Medicine and Demonism: Psychopathia Diabolica.
Some years back, I was posted to the university medical centre of one of the tertiary institutions of learning in northern Nigeria a predominantly Muslim community for my National Youth Service Corps. Then, one cool evening, whilst lying on bed in the call room, one of the nurses came calling on me, informing, that there was an emergency. Prior to her notifying me, I could already hear noises at the corridor leading to the emergency room (ER) which was one stone throw from where my call room was situated. The noises came off like those of young boys and girls trying to restrict a young screaming female undergraduate student who was manifesting aggressive behaviour.
Therefore, I quickly picked up my steth and rushed to the ER; a plethora of imaginary diagnoses already flickering through my mind in swift succession and me ruling some out, ever before even having an interaction or contact with the index patient. My best guess was that the new arrival could be an acute appendicitis, acute ulcer exercerbation or a fight/trauma patient .
I reached the ER to find 3 young men and a lady all restricting a young less-bodied damsel about 20 years old or so, who also could be no more than 55 kilograms by weight, by my first and best judgment. It therefore, immediately struck me as anomalous, yet surprising that it took 3 hefty young men to demobilise her on bed, with the other lady helping to restrict her nether regions, which the index patient couldn’t care less whether they were apposed or ajar in spatial orientation, given her present predicament.
Note, that this facility where I was working was situated in a region that could be easily described as “core north” by and amongst many Nigerians. This was a region where young men were naturally tabooed from touching women [openly and carelessly] especially if they were Muslim faithfuls and if the women in question weren’t their spouses or if nothing was at stake or if situation didn’t warrant. Therefore, finding that young machos were restricting a young astenic signora only meant that the situation made it absolutely necessary.
Accordingly, I began to ask about the history of the patient.
“What happened?” I asked. My question not exactly directed to any person in particular but at the whole group of young people who had brought the index patient in. These, were obviously her flat and room mates, and other fellow concerned students. The answer I got from the first respondent was a straight diagnosis in Hausa, rather than a complaint or symptom. She blurted coyly loudly, “Al-jánnuu, neh”. (I don’t know if spelt that right), which in translation means, ‘it is a spirit’ or ‘its demon possession’.
“Hmmmm, Interesting!” I retorted. My skepticism no less hidden upon my raw-boned face as my irritability about the response. I turned to one or two other informants, in hopes of hearing something different, but who also nonetheless, reiterated the ‘nonsensical’ verbiage that the first respondent had given me (nonsensical at least to me, as at the time). I then felt, perhaps, the way I was framing my question could be the issue, perhaps, it was grotesque or coming off as unclear. So, I asked again, this time, rather differently: “so, before your so-called “Al-jáannuu” , what happened to her?” “Any headache, any falls or any complains prior?”. I quipped. All the informants chorused a “NO” answer, signifying she was perfectly fine before “Al-jáannuu” interfered.
Her roommate then began to recall that she was just sitting on bed and discussing with the other roommates when, all of a sudden, she gave a loud shout, flung herself to the floor, started talking irascibly and acting violently. Not just that she was aggressive towards the other roommates who wanted to find out what was going on with her, but she was also acting with intents of self harm; throwing herself on the floor and pulling her hair, nodding her head violently all around and other similar behaviours.
On a further probe, I gathered that she had had prior history of similar behaviours and manifestations. It was something that happened not so frequently to her, yet, sometimes as much as twice or thrice a year ever since she lost her twin sister a couple of years back (I can no longer remember the cause of her twin sister’s death, even though I had asked at that time).
To cut the long story short, I asked the people restraining her to leave her temporarily while I tried interacting with her directly. All the while, she had been talking, even though sensibly (because everyone hearing her could relate with the things she was saying), but they were albeit inappropriate. As soon as the young men left her alone, she pounced on me, holding tightly to my shirt close to the upper chest and collar regions. The young men and my nurses quickly intervened. It took a minute or two for all efforts to successfully get me untangled from the aradite clenches of her weak strong fists. Wow, I could feel her gush of energy in that moment. She, was definitely not alone, I, even I, began to reconsider.
Being let out of her hold, I then began to direct my questions to her, rather than to the numerous informants acircling her bedspace, a few of which I had already excused with some of our nurses now doing the restraining. I asked what her name was. She obliged me a name — a wrong one. The name she gave did not correspond to that of the index patient. Or better still, she gave me the name of the ‘Al-jánnu’ in question. Interestingly, the name she gave me corresponded to the name of the dead twin sister of the index patient. I then asked her, how old she was? She replied she was a two hundred and fifty years old. She then began began to tell me that she knows my age and she knows me well. That caught my interest.
This was definitely beginning to get pretty interesting, even to me. I felt it may be nice to capitalise on the opportunity to know what a demon thought of me. So I asked her, how old she thought I was, she didn’t tell me the exact numbers, but she dismissed me as being a “very small boy”. Boy? I felt my blood boil within, how dare you? I felt the demon wasn’t showing me enough respect. If the time, place and circumstances were right, not only would I have casted it out, but I would have banished her not into swines but into the fort of Sisyphus in Hades. Nevertheless, the protégés of Hippocrates are trained to maintain their cool even in the midst of far worse provocations. My curiosity already aroused, I temporarily shifted the focus of the questions from her to myself. I wanted to find out what else she could possibly know about me, but she wouldn’t telling me nothing more other than, she knows that I was a Christian but that I am just a “very small boy” (perhaps cognisant of what her age was in contrast to what she thought mine was).
We got cyclical in our interactions, with her evading some of my very peering questions like where she comes from and what she wants. I was even enjoying some of her ridiculous responses and laughing at some of her stories, but I soon remembered I’ve got a job to do — a duty to perform — which was, rendering any help within the capacities of Medicine to a mentally compromised maiden. So to quickly round off my brief history taking, I asked her whether she loved her sister? To which she responded, yes! Then, I followed up with, why she would be tormenting some one she claimed she loved? She responded that she wanted the sister to be where she is. That she told her not to get married but she’s going against her instruction and about getting wedded and that the sister’s friends were turning away her heart from her. I could also gather that she was giving her sister some suicide ideation during these intermittent attacks as a means of coming over to be with her where she is. Well, at this point, I actually began feeling that if this where somewhere else, I’d cast out this demon (I do believe they exist and oppress people anyway).
However, the ethics of medicine can be constraining at times. We were always taught to not mix duty with being a pastor or an imam, on the line of duty, even if you were professionally one. It wasn’t your call in the line of duty to leave what you should do medically to be conducting a prayer session. Even where you feel other forms of support, like psychology or counseling or spiritual support can play a role, you are supposed to make referrals or invite the relevant authorities in that area to do it. In rare instances, where a doctor does so himself, it is usually off record (unless the counseling was medical) and indeed in all cases, the guidelines remain that it should be against the backdrop of the patient’s or relative’s informed verbal or written consent. More so, in this case, I was in an environment where I was virtually the only Christian medic in the facility. Every person surrounding me at that particular moment in the ER was a Muslim. I did not think they’d find it acceptable, the suggestion to conduct a short Christian prayer over a Muslim lady, more so in public in an attempt to exorcise a so-called Al-jáannuu. Furthermore, a few of her Muslim colleagues were already chanting silent Quranic prayers. So, I quickly brushed aside the waves of heroic ideas roaming through my mind.
I had to do my job, which was strictly medical. More so, doing it in a scientific and empirical manner, in tandem with global best practices. As these thoughts continued within me, the lady got the more violent. She was intensely struggling with the restrainers and yelling, disturbing the peace of the hospital and its immediate environs thereby. So, I requested one of the nurses to get me a particular dose of an opiate analgesic which had sedative effects as well. I needed to relax the young woman, for the demon or Al-Jáannu or whatever it was I was dealing with, was already exhausting my patient physically, as she was now profusely diaphoretic, her voice cracky, waning and hypophonetic.
The nurse returned with the sedative already withdrawn into a syringe, in a jiffy. I collected and approached her bed intending to administer the injection on one of her thighs. However, at this point she started pleading with me desperately and soberly not to administer the said sleeping med to her. When, I asked why? She gave me no reason but maintained that she doesn’t like the injection. I asked the remaining informants especially her roommate and bunk partner if her friend has any known drug allergies and whether she ordinarily tends to reject injections (any particular type) even in normal health? She said: none that she was aware of. So, I turned to the patient and said, I know you don’t like this, but I have to do my job. Now, kindly come out of her if you do not want this medication and I will leave administering it. But she gave me a blatant, “No!” answer. “Joker”, I cursed in my mind. ‘You think you can have your cake and eat it?’ Lai-lai, not here.
‘Well, suit yourself, then!’, I lashed back, in my mind, still. I listened to her brief silence, then uncapped the cover of the needle and syringe. She struggled with every force left within her, but the restrainers proved too powerful for her to overcome. As soon as my needle pierced her ruddy skin, and I drove the plunger forcing out jets of the aqueous opiate into her muscular interstitial spaces, she let out one last violently loud cry, and then there was this hissing snake sound that followed. Everyone present, all heard the sound (far louder and longer than any hiss, I have heard all my life). When I asked the others, what they thought, that could be? They replied that, it was the “Al-Jáanu” leaving. Hmmmm, after all I had seen for myself that night, I had no reason to doubt what they were telling me now. “It must be the ‘Al-Jáanu’, indeed”! I concurred. And we all bursted out in thunderous laughter.
“This is African Science, doc”, one of my own nurses blurted out to me. “No”! I contradicted, “this is Al-Jáannuu” Science.
The lady became quiescent afterwards and fell asleep. She awoke many hours later free from her irrational talks and violent behaviours; and interestingly did not remember jack about any of the things she said to me or anyone for that matter, whilst still in her acute confusional state. We discharged her the following 24hrs, well, sound, oriented and drama-free after checking a few of her biomedical lab parameters without finding anything and with further recommendations to continue follow up with a psychiatrist.
This has become one of the rarest medical presentations I’ve dealt with in my nascent practice.
I had no luxury to write down the case note concurrently during the interactions or while the whole drama was ongoing. I was now at my desk moments later, trying to pen the whole narrative into the case file, as is normal practice.
However, when I got to the section where I decide or write down what the diagnosis is, I got somewhat confused there and struggled with what to call this whole drama in medicine.. I thought of writing “Al-Jáanu” as the diagnosis but I knew that would sound so ridiculous and humorous to the next medic who happens to read that, as there was no such thing in Medicine neither does Medicine veer into the realms of spirits and metaphysics. Such a person might wonder if I acquired my own MBBS at Dr Benbela Specialist Trado-Medical University. I thought and thought about what to call my encounter, till my brain began to “hurt.” On one hand, I had witnessed the whole thing and knew that this was indeed, “Al-jâannu”, on the other hand, modern medicine would scarcely believe me and always directs me to seek explanations for every illness presentation within the perimeters of empirical science. Spiritual science or African science or Demon science must be left to the disciples of the other men but not for the protégés of Hippocrates. I often encounter these tensions and contradictions (given that I am a person of Faith, and also a person of Science), which sometimes proves difficult to reconcile.
At the end of the day, under the Assessment/Diagnosis section of my write-up, I decided to write:
“Acute Confusional State, Secondary to Transient Psychopathia Diabolica”.
Now, there is no such thing as Transient Psychopathia Diabolica (TPD) in Medicine. I invented it in an attempt to describe what I thought I dealt with. TPD will literally translate or transliterate to ‘Transient Diabolic Psychological/Mental Illness. A variant of mental illness with its origin in diabolism or demonism.
I have not seen a second case again in my continued practice. I’m thinking, if I get to see one or two more, I should publish these findings or experiences perhaps, in an International Journal of Psychiatry or other like ones. I don’t know the possibility of the existence of similar cases, but I strongly feel they exist.
This index case left me with unanswered questions, one of which was : “why did the “Al-Jáanu” not want a particular injection?”.
~ Mark Godwin.