Prolonged environmental stress can disrupt the normal integrative functions of personality. Prisoners of war, civilian prisoners of Chinese Communist captors, political prisoners (e.g., Cardinal Mindszenty), victims of the “Stockholm Syndrome,” hostages, concentration camp inmates, and members of totalist cults often adapt to prolonged environmental stress by means of dissociation, that is by generating an altered persona, or pseudo-identity. When internal defense mechanisms break down, pseudo-identity can become destabilized, producing one or more of three clinical pictures: the “floater,” the “contemplator,” and the “survivor.” The goal of treatment is to relieve clients’ induced psychopathology and thus restore their pre-cult personality. Treatment, which varies somewhat with the three clinical pictures, should examine pre-abuse factors and the nature of the environmental stress, which is unique to thought-reform systems. This approach helps clients come to understand that their symptoms are largely responses to stress. Case examples and specific treatment strategies are discussed.
Dissociative phenomena are not necessarily symptomatic of illness, and probably represent a continuum beginning with normal psychobiological modulation of information–incoming, stored, and outgoing–by the brain (West, 1967). In recent years there has been a sharp increase of interest in dissociative phenomena accompanying psychiatric disorders, especially multiple personality and related disorders of identity, including states of possession (Bliss, 1986; Kluft, 1991; Suryani & Jensen, 1993). Dissociative symptoms also are important in many other types of psychopathology, and commonly accompany a range of psychiatric disorder from schizophrenic illnesses to severe stress reactions. Still, the distortion or alteration of a person’s identity and the appearance of a new and different persona remains one of the most interesting manifestations of dissociation.
Prolonged environmental stress, or life situations profoundly different from the usual, can disrupt the normally integrative functions of personality. Individuals subjected to such forces may adapt through dissociation by generating an altered persona, or pseudo-identity (West, 1994). Such a pseudo-identity enables the subject better to cope with the extraordinary situation in which he finds himself, regardless of how he got there.** Parents and others close to individuals who have become members of totalist cults are often astonished at such changes, saying AHe has become a different person.” This article is based on observations of such changelings from a clinical point of view.
Conditions of brutal captivity, such as those experienced by prisoners of war (POWs) or civilian victims of hostage taking, in which the captor seeks to force a false confession or induce compliant behavior, can generate a type of post-traumatic stress disorder (PTSD) in which dissociative features are prominent. During the Korean War, the relative success of the Chinese communists in eliciting false confessions of war crimes (e.g., germ warfare), self-denunciations, and participation in propaganda activities was in large measure achieved because of the captors’ absolute control over the environment of the prisoners. To achieve this control, the communists contrived a variety of stressors, which produced in their captives a state of debility, dependency, and chronic apprehension or dread (Farber, Harlow, & West, 1957; West, 1964).
Civilian prisoners were also subjected to prolonged manipulation by their Chinese communist captors to produce altered political convictions, as described in Lifton’s discussion of thought reform (Lifton, 1961). As with the Korean War POWs, these civilian victims were subjected to prolonged stress in situations from which, at least for a time, there was no escape. Necessarily, they became dependent upon their captors for various physical and psychological needs. In response to these conditions their personalities begin to change in many cases. O’Neil and Demos (1977) have likened the first step in the thought reform process to the creation of an identity crisis. In our view, it is during such a crisis that a new pseudo-identity may begin to emerge. Once formed, it is likely to endure, and gradually grow stronger and better defined, as long as the demand characteristics of the situation require it.
Long before the term AStockholm syndrome” was coined (see below), difficult-to-explain feelings of sympathy and even identification with one’s captors were recounted by former prisoners. One of these was Hungary’s late Cardinal Mindszenty, who was arrested, tried, and imprisoned from 1948 until the 1956 uprising in Budapest. In his Memoirs (1974), Mindszenty wrote that within 2 weeks of his arrest, under constant coercive interrogation he found himself thinking along different lines from before, and seeing things from his captors’ point of view. His judgment, reasoning, and sense of self became distorted. He wrote: “Without knowing what had happened to me, I had become a different person” (p. 114).
Patricia Hearst was violently abducted by members of the Symbionese Liberation Army in February of 1974, brutalized, raped, tortured, and forced to participate in illegal acts beginning with the bank robbery for which she was later (in our view wrongly) convicted. The traumatic kidnapping and subsequent 2 months of torture produced in her a state of emotional regression and fearful compliance with the demands and expectations of her captors. This was quickly followed by the coerced transformation of Patty into Tania and subsequently (less well known to the public) into Pearl, after additional trauma over a period of many months (Hearst & Moscow, 1988; The Trial of Patty Hearst, 1976). Tania was merely a role coerced on pain of death; it was Pearl who later represented the pseudo-identity which was found on psychiatric examination by one of us (West) shortly after Hearst’s arrest by the FBI. Chronic symptoms of PTSD were also prominent in this case.
The term “Stockholm syndrome” was coined to describe a certain psychological phenomenon in hostages following a 1974 bank holdup in Sweden. Four employees were held captive by two robbers for 52 days. During the ordeal, some hostages became sympathetic toward the robbers. In fact, one female hostage swiftly and unaccountably fell in love with one of her captors and then publicly berated the Swedish prime minister for his failure to understand the criminal’s point of view. For a limited period of time after her release, the former hostage continued to express affection for her captor (Ochberg, 1978).
Other hostages have also developed sympathy for–or identified with– their captors. For example, in 1975, during the 13-day seizure of a Dutch train by South Moluccan gunmen demanding freedom for their islands in the Malay archipelago, despite the executions of 2 hostages, some of the surviving captives rapidly developed feelings of affection or sympathy for their murderous captors, along with attitudes of distrust toward the legitimate Dutch authorities. A psychiatrist might better define this phenomenon using the more psychodynamically descriptive phrase: Aidentification with the aggressor” (coined for a different purpose during World War II by Anna Freud). If this process is sufficiently profound and prolonged, in our view the accompanying personality change may best be understood in terms of pseudo-identity as explicated below.
Identification with the aggressor has been analyzed in relation to a variety of psychiatrically important situations, ranging from imprisonment in Nazi concentration camps, where doomed prisoners sometimes sought out discarded insignias and other shreds of SS uniforms with which to adorn their rags, to the battered children who grow up to become child-battering parents. However, some cases do not involve prisoners or captives. For example, Solomon Perel, the subject of a recent film (Europa, Europa [Holland, Menegoz, & Brauner, 1991]), was a German Jewish boy who assumed a non-Jewish identity in order to cope with the life-threatening conditions of the time. He transformed himself into Joseph (“Jupp”) under extremely stressful circumstances.
Knowing that Jews would be killed, he got rid of all documents identifying him as a Jew and, in the chaos of war, said, AI am a patriotic German.” He even served in the German army. Gradually, however, the teenager’s role became a new identity because of the demand characteristics of his situation. For years after the war, following his emigration to Israel, Perel experienced moments when he had to ascertain whether it was Sol or Jupp who was answering a question (Williams, 1992). Like the incomprehensibly compliant Jozsef Cardinal Mindszenty and the abnormally passive Patricia/Pearl/Hearst, under stress, Solomon Perel’s identity had changed. The new pseudo-identity, initially formed as a role played in response to stressful circumstances, was a different personality of sorts. This personality was superimposed upon the original which, while not completely forgotten, was enveloped within the shell of the pseudo-identity.
Through the exercise of psychosocial forces more subtle than those described above, people can be deliberately manipulated, influenced, and controlled to a considerable degree, and induced to express beliefs and exhibit behaviors far different from what their lives up to then would have logically or reasonably predicted. While the thought reform program of the Chinese communists to convert people to Aright thinking” was hardly subtle, the indoctrination techniques applied to new recruits by contemporary totalist cults can be very subtle indeed (West 1989, West 1993). Subjects are forced to communicate verbally and continuously, in a strictly controlled fashion. Most of these cults rely also on the effects of structured group dynamics, environmental manipulation and control, the relationship of dominant leaders to dependent members, the relative initial isolation of recruits from previous ideas or relationships, and the evolution of a new identity with constant group pressures to bring errant individuals into line.
A totalist cult is defined as follows: A (totalist type): a group or movement exhibiting a great or excessive devotion or dedication to some person, idea, or thing, and employing unethical, manipulative or coercive techniques of persuasion and control (e.g., isolation from former friends and family, debilitation, use of special methods to heighten suggestibility and subservience, powerful group pressure, information management, promotion of total dependency on the group and fear of leaving it, suspension of individuality and critical judgment, and so on, designed to advance the goals of the group’s leaders, to the possible or actual detriment of members, their families, or the community).” The basis for this definition, and a general discussion of the cult problem, is given elsewhere (West, 1989). Among various totalist cults, there may be some differences as to how intense the persuasive activities are, and in the degree to which recruits can be separated from their previous social networks. Even though he may have been attracted to the cult by elaborate and deceptive recruiting techniques, the neophyte cultist enters it “voluntarily.” With rare exceptions, nobody puts a gun to his head. Yet, successful indoctrination of a cult member often includes many elements similar to the political indoctrination by such groups as the Chinese communists, which Schein (1961) described as coercive persuasion. In cults, as in the Chinese “brainwashing,” “thought reform,” or “coercive persuasion,” people are often encouraged to criticize them-selves in small-group confessionals as a means of strengthening their dependence on the group. As the process continues, members are systematically trained to relinquish independent action and thought, since only obedient behaviors and passive attitudes are rewarded, while resistance or self-assertion is punished.
Even groups that have derived from respectable religious sects (such as the Lundgren cult, a splinter of a sect of the LDS, see below) or that have evolved from therapeutic communities such as Synanon, can evolve into totalist cults if the autonomy of the members is progressively diminished, while the concentration of power in the leadership grows more and more absolute. Under these conditions usually the emphasis shifts from the members’ well-being to their manipulation and exploitation. In this way, it is easy to understand how the followers of Jim Jones (People’s Temple), L. Ron Hubbard (Church of Scientology), Sun Myung Moon (Unification Church), Moses David (Children of God), Elizabeth Clare Prophet (Church Universal and Triumphant), Rajneesh, and others are successfully influenced to become “different people.”
Lifton (1961) describes how certain Chinese citizens and Westerners, having undergone the stressful process of “thought reform” and apparently changed their political beliefs, upon liberation continued to parrot the programmed Maoist clichés for a time until, in the new and free environment, those beliefs and the attendant formulae began to crumble away, leaving each bewildered survivor with an acute identity problem. Lifton characterizes this process as resembling death and rebirth. Former members of religious cults, or veterans of mass-marketed group therapies and self-help techniques, have called abrupt forms of such transformation “snapping” (Conway & Siegelman, 1978). This corresponds to the observations of many former cult victims, who have undergone “deprogramming” and, as a result, abruptly reverted from their cult-induced pseudo-identity to something resembling their previous or original personality. Indeed, snapping seems like an appropriate term when the victim, having been coerced or manipulated into his strange pseudo-identity, eventually “snaps out of it.” He is again his old self, but with some serious new problems as a result of the cult-related experience and the trauma involved in relation to it. Furthermore, years may have passed since the original identity was functioning normally; meanwhile the world has become a different place.
The term pseudo-identity has only been used twice previously in the scientific literature. In 1974, Glatzel used it to describe a delusional alteration of self in cases of major depression involving cyclothymic illness (Glatzel, 1974). To the best of our knowledge this usage has not since been repeated. More recently, Girodo (1985) employed the term when describing problems experienced by certain undercover narcotics agents who, after prolonged role playing, found it difficult to discontinue assumed behaviors when an operation was finished. Employed only once or twice in Girodo’s article, the term was used casually to convey the sense of a long-assumed role, not a dissociative disorder, and was limited to the highly specialized circumstances of undercover work. In fact, Girodo minimized the possibility of dissociative reactions in the subjects he studied. However, careful review of his clinical material suggests that some cases of pseudo-identity in our sense may indeed have occurred in certain cases, studied by Girodo, of law-enforcement officers who were required to play the part of criminals for months or even years. In our view some of these officers showed symptoms of PTSD as well.
Through hypnotic suggestion, it may be possible to create temporary distortions of values, viewpoints, or perceptions of reality, which are sufficient to induce in some subjects behaviors that would be otherwise unacceptable to them. Certain hypnotists (e.g. the late Harold Rosen and Milton Erickson) specialize in hypnotic induction that does not involve trance induction or the exercise of traditional techniques such as eye closure. Clinical literature is also replete with examples of increased suggestibility or controllability of individuals during altered states of consciousness, such as those induced by psychotropic substances, environmental manipulation, sensory isolation, powerful emotions elicited by group dynamics (especially in large groups), religious ceremonies, and other special circumstances. Latah is a special case in that hypersuggestibility usually occurs as the consequence of the subject’s being taken by surprise through a harmless maneuver (e.g., an abrupt noise, tickling, etc.) (Suryani & Jensen, 1993).
Pseudo-identity is more than a temporary role assumed by a subject in a laboratory exercise or during a transient period of intoxication. It is more like an Aalter” in a case of multiple personality disorder (MPD). However, pseudo-identity differs from the alter of MPD in the following important respects:
Pathogenesis. MPD is most likely a consequence of early childhood trauma, with symptoms appearing later in life as a result of inner conflicts interacting with experiential circumstances. A pseudo-identity is usually generated by external stress originating in the environment of a person who may have been previously quite free of any signs or symptoms of personality malfunction, and for whom the new persona represents a transformation required to meet the demand characteristics of a life situation markedly different from the person’s previous one.
Psychopathology. The MPD patient may have more than one alter; in the case of pseudo-identity, the personality change, whether swift or gradual, usually involves the generation of a single different personality. In pseudo-identity, under certain conditions there may be abrupt switching back and forth between behaviors characteristic of the two separate personalities (a phenomenon sometimes referred to as “floating”), but without MPD’s typical boundaries between the two personalities, and without the MPD patient’s sense that one self is separate from the other one. In MPD, the different alters or personalities primarily reflect facets of the original character. In pseudo-identity, the new personality primarily reflects the new situational forces and requirements. In MPD, the original identity is usually unconscious of the existence of the alters as they emerge and submerge. In pseudo-identity, the original persona remains but is overlaid or enveloped by the new identity.
Prognosis. MPD is notoriously difficult to treat (Braun, 1986; Kluft, 1984b). The outlook is generally better for the patient with pseudo-identity, although the syndrome may become chronic like any dissociative disorder or (in the old terminology) monosymptomatic major hysteria. Sometimes merely returning the patient to his original life situation (or even a neutral environment where information is freely and honestly exchanged and nonexploitive people are available for support) will, in a few weeks, result in the abrupt (“snapping”) or gradual disappearance of the pseudo-identity. However, the patient then faces resuming many long-neglected functions of his former personhood, and working through the complex emotional aftermath of having–for whatever period of time and to whatever degree–become a different person.
Treatment. Therapy of both syndromes requires appreciation of the mental mechanisms involved, the reality of traumata or stress–however subtle–in pathogenesis, and the technical maneuvers known to be useful in management of dissociative disorders. While in the psychotherapy of MPD the usual goal is primarily the reconciliation and integration of the alters into a new and healthier whole, the goal in therapy of the patient with pseudo-identity is restoration of the original identity. However, the patient then usually requires treatment for the residual PTSD which is the legacy of the stress which produced and maintained the pseudo-identity syndrome.
Cases of pseudo-identity observed among cult victims are often very clear-cut, classic examples of transformation through deliberately contrived situational forces of a normal individual’s personality into that of “a different person”. (Others are colored by certain prominent additional symptoms into types that have been described as “floaters,” “contemplators,” and “survivors,” see below.) The following brief case description illustrates a more or less classical case of pseudo-identity in a small totalist cult.
Danny Kraft grew up in a small town in the midwest. Testimony from over 60 family members, friends, and former teachers indicated that Danny was a fairly normal young man. He appeared to be well adjusted, sociable, performed well in school, had many friends and showed no signs of anti-social behavior. There was no evidence that Danny suffered from any mental or personality disorder. His parents were divorced, and he sometimes appeared to experience conflicted loyalties between his father and mother, but not inappropriately so.
Towards the end of his teen years, Danny became interested in religion and eventually joined a sect (by our definition a totalist cult) that was an offshoot of the Reorganized Church of Jesus Christ of Latter Day Saints (LDS). His parents grew concerned about the personality change they saw in their son. Danny’s father made several trips to the town where the cult was located, and talked to pastors, police officers, and the FBI. They assured him that his son was merely going through a “phase” and that he would soon grow weary of the group and return home. However, far more ominous events transpired. The cult leader, Jeffrey Lundgren, declared that God had told him that members of a certain family within the group must be judged. “Judgment” meant that blood must be shed. Danny participated in Lundgren’s murder of the victimized family. He assisted the Lundgrens in killing the two parents and all three daughters, aged 7, 13, and 15. The family members were lured one by one into a barn, bound and gagged, and then taken to a large hole that had been dug in the barn floor, where Lundgren shot them with a .45 automatic pistol and buried the bodies. Lundgren, his family and followers then moved westward. Eventually they were apprehended in California, returned to Ohio, and tried for murder.
In subsequent interviews, Danny appeared calm and unperturbed. There was no evidence of personality disorder, except for the appearance of high dependency elevations and high normal elevations on the narcissistic and antisocial scales of the Millon Clinical Multiaxial Inventory (MCMI). All other tests and repeated clinical interviews showed no evidence of emotional distress or thought disorder.
At first Danny denied that he had had anything to do with the murder of the family. But when he was asked about the judgment of God, he admitted that he had served as God’s instrument in executing His judgment. While confessing, Danny showed no apparent remorse. In fact, there was a wooden, matter-of-fact quality in his admission and in his entire demeanor.
At the sentencing hearing, Danny’s father appealed without success for professional help for his son to break the spell that Lundgren had seemingly cast over him. As one reporter observed, “the younger Kraft (Danny) only smirked and appeared indifferent as Lake County Common Pleas Judge James W. Jackson listened to witnesses in the second day of the ex-cult member’s sentencing hearing” (McGillivray, 1990, p. 2). His defense lawyer, Elmer Giuliani, argued, AHe (Lundgren) has divided this young man from what he was at one time to what you see today. He divided this man’s mind from a free thinker to a mirror image [of Lundgren]” (McGillivray, 1990, p. 2).
Other than Lundgren’s wife and son, Danny is the only person who was convicted who is apparently still under the control of Lundgren. The zealous beliefs of the other cultists eventually faded and they now perceive Jeffrey Lundgren as anything but a prophet of God. It remains to be seen whether Danny’s fairly classical case of pseudo-identity will yield to treatment (if any can be provided in prison) or to the passage of time.
Sometimes the pseudo-identity becomes destabilized. Such destabilization can occur when internal defense mechanisms break down; when changes in the group occur that cannot be explained or tolerated by the member; when information is received from outside sources that is dissonant with currently held beliefs, or otherwise anxiety provoking; when gradual fatigue and strain occur after a period of arduous work on behalf of the cult, perhaps with concomitant threats of punishment for poor performance; or when the cult member is traumatized by such events as humiliation by a superior. Destabilization may also be seen when a cult member experiences a sense of failure or impending doom for not being able to meet the group’s demands or otherwise satisfactorily to conform. The three clinical pictures described below may be seen in recent converts who experience destabilization to the point that they drop out before a more fixed pseudo-identity is formed. They may also be seen after a pseudo-identity is formed but is subsequently destabilized, even after departure from the cult.
The “Floater.” Nothing distresses parents and loved ones more than witnessing a recovering, former cult member begin to Afloat.” Floating is a dissociative phenomenon that is best described as a sudden switch back to the pseudo-identity, a regression which is most commonly triggered by certain sights, sounds, touches, smells, or tastes in everyday life that were ubiquitous and salient stimuli in the cultic milieu. Characteristically, floating occurs in cult members who have left the group of their own accord, have received incomplete counseling, or are still in the beginning phases of counseling. A former member who floats after phoning a cult member may as a result even return to the cult.
Jennifer, a college graduate, had served as a teacher overseas for 7 years with a well-respected religious organization. She then returned to the United States and joined a different church. Gradually, she and others of the congregation became entranced by their charismatic pastor. Over time, Jennifer began to believe ideas, and to practice behaviors, that previously would have been unthinkable to her. Despite her previous fundamentalist Christian beliefs regarding ethics and morality, Jennifer repeatedly engaged in illicit sexual activity with her cultic pastor, who told her that it would make her Amore spiritual.” No amount of persuasion by friends and family could convince her that the group or its teachings and practices were unhealthy. She eventually agreed to seek counseling, but only to convince her parents and friends that the cult was in fact healthy, and that their fears were unfounded.
Initially Jennifer presented a rather robotic picture to the therapist. Her affect was flat and her speech was mechanical, as were her bodily movements. She exhibited clinical signs of dependency, anxiety, and depression. After many daily sessions, one day the therapist said something that shifted Jennifer away from her pseudo-identity. In the following session her affect and bodily movements were no longer stilted, and she began to express some of the doubt and pain that were appropriate to the reality of her experiences in the cult. In short, the “old Jennifer” began to re-emerge. The change was dramatic. Needless to say, Jennifer’s parents were much encouraged.
A few days later in a group therapy session another patient said something critical about Jennifer’s cult leader. The therapist watched Jennifer’s eyes lose their focus. She stared off into space. Suddenly the pseudo-identity was back. Criticism of the leader apparently served as a trigger for her automatically to recite the programming that she had received in the group: that is, to defend the leader against all criticism. Subsequently Jennifer required 5 to 6 hours of continuous discussion during which the therapist reviewed with her the cult leader’s abusive and unethical behavior. With this cognitive exercise, Jennifer’s frozen affect began to thaw again. She has since remained free from the cult, is now married with one child, and works as a school teacher.
The “Contemplator.” Dissociated trance-like symptoms are often seen in members of cults or sects in which contemplative exercises are practiced, such as chanting or meditation. “Speaking in tongues” may also produce this effect.
Sabrina was a member of a martial arts cult for a number of years. Her parents became concerned about progressive behavioral and personality changes, together with her gradual estrangement from the family. Eventually Sabrina sought counseling when she began to experience significantly distressing symptoms. She was found to be suffering from a major depressive episode, with predisposing passive-dependent and schizoid personality characteristics. Her therapist noted that sometimes Sabrina would begin to stare, her eyes would become unfocused, and she would become unaware of her surroundings. The therapist would literally have to call out her name several times in order for Sabrina to reorient herself as to time, place, person, and event. With Sabrina, there were no apparent cues or triggers for these trance-like states. When she entered them she would find herself automatically engaging in some of the activities that had been a part of her martial arts training. Over the course of several weeks of therapy, Sabrina’s episodes of contemplative dissociation diminished in frequency. In time, they disappeared entirely.
Sabrina was fortunate. In some cases, contemplative dissociation is very resistant to modification. Former cult members who have practiced chanting and meditation for hours a day over a period of many years may require special rehabilitation or extensive therapeutic measures (see AGeneral Treatment Issues,” below).
The “Survivor.” Certain dissociative symptoms are frequently evident in persons who have survived severely traumatic events. Herman (1992) notes that victims of incest, rape, terrorism, concentration camps, and cults share common responses to trauma, which may include feeling disconnected or detached from their selves or their surroundings (depersonalization, derealization), psychophysiological hyperarousal, intrusive memories of the trauma, and/or emotional and behavioral constriction.
Our clinical experiences with former cultists confirm that they may develop symptoms similar to those seen in victims of imprisonment, torture, terrorism, incest, physical abuse, or rape. In about 25% of our cases, cults are found to have perpetrated sexual and physical coercion and other abuse, including the inculcation of fear, terror, or dread. Further, cults are seen to exploit group dynamics for social control, and to employ specific techniques to induce altered states of consciousness. It is interesting to note that one study of former cultists (Martin, Langone, Dole, & Wiltrout, 1992) revealed no significant differences in the MCMI between those who had been subjected to sexual and/or physical abuse, and those who did not report an abuse history. While usually the case, apparently neither brutal treatment nor confinement is necessary to produce the survivor type of clinical picture, as is illustrated in the following case.
Charles was a graduate of a large state university. His parents enjoyed a solid marriage. His father was an anesthesiologist. Charles had joined a Bible study group while at the university and after graduation he, along with many of the group’s members, moved to be closer to the leader of the group. These Bible study members found themselves part of a small cultic rural compound that advocated white supremacy, militancy, and a belief in demons as the source of virtually every personal problem. The leader advocated a series of extreme measures to rid the cultists of their demons. These measures included long and arduous fasts, beatings, physical threats of death, prolonged verbal abuse, isolation, public confession, and almost constant shaming and humiliation. Charles was subjected to all of these methods to exorcise his demons. His parents, fearing that he might be dying from the fasts, contacted local police and had their son seen by a counselor. Charles was later referred for more extensive counseling in a residential setting.
At first appearance Charles was gaunt, his eyes were sunken, and he stared into space incessantly. He was listless and pas-sive, resembling a Holocaust survivor. Although Charles was no longer in the cult, he had apparently come to believe that he was indeed hopeless, wicked, and demonized. Clinically, Charles suffered from a depressive illness with obsessive-compulsive features. He also met the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of Acute Stress Disorder and Brief Reactive Dissociative Disorder. His dissociative symptoms included trance-like states, derealization, depersonalization, and psychic numbing: AI feel nothing; I feel dead.” In addition, Charles experienced fear, intrusive recollections or flashbacks, hopelessness and despair. Charles received daily intensive psychotherapy for more than 5 weeks. He was also prescribed fluoxetine, an antidepressive medication. By the time Charles left the treatment center he had gained weight and was no longer depersonalized, numb, or feeling a sense of despair. He continued in outpatient therapy for nearly a year. Currently, he is performing very well as a graduate student and was recently married.
General Treatment Issues
Misunderstandings about cult victims and their treatment abound (Martin, 1989; Singer & Addis, 1992). Perhaps the most disturbing myth is that only troubled individuals, or those from dysfunctional homes join cults, while well-adjusted youth are immune. Although several well-designed studies and numerous clinical reports have refuted this idea, it stubbornly persists (Wright & Piper, 1986; Maron, 1988). Another common misconception about cults is that their dangers are either greatly exaggerated or are nothing more than fictions concocted by over controlling, neurotic, or ignorant parents; by misinformed religious (or antireligious) bigots; or by unscrupulous therapists bent on terrifying families, traumatizing followers of Anew religions” through brutal deprogramming sessions, and collecting enormous fees (Bromley & Shupe, 1981; Bromley & Richardson, 1983; Barker, 1984; Robbins, 1988). Objective therapists will reject such viewpoints (often promulgated by nonclinicians if not armchair philosophers) and will prefer to trust the evidence of their own information as obtained from experienced colleagues, patients, family members and other reliable informants. Such therapists will quickly perceive that the cultic situation impinges upon the particularities of each member’s personality and behavioral history to produce a resulting constellation of symptoms, or even to precipitate a serious psychiatric illness.
Some specific methods used in treating cult victims have been described in a number of recent books and articles (Martin, 1989; Martin, Langone, Dole, & Wiltrout, 1992; Martin, 1993a; Martin, 1993b). These publications note that proper treatment can be difficult, that it is more education-oriented than many other therapies, and that it progresses through several fairly predictable phases. Following is a brief summary of the salient features of these treatment methods.
The goal of treating a former cultist is to relieve the patient’s cult-induced psychopathology and thus to restore his pre-cult personality. This can be a daunting task. The difficult and necessary challenge of all therapy with former cult members is to carefully restructure the patient’s unhealthy responses to the stressful demands made by the cult on the patient’s previous sense of identity, including values, mood, thought and behavior. The therapist must also clearly define the patient’s dissociative symptoms, so that treatment can be oriented toward the particular type of psychopathology that is present. For example, dissociation caused by meditative practices may require a different approach than dissociation secondary to physical trauma. Moreover, more than one dissociative symptom may be manifest in the same patient, either simultaneously or sequentially. Different types of dissociation must be identified clearly and treated appropriately for the best therapeutic results.
Classic pseudo-identity cases require treatment very much like that employed by most therapists who treat patients coming out of cults. Generally treatment of cult victims contains several elements. Some or all of the following may be required:
1. Medical care for illness, often related to malnutrition, avitaminosis, neglect of chronic disorders such as diabetes or peptic ulcer, and neglect of preventive health measures such as inoculations, proper diet, regular exercise and the like.
2. Psychiatric treatment for mental illness, including medication to manage symptoms of depression, anxiety, panic disorder, etc., and perhaps the use of special methods such as hypnosis or narcosynthesis for resistant dissociative symptoms.
3. Individual psychotherapy.
4. Group psychotherapy.
5. Exit counseling.
6. Family therapy.
7. Educational guidance and counseling.
8. Vocational rehabilitation and training.
9. Special referrals for pastoral counseling if indicated (e.g., when the recovering patient seeks affiliation with a legitimate religious group, or wishes to return to his original family church).
10. Legal consultation if needed to help the patient put his affairs back in proper order if–as often happens–they have been much neglected, disrupted, or exploited during the period of cult membership. Legal action, including both punishment of offenders and recovery of damages by the victim, can be very therapeutic in many cases.
Patients showing clinical pictures of the subtypes described above may require special treatment strategies. Suggestions about these include the following.
Treating the “Contemplator.” Dissociative and other symptoms result-ing from contemplative cult practices may continue to be problematic in treatment long after other symptoms have improved. Contemplative symptoms can include inability to concentrate, relaxation-induced anxiety, and dissociative phenomena such as automatic lapsing into meditation, chanting, or trance-like states. Ryan (1993) found that one of the most effective methods to remedy “spacing out” is physical exercise. Exercise may also help to alleviate other contemplative symptoms, such as lack of awareness of bodily sensations, muscle tension, fatigue, and the association of these with emotional dysfunction or distress. Other helpful techniques include identifying aspects of the environment that create stimulus overload, slowly building up reading stamina by setting a timer and thereby gradually prolonging reading time, and learning to counter magical thinking through a specific series of reality checks.
Dissociation has been viewed as a phenomenon that is associated with subcortical areas of the brain (West, 1967; Putnam, 1989). To a certain, though lesser, degree the cognitive processing problems ex-cultists experience resemble difficulties encountered by some head trauma or stroke patients. Therefore, as with patients who have known neural lesions, selected cult victims may benefit from the employment of structured linguistic remediation. Some patients report that such methods, which focus on memory, concentration, and linguistic encoding and de-coding, are very helpful in reducing various types of dissociation. Specific exercises include (1) reading several paragraphs aloud to the patient and asking him to re-state the ideas expressed in the passage, (2) asking questions pertinent to the sequence of the content read to the pa-tient, (3) asking the patient to analyze the story or to repeat it, and (4) inviting the patient to respond to sentences that require an expression of opinion relevant to the content. The clinician should note the latency of responses, the need for clarification of the task or topic, the patient’s memory for details, problems in his ability to focus and concentrate on the task, and deficits in expressive verbal skills.
Since altered states may result from a narrowed focus of attention and a limiting or restricting of external stimuli (as occurs in many cultic environments), awareness training in the visual, auditory, and aesthetic modes can be helpful. For example, by encouraging clients to name all the different sounds they hear in 30 seconds, and then all the colors and shapes they see in a room, the therapist reinforces awareness of sensory stimuli that a dissociative state may have diminished or even (in the case of a trance) abolished.
Various mnemonic devices for remembering the details needed to engage in everyday activities can be taught to a former member so that he can better recall, for example, the five or six items that he recently purchased at the grocery store. Daily readings of newspapers, magazines, or short stories can be useful as well, particularly when the patient interrupts the activity at regular intervals to check his recall ability, and his awareness of the present environmental situation.
Treating the “Floater.” Typically, a former member floats, or returns to a pseudo-identity state, as a result of a trigger that can be visual (e.g., seeing a book written by the cult leader), verbal, physical, gustatory, or even olfactory. To defuse the trigger, it must be identified and the cultic language or jargon associated with it examined. Words that are given unique or idiosyncratic meaning by the cult should be correctly redefined by showing the client the dictionary definition of the word. Sometimes merely concentrating on crossword puzzles and other word games may help a patient to diminish or prevent floating (Tobias, 1993).
The immediate or crisis treatment for floating involves orienting the patient sharply to present reality with respect to time, place, person, event, and self. It may be necessary repeatedly to remind him that he is no longer in the cult, to encourage him to engage in conversation, and to review facts that promote the experience of being himself in the here and now. Crisis treatment should also include a review of why he left the cult and the problems associated with it (e.g., exploitative or criminal behavior). Patients should be encouraged to make notes and list the reasons why they left the cult, along with the personal and social problems that ensued from their cult experience. If they cannot reach their clinicians when episodes of floating occur, they can review their notebooks until the floating stops or they receive help.
Generally, floating is diminished by a thorough and comprehensive exit counseling process. The more the former member learns about the cult, and the more he is helped to understand the negative impact the cult has had on him, the less likely he will be to experience episodes of floating. If these episodes persist, more rigorous methods–similar to those employed in treatment of major dissociative disorders–may be required.
Treating the “Survivor.” People forced by manipulative cult leaders to engage in and/or witness heinous acts often manifest symptoms of post traumatic stress disorder (PTSD). Nightmares, intrusive thoughts or images, fearfulness, and various psychosomatic malfunctions are common reactions. However, the formation of a pseudo-identity is not necessarily associated with specific traumata, and the symptoms that cult members experience after they leave the cult may not be exactly those which meet the diagnostic criteria for PTSD. Nevertheless, the cult experience itself, and the process of disengaging from the cult, inevitably involve some degree of trauma to the person. The picture of a concentration camp survivor may result. To promote a full recovery from the sequelae of cult membership, the therapist should help the former member to learn about the dynamics of cultic groups, and to understand how individuals in such situations can be induced to behave in ways highly deviant from their previous patterns, or to fail to behave in ways that were previously characteristic. Therapy should focus on “detriggering” and “reframing” the traumatic incidents that continue to affect the former cult member via educative strategies, cognitive-behavioral techniques, memory work, and dynamically oriented psychotherapy, as indicated.
Specific Treatment Issues
During the course of therapy, the following issues must be addressed in treating the traumatized former cult member.
1. To formulate how the cultic trauma interacted with the unique aspects of the patient, pre-abuse factors must be evaluated including the patient’s age, gender, personality, coping style, family of origin, and pre-cult personal history.
2. The specific nature of the cultic trauma must also be examined; including the following:
a. Did predisposing personality or situational factors render the cult member vulnerable to recruitment? It is important to note that most people who are recruited into cults were not seeking to become cult members, did not suffer from any significant psychosocial handicaps, and did not come from atypical family situations. Although it is important to explore the individual vulnerabilities of the patient to the recruitment process, it can also be helpful for former cult members to recognize that cult recruiters regularly play on a myriad of personal characteristics that are normal or even desirable in the general populationCcharacteristics such as loyalty, honesty, idealism, and a trusting nature.
b. How was the cult member’s pseudo-identity shaped by use of deception, guilt, coercion, conditioning techniques involving deliberate positive and negative reinforcement, group indoctrination, environmental manipulation, hypnotic methods and other maneuvers to increase suggestibility or produce trance-like states?
c. How was the patient affected psychologically by the “thought reform” elements in the cultic environment? Specific issues and symptoms that can be addressed include denial, fragmentation of the self, depression, anxiety, phobias, dissociation, dissociation triggers, and how these various mental mechanisms and symptoms are related to the cultic milieu.
d. How were specific traumatic incidents stored? Storage could be cognitive via the doctrinal framework, sensory via visual and auditory stimuli, or interpersonal in terms of automatized behaviors, action tendencies, or group-determined roles. Further, what is the means by which this patient’s trauma-related stimuli trigger memories of painful, confusing, and guilt-producing cult experiences?
e. How can painful memories of the cult experience, and the eventual disillusionment, be defused? As with victims of other types of trauma, three basic assumptions have been violated or undermined with respect to ex-cult members’ view of themselves and the world: “the belief in personal invulnerability, the perception of the world as meaningful, and the perception of oneself as positive” (Janoff-Bulman, 1985, p. 15). The clinician must facilitate the former member’s task of recapturing or reframing positive attitudes about life, the self, the family, society, and the like.
The consequences of pre-cult abuse (if any) and the subsequent cultic abuse are treated initially by educating the former cult member with respect to the psychological manipulation techniques that were used to deceive or mislead him. In this way, he learns that he was not solely responsible for his misfortune. (Blaming the victim is ubiquitous; even victims do it.) Some former members may say, “I’m fine,” and show extreme defensiveness about the group’s flagrant abuses. Such denial must be confronted by educating them about the aftereffects of cultic abuse in a manner analogous to the early intervention work with victims of rape, physical abuse, and other types of interpersonal trauma.
Former members can gain a sense of perspective about their cultic involvement by learning about the manipulative teaching of their particular cult, the practices of their cult leader, and the group’s ethical tenets and exploitative use of personal relationships. This can be accomplished by presenting didactic material on the techniques of thought reform used; showing the ex-member testimonials of other former cult members who have made a successful post-cult recovery; encouraging the ex-member to talk to or visit with other former members; providing general readings and other educational materials about cults; and examining how a cult, if it claims to be religious, actually deviates from the main traditions of the religion from which it presumably derived (e.g., Protestant Christianity), or how a psychotherapy cult departs from the accepted standards of care and ethics practiced by reputable mental health professionals.
The educational aspects of treatment are primarily part of the first of the three stages of recovery, which overlap with each other. The three stages of recovery can generally be assessed by the type of questions the ex-cultist asks. For example, when a therapist hears the following questions and statements, he will know that the former cult member is in the first phase of recovery: “Is the group really a cult?” “Maybe I could have tried harder.” “I’m so confused.” “Were my needs really being met in the group?” “I’m fine. The group had some problems, but it wasn’t that bad.” AI know something is wrong; I just can’t put my finger on it.” The initial treatment goal for the patient who asks such questions is to finish the exiting process. This entails a thorough examination of the cultic milieu, the resultant trauma, and the various pre-abuse factors that may be relevant. In short, the clinician must educate the patient, as described above. Valuable insights may be gained at this stage by using instruments such as the MCMI and asking patients specific questions about the cult and why they left. High scores on the Dependency, Avoidant, Schizoid, Anxiety, and Dysthymia scales are typically associated with untreated former cultists. Defensive and guarded answers about the group may indicate that the patient is still processing or denying a well-documented history of abuse within the cult.
Once issues in the first stage of post-cult recovery are resolved, patients will begin to make comments along the following lines: “I miss my friends in the group.” AI feel like a fool.” “I want to get my things back from the cult.” “I don’t know what to believe anymore about God, groups, religion, or friends.” “There are issues I never dealt with before joining.” “I want to learn all I can about cults.” “Will they try to come after me?” “I have lost all this time.” Patients who express such thoughts are in the second stage of recovery. While the first stage corresponds to a focus on the past, comments made during the second stage of recovery reflect an ability to focus on the present, and to view the cult involvement as a past experience. At this point, the dissociative symptoms of floating are usually no longer evident. Likewise, the stunned and frozen affect of the post-traumatic first phase is often much diminished, although in some ex-members, contemplative dissociative states may linger and persist throughout the second and even the third stages of recovery.
Treatment issues at the second stage correspond more to those of traditional therapy. Permission to grieve is of utmost importance. Anger and rage at this stage can be intense. Agonized verbalizations such as “I feel as though I have been murdered” are not uncommon. In addition to grief work, patients are now able to examine how they were recruited. Because cults manipulate each person’s strengths and weakness, it is important for the patient to realize fully how he was lured into involvement with the cult. At this stage, it is important for the ex-cultist to regain his ability to validate the pre-cult self and to learn in more detail how this self was suppressed and displaced by the pseudo-identity. Work on emotional expression and self-awareness of feeling states is essential because psychic numbing can still persist at this stage of treatment. Special exercises are necessary for patients who cannot yet normally experience emotions, or who are too guilt ridden to express rage or anger.
Stage three is more future oriented and optimistic than stage two. At this phase of treatment, patients ask questions pertinent to what they will do in the future regarding jobs, going back to school, finding careers, where they will live, whom they will date, and how they will rejoin their families. Treatment at this time is best oriented to career and guidance counseling. Family therapy, time and skills management training, and job and interview skills training may well be pursued at this juncture. Certain cult victims may require legal advice if criminal or civil charges against the cult are contemplated or pending.
Each stage of recovery can be marked not only by progressive insight but also by appropriate emotions. It is important for the clinician repeatedly to return to the source of emotional distress. For example, the early depression that a former member might feel for having Afailed God,” which accounts for why he is no longer in the group, is very different from the depression of a member who finally comes to the full realization that his trust fund was stolen by the cult leader or that his spouse became the cult leader’s concubine. It is important for the clinician to analyze the nature of the conflicts and issues facing the patient, in addition to evaluating the patient’s psychopathology, as treatment proceeds.
Natural strengths and assets can be discerned in the recovering cultist, and the clinician will be gratified to notice the accelerating momentum of improvement as he fosters the former cult member’s progress from the early to the more advanced stages of recovery. In every way the clinician should strive to facilitate the recovery process and to help provide the appropriate resources, support, and tools needed by the patient along the path of recovery. Ultimately, if all goes well, the clinician who has facilitated the patient’s recovery will be deeply gratified as the symptoms of the pseudo-identity syndrome progressively vanish, and the pre-cult self is restored, repaired, and returned to a more normal life.
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Louis Jolyon West, M.D., is Professor of Psychiatry at the Neuropsychiatric Institute, University of California, Los Angeles. He has written widely on cults, dissociation, hallucinations, alcoholism, and other subjects. For many years he directed UCLA’s Neuropsychiatric Institute.
Paul Martin, Ph.D., is Director of Wellspring Retreat and Resource Center, a JCAHO-accredited residential treatment facility for former cult members in Albany, Ohio. He is the author of Cult-Proofing Your Kids (Zondervan, 1993) and many articles on the cult phenomenon.