Moral Injury, Trance and Possession State or a Schizophrenic Illness

Abstract Moral injury, characterised by intense cognitive and emotional distress following an event that violates one’s ethical beliefs, has been primarily associated with post-traumatic stress disorder. However, its role in the development of primary psychotic disorders remains underexplored. This case report presents a 22-year-old Nigerian male with a conservative Christian background who developed schizophrenia following an experience of moral injury. After receiving prophecies discouraging premarital intercourse, he began exhibiting symptoms of mental illness a month after coitarche, including intrusive flashbacks, excessive guilt, and disorganised thoughts. Seven months later, he presented with psychotic symptoms, including beliefs of possession, altered voice textures, and self-harm. A diagnosis of schizophrenia was considered, and treatment with Olanzapine led to significant improvement within two weeks. The case highlights the potential for moral injury to precipitate psychotic disorders, possibly influenced by cultural and religious beliefs. These findings suggest the need for further studies on the relationship between moral injury and primary psychosis, as well as the impact of sociocultural factors on psychiatric phenomenology.