Cultic Studies Journal, 1987, Volume 4, Number 1, pages 25-37
Psychoanalysis and Cult Affiliation: Clinical Perspectives
David A. Halperin, M. D.
Cult affiliation presents a continuing concern to society and the mental health professional. The recent debacle of Rajneeshpuram reemphasizes the potential for destructive behavior which cult groups present. Psychoanalysts and psychiatrists have been called upon to help cult members (past and present) and their families in a wide variety of contexts. This article describes the manner in which psychoanalytic insights provide guidance in working with the cult member and his family.
It is extremely difficult to define cults or to characterize a group as a cult with exactitude. Cults have been described as groups organized by the veneration of an authoritarian, often self-proclaimed leader who claims a uniquely exalted relationship to God or some other supranatural force, and/or unique powers based on this relationship. The leader's pretensions often extend to granting him a totalistic control over every aspect of the member's spiritual, social, and sexual life. While most of these groups are quasi-religious in nature, mass therapeutic groups, drug rehabilitation programs, therapeutic communities, and radical political groups have assumed a cult-Eke character.
The recent growth of cults is multi-determined. The loss by authority of a consensually accepted legitimacy in the aftermath of the Vietnam War and Watergate has led to a search for newer, more legitimate authorities. The growth of the drug culture during the sixties, with its pharmacologically-based access to transcendent experience, and the counterculture's fascination with the East have been implicated. On the individual level the blurring of roles and boundaries has led to a recrudescence of rigid orthodoxies. Moreover, ours is a society whose media have consistently undercut parental authority, which fuels unrealistic expectations of instant solutions to complex personal problems, and has encouraged the search for newer authorities (Halperin, 1983). In dynamic terms, the presence of severe borderline and/or narcissistic pathology, as well as an exaggerated pattern of familiar enmeshment, have been advanced as causal factors (Markowitz, 1983). It is still an active and unsettling question whether or not cult affiliation is a matter of individual psychopathology, familial dysfunction, deceptive recruiting practices, or simply the product of a spiritual quest followed by a genuine religious conversion.
In order to examine this complex of problems as it presents itself in clinical terms, it is most important to realize that cult members represent a very disparate group of individuals. The actual number of cult members who have a diagnosable mental illness is, itself, in dispute. Estimates vary widely. Moreover, the cult groups (numbering some 2,000 by a recent estimate) are exceedingly varied in their practices and even in the control they exert over their members' fives. And significantly, the member's position within the group modifies his experience during the period of active cult affiliation.
The role played by the psychoanalyst/psychiatrist, and the nature of the therapeutic interventions, change with the actual status of the cult member. This article will examine clinical issues as they are presented by (1) the individual considering affiliation with a cult group, (2) the individual who is actively associated with a cult group, and (3) the former cult member, this last with particular reference to issues arising during rehabilitation.
The primary responsibility of psychoanalysts and psychiatrists is to the individual. We have a profound obligation to protect individuals, to preserve their autonomy and sense of self, particularly when the patient is pursuing a course of action which is predictably self-destructive. These issues can arise while working with a patient in psychoanalytically oriented psychotherapy, as the case of Olive J. illustrates.
Olive J., a 62-year-old woman, devoted the last 15 years to the cue of her ailing father. She sacrificed many social opportunities ostensibly because of fear that if she were to leave her ill father he would hurt himself. Despite her fears, she did work outside the house. But her preoccupation with her father's health extended to attending meetings of a variety of parapsychological groups whose .research' focused on the possibility of survival after death. (Many individuals who join cults are distressed over the loss of loved ones and many cult groups are particularly focused on the spirit world.) After her father's death (at age 89), she became more and more depressed and increasingly questioned her past preoccupation with her father's welfare and her need to gain his approval. During her therapy, Olive began to explore her preoccupation with her father's illness and her ambivalence toward him. Her depression began to lift. Still, she continued to ruminate obsessively about survival after death and continued to attend parapsychologically oriented groups. Attempts to help her understand her ambivalence toward her father, and her attempt to maintain him active in “another plane of existence” were not fruitful. However, her attendance at psychic meetings did not interfere with other aspects of her life - a point which illustrates the essential difference between the eccentric and the cultic.
One day, Olive entered my office and started to speak in an exhilarated manner. She began to talk about a “new friend” who had suggested that she join a spiritually oriented group. The group's meetings consisted of people chanting in front of a scroll. Her initial response was that the monotonous repetition of a single phrase over and over again in front of a scroll was absurd. However, she found herself caught up in the process, and even wondered if, in some magical way, the process of chanting was “helpful.” She added that she planned to attend additional meetings, although she was unclear about the goals of the group or the implications of membership. At that point, Olive was informed by the therapist that her 'new friend' appeared to be a recruiter for an Eastern style cult-like group, and that his primary interest might well be recruitment rather than friendship.
Several aspects of Olive's situation deserve examination. She was an isolated individual, had just suffered a severe loss, and was in transition. Thus, she was vulnerable to the blandishments of a group offering social contacts. Indeed, it has been increasingly recognized that the elderly are receptive to recruitment initiatives because of their sense of isolation. Olive's response to being informed that the group was a cult was ambivalent. While she recognized that the group might be authoritarian and controlling, she was reluctant to give up her relationship with her “friend.” She preferred to see the recruiter as a supportive figure whose primary interest was friendship rather than recruitment. And Olive's response was not unique. Indeed, the object hunger of the potential cult member is so great that he or she will often deny that the cult recruiter has any secondary or covert agenda. Even when they are able to intellectually appreciate that the cult recruiter has a covert agenda, potential recruits still experience intense guilt after rejecting offers of "friendship." Olive, in fact, was extremely concerned that her friend would feel rejected when she did not pursue the "relationship."
During the course of her treatments Olive developed an appreciation that her isolation had left her particularly vulnerable to the cult group's promise of total approval and to its blandishments of fusion. Psychiatric intervention had alerted Olive to the secondary agenda implicit in the recruiter's overtures. Later, she was able to examine more intensively her equation of self-assertion with hostility. This equation was a factor in creating her secondary guilt at her “rejection” of the recruiter. It should be noted that recent research indicates that cult members are particularly uncomfortable with the expression of anger (Deutsch & Miller, 1983). Cult recruiters are often able to use this guilt as a means of recruitment and later as a means of stabilizing membership. Eventually, Olive accepted her right to be assertive and to experience anger when she was exploited. Through the exploration of this issue, which appeared so dramatically in the context of cult recruitments she was able to expand her social and sexual horizon.
The case of Edward C. raised different issues.
He entered treatment because of longstanding marital difficulties. He had had a series of extended extramarital affairs. In his first dream while in psychotherapy, however, he expressed an in- concealed incestuous interest in his daughter. In his associations about the dream, he mentioned that his daughter had recently joined a bizarre, radical political group with significant anti-Semitic and anti-Zionist leanings. (Both W. C. and his daughter were Jewish.) He later discussed his ambivalence about his daughter's affiliation with this group because the group had initially helped his daughter separate from him (a situation he found less threatening than their previous closeness) and was apparently meeting some of her intense dependency needs. (“At least she doesn't call me at three o'clock in the morning, and stops crying.”)
Mr. C.'s initial lack of concern over his daughter's affiliation with a cult-like political group is not unique. Indeed, many of the parents of cult members initially view cult affiliation in relatively detached terms because the cult creates boundaries between the parents and the child and establishes limits in what has often been a symbiotic or enclitic relationship. During the course of treatment, Mr. C. was able to develop a less intrusive, less controlling relationship with his daughter. Subsequently, both she and her male friend were able to disengage from the cult group.
The importance of the symbiotic, enmeshed relationship between parent and child as predisposing the child toward cult affiliation is illustrated in the following case which has a less fortunate outcome.
Nora L. was seen in psychoanalysis to help her deal with severe depression. Her marriage was characterized by her husband’s detachment and absences, primarily because he was a workaholic. She had always overinvested herself in rearing her children and her depression reflected her sense of emptiness after their departure. During the course of her analysis, she developed a severe lower back syndrome and was advised to remain at home on bedrest. She remained at home, nursed during the months of confinement by her daughter. Nora had always had a particularly close bond with her daughter, and this was intensified during this period. After Nora’s recovery, her daughter, Linda, left for California to take up a graduate fellowship. But within six seeks of her arrival in California she joined a bizarre, fundamentalist Christian group. Nora was heartbroken. She began to explore alternatives which might help her daughter leave the group. She contacted her daughter’s former therapist, who refused to discuss any aspect of her daughter's therapy but said that the daughter would certainly outgrow this “phase.” The child's father dealt with the matter in terms of First Amendment issues (he was an attorney). Ultimately, Nora simply decided to trust in the optimistic view that her daughter would grow out of the group. Unfortunately, the daughter soon married a group member and has remained with them albeit with less intense commitment than initially.
The evolution of Nora L.'s case presents issues of particular interest Let us consider the response of the daughter's therapist. He looked upon Linda's cult affiliation as “acting out” - as a transient stage in her growth and development His opinion is, unfortunately, all too common. It represents an optimism which does not take into account the intensity of the group processes operating within the cult setting. Moreover, it grossly underestimates the seductiveness, intensity, and persistence that cult recruiters utilize in reaching their objective. Nor does it appreciate the vulnerability of the isolated, depressed youth and the need to fuse with an all-powerful protective figure.
While Linda was not seen in treatment after affiliating with the cult, Nora's response to the process suggests that certain dynamic factors were operative. Of primary importance was the close and intensely symbiotic relationship between Nora and her daughter. The mother's illness certainly placed the future of that relationship in question. Likewise, the loss of her psychoanalyst, and the departure from the holding environment of New York to the reaches of the far West, intensified Linda's separation anxiety. in this context, a group of superficially concerned, united, and interested adults became an important and available support figure. Linda's story is not unique. Clinical experience shows that a significant number of cult members affiliate at times of transition during the periods of depression that are the products of separation from closely knit, enmeshed families (Halperin, 1983a).
Nora and her husband decided to accept Linda's new religious affiliation without any real attempt to confront her with their feelings about the change. In her effort to do so, Nora was hampered by her husbands detachments even in this family crisis. Moreover, his resort to legalism even when confronting his daughter with his concerns about her conversion inhibited any possible action. Experience in such settings such as the Cult Hotline and Clinic of the Jewish Board of Family and Children's Services in New York has repeatedly demonstrated the importance of a united family as part of the process enabling the cult member to reconsider his or her actions (Markowitz, 1983).
Psychiatric intervention was more successful in the case of Connie I., which also illustrates the diversity of cults.
Connie was an extremely attractive 25-year-old woman who had apparently achieved a middle-level management position in an investment bank. Despite her apparent success, she was unhappy at work and suffered from a pervasive malaise and ennui. In addition, she frequently practiced self-mutilation. This practice, and her history of sudden, intense enthusiasms and withdrawals, were consistent with a diagnosis of Borderline Personality disorder. While being followed in psychoanalytically oriented psychotherapy, Connie decided to attend a vocational counseling program given under the auspices of a mass therapy group. During the course of the session, the group leader told her to perform the exercise of getting out of her body and looking at herself. She experienced a loss of continuity and accompanying panic compounded by feelings of unreality and depersonalization. She contacted her psychotherapist and by the use of psychotropic drugs and intensive therapy she was able to reintegrate. During the course of psychiatric work, Connie was able to develop an appreciation of her difficulties in maintaining her boundaries and of her tendency to fuse with external objects.
Connie's experience illustrates the very real threat that confrontational mass therapies pose to the vulnerable individual. Particularly since Yalom’s work in 1971 and 1976, there has been an appreciation of the threat that the charismatic, confrontational, controlled group leader represents to the borderline individual. If the psychiatrist provides a holding environment, however, and intervenes with appropriate speed, real damage can be avoided.
During the period of cult affiliation, the opportunities for therapeutic work with the cult member are usually very limited. Many (if not all) cult groups are very skeptical about the entire psychotherapeutic process, and consider heretical the very suggestion that they might not be meeting all their members' needs. And, certain cult members do gain a certain surcease from anxiety by affiliating (Galanter, 1982), particularly since they are often individuals of whom "it is quite certain that they are not capable of dealing with anxiety of psychotic or near psychotic proportions' (Gordon, 1983). The cult groups' distrust of therapy often extends to treating members who become psychotic in a punitive and rejecting manner. They may consider mental illness to be evidence of satanic or demonic possession. Their disinterest in their members' welfare is cogently illustrated by the following.
Ken C. joined a bizarre, neofundamentalist group when he was 16- years-old. He spent the next ten years either raising funds for the group or on "mission.' At 26, he became increasingly bizarre and aggressive. He soon became unmanageable, and the group decided to return him to the United States. They peremptorily placed him on a plane (he was in Japan) and sent him back without any money or direction. Fortunately, his behavior on arrival in Los Angeles was so bizarre that his family was contacted. After a brief hospitalization in California, he returned to his family in New York where he required prolonged hospitalization. Throughout this time, his only contact with the group consisted of a notice from them that he had been excommunicated for demonic possession.
When Ken was seen in psychiatric evaluation, he still professed belief in the group's ideas, including a skepticism about medication. Nonetheless, he did accept psychotropic medication temporarily. Over a period of time he was able to become asymptomatic and to recognize that continued involvement with the group would be self-destructive.
Even if the cult member is initially inaccessible, psychiatric consultation can be helpful to the family members who are appropriately concerned about the member (Halperin, 1983; Levine, 1979). In many cases, the pattern of communication within the family of the cult member is skewed and fragmented. The family can unite and develop a viable consensus for action when the psychiatrist provides a “holding” environment in which the family can verbalize its anxiety about the cult member's future, the narcissistic injury that cult affiliation may present to the family, and even 'mourn' the absence of the cult member. At times, the family and the cult member can meet with the psychiatrist to discuss the change in lifestyle in an open and voluntary manner. In other cases, particularly when the individual has been involved with a cult group for a considerable period of time, the psychiatrist can meet with both cult member and family to offer an independent assessment, which may improve communication within the family regardless of the cult member's decision about his ultimate religious affiliation. When a family can utilize a child's cult affiliation as a crisis around which it is able to mobilize itself and its feelings toward the cult member in a unified fashion, the family is often successful in getting the individual to reexamine his or her position. In other cases, unfortunately, the family may continue to use the crisis in the service of scoring points in separate conflicts not directly related to the cult affiliation. In these cases, particularly when the cult member has a borderline personality disorder with severe dependency needs, the cult member may decide to remain in the group because it provides a holding environment.
A more complex situation is presented when an individual has withdrawn from active participation in the cult group's activities but still professes adherence to its ideology. Ken C. still considered himself to be a member of the cult even though he had been formally excommunicated. This paradoxical situation may arise in other contexts, as when the leader dies or the group disintegrates (as did Rajneeshpuram) from outside pressure. In such cases, members are truly isolated because the group is no longer available to provide them with an identity, and yet they do not consider themselves to be members of the non-group surround. Voluntary exit counseling in which the individual meets with a former group member in an open, supportive setting is often particularly helpful in bridging the transition between the cult and the non-cult world. If these individuals are seen in psychotherapy, they are depressed, fearful, and may present with the detachment and depersonalization characteristic of the Atypical Dissociative Disorder (DSM III - 316.00). During the course of ongoing psychotherapy, they may utilize the cult's ideology and skepticism about psychotherapy as an ongoing resistance. Great tact is required in engaging the individual in psychotherapy. It is particularly important that the psychoanalyst approach the period of cult affiliation as having been an attempt by the individual to pursue genuine spiritual longings. If the psychoanalyst simply adopts an oppositional attitude toward the cult group and all its pretensions, he may well reinforce the individual's interest in the group and the episode of affiliation will remain an expression of his attempt at individuation and separation. By negating the group and all its works in a reductionist manner, the psychoanalyst may reinforce the individual's defensive use of a splitting which both predated cult affiliation and was intensified during active membership.
Once an individual has left the cult, he is most accessible to treatment While "involuntary deprogramming” has gained a great deal of notoriety and generated a great deal of controversy, most people who decide to leave cults do so on a purely voluntary basis after having decided that the leader does not live up to his pretensions of wisdom and/or that the group cannot measure up to its idealistic claims. Many former members are extremely angry at the cult (which is hardly surprising considering the sacrifices they have made while in the group, particularly when contrasted with the flamboyant, expansive life styles of many cult leaders).
The question arises as to the effect on the individual of having made the initial decision to leave the group voluntarily. Galanter (1983) and Gordon (1983) have noted that individuals who have left cults after contact with “deprogrammers” or “exit counselors” appear to be much angrier at the cult than those who have left without the benefit of such contact. It should be noted that cult members often have considerable difficulty with the expression of anger (Deutsch, 1983). While in the cult, members are not totally inhibited in expressing anger; rather, they are encouraged to externalize anger and direct it toward the non-cult world, which is seen as evil, satanic, etc. It is hardly surprising, therefore, that after having contact with authority figures who grant them permission to express anger and to be comfortable with this expression, the cult member proceeds to express anger toward the group which has exploited them.
The presence of the Atypical Dissociative Disorder (DSM III 300.15), characterizes many former cult members. Individuals appear to be disengaged from their environment and unable to concentrate or even speak coherently because their speech is interrupted by periods of dissociation. Various explanations have been advanced for “floating.” It is doubtless the product both of the trauma experienced when an individual leaves a group's restrictive environment and of such factors as lengthy periods of sleep deprivation, excessive meditation, and nutritional depletion due to a low protein diet. The presence of “floating" dictates the adoption of an active analytic stance which attempts to engage the individual.
While an active stance is necessary, it should be recognized that a significant problem which arises in working with former cult members is that many of them have already been subjected to a harsh, confrontational style of interaction during the period of affiliation. The following case is illustrative:
Lyn P. was a student in one of the health care professions. Because of her malaise, she began to attend workshops sponsored by a mass therapy group. At first, her experience appeared to be constructive. Her enthusiasm was boundless. The group's style was extremely confrontational but she was reassured by the leader that physical violence was never employed. Lyn decided to attend a 24-hour marathon sponsored by the group. During the course of the evening, other group members commented on Lyn's inability to express anger. Initially, they attempted to provoke her into expressing anger by verbal threats and verbal abuse. When this failed, they began to physically assault her. Lyn felt totally intimidated during the session. Despite her torment, she was unable to leave. When she was seen in emergency psychiatric evaluation, she was an anxious, fearful, frightened woman who described in vivid terms her sense of helplessness in the face of an assault. She emphasized that during the marathon, the other group members had been totally unresponsive to her pleas that they limit their assaults. Yet, when questioned about why she had not left the “session,” she was unable to reply except to acknowledge that she had not been physically restrained from leaving.
In Lyn's early psychiatric sessions, she began to express her anger toward the group. Yet, while she could intellectually express disapproval of the group experience, her affect as she expressed this anger was flattened. It was clear that she was still tied to the group. Throughout this early period of treatment, her departure from the group remained very tentative, in part because it was important for Lyn to maintain her fantasy of the group leader as a benevolent idealized object. As her treatment progressed, Lyn was able to examine her need to maintain other significant figures in her life as benevolent, idealized objects because of her inability to express the anger she had felt towards them when they had exploited her. In this regard, Lyn's dependency is typical of many cult members - a dependency which expresses itself in a need to preserve both the cult leader and even cultic practices as viable alternatives. Thus, we find the process of splitting by which many cult members disassociate the group leader's flamboyant and exploitative style from his presumed concern for the individual member. As Lyn's treatment progressed further, she became much more comfortable with the expression of anger at her exploiters. At the time of termination she was seeking legal counsel regarding the possibility of receiving recompense from the cult.
Other aspects of the post-cult experience are illustrated by Edward C..
Edward C. was a member of a neo-Christian fundamentalist group in which he reached a position of responsibility. His behavior, however, became so grandiose that he was asked to resign his position, and he eventually left the group entirely. Despite a graduate degree, he supported himself marginally by odd jobs. A month prior to his seeking psychiatric consultation, he developed an exceedingly volatile relationship with a girlfriend. As a result, Edward began to drink excessively and used a variety of analgesics in conjunction with alcohol. Acutely depressed, he was referred for an emergency psychiatric evaluation. During the course of the interview, he expressed anger, fear, and timidity, denying any difficulties, and alternated between a grandiose overvaluation and suicidal ideation. When hospitalization was suggested because of his very tenuous support system, he acquiesced, although commenting that “you're only doing this to me because I was a member of the [x] group." The course of his hospitalization was notable because he began to organize the ward's patients against the staff. His grandiosity did not allow him to participate in many aspects of the treatment program. Nevertheless, at the time of discharge, his depression had lifted and he no longer expressed suicidal ideation.
Edward’s case presents several features that deserve further consideration. Of particular interest is his history of rapid alteration of moods in which he oscillated between extremes of grandiosity and deep self-denigration. The question is raised as to whether a bipolar disorder was present particularly if one compares the elation at the time of cult affiliation with the euphoria during the manic phase of a bipolar illness. Further research is necessary along this potentially intriguing line of inquiry. Rapid alterations of mood, and the formation of a therapeutic alliance characterized by periods of idealization and denigration, are noted in the narcissistic personality disorder and in individuals with an underlying borderline personality structure. It would appear that Edward's approach to treatment was characteristic of the individual with a borderline personality structure when one considers his reliance on splitting and projective identification defenses. Moreover, his reliance on these defenses was exacerbated by his period of cult affiliation in which he saw the world in polarized terms as split between the forces of good and evil. His inability to form a stable therapeutic alliance was also exacerbated by the grandiosity inherent in the cult's ideology - if an individual has been told to consider himself to be a member of the “elect” who will govern the world after Armageddon, it is difficult to accept working with a psychoanalyst on mundane problems in the here-and-now. Edwardd was not unique in this regard. Indeed, former cult members' resistance to engaging in the therapeutic process may arise out of a sense of entitlement and grandiosity which accompanies their feeling that in leaving the group, they are giving up a unique and valued status. Their sense of higher destiny may remain long after they have formally left the group and intellectually recognized the unrealistic picture of the future that the cult provided.
Former cult members are often difficult patients to engage in the therapeutic process. As noted, their sense of grandiosity and elitism makes them see the psychoanalytic process as a deprivation. But their resistance also arises from other aspects of their cult experience. Many cult members join as an expression of an idealism and a desire for acceptance. When this idealism is “betrayed,” a skepticism and cynicism is created which makes it extremely difficult to accept the bona fides of other ostensibly positive figures such as the psychoanalyst Thus, the psychoanalyst must approach the patients achievements during the period of cult affiliation with respect and a recognition that the individual's accomplishments while a member should be integrated into the total personality. It was useful for Edward to see himself as an individual who could rise to hold a respected position within a religious community.
Individuals with a strong sense of entitlement and a grandiose picture of themselves and the role they are destined to play in history often evoke intense counter-transference reactions. The psychoanalyst who works with the former cult member may begin to experience negative countertransference feelings as he continues to work with an individual who demeans the therapeutic process and psychoanalysis while at the same time commingling this with intense dependency striving and a desire for fusion. Nonetheless, the psychoanalyst can be surprisingly effective if he adopts an active therapeutic stance, sets boundaries, actively interprets efforts to breech boundaries, and monitors the uncomfortably negative feelings that arise during the course of treatment (Halperin, 1983).
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David A. Halperin, M. D., is Assistant Clinical Professor of Psychiatry, Mount Sinai Medical School, New York City, and Consulting Psychiatrist to the Cult Hotline and Clinic of the Jewish Board of Family and Children's Services, also in New York City. Among other works on the subject of cultism, Dr. Halperin edited and contributed to Psychodynamic Perspectives on Religion, Sect, and Cult (John Wright, 1983).