Skip to main content
×
×
Home

Did Ezekiel have first-rank symptoms?

  • George Stein
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Did Ezekiel have first-rank symptoms?
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Did Ezekiel have first-rank symptoms?
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Did Ezekiel have first-rank symptoms?
      Available formats
      ×
Abstract
Copyright
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 16 *
Loading metrics...

Abstract views

Total abstract views: 102 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 15th August 2018. This data will be updated every 24 hours.

Did Ezekiel have first-rank symptoms?

  • George Stein
Submit a response

eLetters

Authors Reply

George Stein, Psychiatrist
08 July 2009

I am most grateful for Professor Moreira-Almeida’s comments on my suggestion that Ezekiel may have had Schneiderian first rank symptoms (FRS). His study showing that Brazilian spiritist mediums who are not suffering from any current mental disorder may have a high prevalence of FRS is an important addition to the debate on just how specific/non-specific FRS are to the diagnosis of schizophrenia. In this light, making any judgement about a prophet such as Ezekiel who lived more than 2,500 years ago and basing it on only a few verses from the Book of Ezekiel (which many scholars believe he wrote himself) would seem at best to be a highly dubious exercise. Nevertheless in the setting of a mental illness, particularly a psychotic episode, the presence of FRS usually does point to a diagnosis of schizophrenia and in this context may have a helpful discriminating function.

However I believe in Ezekiel’s case these were the genuine FRS of schizophrenia. This is because there is other corroborative evidence that he suffered from mental illness. Thus there is good evidence of two catatonic episodes, one lasting for 340 days and a second shorter period lasting for 40 days, and also that he had a variety of different types of auditory hallucinations as well as several visions. Whilst any one of these phenomena taken separately can be explained away as being due to thereligious experiences in a devout person, the combination of having FRS, catatonia, auditory hallucinations, as well as probable visual hallucinations all of a schizophrenic type, can only really be explained by the subject actually having schizophrenia.. Perhaps it would have been more coherent to have written a single article on all aspects of Ezekiel’sillness but because of the space restrictions of the BJP’s fillers Ezekiel’s phenomenology cannot be revealed to readers all in one go, but only as several smaller items. Interested readers should therefore watch this space and read the forthcoming BJP fillers!
... More

Conflict of interest: None Declared

Write a reply

Re: Differentiating spiritual from psychotic experiences

Kazuhiro Tajima-Pozo, Psychiatry MD
01 July 2009

At the end of the XIX century in France, Legue and Gilles de la Tourette already made a psychopathological interpretation of several casesof devilish possession. In 1921 Oesterreich (German) differentiated real cases of possession from those cases in which the symptoms of possession were clear manifestations of a mental disorder. Differentiating an histrionic form, and an obsessive form, depending of participation of “the self”, which was absent in the second case. Freud (1946) considered that the real possession was the manifestation of a neurotic prominent pathology, corresponding with the current diagnosis of neurosis.

References- Berrios GE. The insanities of the third age: a conceptual history of paraphrenia. J Nutr Health Aging 2003; 7(6):394-9.- David Enoch y Hadrian Ball. Síndromes raros en psicopatología (278-297)Editorial Triacastela.- Magnan V, Sèrieux, P. Delirios sistematizados de los degenerados. Psiquiatría.COM [revista electrónica] 1998 Marzo. [citado: 16 Marzo 2008];2(1):[9 pantallas]. Disponible en: URL:http://www.psiquiatria.com/psiquiatria/vol2num1/art_8.htm- Pereyra CR. Parafrenias. Delirio crónico de ideas polimorfas. 2ª ed. Buenos Aires. Editorial Salerno, 1965.- Roth M, Kay DW. Late paraphrenia: a variant of schizophrenia manifest inlate life or an organic clinical syndrome ? A review of recent evidence. Int J Geriatr Psychiatry 1998;13(11):775-84.
... More

Conflict of interest: None Declared

Write a reply

Differentiating spiritual from psychotic experiences

Alexander Moreira-Almeida, Professor of Psychiatry
18 June 2009

Stein1 puts an interesting and important question when he shows that Ezekiel as described in the Old Testament has experiences that might be interpreted as first-rank symptoms (FRS). This situation raises the crucial question of differential diagnosis between spiritual experiences and psychotic disorders with religious content. In addition to the religious implications of making such a diagnosis for the prophet (and possibly other spiritual leaders), there are critical implications for theevaluation and conduct of people that seek our clinical care with similar experiences.

We have conducted research on the relationship between spiritual experiences and psychotic and/or dissociative symptoms. A sample of spiritist mediums in São Paulo (Brazil) reported on average 4 FRS, the same number as Ezekiel. However, the number of FRS was not correlated to other markers of mental disorders such as scores on the Social Adjustment Scale (SAS-SR), Self-Report Psychiatric Screening Questionnaire (SRQ), andhistory of childhood abuse. Despite showing a high level of what could be interpreted as psychotic and/or dissociative symptoms, the total sample of115 mediums had a high socio-educational level, a low prevalence of mentaldisorders and were socially well adjusted2,3.

There is an increasing literature showing a high prevalence of psychotic and dissociative symptoms in the general population. However, most of our knowledge of those experiences is based on clinical, often hospitalised, samples. Those and other studies indicate the necessity of being cautious when analysing the clinical significance of anomalous experiences emerging in non-clinical contexts, especially since our knowledge about these experiences is based on clinical samples. It seems that these psychotic or dissociative experiences are not necessarily symptoms of mental disorders. (Similarly, certain medical symptoms such asshortness of breath, tachycardia etc. may be pathological in some circumstances and physiological in others.)

Certain additional features may suggest a non-pathological basis for the experience: lack of suffering or functional impairment, compatibility with the patient’s cultural background, absence of co-morbidities, control over the experience, and personal growth over time. These criteriaare useful pointers, but there is lack of well-controlled studies4.

Experiences like those of Ezekiel have had an important role in the Greek, Jewish and Christian roots of western society and in our time they are prevalent in spiritual groups such those related to Spiritism, Channelling, Pentecostalism and the Charismatic Catholic movement.

Research to clarify our understanding of this aspect of human experience will not only enlarge our knowledge of human nature but also improve the cultural sensitivity and effectiveness of our clinical practice.

1. Stein, G. Did Ezekiel have first-rank symptoms? - Psychiatry in the Old Testament. Br J Psychiatry 2009; 194: 551

2. Moreira-Almeida A, Neto FL, Cardeña E. Comparison of brazilian spiritist mediumship and dissociative identity disorder. J Nerv Ment Dis 2008;196:420-4.

3. Moreira-Almeida A, Lotufo Neto F, Greyson B. Dissociative and psychotic experiences in Brazilian spiritist mediums. Psychother Psychosom2007; 76:57-8. Erratum in: Psychother Psychosom 2007; 76:185.

4. Menezes Júnior A, Moreira-Almeida A. Differential diagnosis between spiritual experiences and mental disorders of religious content. Rev Psiq Clin 2009; 36:75-82.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *