. The patient had bitemporal in-
dependent spikes on EEG. Treatment with antiepileptic
drugs (AEDs) has decreased the frequency of seizures.
Case 3
This 36-year-old woman had several years of recurrent
complex partial seizures that manifested as a strong
sense of fear and epigastric coldness, followed by loss of
awareness, utterances of nonsensical phrases, and com-
plex motor automatisms. The local mambo attributed the
events to her being taken by “Melle Charlotte,” a french
loa, with the nonsensical speech being interpreted as a
foreign language. It is said that during the possession by
this spirit, a person will speak perfect French or other
languages, even though in life, the person has no knowl-
edge of that language. She continued to have seizures
despite the mambo’s attempts to conjure the spirit. He
explained his failure to the fact that Melle Charlotte is a
very particular loa who makes only sporadic appear-
ances. She was not treated with AEDs until she left Haiti
at the age of 34. An EEG revealed a right anterior tem-
poral focus, and magnetic resonance imaging (MRI)
showed right hippocampal atrophy. Seizures improved
with carbamazepine (CBZ), although compliance with
medication was a problem, largely because of family
interference.
Case 4
This 44-year-old Dominican woman (of Haitian par-
ents) for years has been experiencing partial seizures
which she refers to as “la cosa” (the thing). Her sei-
zures, with a sudden overwhelming sensation of empti-
ness, were attributed to her “good angel” leaving her as
the spirit of the dead tried to take hold of her (“me
mandaron un muerto”). The sending of the dead,
l ’envoismorts, is a feared Voodoo curse, which is said to
affect health and prosperity. The mambo explained the
failure of the attacks to respond to his exorcisms to the
strong hold of the spirit. EEG showed a right temporal
focus, and the MRI was normal. Seizures were controlled
with phenytoin (PHT) monotherapy.
Case 5
This 47-year-old Jamaican woman of Haitian descent
with a history of Chiari I malformation, syringomyelia,
Epilcpsia V d 40, N o . 2, 1999
and arrested hydrocephalus, has a long-standing history
of complex partial seizures with and without secondary
generalization. The patient and her family attributed the
seizures to Voodoo spirit possessions, being influenced
by the olfactory hallucination of a burning smell, and a
rising epigastric aura “taking over the body.” A pro-
longed postictal psychosis would follow, in which the
patient would alternate chanting and wooing with peri-
ods of total unresponsiveness. EEG demonstrated inde-
pendent bitemporal interictal epileptiform discharges.
She denied her diagnosis of epilepsy, resisted diagnostic
and therapeutic interventions, and insisted that she was
possessed by spirits of the dead. On immigrating to the.
United States, she ultimately became seizure free with
PHT monotherapy.
DISCUSSION
Possession by spirits is part of many African cults.
Their influence was spread to the New World by the
slave trade. From the ports of Benin, Dahomey, and
Guinea, natives were sold as slaves primarily to the colo-
nies in the Caribbean basin and Brazil. Holds of slaves
contained representatives of all social classes including
“servants of the gods,” who knew the cults’ rites and
kept them alive in exile. Many of their descendants have
held onto these traditions to the present, because of either
geographic isolation or sociocultural constraints and in-
fluences or both. Attempts to eliminate slave cults in the
colonies were not very successful because of a lax po-
litical authority and resistance to Church interference in
slave matters on the part of land owners. This influence
is clear in the synchretic religions that developed there-
after, such as Santeria in Cuba, Mayombe in Brazil,
Espiritismo in Mexico, Obeah in the Bahamas, and Voo-
doo in Haiti (2).
Many people in Haiti still adhere to the practice of
Voodoo and believe implicitly in magic. Voodoo, as it is
practiced today, is not substantially different from the
Dahomean cults of the 17th and 18th century, except for
human sacrifice, which was then widely practiced. In
Dahomey, a voodoo is a “god,” a “spirit,” or a “sacred
object” (2). The spirits, the worship of whom is the
essence of Voodoo, are called loas, mysteries, saints, or
angels. Not only do they range from known Catholic
saints to the old gods from Africa, but minor local spirits
also are worshiped. Voodoo is always enriching itself
with new loas; some are revealed and imposed on mem-
bers of a cult group when a devotee is suddenly pos-
sessed by an unknown spirit who demands worship; oth-
ers owe their existence to dreams, particularly of influ-
ential mambos (2). This dynamism of Voodoo, as
illustrated in cases 2 and 3, allows simple religious con-
cepts to provide explanations for a range of life circum-
stances,including health matters.
 EPILEPSY AND VOODOO POSSESSIONS
In Voodoo circles, possession and trance are not re-
garded as cause for shame or even anxiety; they are a
mark of divine favor (4). Adepts of Voodoo, however,
make a clear distinction between possession by a
“radu” loa, which is sought after and desired, and pos-
session by evil spirits from the “petro” family of loas,
which is frightening and morbid (2). Possession by petro
loas is often delivered by sorcerers as punishment, as in
case 1. Voodoo tradition holds that humans have two
souls, the “Big” and the “Little” good angels. A guard-
ian role is attributed to the “Little Good Angel.” Serious
illness takes hold only when the guardian has been over-
whelmed by evil spirits stronger than itself or when,
through weariness or any other reason, it finds itself un-
able to cope. Possession by loas takes place when the loa
drives out the “Big Good Angel.” The eviction of the
soul is responsible for the tremblings and convulsions
that characterize the trance. The trance is typically fol-
lowed by a period of sleep or confusion, and the pos-
sessed remembers nothing of what was said or done. The
intensity of the crisis varies according to the character of
the spirit seeking incarnation (2). The description of
pseudoseizures in the literature is quite similar (5). Thus
we could appreciate how easily an epileptic seizure may
be attributed to a spirit possession by a medically unso-
phisticated mambo. As case 1 illustrates, the generalized
tonic-clonic seizure’s timing and severity lead the
mambo to incriminate the deceased’s protecting loa. The
sleep deprivation and the flickering effect of the flames
at the wake may have triggered the seizure in this patient
with probable juvenile myoclonic epilepsy.
The symptoms accompanying epileptogenic dis-
charges in the temporal lobe are fertile ground for mystic
interpretations. Depersonalization, derealization, and
double consciousness are common in patients with a
temporal lobe focus (6) and have been elicited during
intraoperative stimulation of the amygdala, hippocam-
pus, and first temporal gyrus (7,8). Similar feelings also
are described with religious conversions (1). Other fea-
tures common to both conditions are the abruptness, the
depth, the lack of control, and the perceptual changes
occurring during the seizures. Autoscopy, or the sensa-
tion of leaving the body and viewing it from above, can
also be affiliated with religious experiences. It is a rela-
tively common experience of those with temporal lobe
epilepsy, either at the onset of the seizure or during the
postictal phase (9). The mystical experiences of Saints
Paul, Catherine of Ricci, Theresa of Avila, and Catherine
of Genoa have been considered examples of ecstatic epi-
lepsy (lo). Auditory and visual hallucinations, although
less common features of temporal lobe partial seizures,
are frequently interpreted as celestial voices and visions
241
as well (11). Patients 2 through 5 have temporal lobe
epilepsy, with their complex partial seizures miscon-
strued as possessions; the nature of the incarnated loa
was identified by the mambo based on the clinical mani-
festations of the epilepsy. The services of the mambo
required periodic “contributions,” which can total hun-
dreds of dollars in each case. The patients and relatives
pursued treatments with mambos for many years despite
the persistence of seizures. This failure was attributed to
the uniqueness of the loa in one case and the unyielding
grip of the loa in the other. Medical help was not sought
until the patient moved away from the native town. The
patients and families acknowledged that they feared go-
ing against the lous or disobeying the mambos. Tradition
has it that either act can be punished with revenge and
deliverance of even worse ailments ( 2 ) .
Although we are in no position to deny a true Voodoo
spirit possession, in likelihood, cases as these are more
likely the application of cultural and religious beliefs to
otherwise unexplainable occurrences by a medically un-
sophisticated population. When treating patients, the
physician must take into account the patient’s cultural
background and system of beliefs, an important point
particularly in areas with a high percentage of new im-
migrants. Regardless of the faith, epileptic seizures
should be considered in the differential diagnosis of
atypical and episodic religious experiences.
Acknowledgment: We are indebted to Mrs. Esther
Dominguez and Ms. Patricia de la Torre for their invaluable
help in preparing the manuscript.
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Epilepsia. Vol. 40, No. 2, 1999