transcultural

psychiatry
December
2003
ARTICLE

Religious Construction of a First Episode of

Psychosis in Urban Brazil
CRISTINA REDKO
Centre for Addiction and Mental Health
Abstract Religion plays an important role in the lives of people with
psychosis. Based on fieldwork with 21 families living in poor neighborhoods
of So Paulo, Brazil, this article examines how youth suffering a first episode
of psychosis resort to religion for help (including, Catholicism, Pentecostalism, Candombl, and Umbanda) and how this frames their experience
of psychosis and that of their family members. For young people, the
personal articulation of religious idioms and signifiers served to communicate, elaborate and transform their experience of psychosis. Family
members resorted to religion as a source of healing, complementary to
psychiatric treatment, as well as for personal relief and comfort. For youth,
involvement with religion worked in both progressive and regressive ways,
to improve and, at times, to diminish functioning and well-being.
Key words Brazil psychosis religious healing religious help-seeking

A first episode of psychosis is a devastating experience that involves

the construction, or better still, the creation of a world that makes sense
for the person who is experiencing psychosis, but does not make sense for
others. Phenomenological psychiatrists such as Binswanger (1963) have
described psychosis as a particular mode of being-in-the-world in terms
of inconsistency, disordered experience or the inability to let things be.
Blankenburg (1991) defined psychotic experience in terms of the loss of
the sense of the self-evident that nurtures ones feeling of inhabiting a
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familiar world. People suffering from psychosis lose access to common

sense and to the rules of the game that regulate everyday life. These losses
affect their relationships with others because people with psychosis are
unable to master the rules that run through and orient interpersonal
relationships.
In general, it is quite common to hear people talk about their experience of psychosis by using religious referents: Im Jesus Christ, It is like
manifesting the devil, I became biblical, pure of heart and soul, It seemed
like the Apocalypse . . . nothing was real, nothing was true, Just like the
voice of God calling me. Because these religious referents emerge with
great frequency, it becomes evident that religion influences the manifestation and the experience of psychosis. Beyond this, religion is also
considered a potential source of help and healing. In these ways, religion
plays an important role in the lives of people with psychosis. However, I
argue that resorting to religious referents does not necessarily have a
healing function. Religious referents occasionally reinforce only fear and
confusion, depending on the attitude adopted towards them.
In this article I describe how young people suffering a first episode of
psychosis in urban Brazil resorted to religion and how this framed their
experience of psychosis and the reactions of their families and communities. All of the families who participated in this study sought religious
sources of help in addition to psychiatric care. After psychiatric services,
religious sources of help were by far the most prevalent in their helpseeking trajectories. As has been documented in the literature (Loyola,
1984), seeking religious help is related to the importance attributed to
spiritual healing in Brazilian culture, as many Brazilians believe that
healing must involve both bodily and spiritual aspects of the person.

Religious Idioms, Signifiers and the Work of Culture

Religious idioms and signifiers are diverse and pervasive in Brazilian
culture. Religious idioms are the specific discourses disseminated by
popular Catholicism, Pentecostalism, Candombl, and all other religions.
Religious signifiers (or referents) may intersect several religions, but have
more specific attributes than idioms, such as the notions of God, devil,
Bible, macumba (black magic), and so forth. For instance, spirit possession
provides a particular religious idiom that enables the possessed individual
to articulate a certain dimension of his or her experience and to give it new
meanings. According to Crapanzano (1977), this articulation of the
persons experience takes place because cultural idioms represent a matrix
of meanings and provide a basis for action both at the personal and the
cultural levels. It is also important to pay attention to the different ways
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that cultural idioms and signifiers are borrowed, used, and transformed by
particular persons.
Through the notion of work of culture, Obeyesekere (1985, 1990)1
examined how certain religious idioms and signifiers contribute to elaborate the inner experience of the person suffering psychosis. A particular
religious signifier may be interpreted or used differently by people with
psychosis and their families, in different contexts or at different periods of
their lives. Obeyesekere explored the ways in which collective symbols are
appropriated by singular persons and used to express, transform, and
communicate personal experiences of distress and suffering. His notion of
personal symbols expresses the idea that some symbols operate simultaneously at the personal and cultural levels; they allow the expression of
the unconscious thoughts of the individual and provide a basis for selfreflection (private dimension), as well as for communication with others
(public dimension). Because these personal symbols are public and private
at the same time, they provide the person with options, choices, and the
leeway for manipulation. In addition, they can operate either in a progressive way, towards restoration and elaboration, or in a regressive way,
remaining trapped within repetition, personal conflicts, or problems
(Obeyesekere, 1981, 1990).
Resorting to cultural signifiers, and more specifically religious signifiers,
can contribute to articulating personal and interpersonal reactions to
psychotic symptoms and in framing this experience lead to the further
evolution of the disorder. This perspective is demonstrated in the seminal
work of Ortigues, Martino, and Collomb (1967) conducted in a clinic in
Dakar. They showed the particular ways that a patient, Aminata, was able
to solve interpersonal conflicts, and to re-organize her initial psychotic
state of bouffe dlirante while manipulating a series of religious signifiers
that involved her affiliation with the Islamic cult of rab, as well as her
beliefs in child spirits and magical practices. In a similar vein, Corin,
Thara, and Padmavati (n.d.) have shown how people with psychosis
and their families in South India mobilize different representations
including religious referents while elaborating what is specific in their
experience of psychosis.

Method
This research is based on 12 months of ethnographic fieldwork in the city
of So Paulo, Brazil. The first phase of fieldwork consisted of the recruitment of and participant observation with 21 young people (10 males, 11
females) in the psychiatric emergency service of a large public university
hospital that primarily provides care to a low-income population. The
second phase of fieldwork unfolded as I interviewed these youths and their
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families and followed them in their everyday lives for a period of at least
6 months after the initial recruitment and informed consent. I normally
contacted them once every two weeks. Initially, each young person and,
separately, a family member (usually the mother) responded to the
Turning Point Interview (TPI), a qualitative semi-structured questionnaire
for the retrospective evaluation of the development of signs and difficulties, interpretations, and reactions in early schizophrenia (Corin,
Lesage, King, & Van Haaster, 1996). The elements of the perceived life
history collected through the TPI were complemented during the second
phase of fieldwork with more interviews and informal conversations. I also
spent time with the youths during their daily lives trying to understand
their life strategies, and their interactions with their family, social
networks, and neighbors. I paid special attention to their direct or indirect
contact with religious settings in order to understand how the youths
perceived their significance. The lengthy period of follow-up allowed me
to interview other people in the social networks of the participants. Besides
the young person and the mother, in many cases I was able to conduct
tape-recorded interviews with brothers and sisters, the father, neighbors,
boyfriends, girlfriends, cousins, and psychiatrists
I selected participants who were experiencing a first episode of psychosis
because during this period one can see more clearly the role played by
cultural and social dimensions, because the process of experiencing
psychosis is not totally settled. Therefore, those people who had already
experienced previous episodes of psychosis were not included. I also
selected only individuals 1727 years of age, because youths share life
experiences common to their life stage. Throughout this article, case
examples of youths are provided under fictitious names to protect the
anonymity of the research participants.

Mapping Out the Religious Terrain

Recent increases in poverty, violence, and daily hardships have caused
meaningful changes in the quintessential Catholic religious landscape of
Brazil. For poor people, such changes have greatly affected their lifestyle
and their culture in general, and many have converted to other religions.
Especially in the impoverished urban areas, religious migration has often
become the norm, not the exception (Burdick, 1993). Although threequarters of the population still consider themselves Catholics, other
competing religions have significantly increased their number of followers
in the past few decades, especially the various forms of Pentecostalism,2
Kardecismo, and the Afro-Brazilian religions of Umbanda or Candombl
(Pierucci & Prandi, 1996).
Catholicism in Brazil can be classified in traditional or internalized
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(Camargo, 1973). Most Brazilian Catholics are traditional, they go to

church only sporadically, and for special occasions like baptisms,
marriages, and funeral rites. These people usually call themselves nonpracticing Catholics and only keep religion as an indicator of their social
identity. This group also includes some people who attend mass regularly,
but who do not become involved in any Catholic movement that proposes
the revitalization of Catholic life. Popular religion also integrates a larger
range of practices that constitute traditional Catholicism, like the devotion
to saints, promessas (promises), miracles and pilgrimages to sanctuaries.
The Catholic charismatic renewal is exemplary of the internalized
Catholicism, because people experience Catholicism in a more internalized way that involves a personal movement of reorientation and a real
commitment to religion. A distinct characteristic of charismatic renewal
in Brazil is the devotion made to the Virgin Mary, which is also found in
traditional Catholicism, but does not exist in Pentecostalism. However, the
message transmitted by the Catholic charismatic renewal is very similar to
Pentecostalism in the sense that some of the followers also speak in
tongues(glossolalia) during meetings, practice touch-healing, believe in
the gift of the Holy Spirit as a spontaneous experience rather than as a
ritual sacrament delivered by some authority of the Church, and emphasize that people have the chance to change their lives by accepting the Holy
Spirit (Lehmann, 1996; Machado, 1996; Prandi, 1997).
Development of Brazilian Pentecostalism can be divided into three
waves: the first decades of the twentieth century, the 1950s and early 1960s,
and the late 1970s and 1980s. Most Pentecostal churches in Brazil have
developed autonomously and have gone through divisions into smaller
sects a common form of proliferation. The Assembly of God (first wave),
God is Love (second wave), and Universal Kingdom of God Church (third
wave) are the most representative Pentecostal churches sought out by the
people who participated in this study. In brief, while the emphasis of the
Assembly of God is on baptism in the Holy Spirit as certified by speaking
in tongues (glossolalia), God is Love is characterized by divine healing,
while the Universal Kingdom of God Church stresses exorcism from
demon possession. The Universal Kingdom of God Church also makes
extensive use of television in order to divulge the exorcisms from demon
possession and the theology of rapid prosperity, which is interpreted as the
outcome of real work of God in ones life (Corten, 1995; Freston, 1994;
Prandi, 1997).
Although Brazilian Pentecostalism emphasizes popular notions of
magic and miracles, the rational dimension of life of the Pentecostal
world-view is also very appealing. Pentecostalism attracts the urban poor
more than any other religion in Brazil. Pentecostalism is also becoming a
cultural strategy for coping with urban poverty. It succeeds in part because
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Pentecostalism fosters a sense of closeness to God, enhances self-esteem,

develops leadership skills, promotes literacy, provides support networks,
and encourages a sober and ascetic style of life (Mariz, 1994).
Parallel to the various Catholic movements and Pentecostal churches,
the Brazilian religious terrain also includes more local forms of religion
based on spirit possession, mainly Kardecismo, Candombl, and
Umbanda. Kardecismo has a significant influence among intellectuals and
urban middle classes. They value the intellectual and spiritual progress of
the individual and advocate social mobility through formal education. Its
system of practices involves three interrelated principles that contribute to
the spiritual evolution of the person: development of spirit mediumship,
the study of books about Spiritualism, and works of charity (Aubre &
Laplantine, 1990).
Candombl is a religion of spirit possession with an African origin,
which was restricted to black people until the 1960s. Afterwards, its rapid
spread in So Paulo and Rio de Janeiro opened Candombl to people of
all colors and social classes (Gonalves da Silva, 1995; Prandi, 1997).
Umbanda is a religion of spirit possession derived from the confluence of
Kardecismo, Candombl, and traditional Catholicism. Most people are
first attracted to Umbanda to obtain a spiritual consultation in order to
solve their everyday problems like illness, unemployment, family conflicts,
or love affairs (Brown, 1994; Montero, 1985).

Religious Help-Seeking
In Brazil, religion is lived as a family matter. The initial religious affiliation
of each person is usually framed by the familys previous religious background, most frequently by that of the mother. Most people expect the
mother to be in charge of the religious life of the entire family. However,
this initial affiliation tells very little about the meaning of religion in
peoples lives. I observed that peoples original religious affiliation is
insufficient to understand how religion affects everyday life for two main
reasons: (1) people often have different levels of religious participation
over time, and (2) people make use of a variety of religious signifiers independent of active religious participation or affiliation. This was most
evident in those families with traditional Catholicism as the dominant
religious background. Catholic families are not as engaged in religious life
as other denominations, they are also more receptive to simultaneous
participation in other religious milieus. In the case of Pentecostalism,
families often participate more in the everyday religious life of their own
congregations. This does not imply, however, that they restrict themselves
to their own church, or that they would not try other religious pathways
in situations of deep crisis.
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Although most families who participated in this study initially sought

religious help from their original religious background, they also explored
a wide range of religions, most frequently Pentecostalism and Umbanda.3
Both religions emphasize practices of spiritual healing, but Pentecostalism
expects religious conversion to be a major step towards healing, whereas
Umbanda is commonly practised as a therapy independent of religious
conversion. The religious help-seeking trajectories were also influenced by
the fluidity of boundaries between the different religious domains, which
are further cross-cut by a common ground of shared beliefs, most significantly, spiritual healing, belief in sorcery and witchcraft, and moral
definitions of good and evil.
During my fieldwork, families emphasized how their religious beliefs
and practices reinforced morality, provided social links, and helped them
to tolerate human suffering. Spiritual healing represented the key motive
for them to seek religion as a source of help and treatment. Practices of
spiritual healing are widely accepted because many Brazilians experience
possession and the presence of spiritual beings as a natural occurrence
in their lives. Every individual is conceived as a person with at least some
tenuous link to some spirit. Consequently, the existence of spirits and the
possibility of spiritual healing is not even questioned, although these
spirits assume different identities in each religion: the Spirit Guides in
Kardecismo or Umbanda, the Holy Spirit in Pentecostalism, and the Saints
in Catholicism. Another element mediating the different religions is that
some healing rituals have the analogous purpose of expelling or taking out
the supernatural source of evil from the persons body. Rituals of exorcism
and purification often operate as a gateway to religious conversion
(Campos, 1997). Practices related to spiritual healing are varied and extend
beyond rituals of exorcism of the devil or other evil spirits, for instance,
prayer groups, pilgrimages, blessings, offerings to spiritual entities, and so
forth.
It is important to remember that religious help-seeking ran parallel to
psychiatric help-seeking. Of the 21 families who participated in this study,
only one did not seek religious sources of help. Most psychiatrists accepted
the religious beliefs and practices of these families because most youth
accepted being medicated while attending religious rituals.

Families Perspectives
Families felt confused, lost, and helpless during the outbreak of psychosis;
they tried whatever was within reach to solve the problem. Even before the
family had the chance to consider existing sources of religious help, believers often would come to visit. Neighbors, friends, and the extended family
would come to suggest names of spiritual healers, or they attracted the
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family to their church or spiritual center. The most common form of

religious help was home visits by faithful from different Pentecostal
churches who came regularly to pray, and to bless the person and the whole
family. This phenomenon intensified during the first weeks of the
psychotic crisis, although I observed it happening over the whole course
of the study. These visits were well received because they motivated
families to find alternative forms of religious help. Some families
mentioned that sometimes they felt overwhelmed with the diversity of
religious resources being offered to them, which was then experienced
more as an added burden to the problem. In most cases, religious people
tried to help families tolerate the chaotic situation in which they were
engulfed. Messages of hope and faith were extremely significant, sometimes even more important than expecting that the person would be cured
through religious healing. Caring for the spiritual well-being of the sick
person was often more meaningful than finding the best religious therapy.
Religious resources commonly complemented psychiatric care, rather than
being the main option.
One might suppose that families struggled to take the young person to
innumerable religious places due to some lack of efficacy of the previous
option, but this was not always the case. However, families claimed a kind
of added efficacy: the more religious places to which one goes, the more
Gods power one attains to solve the problem:
I took my son to the Church of Grace because the God who is in my church
is inside all the others. I have faith that God operated in his life, and that
God helped in his treatment, and still is helping. We did prayers. In several
churches we prayed for him. When the person has a problem we do collective praying for 6 days, 7 days always at the same time, to talk with God
about it. Thanks God, God has been operating. [Mateus mother]
It was God [who healed my daughter]. In part it was the physicians help,
but in another part it was God through prayers and searching for [God]. We
did two collective fasting and prayers. I would search for people in churches,
and when they got acquainted with her they would always pray and fast for
her. I took her to four churches . . . Trombetas, Assembly of God, Celestial
Arc, and God is Love . . . they are all good, all of them have the correct
doctrine to be followed. Just like in the words of . . . the more prayers, more
power, like they say. If I go into somebodys church then to somebody elses
church, then the church sisters will help more, they are going to see her situation, and mine, that I am fighting with her, they will pray more for her and
look more for [God], consequently God will liberate her [spiritually] even
faster, thats why I did it. [Sarahs mother]

The basic reasoning remained the same whether it was expressed in terms
of added efficacy or added burden. Most families strongly believed that
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religious resources were essential to complement the treatment provided

by psychiatric care:
There is the spiritual part and the material part. The spiritual part belongs
to the church while the material part belongs to the medical specialities.
[Leonardos mother]
There is a part that was done by physicians; there is another part that was
done by God plus the power of prayers and [spiritual] healing. [Sarahs
mother]

The narratives of the various families reflect the widespread belief that the
persons body is composed of a spiritual and a material part, and that both
have to be healed. In other words, Gods power in combination with
spiritual healing transcends the work of physicians because physicians
attain their power through Gods will. Physicians remain important
because they take care of the material part of the sick person, whereas God
looks after the spiritual part. Several parents were unable to determine
whether their child suffered from a spiritual or material problem. For this
reason, they took the youth to several religious places, frequently Pentecostal churches, in addition to the psychiatric emergency room. Because
they perceived the efficacy of spiritual healing as ultimately certain, most
families preferred to try another religious place whenever the help being
provided did not solve the problem, and this happened frequently. For
these families, spiritual healing always remained an open possibility. Most
families aimed to take care of both the spiritual and the material dimensions of the person.
Another reason, which impelled families to seek religion, is that several
psychotic symptoms are easily confused with signs of spiritual possession,
or some other kind of spiritual disturbance. Religious explanations were
generally well accepted by families because they resonated with their own
observation that the youth expressed signs of nervousness, fear, insomnia,
fainting or nervous attack, visions and hearing voices, which are popularly
associated with signs of spirit or devil possession. These signs of disturbance or the strange behaviors might also be the consequence of some kind
of malice, black magic committed by some other human or spiritual
being to harm the youth. This can be exemplified by the case of a youth
that will be called Jos. His mother was convinced that Joss problem had
a supernatural causation: some evil spirit was disturbing her son, or that
he was the prey of some black magic perpetrated by her ex-lover. This
belief motivated Joss mother to force her son to be exorcised in a Pentecostal church. In this case, as in many others, the ritual of exorcism,
through the work of culture, did not succeed in helping the youth to
elaborate or to transform his experience of psychosis. Joss participation
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in the exorcism ritual only reassured him that his problem was not related
to evil spirits, or analogous religious referents. He rejected any relation
between the voices he was hearing and signs of devil possession:
After hearing voices, my mother took me to church to see if I would get
better and to check if it was something, some evil spirit. She took me and I
felt well there, I didnt see anything [of importance], I saw people fall down
but I didnt fall down. When the pastor said whoever hears voices, evil
things, things from the devil, things from Lucifer, you burn now! I remained
normal, I felt I was there normal, the pastor came to bless me, I believe I
have nothing to do with the supernatural. [Jos]

The case above illustrates how families often resorted to religion because
it yields causal explanations for the problem; however, this belief was not
necessarily shared by the youth. For families, religious explanations
provided some benefit by removing the blame from the psychotic person
and shifting it to spiritual entities or acts of sorcery perpetrated by other
people. This process allowed parents to keep a positive image of their
children as individuals who have not failed, or sinned, and who could not
be held responsible for their sudden strange, unexpected, or unexplainable
actions. Besides the urge to exculpate their offspring, this reliance on
religious explanations helped parents to re-situate the problem within the
shared social space of religion, and to become more actively involved while
trying to find alternative ways to solve the problem.
Active religious involvement through prayers, consultations with
spiritual healers, household rituals of protection, or church attendance
provided a bounding frame for families to deal with the problem, but on
the negative side, this back-and-forth movement between different
religious places generated ambiguity and contradiction. It was unacceptable for some families to see themselves transgressing some of their
previous religious beliefs and faith. For other families, the contradiction
occurred because different religions gave different definitions and
solutions to the problem, and yet a large space for fluidity and common
shared beliefs co-existed. In some circumstances, the family member
created a cleavage between their previous (or present) religious identity,
beliefs, or the involving religious context. For example, some mothers
converted to a different religion hoping that this would help their children
improve. More frequently, however, families apprehended religious
meanings and signifiers through a process of bricolage of the different
religious world-views and practices.

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Young Peoples Perspectives

Most youths only attended religious places when taken by their parents,
although some also had the initiative to attend religious rituals by themselves. Those who wanted to attend felt in many instances that their
psychotic symptoms disappeared inside the religious setting. Leonardo
said that:
When my mother doesnt go to church, I go by myself or my father takes
me to church. Ah, there I feel well, I feel well. . . . The voices, inside the
church, I do not hear the voices! Not inside there, not inside! [Leonardo]

This feeling of wellness is not constant; some individuals felt threatened

while participating in the religious ritual, causing some youths to abandon
the faith altogether, and to question whether religion is what made them
feel worse:
I can only be very thankful to the pastor and all the other church brothers.
The only issue is that I was not feeling well inside the church: sometimes the
pastor would be there giving his sermon, while I only wanted to run away
from the church. . . . The pastor would be talking up in front but I was not
paying any attention. I was not really feeling well inside the church.
[Leonardo]

Most youths attended church or other religious rituals more regularly

during the outbreak of psychosis, however, their degree of religious
involvement varied through time, as suggested by Leonardos narrative
above. Like their parents, the youths were particularly attracted to Pentecostalism, and in second place, to Umbanda. On some occasions, their
religious involvement became very intense, and religion appeared to be
their leitmotif of being-in-the-world.4 They would go to church everyday,
pray all the time, or always carry the Bible with them. On other occasions,
they avoided any kind of contact with religion. It was far more common
to arrive at the familys home, only then to discover that the youth
preferred to postpone our visit to a religious setting for another day.
In most cases, the youths became involved with Pentecostalism because
they were trying to escape from the evil world in which they lived. This
evil world represented the strange experiences they were having while
psychotic in addition to the ubiquitous adverse conditions of poverty and
urban violence, and particularly, of drug addiction. Through their participation in the Pentecostal community, they tried to protect themselves
against the modes of life in which the people of the world live. Pentecostal
followers distinguish themselves from the inclusive society by calling every
non-Pentecostal, people of the world, those who are liable to commit evil
and sinful actions. Pentecostals reject the world in such a way that a social
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withdrawal within their religious community protects them from the

malignant forces that dominate the external world (everyone outside the
religious community). Within this religious community a private
morality is created because you may keep an eye on the other followers,
but they watch your acts as well (Machado, 1996). For instance, followers
easily recognize each other by the way they dress and the discrete way they
always behave in public places (not religious places). They are also more
confident of interacting with each other because they are reassured that
these people are not affected by evil forces like every one else would be.
Religious participation remained unstable for most youths. In the case
of Pentecostalism, this could be partly explained because the world space
created inside the religion community comprises two main facets: on the
one side, the faithful feel protected among the other believers, yet separated from the evil that affects all the people of the world; on the other
side, people from the same religious community are allowed to keep an eye
on each other. However, this vigilant behavior might have exacerbated the
initial feelings of persecution that probably led the youths to look for
protection inside the religious community in the first place.
The strictness and ascetic behavior required to frame ones life after
converting to Pentecostalism kept the youths in the mediating position of
new-converted (without any converting baptism), or led them to quit
such a straight path. This strategy of maintaining a position betwixt-andbetween a previous lay life and a future religious conversion is a common
behavior among young people, and therefore, not necessarily linked with
the experience of psychosis. Nevertheless, the strictness and a certain
rigidity of rules imposed by these ascetic behaviors may be too hard or
overwhelming to follow for those youths with psychosis because they have
lost access to the common sense rules of the game that regulate everyday
life. Thus, conversion to Pentecostalism pursued as a path towards healing
remained controversial and contradictory.
Those few youths who alleged conversion to Pentecostalism revealed
other ambiguities regarding their religious involvement. Their participation in rituals of baptism (conversion) was a sudden decision they made
on their own while watching the ritual, hence without any previous
approval from the other church members. However, the church members
did not prohibit their impulsive action allowing the youth to join the
ritual. Yet the significance of this mock conversion was not sustained, and
they also ended up abandoning the faith. This exemplifies how the youths
in some circumstances articulated the religious idioms idiosyncratically
because what they did was not completely accepted by the other believers.
Each time I had the opportunity to accompany youths to religious places
I was struck by how they maintained a certain position of distance and
detachment in relation to the general commotion of the religious ritual.
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They were often restless and paid little attention to what was happening.
My impression was that these youths were participating in the religious
ceremony without really being there. Apparently, they needed to create
some kind of inner distance towards the religious ritual. They also seemed
to experience the ritual in a more positive and soothing way when they
were allowed to maintain a free circulation and tenuous links with the
religious ritual.
When comparing Umbanda practices to Pentecostalism, the youths
usually demonstrated more aversion towards Umbanda rituals: Ah I didnt
like it, I got very anguished, I only got worse. Or they responded that they
felt just the same, and experienced only a momentary relief. Two other
elements contributed to enhance their rejection of Umbanda: the context
of the help-seeking initiative, and of the healing ritual itself. Consulting
Umbanda was normally veiled from the other family members. For
instance, the father took the youth without telling him or her where they
were really going or without the mothers knowledge or will. Those youths,
who consulted Umbanda on their own initiative, did so secretly. They also
preferred to keep secret most of what happened to them there. Right from
the beginning most often the youths and their families regarded Umbanda
with suspicion and mistrust. This character of secrecy is related to the
ambiguous place occupied by Umbanda in the religious arena of So
Paulo, particularly for those people with a Protestant religious background. This initial shared attitude of suspicion, mistrust, and secrecy
helped to create an atmosphere of incredulity even before the start of the
Umbanda therapy. Because most young people only stressed their uneasiness and discomfort while undergoing the therapy, Umbanda probably
reinforced fearful rather than soothing experiences.
What the youths resisted most was the directness and closeness of the
physical one-to-one interaction between the Umbanda healer (or the
Pentecostal pastor) and the sick person that inevitably occurs during
rituals of religious healing. For instance, the pastors gesture of laying-onhands over the sick persons head to expel the evil spirit away from the
sick persons body. This gesture conveys a very powerful meaning as it
represents the direct contact with the evil (or devil) that has to be exorcized from the persons body in order for the patient to enter into direct
contact with the Holy Spirit. One can only speculate about how the youths
experienced this ritual of a direct contact between the Holy Spirit and the
evil forces. They may have confused the meanings attributed to the
beneficial power of the Holy Spirit with the malignant power of the evil
(or devil). These therapeutic rituals also invaded bodily frontiers of the
youth, which were already blurred.
Another common way that youths resorted to religion was through the
creation of private rituals. They usually repeated or transformed portions
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of some well-known religious ritual, alone and idiosyncratically. For

example, Alices automated behavior of reading the Bible continuously
and of throwing away all Catholic saint images that she found in her way;
Marias intransigent fasting and sole attempts of exorcism while kneeling
down over her bed and crying out loud burn the devil, burn the devil;
Leonardos simulated work of macumba (black magic) while burning
photos and other personal objects in a campfire lit in the backyard; or
Doras unremitting preaching and Bible reading around the town on
behalf of the salvation of all souls. Often the idiosyncratic, persistent, exaggerated, or displaced character of these religious performances was what
first alerted family members to the existence of a problem.
In sum, the youth participated in a marginal way in most religious
healing rituals, or alternatively, they elaborated their experience of
psychosis by making a profuse use of religious signifiers, for instance, when
they created their own private rituals. In other words, the youths resisted
becoming normal followers by remaining at the margins. In this sense, the
modes of behavior expected in religious rituals were played out by the
youths in a very flexible way. Since they resisted becoming normal followers, why did religious referents continue to be so important to them?

Anchoring the Experience of Psychosis

It was unusual for youths to explain their resort to religion by looking for
a causal explanation to their problems; even if they seemed perplexed
regarding the meaning of what they were experiencing. When I explicitly
asked them about their ways of explaining their problems, their most
immediate answer was I dont really know or I am not sure. They were
constantly perplexed, confused, and full of uncertainties. In Joss case,
although he rejected a supernatural cause of his problems when he noticed
that he was not being possessed by the devil like some of the other people
in the church (who fell down during exorcism), on many other occasions
Jos used religious signifiers (something spiritual, something supernatural,
God) to give shape to try to understand the meanings of the unnatural,
ambiguous, and exceptional quality of what he was experiencing:
I was running in the roadway and there was a guy following me. It seemed
like an animal thing. It seemed something spiritual, which knows, something sent by God. I dont know why. I am, I have a lot of faith in God, but
I dont know what it was. Maybe it is somebody who is coming to give some
message. I dont know, I dont really know how to explain, it is something
supernatural, it seemed supernatural.

Expressions of bewilderment and vague allusions to the supernatural

realm prevailed among the youths when they tried to describe their
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experience of psychosis or the drifting quality of their perceived environment. It was much more an attempt to put into words and to qualify their
shifting and uncanny experience, rather than to provide an explanation as
such. I also observed qualitative variations attributed to the voices or
visions which constantly disturbed them and sometimes made them feel
even more unstable and uncertain regarding their own feelings and
perceptions. For instance, sometimes the youths attributed positive and
soothing qualities to the voices they were overhearing, albeit most of the
time the negative, threatening, and uncanny aspects of these voices dominated their narratives. Voices that threatened to kill them or to destroy the
whole world were intermeshed with messages from God.
Being completely immersed in a world of uncertainties, strangeness, and
chaos induced the youths to look for religious referents as some kind of
anchoring point, they were looking for some stability in the deteriorated
world they were experiencing:
In my mind I was feeling well . . . the unusual things I saw is because I
believed it was the end of the world that was normal for me. I had to search
for the salvation of souls and preach to the people, that is what I thought.
[Sarah]
I thought that the world had ended. That just bad people remained on earth.
I would see everyone different, I would see everyone in the shape of devil.
[. . .] Nothing was real, it was something from my head, and nothing was
true. It was something from my head because it was not possible for people
to remain in the way I saw them, of hearing voices . . . [Mateus]

In the excerpts above, Sarah evoked a more active reaction than Mateus
paralysing mode of being-in-the-world because she also started to search
for salvation and preached to all people as a way of fighting against the
imagined end of the world. One could hypothesize that both of them were
also trying to protect their precarious sense of self in projecting the
deterioration of their experience to the outside world, as well as attaching
religious referents to describe and name their unusual experiences. Most
young people made frequent allusions to their missing a personal sense of
boundaries in relation to themselves, to other people, or to the outside
world. Their sense of self seemed to be constantly dissolving and changing
limits or boundaries. In this context, any attempt to find or establish some
kind of anchoring point becomes inevitable. Perceptions like everyone in
the shape of the devil; the end of the world further indicates how the
world around them appeared dominated by a fixed feeling of evil and of
ending sometimes-even death. The youths repeatedly alluded to existential questions concerning life and death, or they were particularly
concerned with answering questions such as Who am I? and Do I exist?
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In sum, the young people manipulated the fluid semantics of religious

signifiers from one or more religions to play with psychosis, or even to put
it out of play (Blankenburg, 1991). In this context, the diversity and ambiguity of religious referents allowed youths to cope with psychosis.
Nonetheless, the opposite movement was likely to happen as well. The
ambiguity and diversity of religious signifiers momentarily accentuated
the absence of anchoring points in which one could sustain ones sense of
being-in-the-world. When religious signifiers and anchoring points were
continuously being re-signified, the psychotic person not only experienced
a lack of stability, but a deterioration of his or her position within the
surrounding world.

Capturing Religious Signifiers

It is easier to understand how the youths resorted to religion in search of
anchoring points that would help them to overcome their existential angst
by describing how they captured and interpreted religious signifiers.
Instead of exploring the diversity of religious signifiers available, I have
chosen to emphasize only how the Bible and God were appropriated as
core religious signifiers. For most young people, the Bible acquired a
particular and more exclusive significance during the outbreak of
psychosis: I am reading the Bible now to see if I find the answer . . . there
are beautiful things in the Bible, I go back to read the Bible . . . because
the Bible helps you a lot, one needs to read the Bible all the time,the Bible
explains to you how things are, I lost the fear by reading the Bible. Like
most other people, the youths started reading the Bible seeking some kind
of religious consolation and reassurance. In some cases, however, the
youths spent whole days reading the Bible, while others integrated
the Bible in their private rituals, and some would only go to sleep with the
Bible under their pillow.
Because the Bible is representative of the eternal truth, it hypothetically
contains all the answers that people need. The Bible is also considered a
core symbol that reveals the origins of human existence. When the young
people clung to the Bible, they were also questioning the meaning of life,
of their own existence, and the very certainty of reality, destabilizing everything that was taken for granted in their common world. While they were
immersed in uncertainty, the act of reading the Bible potentially provided
them with some certainty and truth. When everything around them
seemed replete with religious meaning, the youths associated the act of
reading the Bible with their talks with God. The faithful equate the words
written in the Bible with personal talks with God. This occasionally
generates confusion between the words of God (written in the Bible) and
ones reality: people talk about God and with God simultaneously (Cesar,
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1996). This confusion sometimes gained insurmountable proportions for

some youths, like Alice, because the Bible emerged absorbed into the
delirious quality of their lived world.
Alice recalled an episode in which she remained praying in the kitchen
the whole night and talking with the Bible (and God). She reacted with
estrangement and was feeling very pressured because she was seeing
shadows. She was not sure whether these shadows were something
beyond the lit candle over the neighbors window. Alice established a
contiguous relationship between herself, the Bible and the lit candle. When
she read or talked to the Bible, the flame of the candle seemed to respond:
the more she talked, the more the flame started to blaze; she interpreted
this as a work of black magic. Her reactions towards the lighted candle
became exaggerated: she felt the urge to talk even more to the Bible,
kneeling down in a praying position, and fainting on the floor as if she had
abandoned herself to the Holy Spirit. She only wanted to counteract the
work of black magic that she associated with the lighted candle. She also
asked the Bible systematically why all this was happening to her. She
mentioned that on several other occasions she was unable to sleep because
she would only think and talk to the Bible. Although she was using the
Bible to cope with the enveloping strangeness, this also triggered a negative
experience, especially when her reactions became exaggerated and out of
control. Nevertheless, she always attributed a positive value to the Bible
because she read it in search of some protection and orientation while
facing such unstable reality, and during her incessant quest for significance
of such disturbing experiences: I would feel more safe because I was able
to read the Bible, I would feel more safe, and I had the urge to read it to
learn more . . . the religious teachings, I felt like reading it to understand
better what was happening. The Bible reading retained a double meaning
and ambiguous position in Alices world.
Several other youths suddenly found themselves imprisoned with Bible
reading or some other religious referent, such as interminable praying,
repetitive exorcisms, out-of-context rites against black magic, and fasting
until starvation. Their feelings towards the world were dominated by an
unbearable dread towards the evil world, or they divided the world in a
very rigid way between good versus evil. These situations represent a
paradox because while the youths were primarily trying to find positive
ways to cope with psychosis, they ended up incorporating the religious
referents in rigid or negative ways.
In certain circumstances, the youths captured religious signifiers in
order to construct a more positive image of themselves. For instance, some
youths started to perceive themselves as very special persons. This selfperception resonated with religious beliefs claiming that the faithful have
been elected by God. Nevertheless, the idea of becoming a special person
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or in some way of having acquired special powers, is quite common

among psychotic people. In psychiatric terms, it is only qualified as a
feeling of omnipotence. However, for these youths, their feelings of specialness helped them to tolerate the uncertainty and incomprehensibility of
what they were experiencing. Only people with special powers would be
able to overcome so much anguish and terror. Such feelings sometimes
took an extreme form giving the impression of them becoming in some
way identified with God:
Oh . . . God helped me in such a way that I even had powers. I would look
like this to the light, the devil would turn off the light, and I would turn the
light back on with my eyes. I was fighting against the devil face to face [. . .]
I made the sky and earth . . . die the sky and earth with my faith. With my
faith, I was able to move the skies and earth fighting against the devil.
[Sarah]
When I started to go to church it seems that . . . The Spiritism started to
chase me, with voices and doing macumba to me . . . They are spirits . . . I
am the Holy Spirit, and they are the spirits of evil [voices]. They do
macumbaria, sorcery, and this kind of stuff. [. . .] And so people say that I
dribble . . . that I listen to the voices . . . and then I dribble the spirit . . . that
I was going to die, that they [voices] wanted to kill my family. [Leonardo]

In the earlier narrative, Sarah associated her experience of psychosis with

the dreadful presence of the devil. She only felt capable of reacting against
this terrifying experience after acquiring godly powers, which enabled her
to try every strategy possible to deceive the devil. Leonardo attempted to
dribble the spirits of evil by identifying himself with the Holy Spirit.5 This
gave Leonardo some sense of power which helped him to deal with the
unbearable persecution in which he found himself caught. I suggest that
this new sense of empowerment is what allowed him to dribble, irritate,
and fight back the voices that had been disturbing him. One may hypothesize that dribbling these voices placed him in an active stance (by provoking the adversary) and gave him some sense of self-control (by controlling
the ball) towards his own existence. This is specially the case on those
occasions when the voices were there playing the soccer game against him.
It could also be possible that a youths insurmountable fear and anguish
are metamorphosed into some kind of power that dribbles psychotic
symptoms. In any case, Leonardo preferred to keep secret about how he
managed to dribble these evil spirits.
Having special powers is not always experienced in such a positive
way. Because these special powers are often experienced as limitless,
sometimes the youths believed that they were also able to harm other
people. For instance, Sarah was very reluctant to tell her mother about her
personal fight against the devil because she imagined that the power of
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this revelation could kill her mother. Other youths were also anguished,
frightened, and perplexed when they imagined that they could even kill
people just through thinking because of their powerful telepathic
thoughts. Sarah commented that she dealt with this threatening situation
because she finally lost her special powers when she abandoned herself to
God, thus allowing God to carry on with the fight against the devil.
The figure of God on whom youths relied was always that of an omnipotent God. Youths derived some sense of stability from believing that they
had been elected by God, or even that they had become God, but this kind
of perception occasionally remained entrapped within psychosis. Thus, a
very thin and flimsy line seemed to separate ones experience of God from
oneself. One may question whether this close association between aspects
of the psychotic experience and ones experience of God weighted up in
the religious experience towards the negative or towards the positive, as the
only way out for youths to cope with psychosis. Therefore, the youths were
not always able to cope with psychosis in what psychiatry conceives as a
positive way. Even so, the identification with God was a common attitude
that helped several youths create some kind of protection against the evil
world in which they felt themselves engulfed. From the psychiatric
perspective, this attitude only reveals the prominence of psychotic
symptoms.

Conclusion: Transforming the Experience of Psychosis

I have examined how resorting to religion became important to youths
because this allowed them to articulate their personal and interpersonal
reactions to psychotic symptoms through the manipulation of religious
referents. What usually differed between individuals was the degree of
involvement that youths had with specific religious idioms and signifiers,
and the particular ways they captured these signifiers and tried to make
sense of their experience. The youths appropriated some religious signifiers more than others because they converged with their reality more
easily. Therefore, religions have the potential to provide a set of representations and meanings, which contribute to inserting a personal and
alienating experience within a stable frame of reference. In the case of
psychotic people, religion equips them with a range of notions and
symbols that they can appropriate for their own quest for significance.
These young people manipulated the religious signifiers at three
different levels. First, religious signifiers were useful to label or describe
what they were experiencing. For example, when the youths mentioned
that what they were experiencing resembled something spiritual, supernatural. Second, the religious signifiers indicated continuous attempts or
strategies of coping with psychosis or in finding a way out of psychosis.
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At this level, religious signifiers eventually worked as anchoring points,

which people with psychosis adhered to in their novel mode of being-inthe-world. For instance, some youths read the Bible all the time because
they were seeking some kind of reassurance. Third, they reflected the quest
for comprehensibility necessary to perpetuate and reassure ones own
existence and sense of self. This was exemplified by the cases of Sarah and
Mateus who were fighting against the end of the world. It was common
to observe a convergence of religious idioms with ones own experience
and quest. In sum, the personal articulation of religious idioms and signifiers brings together three main functions in relation to ones experience
of psychosis. They help to communicate, to elaborate, and to transform
the experience of psychosis.
Family members resorted to religion from a slightly different perspective. They were primarily seeking alternatives, but most often,
complementary forms of healing the patient. Religion was also a source
of personal relief and comfort for family members, in addition to furnishing causal explanations that exculpated the psychosis of the child. When
the despair, confusion, and anguish of family members became insurmountable, this often precipitated a back-and-forth help-seeking
movement between a diversity of religious therapies and religious signifiers. The fluid semantics and ambiguity of religious idioms and signifiers
provided alternative ways of solving, explaining, or coping with the youths
problems, however, family members eventually felt burdened by the
variety of possible solutions they could have followed.
A crucial question that remains to be answered is to what extent these
religious idioms and signifiers helped the youths to cope or find a way out,
or whether they only tended to exacerbate the symptoms of psychosis. The
outbreak of a first psychotic episode is such an unstable (and usually rapid)
experience that it was rather difficult to distinguish the positive effects of
religion from its negative or neutral effects. For both the youths and their
families, certain religious idioms and signifiers had more potential to help
the person muddle through his or her existential angst than others. This
was also dependent on the particular ways that each person re-interpreted
and made sense of the variety of religious idioms and signifiers available.
For many youths, the fundamental aspect of resorting to religion was
their attempt to seek a way out of psychosis in order to preserve and safeguard their own existence. It also represented the youths quest for the
significance of the unexplainable mode of being-in-the-world in which
they felt engulfed. Because the youths seemed more preoccupied in finding
ways to understand what was happening to them, they very seldom attributed a healing function to religion. Family members usually expected that
religion would always bring positive effects, particularly through its
healing function.
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Through the notion of work of culture Obeyesekere (1985) suggested

that some cultures offer a greater potential than others for a personal elaboration of psychiatric disorders, including psychosis. Considering the
work of culture in relation to the inner experience of psychotic patients,
Obeyesekere noticed that religious and cultural signifiers may operate both
in a progressive way, towards restoration and elaboration of ones mode
of being-in-the world, or in a regressive way, leaving the person trapped
within repetition, personal conflicts or problems. In my study, youths and
family members often gave more weight to the regressive elaboration of
the experience in relation to these signifiers, rather than the progressive.
I am not suggesting that youths resort to religion was merely regressive,
but that they have paid far more attention to this aspect of their religious
involvement during the outbreak of psychosis. I believe that many youth
were so absorbed in their own delirious experience that together with their
family members, they were often impelled to emphasize the regressive
aspects. The progressive elaboration of the experience was also present,
but less evident. However, one has to take into account the fact that I met
youths and their families during the outbreak of psychosis and just after,
so that time had not yet allowed for the elaboration of more stable
strategies to cope with psychosis.
In addition, to talk in terms of the regressive or progressive elaboration of experience is also a value judgment. This became evident when I
tried to discriminate in which situations youths were able to cope with
their psychosis through the use of religious signifiers, and when they were
not able to do so. I recall Leonardos initial involvement with NeoPentecostalism when he would go to church every day. He was feeling a
sense of protection inside the church, because he would not hear the
voices during the rituals. This illustrates a way in which religious idioms
and signifiers helped Leonardo cope positively with psychosis. However,
Leonardo also created a series of idiosyncratic macumba (black magic)
rituals during both psychotic episodes that he went through. In this
instance, macumba protected Leonardo from his fears, but that on another
occasion macumba also contributed to exacerbating his suicidal ideation.
To the eyes of outsiders, the persistence and idiosyncratic nature of these
rituals often indicated a worsening and accentuation of psychotic
symptoms. Why did Leonardo insist on the rituals? Perhaps this was the
only way he was able to cope with the strangeness and dreadful experiences
through which he was going.
In conclusion, religion occupies an important and irreplaceable space in
the experience of psychotic people and their significant others in Brazil. It
provides support through the religious web to overcome and accept such
overwhelming and anguishing experiences even when religion is taken out
of context and is mainly absorbed in the delirious quality of the psychotic
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experience. However, the support provided by religion can be very

ambivalent, sometimes acting in a more progressive, and in other times
regressive way. Nevertheless, what other cultural signifiers could carry out
the same function in the sense of elaborating ones experience in relation
to oneself and the world? One may wonder what people with psychosis
would do if religion did not exist as some kind of anchoring point, even
when it works only temporarily.

Acknowledgements
I would like to express my gratitude to Nora Jacobson for her insightful suggestions regarding the organization of this paper.

Notes
1.

2.

3.

4.
5.

Obeyesekere (1990: xix) has defined work of culture as the process whereby
symbolic forms existing on the cultural level get created and recreated
through the minds of people.
Rolim (1992) defines autonomous Pentecostalism in opposition to classic
Pentecostalism. The former, he explains, is developed around strong leadership, yet is dissident from the classic that originates from the Pentecostal
churches of North American missionaries, and is very uncommon in Brazil.
Healing, exorcism, and prosperity are the most significant characteristics that
define autonomous Pentecostalism in Brazil.
The cultural psychiatry literature describes how the experience of psychosis
is often a burden to the family (e.g. Jenkins & Schumacher 1999). I am also
suggesting that religious help-seeking can eventually enhance this burden that
families are already experiencing with the problem.
This is a common expression employed by Pastors of Pentecostal churches
during rituals of exorcism.
Dribble is a slang term in Brazil used in soccer games which means that the
soccer player is able to fool his adversary by provoking him through body
movements to keep control of the ball, to run with it or to pass it over to
another player.

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CRISTINA REDKO, PhD (McGill University) is an anthropologist particularly interested in child and youth mental health. She wrote this article during her postdoctoral fellowship at the Centre for Addiction and Mental Health, Toronto,
Ontario, Canada. Address: Wright State University, School of Medicine, Center for
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Colonel Glenn Hwy., Dayton, Ohio 45435-0001, USA. [E-mail: cristina.redko@
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