The Uncanny: A Biopsychosocial Perspective

Alcohol or drugs may cause many unusual experiences. Substance intoxication can generate perceptual distortions, impaired cognition, stupor, psychomotor problems, mood lability, inappropriate behaviors, and personality changes. The hallucinogenic properties of psychedelic substances such as psilocybin and LSD are well known. Furthermore, individuals addicted to a substance may experience withdrawal symptoms, including hallucinations, seizures, psychomotor agitation, palpitations, and anxiety. Evidence has indicated that certain paranormal experiences are related to substance use. For example, marijuana and ketamine can generate out-of-body experiences (35, 36), and ketamine is also capable of creating near-death experiences (37).

A peculiar phenomenon can occur when an individual is falling asleep and in a hypnagogic state or waking up and in a hypnopompic state. The individual has some conscious awareness, yet is physically paralyzed, and experiences physical sensations and vivid visual, auditory, tactile, or vestibular hallucinations (38). The phenomenon is called sleep paralysis, and an episode can last from a few seconds to several minutes. It likely results from neurochemical transitions as the brain enters or exits rapid eye movement sleep (38, 39).

Physical sensations include muscle paralysis, heart palpitations, and respiratory difficulty. Hallucinations include seeing animate or inanimate images; seeing shadows; hearing crashing, banging, humming, or buzzing noises; hearing footsteps; hearing one’s name being called; feeling vibrations; feeling heavy; feeling pressure on the body; feeling weightless; feeling as though one is floating or falling; feeling disoriented; sensing a presence nearby; and sensing imminent catastrophe (40, 41). Understandably, these sensations and hallucinations can be frightening and distressing (42). Because sleep paralysis is not well known, many people lack a scientific explanation for their experience and attribute it to a paranormal entity such as a demon, ghost, or extraterrestrial (43, 44). Individuals reporting abduction by extraterrestrials are more likely to experience sleep paralysis than those who do not report abduction (5).

Sleep paralysis is a common experience. Sharpless and Barber (45) found that 7.6% of the general population, 28.3% of college students, and 31.9% of psychiatric patients have experienced at least one sleep paralysis episode. According to the American Academy of Sleep Medicine (46), nearly 40% of the general population experience sleep paralysis at least once over the course of a lifetime, and 3%–6% experience it more frequently. Should these episodes recur and cause significant distress or social-occupational impairment, and there is no co-occurring neurological or medical condition, the individual may be diagnosed with a sleep disorder (47).

Stressful events can adversely affect an individual’s psychology. The death of a spouse, relative, or loved one is a significant life stressor. After a death, nearly 70% of recently bereaved people experience either illusions or audio, visual, or tactile hallucinations of the deceased (48, 49). These hallucinations include hearing the deceased’s voice, feeling his or her touch, and seeing the deceased (50). Sometimes the deceased’s presence is felt, although it does not register through the physical senses (50). Such hallucinations should not be viewed reflexively as pathological. In fact, Hayes and Leudar (50) argued that they can be part of the grieving process. However, if a hallucinatory experience causes significant distress or leads to social or occupational impairment, then a clinician may want to provide psychotherapeutic intervention.

People may have manifest or latent motivations to claim belief in, or experience of, paranormal phenomena. When there is deliberate intent to deceive, it could be malingering or a hoax or prank because someone is bored or pursuing financial or social gain. In some cases, such as those involving a factitious disorder, there may be no apparent external reward yet an individual still falsifies or deliberately induces symptoms to appear ill or injured. In some cases, there may be no manifest intent to deceive. Rather, confabulation occurs as the result of a somatic or conversion disorder in which an individual is unconsciously motivated to assume the role of someone who is sick. Regardless of an individual’s motivation, examples of proven paranormal deceptions are plentiful (e.g., 51).

The human mind appears organized to process stimuli as quickly as possible using information processing shortcuts known as heuristics (52, 53). This is likely an evolutionary adaptation, because potential threats need to be assessed instantaneously. When information is processed rapidly, however, complex cognitive faculties are bypassed, and more intuitive interpretations are made. Information becomes susceptible to cognitive biases, logical fallacies, magical thinking, and probability misjudgments, which can contribute to perceptual distortions (54), memory impairments (55), poor judgment (56), and inferior decision making (57). According to Irwin (58), intuitive interpretations, which lack analytical processing, are more likely to generate anomalous perceptions, paranormal beliefs, and unusual experiences. Individuals who believe in paranormal phenomena are more likely to have an intuitive processing style (59).

Personality can be defined as “a complex pattern of deeply imbedded psychological characteristics that are expressed automatically in almost every area of psychological functioning” (77, p. 2). These characteristics (or traits) produce habitual patterns of thoughts, feelings, and behaviors that are then labeled personality. Multiple traits are associated with individuals who believe in, or report experience with, paranormal phenomena, including absorption, fantasy proneness, porous boundaries, and external locus of control.

A fundamental psychodynamic principle is that competing motivations produce psychological conflict (92). This is a feature of human psychology and produces normal, as well as pathological, functioning. Bodily impulses, thoughts, emotions, psychological defenses, and societal constraints are always in tension, and the mind’s effort to reconcile these components produces compromise formations. Throughout the course of any given day, there are innumerable things people want or would like to do (typically rooted in libidinal or aggressive wishes), yet to take action would produce an unpleasant (painful, frightening, dangerous) outcome. Furthermore, most societies do not permit unfettered expression of every desire. Thus, defenses (e.g., repression, reaction formation) ward off some impulses, thoughts, and emotions. The result is called a compromise formation: the impulse, thought, or emotion is transformed into either an adaptive activity or a maladaptive symptom. According to psychodynamic theory, conflicts can occur entirely outside one’s awareness, can influence any aspect of mental or physical functioning, and are often derived from unresolved childhood issues (92). In Freud’s (9) essay “The Uncanny,” he concluded that paranormal beliefs and experiences result from compromise formations. A sexual or aggressive impulse, thought, or feeling is triggered by a precipitating event and must be defended against, with the resulting compromise being an uncanny thought or experience. Arlow (93, 94) described how unconscious conflicts can influence conscious mental functioning and produce anomalous compromise formations, such as déjà vu experiences. In contemporary psychodynamic theory, conflict and compromise formation also occur within a relational matrix. Thus, a paranormal belief or experience may also serve a relational function, such as bringing attention or nurturing to the individual.

Roll and Persinger (95) summarized numerous poltergeist and haunting investigations they conducted over several decades. Their reports typically involved families with high emotional tension as well as dysfunctional interpersonal and communication patterns. Children or adolescents were usually the focal point of the paranormal activity. Whenever possible, Roll and Persinger had subjects assessed using psychological tests (e.g., Minnesota Multiphasic Personality Inventory, Rorschach Inkblot Method, Thematic Apperception Test). Test data indicated critical, possessive, and controlling parents and fantasy-prone children or adolescents who had difficulty expressing anger and were passive-aggressive.

From a psychodynamic perspective, it is likely that the children or adolescents in these paranormal cases struggled with competitive, rebellious, and angry feelings toward an overprotective and controlling parent. Because the child or adolescent feared that directly expressing these intense feelings would result in punishment or retaliation, various defenses (repression, somatization, displacement) were used to ward them off. The resulting compromise formations included superficial compliance, somatic symptoms, and an aggressive “poltergeist” that plagued the household.

Psychopathology is described as a pattern of maladaptive thoughts, feelings, or behaviors that leads to distress or impairment (47). Although the boundary between normal and abnormal psychological functioning can be fluid, dimensional, and influenced by biological and sociocultural factors, types of psychopathology can be identified by observing specific diagnostic criteria.

Statistically, there is little significant difference in paranormal beliefs on the basis of age, gender, education, race, economic status, religion, or marital status. As indicated previously, belief in paranormal phenomena decreases from childhood to adulthood as a result of cognitive maturation. Increasing education and economic status appears to diminish general paranormal beliefs, although not specific ones (126). Regarding religion, Christians are more likely to hold paranormal beliefs than non-Christians, although sizable majorities in most religious groups believe in paranormal phenomena (4). Some evidence has indicated that gender differences exist in specific paranormal beliefs: Women are more likely to believe in life after death, witchcraft, precognition, astrology, and reincarnation, and men are more likely to believe in extraterrestrials and extraordinary life forms (5).

Knowledge needs to be understood in terms of the circumstances in which it is generated. Thus, biology and psychology are embedded within sociocultural narratives. These are local, historical, socioeconomic, cultural, religious, and political conditions that produce norms and values, which then influence how facts and experiences are interpreted. Paranormal beliefs and experiences are further understood by locating them within an individual’s culture of origin. According to cultural source theory, paranormal beliefs and experiences are derived from culturally specific factors, such as folklore and the aforementioned conditions. When an individual lacks a plausible scientific explanation for an unusual experience, he or she implicitly uses sociocultural narratives.

Cultural source theory may be tested by examining explanations for paranormal and psychiatric phenomena across cultures. Culture-specific variations are predicted to occur, indicating that cultural narratives are involved. First, nearly half of all alien abduction reports come from the United States, with Argentina, Australia, Brazil, and Great Britain accounting for most of the rest; there are very few abduction reports from Africa, Asia, and the Middle East (127). The most plausible explanation for this significant geographical disparity is that differing sociocultural narratives are used to describe a sleep paralysis episode. In the United States, contemporary popular culture (e.g., Close Encounters of the Third Kind, Communion, Contact, The X-Files) has saturated its citizens with such content for decades. Interestingly, no alien abductions are reported anywhere before the 1950s and the advent of the space age. Next, although ghosts and hauntings appear to be universal, how they manifest varies across cultures. For example, visual apparitions are rarely reported in Jewish culture (128). One reason may be the Jewish prohibition against communicating with the dead. Moreman (128) stated that after requesting Jewish ghost stories on an Internet message board, someone replied, “Jews are not allowed to see ghosts.” Finally, even psychiatric disorders appear to manifest differently on the basis of culture. McLean et al. (129) found that schizophrenic symptoms varied according to ethnicity. Lim et al. (130) found that Islamic patients who experienced psychosis were more likely to attribute their symptoms to invisible entities known as jinn.

As with any presenting issue or symptom, the clinician conducts a thorough evaluation. Whether the paranormal belief or experience is the reason for an initial consultation or emerges as part of an ongoing treatment, the clinician’s task is to gather general information about the individual’s biopsychosocial history and specific information concerning the presenting problem. First, the clinician needs as comprehensive an understanding as possible of the individual’s biopsychosocial functioning. For prospective patients, a semistructured or structured clinical interview may facilitate gathering information. Sample pertinent questions include the following: Do you have any current or past illnesses or medical conditions? Do you take any prescribed medications? Have you ever been hospitalized or had any surgery? Have you ever lost consciousness or had a seizure? Do you use alcohol or drugs? Have you ever been treated for a psychological disorder? Have you ever experienced a traumatic event? Do you have any difficulty making or keeping friends? As part of the clinical interview, the clinician may also conduct a mental status examination. This examination provides information about the individual’s appearance, attitudes and behaviors, speech, reality testing, thought processes, affect and mood, and capacity for insight and judgment. Finally, the clinician obtains information about the individual’s racial, ethnic, religious, and cultural identities, as well as his or her culture of origin. Inquiries regarding specific values and practices may also elucidate the individual’s clinical presentation.

Next, the clinician captures the presenting problem by describing its phenomenology and identifying a precipitating event. What are specific details concerning the paranormal belief? What are the physical and psychological symptoms associated with the paranormal experience? Paranormal beliefs and experiences may seem to emerge suddenly, but it is unlikely that they emerge randomly; underlying biopsychosocial causal mechanisms are involved. It is helpful to create a timeline beginning with the paranormal phenomenon’s onset and then work backward, examining any circumstances that could have triggered the presenting problem.

Information acquired through the evaluation is used to make a preliminary diagnosis. The clinician is attuned to aberrant perceptions or thoughts, idiosyncratic reasoning, peculiar personality traits, personality changes, labile or flat affect, linguistic disorganization, and various physical symptoms. In clinical samples, reports of paranormal phenomena were more detailed, negative, bizarre, and disturbing (11), and auditory hallucinations occurred more frequently and were less controllable (12). Furthermore, clinical participants often did not recognize the strangeness of their beliefs and experiences (131) and had social skills deficits and interpersonal problems (5). In nonclinical samples, participants had better premorbid functioning, were better able to incorporate paranormal beliefs and experiences into their lives, and were interested in exploring the meaning of their beliefs or experiences (132). In both samples, paranormal beliefs and experiences usually followed an emotionally arousing or stressful precipitating event (11).

If an issue or problem requires clinical attention, then the clinician develops a treatment plan that addresses the patient’s needs. Identifying appropriate treatment modalities is paramount. If a clinician suspects a neurological or medical condition, then an appropriate referral for further evaluation and treatment is provided. If a psychological disorder is diagnosed, then the clinician determines whether he or she has the appropriate education and training to begin or continue individual psychotherapy. If the clinician lacks the necessary competency, then he or she makes a referral to a more qualified mental health professional. In cases involving a thought disorder or severe mood disorder, a psychiatric referral for possible psychotropic medication should be considered. For particularly complex or confusing cases, referral for psychological assessment (i.e., testing) may provide valuable information that could facilitate both making a differential diagnosis and treatment planning.

It is beyond the scope of this article to provide specific interventions given the multiple factors potentially involved. Still, some general considerations may be summarized. The clinician maintains a respectful, nonargumentative, noncritical attitude when working with an individual who reports a paranormal belief or experience. At the same time, the clinician is allied with reality and does not endorse paranormal phenomena. It may be helpful to adopt a dialectical stance in which the clinician both accepts that the patient has a sincerely held belief or experienced something unusual and expresses curiosity about its meaning and possible explanatory factors. Practically, this may mean the clinician switches back and forth during a session, perhaps in the same intervention, flexibly navigating this contradiction.

Broadly, interventions focus on clarification, support, psychoeducation, and exploration. Clarification occurs whenever the patient says something vague, confusing, or contradictory. Supportive interventions involve validation, affect regulation techniques, breathing and relaxation exercises, and recommendations for alternative coping methods. Psychoeducational interventions address misperceptions, cognitive biases, logical fallacies, and probability misjudgments. Such interventions need to take into consideration the patient’s ability to hear and make use of them. No matter how tactful the clinician may be, a patient might experience a psychoeducational intervention as being told that his or her thinking is dysfunctional. Thus, the clinician’s motivation may be misconstrued, which could provoke a rupture in the therapeutic alliance. Exploratory interventions facilitate learning, in as detailed a manner as possible, how the patient’s mind organizes its beliefs and experiences, particularly paranormal ones. Gradually, the clinician and patient identify and connect potential dynamic conflicts, precipitating events, and the resulting compromise formations.