Working with former members involves understanding the severity of the trauma and the power of group dynamics. This paper highlights the special considerations necessary for professionals who work with former cult members. Best practices include stage-oriented treatment that emphasizes stabilization and psychoeducation.
Trauma Is in the Body, Not in the Event
On September 11th, 2001, Peter was working in tower seven at the World Trade Center. He looked out the window and saw what was happening at tower one just as his brother John stumbled into his office. Peter screamed, “John, don’t look—we have got to go—the collapse area of a building like this is huge!” Peter knew this because he is a volunteer firefighter in Yonkers. His coworkers stood frozen around him, staring out the window. He dragged his brother out of the building and they ran all the way to Canal Street, where he aggressively cornered a cab and sped home. Peter presented as a client later that week. He was upbeat and grateful, and he began working in a new Manhattan office where he still works today. He was somewhat nervous during his commute to the city the first few weeks following 9/11, but he had no symptoms of traumatic stress.
Another client, Michael, was between semesters at graduate school when Linda, the girl he was dating, brought him to an all-day workshop that combined his interests in politics and psychotherapy. The charismatic speaker at the workshop reached Michael, who was soon working long hours distributing leaflets and examining his “selfish” capitalistic motives in small-group sessions led by the speaker. Michael later learned that the speaker was the leader of a tight-knit and isolated group. Michael was eased into fraudulent activities to further the group’s aims, activities that months before would have made his skin crawl. One day, he dropped by his girlfriend’s apartment. Her bedroom door was open, and he could hear that she was in bed with the leader, laughing about how easy it was to recruit him. Michael froze in the doorway, utterly shocked. Soon after this experience, he left the group. Michael had trouble sleeping for the next 5 years, and he was alternately wary and angry in relationships. He had seemingly random auditory flashbacks of Linda’s laughter, and he was haunted by the way he deceived others, as instructed, while he was a part of the group. The few people he had told about his months in this group didn’t seem to grasp the gravity of what he had gone through. They also kept looking for “why he got taken so easily.”
Many think of trauma as a big event: war, earthquakes, or hurricanes. But Peter and Michael’s stories underscore that trauma is in the body, not in the event (Levine, 1997; Levine, 2010). I am defining psychological trauma as “the result of a frightening or shocking experience or ongoing experiences that overwhelm a person’s nervous system, causing ongoing emotional dysregulation and faulty memory integration of the thoughts, feelings, behaviors, and body sensations of the event.”
Although Peter witnessed a horrible disaster, as a volunteer firefighter he was prepared for catastrophic situations. Peter’s strong connection to his family served to help him in a split second take care of himself and his brother and flee toward home. He mobilized his energy to take charge and consciously protect himself from the frightening sights and sounds. At home, he received immediate support and respect for his actions.
Peter saw a disaster coming. He used his energy, protected himself, and triumphed. He tells his story with sadness and gratitude, and he remembers the details in the order they occurred. When we are not traumatized, the sensory, imaginal, narrative, behavioral, and emotional aspects of memory remain interconnected. The memory survives with a positive view of the self, and we are able to learn from the experience (Shapiro, 2001).
Michael, in contrast, was traumatized. He was unprepared and shocked by what he heard in the doorway. The world was not as he thought it was. The nervous-system shock was involuntary, and it blocked or immobilized his survival reactions to flee or fight.
This involuntary shut down, a common antecedent for post-traumatic stress disorder (PTSD), is out of awareness and out of conscious control. It is an ancient mammalian, last-ditch reaction to danger (Levine, 2010; Porges, 2011). The organism shuts down, freezes, and cannot move. It is in a state often referred to as “tonic immobility” (Abrams, Carleton, Taylor, & Asmundson, 2009; Bados, Toribio, & Garcia-Grau, 2008; Brand, Lanius, Vermetten, Lowenstein, & Spiegel, 2012 [p. 18]; Volchan et al., 2011). We see this response on PBS nature programs when we watch predators about to pounce on their prey. Just before the lion pounces, the gazelle, with no time to run and no match for this fight, collapses, still energized but immobile. Michael was also shocked by the betrayal. He suddenly saw and felt the connection to Linda for what it was—dangerous. Under these circumstances of frozen high energy, neurobiological systems become detached and unintegrated (Lanius, Lanius, Fisher, & Ogden, 2006; Nijenhuis & den Boer, 2009; Van der Hart, Nijenhuis, & Steele, 2006). It’s as if the gas and the brake are on at the same time and it’s too much for the system to bear (Napier, 2008). In some ways, the situation is like a fuse that blows—too much disorganized energy to hold, and there is a resulting blankness, a felt absence or forgetting. In other ways, it’s like a bomb that explodes, scattering the experiential elements of the event to disparate parts of the body and mind (Pain, Bluhm, & Lanius, 2009). We call all of these experiences dissociation, and these parts or elements “get stuck.” A striking physical example of this “stuckness” is phantom-limb pain (Amano, Seiyama, & Toichi, 2013; Ramachandran & Hirstein, 1998). These parts—anxiety reactions, flashbacks, body pain, involuntary movements, intermittent or persistent numbness or spaciness, and other sensory experiences—will remain sensitive to internal and external cues as long as they are unintegrated (Lanius, Bluhm, Lanius, & Pain, 2006; Sartory et al., 2013). They will reverberate in our associative memory networks (Hebb, 1949) with thematically similar events, which triggers a set of neural connections that in turn leads to what we often refer to as “symptoms” (Shapiro, 2001).
These cues, and the experiences they trigger, resemble the original overwhelming scene. At first, Michael reported that Linda’s mocking voice would “come out of nowhere.” This experience was an auditory flashback, a hallmark of PTSD. But we soon discovered the trigger. The aural flashback occurred whenever Michael entered a doorway in a quiet area. The set of connections was quiet→door→Linda’s voice→betrayal→shaky body sensations→
feelings of fear. Michael would also become irritable after one or two dates with women he was seeing. This was a stuck “fight” response triggered when he was out with a woman. As Michael was frozen at the door during the betrayal trauma, his shocked nervous system had blocked his ability to fight. These responses are the unfinished behavioral strivings that keep repeating, looking for completion and mastery. In psychoanalytic thinking, this pattern is labeled repetition compulsion.
Michael shared that, at that moment at the door, energy raced through his body but he couldn’t move. The energy “had nowhere to go.” Michael couldn’t remember how he confronted Linda and the leader, or how he left the building. He was spaced out. He also reported feeling ashamed and guilty, as if this betrayal was his fault—a meaning distortion typical in traumatic stress reactions. Later, Michael’s friends’ attitudes and comments about his being taken so easily resonated with and confirmed this distortion, which deepened his shame and guilt. Michael presented with PTSD symptoms.
Clinicians and researchers who work with trauma survivors understand traumatic reactions from a neuroscientific perspective, which includes varied types of dissociation, reexperiencing, and problems in integrative brain functions that impact memory consolidation, actions, and personality organization (Courtois & Ford, 2009; Dell & O’Neil, 2009; Sartory et al., 2013; Van der Hart, Nijenhuis, & Steele, 2006), For the purpose of this paper, I am referring to symptoms of the two most widely accepted trauma categories, PTSD as delineated in the DSM5 manual, and C-PTSD, to denote the psychological sequelae of prolonged, repeated trauma. Although the DSM does not currently list C-PTSD as a diagnosis, it is poised to become one in the ICD11 in 2015 (Singh, 2012). The C-PTSD category is widely used in psychological and neurobiological research. C-PTSD is also defined and highlighted by the U.S. Department of Veterans Affairs (available at http://www.ptsd.va.gov/professional/pages/
Not all people who experience overwhelming or life-threatening events develop PTSD. The National Comorbidity Survey Replication (NCS-R) conducted interviews of a nationally representative sample of American adults and found that lifetime prevalence of PTSD among adult Americans is 6.8% (Kessler et al., 2005). The survey also found the lifetime prevalence of PTSD among men to be 3.6% and among women, 9.7% (National Comorbidity Survey, 2005). Prevalence rates for a more high-risk population—in this case, military personnel, post-deployment—fall between 10% and 25% (Hoge et al., 2004; Thomas et al., 2010). Results of research on former cult members reported rates of PTSD in a sample of former members in Spain at 27.9% (males) to 43.6% (females). In the United States, a study listed PTSD in former members at 61.4% for males and 71.3% for females (Almendros, C., 2006; Carrobles, J. A., Almendros, C., Rodriguez-Carballeira, A., & Gámez-Guadix, M. (2010).
The Power of Relational Trauma
Shock, timing, and the ability to move distinguish the stress reactions of Michael and Peter, but it’s likely that an important difference in their experience is that Michael’s trauma was interpersonal. Numerous studies indicate that relational trauma is likely more traumatizing than many physical events (Briere, Hodges, & Godbout, 2010; Butaney, Pelcovitz, & Kaplan, 2011; Freyd, 1998).
In a study by Briere and colleagues (2010) of adults who were abused as children, familial emotional abuse was more highly correlated with adult nervous-system dysregulation and avoidant behavioral symptoms than was physical abuse within the family or sexual abuse by a nonfamily member. Professionals who work with traumatized clients often recognize that, even when a client develops PTSD as a result of a powerful physical event, the individual’s reactions to the event bear an interpersonal marker. When a therapist asks a client, “What was the worst part of the experience?,” the therapist will invariably get a relational answer. Whether the event was a physical assault, a mass disaster, or a war experience, clients say things like “I was alone”; “I felt attacked and betrayed”; “My brother couldn’t get to the hospital on time”; “My partner was unhelpful”; and so on.
In small ways, our individual survival responses (to fight or to flee) can be immobilized by group survival responses, the social self. This is what we call stress. If, after an individual has worked long hours on a difficult job, a boss gives a poor evaluation, the individual can’t run out of the room or physically attack the boss. Doing this would likely cause more trouble for the individual on the job, and the response may feel immoral to him. As humans, we are challenged daily by threats of real or imagined hurts and abandonments by the people around us, which mobilize both our need to connect and at the same time our need to protect ourselves. The stress reaction is the tension caused by the conflict between the fight-or-flight survival reaction and the need for connection, another example of the gas and the brake engaging at the same time. This is an alternate conceptualization of Freud’s hypothesis that symptoms are a result of conflicts between the ego (social selves) and the id (animal selves) (Freud, 1961). This conflict is why individuals seek exercise, meditation, television viewing, dancing at a club, or a glass of wine at the end of the day. These are activities that can reregulate our nervous systems after a day of managing these conflicts at home and at work.
In cultic groups, this social pressure is constant. The verbal abuse, physical abuse, and neglect can be severe in high-demand groups. There is often limited or no ability for one to physically leave the stifling other(s). And once a person is indoctrinated, it’s often impossible to leave the demands that have become part of one’s own way of thinking. This is not stress that can be worked out at the end of the day. This is traumatic stress that overwhelms and gets stuck as a result of social and emotional captivity. Judith Lewis Herman, a pioneer in trauma theory and treatment, explains that captivity conditions in cults can be like those in slave camps or concentration camps (1992b). Cult leaders and group members often behave erratically, sometimes criticizing and punishing, sometimes loving and supporting. This pattern is described in studies regarding Stockholm syndrome wherein those who are captive become traumatically attached to their captors, sometimes within days (Ochberg, 2005). There is some evidence that this phenomenon of traumatic attachment has its origins in primate evolution (Cantor & Price, 2007).
Overwhelming interpersonal abuse and manipulation coupled with being trapped or immobilized by internalized fears and traumatic attachments are factors that can lead to the most serious trauma reactions. Thus, cult involvement has the potential to be one of the most highly traumatizing of human experiences. The adored leader, the traumatizing narcissist, perpetrates trauma using guilt and shame to dominate members and fulfill her needs (Shaw, 2013). Guilt and shame are painful but necessary emotions that may have evolved to help socialize developing children to belong, fit in, and be a part of the larger group. These emotions likely augment group cohesion and survival (Norenzayan & Shariff, 2008). Because humans all carry guilt, shame, and altruism, those who are not sociopathic have the potential to be manipulated (Cialdini, 1984). Cult leaders, who are narcissistic and often sociopathic, manipulate with aplomb.
For second-generation cult members (those born and raised in cultic groups), this dynamic is magnified. They have been raised in an encompassing community whose culture is defined by the needs and abusive practices of the leader during times of critical social and emotional development for them. In addition, their own parents will likely transmit some of the traumatizing and immobilizing aspects of the group in their own efforts to be good soldiers.
Thus, many people born and raised in high-demand groups, or adults who have spent many years in groups that are isolated and controlling suffer from C-PTSD. C-PTSD is marked by significant problems in nervous-system regulation, identity confusion, avoidant addictive behaviors, and more severe depression than those with PTSD (Briere et al., 2010; Courtois & Ford, 2009; Herman, 1992b; Thomaes et al., 2011; Van der Hart et al., 2006).
This reality then raises the question: If high-demand groups are so traumatizing, how and why do so many people get drawn in?
The Epigenetics of Group Affinity
In The Social Conquest of Earth (2012), E. O. Wilson argues that there have been only a few animal species in natural history that have evolutionary “group selection,” and that humans are one of those species. Wilson and others have long wondered about this hypothesis first proposed by Darwin (1871); but with recent advances in behavioral genetics and applied mathematics, Wilson set out to prove it. In 2010, he worked with mathematicians Martin A. Nowak and Corina Tarnita to run mathematical models to support the theory. Natural selection is Darwin’s theory, which postulates that individuals compete for life-sustaining resources, and that the fittest survive and pass on their genes (1871). The strongest individuals survive and move the species’ evolution in adaptive directions. But Wilson argues that humans also may have evolved through selection of groups of unrelated (nonkin) or distantly related individuals. That is, in the evolutionary record, groups of humans who worked together in a cooperative manner would advance the gene pool of that group. In this vein, altruism for the group and its strivings may be a genetic advantage for humans in the same way that selfishness and individual competition are viewed as an advantage.
Wilson argues that survival modes are epigenetic and flexible. That is, when individuals are in situations in which group survival is needed, the gene will express itself as strong altruism and group cooperation. When environmental needs favor individual competition, the gene will express itself as relative selfishness. The more flexible the gene, the more flexible the organism. Humans can thus adapt to a variety of habitats and circumstances.
If people are predisposed to be both morally altruistic to favor group survival and self-protective as individuals, then humans live with conflict at all times: When and how much do we strive to survive and protect ourselves, and when and how much do we cooperate and submit our personal needs for the group? This conflict is evident in the case of 9/11 survivor Peter. He actively protected himself and his brother and survived, but he also left many colleagues frozen and staring out the window. He did briefly call out to his colleagues to get out of danger, but that was the extent of his efforts toward his coworkers. His coworkers at the window did all survive; but, unlike Peter, they had lasting stress reactions. If he had spent a few minutes urging his colleagues to leave and had ushered them out of the building, Peter would have been seen as a hero, reflecting human group/altruistic traits. But then he might not have survived.
Everything Is Multidetermined
If we accept Wilson’s premise that group seeking is epigenetic, then environmental factors by definition can shape the expression of these genes, which impact affiliation and cooperation. Environmental possibilities may influence whether the expression in human behavior goes one way or the other. I propose that the factors that impact the genetic expression of altruism and group cooperation are necessary but not sufficient to cause or predict cult involvement, and that contextual issues will be part of the multidetermined mix. In addition, as is the case with so many other hereditable traits (Segal, 2012), it is possible that affiliation leanings are genetically wired so that an individual is predisposed to express the affiliation in one way or another.
Parental misatunement is ubiquitous. All parents are flawed, and they inadvertently affect the ways in which their children will dissociate or deny their own needs, proclivities, and self-protection (Fosha, in press). Some other-oriented behavior likely develops in the context of the family.
Other possible factors that may influence the propensity for altruism and cult involvement are
having grown up in an altruistic/idealistic family or community. Individuals are often affected by the cultural norms of the families and peer groups they grow up in (Harris, 1998).
having had early experiences of hurt and vulnerability that lead one to project vulnerability and innocence on others. This factor can also make it hard to read narcissists and sociopaths (Rosen, 2006).
having anxiety about competition (Rosen, 2006).
having giftedness, defined as having unique intelligence and sensitivities (Rosen, 2006).
biological/environmental factors that influence systemic levels of oxytocin, testosterone, and serotonin (Zak, 2012).
having a genetic predisposition for religiosity (Segal, 2012).
Some of the contextual factors for more likely cult involvement are
going through a transition or experiencing a recent loss or disappointment.
being raised in an isolating environment.
not being taught to recognize manipulation.
embarking on adulthood without being given the skills to be successful/powerful in work and love (Rosen, 2006).
being at a moment in development when the drive for transcendence/group is strong.
The Draw of the Narcissistic Leader
There exist two key factors in the evolution of group affiliation: Humans naturally organize into us-versus-them configurations (Berreby, 2005; Haidt, 2012; Harris, 1998; & Sherif, Harvey, White, Hood, & Sherif, 1961), and the best groups survive. If the individual’s group is better, stronger, more cohesive, then the individual will be more likely to gather resources, survive, and reproduce. If individuals are group seeking, they are thus more likely to be drawn to groups and leaders who appear to be strong and sure of themselves, and who promote superior ideals. In this context, being drawn to narcissistic leaders is likely more the norm. The group process of indoctrination is both sophisticated and slow (Lalich, 2004; Lifton, 1989). Very smart and able people do not know they are being manipulated; it’s an almost invisible affair. Thus, when group affiliation and altruism are viewed as natural human traits, and with the acknowledgement that narcissists can be attractive, seductive, and interpersonally powerful as leaders, there exists a potential recipe for disaster: a painful combination of human strivings and a leader who will invariably use blame, shame, and group pressure to cement the cohesion of the group to fulfill his narcissistic needs. This dynamic results in repeated betrayal traumas, which trigger potent destabilizing nervous-system arousal and harm the psyches and souls of members. It is more humane and more accurate to think of this scenario not as pathology, but as tragedy and trauma—a natural disaster.
Phase-Oriented Therapy with Former Members: Best Practices
If the trauma from cult involvement is about loss, dissociation, boundary ruptures, and betrayal, then healing impacts growth in connection, integration, self-recovery, self-respect, and trust. Healing is also about learning how to live in a world of ambiguity and multiple relationships, including group involvement. It involves understanding layers of cultural identity and the sense of otherness that comes with a stigmatized experience. The most comprehensive approach to addressing these issues is the standard of care in the trauma field, the phase-oriented model Pierre Janet first proposed (1919), and that various other trauma theorists and clinicians have most recently embraced (Courtois & Ford, 2009; Herman, 1992b; Ogden et al., 2006; Van der Hart et al., 2006). I have labeled these phases as Assessment, Stabilization, Trauma Processing, and Reintegration.
As in all psychotherapies, the therapist needs to assess the trauma client in terms of the client’s situation, history, culture, and current troubles.