The Uncanny: A Biopsychosocial Perspective

Research has consistently found that paranormal beliefs are exceedingly prevalent. Global surveys have shown that 48%–67% of people believe in paranormal phenomena (1–3). A Gallup survey (4) found that nearly 75% of Americans believe in at least one type of paranormal phenomenon, including demonic possession, extrasensory perception, ghosts, communicating with the dead, psychic healing, and reincarnation. Subjective paranormal experiences are also common (5). These beliefs and experiences can be very meaningful, distressing, or both.

Despite the prevalence of paranormal beliefs and experiences, mainstream psychologists rarely study such topics. When inquiries do occur, they are usually conducted by parapsychologists and dismissed as pseudoscience. This was not always the case; many early psychologists studied all manner of anomalous experiences. For example, Freud (6–8) had a keen interest in telepathy, numerology, demonic possession, ghosts, and doppelgängers and addressed these matters numerous times throughout his career, with his most focused analysis occurring in an essay titled “The Uncanny” (9). Derrida (10) wrote, “It is known that Freud did everything possible to not neglect the experience of haunting, spectrality, phantoms, ghosts. He tried to account for them. Courageously, in as scientific, critical and positive a fashion as possible” (p. 85).

In this article, I provide a contemporary understanding of paranormal phenomena using a biopsychosocial model. From this perspective, paranormal beliefs and experiences are best understood by identifying biological, psychological, and sociocultural explanatory factors. Some might argue that studying paranormal phenomena is unnecessary. Yet there are several important reasons why providing relevant information may be helpful for mental health professionals. First, given the prevalence of paranormal beliefs and experiences, most clinicians will encounter individuals who believe such things over the course of their practice, and concise, accessible information covering such topics is lacking. Does the person have an underlying medical condition? Is the person prodromal? Did a culturally influenced spiritual experience occur? By identifying biopsychosocial factors that may contribute to such beliefs and experiences, clinicians are better positioned to make an accurate diagnosis, find appropriate treatment modalities, and provide therapeutic interventions.

Next, clinicians are educated and trained in behavioral science and may reflexively view such phenomena as pathological symptoms, or they may express incredulity and ignore such topics. Neither approach is helpful. Many unusual phenomena, including auditory and visual hallucinations, commonly occur in nonclinical populations (11, 12). Alternatively, paranormal beliefs and experiences should not be ignored because they may indicate a serious neurological, medical, or psychological disorder. A clinician, functioning as a local clinical scientist (13), should explore the phenomenology and biopsychosocial contexts of paranormal beliefs or experiences. Finally, an individual’s paranormal beliefs or experiences can be exploited for others’ financial gain, with potentially adverse consequences (e.g., a quack medical treatment). Thus, clinical psychology has a pivotal role to play as a matter of public health and education (14).

Understanding Paranormal Phenomena

Defining and categorizing what is paranormal can be difficult. One problem is that multiple words refer to similar beliefs and experiences. The terms paranormal, supernatural, magic, and superstition are used interchangeably, and there is no consensus on how any given phenomenon is defined. For example, Lindeman and Svedholm (15) found that belief in witches has been described as paranormal (16), supernatural (17), magical (18), and superstition (19). Another problem is that disparate beliefs and experiences are categorized similarly. Lucky charms, Feng Shui, telepathy, or ghosts may all be labeled paranormal (15).

I use the term paranormal (“para” = against, contrary; “normal” = ordinary, expected) and adopt a pragmatic definition for the sake of parsimony and conceptual clarity. A paranormal belief or experience is one that differs from, or violates, generally accepted explanations of reality established through the scientific method (20). Included are near-death experiences, out-of-body experiences, experiences of clairvoyance, telepathy, extrasensory perception, and psychokinesis; believed experiences with extraterrestrials, ghosts and hauntings, and extraordinary life forms (e.g., Bigfoot); as well as beliefs and behaviors labeled superstitious (e.g., luck-related objects or rituals) or magical (e.g., voodoo, spells).

Historically, a schism exists between psychology and biology over the causes of many psychological phenomena (e.g., schizophrenia). Furthermore, psychology is fragmented by multiple systems (e.g., behavioral, humanistic, psychodynamic), each of which generates its own explanations. Such schism and fragmentation interfere with a comprehensive understanding of any particular phenomenon. Knowledge becomes compartmentalized within disciplines and systems so that theorists, researchers, and clinicians working within a specific framework may not be familiar with advances occurring beyond it. Another problematic tendency is reductionism. Reductionism occurs when someone working within a specific discipline or system attempts to explain virtually all outcomes using that approach. For example, psychology is often reduced to biology: Depression occurs because of an imbalance in neurotransmitters, which is itself rooted in genetic traits. Reductionism results in incomplete explanations because other factors are not considered.

Each discipline and system provides necessary information, but each alone is also insufficient given that most psychological phenomena are complex and multifactorial. The biopsychosocial model (21, 22) proposes that biological, psychological, and sociocultural explanatory factors are inextricably connected and can influence mental and physical functioning. The biopsychosocial model fosters a multidisciplinary approach that counters the tendencies toward compartmentalization, fragmentation, and reductionism. In the next section, I identify biological, psychological, and sociocultural factors that may contribute to paranormal beliefs and experiences. These factors are neither exhaustive nor exclusive.

Biological Factors

Neurological and Medical

Anoxia, hypoxia, hypercapnia, and hypercarbia.

Absence of oxygen (anoxia) or decreased oxygen (hypoxia), which commonly occurs during a heart attack, may contribute to certain paranormal phenomena such as out-of-body and near-death experiences. Anoxia and hypoxia can also generate hallucinations and delirium. Hypoxic delirium can be a highly distressing experience for those who later recall perceptual changes and hallucinations (23). Increased carbon dioxide (hypercapnia) and carbon monoxide (hypercarbia) also contribute to near-death experiences (5).

Brain lesion.

A brain lesion, depending on its location, can produce physical symptoms, including aphasia, limb paralysis, dizziness, nausea, headaches, and seizures. A lesion can also produce psychological symptoms, such as anxiety, depression, mania, psychosis, and personality changes (24, 25). Evidence has shown that lesions along the temporal-parietal boundary may play a role in generating paranormal experiences (26).

Hypoglycemia.

Hypoglycemia occurs when the body’s blood sugar (glucose) falls below normal levels. Although most common among people with diabetes, it can also occur in people without diabetes as a result of fasting or dieting. Hypoglycemia can produce physical and psychological symptoms. Physical symptoms include sweating, palpitations, nausea, vomiting, pallor, tingling (“pins and needles”), fatigue, dizziness, muscle shakiness, muscle paralysis, and auras (blurred vision, double vision, flashing lights). Psychological symptoms include anxiety, depression, belligerence, distorted thoughts, memory loss, impaired judgment, personality changes, automated behaviors, and stupor.

Migraine headache.

A migraine is a moderate to severe headache often characterized by throbbing pain, nausea, and hypersensitivity to sensory stimuli (light, temperature, pressure, sound, or smell). Many people also experience an aura, which involves visual, tactile, and motor sensations. Migraine auras can produce black and white, as well as chromatic, perceptions, including geometric forms and scintillations; auras can also blur vision and create blind spots. Tactile sensations include numbness and tingling; motor sensations include feeling as though the room is spinning and muscle weakness. A little-known migraine experience is labeled Alice in Wonderland syndrome because it involves alterations in the sense of time and visual hallucinations in which objects or body parts are seen as larger or smaller than they actually are (27). Migraines occur more frequently among individuals who report out-of-body experiences than among those who do not (28, 29).

Temporal lobe epilepsy.

The temporal lobe, part of the cerebral cortex, is involved with memory, language comprehension, and hearing. Epileptic seizures originating in the temporal lobe can produce numerous sensations and symptoms, including déjà vu (a feeling of familiarity), jamais vu (a feeling of unfamiliarity), amnesia, and hallucinations. If the seizure spreads to other parts of the brain, it can produce vacant staring, stereotyped movements, and bizarre speech or behaviors. If the seizure spreads to the entire brain (a grand mal seizure), then the person’s body typically convulses, and he or she may become unconscious.

Considerable evidence exists that elevated neural activity in the temporal lobe, such as during an epileptic seizure, is associated with paranormal experiences. Persinger (30) found that individuals with temporal lobe epilepsy frequently reported unusual and mystical experiences. Braithwaite et al. (31) found that individuals with temporal lobe instability were more likely to report out-of-body experiences. Furthermore, electrical stimulation of the temporal lobe can produce distortions in body image as well as perceptions and sensations similar to those described during out-of-body experiences (32, 33). There is also evidence that some people are vulnerable to heightened activity in the temporal lobe and, although not diagnosed with epilepsy, may experience nonconvulsive “microseizures” (34). Subclinical temporal lobe hyperactivity might account for some paranormal experiences.

Pharmacological

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).

Sleep-Wake Disturbance

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).

Psychological Factors

Bereavement

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.

Deception

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).

Perceptual-Cognitive

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).

Cognitive biases and fallacies.

When a heuristic distorts information processing, it is called a cognitive bias or logical fallacy. Many biases and fallacies have been identified (60, 61). The correspondence bias (also known as the fundamental attribution error) is the tendency to overestimate someone’s behavior or an event as being intentional rather than the product of random circumstances. A related tendency is attributing outcomes to one’s own intentionality and then believing (falsely) that random processes are under one’s control. Confirmation bias is the tendency to seek out information that confirms one’s existing beliefs while disregarding contradictory information or not seeking information that could challenge one’s beliefs. Once an individual settles on an explanation, it usually persists because contrary evidence is either dismissed or not even considered. Hindsight bias refers to the tendency to interpret an experience, after it has occurred, as having been predictable, although there was no basis for prediction before its occurrence. Through hindsight bias, knowledge of what happened can subtly distort memories. The pareidolia effect is a perceptual bias in which an observer creates an identifiable pattern out of an ambiguous visual or auditory stimulus. A variety of logical fallacies are related to faulty cause-effect reasoning. For example, the post hoc ergo propter hoc (“after this, therefore because of this”) fallacy occurs when event B follows event A, and it is believed that A caused B when there is no causal connection. In general, it is easier to reason from cause to effect rather than from effect to cause. This allows quick causality detection based on temporal contiguity, although at the cost of potentially developing erroneous beliefs.

Many paranormal beliefs and experiences revolve around cognitive biases and errors in causal reasoning (14). Evidence has indicated that paranormal believers attribute intentionality to random, naturally occurring events (the correspondence bias) more frequently than do nonbelievers (62) and are more likely to see meaningful forms in random patterns (pareidolia effect) than nonbelievers (63). Paranormal believers are predisposed “to accept an answer on too little evidence and too little inclination to test the answer carefully” (5, p. 116).

Probability misjudgment.

The estimation of whether something will occur is referred to as its probability. Accurate assessment of anything but the most simple event (e.g., a coin flip) can be difficult because most events occur in complex systems in which multiple factors influence the outcome. Probability assessment typically requires an awareness of randomness and familiarity with basic statistical procedures. In general, human beings have difficulty assessing probability and are prone to finding connections between unrelated, random events.

Research has consistently found that individuals who believe in paranormal phenomena attribute meaning to a coincidental experience rather than assess its probability and consider that its occurrence was random (64–66). When an atypical event occurs, it stands out because it does not occur frequently and also because it may be frightening or exciting. “Picking on a single coincidence and holding it up as requiring explanation is misunderstanding the principles of randomness and large numbers” (5, p. 123). For example, Paulos (67) calculated the likelihood of any individual person having an apparently precognitive dream on any given night at 3.6%.

Magical thinking.

Magical thinking is an immature form of reasoning and may take several forms (68). First, believing thoughts or behaviors can influence external events without any logical or physical connection is a form of magical thinking. Next, magical thinking can involve attributing a nonphysical cause to an event for which a natural explanation is lacking. Finally, magical thinking can involve believing inanimate objects are alive.

Children’s cognitive development generally proceeds in a predictable manner. Piaget identified how a child’s cognitive abilities develop gradually from rudimentary sensorimotor behavior patterns to more sophisticated symbolic reasoning, a process involving successive, identifiable stages (69). Findings from developmental psychology have demonstrated that magical thinking is a prominent component of childhood ideation but gradually declines through adolescence and adulthood, although it is never abandoned entirely (70). Young children have difficulty distinguishing between fantasy and reality and will use paranormal explanations (e.g., “magic”) to understand events for which they do not grasp the natural causes (71). As children cognitively mature, they learn about causality, differentiate reality and fantasy (make-believe), and become more skeptical (70, 71). However, magical thinking does persist into adulthood. It is most evident in superstitious individuals but can be observed in adults when they lack control, are in ambiguous situations, or lack information and explanations for events (72).

Magical thinking plays a prominent role in paranormal beliefs and experiences. Someone using magical thinking turns away from reality and toward fantasy. Thus, when someone believes an outcome can be influenced mentally or identifies nonphysical causes of an event, he or she is likely to have paranormal beliefs and report paranormal experiences (73–76).

Personality Traits

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.

Absorption.

Absorption refers to the ability to immerse oneself in an activity or experience. When adaptive, it permits an individual to focus and concentrate intensely, block out distractions, and exist in the moment. Absorption is correlated with paranormal beliefs and experiences (78). Furthermore, according to French and Stone (5), people who report paranormal experiences that have a strong physical sensation component have the capacity to have an experience without distraction.

External locus of control.

Locus of control refers to beliefs about how much influence an individual has over his or her life circumstances (79). Individuals with an internal locus of control believe they can take actions that directly influence their environment. In contrast, those with an external locus of control believe they have little influence over their environment and that their life is controlled by external factors, including chance or fate. External locus of control appears to be related to higher levels of paranormal beliefs and experiences (5) because the paranormal may provide a way to cope with the unpredictability and ambiguity inherent in lacking control over one’s circumstances (80).

Fantasy proneness.

Fantasy-prone individuals exhibit a propensity for making their imaginative experiences seem real. Such individuals have a vivid fantasy life and are able to construct intense, sensory-laden daydreams (81, 82). Not surprisingly, fantasy proneness is strongly associated with absorption. People who score high on both scales can suspend their reality testing and judgment so thoroughly that they sometimes become confused between imaginary and actual events (83).

People high in fantasy proneness are extremely susceptible to paranormal beliefs and experiences. An active imagination is likely a necessary component for creating a believable paranormal experience (84). Fantasy proneness is correlated with out-of-body experiences (85), as well as apparitions, near-death experiences, precognitive abilities, astrology, and reincarnation (86). Bartholomew et al. (87) concluded that the vast majority (87%) of reported alien abductions are consistent with characteristics associated with fantasy proneness.

Porous boundaries.

Everyone has psychological boundaries that separate internal experiences from external ones so that they are not overwhelmed by every sensation. Boundaries also divide what is conscious from what is unconscious so that people are not flooded by primitive thoughts and feelings (88). Individuals with porous boundaries are likely to be involuntarily susceptible both to the external environment and to preconscious or unconscious mental content crossing the threshold into consciousness; this is referred to as transliminality (89). Transliminality is likely a component of paranormal beliefs and experiences (90, 91).

Psychodynamic

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.

Psychopathological

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.

Psychotic disorders.

External reality and internal experience merge and become indistinguishable to a psychotic individual, even with conscious effort, resulting in hallucinations that may manifest through any sensory modality. A psychotic individual’s reasoning ability becomes idiosyncratic and arbitrary, resulting in circumstantial or tangential reasoning, irrational thoughts (delusions), and linguistic disorganization. For example, the individual may connect loosely associated or unassociated stimuli, turning a coincidental experience into something that appears connected or meaningful. Finally, a psychotic individual is prone to affect dysregulation. Emotional experiences predominate and are difficult to integrate, resulting in agitation, childlike silliness, or inappropriate or primitive emotional expressions.

Schizotypal spectrum disorders.

The concept of a schizotypal spectrum results from genetic research (96, 97) and clinical observations (98) that gradations of schizophrenia may exist. Meehl (99) suggested that some individuals who have a genetic predisposition to schizophrenia may not manifest all the symptoms of the illness but may display evidence of schizotypal functioning. Clinicians have long observed individuals who exhibit schizophrenic traits without chronic psychosis or functional deterioration: Zilboorg (100) described a disorder he termed ambulatory schizophrenia; Hoch and Polatin (101) wrote about “pseudo-neurotic schizophrenia.” Currently, schizotypy is viewed as existing on a continuum, ranging from subclinical traits to schizotypal personality disorder to schizophrenia (102).

Schizotypal personality disorder is characterized by unusual beliefs; unusual perceptual experiences; inappropriate or constricted affect; social anxiety; circumstantial, idiosyncratic, or overelaborated speech; suspiciousness; and eccentric behaviors (47, 103). DSM-5 specifically lists preoccupation with paranormal phenomena and proneness to unusual experiences as diagnostic features (47). Schizophrenia is considered a specific psychotic disorder characterized by hallucinations, delusions, paranoia, lack of motivation, sparse or slurred speech, flat affect, catatonia, disorganized behaviors, and functional impairments resulting in social or occupational dysfunction (47, 104). Individuals diagnosed with schizophrenia often experience hallucinations and delusions with mystical, paranormal, or religious content (105).

Considerable research has connected schizotypy with paranormal beliefs and experiences (106, 107). Such research has consistently found greater auditory, visual, and tactile hallucinations; fantasy proneness; and absorption in schizotypal-spectrum individuals. Although factor analysis has indicated that multiple factors contribute in complex ways, the Unusual Experiences factor (i.e., aberrant perceptions and beliefs) correlates best with paranormal phenomena (5).

Trauma-related disorders.

A trauma is a highly distressing event that threatens an individual’s health or safety and overwhelms his or her psychological coping capacities. Most people exposed to a traumatic event report psychological and physical symptoms in the initial weeks after the trauma, including avoidant behaviors, intrusive and ruminative ideation, misperceptions, memory lapses, hallucinations, time distortions, phobias, panic attacks, separation anxiety, atypical experiences of consciousness (e.g., out-of-body experiences), loss of continuity in sense of self (e.g., multiple identities), fugue states, and stereotyped motoric expressions (47, 108–112). These symptoms are typically transient, and most people recover without lasting consequences. However, acute or chronic traumatization may contribute to numerous psychological disorders, including mood disorders (113), substance abuse disorders (114), eating disorders (115), posttraumatic stress disorder (116), somatoform disorders (117), and dissociative disorders (118).

Trauma-related disorders appear connected to both general paranormal beliefs and experiences (119) and specific ones, particularly out-of-body experiences (120). Research has indicated that paranormal beliefs increase after exposure to trauma (121, 122). Ross and Joshi (123) found that people who experienced trauma were more likely to report paranormal experiences. Irwin (124, 125) hypothesized that paranormal beliefs protect traumatized individuals by providing meaning and a sense of control in response to feeling helpless.

Sociocultural Factors

Demographic

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).

Sociocultural Narratives

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.

Treatment Recommendations

Evaluation and Diagnosis

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).

Treatment Planning and Interventions

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.

Conclusions

Many people report belief in, and experience of, paranormal phenomena, including demonic possession, extrasensory perception, ghosts, haunted houses, communicating with the dead, psychic healing, and reincarnation. These beliefs and experiences can be very meaningful, distressing, or both, yet they are rarely studied by mainstream psychologists, and few resources exist for mental health professionals. Although some might argue that studying paranormal phenomena is unnecessary, it is important to differentiate unusual nonclinical phenomena from potentially serious neurological, medical, and psychological disorders. Furthermore, clinical psychology plays a public health and education role by providing information that can protect vulnerable individuals from exploitation.

In this article, I provide a contemporary understanding of paranormal phenomena by identifying biological, psychological, and sociocultural explanatory factors. This biopsychosocial approach fosters a multidisciplinary perspective that counters tendencies toward compartmentalization, fragmentation, and reductionism. Biological factors include neurological or medical issues, substance use, and disturbances in the sleep-wake cycle. Psychological factors include bereavement, deception, perceptual-cognitive issues, personality traits, psychodynamic conflicts, and various forms of psychopathology. Sociocultural factors include demographic features and cultural narratives. The factors presented in this article are neither exhaustive nor exclusive.

Given the prevalence of paranormal beliefs and experiences, most clinicians will encounter individuals who hold such beliefs over the course of their practice. Does the person have an underlying medical condition? Is the person in the early stages of a psychological disorder? Or did a culturally influenced spiritual experience occur? By identifying biopsychosocial factors that may contribute to such phenomena, the clinician is better positioned to make an accurate diagnosis, recommend appropriate treatment modalities, and provide therapeutic interventions.