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The Validity of the Dissociative Disorders

58 Even considering only the experiences occurring outside spiritist centers, twelve of the 24 mediums interviewed with the Schedules for Clinical Assessment in Neuropsychiatry were diagnosed with schizophrenia by ICD-10 criteria. A diagnosis based exclusively on the fulfillment of objective diagnostic criteria has a series of limitations (in our case regarding mainly spiritual experiences [3] ), and especially when dealing with a non-clinical population [19] . Co-morbidities and additional impairment have been proposed as further criteria [19] . On this basis, we tested whether mediums diagnosed with schizophrenia had different MD indicators (SRQ and SAS scores) to those who were not diagnosed as schizophrenic: there were no significant differences. These considerations make the diagnosis of schizophrenia unlikely in this sample. In summary, mediums included in this study had a high socio-educational level, a low prevalence of MD and were socially well adjusted. The mediumistic process was characterized by dissociative and psychotic experiences that were not related to MD. These results may not be generalizable to mediums as a whole; a bias may have occurred in selecting healthier mediums because, in order to participate as medium in Spiritist centers, candidates are required to attend a 2-year course. Other possible explanations of our findings include the fact that high educational level and religious involvement have been associated with better mental health [17, 20] . Finally, it might be postulated that the mediumistic experiences have functions such as the relief of emotional problems and assigning meaning to life [21] . This hypothesis is reinforced by the correlation found between the frequency of mediumistic activities and better scores in SRQ and SAS. Our findings do not corroborate the view that the mediumistic experiences are less severe symptoms in a continuum with dissociative or psychotic disorders. If this was the case, a directly proportional correlation between the intensity of the mediumistic experiences and psychiatric symptoms or social maladjustment would have been found. Future prospective and transcultural studies will be fundamental for the advance in the understanding of spiritual, dissociative and hallucinatory experiences in non-clinical populations, as well as the differential diagnosis of these and MD.