Cultic Studies Review, 9(1), 2010, 53-77
This article introduces diverse theoretical and clinical reflections on folie à deux as a model for understanding cult relations. It draws on concepts from psychoanalysis such as transference/countertransference, projective identification, the psychotic/nonpsychotic parts of the personality, and benign/malignant regression. As an example, the author will present the case of a music group that adopted a style of relationship among its members that resembled what we have been able to observe both in cult dynamics and in situations of folie à deux. This is followed by a presentation of a multifamily approach taken to help the families enable their loved ones to exit the group. It is hoped that this formulation will further our understanding of the psychic processes that draw individuals into cult groups and of how certain groups tend to develop cultic characteristics.
I originally presented the history of the group described in this paper at a conference on intersubjectivity and bonds held in Barcelona three years ago with the psychoanalyst Janine Puget. At that conference I presented the material without any theoretical reflection, merely as an account of the facts as they unfolded. Although therapy took place in a clinic specializing in cultic relations, I deliberately omitted any reference to the cult aspect during the presentation. Significantly, during the course of discussion, the psychoanalysts and psychotherapists who participated in the seminar began to speak spontaneously of the group as “cult-like.” Some noted in particular how the psychotic breakdown of the leader reverberates through the group and shapes and illuminates its dynamics. The suppression of subjectivity and resulting diminution of symbolization and creativity among the group of musicians emerged as the central feature that led to the ‘cult’ characterization.
Several factors led to my thinking of cultic dynamics as a form of folie. First, relating to cultic studies of thought reform, is the common observation of loss of identity under significant group pressure (Lifton, 1989; Singer & Ofshe, 1990). Second is my clinical experience with a variety of cultic situations, including exit counseling with current members and psychotherapy with former members who often presented with substantial impairment in their relationships.
However, a third element also seemed significant in both situations: malignant regression. The levels of regression that may occur in groups are variable, and depend on numerous factors (social conditions, group history, degree of intimacy between members and leader, degree of pathology of the leader, level of isolation of members, etc.). As Volkan notes, “group regression becomes malignant when the members begin to tolerate extreme levels of sadism and masochism in defence of the group identity” (Volkan, 2007: 150). Sadism turns aggression outward, in an attempt to destroy alterity, the other, who is viewed as different and therefore dangerous; masochism in contrast turns aggression inward in a desperate attempt to maintain the identity of the group. We can observe regressive phenomena of both types in extreme form in religious fundamentalism, but also in other social phenomena.
Without reaching these extremes, we can still observe regression in the practices implemented by cults, which give rise to diverse degrees of alteration in the relationships among their members. The notion of malignant regression comes from Michael Balint’s work. In Thrills and Regressions (1959), Balint distinguished two types of regression that can appear during psychoanalytic treatment. The benign form is minor, temporary, and reversible, while the malignant form is major, lasting or even irreversible. The former brings with it beneficial, therapeutic effects; the latter is pathogenic and can potentially result in insurmountable problems for the patient and the analysis. Balint noted that “regression is not only an intrapsychic phenomenon, but also an interpersonal one” (Balint, 1979: 147).
Referring to the main characteristics of the malignant form of regression, Balint notes that
most cases ... show the following picture: (1) since the mutually trusting relationship is highly precariously balanced ... the unsuspecting atmosphere breaks down repeatedly, and frequently symptoms of desperate clinging develop as safeguards and reassurance against another possible breakdown; (2) a malignant form of regression, several unsuccessful attempts at reaching a new beginning, a constant threat of an unending spiral of demands or needs, and of development of addiction-like states; (3) the regression is aimed at gratification by external action; (4) suspiciously high intensity of demands, expectations, or ‘needs’; (5) presence of signs of severe hysteria in the clinical picture, and of genital-orgiastic elements both in the normal and in the regressed form of transference. (Balint, 1979: 146)
In group terms, the unconscious bond between leader and followers tends to be malignantly regressive, and also bidirectional, so that the group process unleashes regression in the leader as well as the members. In the clinical material to be presented, such a folie (and pathological regression) process occurred. Strong ties were established between the leader (a music teacher) and the followers (his music students). At a few key moments the followers were dazzled by the Teacher, which led to intense attachment followed by mutual regression. As the group members became increasingly reliant on the leader, they took on his paranoid anxiety and the group became more cult-like.
According to Volkan’s psychoanalytical contributions to large-group regression (2007: 151), numerous signs indicate when group regression has become malignant. I see these signs as extremely relevant when we are evaluating the degree of risk posed by a cult. The criteria Volkan defined are
As I will try to show in this paper, the separation anxieties of the members themselves—many of them involved in desperate attempts to free themselves from their families—together with an intense identification with the Teacher led to a style of relating characterized by intense idealization and malignant regression, which progressively led to isolation and a state of withdrawal similar to that which we can observe in cults and clinical situations of folie.
Because comparison of cults with folie is fundamental to this paper, I will present a brief summary of the history and usage of the concept. Folie à deux and related ideas have been described since 1857 in different cultures and clinical settings with diverse terms (Table 1). Lasègue & Falret (1964) defined the folie as a “transmission of delusional ideas from a psychotic to closely associated individuals, who have experienced his/her domineering influence for a prolonged space of time. The condition may be transferred to three and/or more individuals.”
The parallel between cult dynamics and folie can be traced to Ireland (1855), who notes that
...the history of religious imposture shows how powerful may be the influence of the insane upon the sane … we might trace [how] the characteristics of some of the founders of the wild sects … infected some educated people and many of the vulgar with his claims.
Significantly for cultic studies, Sacks (1988) noted that “this sequestration [folie] …may contribute to the vulnerability of the secondary because of an increased dependency on the primary. Additionally, a process similar to brainwashing may occur” (Sacks, 1988: 273).
In 1942, Gralnick published what has come to be the definitive paper on this subject, with a complete review of the literature and the 103 cases reported up to that date. He divided folie into four categories and noted the importance of four hypothesized etiological elements in the underlying traits of participants: the interdependence between individuals, the identification processes, the dominance/submissive relationship, and some similarities to a prepsychotic personality.
The four subgroups Gralnick defined were
Dewhurst and Todd (1956) stated three criteria for the folie à deux diagnosis: 1) the partners should have a very close association; 2) the content of delusions should be identical or very similar; and 3) the partners should accept, share, and support each other’s delusions. The folie à deux has been categorized in DSM-III and DSM-III-R as a “shared paranoid disorder”; in DSM-IV the title was changed to “shared psychotic disorder.” Although the DSM emphasizes the paranoid nature of delusions (which will be prominent in this case), other clinicians ha e suggested the significance of religious and hypochondriacal delusions (Sanjurjo-Hartman, Weitzner, & Santana, 2001) or severe individual obsessive-compulsive pathology that emerge as a shared process (Yaryura-Tobias, Toro-Martinez, & Spinetto, 2001; Grover & Gupta, 2006).
For cultic studies, it is striking to note that suicide pacts and criminal acts have been described as occurring frequently in shared psychotic disorder. The factors that predispose persons to suicide pacts strongly parallel those factors that predispose them to folie (Tishler & Meltzer, 2004; Noyes, Frye & Hartford, 1977). As a result of group regression, isolation and persecutory delusions can lead to group suicide pacts whose nature may be contagious, religious, or based on personal loyalty (Brennan, 1989). This idea did develop in the group presented here, as will be noted in the clinical material.
Mentjox, van Houten, and Koolman (1993) conducted the second important review of the literature. Reviewing the studies published between 1974 and 1991, they found 76 descriptions compatible with a shared psychotic disorder. According to these authors, 59 of the cases were folie à deux, in another 17 cases, the delirious conviction was shared by more than two people; and the last 4 cases demonstrated a complete family contagion. Waeltzer (1963) recorded a psychotic family folie à douze. Dewhurst and Todd (1956) have suggested the term folie collective as being appropriate in a number of such cases. Evans and Merskey (1972) have coined the term folie partagée (shared folie), suggesting that each participant of a folie contributes to the folie although not necessarily with the same degree of conviction. Lloyd (1973) applied these ideas to the analysis of a religious group (eight to fifteen people) with a leader who claimed to have the power to heal illness through the use of prayer; further, he suggests that folie partagée may also be applied to cases not religious in nature.
From a psychoanalytic perspective, various authors have raised ideas that deserve some attention. For example, Helene Deutsch wrote on the subject of folie that
...processes such as we have seen here in individuals can also affect large groups of men, entire nations, and generations. We must, however, distinguish here as with individuals between hysterical, libidinally determined mass influences, and schizophrenic ideas held in common; likewise between mass liberation of instincts under the guise of ideals, and paranoid projections ... many things have their place in these folies en masse and the approval or disapproval of the surrounding world is often the sole criterion as to whether a particular action is deemed a heroic deed or an act of madness. (Deutsch, 1938: 318)
Deutsch, in one of the earliest papers on the subject, interpreted the folie delusion as an attempt to rescue the object:
Freud considers the delusional ideas of the psychically ill person a ‘rebuilding of the vanished object world’. I believe that induction plays an important role in this process. In folie à deux in psychotics, the common delusion appears to be an important part of an attempt to rescue the object through identification with it, or its delusional system. (Deutsch, 1938: 317)
Fliess (1953) showed the mutuality of the identification in folie. In this case, we should no longer talk of an inducer who pushes the other to accept delusions as truth, but rather of a complex interplay of identifications. Other psychoanalysts emphasized the belief that this identification is repetitive of an earlier one, and they emphasized the intense attachment of the secondary partner, who seeks to preserve the relationship because of the threat of the loss. From this perspective, delusions function as psychotic defence against separation anxieties. In folie, the mutual acceptance of bizarre contents enables the inducer to stay in contact with at least one other person despite loss of contact with reality. Reciprocally, the more dependent recipient is willing to accept delusions at the price of preserving the connection. The relationship established is then one of ambivalence, but the connection protects the recipient from his internal conflicts. The recipient uses psychotic defences and shares the delusion to maintain the link.
Additionally, the earliest mother-child bond, itself characterized by projective identification, offers a template for understanding later folie-type relationships. psychoanalyst Melanie Klein introduced the term “projective identification,” which refers to an unconscious psychic mechanism revealed in fantasies in which the subject inserts his self, or part of it, into the object in order to control, possess, or harm it (Laplanche & Pontalis, 1973: 356). Post-Kleinian theorists observed that projective identification is a form of unconscious communication whereby one gets to know something about the other’s experience by experiencing one’s own feelings in response; in a broader sense, it is often thought of as a form of empathy. In my clinical experience, both in cult dynamics and the folie à deux, projective identification tends to be intrusive and violent, penetrating the inner world of the member and transforming him/her into a thing, annulling differences, and altering the subjectivity of the members, who are then left at the mercy of an all-embracing and depersonalizing discourse.
Some writers on the cult phenomenon have seen parallels between hypnotic processes and cultic relationships. Mason (1994) noted that many psychoanalytic observers support the idea that hypnosis is a form of folie caused by mutual projective identification between two people, and that in a less dramatic form this condition commonly occurs in normal development. In Grotstein’s (1994) terms, “it is one of the basic characteristics of the primitive employment of projective identification to assign (projectively and identificatorily) self-sameness to the otherness of the object in order to erase its separateness” (Grotstein, 1994: 739).
Eight years ago, I was approached by four different families who came to me after one of them met a young man on the street who described some extreme experiences he and others had in connection with their music Teacher. (Editor’s note: It is Perlado’s clinical work with this young man that Wehle discusses in the next article in this issue, where he is identified as Alex.) The families reported their sons and daughters had started private music lessons and shortly thereafter they had gone to live in a house together with the Teacher. The young man they chanced to meet confirmed that the music Teacher had formed a “cult”, and he was afraid of “what could happen inside…they have all gone mad.”
One of the significant elements in this case is that the individuals had met this former member in the street by chance, and it would be a chance meeting with the rest of the current members that would help them exit their loved ones. Another significant element of this case was that one of the families that asked for help was that of the music Teacher.
At the outset, I conducted my work with the family members on an open-ended basis, which was the manner they themselves felt most comfortable with. After meeting with the various family members, I decided to adopt a multifamily strategy in which all family members met together in a group setting. This multifamily working approach allowed us to address the participants’ anxieties and to better strategize an encounter with the Teacher’s followers.
Two former members who had been involved with the group years ago also joined us after several multifamily interviews. As the relatives heard from those who had previously been close to the Teacher, their anxiety increased. They learned that the project began as a group that would experiment with novel rhythms and other innovations, and that initially they had many successful public performances. After this honeymoon period, the group started to close in around them, cutting their ties with other musicians and family members and leaving them isolated.
After a number of multifamily interviews, it became clear that the sons and daughters had changed some important aspects of their lives. The symptoms that both family members and those who had managed to leave the group cited were consistent with those we observe among cult members. They had disconnected from previous friendships; their professional performance decreased (they played less music); the language they used was very restricted, largely consisting of repeating the Teacher’s expressions to the point of cliché (loaded language); they showed limitations in their autonomous thinking (mental blocks, lacunae); and they became distrustful, exhibiting paranoid feelings of being spied on by other musicians. Also, all the relatives agreed that their children had shifted from an interest in learning from other musicians to being attached to the man they were now required to call 'Teacher.' In addition, he renamed his followers with biblical names. Some reported their children became annoyed or aggressive when questioned about the Teacher or the Project.
Through family interviews, I learned these facts regarding the five people who were members at the time of this intervention: 1) A significant number of them had used drugs during adolescence; 2) they shared a great passion for music despite family opposition; 3) they had either a dominant or an absent father figure; and 4) most had a family history of past involvement in dogmatic religious movements.
On learning of how the group had closed in upon itself and of the malignant regression of the followers in response to the leader, I experienced counter-transferential feelings of confinement and claustrophobia. It was difficult to think clearly, to organize my impressions, to deal with the impact of all the family members. Gradually, I shifted from bewilderment, excitement, anguish, and confusion to the slow emergence of anger that motivated my desire to do something to help unblock the situation.
My exit counseling strategy in this case used ideas from network therapy. Exit counseling, according to Langone and Martin (1993), is “a voluntary, intensive, time-limited, contractual educational process that emphasizes the respectful sharing of information with cultists.” Network therapy (Sirkin & Rueveni, 1992), like exit counseling, is based on involving family members and friends in a process designed to build bridges of dialogue with the affected person.
Network therapy involves joint work with a specialist who helps family members and friends coordinate their attempts to get closer to the affected person, so they can arrange an intense meeting with the person, with the goal of accessing areas of doubt in that person. The goal here is to counter the malignant effect of certain group dynamics via the concerted efforts of another group that seeks to generate critical thinking.
In addition to multifamily interviews, I conducted interviews with each family. We developed a family network strategy and created a virtual communication system to allow the families to talk with each other and share ideas and details of their approaches to their children. Having the Teacher’s family involved gave us the advantage of knowing some of his movements.
As noted, members of the leader’s family were part of the multifamily group. Because of this, we learned considerable background information about the teacher. Naturally, in the interest of confidentiality, I will present only some of this information.
Regarding this family, the Teacher’s paternal grandfather had been a member of a closed religious community, which suggests to me that it might have been cultic. The Teacher’s father was a dominant person, and the teacher himself attended a religious seminar in his adolescence. The mother was a fragile woman who felt victimized by her husband. Mother and son became close when the parents broke up. She got her son a musical instrument to deal with the depressive environment at home, and showed him off in a narcissistic manner, publicly displaying her pride. He began playing music with various groups at the age of 14 and was considered a virtuoso.
During his adolescence, he played with different musicians outside his country, returning at the age of 33 with a plan to form “a different kind of group,” which he intended to lead. Five years later, his partner had two pregnancies that did not come to term; the Teacher consoled himself each time by talking to stuffed animals he kept in his bedroom. After one year, his father died, leaving him feeling both sad and guilty. Following this series of traumas, he spent months locked alone in his apartment. One year later he emerged reporting he was “transformed,” and he spoke more actively about forming a new music group. He formed the new group from some of his private pupils.
He started to draw his students closer to him, talking about retiring to an isolated house so that he could experiment with “the total experience of the music.” These students, who were between 20 and 25 years old, felt privileged to live an experience of musical creation. Soon after getting established in the new house, which had belonged to the Teacher’s late father, he dug a big hole in the ground, searching without success for a treasure he was convinced his father had hidden underground. Increasingly, he introduced certain “novelties” to the group’s practice of music. Hand movements and meditation were combined to “improve the music’s quality,” all of it dense with new-age ideas (energies, the movement of the sea and the music, the connection with the cosmos, an internal music-man, hand-reading and music, etc.).
Feeling everyone misunderstood him musically and failed him emotionally, the Teacher’s speech became increasingly idiosyncratic. He talked about the “state of the verb,” saying his Method could lead to the state of “music-man” and the “verb’s grade,” that could then speak with a “mystical connection.” In addition, he became more imposing and threatening, saying, “you will become mediocre if you leave,” or “if you are not with me, you are against me.” In what can be seen as a projection, he explained that other musicians didn’t recognize him because “they envy me.” He displayed frequent mood changes and when depressed spent entire days in his room. Group members responded protectively, completely convinced that they would achieve the promised state of “musical evolution,” something close to a profound creative connection.
Gradually, the group stopped playing in public, locked themselves in the house, and refused concerts and shows “because they were not ready yet.” Inside the house, the use of instruments diminished while much time was dedicated to listening to the Teacher’s speeches about the Method and the necessity for them to follow him. He presented monologues up to fifteen hours long, with punishments for those who didn’t listen, including public derision, isolation, and spraying them with water from a high-pressure hose. He prevailed on them to break with their families, “since they are useless, and they will surely be opposed to us being here creating music.” Followers were required to ask permission to see their families, the Teacher set the duration for the visits, and another group member always accompanied them on the visits. Playing with nonmember musicians was forbidden because they had not been through the ‘transformation.’
The Teacher cut contact with outside reality, controlling use of television, the Internet, radios, and the telephone. As time went by, all the members shared the same paranoid delusion in relation to possible attacks from outside energies or entities. The teacher proposed excessive dieting and even fasting, saying “not pooping will help us be more creative.” He restricted sleep, keeping the others on watch against ‘the entities.’ He said major transformation was needed regarding sex, and therefore each group member regardless of gender had an obligation to sleep in his bed with him on an alternating basis. According to the Teacher, “you have to experiment to get rid of pickiness." Some who left noted his increasingly paranoid deterioration, culminating in the catastrophic belief the world would end soon and the development of a ‘system’ by which to escape.
Four months after my initial consultation with the families, communication among them and with some of their children in the group had progressed, and some members were opening up slightly. During a visit, one female member was able to tell her parents she wanted to leave; she could not handle the emotional pressure any more. They immediately got her in the car and brought her back home. This girl advised the families that something should be done immediately because travel arrangements were being made. In response to family calls and visits, tension in the house was rising and the Teacher was getting more suspicious, more controlling; he was planning to leave for other countries and take the remaining students with him. The girl indicated she was sure those who had stayed had some doubts but would not dare to leave the Teacher.
At that point, the families made up their minds to do an intervention and have me join them. We decided that the ideal scenario would be a “chance meeting” in the street between two former members and the four remaining current members. The families’ fear was that the “chance” would trigger suspicion and a willingness in the remaining members to join the teacher in flight (because of the paranoid tone of the group), rather than doubt and exit from the group. The families’ opinions were split on this one, but they decided to do an active intervention. They finally agreed to create the “chance” meeting in the street, taking advantage of their knowledge that the Teacher and his partner were attending an appointment.
The intervention went on for nine hours, with the collaboration of two former members and fifteen relatives. Finally, the members decided to leave the group, although the next day one of them sneaked back to talk to the Teacher and tell him what had happened. It was this member’s belief that everything had happened as the Teacher had predicted when he said “an attack from the outside would destroy the World.”
A few months later, neighbours of the Teacher’s relatives stated that they had seen him on the street talking to himself, saying, “the stones are blue.” Six months after that I learned that the Teacher and his partner had been seen, sickly looking, on a traffic island next to a homeless shelter. Maintaining minimum contact with the Teacher’s family, his partner made sure nobody got close to him. However, a psychiatric internment was never possible because either the Teacher at times seemed stable, or, in times of crisis, his family could not bring themselves to confine him.
This case was exceptionally interesting in several ways. First, a group that formed to create music with an emphasis on spontaneity paradoxically developed into a cult-like group that undermined and controlled the members’ creativity. Second, several family groupings requested help concurrently, fearfully, and without knowledge of each other’s intention. Third, the leader’s family was one of these groups, which enabled me to learn about his psychological development directly, through primary sources.
The fact that so many family members turned up at my office around the same time also determined a rhythm and approach that was different from what I am accustomed to. They organised themselves spontaneously after the first chance encounter of one ex-member with a family on the street. If they had come separately, the results would probably have been different. As I mentioned, having learned about the reality of this group, the families arrived with considerable anxiety and fear, in a state of benign regression. Work with the families was no easy task because they were intensely defensive about the panic that the situation created in them. Some rationalized the problem, saying it was a creative process that they would come through eventually, that many musicians are eccentrics. Others vehemently upheld the words and ideas of the Teacher while dissociating from the information about abuse and shared madness that came to light.
In this respect, the ideas of W. R. Bion (Grinberg & Tabak de Bianchedi, 1972) on the basic assumptions that operate within a group are also pertinent for a better comprehension of the case. “Basic assumptions” form one of the unconscious emotional foundations of the mentality of a group and its culture, and these are configured by extremely intense emotions of primitive origin. In this way these assumptions form certain group fantasies of an omnipotent nature. The group that functions according to a basic assumption—as was the case of the group we have described—stands in opposition to the working group. Bion describes three basic assumptions:
Initially, the basic assumption of the families that came to seek help in this situation was one of dependency—they were looking for a leader-therapist who could satisfy their needs as a group. They were convinced that I would resolve all the problems they had come to see me about. Sustained work was necessary to effect a change in these families, so they could shift from dependency to work as a group to help their kin. Working in a group requires from each person effort, tolerance of frustration, reduction of omnipotence, contact with reality, and emotional control—all necessary elements for task-oriented work.
We could equally view the initial formation of the music group around the Teacher as operating according to the basic assumption of dependency, “as a group of adepts of an idea or a person whose goodness is not questioned” (Grinberg, Sor, & De Blanchedi, 1991: 26). Gradually, now in a state of regression, the group began sliding toward the second basic assumption of fight/flight, from which there began to circulate a conviction of the existence of a common external enemy they had either to defend themselves against or flee from. It is during this drift from one assumption to another that the greatest risk of violent conduct might appear. At one point in the evolution of the group, when the Teacher was in a state of disarray because of the desertion of his members, he considered moving to a remote island with the few remaining members, where they could protect themselves against “imminent destruction.”
As Volkan notes (2007), in situations of malignant regression —and therefore of group folie—the risk of violent counter-action may increase if no account is taken of reactive responses. We can see this in the Waco case, for example, where ATF agents interpreted Koresh’s discourse as an aggression against them and consequently decided to attack the Mt. Carmel Center. Although we may also observe reactions of this type in a therapeutic context, they acquire greater proportion in public situations in which the paranoid decompensation of the leader leads him to interpret any external maneuver as an attack. Therefore, it was essential for me to attend to my own emotions and reactions in the situation with the music group.
Significantly, my counter-transferential responses (tension, claustrophobia, difficulty in thinking straight) echoed the atmosphere in which the members of the music group were living, as consciously and unconsciously transmitted to me by the family members. Having the courage to experience these difficult feelings emboldened this working group to develop an approach sufficiently intense to open a breach in the defensive bunker in which the members had barricaded themselves around the Teacher.
In terms of the regression we mentioned earlier, we could say that the family members were capable of entering into a process of benign regression, investing in me a minimum of trust. This made it possible for us to organize a working group that deployed a network intervention to gain access to the music group. The emotional reciprocity established over time between the family members and me enabled them to try to feel the intensity of their loved ones’ experience rather than to defend against the pain of loss. Despite the fear and skepticism with which they came to seek help, they managed to establish a sufficiently good relationship with me to avoid a new, malignant regression centered on me. I had to work with them to counter their idealization, which had to remain within realistic limits if we were to accomplish the task of helping. In contrast to the blind trust that the Teacher demanded of his pupils, my function in this multifamily context was to cultivate in the family members and friends a basic confidence in their own abilities. This shifted them from a dependent request for help to a more proactive stance with a basic confidence in their own abilities.
Psychoanalytic experience shows us how easy it is for a relationship to become malignant in the absence of adequate recognition and use of counter-transference. It also shows us this potential danger where the helping relationship serves the interest of the helper rather than the interests of the individuals and the group. Various studies have shown us the psychotic potential of groups and the risks of entering a situation of malignant regression and, therefore, of folie, if the individuality and differences of group members are not respected. Bion’s concept of the psychotic personality is equally pertinent; rather than a psychopathological diagnosis, the term suggests a mental state that coexists alongside another state, which Bion calls the non-psychotic personality. Among the central features of the psychotic personality are intolerance of frustration, the predominance of destructive impulses, the undermining of perceptive reality, and the ability to form bonds; the fundamental mechanism of the psychotic part of the personality is precisely pathological projective identification.
In general terms, this division between the psychotic and nonpsychotic parts of the personality coexists in everyone as a primordial mental partition. The nonpsychotic part of the personality is capable of tolerating ambivalence and frustration, and can progressively readjust itself to reality. The psychotic part of the personality denies anguish and frustration; such denial leads to the need to find solutions to eliminate any psychological discomfort. In the situation we have been examining, the psychotic part of the personality was exacerbated by the progressive isolation of the group members, in a frantic attempt to negate separation anxiety.
As for experiences shared on an unconscious level (difficulties in separating from the family of origin, fear of emotional loss), both the Teacher and his pupils entered a closed loop of mutual projective identifications that protected them against their own separation anxieties, although the ultimate outcome in group terms was intensified malignant regression.
I suggest that the manner in which both leader and member regress is in part via folie caused by mutual projective identification. Although this mechanism is found in normative functioning, it is used excessively within the delusional exchange, where identification serves as a defense against anxiety over potential separation between leader and member. In her response to my clinical presentation (included in this journal), Dana Wehle focuses on the association of the mechanism of projective identification with cultic functioning; she draws heavily on Grotstein, who suggests that, with the unconscious use of what he calls “total projective identification,” we see others as the same as ourselves in order to erase the experience of separateness. In this sense, we can understand the suppression of creativity in this music cult by combining Lifton’s and other criteria of thought reform with the unconscious processes defined within psychoanalytic thinking as folie, malignant regression, and total projective identification.
Given these unconscious processes, attention to transferential/countertransferential reactions is essential to prevent inappropriate action and increased folie on the part of the group, which submerges its members in a spiral from which it is difficult for them to escape. Folie à deux, based on mutual projective identification and intense malignant regression, leaves the member in a state of pathological dependency, which we have described elsewhere (Perlado, 2003). This excessive, unlimited dependency may be the reflection of a longing that is deeply embedded in all of us, with its roots in the early mother-baby relationship where the desire is to create an ambience or atmosphere of complete and undifferentiated fusion, or, in the words of Balint,
...the re-establishment of the harmonious interpenetrating mix-up, between the individual and the most important parts of his environment, his love objects, is the desire of all humanity. [...] In adult life there are a few more possibilities for achieving this ultimate aim, all of them requiring considerable skills and talents. These comprise religious ecstasy, the sublime moments of artistic creation, and lastly, though perhaps more for patients, certain regressive periods during analytic treatment. Although in all these states the individual is on his own, creating the impression of narcissistic withdrawal, all of them have in common the fundamental characteristic that for these very brief moments the individual may truly and really experience that every disharmony has been dispelled, he and his whole world are now united in undisturbed understanding, in completely harmonious interpenetrating mix-up. (Balint, 1979: 74–75)
In my work with these families, I explicitly attended to countertransferential responses as a means to harmonize with the feelings of the former members and parents, to approach the mix-up that fostered therapeutic understanding. With regard to the scope of creation, Balint observes that
...this latter [creative area] may entail as a first step a regressive withdrawal from objects found too harsh and frustrating, to the harmonious mix-up of earlier states, which is then followed by an attempt to create something better, kinder, more understandable, more beautiful, and above all, more consistent and more harmonious than the real objects proved to be. Unfortunately this attempt does not succeed each time; much too often the creation is no better—even worse—than the bitter reality. (Balint, 1969: 68)
Something of this nature happened in the music group we have described; from the initial creative activity in which the individuality and subjectivity of each participant was respected, the group ended up in a spiral of malignant regression and suppression of subjectivity—and therefore of the members’ capacity to be creative and live in freedom.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Washington, DC: American Psychiatric Association.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: American Psychiatric Association.
Balint, M. (1959). Thrills and Regressions. London: Hogarth Press.
Balint, M. (1979). The Basic Fault: Therapeutic Aspects of Regression. London/New York: Tavistock Publications.
Brennan, W. (1989). “Folie à deux and suicide pacts: Psychoses of association”. Psychiatric Forum, 15(1): 85–93.
Deutsch, H. (1938). “Folie à Deux.” Psychoanalytic Quarterly, 7:307-318.
Dewhurst, K., & Todd, J. (1956). “The Psychosis of Association. Folie à deux.” Journal of Nervous and Mental Disease, 124: 451–459.
Evans, P., & Merskey. H. (1972). “Shared Beliefs of Dermal Parasitosis. Folie partage.” British Journal of Medical Psychology, 45: 19–25.
Fliess, R. (1953) "Countertransference and Counteridentification.” Journal of American Psychoanalytic Association, 1: 268–284.
Freud, S. (1921). Group Psychology and The Analysis of the Ego. London: The International Psychoanalytic Library.
Gralnick, A. (1942). “Folie à deux: The Psychosis of Association. A Review of 103 Cases and the Entire English Literature with Case Presentations.” Psychiatric Quarterly, 16491–16520.
Grinberg, L.; Sor, D. & De Bianchedi, E. T. (1972). Introducción a las ideas de Bion. Buenos Aires: Nueva Visión.
Grinberg, L.; Sor, D.; & De Bianchedi, E. T. (1991). Nueva introducción a las ideas de Bion. Madrid: Tecnipublicaciones.
Grotstein, J. S. (1994). “Projective Identification Reappraised—Part I: Projective Identification, Introjective Identification, the Transference/countertransference Neurosis/psychosis, and their Consummate Expression in the Crucifixion, the Pieta, and "Therapeutic Exorcism." Contemporary Psychoanalysis, 30:708–746.
Grover, S., & Gupta, N. (2006). “Shared Obsessive-Compulsive Disorder.” Psychopathology, 39: 99–101.
Ireland, W. W. (1855). “Folie à deux, a Mad Family.” History of Psychiatry (1998), 9: 383–388.
Langone, M., & Martin, P. (1993). "Deprogramming, Exit Counseling, and Ethics: Clarifying the Confusion." Cult Observer, 10 (4).
Laplanche, J., & Pontalis, J. B. (1973). The Language of Psycho-Analysis. London: Karnac Books.
Lasègue, C., & Falret, J. (1964). “La folie à deux (ou folie communique).” American Journal of Psychiatry, 121: 1–23
Lifton, R. J. (1989). Thought Reform and the Psychology of Totalism. A Study of Brainwashing in China. North Carolina: University of NC Chapel Hill.
Lloyd, J. H. (1973). “Religion and Insanity, Folie partagée, Folie à trois.” Australian and New Zealand Journal of Psychiatry, 7: 193–199.
Mason, A. A. (1994). “A Psychoanalyst Looks at a Hypnotist: A Study of folie à deux.” Psychoanalytic Quarterly, 63(4): 641–679.
Mentjox, R.; van Houten, C. A. G.; & Kooiman, C. G. (1993). “Induced Psychotic Disorder: Clinical Aspects, Theoretical Considerations, and Some Guidelines for Treatment.” Comprehensive Psychiatry, 34: 120–126.
Noyes, R.; Frye, S.; & Hartford, C. (1977). “Conjugal Suicide Pact.” The Journal of Nervous and Mental Disease, 165(1): 72–75.
Perlado, M. (2003). "Clinical and Diagnostic Issues of Cultism: Group Dependence Disorder." Cultic Studies Review, 2 (2).
Sacks, M. H. (1988). “Folie à deux”. Comprehensive Psychiatry, 29 (3): 270–277.
Sanjurjo-Hartman, T.; Weitzner, M. A.; & Santana, C. (2001). “Cancer and folie à deux. Cancer Practice, 9(6): 290–294.
Singer, M. T., & Ofshe, R. (1990). “Thought Reform Programs and the Production of Psychiatric Casualties.” Psychiatric Annals, 20 (4)
Sirkin, M. I., & Rueveni, U. (1992). “The Role of Network Therapy in the Treatment of Relational Disorders: Cults and folie à deux.” Contemporary Family Therapy: An International Journal, 14(3): 211–224.
Tishler, C. L., & Meltzer, J. (2004). “Folie à deux in Children: An Emergency Room Presentation.” Clinical Case Studies, 3(1): 49–56.
Tobias, M. L., & Lalich, J. (1994). Captive Hearts, Captive Minds: Freedom and Recovery from Cults and Abusive Relationships. California: Hunter House.
Yaryura-Tobias, J. A.; Toro-Martinez, E.; & Spinetto, M. (2001). “Shared Obsessive-Compulsive Disorder: A Clinical Report.” Behavior Therapist, 24(6): 126, 133.
Volkan, V. (2007). “De Waco al Valle Bamian: Regresión y fundamentalismo religioso.” En M. Perlado (Coord.), Estudios clínicos sobre sectas. Barcelona: AIS.
Waeltzer, H. (1963). “A Psychotic Family. Folie à douze.” Journal of Nervous and Mental Disease, 137: 67–75.
Wehmeier, P. M.; Barth, N.; & Remschmidt, H. (2003). “Induced Delusional Disorder: A Review of the Concept and an Unusual Case of folie à famille.” Psychopathology: 36(1): 37–45.
West, L. J., & Langone, M. D. (1986). “Cultism: A Conference for Scholars and Policy Makers.” Cultic Studies Journal, 3: 117–134.
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders (10th ed.). Switzerland: World Health Organization.
Miguel Perlado is a psychologist, psychotherapist (associated member of the Spanish Federation of Psychotherapy Associations, FEAP/EAP), psychoanalyst (Barcelona Institute of Psychoanalysis, IPB/SEP), and member of the Board of Directors of iPsi Psychoanalytic Training Center. He worked for eleven years with Attention and Research on Social Addictions (AIS) in Barcelona, and now he is the Director of AIIAP (Iberoamerican Association for Research on Psychological Abuse). Dr. Perlado has specialized in cult-related problems, helping families, current members, and ex- members of cults. He has published a number of professional articles on the subject and has organized numerous seminars for mental health professionals in Spain. (email@example.com)
Cultic Studies Review, Vol. 9, No. 1, 2010, Page
 A briefer version of this material was previously presented in two different forums in 2008: first, at the seminar in iPsi, Formació Psicoanalítica with Janine Puget, Barcelona www.centreipsi.com; and second, at the Annual Conference of the International Cultic Studies Association (ICSA), Brussels (www.icsahome.com). I would like to thank Valentín Barenblit, Janine Puget, and Dana Wehle for their support and suggestions.
 According to West and Langone (1986), “cult” should be defined as a group or movement that exhibits excessive devotion or dedication to a person, idea, or thing and employs unethical manipulative 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 pressures, information management, suspension of individuality or critical judgment, promotion of total dependency on the group and fear of leaving it, etc.) designed to advance the goals of the group’s leaders to the actual or possible detriment of members, their families, or the community.
 According to Tobias and Lalich (1994), “cults may be large or small. What defines them is not their size but their behaviour. In addition to the larger, more publicised cults, there are small cults of less than a dozen members who follow a particular "guru"; "family cults," where the head of the family uses deceptive and excessive persuasion and control techniques; and probably the least acknowledged, the one-on-one cult […] the one-on-one cult is a deliberately manipulative and exploitative intimate relationship between two persons, often involving physical abuse of the subordinate partner. In the one-on-one cult, which we call a cultic relationship, there is a significant power imbalance between the two participants. The stronger uses his (or her) influence to control, manipulate, abuse, and exploit the other. In essence the cultic relationship is a one-on-one version of the larger group. It may even be more intense than participation in a group cult since all the attention and abuse is focused on one person, often with more damaging consequences.”
 As Laplanche and Pontalis (1973: 385) noted, “the idea of regression is evoked very often in psycho-analysis and modern psychology; it is generally conceived of as a reversion to earlier forms in the development of thought, of object-relationships or of the structure of behavior.”
 In the formative period of the group, the music teacher began simply as the tutor of his students, but ended up setting himself up as a Teacher, which in fact was how he asked to be addressed by his followers, who were made to feel different and special by virtue of sharing the “experience” with him. For this reason, from now on we’ll refer to him as the Teacher, with a capital “t”.
 According to Laplanche and Pontalis (1973: 273), “psycho-analysis considers the notion of object from three main points of view: (1) In correlation with the instinct: the object is the thing in respect of which and through which the instinct seeks to attain its aim (i.e., a certain type of satisfaction). It may be a person or a part-object, a real object, or a fantasized one. (2) In correlation with love (or hate): the relation in question here is that between the whole person, or the agency of the ego, and an object which is itself focused upon in its totality (person, entity, ideal, etc.). (3) In the sense traditional to the philosophy and psychology of knowledge, in correlation with the perceiving and knowing subject: an object is whatever presents itself with fixed and permanent qualities which are in principle recognisable by all subjects irrespective of individual wishes and opinions (the adjective corresponding to this sense of ‘object’ is ‘objective’).”
 In psychoanalysis, the use of the term “psychotic defence” does not necessarily imply that the subject is psychotic. It rather denotes defences, such as splitting, which arise at an early stage in emotional development and persist in neurotic behaviour, and which can be used for a variety of purposes including the avoidance of mental suffering and separation anxiety.
 In this sense, it’s interesting to note that Freud stated in relation to hypnosis and love, “the same humble subjection, the same compliance, the same absence of criticism, towards the hypnotist as towards the loved object. There is the same sapping of the subject’s own initiative; no one can doubt that the hypnotist has stepped into the place of the ego ideal” (Freud, 1921: 114).
 Sirkin and Rueveni (1992) designed a network intervention using a team of network specialists (approximately 70 persons over 4 hours), in a case of cult-involvement and folie à deux, specifically designed to help a family in which one member had become involved with an individual who claimed to be the Messiah.