Patients' Supernatural Beliefs on Cause of Multiple Sclerosis

Multiple sclerosis (MS) is one of the most common nontraumatic disabling neurological disorders to affect young adults. It is a chronic autoimmune disease of the central nervous system presented with multifocal clinical findings modulated by various external factors.1,2 The cause of MS is unknown, but it has historically been classified as an organspecific T-cell mediated autoimmune disease. Additionally, many genes may increase disease susceptibility in addition to several well-defined environmental factors such as low serum levels of vitamin D, smoking, ultraviolet B light exposure, childhood obesity, and infection with the Epstein–Barr virus.1 However, considerably less attention is focused on supernatural causes in MS.3 Herein, we discussed patients’ supernatural beliefs on cause of MS to attract attention to the importance of plausible supernatural causes in MS. “Supernatural” refers to a phenomenon or entity that is beyond the laws of nature. It is featured in folklore and religious contexts. It can also feature as an explanation in more secular contexts, as in the cases of superstitions or belief in the paranormal. The term is attributed to nonphysical entities, such as angels, demons, gods, and spirits.4 Frequent supernatural causes linked to illness in many cultures are fate (qadar), Allah’s will, a gift from Allah, test from Allah, punishment from Allah, Nazar (evil eye), Sihr (magic or sorcery), Jinn possession, lack of faith, payback for things done wrong, disobeying family, sinful acts, sinful thoughts, etc.5,6 Koffman et al3 explored meanings of illness causation amongMSpatients. Three central themes emerged from their interviews: uncertainty, logical and scientific, and supernatural explanations. The supernatural theme comprised of three subcategories: “my challenge, my test,” “punishment,” and “fate, destiny, or just bad luck.” The belief that MS could be associated with a “challenge” or “test” was deeply embedded within religious belief system of black Caribbeanparticipants. The categoryof fate, destiny, or bad luck was also specific to black Caribbean participants, a number of whom drew on biblical phrases to help convey their thoughts. They provided accounts where theirMSwas viewed an inevitable part of Allah’s life plan for them. Punishment was characterized by wrongdoing that in some instances justified as a retribution. It was voiced by participants across both black CaribbeanandwhiteBritish ethnic groupswhoeither perceived their punishment as being justified, leveled at them personally or more widely at humankind. Most of the participants in both groups were Christian.3 Obiwuru et al7 noted that of Hispanic Americans participants more than half expressed sociocultural factors such as supernatural events (a gift from Allah) and experiencing strong emotions (fright and sadness) as the perceived cause of MS. Chen et al8 found a negative connection between spirituality and disability in MS patients on the following items: “I believe that my disability is a punishment for wrongdoings that I have committed in the past” and “I believe that my disability is a punishment for the wrongdoings of my family members.” They also found a positive connection between spiritualityanddisabilityon following items: “I believe that, through my spiritual connection, my disability can be completely cured,” “I believe that my disability was caused by Allah or a spiritual power,” “my family believes that Allah or a spiritual power can reducemydisability,” “I amgrateful to Allah or a spiritual power that I havemydisability,” and “I believe that there isaspiritual reason formydisability.” In thisseries,mostof the participants (91.6%)were Caucasian (non-Hispanic) and the most common religious affiliation was Protestant (62.1%), followed by Catholic (23.8%), and atheist (7.9%).8 A quarter of MS patients gave nonmedical explanations such as chance, destiny, and supernatural causes about causation of MS.9 In another series supernatural reasons includingmagic, possession, and/or an “evil eye” were noted in more than half of MS patients as a