This article is an electronic version of an article originally published in Cultic Studies Journal, 1992, Volume 9, Number 1, pages 78-88. Please keep in mind that the pagination of this electronic reprint differs from that of the bound volume. This fact could affect how you enter bibliographic information in papers that you may write.
Psychiatric Problems in Ex-Members of Word of Life
Gudrun Swartling, O.T.
Academic Hospital, Uppsala, Sweden
Per G. Swartling, M.D.
Tierps Hospital, Tierp, Sweden
Severe and often long-term psychiatric problems have been recognized in former students of the Word of Life Bible School. Almost half of the 43 individuals interviewed had experienced psychosis-like symptoms, and one out of four had attempted suicide. Anxiety, feelings of guilt, and emotional disorders were common. Knowledge of the Bible movement is essential in order to understand the crises of these patients.
People who leave faith movements -- represented in Sweden by Word of Life headquartered in Uppsala -- may display serious and long-term psychiatric problems that necessitate contact with a physician. Swedish psychiatric textbooks do not touch upon the subject, but there is a short description of cult victims in a textbook on general medicine (Tibblin & Haglund, 1989).
In the United States, Louis West, Professor of Psychiatry, UCLA, and Margaret Singer, Professor of Psychology, UC-Berkeley, have coauthored a chapter on cults (West & Singer, 1980). In this extensive account of various cults and their common characteristics, the authors describe a particular indoctrination syndrome. Among other things, this indoctrination includes change of personality, emotional desensitizing, and physical changes in posture and appearance which may be recognized as a mask-like happy facial expression with a sometimes absent evasive or staring look.
Those who leave a cult are often hit by a strong feeling of loneliness and depression, existential emptiness, and difficulty in making decisions. Sometimes there are psychopathological traits such as compulsive thinking, delusions, and hallucinations. Singer (1987) stresses that extensive knowledge of the operation of these movements is essential in the treatment of former cultists.
On the one hand, Word of Life resembles other Christian churches in several respects. On the other hand, however, there are great similarities with cults such as the Unification Church of the Rev. Sun Myung Moon ("The Moonies"), Hare Krishna, and the Church of Scientology, particularly in their methods of controlling the members. This becomes evident when ex-members from the various cults compare their experiences.
A common characteristic of cults is the intense mind control that members are subjected to, which is introduced slowly and gradually increased. There are four characteristics of mind control, as described by Hassan (1988):
1) Strict Rules of Living. Often this includes a particular style of dress; prohibition or strong dissuasion of films, books, or music not approved by the cult; and a weakening or breaking of former relationships with friends or family.
2) Thought Control. This occurs in the form of thought-preventive rituals with monotonous repetitive mantras, speaking in tongues (which can be done silently also), and time-consuming services with singing of praise. These activities reduce the time for private reflection but do not lead to thought control per se. Actual thought control only occurs when these activities are used mechanically with the intention of suppressing doubt and critical thinking. Critical thoughts against the group are regarded by the leadership as originating from Satan and therefore must be prevented.
3) Emotional Control. This is carried out with, among other things, fear of the Devil as a constant threat; fear of leaving the cult and thereby going against God; and feelings of guilt because of negative or critical thoughts regarding the movement.
4) Information Control. It is inappropriate to read daily newspapers, listen to the radio, or watch television. Members are expected to gather information only through sources produced by the cult, such as books, tapes, and so forth. Members are discouraged and at times forbidden to meet with people who are critical of the movement.
Particular Characteristics of Word of Life
In order to understand the group of patients described here, it is essential to know some of the characteristics of Word of Life doctrines. This examination also reveals the four traits of mind control mentioned above.
There are constant reminders in the teaching that God himself is the source of everything that is said or done in the movement. Therefore, anybody criticizing Word of Life, or its leadership, goes against God. Examples are given showing that bad things can happen to anyone who criticizes the movement and to members who leave it: they may suffer illness, misfortune, sudden death, or have deformed children. Anyone who takes the teaching seriously is caught in a self-perpetuating grip that can be very difficult to get out of. The fear of speaking negatively of Word of Life may remain for a long time after the person has left the movement.
The responsibility to keep away the Devil and evil spirits or demons rests solely on the believer, according to Word of Life. This task is carried out regularly by speaking harshly directly to the demons. There are demons of illness, criticism, and sexual lust, for example. If the believer fails to avert the demons' attacks, the individual readily assumes the blame and may despair of any help. The distraught member may think that there is no stopping the Devil and this results in anxiety.
Another doctrine states that you get what you say, which means that the words you speak have the power to change reality. If you say that you are ill or don't feel well, you will, according to the doctrine, feel even worse. This makes it difficult to seek help in the case of depression with suicidal thoughts, for example, because if you speak about your thoughts they may come true.
In order to gain health, as promised in the teaching, you are to act as if you already attained it. If you are depressed, you are to look happy and healthy. Some people become so trained in showing an unaffected face and denying depressive thoughts that it can be difficult to assess their actual state of mind during a brief doctor's appointment.
Interview Study with 43 Bible School Students
Since 1986, Gudrun Swartling has had personal and, in many cases, extensive contact with about one hundred former followers of the faith movement all over Sweden. Seventy attended Bible school for a period of one to two years. The Bible school belonged to the faith movement, primarily Word of Life, with teachers from the cult. Interviews by telephone or personal visit took place with 43 of the 70 individuals. Six declined to participate or had returned to the movement; 21 former Bible school students had not been reached or were not psychologically fit for an interview.
The data in this report result from the interviews with the 43 former Bible school students. Gender distribution is even, but the younger age group dominates, with 80% under 25 years of age. The interview group is homogeneous in that all had received the same kind of systematic Bible school instruction.
The interview was semi-structured, that is, the same questions were used for everyone; yet there was room for expansion and deeper penetration. The result is a combination of answers and personal observations. (Gudrun Swartling has worked with psychotic patients for many years, which has been the source of her training and experience in assessing psychiatric symptoms.)
Social Contacts Broken
Deterioration of contact with families and friends after joining the movement was reported by 85% of those interviewed. Also, to a large extent, many had ceased keeping themselves informed through radio, television, or daily newspapers and had given up their former interests. Often their financial status had deteriorated, sometimes drastically, because of the generous offering expected in Word of Life's collection, in addition to the tithing.
Those interviewed were asked about symptoms they had experienced after contact with the movement that had not posed a problem previously. The new symptoms are reported in Table 1.
New psychiatric symptoms in former Bible school students (N=43)
Anxiety, especially panic attacks
Fear of losing one's
Feeling of emptiness
Feeling of loss of
Feelings of guilt
In 60% of the cases, others, for instance, parents, noticed a change in appearance after the individual had joined the movement. Body posture became tense, with a frozen facial expression and eyes that were staring or had an absent or evasive look. In 35% of the cases a regression was observed.
Symptoms of schizoaffective-like psychosis were seen in 47%. These are loss of a sense of reality, pathological assumption of guilt (in addition to the almost obligatory feeling of guilt of wrongdoing), and auditory and visual hallucinations.
Psychosomatic problems were common during the time in Bible school and during the period immediately afterward. Stomach pain, heart palpitations, headache, and dizziness, which had not been a problem previously, were reported by 63% of those interviewed. Some sought medical help for their symptoms.
The extent of psychiatric care is reported in Tables 2 and 3. Prior to Bible school, seven students (16%) had been in contact with a psychiatrist; in four of the cases this contact was brief due to an acute crisis, with one having been committed for three days.
Subsequent to leaving the movement, 27 former students (63%) sought psychiatric help because of problems they attributed to their contact with Word of Life; six of them had been in need of psychiatric help prior to their involvement. In nine cases the symptoms were moderate and required only sick leave and some medication. Eleven former students received inpatient psychiatric care; six of those were, according to Swedish law, committed to involuntary psychiatric care.
Medication, usually benzodiazepines and antidepressants, was prescribed to 28 of the interview group. Neuroleptics were used in 10 cases, without noticeable effect, according to the opinion of the interviewed. Maprotilin, prescribed for panic attacks, was reported by the patients to have had a good effect as a rule.
Psychiatric care among former Bible school students
(N = 43)
Before Bible school After Bible school
Contact with a psychia-trist
Care in psychiatric clinic or mental hospital
Length of stay in a psychiatric clinic by former Bible school students. (A total of 11 out of 43 interviewed, or 26%, received psychiatric care.)
Length of stay
Less than 1 week
1 - 4 weeks
1 - 3 months
More than 3 months
Sick leave attributed to involvement with the movement was reported in 56% of the cases (see Table 4). In two thirds of the cases, the sick leave extended beyond two months; in five cases, it was more than a year; and for four patients, it lasted several years.
Sick leave due to cult problems in former Bible school students. (A total of 24 out of 43 interviewed, or 56%, required sick leave.)
Length of sick leave
Less than 2 months
2 - 6 months
6 - 12 months
More than 12 months
Many in the interview group who had left Word of Life have demonstrated severe and sometimes long-term psychiatric disorders. Similar problems have been recognized in ex-members of other cults, such as the Unification Church, Hare Krishna, and the Church of Scientology. Our study does not illustrate how common psychiatric disorders are in the group of Bible school students as a whole. Interviews with active members of Word of Life would not be enlightening since, according to the teaching, they are not to admit that they suffer from depression or any other symptoms of illness. On the contrary, in the movement, disorders, such as anxiety or lack of a will to live, are explained or described as attacks by the Devil or the influence of demons. However, during a service a considerable number of participants have, by show of hands, admitted to affliction with the symptoms attributed to these demons (Carlsson, J., 1988). According to doctrine, psychiatric disorders are not to be viewed as warning signals but rather as a sign that one is working for God and therefore is subject to attacks.
It is important to ask whether the commonly occurring thoughts of suicide in former Bible school students lead to an increased risk of suicide. It is not possible to address that issue in this report. However, we found in our data that one out of four had made a serious suicide attempt. We know of 16 suicide cases in Sweden where family and friends regard the deceased person's contact with the movement as the determining factor in the suicide. This conclusion is supported by previous conversations or letters left behind.
It is difficult for physicians without any experience with cults to assess patients with psychiatric problems that possibly are related to involvement with Word of Life. The strong influence of the doctrine and the leadership on the members can result in very severe disorders, sometimes with symptoms similar to schizophrenia, sometimes long-term psychological deficiencies. There is a risk that these individuals will require extended sick leave (15 out of 43 had a sick leave of more than two months). They need help early on to tackle their problems.
Knowledge of the movement and its teaching is essential in order to understand these patients' crises. Because of their own experience, former members in particular have the necessary insights to disclose the dogma and the rules that bind a person to the group and cause doubt regarding one's own judgment. According to those interviewed, contact with ex-members is invaluable and is often regarded as essential for the return to normal life. Obviously, medical interventions are needed also, such as hospital supervision during a crisis with the risk of suicide.
The Risk of Relapse
It is common that individuals who have recently left the movement swing between attempts to free themselves and the temptation to return to the group. This "floating" phenomenon is comparable to a detoxified addict's craving for narcotics in certain situations, such as the sight of needles, with the risk of relapse. In the same way, an ex-member runs the risk of returning to the movement if he meets old cult friends or participates in a service. It is not uncommon that members of the movement seek out individuals who are on the way out of the group and, through loving treatment ("love bombing"), try to entice these members to return to the fold.
There may be risk of relapse for a long time after the association ends. The more wholehearted the engagement in the movement's message and in the leader, the more difficult it seems to be for a person to leave the group. Often this results in an identity crisis. Vulnerability is great when former social ties are severed. The time immediately after breaking with the group carries the risk of social isolation. In addition, there is the anxiety that maybe Word of Life is right after all and the world outside is wrong. The temptation to return to the familiar world of the movement is great during these moments.
Often it is difficult for the former member to resume studies that were interrupted several years previous to involvement with the group. One's self-esteem has been damaged; one feels deceived and manipulated. It may take years before ex-members can feel that they have overcome the influence of the movement.
There have been speculations whether certain personality traits lead individuals to be drawn to cults. According to Margaret Singer (1987), just about anybody can join a cult. However, often it happens during a time of vulnerability in the person's life.
We regard the long-term prognosis of ex-members of the cult discussed here as good. Most have been able to resume their studies, employment, and normal social relations with parents, siblings, and others. Also we have been able to notice that their self-confidence has returned gradually and that regression and cultic behavior have disappeared. In some cases the rehabilitation has been very difficult and is still incomplete after several years.
Carlsson, J. (1988). Elias ande och kraft kontra Isebels ande (The spirit and power of Elijah against the spirit of Jezebel) (Cassette recording, LF 501). Uppsala: Word of Life.
Hassan, S. (1988). Combatting cult mind control. Rochester, NY: Park Street Press.
Singer, M. (1987). Group psychodynamics. In R. Barkow (Ed.), The Merck manual of diagnosis and therapy (Chapter 136, pp. 1467-1471). Rahway, NJ: Merck & Co.
Tibblin, G., & Haglund, G. (Eds.). (1989). Allmanmedicin. Stockholm: Almqvist & Wiksell.
West, L., & Singer, M. (1980). Cults, quacks, and non-professional psychotherapies. In H. Kaplan, A. Freedman, & B. Sadock (Eds.), Comprehensive textbook of psychiatry, III (pp. 3245-3258). Baltimore: Williams & Wilkins.
This article was originally published in Lakartidningen, No. 24, pp. 2211-2214, 1991, a journal published by the Swedish Medical Association. The article was translated into English by Gunilla Stenman Gado. It is reprinted with permission.
Gudrun Swartling, an Occupational Therapist, is head of a day center for psychiatric patients at Academic Hospital in Uppsala, Sweden.
Per G. Swartling, M.D., is head of a group practice of district doctors at Tierps Hospital in Tierp, Sweden.