|Year : 2019 | Volume
| Issue : 1 | Page : 63-66
Snakes and their relevance to psychiatry
Anil Kakunje1, Ramesh Ammati2, Prakash Tolar3, Sowmya Puthran4, Mohammad Swaroop5
1 Department of Psychiatry, Yenepoya Medical College, Yenepoya University, Mangalore, India
2 Department of Psychiatry, Institute of Mental Health, Osmania Medical College, Hyderabad, India
3 Consultant Psychiatrist, Matha Hospital, Kundapur, Karnataka, India
4 Department of Psychology, Agnes College, Mangalore, India
5 Department of Psychiatry, Yenepoya Medical College, Mangalore, India
|Date of Web Publication||24-May-2019|
Dr. Anil Kakunje
Department of Psychiatry, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kakunje A, Ammati R, Tolar P, Puthran S, Swaroop M. Snakes and their relevance to psychiatry. Ann Indian Psychiatry 2019;3:63-6
|How to cite this URL:|
Kakunje A, Ammati R, Tolar P, Puthran S, Swaroop M. Snakes and their relevance to psychiatry. Ann Indian Psychiatry [serial online] 2019 [cited 2019 Jun 16];3:63-6. Available from: http://www.anip.co.in/text.asp?2019/3/1/63/259091
India was known to the western world as “the land of snake charmers.” Ancient Indians both feared and revered the snakes. Snakes played a major role in majority of world mythologies and religions. Hindus most commonly worship cobras in temples and their natural habitat by offering them milk and prayers. However, with rapid and widespread urbanization, snakes in their natural habitat come under threat due to encroachment leading to more and more instances of snake sightings in unusual places, particularly urban areas. Increased consumption of food in urban areas leads to increased food waste, attracting rodents which thereby leads more and more snakes to urban areas pursuing prey. This has, therefore, put both snakes and humans at risk of encounter and fatality.
| Snakes in the Indian Context|| |
Snakes have high status in Hindu mythology. The snake primarily represents rebirth, death, and mortality, due to casting of its skin and being symbolically “reborn.” Over a large part of India, there are carved representations of cobras or “nagas” at various temples and shrines to which food and flowers are offered and lamps lit before the shrines. Shiva, the prime Hindu God, is depicted wearing a snake around his neck. In Northern India, a masculine version of the serpent named Nagaraja and known as the “king of the serpents” is worshipped. Instead of the “king of the serpents,” actual live snakes are worshipped in Southern India.
Nag Panchami is an important Hindu festival associated with snake worship which takes place on the 5th day of Shravana (July-August). Snake idols are offered gifts of milk and incense to help the worshipper gain knowledge, wealth, and fame.
| Cultural Beliefs Surrounding Serpents|| |
Concepts and symbolization of snake differ in each religion. In some Abrahamic traditions, the serpent represents sexual desire, as he lured Eve with the promise of forbidden knowledge in the Garden of Eden. In Hinduism, Kundalini is a coiled serpent, the residual power of pure desire. “Kundalini” refers to the mothering intelligence behind yogic awakening and spiritual maturation leading to altered states of consciousness. It has been suggested by Joseph Campbell that the symbol of snakes coiled around a staff is an ancient representation of Kundalini physiology. The staff represents the spinal column with the snakes being energy channels. In the case of two coiled snakes, they usually cross each other seven times, a possible reference to the seven energy centers called chakras.
Serpents are represented as potent guardians of temples and other sacred spaces. This connection may be grounded in the observation that when threatened, some snakes (such as rattlesnakes or cobras) frequently hold and defend their ground, first resorting to threatening display and then fighting, rather than retreat. Historically, serpents and snakes represent fertility or a creative life force. As snakes shed their skin through sloughing, they are symbols of rebirth, transformation, immortality, and healing. For example, the Hopi people of North America performed an annual snake dance handling live snakes in an attempt to renew the fertility of nature and a guarantee for good crops.
In Hindu mythology, Lord Vishnu is said to sleep while floating on the cosmic waters on the serpent Shesha who is said to hold all the planets of the universe on his hood and constantly sing the glories of Vishnu. Serpents are pictured as patrons of fertility, water, and wealth in objects of ancient Iran while Aryan religions call the serpents diabolic with mentions of scary, serpentine entities.
| Snakes in Movies|| |
Snakes have since long been used in movie plots. Most movies are potboilers, created solely for entertainment with the serpent being portrayed as a diabolical and vengeful creature, out to destroy the ones who do it harm. There are instances of snakes being used in horror movies, Anaconda, Snakes on a Plane, for instance which perpetuate fear of snakes among the viewers. The Snake Pit is one of the first films to deal with mental illness as its main theme. The film is based on Mary Jane Ward's novel also titled The Snake Pit. The movie tells the story of Virginia Cunningham, played by Olivia de Havilland, who has a mental breakdown and is hospitalized in a New York state facility. The film draws attention to controversial treatments and overcrowded conditions at a state facility. The film drew attention to the subject of mental illness and the large number of people who suffer from mental illness. The Snake Pit had a profound impact on how our society regarded and treated people with severe mental illness. Soon, deinstitutionalization was the big new idea – the way to provide a much brighter future for the most vulnerable in our society who had previously been so shamefully neglected. An added bonus, deinstitutionalization would be cost-neutral because hospitals were more expensive than outpatient care. The run-away success of the best-selling book shamed many states into making dramatic reforms.
| Other Symbolizations of the Serpent|| |
From a health perspective, the snake is often portrayed in mythology as a healing reptile as its venom could be used as an antidote for certain ailments or in case of a snake bite. The snake's venom is associated with the chemicals of plants and fungi that have the power to either heal poison or provide expanded consciousness (and even the elixir of life and immortality) through divine intoxication. The long association of snakes with healing can be seen today in the caduceus, a common symbol for the medical profession, which is made up of two snakes wrapped around a pole.
Eigen said that snakes take different symbolic meaning depending on which part of it is emphasized and it can be its eyes, tongue, fangs, anatomical form, or movement. Its various aspects constitute a complex system of references to unconscious mental and body self-configurations.
| Snakes and Dreams|| |
Snakes in dreams have many meanings as many people interpret it differently.
Freud is the founder of psychoanalysis. Toward the end of the 19th century, he wrote Interpretation of Dreams and started to work with the dreams of his patients. Freud's interpretation of dreams revolves around the expression of the unconscious through dream imagery and symbols. A famous quote from Freud: “Dreams are the royal road to the unconscious activities of the mind.” Sigmund Freud believed that the snake is connected to our sexual energy. According to Freud, the snake is the symbol for penis. He stated that male sexual symbols in dreams are snakes, reptiles, and fish. The meaning of snakes in dreams is associated with sexuality, as an extension of the male figures in life, or how one experiences his own manhood. Relationships with men or male energy are symbolized by the snake in dreams seen by women.
Carl Jung said the most common dream symbol of transcendence is the snake. He mentioned that the unconscious mind speaks through images, scenes, and symbols showing a representation of what is presently happening in life and what could happen in the future.
| Phobia of Snakes|| |
Phobia of snakes is termed as Ophidiophobia. It is possibly the most common subcategory of herpetophobia, the fear of reptiles. Snakes are among the most feared objects. Davey reported that snakes elicited anxiety in 53.3% of participants. Half of the population feel anxious about snakes and 2%–3% meet the diagnostic criteria for snake phobia. Snake anxiety questionnaire was developed to measure ophidiophobia.
| SNAQ - Snake Anxiety Questionnaire|| |
The SNAQ is a 30-item self-report scale to assess the verbal-cognitive component of snake fear. Each item is a fearful or nonfearful statement related to snakes. Participants rate each item as true or false. The instrument is scored by assigning a “1” to each true response and “0” to each false response, and 9 items are reverse scored. A total score (ranging from 0 to 30) is calculated by summing all “true” statements and it serves as a measure of the degree of phobic fear. The SNAQ takes about 5–10 minutes to complete.
At its extreme ends, Ophidiophobia can be so strong that it interferes with people's ability to go anywhere that snakes might be, such as pet stores, the woods, or to homes with pet snakes. The snake phobia could be due to learned response or early traumatic experiences with snakes, such as being bitten by snakes and also has genetic origin. Augmentation of systematic desensitization through posthypnotic dream suggestion showed effective treatment for snake phobia.
| Snakes and Delirium|| |
Delirium is a condition characterized by clouding of consciousness and perceptual disturbances. Delirium Tremens (DTs) is a similar condition occurring due to alcohol withdrawal syndrome. Visual hallucination of seeing snakes and insects is one of the most common forms of hallucination.
In a study by Platz et al., on phenomenology of perceptual hallucinations in alcohol-induced DT, visual hallucinations predominated followed by auditory and tactile hallucinations. Animals appearing most frequently in visual hallucinations were cats, dogs, and snakes.
| Snakes and Delusions|| |
Delusional infestation, a condition wherein a person believes his or her body to be infested with living organisms, has been observed in patients with primary psychotic disorders, as well as those with psychotic episodes secondary to mood disorders. Winford et al. reported two cases of delusional snake infestation following sexual intercourse in female patients of schizophrenia and bipolar affective disorder respectively. During the course of hospitalization, both patients misinterpreted abdominal pain/abnormal sensations following sexual intercourse as snakes infesting various parts of the abdomen and genital tract. In both cases, symptoms rapidly resolved after appropriate medical treatment and the use of antipsychotic medication.
Ophidianthropy is the type of delusion in which patients believe that they have been transformed into a snake, rare, yet seen in few cases of schizophrenia. Kattimani et al. reported a case of a 24-year-old woman with the delusion that she has been transformed into a snake. A similar case of Ophidanthropy was reported by Mondal et al. from Ranchi along with other bizarre delusions.
| Snake Venom as a Psychoactive Substance|| |
The use of snake venom for recreational purposes is documented. Few cases were reported where snake venom was used to achieve psychoactive effects. Furthermore, a few cases of addiction to snake venom were reported.
Senthilkumaran et al. reported a case of two software engineers who wilfully and repeatedly took lethal snake bites as to attain relief from stress and as a means of recreation.
Of all the novel forms of psychoactive substance use reported, snake venom represents the potentially most lethal form.
Ancient cultures all over the world believe that repeated snake bites/snake venom inoculation renders a person immune to fatal snake envenomation. Tribal regions even in India are known to give snake bites purposefully to their children to protect them from the fatal effects of a snake bite.
Multiple factors such as easy availability, adventure seeking, social/peer-pressure, novel sensation, pain relief, and cultural beliefs might have precipitated the use of snake bite as a form of substance abuse.
Snake venoms have antinociceptive and analgesic activity with certain isolated neurotoxins which have demonstrated significant analgesia in animal models. The venom on entering human blood releases active metabolites such as serotonin, bradykinin, peptides, prostaglandins, and other slow reacting substances. Drowsiness was the most common symptom observed among cobra bite, which may be due to the effect of the toxins on the brain.
The literature review showed that individuals injected with cobra venom had marked relief of pain in nearly 65% of patients and mild to moderate in more than 80% with the site of analgesic action being the peripheral and central nervous system. Furthermore, long-form alpha-neurotoxin from cobra venom produces a potent opioid-independent analgesic effect by acting on nicotinic acetylcholine receptors (nAChRs).
Cobra venom resembles the action of morphine but differs from the opiate in that it does not produce addiction and other disagreeable or dangerous side effects. Moreover, nAChRs are involved in the mesolimbic dopaminergic reward system of the brain. This pathway may be responsible for the experience of being “high.”
Pradhan et al. reported two cases of snake venom intoxication as a habit, associated along with addiction to heroin and cannabis. These patients reported that they had taken these snake bites at special places called “snake den” where different types, colors, and sizes of snakes are available and used to take bites on mainly the great toe for an “extra kick” and on the tongue to get quick effects. However, both patients did not show any withdrawal symptoms, indicating that they were not addicted. As the snake bite was not taken daily, mostly due to its high cost and likely lethlity, addiction to it could not develop. However, one patient showed tolerance to its effect. It is noteworthy that both patients preferred snake venom to heroin. Similar cases were increasing in incidence and reported in various newspapers where youth are involved. Few case reports mentioned about the use of snake venom in rave parties.
The review of the literature on snake venom use by Mehra et al. suggests that patients occasionally use snake venom as a substitute for opioids or additional agents for intoxication.
There was a long-standing belief in certain tribal communities that repeated poisonous snake bites render individuals immune and reduce fatality of subsequent bites. However, after analyzing the effect of repeated bites in 14 patients, it was then concluded that bites from pit vipers do not produce any kind of immunity and can cause death due to anaphylaxis. However, one case of achieved immunity was reported in a reptile handler bitten by king cobra “Ophiophagus Hannah” in Myanmar.
| Snakes as Possession State|| |
Dissociative trance or possession state is one among the dissociative disorders where the person is convinced that he or she has been taken over by a spirit, power, and deity or there is temporary altering of the state of consciousness.
In most cases of possession, the possessing agent is unique and well known, whether it corresponds to a local entity belonging to the culture of the patient or the universal figure of God or the Devil. Common categories of agents are goddesses, deities, God, the Holy Spirit, or an angel (43%), deceased relatives and human ancestral spirits (29%), animals such as snakes, foxes, and turtles (5%).
| Snakes as Therapy Animals|| |
The use of animals during therapy sessions is not a new concept. Back in the late 1800s, Florence Nightingale made huge discoveries regarding the use of animal therapy. She noticed small pets helped reduce anxiety in both children and adults who were living in psychiatric hospitals and institutions, and she took notes on the fact small animals played a key role in helping patients recover which has since continued till date with dogs, cats, guinea pigs, pigs, and horses being the most popular types of pets. However, reptiles tend to go overlooked when patients are picking out a therapy animal or emotional support animal. Their long life spans, different levels of care, beautiful and unique coloring and patterns, and fascinating behaviors are all factors that make reptiles excellent emotional support companions.
The reduction of free-floating anxiety, as well as other negative psychological symptoms, is exactly why the National Health Service has recruited snakes as animal “therapists” for patients who are suffering from depression. For instance, the Huntercombe Hospital Roehampton, in London, England, uses 'Angel', a 7-year-old, 5-foot-long corn snake during group sessions. Patients are able to touch, feed, and take care of 'Angel'.
Doctors in this hospital have observed that those participating in this animal-assisted therapy have shown great improvement. Those that are in the strong grip of depression often find it hard to get out of bed in the morning, yet 'Angel' and other snakes serve as a great motivator to get up and get moving. Taking care of the snakes is reported to be a stimulating activity, and it also gives patients an undeniable sense of responsibility. This provides the motivation they need to step through their depression and take their first steps to start their day each morning.
These therapy snakes also help male patients who do not feel as comfortable taking care of cuddly animals. The male patients do not feel there is any weakness or perceived stigma surrounding caring for a reptile like there sometimes maybe when it comes to adorable, furry pets. Boas and pythons are popular choices when it comes to picking out a snake, but again, primarily due to size/housing issues, beginners are better off with king-snakes, milk snakes, or one of the various types of rat snakes, especially a corn snake such as the previously mentioned Angel that is already providing comfort to patients at Huntercombe Hospital.
There is, notably, a significant connection between snakes and psychiatry. The knowledge and implications of which will go a long way in helping clinicians and psychiatrists to understand patients and cases better, thereby contributing to the field and its practice.
The write up is inspired by a snake show organized by the Indian Psychiatric Society Karnataka Chapter.
| References|| |
Tett J. The snake pit and social awareness and treatment of mental illness. ESSAI. 2006;37:136-41.
Ramoutsaki IA, Haniotakis S, Tsatsakis AM. The snake as the symbol of medicine, toxicology and toxinology. Vet Hum Toxicol 2000;42:306-8.
Eigen M. Comments on snake symbolism and mind-body relations. Am J Psychoanal 1981;41:73-9.
Strachey J. Sigmund Freud – The Interpretation of dreams. Basic books Publisher; New York, 2010. p
Davey GC. Self-reported fears to common indigenous animals in an adult UK population: The role of disgust sensitivity. Br J Psychol 1994;85(Pt 4):541-54.
Klieger DM. The snake anxiety questionnaire as a measure of ophidophobia. Educ Psychol Meas 1987;47:449-59.
O'Brien RM, Cooley LE, Ciotti J, Henninger KM. Augmentation of systematic desensitization of snake phobia through posthypnotic dream suggestion. Am J Clin Hypn 1981;23:231-8.
Platz WE, Oberlaender FA, Seidel ML. The phenomenology of perceptual hallucinations in alcohol-induced delirium tremens. Psychopathology 1995;28:247-55.
Winford S, Dur DM, Klise A, Cáceda R. Delusion of snake infestation following sexual intercourse: Report of two cases. Int J Emerg Ment Health Hum Resil 2015;17:624-5.
Mondal G, Nizamie SH, Mukherjee N, Tikka SK, Jaiswal B. The 'snake' man: Ophidianthropy in a case of schizophrenia, along with literature review. Asian J Psychiatr 2014;12:148-9.
Senthilkumaran S, Shah S, Balamurugan N, Menezes RG, Thirumalaikolundusubramanian P. Repeated snake bite for recreation: Mechanisms and implications. Int J Crit Illn Inj Sci 2013;3:214-6. [Full text]
Wiener S. Active immunization of man against the venom of the Australian tiger snake (Notechis scutatus
). Am J Trop Med Hyg 1960;9:284-92.
Katshu MZ, Dubey I, Khess CR, Sarkhel S. Snake bite as a novel form of substance abuse: Personality profiles and cultural perspectives. Subst Abus 2011;32:43-6.
Das S, Barnwal P, Maiti T, Ramasamy A, Mondal S, Babu D, et al.
Addiction to snake venom. Subst Use Misuse 2017;52:1104-9.
Macht DI. Experimental and clinical study of cobra venom as an analgesic. Proc Natl Acad Sci U S A 1936;22:61-71.
Chen ZX, Zhang HL, Gu ZL, Chen BW, Han R, Reid PF, et al.
Along-form alpha-neurotoxin from cobra venom produces potent opioid-independent analgesia. Acta Pharmacol Sin 2006;27:402-8.
Pradhan PV, Shah LP, Ghodke PR, Nayak PR. Snake venom habituation in heroin (brown sugar) addiction: (report of two cases). J Postgrad Med 1990;36:233-4.
] [Full text]
Umate MK, Khot P, Salukhe R, Kale V. Snake venom abuse in rave parties: A case report. Indian J Ment Health 2015;2:227-9.
Mehra A, Basu D, Grover S. Snake venom use as a substitute for opioids: A case report and review of literature. Indian J Psychol Med 2018;40:269-71.
] [Full text]
Parrish HM, Pollard CB. Effects of repeated poisonous snakebites in man. Am J Med Sci 1959;237:277-86.
Tun-Pe, Aye-Aye-Myint, Warrell DA, Tin-Myint. King cobra (Ophiophagus hannah
) bites in myanmar: Venom antigen levels and development of venom antibodies. Toxicon 1995;33:379-82.
During EH, Elahi FM, Taieb O, Moro MR, Baubet T. A critical review of dissociative trance and possession disorders: Etiological, diagnostic, therapeutic, and nosological issues. Can J Psychiatry 2011;56:235-42.