Mesopotamian āšipu and asû healing

1. Introduction

Version followed: the Assyriological account of Mesopotamian healing in Scurlock, Sourcebook for Ancient Mesopotamian Medicine (SBL Press, Writings from the Ancient World 36, 2014), with Geller, Ancient Babylonian Medicine: Theory and Practice (Wiley-Blackwell, 2010) as summarised in Siddall's 2011 BMCR review, the University of Würzburg Corpus of Mesopotamian Anti-witchcraft Rituals (CMAwRo) page on experts, and Reynolds and Kinnier Wilson's neurological-psychiatric readings (Brain 2014) as Reynolds summarises them. Where these differ, the difference is named.

This is a historical practice, not a therapy. It is included for the history of ideas and for the clinician's literacy, and nothing here is recommended as treatment. Mesopotamian cuneiform texts name two healing experts: the āšipu (usually rendered "exorcist"; also called mašmaššu) and the asû ("physician"). Their lores, āšipūtu and asûtu, shaped how the medical and magical texts were organised, and many prescriptions cite both as complementary strategies against illness [source: CMAwRo, Experts]. The core idea of how change happened, as historians reconstruct it: illness could be explained naturally (a malfunctioning body part) or supernaturally (affliction by a god, ghost, demon or sorcerer, often written as the "hand of" a named power), and healing aimed to identify the cause, remove it, purify the patient and protect against recurrence [source: Scurlock 2014, introduction; CMAwRo]. Babylonian texts describe states that modern readers have compared with epilepsy, psychoses, depression, anxiety and obsessive-compulsive presentations; these were mostly attributed to demons, spirits or the anger of personal gods [source: Reynolds, World Neurology 2015; Reynolds, BSHM 2017]. Scholars caution that "Babylonian psychiatry" is a modern grouping, not an ancient category [source: Couto-Ferreira 2020].

What survives today: no continuous practice of āšipūtu or asûtu is documented [uncertain: not verified]. The legacy lives in scholarship, museum collections and online text corpora (for example the CMAwRo corpus, which publishes translations), in popular-science stories about "ancient PTSD" or "ancient depression" [source: Smithsonian 2015; JSTOR Daily 2024], and, by report, in esoteric and neo-pagan revivals and popular culture that use Mesopotamian demons and amulets [uncertain: not verified]. It reaches clients mainly through an interest in history, family heritage (for example Iraqi or Assyrian-diaspora identity) [synthesis], media, and occasional revivalist groups.

2. Framework

The historical phases in outline [source: Scurlock 2014; Reynolds 2015; Siddall 2011 on Geller 2010; Smithsonian 2015]

Old Babylonian period (first half of the second millennium BCE): most of the texts Reynolds and Kinnier Wilson studied date from here, under Hammurabi (1792–1750 BCE) [source: Reynolds, World Neurology 2015].
Organisation of the Diagnostic and Prognostic Series (the "Diagnostic Handbook", Sakikkû): a forty-tablet handbook arranged largely from head to toe, which tradition credits to the scholar Esagil-kīn-apli under King Adad-apla-iddina (1068–1047 BCE); earlier and outlying versions are known from Hattusa, Assur and Sultantepe [source: Scurlock 2014]. Geller, per Siddall, reads it as disease descriptions framed as diagnostic omens, not case histories [source: Siddall 2011].
Assyrian period (about 14th to 7th centuries BCE): texts dealing with soldiers' afflictions attributed to ghosts, which some authors have compared with post-traumatic stress [source: JSTOR Daily 2024; Smithsonian 2015] and others dispute [source: Bell, Mind Hacks 2015].
Late period: Geller, per Siddall, describes exorcists overlapping with pharmaceutical work while the physician fades from the sources, and links the decline to the Persian court's preference for foreign, usually Greek, physicians [source: Siddall 2011].

How the two roles are described (versions differ)

Scurlock: the āšipu diagnosed and treated disease and worked as a team with the asû, whom she compares to a pharmacist responsible for plant and mineral materials [source: Scurlock 2014].
Geller (per Siddall): exorcists were temple administrators holding prebends who handled prevention and prognosis; physicians were largely independent, treated existing symptoms and sold recipes [source: Siddall 2011].
Reynolds: the asû treated disorders thought physical (stroke, facial palsy); the āšipu treated those thought supernatural (epilepsy, psychoses, depression) [source: Reynolds 2015, 2017].
CMAwRo: both belonged to the urban elite at temples or court; equating āšipūtu with "magic" and asûtu with "medicine" is misleading, since each crossed into the other's methods [source: CMAwRo].

Phases of the psychotherapist's own work [synthesis, using the Cultural Formulation Interview as the assessment frame: source: APA DSM-5-TR CFI]

Recognition: notice how the topic has arrived (curiosity, heritage, a media story, a revival group, a belief that a ghost or spirit is causing distress). Move on when you know what role the topic plays for the client.
Assessment: core CFI and relevant supplementary modules (Explanatory Model; Spirituality, Religion and Moral Traditions; Coping and Help-Seeking; Cultural Identity), plus routine risk, medical and mental-state screening. Move on when the client's explanatory model, supports, risks and any medical needs are mapped.
Meaning-making and psychoeducation: accurate, attributed history; comparison of explanatory models without ridicule or endorsement. Move on when the client can hold their own model alongside the treatment plan.
Safety and routing: medical review for physical or neurological symptoms; screening of revivals and unregulated healers; safeguarding where beliefs lead to accusations or harm to others. Move on when risks are addressed.
Integration and follow-up: the history as a resource (identity, continuity, normalising) rather than a substitute for care; review at agreed points.

Session number and length follow the client's needs and the setting [synthesis].

3. Guiding principles

Attribute every historical claim. Practical meaning: say "Scurlock describes…" or "Geller argues…", never "the Babylonians believed…" as settled fact [source: version differences above].
Distrust retrospective diagnosis. Practical meaning: treat "PTSD in Assyria" or "schizophrenia in Babylon" as interpretations; Reynolds notes the texts lack subjective accounts and modern classification, and Bell argues the "ancient PTSD" symptoms fit epilepsy equally well [source: Reynolds 2015; Bell 2015].
Emic before etic. Practical meaning: start from the categories people used (or the client uses), then translate; Couto-Ferreira calls labels such as "Babylonian psychiatry" artificial [source: Couto-Ferreira 2020].
No "magic versus medicine" caricature. Practical meaning: do not present the āšipu as a superstitious foil to a rational asû; sources describe overlap and teamwork [source: CMAwRo; Scurlock 2014].
The client's explanatory model is data, not a symptom. Practical meaning: a supernatural explanation is assessed for meaning and function, not pathologised by default [source: CFI Explanatory Model module].
Nothing historical is offered as treatment. Practical meaning: the therapist never provides, supervises or refers to ritual healing, incantation, exorcism or ancient remedies [synthesis].
Physical symptoms go to medicine. Practical meaning: seizures, confusion, speech change or new neurological signs get prompt medical review, whatever the client's explanation [synthesis].
Never advise on medicines or remedies. Practical meaning: you do not suggest starting, stopping or changing any medicine or herbal product; route questions to the prescriber or pharmacist [synthesis].
Cultural humility and heritage respect. Practical meaning: for clients of Iraqi, Assyrian or wider Middle Eastern heritage, ancient history may be identity; let the client define what it means [synthesis; source: CFI Cultural Identity module].
No ridicule, no endorsement of revivals. Practical meaning: explore what a revival offers and what it costs; avoid moralising [synthesis].
Do not reproduce ritual content. Practical meaning: discuss purpose and context, never incantation wording, ritual steps or recipes, even if the client asks [synthesis].
Safety outranks interest. Practical meaning: where belief in ghosts, spirits or witchcraft is linked to fear, self-harm, or accusations against others (including children), risk and safeguarding come first [synthesis].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis]. None is a step of āšipūtu or asûtu, and none involves ritual, incantation, amulets or ancient remedies.

4.1 Building your own historical literacy

Purpose and when to use: before working with a client who raises Mesopotamian healing, ancient "demons" or "ancient PTSD" stories; also for teaching and supervision [synthesis].
Steps: (1) Learn the two roles and the two lores and that the sources disagree on their division of labour (Scurlock 2014; Geller 2010 via Siddall 2011; CMAwRo). (2) Learn the outline dates: Old Babylonian texts, the Diagnostic Handbook credited to Esagil-kīn-apli (1068–1047 BCE), Assyrian-period texts. (3) Learn the "hand of" a god or ghost as a diagnostic formula, without memorising ritual content. (4) Read at least one critique of retrospective diagnosis (Bell 2015; Couto-Ferreira 2020). (5) Keep a short note of sources so you can attribute in session [source: Section 2 sources; synthesis].
Example language (illustrative): "Historians describe two kinds of healer in Babylonian texts, and they don't fully agree on how the work was split."
Watch for: speaking with more certainty than the sources allow; drifting into lecturing. It is working when you can answer a client's question in two or three attributed sentences and return to their concern.

4.2 Recognising how the topic enters therapy

Purpose and when to use: when a client mentions Babylonian or Assyrian healing, ghosts, demons, amulets, "ancient wisdom" or a revival group [synthesis].
Steps: (1) Note the route: curiosity, heritage, a media story, a revival or esoteric group, or a personal belief that a spirit or ghost is causing distress. (2) Ask what drew them to it now. (3) Ask whether it is something they read about, believe, or practise. (4) Note any links to the presenting problem. (5) Decide whether the topic is background, resource, or risk [synthesis].
Example language (illustrative): "You mentioned the old Babylonian idea of a ghost's 'hand' on someone. Is that something you've been reading about, or does it feel close to what's happening for you?"
Watch for: assuming belief from interest, or interest from belief. Working when you can name the topic's role in one sentence.

4.3 Core Cultural Formulation Interview

Purpose and when to use: structured cultural assessment early in work with any client whose distress is framed in spiritual, ancestral or historical terms [source: APA DSM-5-TR CFI].
Steps: Use the 16-question core CFI in its published order: cultural definition of the problem; cultural perceptions of cause, context and support; stressors and supports; role of cultural identity; self-coping and past help-seeking; current help-seeking preferences; the clinician–patient relationship. Follow the italicised interviewer instructions; do not modify the instrument (APA permits reproduction for use with your own patients) [source: APA DSM-5-TR CFI]. Record answers in the client's words [synthesis].
Example language (illustrative): "I'd like to understand this the way you and the people close to you understand it, before I add any ideas of my own."
Watch for: using the CFI as a checklist rather than a conversation; the APA notes it is not a sole basis for diagnosis [source: APA DSM-5-TR CFI]. Working when the client corrects or adds to your summary.

4.4 Explanatory Model module: supernatural explanations

Purpose and when to use: when the client explains distress through ghosts, spirits, an angry god, a curse or witchcraft, whether or not drawn from Mesopotamian sources [source: CFI Supplementary Modules, Explanatory Model].
Steps: Use the module's topics: the client's understanding of the problem; past experience and others' experience; causal beliefs and how they compare with family and community views and whether they have changed; effects on body, mind and spirit; expected course and seriousness; views on the best way to deal with it [source: CFI Supplementary Modules]. Then ask how firmly the belief is held and how it affects daily life [synthesis].
Example language (illustrative): "Some very old traditions explained this kind of fear as being touched by a ghost. What's your own sense of where it comes from?"
Watch for: the difference between a culturally shared explanation and beliefs that are fixed, idiosyncratic and accompanied by other features of psychosis; new perceptual changes or episodes of confusion that need medical and psychiatric review [synthesis]. Working when the client's model and the care plan can be stated side by side.

4.5 Spirituality, Religion and Moral Traditions module

Purpose and when to use: when a tradition, revival or ancestral practice shapes the problem or coping [source: CFI Supplementary Modules].
Steps: Cover the module's areas: identification and involvement (community, family background); the tradition's role in daily and family life; its usefulness for coping (leaders, texts, media, practices); and stresses or conflicts, including whether it contributes to the problem, discrimination or disputes [source: CFI Supplementary Modules]. Where the difficulty centres on a tradition, consider recording "Religious or Spiritual Problem" (ICD-10-CM Z65.8, "Other specified problems related to psychosocial circumstances") [source: ICD-10-CM Z65.8 (Unbound Medicine); DSM-5-TR wording uncertain: not verified].
Example language (illustrative): "Does this tradition help you cope, add to the strain, or both?"
Watch for: reducing a living faith to a historical curiosity; spiritual and religious competencies such as those set out by Vieten and colleagues (2013) are a further guide [uncertain: not verified]. Working when the client feels the tradition was taken seriously.

4.6 Coping and Help-Seeking module: mapping other healers and remedies

Purpose and when to use: to learn whether the client is using revivalist healers, ritual specialists, amulets or herbal products alongside or instead of care [source: CFI Supplementary Modules, Coping and Help-Seeking].
Steps: Ask, as the module covers, about self-coping, information from media or the internet, private spiritual practices, over-the-counter or natural remedies, help from family, religious communities, doctors, mental health clinicians and other healers, and what led to this episode of care [source: CFI Supplementary Modules]. Note costs, frequency and whether anything has replaced medical care [synthesis].
Example language (illustrative): "Lots of people try several kinds of help at once. What else have you tried, and what did each one give you?"
Watch for: ingestion of unregulated remedies, stopping prescribed treatment, large payments. Route remedy and medicine questions to the prescriber or pharmacist; never advise on them yourself [synthesis].

4.7 Psychoeducation: the two healers, accurately

Purpose and when to use: when a client holds a simplified picture ("ancient people thought everything was demons" or "the priest was a fraud and the doctor was real") that feeds shame or contempt for their own or a family member's beliefs [synthesis].
Steps: (1) Ask what they have heard. (2) Offer the attributed outline: two experts, complementary lores, natural and supernatural explanations both present (Scurlock 2014; CMAwRo). (3) Name that scholars disagree on the split (Geller via Siddall 2011). (4) Link back to the client's concern [synthesis].
Example language (illustrative): "Historians describe the exorcist and the physician as often working side by side, and both used methods we might file under the other's heading."
Watch for: turning therapy into a seminar. Working when the client's stance softens toward the beliefs at issue.

4.8 Psychoeducation: retrospective diagnosis and "ancient PTSD" stories

Purpose and when to use: when a client (often a veteran or trauma survivor) draws meaning from reports that Assyrian soldiers had PTSD [synthesis].
Steps: (1) Acknowledge the meaning the story holds. (2) Give the claim and its source: Abdul-Hamid and Hacker Hughes (Early Science and Medicine, 2014) read Assyrian-period texts on ghost-attributed symptoms as PTSD-like (JSTOR Daily 2024; Smithsonian 2015). (3) Give the critique: Bell argues the same texts fit epilepsy, that ghosts cause many disorders in Babylonian medicine, and that culture shapes how trauma is expressed (Bell 2015); Reynolds notes the texts lack subjective accounts. (4) Keep what helps: that soldiers' suffering was recorded and that care was sought (JSTOR Daily 2024) [synthesis].
Example language (illustrative): "Scholars argue about whether those tablets describe PTSD as we know it. What seems clear is that people long ago noticed soldiers suffering and tried to help."
Watch for: stripping a client of a sustaining story without need; or using it to say symptoms are "just human" and need no treatment. Working when the client keeps the meaning and stays engaged in trauma-focused care.

4.9 Heritage and identity work

Purpose and when to use: for clients of Iraqi, Assyrian, Chaldean, Syriac or wider Mesopotamian heritage for whom ancient history is part of identity, particularly after displacement [synthesis; source: CFI Cultural Identity module named in the CFI].
Steps: (1) Use the Cultural Identity and (where relevant) Immigrants and Refugees modules. (2) Ask what the history means to them and their family. (3) Distinguish pride in heritage from beliefs about illness. (4) Where loss of homeland or heritage sites is part of grief, treat it as grief [synthesis].
Example language (illustrative): "When you talk about these old cities and healers, it sounds like you're also talking about home. Can we stay with that?"
Watch for: assuming religious or ethnic identity from origin; assuming belief in ancient practices. Working when the client defines the history's meaning in their own words.

4.10 Medical routing for spirit-attributed symptoms

Purpose and when to use: when distress the client attributes to a ghost, spirit or curse includes episodes of confusion, wandering, unintelligible speech, lapses, convulsions, new perceptual changes or sleep-related events. Babylonian texts attributed such episodes to ghosts, and Kinnier Wilson and Reynolds read some as epilepsy (Reynolds 2015; Bell 2015) [source].
Steps: (1) Ask neutrally about the physical features of episodes (timing, awareness, injury, recovery). (2) Explain that some of these need a doctor whatever their cause. (3) Arrange or encourage prompt GP, neurology or psychiatric review; urgent care if episodes are prolonged, repeated in close succession or cause injury. (4) Keep the client's explanation in the conversation rather than arguing it away [synthesis].
Example language (illustrative): "Whatever is behind these episodes, the blackouts themselves are something a doctor needs to look at. Can we set that up, and keep talking about what they mean to you here?"
Watch for: the client hearing "it's not real"; delay because a spiritual explanation feels sufficient. Working when medical review happens and the alliance holds.

4.11 Using history to normalise without minimising

Purpose and when to use: when a client feels uniquely broken; Reynolds reports Babylonian descriptions resembling agitated depression with insomnia, poor appetite and poor memory, and anxiety (Reynolds 2015, 2017) [source].
Steps: (1) Offer, briefly and attributed, that people recorded similar suffering thousands of years ago. (2) Add the caution that the match to modern diagnoses is interpretive (Reynolds 2015; Couto-Ferreira 2020). (3) Link to present care: being common does not mean it should be endured untreated [synthesis].
Example language (illustrative): "Some of the oldest medical writing we have describes sleepless, low, forgetful states not unlike yours. You're in long company, and there's more help now."
Watch for: the client concluding the condition is fixed or fated. Working when the client reports less shame and stays with the plan.

4.12 Working with a client drawn to a revival or esoteric group

Purpose and when to use: when a client joins or considers a group, course or practitioner offering Mesopotamian-style ritual, demon lore, amulets or "ancient healing" [uncertain: such revivals are not verified in the sources; synthesis].
Steps: (1) Explore what it offers (belonging, meaning, aesthetic, protection). (2) Screen for costs and risks: money, secrecy, pressure to stop medical or psychological care, isolation from family, escalating fear, ingestion of products. (3) State your own role: you do not provide, supervise or refer to ritual healing. (4) Agree on how the client will keep medical and therapeutic care in place [synthesis].
Example language (illustrative): "I can see the group gives you something real. I'd like us to keep an eye on whether it ever asks you to give up other help, or leaves you more frightened than before."
Watch for: ridicule (it ends disclosure) and collusion (it implies endorsement). Never present a revival as treatment. Working when the client can discuss the group openly and keeps other care.

4.13 Amulets, protective objects and rituals: meaning versus compulsion

Purpose and when to use: when a client uses protective objects or rituals inspired by ancient practice (museums show Mesopotamian protective amulets, e.g. against Lamaštu: CMAwRo). Reynolds reports Babylonian descriptions of obsessive themes including contamination, orderliness and religion (Reynolds 2015) [source].
Steps: (1) Ask what the object or ritual does for the client and what happens if it is missed. (2) Distinguish meaning-making (comforting, flexible) from compulsion (driven, time-consuming, anxiety-relieving only briefly, spreading). (3) If compulsive, assess for OCD and offer evidence-based care; respect the object's cultural or religious meaning while working on the compulsion [synthesis].
Example language (illustrative): "When you leave it at home, what goes through your mind? Does carrying it feel like a comfort, or like something you have to do?"
Watch for: pathologising ordinary devotion; missing scrupulosity. Working when the client can tell the two apart.

4.14 Fear of witchcraft or curses, and safeguarding

Purpose and when to use: when a client fears they are bewitched or cursed, or blames another person (a partner, relative, child) for their illness. Witchcraft accusation was part of the ancient anti-witchcraft tradition (CMAwRo, on the Maqlû texts) [source]; in modern settings accusations can lead to harm to the accused [synthesis].
Steps: (1) Assess the client's fear and its effect on functioning. (2) Ask whether anyone is being blamed, and what the client or others intend to do. (3) If a child or vulnerable adult is accused or at risk, follow your local child-protection or adult-safeguarding procedure and mandatory-reporting duties, and consult your safeguarding lead. (4) Do not refer to anyone offering exorcism or curse-removal [synthesis].
Example language (illustrative): "You've told me you think someone has put this on you. Has anyone talked about doing something about that person?"
Watch for: plans to confront, isolate or punish an accused person. Working when risk is assessed and, where needed, reported.

4.15 Collaboration with religious or community leaders

Purpose and when to use: when the client's own tradition (not a revival of ancient ritual) is a source of support, and the client wants its leaders involved; the CFI spirituality module notes guidance from leaders as a coping resource [source: CFI Supplementary Modules].
Steps: (1) Obtain explicit consent and agree what will be shared. (2) Clarify roles: the leader offers spiritual support; you offer psychological care; medical care continues. (3) Agree a plan if the leader's advice conflicts with safety [synthesis].
Example language (illustrative): "Would it help if your priest and I were on the same page? You decide what I share."
Watch for: pressure toward exorcism or ritual healing in place of care. Working when supports align.

4.16 Family work across explanatory models

Purpose and when to use: when family members hold different explanations (spiritual, medical, historical) and conflict over care [synthesis; source: CFI Social Network and Caregivers modules named in the CFI].
Steps: (1) Invite each person's explanation without ranking them. (2) Find shared goals (safety, recovery, dignity). (3) Agree which help each explanation can sit alongside. (4) Address blame directly [synthesis].
Example language (illustrative): "You each explain this differently, and you all want her well. Let's start there."
Watch for: the therapist being recruited to one side. Working when the family agrees a joint plan.

4.17 Suicide-risk assessment when spiritual fear or despair is present

Purpose and when to use: when a client feels doomed, punished by a god, or haunted, or expresses hopelessness [synthesis].
Steps: Ask directly about suicidal thoughts, intent, plans and protective factors; follow your service's risk protocol; agree a safety plan; discuss reducing access to means as lethal-means counselling requires (safe storage and removal, not method detail); give crisis resources: 988 (US); Samaritans 116 123 (UK and Ireland) [synthesis].
Example language (illustrative): "When you say you feel cursed and there's no way out, I need to ask: have you had thoughts of ending your life?"
Watch for: spiritual framing masking intent. Working when risk is named and a plan agreed.

4.18 Duties when a colleague or institution offers ritual healing as therapy

Purpose and when to use: when a colleague or service offers "ancient Babylonian" exorcism, incantation or remedies as psychological treatment [synthesis].
Steps: (1) Raise the concern with the colleague where safe. (2) Consult supervision or your professional body. (3) Use your organisation's and regulator's reporting routes if clients are at risk. (4) Note that a clinician acting as both therapist and ritual healer for one client may create a multiple relationship (APA Ethics Code Standard 3.05, APA Ethics Code); other ethical points here are [synthesis].
Example language (illustrative, to a colleague): "I'm worried that offering ritual healing inside therapy blurs roles and may delay care. Can we talk it through with supervision?"
Watch for: clients pressured to pay or to drop medical care. Working when the practice stops or is separated from clinical care.

4.19 Teaching, supervision and the field's lessons

Purpose and when to use: in training and reflective practice [synthesis].
Steps: Use the material to discuss: (1) the age of the idea that distress has more than one kind of cause (natural and supernatural, per Scurlock 2014); (2) the risks of reading modern diagnoses into the past (Bell 2015; Couto-Ferreira 2020); (3) teamwork between different experts (Scurlock 2014); (4) how today's categories may look to future historians [synthesis].
Example language (illustrative): "Babylonian healers had more than one explanation for the same symptom. What does that tell us about our own certainty?"
Watch for: romanticising or mocking the past. Working when trainees can state the history accurately and apply cultural formulation.

5. Handling problems

Everything in this section is [synthesis] unless a source is named.

The client asks you to explain or reconstruct an ancient ritual, incantation or remedy. Decline clearly and kindly; explain that you work with meanings, not with rituals or remedies, and offer attributed history in outline (roles, dates, ideas) or point to scholarly sources such as Scurlock 2014. Do not reproduce ritual wording or recipes, and never suggest ingesting any product.
The client wants you to confirm a spiritual cause ("so it really is a ghost?"). Neither confirm nor dismiss. Reflect the meaning, note that people across history have explained such experiences this way (Scurlock 2014; Reynolds 2015), and return to what would help now.
Stuck in historical discussion as avoidance. Name the pattern gently, ask what the history protects them from talking about, and agree a balance (for example, a few minutes of history, then the present concern).
Resistance to medical review ("doctors won't understand spirits"). Validate the fear of being dismissed; explain that a medical check does not cancel their explanation; offer to help prepare for the appointment or, with consent, write to the doctor about cultural context. Persist where symptoms suggest seizures or acute confusion (Section 4.10).
Non-adherence because a revival group discourages treatment. Do not issue ultimatums; explore what the group says and what the client fears; restate risks plainly; keep the door open; if a child's care is being withheld, follow child-protection procedures.
Overwhelm or terror linked to belief in haunting or curses. Prioritise stabilisation (grounding, sleep, routine, support), assess for trauma, psychosis, depression and medical causes, and assess suicide risk (Section 4.17). Crisis resources: 988 (US); Samaritans 116 123 (UK and Ireland).
Possible psychosis versus cultural belief. Look for features beyond the shared belief: idiosyncrasy, fixity against the client's own community's views, functional decline, other psychotic features. Consult cultural informants where the client consents, and refer for psychiatric assessment where indicated. The CFI explanatory-model topic on how beliefs compare with family and community views helps here (CFI Supplementary Modules).
Ruptures from perceived ridicule or perceived endorsement. Name the moment, apologise for the impact, restate your stance (respect for their meaning; no role in ritual practice), and ask what would rebuild trust.
Heritage grief overwhelms the work. For clients displaced from Iraq or the wider region, loss of homeland, community and heritage may be central; slow down, treat it as grief and, where relevant, trauma, and use the CFI Immigrants and Refugees module.
The client is upset by the "ancient PTSD" critique. Return to what the story means to them; the debate is among scholars (Smithsonian 2015; Bell 2015) and need not decide their own experience.
Your own discomfort, fascination or scepticism. Take it to supervision; monitor for lecturing, exoticising or dismissing; revisit the principle of attribution.
A family member is accused of causing the illness through witchcraft. Treat as a safeguarding concern; assess immediate risk; follow local procedures and mandatory-reporting duties; do not mediate the accusation through any spiritual practitioner.
A colleague offers "Babylonian" ritual healing in therapy. See Section 4.18.

Sources

Web sources:

Works cited:

Scurlock, J. (2014). Sourcebook for Ancient Mesopotamian Medicine. Writings from the Ancient World 36. Atlanta: SBL Press.
Geller, M. J. (2010). Ancient Babylonian Medicine: Theory and Practice. Chichester/Malden, MA: Wiley-Blackwell (cited as summarised by Siddall 2011).
Reynolds, E. H., and Kinnier Wilson, J. V. (2014). Neurology and psychiatry in Babylon. Brain, 137, 2611–2619 (cited as summarised by Reynolds 2015, 2017).
Abdul-Hamid, W. K., and Hacker Hughes, J. (2014). Nothing new under the sun: post-traumatic stress disorders in the ancient world. Early Science and Medicine, 19(6), 549–557 (as listed by JSTOR Daily 2024).
Couto-Ferreira, M. E. (2020). Disturbing disorders: reconsidering the problem of "mental diseases" in ancient Mesopotamia. In Systems of Classification in Premodern Medical Cultures, pp. 261–278. Routledge.
Vieten, C., et al. (2013). Spiritual and religious competencies for psychologists [uncertain: not verified].

ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances

APA, Ethical Principles of Psychologists and Code of Conduct, https://www.apa.org/ethics/code

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