Unusual cases of succubus: A cultural phenomenon manifesting as part of psychopathology.

Succubus is also known as demon female lover who approaches males in their dreams to have sex. This is the phenomenon which is rarely described in psychiatric literature. It is more identified as a cultural belief in different religions. We report the two cases diagnosed with schizophrenia, who reported this rare phenomenon of succubus as part of their psychopathology and discuss the phenomenon of succubus.

Succubus is understood as a Lilin-demon in female form or supernatural entity that appears in dreams to seduce men, usually through sexual activity.[1] The descriptions of the same can be traced back to the folklore of medieval times.[1] The male equivalence of this is known as an incubus.[1] Many anthropologists and psychologists believe the explanation of succubus and incubus to be supernatural explanations for sleep paralysis and hypnagogic and hypnopompic hallucinations.[2] Although there are few case reports of incubus syndrome in patients with psychotic disorders in literature,[3] the description of succubus is lacking in psychiatric literature. In this report, we present two cases, diagnosed with schizophrenia, who had phenomenon suggestive of succubus.

CASE REPORTS

Case 1

A 18-year-old male, from middle socioeconomic status, who had no family history of any mental illness presented with an insidious onset and continuous illness of 3 years' duration, characterized by delusion of persecution, delusion of reference, delusion of grandiosity, delusion of control, auditory hallucination of commanding and discussing type, thought broadcast, apathy, poor self-care, and marked sociooccupational dysfunction. In addition to the symptoms listed, he elaborated about someone having sexual intercourse with him, against his will. On mental status examination, the patient appeared to be very much distressed with his psychopathology. He described the phenomenon of auditory hallucination (commanding and discussing type) and thought broadcast. In addition, the patient explained that at night, when he would go to his bed, he could feel the sensation of being touched by a female, whom he would describe as a good-looking woman. He would be able to feel his private parts being touched, leading to erection and ejaculation. As per patient, he did not want this experience, this would happen against his will, would feel guilty about having such an experience and having sexual contact with an unknown female, and he was fully convinced about having such an experience. Very occasionally, he would get up from the sleep, after this experience and remain distressed and fearful. In his explanation, he had a strong belief that a “witch” was doing so, but would not be able to point out the exact figure of “witch.” His cognitive functions were intact and he had poor insight.

There was no history suggestive of narcolepsy, insomnia, hypersomnia, sleep terrors, nightmares, sleep-related movement disorders, and sleep paralysis; symptoms suggestive of Dhat syndrome, panic attacks, posttraumatic stress disorder, cognitive deficits, and recent change in medications. Based on the available information, a diagnosis of schizophrenia was considered. His investigations in the form of haemogram, renal function test, liver function test, serum electrolytes, thyroid function test, electroencephalogram, and magnetic resonance imaging of brain did not reveal any abnormality. He was started on aripiprazole which was increased up to 15 mg/day, with which all his symptoms including the phenomenon of succubus improved completely. He would now report lack of any such experience but was not sure about the previous experience being real or part of the illness.

Case 2

A 24-year-old male, who has been using cannabis in dependent pattern presented with an insidious onset and continuous illness of 2 years' duration, characterized by the delusion of reference, delusional percept, delusion of love, auditory (commenting, commanding, and discussing), and tactile hallucinations. At presentation, on mental status examination, he was untidy and ill-kempt, had blunt affect; however, there was no formal thought disorder. When asked about his psychopathology, he ascribed the voices heard to one of his female teacher, who would express her love toward him in the conversations heard as part of the auditory hallucinations. He also ascribed the tactile hallucinations to the same teacher. He described this as a sensation of vibration, which he would feel all over his body, more so in his thighs, and genital region. This would occur mainly at night, when he would be fully awake or asleep and alone, would feel aroused, and simultaneously hear the voice of his teacher claiming to be responsible for these sensations. As per him, he would hear that she is in deep love with him and wanted to have sexual intercourse with him, would feel his penis to be touched, and in the process would have erection and occasional ejaculation. He would be unable to describe exactly how she would be doing this but was convinced that it was she who was doing so. He also believed that his body is under the control of his teacher, who forces him to indulge in sexual activities, against his will. He would deny drawing any pleasure out of these activities and would say that he was not able to avoid this experience. This experience was not associated with any active cannabis use or abstinence from cannabis. At the time of mental status examination, his cognitive functions were preserved, and he had poor insight.

Due to all these symptoms, he had to discontinue his education and became homebound. Based on the available information, a diagnosis of schizophrenia and cannabis dependence syndrome was considered, and he was sequentially treated with olanzapine, risperidone, Trifluoperazine, and the combination of olanzapine and fluphenazine decanoate, in adequate doses for adequate duration. He showed 40%–50% improvement in auditory hallucinations but no significant change in tactile hallucinations with these medications. Finally, he responded to clozapine in the dose of 200 mg/day. After being treated with clozapine, his insight improved, he would acknowledge that all his previous symptoms were unreal and part of the illness.

DISCUSSION

The term “succubus” was for the first time used in the late 14th century,[4] to describe supernatural being, derived from a Latin word succuba, meaning “to lie beneath” (sub-“under” + cubāre “to lie in bed”).[4] According to the folklore belief, succubus is a descended from the ancient figure of Lilith, who was the first wife of Adam. She left Adam and refused to return to the Garden of Eden after she mated with arch angel Samael, who mated with four succubi.[5] From Mesopotamian to Hebraic, Lilith was usually associated with the devil in both proximity and depiction.[67] Lilith is blamed for diseases “inflicted” on men but also for “wandering about at night time, vexing the sons of men, and causing them to defile themselves.”[8]

Further, as per the folklore belief, the succubus can take the form of a beautiful young girl, who may have deformities of her body such as bird-like claws or serpentine tails.[9] One of the few references to Lilith in the Bible is Isaiah 34:14. Here, she is referred to as a “screech owl,” i.e., a creature of the night, and more aptly referred to as “the night monster” in the Good News Bible.[1011] Regarding sexual activities, folklore descriptions suggest that the succubi force the men to perform cunnilingus.[5] As per the religious beliefs having repeated sexual activity with a succubus can lead to deterioration in both physical and mental health or can also lead to death.[1]

Many other cultures have sex demons as part of their mythology, analogous, or similar to the incubus and succubus. In Arabic culture, there are descriptions of jinns, who are thought to be responsible for similar sexual acts.[12] According to African beliefs, men who experience having sex with such principality (succubus) in dreams (usually in the form of a beautiful woman) find themselves exhausted as soon as they awaken.[12] The alp of Teutonic or German folklore is one of the better known. In Zanzibar, Popobawa primarily attacks men and generally behind closed doors.[13] In Hungary, a lidérc can be a Satanic lover that flies at night and appears as a fiery light (an ignis fatuus or will o’ the wisp) or in its more benign form as a featherless chicken.[14] In Swedish folklore, there is the mara or mare, a spirit or goblin that rides on the chests of humans while they sleep, giving them bad dreams (or “nightmares”).[15] Belief in the mare goes back to the Norse Ynglinga saga from the 13th century.[16] In Turkish culture, incubus is known as Karabasan. In all traditions, generally, it is believed that repeated sexual activity with a succubus may result in the deterioration of health or even death.[16]

In India, the succubus is referred to as Yakshini, who are attendees of Hindu God of Wealth, Kubera and are considered to be guardians of hidden treasure in the earth. They are shown as beautiful, voluptuous females with wide hips and narrow waists, broad shoulders, and exaggerated spherical breasts. Yakshini's are believed to provide gratification to senses as they have extreme beauty and have power to delight the body. Thirty-six different types of Yakshini's are described in the texts of Tantras, who fulfill the different desires of human beings. They are believed to always remain young and beautiful, powerful, and effective, who if pleased can fulfill the materialistic desires of a person. Yakshini Sadhana can be done by following specific tantras.[171819]

In our literature search, we could not find any description of succubus in psychiatric literature, although there are few case reports[20212223] documenting the phenomenon of incubus, which have also being described in relation to erotomania.[20] In both the cases described in this report, both the patients believed that a young beautiful female was having sexual relationship with them, which was distressing to them and was happening against their will. In the Case 2, the phenomenon of succubus was possibly associated with erotomania and fantastic hallucinations. Yakshini's are believed to be staying in the Himalayan region and both our patients came from the same region and had beliefs of the existence of Yakshinis.

In medical literature, researchers have tried to understand the phenomenon of incubus as a feature of sleep paralysis and hypnagogic hallucination, which can easily cause someone to believe that a “demon was holding them down.”[24] In one of our patients, the phenomenon was described in the awake state, and the second patient described the phenomenon during the sleep. However, both our patients were fully convinced about the experiences occurring against their will, had delusional beliefs associated with the same, fulfilled the diagnosis of schizophrenia irrespective of this phenomenon, and these symptoms responded to antipsychotic medications along with improvement in other symptoms. This led to the conclusion that both our patients had phenomenon of succubus.

Our cases reflect the influence of cultural beliefs on manifestation of psychopathology in patients with schizophrenia and emphasize the role of cultural beliefs in origin and shaping of psychopathology.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.