Mental illness or possession? Magic, the evil eye and when to see a doctor

Mental illness or possession? The short answer

Whether it is mental illness or possession, magic or the evil eye is not something you can settle by guessing at home. Many of the experiences blamed on them, such as hearing voices nobody else hears, sudden waves of terror, feeling something pressing on you in your sleep, and seizures, have well-known medical explanations, and most can be treated effectively. The safe path is not to choose between your faith and medicine: start with an assessment that rules out treatable causes, and keep up your prayers, supplication and ruqyah if you wish.

If you are asking about yourself or your son, you are not alone, and your question deserves respect, not mockery. A 2024 scientific article from Qatar on religion and mental health in our region notes that symptoms such as anxiety, altered consciousness and psychosis are often put down to the evil eye, magic or jinn possession, and that traditional and religious healers are often the first people families turn to.

In Egypt, a study from Ain Shams University published in 2020, involving 232 people with schizophrenia, found that 41.8% had gone to a traditional healer before seeing a psychiatrist, and hallucinations were what most often led them there. The researchers warned that this route can expose patients to harmful practices and delay treatment. So the problem is not faith; it is delay.

Am I bewitched or ill? Symptoms with clear medical explanations

These are the most common experiences that people put down to magic or possession:

Hearing voices and seeing things: schizophrenia and the jinn

The US National Institute of Mental Health (NIMH) describes psychosis as a set of symptoms in which a person loses some contact with reality. They include hallucinations, seeing or hearing things that others do not, such as voices that criticize or give orders, and delusions, false beliefs the person holds on to, such as thinking someone is trying to hurt them. It is easy to read these experiences as a jinn speaking to someone or a spell cast on them. Psychosis often begins between the late teens and the mid-twenties, and it can be part of schizophrenia, bipolar disorder or severe depression.

Sudden fear, a pounding heart and a sense of dying: a panic attack

The UK's National Health Service (NHS) lists among the symptoms of a panic attack a racing heartbeat, sweating, shortness of breath, trembling, feeling disconnected from your body and a fear of dying. Most attacks last between 5 and 20 minutes; they are frightening, but they do not cause physical harm. Read more about panic attacks and their symptoms.

Something pressing on you, or someone in the room, as you sleep: sleep paralysis

What many people call "al-jathoom" is known in medicine as sleep paralysis: you are awake but cannot move, speak or open your eyes, and you may sense that someone is in the room or that something is pressing down on you, for up to a few minutes. The NHS describes it as scary but harmless, and links it with insomnia, irregular sleep patterns, anxiety and panic disorder.

Feeling cut off from yourself or the world: dissociation

Dissociation, as the NHS explains, is one way the mind copes with more stress than it can bear: you may feel as if you are outside yourself, watching from a distance, or that the world is not real, and there may be gaps in your memory. It is often linked to trauma, and in some people it comes with seizure-like episodes. The reassuring part is that many people recover fully with treatment.

Fits or strange behavior without awareness: epilepsy

An epileptic seizure is not always a fall and shaking. MedlinePlus, the US National Library of Medicine's health site, notes that it can be hard to tell when someone is having a seizure: some seizures cause only staring spells, and others show up as a brief blackout followed by confusion, odd behavior such as picking at clothing, a bitter or metallic taste, or sudden mood changes such as anger, unexplained fear or laughter. Other seizures can bring sudden falling, shaking of the whole body or jerking of the limbs. It is easy to mistake these scenes for possession.

If what you notice in yourself is a sadness that does not lift and a loss of interest in everything, our article on depression symptoms may help. And if you are troubled by disturbing religious thoughts that keep coming back against your will, read about religious OCD.

Physical illnesses that can look like magic or possession, and must be ruled out

Not every hallucination or sudden change in behavior starts in the mind. The NHS lists physical causes of psychosis, including:

• Low blood sugar
• A high temperature or a head injury, and other sudden illnesses or injuries
• Some infections, such as malaria, syphilis and HIV
• Brain and nerve conditions, such as brain tumors, multiple sclerosis, Alzheimer's disease and Parkinson's disease
• Lupus, an autoimmune disease
• Drugs and alcohol: such as cannabis (hashish), methamphetamine (shabu), cocaine, ketamine and hallucinogens, as well as withdrawal after suddenly stopping alcohol or drugs that were used for a long time
• Some medicines, in rare cases

Delirium: sudden confusion in older people and the sick

MedlinePlus also explains that confusion means not being able to think as clearly or as quickly as usual, and that it can be linked to delirium. Its causes include infections, fever, low blood sugar, some medicines, the effects of alcohol or drugs or withdrawal from them, and lack of sleep. It is more common in older people and often happens during a hospital stay, and many times it lasts only a short time and goes away. But when confusion comes on suddenly, MedlinePlus advises calling the emergency number. So a grandmother who suddenly becomes confused at night needs emergency care first: take her to the emergency department or call an ambulance on 123.

Why does delay do harm? The example of a first episode of psychosis

NIMH notes that it is common for someone to live with psychotic symptoms for more than a year before getting treatment, and that shortening this gap is critical, because early treatment often means a better recovery, and the risk of violence and suicide falls with treatment. Still, do not lose hope if there has already been a long delay: guidelines from the UK's National Institute for Health and Care Excellence (NICE) recommend that early intervention be available to everyone with a first episode of psychosis, whatever their age and however long they have gone without treatment.

Early signs listed by NIMH that deserve attention if they persist or get worse:

• Suspicion and mistrust of other people
• Trouble thinking clearly
• Withdrawing and spending a lot more time alone
• Strange ideas or feelings, or a lack of feelings
• Neglecting self-care and hygiene
• Disturbed sleep and sleeping less
• Difficulty telling reality from fantasy, or confused speech that is hard to follow
• A sudden drop in performance at school or work

Ruqyah and psychiatric treatment: can they go together?

Yes, and you do not have to choose between them. The 2024 article from Qatar mentioned above notes that reciting the Quran and praying can ease stress, calls on psychiatrists to work with religious scholars within clear ethical boundaries, and suggests that respecting a patient's beliefs within the treatment plan may help them stick with it.

But it also warns of two common traps: a patient putting rituals ahead of medication and so stopping their treatment, and a family reading a worsening illness as a sign of weak faith and so delaying help. To bring the two together safely:

• Keep up your prayers, supplication and Quran reading; you do not need to stop them to be treated.
• Tell your doctor what you tried before coming, and do not feel embarrassed to mention ruqyah.
• Do not let ruqyah replace a medical assessment or become a reason to stop medicine; any change to medicine is agreed with the doctor.
• Stay away from any practice that involves harm or humiliation, such as beating, tying someone up, locking them in, or depriving them of food or sleep.
• Do not take a lasting illness as a sign of weak faith: illness is a trial that befalls believers and others alike, and it can be treated.

Warning signs that mean a doctor is needed now

Do not wait if any of these signs appear:

• Voices telling the person to harm themselves or others, talk of death, or threats and violence
• Sudden confusion or a change in awareness and behavior, especially with a fever or in an older person: go to the emergency department or call an ambulance on 123
• A first-ever seizure, a seizure that is still going after 2 to 5 minutes (do not wait past 5 minutes), not waking up or behaving normally afterward, another seizure starting soon after one ends, or anything different from the person's usual seizures: call an ambulance on 123
• Symptoms that appeared after taking drugs or after suddenly stopping alcohol or drugs
• Severe neglect of eating or hygiene, or complete withdrawal from people

What happens at the first assessment, and how is the family involved?

NICE guidelines recommend a full assessment for anyone with psychotic symptoms, covering their mental health, the risk to themselves or others, their alcohol and drug use, a full physical examination to look for a physical illness or medicine that could be the cause, and their circumstances and any trauma they have been through. In practice, a first appointment usually goes like this:

1. A calm talk about the symptoms: when they began, how they developed, and what you tried before coming, including ruqyah.
2. Questions about physical health, then a physical examination, and tests if the doctor thinks they are needed.
3. A direct question about safety: are there any thoughts of harming oneself or others?
4. A clear plan, explained to you and your family, agreeing on the next step.

The family is part of the treatment, not just company on the visit: NICE recommends offering family intervention to every family living with a person who has psychosis, and NIMH notes that informed, involved family members are better prepared to support their loved one's recovery. If your son refuses to come, you can come on your own first to explain the situation and leave with a plan. For more, read our family guide to mental illness.

How does treatment work?

Treatment depends on the diagnosis:

• If the cause is physical, such as an infection or low blood sugar, treating it comes first.
• For psychosis, treatment usually includes an antipsychotic medicine chosen and monitored by the doctor, along with talking therapy, family support and help getting back to study or work. NIMH stresses that recovery is possible with early diagnosis and the right treatment.
• For panic attacks and dissociation, talking therapy is central. For panic, the doctor may also prescribe medicine; there is no medicine specifically for dissociation, but the doctor may treat depression or anxiety that comes with it.

At Oxygen Center, the path starts with an appointment with a psychiatrist, open to men and women aged 15 and over (under 18 with a guardian's consent). The center does not offer services for children under 15, and inpatient stays, if needed, are for males only. The first step is simpler than you imagine, and nobody will ask you to leave your faith at the door.