Excerpted with permission of National Catholic Reporter.

In a few well-publicized cases, failure to make a careful assessment of possible brain dysfunction before performing exorcism has resulted in disaster. In 1976, two Bavarian priests were convicted of negligent homicide in the case of 23-year-old Anneliese Michel, an epileptic whose medical treatment was discontinued in favor of exorcism and who later died.

A lack of standardized procedures can be another problem. A Korean Protestant exorcist in California was convicted of involuntary manslaughter and sentenced to four years in prison for, in effect, trampling a woman to death during a four-hour exorcism in 1996.

Although the exorcists are aware of such cautionary tales, they differ in how, and whether, they concern themselves with a distinction among physical, mental, and spiritual distress.

Rome's Father Gabriele Amorth said he always asks for someone's medical history and consults a psychiatrist if he thinks it useful. On the other hand, he argues that only performing an exorcism provides certainty, because it is in the reaction to the exorcism that one detects the presence of a demon. Besides, he said, "an unnecessary exorcism never harmed anyone."

That is a judgment questioned by some Catholic priests with backgrounds in psychotherapy.

"A popular culture has developed in which some Catholics, if confronted by phenomena that confuse or frighten them, will immediately diagnose the phenomena as demonic and begin a process of ordering an evil entity to leave the person," said Father Joseph Mahoney, a Catholic chaplain in Detroit who works with people suffering from multiple personality disorder. "I believe it to be spiritually dangerous, psychologically dangerous and abusive, and scandalous."Fr. Mahoney operates a website on trauma and religious issues at www.jmahoney.com.

Far from being harmless, Fr. Mahoney believes exorcism can be "extremely destructive" when practiced on patients with undiagnosed multiple personality disorders. He points to research carried out by the Royal Ottawa Hospital in Canada, which concluded that exorcism can create new personalities in such subjects and is "contraindicated."

Several exorcists said they rely on signs such as unusual knowledge or physical strength, an ability to speak foreign languages, and aversion to sacred objects to determine if an evil spirit is present. Fr. Mahoney, however, says that each can also be a symptom of multiple personality disorder.

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