Just six years ago Lita Schwartz and Florence Kaslow (1979) referred to "a dearth of literature ... in the professional journals" regarding therapeutic treatment for the problems used by participation in extremist cults (p. 22). They attributed this state of affairs to a lack of knowledge about the problem, a concern echoed by several others (Carr, 81; Clark, 1978; Conway & Siegelman, 1978; Maleson, 81; and Singer, 1979). Small wonder then, that Jean Merritt remonstrated that "mental health professionals and the clergy are generally the worst people to talk to about Its ("Experts Say", 1981, p. 3).

Despite all the literature that has come out since, the philosophical battles that have dominated the discussions leave much room for doubt regarding just how advanced our knowledge really is. Almost certainly, egalitarians will question the very foundation of this paper, that is, that participation in an extremist cult causes psychological impairment, which, depending on the cult's degree of destructiveness, results in a need for varying levels of ex-cultist counseling (see the exchange, Ash, 1984a; Robbins, 1984; Ash, 1984b).

Egalitarians usually dismiss the presence of psychological problems in current members of extremist cults by referring to such studies as Galanter & Buckley, 1978; Galanter, Rabkin, Rabkin, & Deutsch, 1979; Ross,1983; and Ungerleider & Wellisch, 1979b, which report a relative absence of mental illness and emotional distress in cult members as measured by psychological inventories and clinical interviews. However, while they are quick to point out the very same methodological weaknesses, only in the reverse direction, in the studies reporting a relative absence of impairment. They pay little attention to "the possibility of motivated distortion and/or deception by subjects and the lack of representative samples" (Langone, 1984, p. 66) (Note i).

Furthermore, Galanter's finding an absence of significant emotional distress as measured by his General Well-Being Schedule and Neurotic Distress Scale is not the same as finding an absence of psychopathology, nor can it be implied to indicate such. His results do lend credence to his "relief effect" theory, i.e., that affiliation with such cultic groups brings relief from emotional/neurotic distress (Galanter, 1978, 1980, 1983a, 1983b). However, this is not necessarily the same as "psychological well-being". Galanter says that the relief effect comes from the perception of availability of social support and cognitive guidance in mastering stress (p. 1201). Even if this were true, it still does not rule out the presence of psychopathological defense mechanisms, which aid in bringing about this perception of well-being, through denial and dissociation. Moreover, Galanter cannot deny that self-report questionnaires, such as the General Well-Being Schedule and Neurotic Distress Scale, are dreadfully easy to fake, thereby making both conscious and unconscious forms of denial possible sources of error here.

In using the more powerful Minnesota Multiphasic Personality Inventory (MMPI) Ross (1983) and Ungerleider and Wellisch (1979b) both found support for the notion that cultists tend to "fake good" via elevations on certain validity scales (Ungerleider and Wellisch found L high, Ross found K high). Therefore, the lack of elevation on the MMPI clinical scales for the cultists in these two studies cannot be taken as proof of the absence of psychopathology, for as Ungerleider and Wellisch themselves noted, "it is likely that many of the in-group's (scales) would have been elevated had they not consciously skewed their responses" (p. 281).

Finally, dissociative disorders, of which the author believes the cultic personality to be a type, quite often do show "normality" on objective tests such as the MMPI, while also exhibiting psychopathology on projective tests such as the Rorschach, TAT, or drawings, e.g., borderline personality disorder (Gunderson & Singer, 1975; Stone, 1980, pp. 264-270; Tibe, 1979, pp. 14-15; 18-20, 29-33; Weinger, 1966, pp. 404-405). Therefore, it should come as no surprise that the only two studies which did use projectives did find psychopathology in cult devotees (Deutsch & Miller, 1983; Spero, 1982). Furthermore, Spero specifically found much evidence of "frank borderline-type (dissociative) phenomena" (p. 335) operating in the ego defenses of 37% of his cult devotees.

In conclusion, the egalitarians' use of the actuarial studies of cult devotees to "prove" an absence of psychopathology is highly questionable: the studies reflected the cultists' tendency to avoid acknowledgement of psychological problems; the self-report questionnaires employed in the studies were easily "fakeable" (General Well-Being Schedule & Neurotic Distress Scale) or had questionable validity due to the faking response set (MMPI); and the studies under consideration ignored two other studies which used projective testing and did show evidence of psychopathology.

Regarding the presence of problems in ex-cultists, egalitarians declare that the vast majority left voluntarily, Implying that these individuals suffer no, or at least fewer, problems. Additionally, they call cult critics to task for the lack of statistical data supporting the prevalence of ex-cultist problems (e.g., Saliba, 1985, p. 44). Nonetheless, much clinical evidence, such as that which will be presented in this paper, "suggests that the prevalence of harm is substantial, although not necessarily normative or the same from group to group" (Langone, 1984, p. 66). In fact, the only available study which examined the prevalence of harm (Galanter, 1983b) found 36% of ex-Moonies (71% of whom had clearly departed voluntarily) experienced "serious emotional problems after leaving," problems that continued for an average of 3.8 years (p. 984). Furthermore, the General Well-Being Schedule used in this study (the Neurotic Distress Scale was not employed) is not able to detect emotional problems not labeled "serious" by this self-report method. Therefore, actual prevalence of psychological problems as measured by more powerful psychological assessment techniques could conceivably result in an even higher prevalence rate.

Lately, egalitarians have begun to concede that there are (or can be) problems which surface when individuals leave the newer cult groups, but they also insist that these problems are "cult-related," not cult caused (Robbins, 1984; Saliba, 1985), and they usually relegate them to problems of adjustment akin to the culture shock missionaries experience when they return to the States after an extended absence (cf, Levine, 1984). This paper will argue against these positions as well.

Purpose

The purpose of this paper is to synthesize the available literature into a theoretical overview of the psychopathology resulting from membership in extremist cults. A subsequent paper will provide an overview of psychotherapeutic treatment issues and guidelines. The intent is to provide a conceptual framework for a more comprehensive view of this psychological impairment and its treatment. Future research may add, delete, or revise various parts of this conceptualization according to our ever-expanding knowledge. Nothing said here is intended to be the final word.

In certain ways this paper was meant to be a revision of the only available prior attempt to provide such a synthesis, the American Family Foundation's work, Destructive cult conversion: Theory, research, and treatment (Clark, Langone, Schecter, & Daly, 1981; hereafter referred to as "AFF"). While the etiological aspects of the problem, assumed to be the cult conversion process itself, are only summarized here (cf. Ash, 1983, pp. 46-103 for a more systematic view), this paper still transcends the AFF work by providing: 1) a delineation of the individual personality factors during the cult conversion process and its resulting pathology, and 2) the utilization of stages of cult departure and cult recovery, which provide a framework upon which clinical picture and treatment issues may be placed.

The comprehensive picture which will be portrayed is that of individuals who have been psychologically impaired by their participation in an extremist cult. It should be remembered, however, that not all individuals will experience all the problems described. Nevertheless, the more extremist the cult the greater the liklihood that the specific clinical pathology of a cult-induced dissociative disorder and post-cult readjustment problems will result. In other words, extremism or a lack of balance in groups will undoubtedly result in a lack of balance in its members. Group pathology will generate individual psychopathology.

In earlier papers (1983, 1984a), I proposed detailed criteria for evaluating the level of extremism in groups. I suggested that cultic extremism is a function of two main categories of factors: 1) an exclusive, ultra-authoritarian (or totalitarian) closed "family" system that has rigid boundaries and promotes deep emotional dependency, blind obedience, unquestioning compliance, and conformity to its leadership; and 2) the deceptive use of mind-manipulating, dissociation-inducing techniques during the recruitment, conversion, and retention of its members. The psychopathology which will be portrayed in this paper results from participation in groups which would fit or approximate this definition of an extremist cult.

Not all individuals involved in cults will suffer psychological impairment in the sense of inability to cope with life apart from the group. The author believes that those who don't show such impairment are most likely either very healthy individuals who were not in any transition or crisis at the time of the conversion process or are psychopathic or narcissistic personality types (see "Diagnostic Comments" section below). Nonetheless, with the exception of the latter (and possibly the very healthy) the "poison" of the extremist cult conversion process will affect all participants to some degree. At the very least, all those leaving extremist cults are forced to deal with both the external realities of day-to-day life outside the cult and the shock of having to use their minds again without the cult's direction. just a,,, freedom from emotional distress while in the group had its price tag of relinquishing personal control, regaining personal autonomy has its price tag too.

Etiology

When one speaks of the etiology of cult-induced or related psychopathology, the cult conversion process cannot be ignored; otherwise psychological treatment will be ineffective (Clark, 1978, p. 29; Schwartz & Kaslow, 1979, p. 22; Singer, 1979, p. 82). Furthermore, when the cult is extremist there will be a direct link between the cult conversion process and the resulting psychological impairment in the individual. However, the conversion process is even more effective when prior personality factors render the individual recruit especially susceptible to the cult's manipulative techniques. In short, extremist cult conversion is usually an interplay of personal vulnerability factors and cult milieu factors. Figure I depicts this visually according to three phases suggested earlier (Ash, 1983; cf. AFF).

Personal Vulnerability Factors

A synthesis of AFF's personal vulnerability factors with Zerin's (1982) research on family system vulnerability, along with other relevant literature, suggests the following variables make an individual more susceptible to cult involvement:

1. High level of current distress or dissatisfaction in day-to-day life. Singer referred to a temporary period of stress and vulnerability during the period of "being in between things" (1978, p. 16), i.e., in transition between high school and college, between jobs, between romances or between living at home and on his/her own. Furthermore, Galanter's "relief effect" implies a prior distress, a notion which Is quite liberally supported in the literature (cf. Allison, 1966; Anthony, Robbins, & McCarthy, 1980; Clark, 1978, 1979b; Deutsch, 1975, 1980; Galper in Aversa, 1976; Levine, 1980; Levine, 1979; Levine & Salter, 1976; Pattison, Llamas, & Hurd, 1979; Roche, 1979; Schwartz & Kaslow, 1981; Spero, 1980; Stoner & Parke, 1977; Yamamoto, 1977).

Personality Factors Millieu Factors

Attraction Personal vulnerability factors Recruitment/enticement tactics

Conversion Gradual process with Thought reform/

isolated choices along the way – brainwashing Tactics

snapping

Acculturation Dissociation/information disease Retention tactics

Figure 1. An overview of individual personality factors and cult milieu factors involved in the process of cult conversion, as adapted from Clark, Langone, Schecter, and Daly (1981) and Conway and Siegelman (1978).

Cultural disillusionment in a frustrated seeker--cf. the literature which refers to the idealism in many of those attracted to cults, those who are searching for meaning in life (Blackwell, 1980; Buckley & Galanter, 1979; Burtner, 1980; Carr, 1981; Enroth, 1977, 1979; Gordon, 1977; MacCollam, 1979; Rothbaum, 1980; Schwartz & Kaslow, 1979, 1981; Shapiro, 1977; Singer, 1979; Spero, 1977, 1980; Stoner & Parke, 1977; Ungerleider & Wellisch, 1979b; West & Singer, 1980; Yamamoto, 1977).

Lack of an intrinsic (self-chosen and strongly held as a meaningful part of oneself) religious belief/value system or a more nominal, or more extrinsic, religiosity. While the tendency to conceptualize problems In a religious framework per se does appear to increase one's vulnerability (Austin, 1977; Lofland, 1977), as apparently does a nominal/uncommitted religious background (Cox, 1977, p. 38; Enroth, 1977, p. 153; Isser & Schwartz, 1980, p. 69; Levine & Salter 1976, p. 413; MacCollam, 1979, pp. 4, 42; Schwartz & Kaslow, 1979, p. 24; Spero, 1980, P. 164; Yamamoto, 1977, p. 50), a previous intrinsic religious belief system appears to make one less vulnerable to certain groups, e.g., the Unification Church (Deutsch & Miller, 1983).

Moderately dysfunctional family system of origin (from Zerin's 1982 research), including (in addition to those of a religious or values clarification nature) these particular factors:

a. The "absent father" syndrome: the father being physically present and still "not there" -Zerin's research supported Schwartz & Kaslow's (1979, 1981) earlier contention that a weak father-child relationship increased one's vulnerability and a strong one decreased it. This is also supported by many authors suggesting that cultists joined their groups in search of a father to replace the one they didn't have either physically or emotionally (Blackwell, 1980; Buckley & Galanter, 1979; Cox 1977; Enroth, 1977, 1978, 1979; Gordon, 1977; Hunt, 1980; Levine & Zegans, 1974; Levine, 1980; maccollam, 1979; Spero, 1977, 1980). Likewise, Yamamoto (1977) noted specifically that "the Unification Church has had the most difficulty (in recruiting) with those converts who have a close relationship with their fathers" (p. 50). Deutsch and Miller's (1983) four female Unification subjects all "cherished their fathers--in spite of perceived shortcomings," although the authors didn't say whether these relationships were close or not (p. 768).

b. Lack of parental direction, guidance, structure and limits--lack of preparation of the young for independence, which may include a traumatic switch in family style at the point of high school graduation (from binding to expelling), i.e., dramatic switch from enmeshed overprotection/dependency to forced independence (cf. Schwartz & Kaslow, 1981) or, after a deprogramming, the other way around (Goldberg & Goldberg, 1982). Also, West and Singer (1980, P. 3250) have said that family systems which foster a combination of indecisiveness and rebellion rear vulnerable youth.

c. Lack of unconditional positive strokes--positive attention and affection given only for performance and good behaviorcf. the literature referring to the search for love, attention, security, or belonging in many of those attracted to cults and/or the promise by the cults to provide for this need (Blackwell, 1980; Buckley & Galanter, 1979; Burtner, 1980; Carr, 1981; Cox, 1977; Deutsch, 1975; Edwards, 1979; Enroth, 1977, 1979; Gordon, 1977; Hopkins, 1978; Levin & Zegans, 1974; Levine, 1980; Levine, 1979; Levine & Salter, 1976; MacCollam, 1979; Schwartz & Kaslow, 1979, 1981; Shubin, 1980; Silnger, 1978; Ungerleider & Wellisch, 1979a; West & Singer, 1980).

d. Poor family communications, especially the parental usage of double binds, cf. Schwartz & Kaslow (1979) referring to "contradictory communications from 'good' parents" (p. 180). Also, poor communication per se in pre-cult families, cf. Blackwell (1980, p. 4); Carr (1981, p. 180); Edwards (1979, p. 231); Enroth (1977, p. 149; 1979, p. 51); Martin (1979, p. 180).

e. Chronic parental marital conflict, usually unacknowledged, which may lead to the family system's need for a scapegoat (cf. Schwartz & Kaslow (1981, pp. 15-16).

Dependent personality tendencies--cf. Schwartz & .Kaslow (1981, pp. 15-16) and the testing results of Deutsch & Miller (1983), Spero (1982), and Ungerleider & Wellisch (1979b), which suggest that dependency antedates cult involvement. The dependent tendencies include:

a. Lack of inner direction or purpose (Ego-Ideal)-cf. the literature above regarding"' the search for meaning, as well as that related to a lack of guidance in the family system of origin;

Lack of adequate self-control (Superego). The entire ego regression theory of cult conversion revolves around the notion of the surrendering of ego controls to the cult because of the cult's "powerful sources of control that compensate tot the lack of internal control" (Schwartz & Kaslow, 1981, p. 14). For Spero (1982) this surrendering process occurs through the coming together of pre-cult field-dependent tendencies, superego surfeits and deficits (pp. 333-334; cf. p. 281), and shame proneness (cf. lack of Ego-Ideal) with manipulative cultic indoctrination techniques that induce dedifferentiation of self-boundaries (P. 341), i.e., blurred ego boundaries between the convert and the cult leaders who become idealized (cf. Galanter, 1983a, p. 988). Likewise, Merritt (in Burtner, 1980, tape 3, side 1) referred to this process as the superimposing of an alien superego over the ego which is shrunk down as small as possible, yet left large enough to keep functioning at whatever level deemed necessary by the group. And finally, Ungerleider & Wellisch (1979b) found MMPI results which suggested "subjects who were still cult members indicated difficulty with impulses in several areas and attendant superego deficits such that the cults appear to serve as externalized superego substitutes" (p. 281).

Low tolerance for ambiguity--cf. the literature referring to the search by individuals for and the promise by cults of instant, simplistic, black and white answers (Burtner, 1980; Clark, 1979b; Cox, 1977; Enroth, 1977, 1979; Isser & Schwartz, 1980; Levine, 1979; Levine & Salter, 1976; Rothbaum, 1980; Schwartz & Kaslow, 1981; Singer, 1978; Spero, 1977, 1980).

Susceptibility to trance states due to impairment in ego differentiation of reality frames (Spero, 1982; cf. Beahrs, 1982, seeing hypnotic, or trance, behavior as spontaneous vivid imagination/fluid perception with primary and tertiary process thinking; pp. 14-22).

Extremist Cult Conversion

Cult milieu factors. Relegating the recruitment and acculturation factors to variations of the same theme (cf. Ash, 1983, pp. 95-96,102-103 for the details), three variables of the cult or group milieu must be available for the conversion process to take place. These may also be seen as stages of the process, albeit overlapping stages. These three components are:

1. Isolation, from:

the world (Enroth, 1977; Clark, 1979b; Schwartz Kaslow, 1979; Singer, 1979);

family and friends (ibid. all 4 ref; & Blackwell, 1980; Etemad, 1978; Isser & Schwartz, 1980; Levine, 1980; Sargant, 1951; Schwartz & Kaslow, 1981; West & Singer, 1980); and even

self --by the cults not allowing time alone unsupervised by cult members (Enroth, 1977; Etemad, 1979; Galper in Aversa, 1976; Levine,1980; Stoner & Parke, 1977; West & Singer, 1980; Yamamoto, 1977), not allowing time to think or critically evaluate (Levine, 1980; Lofland, 1977; Schwartz & Kaslow, 1979, 1981; Stone & Parke 1977; Yamamoto, 1977), and sometimes by even isolating the recruit from access to mirrors (Conway & Siegelman, 1978, p. 33; Enroth, 1977. pp. 34, 48, 106, 179).

This isolation from the world, family, friends, and self serves to separate one from his ordinary frame of reference (Appel, 1983, p. 164; Conway & Siegelman, 1978, pp. 155-156; Stoner & Parke, p. 263-264), thereby decreasing one's base for autonomous reality testing, as well as promoting a state of narrowed focus of attention, which can be a manifestation of dissociation (Clark, 179b, p. 103) and a contributor to heightened suggestibility for later indoctrination. The cult's closed system with its rigid boundaries perpetuates the isolation beyond the conversion proper, thereby aiding the cult in its retention of its members by maintaining them in their dissociative state of mind (cf. Enroth, 1977, pp. 172-173; Galanter, 1983a, P. 988).

2. Induction of a dissociative state via:

Information control, overload, and manipulation --"information overload" (Edwards, 1979; cf. Appel, 1983, pp. 123, 136) via "intense group pressure, endless lectures, lies ... singing, chanting and a constant barrage of the kinds of rhetoric which capture young, idealistic minds" (Clark, 1979b, p. 81); or double-bind communication (Appel, 1983, pp. 100-106) and other language manipulation, including provision of a new language (Clark, 1978, 1979b; Deutsch, 1980; Enroth, 1977; Roche, 1979; Schwartz & Kaslow, 1981; Singer, 1980; Stoner & Parke, 1977);

Emotional overstimulation and/or manipulation --"gutwashing" (Burtner, 1980) and classical conditioning through intense emotional stimulation, particularly "sudden, extreme, and unexpected states of high emotion" (Verdier, 1977, p. 83); e.g., "love-bombing" (cf. "search for love" references in vulnerability section above) or the manipulation of negative emotions such as guilt or shame, e.g., the eliciting of confessions (AFF, 1983; Blackwell, 1980; Burtner, 1980; Clark, 1977, 1979b; Envoth, 1977, 1979; Etemad, 1978; Lifton, 1961; Sargant, 1951; Schwartz & Kaslow, 1979; Shapiro, 1977; Spero, 1977, 1980, 1982; Stoner & Parke, 1977; West & Singer, 1980; Yamamoto, 1977), fear (Burtner, 1980; Clark, 1977, 1979b; Enroth, 1977, 1978; Etemad, 1978; MacCollam, 1979; Sargant, 1951; Schwartz & Zemel, 1980; Shapiro, 1977; Verdier, 1977). and doubt , ( or anxiety , insecurity , and uncertainty--Appel, 1983; Enroth, 1977; Pattison, Llamas, & Hurd, 1979; Sargant, 1951; Spero, 1977, 1980, 1982; Verdier, 1977; West & Singer, 1980).

Physical debilitation via sleep deprivation (Appel, 1983; Burtner, 1980; CFF, 1981; Clark, 1977, 1978, 1979b; Conway & Siegelman, 1978; Enroth, 1977, 1979; Etemad, 1978; Levine, 1980; MacCollam, 1979; Schwartz & lsser, 1979; Schwartz & Zemel, 1980; Shapiro, 1977; Verdier, 1977), diet manipulation (Appel, 1983; Burtner, 1980; CFF, 1981; Clark, 1978, 1979b; Conway & Siegelman, 1978; Enroth, 1977; Etemad, 1978; Lifton, 1961; MacCollam, 1978; Roche, 1979; Spero, 1977; Stoner & Parke, 1977; West & Singer, 1980), and fatigue from constant activity (Blackwell, 1980; Carr, 1981; Clark, 1977, 1978, 1979b; Conway & Siegelman, 1978; Galanter, 1979; Galper in A versa, 1976; Levine, 1980; MacCollam, 1978; Roche, 1979; Sargant, 1951; Schwartz & Kaslow, 1979, 1981; Spero, 1977, 1980; West & Singer, 1980; Yamamoto, 1977). For Verdier (1977) "the essential core of the hypnotic phenomenon" is an increase in suggestibility brought on by activation of muscle senses that inhibits activity in the cerebral cortex, which usually performs the normal, analytic, thinking function of the brain (pp. 54, 61-62). Verdier sees brainwashing as "deeper and more permanent" than hypnosis, "a truly profound state of disinhibition" where "the cortex is more or less completely by-passed" because it utilizes both activation of the muscle senses and the visceral senses via intense emotional stimulation (p. 81). He is supported by several others who believe there is a neurophysiological (brain) component to cult conversion (AFF; Appel, 1983; Burtner, 1980; Clark, 1979b; Conway & Stegelman, 1978; Roche, 1979; Schwartz & Kaslow, 1981; Shubin, 1980; Spero, 1977; West & Singer, 1980).

Continuous utilization of "not thinking" (Note 2) practices such as chanting, Eastern religious ("mind emptying") types of meditation (Note 3,) or speaking in "tongues" (AFF; Appel, 1983; Buckley & Galanter, 1979; Clark, 1978', 1979b; Conway & Siegelman, 1978; Enroth, 1977; MacCollam, 1978; Shapiro, 1977; Singer, 1979; Spero, 1977; Stoner & Parke, 1977; Verdier, 1977; West & Singer, 1980; Yamamoto, 1977).

Religious mystical rituals, such as "deliverance from demons" (Note 4) or initiation into the cult with a renunciation of one's past life and/or acceptance of a new identity/name (Burtner, 1980; Conway & Siegelman, 1978; West & Singer, 1980).

Indoctrination into and reinforcement of exclusive, closed "family" system boundaries (with dedifferentiation between the individual and the cult) via:

a. Doctrinal "carrots" and "sticks" -criticism of the world and family outside of the cult (with Manichean, paranoid pseudo-logic; cf. Galanter, 1983a, p. 988); offer of salvation and absolute (sacred science/black and white) answers, usually as flonly we" can provide it/thern (Clark, 1977, 1979b; Galper in Aversa, 1976; Haack, 1978; Levine, 1980; Levine, 1979; Martin, 1979; Stoner & Parke, 1977; West & Singer, 1980); and suppression of doubt via forced listening (cf. Galper in Aversa, 1976; Schwartz & Zemel, 1980; Verdier, 1977; Yamamoto, 1977) and not allowing, or otherwise dissuading, idiographic expression (Clark, 1979b; Enroth, 1977; Etemad, 1978; Shapiro, 1977) or questions (Blackwell, 1980; Clark 1979b; Enroth, 1977, 1979; Levine, 1980; Levine, 1979; MacCollam, 1979; Roche, 1979; Rothbaum, 1980; Stoner & Parke, 1980; Verdier, 1977).

Selective group reinforcement and punishment, i.e., the systematic application of operant conditioning techniques using the rewards and punishments of peer pressure to promote compliance to closed system rules and promote dedifferentiation of ego boundaries (Blackwell, 1980; Clark, 1979a, 1979b; Enroth, 1977; Etemad, 1978; Galanter, 1983a; Heller, 1982; Isser & Schwartz, 1980; MacCollam, 1979; Roche, 1979; Schwartz & Isser, 1980; Schwartz & Kaslow, 1979, 1981; Spero, 1977, 1982; Stoner & Parke, 1977; West & Singer, 1980; Yamamoto, 1977).

The conversion process. In distinguishing two primary types of conversion, Salzman (1966) saw the psychopathological type as being more abrupt than the maturational conversion. Conway & Stegelman (1978), however, believed cult conversion could come through either sudden transformation or a more gradual process, albeit the gradual conversion also ending in an abrupt moment of transformation which they called the point of "snapping."

Those who advocate a gradual process. contend that the individual recruit typically does make voluntary choices to participate in the cult activities at various points along the way, but that the induction of dissociation and dedifferentiation via isolation and thought reform tactics disallows any serious consideration of the overall process (cf. Galanter, Rabkin, Rabkin, & Deutsch, 1979; Gilmartin in Sage, 1976; Levine, 1980; MacCollam, 1980; Schwartz Kaslow, 1981). The cult milieu control tactics, therefore, promote disengagement of the critical evaluative functions of the brain, which results from the individual's inability to process an onslaught of conflicting information while under sensory bombardment and while separated from his/her usual frames of reality/reference (Conway & Siegelman, 1978, p. 56).

This is the moment of "snapping" vulnerability, the mystical experience of simultaneous mind expansion and dissociation. The cult takes advantage of this event through its indoctrination tactics, which provide the "answer" to the crisis (cf. Galanter's "relief effect"). The "answer," however, has strings attached to it: The cult molds the individual in his dissociative vulnerability according to its liking. This state is then maintained by a continuation of the mental extension to, and deep emotional dependency upon, the cult.

Cult induced dissociation and the mystical experience. Dissociation can be seen as a form of "macroscopic splitting" of the mind or ego (Grotstein, 1981, p. 10). Clark (1979b) noted that these "states of dissociation are in essence emergency states during which a number of CNS functions, such as that of the autonomic nervous system, are changed or suspended" (p. 103). Pruyser (1977) referred to "frozen emergency reactions--as ways of coping that have become habitual long beyond the time they were originally needed in an erstwhile stressful situation. Traits of this order are often ego-syntonic" (p. 343). Ego-syntonic forms of dissociation, according to Grotstein (1981), are "probably due to an adaptation of futility in a compromised and constricted level of mental functioning" - functioning which is marked by "compromised reality testing which ignores distinctions" between the split halves (p. 110).

Spero (1982) saw severely impaired reality testing in cultists in dedifferentiated reality frames: past-present, memory-dream, but particularly inner-outer and self-other (p. 338). Spero's dedifferentiation may be likened to Beahrs' (1982) "extension" or "expansion," i.e., "the process in which an individual's sense of selfhood extends beyond his physical boundaries so that he experiences as self what is actually beyond" (P. 166).

It is most significant that Beahrs saw this extention in licertain religious or spiritual states of mind" (p. 166) -- the mystical experience or state (pp. 176-177). However, three important differences must be pointed out between William James' mystical experience which Beahrs referred to and the cult conversion experience. First, James' experience was expansive, but it was not dissociative (i.e., involving macroscopic splitting of the mind). Second, it was marked by its "transiency--of short duration, the mystic state itself rarely lasting more than a half-hour of clock time" (p. 177), in marked contrast to the frozen state of mind maintained by cults. And third, the mystic state was not affected by compromised reality testing. In this regard, the cult mind is closer to the "symbiotic psychosis" which Beahrs referred to, "where a patient's sense of boundary between himself and non-self is so blurred that reality testing becomes impossible" (p. 166; cf. Galanter, 1983a, p. 988).

Beahrs noted that "individuals with problems in their sense of unity and multiplicity both dissociate and extend simultaneously" (p. 167). Having a combination of both the mystic state and the symbiotic psychosis, yet not quite being either, the extremist cult-induced disorder may, therefore, be best explained via the simultaneous presence of Clark's dissociation (or splitting) and Spero's dedifferentiation (or, extension or expansion).

Stages of Cult Departure

Physical departure from a cult may not be equated with mental freedom from its bondage. While physical departure may be viewed as the necessary first step of any outside intervention (e.g., deprogramming; AFF, p. 63), it is often quite independent of the mental process of withdrawal or deconversion, i.e., the unfreezing of the dissociation/dedifferentiation of the cult mind set. In cases of voluntary departure, this process actually begins prior to the physical withdrawal from the group. Furthermore, the clinical picture presented to the therapist during this process of mental deconversion is sure to be an ever-changing one.

For these reasons, some structure would be most helpful for the therapist attempting to discern the most effective therapeutic goals, tasks, and focuses for each change in the clinical picture. In an attempt to provide such a skeleton of conceptualization, Stoner and Parke's (1977) analysis of withdrawal from a cult has been adapted to suggest three specific stages of the mental aspects of this process:

1. Reevaluation of life in the cult--which terminates with a breaking of the cult-induced dissociative disorder and the individual's decision to leave the cult (i.e., "for good");

2. Readjustment to life outside the cult--the longest phase (up to one or two years) which is usually characterized by a persistent ambivalence regarding leaving the cult

3. Reacceptance of life outside the cult--which is marked by a cessation of ambivalence and a more complete commitment to remain within life outside of the cult.

In essence, the major goal of deprogramming or counseling during the reevaluation stage of cult departure is to unfreeze the cultists' dissociation by helping them to think for themselves again (Etemad, 1978, p. 22; Galper in Aversa, 1976, p. 1; Heller, 1982, p. 131). If this reality-inducing therapy is successful, the individual then begins rehabilitation counseling, which strives to aid his readjustment to life outside the cult. However, this move is made more difficult by the retention of many remnants of the former dissociation, remnants which must be dealt with if there is to be a successful transition into the third stage of cult departure--reacceptance of life outside the cult.

Referring specifically to the clinical picture of ex-cultists during the readjustment phase of cult departure, Goldberg and Goldberg (1982) coined the phrase "post-mind-control syndrome"(P.167), while Spero (1982) proposed "postcommitment syndrome" (p. 342). Though neither helped to delineate the difference between the clinical pictures of the reevaluation and readjustment phases, each still made a significant contribution in this area. Spero's work further established that the existence of these differences reflected a process of mental change as opposed to their representing mutually exclusive syndromes. The Goldbergs' stages of "post-mind-control" recovery greatly advanced the delineation of clinical picture and therapeutic focus during the readjustment phase of cult departure itself.

Goldbergs' Stages of Cult Recovery

From their five years of group work with approximately two hundred ex-cultists (from fourteen different cults) Lorna and William Goldberg (1982) have outlined three distinct, but not mutually exclusive, stages which all ex-cultists pass through following deprogramming. Those individuals who were not deprogrammed have more difficulty, and take longer, in going through these stages of psychological recovery from cult participation than those who were deprogrammed. However, the Goldbergs maintain that all individuals leaving cults must go through them. These stages are:

1. Initial Postdeprogramminig--which begins with the completion of deprogramming, usually lasts from six to eight weeks, and includes the vast majority of the symptoms typically assigned to the ex-cultist's clinical picture. It is during this phase of recovery when the "residues of the imposed personality remain stamped on them" (P. 167), i.e., when dissociative symptoms are the most noticeable. Childlike passive dependency with uncritical receptivity to authority, and cognitive ego deficits (including indecisiveness, subservient physical demeanor, glassy eyes, and a tendency to "float" back into the cult altered state of consciousness) are all hallmarks of this stage. For the Goldbergs the stage one hallmarks were "blandness, self-doubt, confusion, and depression" (p. 170),

2. Reemergence-of the pre-cult personality. This stage usually begins one to two months after deprogramming and lasts for approximately six months to two years. Its major characteristics include the reacquisition of self-confidence, the emergence of anger at the cult and at parents, the onset of anti-cult crusade tendencies, and the testing out of previous "pleasures" that had been denied in the cult. Singer's "fishbowl effect" (yet to be discussed) is ,most bothersome at this time.

3. Integration'--of the individual's cult experience into his life. This stage begins six months to two years after cult departure. While the emphasis here is on future-oriented goals, the Goldbergs indicated that the treatment of choice for this phase, is individual psychotherapy focusing on exploration of the factors which contributed to the individual's vulnerability to the cult's manipulations. Therefore, while some of the therapeutic work in this integration stage might overlap into this paper's cult departure stage of reacceptance of life outside the cult, the majority of the therapy here is focused on the promotion of readjustment to life outside the cult.

Reevaluation Versus Readjustment: A Problem in Clinical Differentiation

The only major weakness of the Goldbergs' stages appears to be their reliance on the occurrence of deprogramming as the onset point for stage one. The Goldbergs do mention that "individuals who do not participate in the deprogramming process after leaving their cults generally have more difficulty placing their experience into perspective than those who undergo deprogramming. In the former, behavior characteristics of the first stage can last for several years" (p.i6q). Thus, they have recognized that all nondeprogrammed ex-cultists do enter this stage just as do deprogrammed ex-cultists. But they have failed to delineate when this occurs or if it results in any difference in the clinical picture between the two groups at this time.

Perhaps the exact determination of the point in time between cult mind set and the post-mind-control syndrome, between reevaluation of life in the cult and readjustment to life outside it, is not always possible. Recovery from the cult-induced dissociation is not always a sudden point of "snapping," but may involve a much more gradual process. This may be seen in Steve Kemperman's autobiography (1981) and also in Spero's individual psychodynamic psychotherapy with 65 cult devotees (1982).

Kemperman experienced two deprogrammings, which essentially failed, and then six weeks at a halfway house for rehabilitation before he made the actual decision to leave his group. And Spero's psychotherapy with nondeprogrammed cultists took an average of 15 months for the 51 successful cases. He did not delineate between the clinical pictures of those still mentally cultists and those experiencing "floating" or any of the other classical ex-cultist symptoms seen in the Goldbergs' post-deprogramming stage one. In fact, one could get the impression that for Spero the "postcommitment syndrome" contains none of the dissociation-related problems, but only affective and interpersonal problems (i.e., depression, irritability, brief isolation and anomie, and caution in resuming interpersonal problems, p. 342). His post-commitment syndrome, therefore, appears to encompass only those clinical problems seen in Goldbergs' second and third stages of cult recovery--reemergence and integration.

Figure 2 presents a visual comparison of the Goldbergs' view with Spero's regarding clinical picture and therapy, along with the author's view of the essence of psychopathology within each phase of cult departure and recovery. Spero began working during reevaluation with the dissociative problems of those still mentally cultists, for whom he favored intensive, long-term individual psychotherapy. The Goldbergs provided short-term group counseling for ex-cultists, thereby, dealing with only the transitory dissociative symptoms of those who had already been deprogrammed (i.e, had been "snapped" out of their rigid cultist dissociative state of mind). Nonetheless, in many respects the bulk of Spero's view of the clinical picture of these cultists resembled what the Goldbergs emphasized in their first stage of cult recovery--dissociative phenomena. (unavailable)

Figure 2. A comparison of the clinical picture and therapy views of Goldberg and Goldberg (1982) with Spero (1982) and the author's view of the essence of psychopathology within each phase of cult departure and recovery.

In summary, no one writer in the literature has differentiated the clinical picture of those being deprogrammed (in the reevaluation phase) and those in the initial post-deprogramming subphase of readjustment. Furthermore, Spero's (1982) work has suggested that different specific syndromes are probably unlikely, and whenever deprogramming is not utilized, any changes in clinical picture which occur are likely to be gradual. Perhaps the essence of this change may be said to be the degree of stability (i.e., frozenness) versus transience of the dissociative symptoms. During reevaluation the individual is still mentally a cultist in a stable dissociative state with blurred ego boundaries between himself and the cult, i.e., "cult-induced dedifferentiation of self-boundaries" (Spero, 1982, p. 341; cf. Galanter, 1983a, p.988; Kirsch & Glass 1977, p. 1257), that is, simultaneous dissociation and extension. After deprogramming, or a breaking of this dissociative state/extensive link with the cult, the dissociative symptoms come and go, i.e., "floating." Other than this, the only other symptoms which seem to mark an individual's entering the initial post-deprogramming stage of cult recovery would be ambivalence, depression, and the return of pre-cult affections and split off emotions. Elaboration upon these will be made below.

AFF Model Critiqued

Only one writing systematically outlines the clinical picture of former members of extremist cults, again the American Family Foundation (AFF) work by Clark, et al, (1981). In listing "problems of former cult members" it outlines pertinent symptoms utilizing a format similar to that seen in most mental status examinations: appearance, behavior, affect, perception, intellectual functioning, memory, thought content, and decision making (p. 18-23).

Two major weaknesses may be attributed to this AFF work, possibly because of the psychiatric mental status format itself. First, interpersonal problems are excluded in this outline, although many of them are mentioned elsewhere in the AFF work. Second, there is little or no consideration of the process element of differing onset points for various symptoms listed in the AFF outline, in contrast to the delineation of symptoms within the Goldberg' post-mind-control stages. Furthermore, as all others, AFF failed to include any systematic consideration of the clinical picture of current cultists or those 'mentally still cultists (but physically out). They followed the pattern of all preceding authors (but Spero, 1982) of relegating such material to their literature review on cult conversion. Consequently, AFF disregarded differing onset points for various symptoms during reevaluation, as well as the readjustment phases of cult recovery as outlined by the Goldbergs.

The proposed overview of the cultist's clinical picture will utilize the AFF ex-cultist material as a foundation, but will strengthen it with interpersonal problem material (while deleting the AFF behavior section), the Goldbergs' stage data, other relevant ex-cultist literature (e.g., Singer, 1978, 1979), and the available, albeit scant, reevaluation/cultist clinical picture data. It will also deviate from the AFF mental status exam model by incorporating its material on perception, intellectual functioning, memory, thought content, and decision-making into a combined section on ego functioning.

Over-view of Clinical Picture

While every effort will be made to point out differing onset points for the various symptoms during reevaluation and the three stages of readjustment/cult recovery, most symptoms and deficits presented below are most prevalent and troublesome during reevaluation and/or initial post-deprogramming. Also, unless noted otherwise, they are assumed to be gradually diminishing in effect throughout all the stages, but to have been reduced sufficiently by the last stage so as to produce a minimum of interference in the life of the individual ex-cultist. Likewise, any problems which begin during the middle stages will probably still be present in the next stage, though again, to a lesser degree of concern. A more exact delineation of symptom transformation awaits future research.

Ego Functioning

As pointed out earlier those entering cults often obtain relief from distress, but pay for this "improved" coping ability with the relinquishing of voluntary control of their individual ego functioning. Marked alterations in the ego functioning of cultists and ex-cultists may, therefore, be seen in their ego defense structure, in their ego strength and self-confidence, and in the onset of certain specific ego deficits.

Defense Structure. Spero (1982) suggested that cult devotees commonly reflect "a strongly preoedipal rather than oedipal quality in defense structure, reality orientation, and object-relational needs" (p. 338). For Spero, this meant narcissistic trends, passive-dependent cognitive qualities, and impairment in the ego function of psychological differentiation (pp. 334-339). While the first two were not completely eliminated by the termination of Spero's long-term individual psychotherapy (p. 339). the "cult-induced dedifferentiation of self-boundaries" with its resulting. idealization of the therapist was seen by Spero as "perhaps one of the most important characteristics of the cult devotee in therapy" (P. 341). This is because dedifferentiation, or extension of the ego interpersonally, is probably the most overt sign of the maladaptive ego functioning of most stable dissociative disorders. Just as "these two processes--splitting and symbiotic extension of ego boundaries--define (the) very pathology ... (of) the narcissistic and borderline personalities" (Beahrs, 1982, P. 38; cf. Kernberg, 1975), so do they also denote the essence of the pathology of the atypical dissociative disorder of cult conversion. In addition to the material on splitting or dissociation, support may be seen for the utilization of the following defense mechanisms by cult members: denial (Deutsch, 1980; Deutsch & Miller, 1983; Pruyser, 1977; Spero, 1980, 1982; Ungerleider & Wellisch, 1979b); externalization (Spero, 1982); overcompensation (Spero, 1980); overconventionality (Clark 1979b; Ungerleider & Wellisch, 1979b); projection (Spero, 1982); rationalization (Deutsch, 1980; Kemperman,1982; Pruyser, 1977); reaction-formation (Pruyser, 1977; Ungerledier & Wellisch, 1979b; West & Singer, 1980). Together these defenses form a rigid coalition (Spero, 1980, pp. 149, 151) to aid the maintenance of dissociation in its frozen emergency mental state.

While most of these defenses will function in the cult recovery stages, the rigid coalition of these defenses and dissociation will either be broken by the reality induction of marathon deprogramrning (Gilmartin in Sage, 1976, p. 47) or the return to more healthy, reality oriented self-other boundaries through the gradual distancing from cultic allegiance and/or the analysis of the therapeutic transference in psychodynamic reevaluation therapy (Spero, 1982, p. 341). Spero did not specify when the latter would take place, except that it would be made evident by the surfacing of a powerful fear of being overwhelmed. This suggests caution in the use of power techniques such as marathon deprogramming since an experience of being overwhelmed by the unmerging of self-other boundaries can precipitate a psychosis in individuals who had weak pre-cult personality ego boundaries (est examples: Kirsch & Glass, 1977, p. 1257; cf. Glass, Kirsch, & Parrish, 1977; Higgitt & Murray, 1983).

As stated earlier, movement from reevaluation to initial post-deprogramming will result in a metamorphosis in dissociation from a stable, frozen state to transient symptoms of dissociation such as cognitive slippage and floating, as yet to be described. Assuming a normal pre-cult personality, a proposed metaphor of the individual's ego functioning during this time will move from the "ice" of reevaluation to. the "slush" of initial post-deprogramming to the "steam" of reemergence before the normal temperature of "liquid water" returns. Assuming pre-cult psychopathology, the reemergence stage of cult recovery will reflect the resurfacing of any pre-cult personality defense mechanisms and coping styles that had not been utilized by the cult.

Low ego strength. This reflects itself in a split approach toward self and authority, in a way somewhat suggestive of the borderline personality disorder. One difference between the two cases appears to be that the borderline will vacillate between idealization and devaluation toward self and authority (i.e., Idealize self/devalue authority, devalue self/idealize others; cf. Kernberg, 1967, 1968, 1975), while the individual in reevaluation and the first stage of recovery from cult-induced dissociation will tend to be stuck in the idealization of authority and the devaluation of self.

The idealization of the cult brought the individual an increase in ego strength via symbiotic linkage/extention. Unfortunately, once a cultist leaves his source of strength, he will be seen to suffer from pervasive lack of self-esteem, self-confidence, and ego strength, with a significant increase in self -doubt and distrust of self-functioning (AFF; Clark, 1979b; Galanter, 1983a; Goldberg & Goldberg 1982; Langone, 1984, p. 72; Levine, 1979; Schwartz & Kaslow, 1981; Singer, 1979; Spero, 1982; Stoner & Parke, 1977, P. 413).

While this could be seen as a return of a pre-cult lack of self-confidence (e.g., Spero, 1982, p. 333), more usually it is seen as an artifact of the cult-induced dissociation and dedifferentiation itself. More specifically, dedifferentiation produced the converse uncritical passive receptivity to, and/or regressive dependency on, cult authority figures, and subsequently post-cult authority figures as well (AFF; Burtner, 1980; Clark, 1977, 1979b; Goldberg & Goldberg, 1982; Singer, 1979; Spero, 1980, 1982; West & Singer, 1980). Even more conclusively however, when the pre-cult personality does reemerge during the second stage of cult recovery, it almost always brings with it an increase in self-confidence and ego strength (Goldberg & Goldberg, 1982). Exceptions, of course, would have to be made for cases of serious pre-cult psychopathology.

Ego deficits. While the emergence of schizophrenia or borderline personality tendencies in some ex-cultists during stage two obviously present ego deficit problems needing therapeutic attention, during reevaluation and stage one of cult recovery almost all (ex-) cultists suffer from some ego deficits due to the cult-induced dissociative state of mind:

Impaired intellectual functioning -- Among the cognitive ego deficits seen in cultists during reevaluation counseling and the first stage of rehabilitation, perhaps the most widely noted in the literature is mental confusion. Extensive reliance on the cult renders the critical thinking of cultists "polarize&' or "dormant" (AFF, pp, 14, 15, 72). Spero (1982) noted the polarization as "significant constriction in cognitive process with a clearly defined preference for stereotypy" (p. 338). This was one of two general personality patterns seen by Spero in his testing of cult devotees, the second relating more to affect. However, both Profiles suffered from "a weakening of critical judgment and reasoning faculties," which was not helped by "mildly to severely dedifferentiated reality frames.,, Nor does deprogramming alleviate this problem. Singer (1979) saw ex-cultists suffering from "a blurring of mental acuity ... with subtle cognitive inefficiencies and changes" (P. 79), while AFF pointed to difficulty thinking "clearly and in a logical, sequential manner about anything," and to intruding thoughts from cult experiences and blind spots in memory (P. 21). Others who have pointed to the universality of this mental confusion In ex-cultists have been: Blackwell (1980); Clark (1977); Conway and Siegelman (1978); Galper in Aversa (1976); Goldberg and Goldberg (1982); Langone, 1984 P. 72); MacCollam (1979); Rothbaum (1980); Schwartz and Kaslow (1981); Schwartz and Zemel (1980); Singer (1978); West and Singer (1980).

Floating - First occurring during initial programming, floating is generally well-accepted as the ex-cultist's experience of slipping back into an altered state of consciousness, a return to the dissociated state where there are "associational disturbances in the flow of consciousness" (AFF, p. 22; cf. p. 62; Goldberg & Goldberg, 1982, p. 168; Schwartz & Kaslow, 1979, p. 23; Singer, 1979, pp. 78-79; West & Singer, 1980, p. 3249). As Spero (1982) has defined it, "Floating refers to a disorder in the ego function of the sense of reality, where the subject experiences something similar to dissociation from self, a foggy feeling, or an experience of being far away while physically stationary" (p. 335). The formula necessary for floating to occur appears to be the combination of a recent dissociative state of mind (i.e., having come out of an extremist cult), a low tolerance for frustration (common in most ex-cultists; cf. AFF, p. 19) and/or low ego strength (Goldberg & Goldberg, 1982, p. 168), and one of the following catalysts or triggers:

Key (cult-used) symbolic words, ideas, music, or chanting (Goldberg & Goldberg, 1982, p. 168; Singer, 1979, p. 78);

Emotional conflict, stress, anxiety, depression, difficulty in making a decision, or powerful emotional stimulation (Burtner, 1950, t. 3, s. 2; Singer, 1979, p. 78; Spero, 1982, p. 341); or

Simply having no focus (Singer, 1979, p. 79).

What occurs from such a mental reaction is best portrayed by Levine (1979):

An experience somewhat akin to 'flashbacks' among psychedelic chemical users occurs occasionally to ex-cultists. There is a sudden feeling of having been carried back against their will to an intense emotional state or even an altered state of consciousness. The individual tells you that he experiences 'being there' in the cult, he' can 'hear' the liturgy or chants, songs or sermons. This is followed immediately by intense fear and confusion. (p. 599)

Perhaps, Spero (1982) might see this as a flashback to symbiotic linkage with the cult via a combination of simultaneous dedifferentiated reality frames of self-cult and memory-dream (cf. p. 338). In addition to Levine, seven others (Burtner, 1980, t. 3, s. 2; Conway & Siegelman, 1978, p. 68; Goldberg & Goldberg 1982, p. 168; Langone, 1984, p. 72; Singer, 1979, p. 79) have seen floating as a return of the cult mind set. However, the AFF work has differed from the usual view of floating by preferring to employ the term to mean "dissociative states in which they often 'float' between their cult and reawakening pre-cult personality" (p. 62; cf. Appel, 1983, p. 146). This is a disturbance in the flow of consciousness where "the ex-cultist seems to vacillate from cult to non-cult ways of thinking and responding to the world" (AFF, p. 22). Perhaps, it may be related to the "transitional zone" Beahrs (1982) referred to, between the "waking" state and the trance of hypnosis (p. 20). Although Conway and Siegelman (1978) have associated floating with a return of the cult mind set (p. 68), they have also referred to it as "the limbo of conflicting emotions that often follows an intense snapping experience" (p.210). Thus, frustrating emotional stimuli will trigger snapping in the ex-cultist, which in turn triggers the floating. However, the fact that this floating contains conflicting feelings suggests that it is quite different from the frozen mind set of the cultist. While the danger is very real for the refreezing to occur should the ex-cultist listen to this impulse to return to the cult (often a major component of floating--cf. Appel, 1983, pp. 142, 148; Schwartz & Kaslow, 1979, p. 23; Stoner & Parke, 1977, p. 404), floating is best described as remaining quite fluid, i.e., "slush," a mixture of cold water and ice.

In summary, the term floating has been used to describe the experience of slipping back into a dissociative state of mind which may represent a return of the cult mind set, an altered state of consciousness somewhere in between the cult mind set and the reemerging pre-cult personality, or both. Figure 3 portrays this dissociative state visually.

Remerging Returning

Pre-cult personality Cult personality

Floating

Figure 3. Floating visually represented.

Indecisiveness--Because of not having utilized individual judgment and intellectual ability for an extended period of time, ex-cultists almost universally have trouble regaining the ability to make satisfactory decisions for themselves without ruminating over the "rightness" of it (cf. AFF, p. 22; Appel, 1983, p. 146; Clark, 1979a; Langone 1984, p. 72; Levine, 1979; Singer, 1978, 1979, p. 75; West & Singer, 1980). This is most troublesome in (reevaluation and) stage one, according to the Goldbergs (1982, p. 67), as it severely impairs the individual's ability to manage the routine tasks of daily living (cf. AFF, p. 66; Clark, 1977, 1979; Enroth, 1979, p. 16; Levine, 1980, p. 36; MacCollam, 1979, p. 27; Singer, 1978, 1979). However, Spero (1982) has noted indecision in stage two as being indicative of a serious risk of the ex-cultist returning to his former group. Spero suggests that this is seen in those ex-devotees for whom indecision and insecurity of an anomic vacuum accompanies the returning pre-cult personality, in contrast to the anger and active protests against cults which the Goldbergs (1982) associate with stage two (p. 342). (Note 5)

Impaired memory--Although cultic dissociation works well to split off and repress (Note 6) pre-cult memories, ex-cultists continue to exhibit "varying degrees" of memory impairment, including "the inability to associate cur-rent with pre-cult experiences, and the haphazard recollection of pre-cult experiences "referring at best to tangential but essentially unrelated subjects" (AFF, p. 21). Blind spots of memory affect intellectual functioning, and haphazard recollection and association of thoughts relate to floating.

Thought content--AFF noted that recovery from maintained dissociation commonly leads to depersonalization and derealization (cf. Clark, 1977), as well as the reverting back to recitation of cultic doctrine and formulas. Spero, on the other hand, saw depersonalization produced by the splitting off of guilt feelings and aggressive tendencies toward parents, self, etc. (1980, p. 167). After cult departure he sees, depersonalization elicited by floating, which is "similar to but not identical with derealization and depersonalization (1982, p. 335). Another thought content problem noted by AFF is obsessional thinking (cf. Deutsch & Miller, 1983, p. 769), which may include both suicidal and homicidal Ideation, as well as transient delusional thinking, including ideas of influence and reference (AFF, p. 22; cf. Duetsch & Miller, 1983, p. 768). These problems no doubt leave when floating does.

Perception difficulties--Although stage two may bring on these difficulties if the pre-cult personality was that of schizophrenia or borderline personality disorder, initial post-deprogramming does see some ex-cultists with AFF suggested this phenomenon is possibly the result of ."a continuation of obsessional thinking developed by conversion" (p. 21). Conway & Siegelinan (1978, p. 160+) suggested it is more likely to occur In those coming out of a group which emphasized practices tending to induce the delusional form of information disease where reality testing is more impaired, e.g. the Divine Light Mission or Scientology. And Kirsch & Glass (1977) saw it as the result of an inability of weak pre-cult ego boundaries to cope with the unmerging of self-cult boundaries (post-est examples, p. 1257). Although almost all ex-cultists suffer from dedifferentiation of reality frames, this ego impairment apparently results in perceptual difficulties of a hallucinatory nature in only a few.

Physical Appearance

While no one has presented a systematic picture of cultists' physical appearance, the literature does suggest that the cult-induced dissociation and/or cult practices of poor diet, health neglect, and lack of medical attention do result in certain specific physiological changes In cult devotees: the celebrated "glassy-eyed" look (AFF; Conway & Siegelman, 1978; Edwards, 1979; Levine, 1979; Singer, 1978; Spero, 1977, 1980, 1982; West & Singer, 1980), hormonal changes such as loss of beard and vocal changes in men and cessation of menstruation In women (Clark, 1979a, 1979b; Conway Stegelman, 1978; Enroth, 1977; MacCollam, 1979; Stoner Parke, 1977), and "wild alterations of weight, appetites, energy levels, and sexual functions" (Clark, 1979b, cf. lethargy in ex-cultists: AFF; Singer, 1979; Stoner Parke, 1977, p. 415; West & Singer, 1980, pp. 3249-3250).

AFF suggested ex-cultists frequently look depressed and usually present themselves with rigid, stooped posture, slow speech and slow response to external stimuli, "fixed, intense focus in the eyes" with rigid facial expression, and many times "an apparent indifference to physical appearance--dress and grooming!' with pale and often acne-blemished facial complexions (pp. 18-19).

The Goldbergs would apparently concur, as indicated by their observation that "physical demeanor often bespeaks their cult," e.g., many "keep their heads bowed and speak in a quiet, meek manner" (p. 167). Further in agreement with AFF, the Goldbergs noted first-stage speech as "monotonous, colorless, and halting" (p. 167), as well as the fact that "almost all the ex-cultists appear to be much younger than their chronological age and display an asexual innocence" (p. 167). During initial post-deprogramming ex-cultists lose many of the physical problems brought on by the cult-induced dissociation. Thus, according to the Goldbergs, menstruation and the growth of beards resume at a normal pace of hormonal activity, and it may be assumed that the glassy-eyed look of the ex-cultists apparently disappears along with the demise of floating.

Affect

Spero's (1982) psychological testing of 65 cultists reflected two basic personality patterns which showed two opposite ways of handling affect: a) the inhibition of most emotional processes with constricted cognitive processes, or b) "a manic denial of depressive trends" with emotional lability (p. 339). Both patterns, however, remained overly disinhibited in polarized guilt and anxiety.

Spero thought that the manic profile might be "merely another side of the constricted profile, (since)..."even constricted cult personalities undergo a manic phase during recovery as the subject attempts to deal with increasingly painful object loss following deidealization of the cult leader, group identity, or the therapist, and also because of the marked evidence of perceptual closure or abience in the Bender-Gestalt performance of most subjects" (p. 338). While several writers noted the flattened affect (Carr, 1981; Clark 1979b; Conway & Siegelman, 1978; Hopkins, 1978; Stoner & Parke, 1977; and West & Singer, 1980), three studies suggested Spero's theory of a mixed affective picture.

In the only other study to use projective testing, Deutsch and Miller (1983) found the test protocols of their four Unification Church subjects to show "a fluid mixture of hysterical (e.g., emotionally labile) and obsessional (e.g., overideational) features" (P. 769). Likewise, AFF, who noted behavioral observations, found a generally flat affect in ex-cultists with "a sense of depletion and distance" (p. 20) which, nonetheless, would give way to "volatility of mood' depicting affective ambivalence (p. 21). The latter feature was reaffirmed in Langone's (one of the AFF team) analysis of questionnaires from 94 parents of ex-cultists (1984, p. 72).

In addition, AFF presented ex-cultists as suffering from depression, guilt, distrust, fear, and outrage. Deleting distrust and adding shame the author suggests a revised list of affective problems which most ex-cultists experience:

Depression. For AFF, this is a mildly chronic depression which does impairfunctioning, though without much subjective distress (cf. Galanter, 1983a, p. 988; Langone, 1984, p. 72; Singer (1978, 1979). They considered depression a major ex-cultist problem and stressed the reappearance of a sense of meaninglessness (cf. West & Singer, 1980; Spero, 1982) and the addition of new losses: lost years, lost career goals, lost innocence and lost self-esteem. Schwartz and Kaslow (1979, 1981) observed a "profound and prolonged depression" in ex-cultists and related it to humiliation over being duped (cf. Etemad, 1978, p. 223; and Shapiro, 1977, p. 82) and over lost time in pursuit of career or other life goals.

The Goldbergs saw depression as a stage one hallmark, particularly as a "grief reaction following the loss of a way of life and of a leader who promised total fulfillment ... of a perfect world" (P. 166); cf. Spero's (1982) object loss following deidealization of the cult leader. AFF, Burtner (1980), Levine (1979), and Singer (1978, 1979) all reported a sense of loss regarding friends still in the cult. The Goldbergs, however, saw adjustment and the anger regarding lost friends (AFF, p. 70) and the missing years as more of a stage two concern.

Guilt. AFF referred to guilt "both for what they Tex--cultists) have done and what they have failed to do" (p. 20; cf. Langone, 1984, p. 72). For Singer (1978, 1979), guilt is a problem as ex-cultists "take up their personal consciences again" and have to face Pttle deception and dishonesty they participated in as part of the common cult activities (1979, p. 80). Others, however, have stressed these guilt feelings as coming from the indoctrination received in the cult, i.e., guilt for leaving the group and/or considering forbidden activities (Blackwell, 1980; Burtner, 1980; Levine, 1980; Levine 1979; Maleson, 1981). Goldberg and Goldberg saw this form of guilt playing "a major role in the initial reentry stage" (p. 168), guilt for having participated in deceptive cult practices, yet guilt feelings for going against the cult's values and doctrines. Clearly this affective problem Is "many sided" (AFF, p. 21) and "highly complex and dichotomous" (Levine, 1979, p. 599).

Shame. In contrast to the mere contemplation of cult-forbidden acts In the first stage, the second stage of cult recovery sees ex-cultists behaviorally trying out previously forbidden pleasures. This, the Goldbergs have suggested, leads to the emergence of feelings of shame, particularly regarding sexuality. The cults often attract recruits through their effective suppression of sexual feelings. When the cultic taboos go, the previous desires for, and conflicts about, sexuality return (cf. Singer, 1979, p. 76).

On the other hand, shame also is multifaceted for the ex-cultists. The AFF guilt for "what they have failed to do"--for having "shunned ordinary life in the first place in favor of bizarre cult activities" (p. 20), would more properly be termed shame (Note 7). It is most likely a reversal of the "logical dishonoring of self" which Lifton (1961) saw in the conversion process, and will, therefore, usually manifest in the "lost years" aspect of the ex-cultist depression, as well as in the sense of humiliation for having been duped (cf. Appel, 1983; Etemad, 1978; Schwartz & Kaslow, 1979, 1981; Shapiro, 1977). Singer (1979) identified this problem as "the agonies of explaining" (p. 80).

Fear. AFF saw three fears: fear of retribution from the cult for leaving, of having to explain their joining, and of becoming (or that they already are) psychotic, i.e., "crazy." AFF also placed Singer's fishbowl effect here--the sense of being continually watched.

Goldberg and Goldberg saw the fear of punishment by the cult for leaving as a first-stage affective problem. They associated it with the frequent occurrence of nightmares, a phenomenon also reported by Clark (1979b, p-4), Heller (1972, p. 133), and Stoner & Parke (1977, pp. 416-417).

Singer (1979) reported, "when members do leave, efforts to get them back reportedly range from moderate harassment to incidents involving the use of force" (p. 79). "At the root of ex-members' fear is often the memory of old humiliations for stepping out of line" (p. 79). Furthermore, "fear may be most acute for former members who have left a spouse or children behind in the cults that recruited couples or families" (p. 80). Thus, while paranoid tendencies might be revealed in psychological testing (Spero, 1982; Ungerleider & Wellisch, 1979b), and while ex-cultists may even demonstrate transient ideas of reference or influence (AFF, p. 22; Galanter, 1983a, p. 988), they still have legitimate reasons for their fears.

Levine (1979) has confirmed that this is a real fear, that it takes one of two forms:

either it is impersonal (spiritual or religious) in nature, or personal .(and physical). The former has to do with breaking the precepts of the religion, or sinning; it implies vague but powerful punishment from the deity or his incarnation on earth. The latter represents fear of retribution at the hands of cultists who have been betrayed. This fear occasionally prevents ex-members from sharing any information about their former religious group. It is usually irrationally based, but certainly has validity in some situations ... (P. 599).

Schwartz and Kaslow (1979) have simultaneously, though not as directly, differentiated between supernatural horrors to come, e.g., "doomed to be invaded by Satan," and more personal and physical punishment by the cult itself for any defection (p. 23).

Finally, in addition to fears of supernatural and physical retribution (with or without accompanying nightmares), fears of going psychotic (cf. Spero's "fear of being overwhelmed", 1982, p. 341--which in some cases should be a legitimate concern for the therapist; Kirsch & Glass, 1977, p. 1257) and fears of being asked to explain. Spero (1977) suggests that "if there were fears and ambivalences and tendencies toward regression prior to an adolescent's cult involvement, the deprogrammed youth experiences these ten-fold" (p. 338). With the reemergence of the old personality (stage two) will undoubtedly come all the fears and conflicts which the regressive conversion had previously helped to repress.

Anger. The reacquisition of self-confidence which accompanies the reemergence of the pre-cult personality (Goldbergs' stage two) almost always involves "a sense of outrage, indignation, and anger toward the cult" (AFF, P. 20) for having been duped, cheated, and used. The Goldbergs said this often takes on the form of a crusade against the cult(s) (cf. Langone, 1984, p. 72; Stoner & Parke, 1977, p. 425; and footnote 6 again), which Galanter (1983a) believes sometimes develops into a genuine "paranoid attitude toward the sect, even to the point of compromised reality testing" (p. 988). It might also spark attempts to rescue friends and family members still in the group (AFF, p. 70).

In addition to anger at the cult, both the Goldbergs (p. 169) and AFF noted the directing of anger at parents for their allowing the conversion to take place, as well as for their part in the rescuing and deprogramming. The Goldbergs, likewise, have suggested that conflicts with parents will begin to emerge during this time, particularly over their overprotective behavior. Schwartz and Kaslow (1981) have associated this conflict with the parental "caretaker response," but have also suggested that some parents' overprotectiveness might have contributed to their child's vulnerability to cult conversion in the first place. Again, whatever conflicts were there prior to conversion are sure to reemerge with the resurrection of the pre-cult personality. And whatever anger emerges can always be distorted into negative transference placed onto the therapist.

Interpersonal Problems

In addition to the effect of depression, guilt, shame, fear and anger upon relationships, the ex-cultists experience some problems unique to their readjusting to the social realm of the extra-cult world. In general, they tend to show poor social judgment or discrimination and a rather labile reaction to post-cult experience: for example, leaping quickly into a romantic relationship, only to withdraw just as swiftly, should the other not reciprocate (AFF, p. 19). Perhaps, passive dependency best describes the cultist's relationships overall, with ambivalence best describing the ex-cultists. For instance, both will want to be dependent on others (especially authority), but the ex-cultists will also oscillate between this blind trust and a suspiciousness and distrust of others (e.g., for having been duped before, cf. AFF, p. 20; Langone, 1984, p. 72). Specific interpersonal problems, then, come from dealing with extra-cult peers, authority figures and family members.

Peer problems. Many ex-cultists experience an impaired capacity for effective horizontal relationship interaction due to their cults having discouraged horizontal relationships in favor of vertical deference to leaders (cf. Enroth, 1977a, p. 174; Goldberg & Goldberg, 1982, p. 169;Martin, 1979, p. 147; Singer, 1979, P. 76; Spero, 1982, p. 342). But one must realize that poor heterosexual relationships often predated the cult experience, with the structured social life of the cult being one of its former points of attraction (e.g., Deutsch & Miller, 1983). Difficulties stemming from social skills lost during cult involvement are then compounded by fear and shame related to cult taboos, pre-cult anxieties regarding sexuality, dating, and marriage, and an upsurge of testing binges of dating, drinking, and sexuality (especially during stage two Goldberg & Goldberg, 1982, p. 169; cf. Singer, 1979, p. 76).

According to an anonymous psychologist quoted by Stoner and Parke (1977), "There is a great fear of commitment when a person leaves a cult. Ex-cultists have tremendous needs to confide and be accepted, but at the same time they are so afraid to get involved" (p. 413). Ambivalence distrust, yet great loneliness due to the loss of friends and intimacy provided by the group is frequently seen. And, in many cases, pre-cult friends are gone as well (Burtner, 1980 t. 3, s. 2; Goldberg & Goldberg, 1982, p. 168; Schwartz & Kaslow, 1979, p. 24; 1981, p. 26; Singer, 1979, p. 76; West & Singer, 1980, p. 3251).

Authoritv Problems. As previously discussed in the "Ego Functioning" section above, the individual withdrawing from an extremist cult will tend to persist in his emotionally dependent, passive receptivity to authority figures because of the continuation of impaired reality frames, which make differentiation difficult. His former mental linkage, or extension of his ego boundaries, to his cult leaders provides him with a boost of "ego strength" at the cost of relinquishing his voluntary control over his ego functioning.

Idealization of authority, therefore, brings with it the dissociative obverse of devaluation of the self, specifically the pre-cult self or personality. Transference seen during reevaluation and the first stage of cult recovery will, therefore, resemble that of the narcissistic and borderline personalities (cf. Beahrs, 1982, p. 159; Kernberg, 1967, 1968, 1975). The three syndromes will differ in that the borderline will vacillate between idealization of authority/devaluation of self and devaluation of authority/idealization of self, the cultist will tend to get stuck on the idealization of authority/devaluation of self, and the narcissist will demonstrate the converse (cf. Grotstein, 1981, pp. 182-183; Masterson, 1981, p. 30). More will be said about the handling of this transferential idealization of the therapist as an authority figure in a subsequent article.

The literature Is silent on what occurs to the ex-cultists' view of authority when the reemergence of the pre-cult personality during stage two brings an increase in self-confidence (i.e., ego strength). A reduction in the idealization of, and passive receptivity to, such figures may obviously be assumed. But an immediate resumption of a realistic view of authority should not be so easily taken for granted. Complicating this path toward reality testing and perception are the factors of stage two anger and the reemergence of pre-cult personality tendencies.

Anger felt toward the cult leaders, the parents, and even toward deprogrammers may be transferred onto the therapist during stage two. The author has found in his own ex-cultist rehabilitation counseling experience that this transference is particularly intense if the client came out of a dysfunctional family system (cf. Zerin, 1982) or encountered an unethical) manipulative deprogrammer.

Negative transference coming from pre-cult dysfunctions family systems may be related to the reemergence of pre-cult individual psychopathology and/or the reemergence of anger regarding family conflicts or problems. Anger which the cult helped to channel and control (cf. Salzman, 1966 pp. 17-19; Pruyer, 1977, pp. 345-347; or see the role of guilt in cult conversion as "anger turned inward," Ash, 1983, pp 68-69) is no longer being displaced so effectively, and the therapist is a much safer replacement for channeling than the family. Furthermore, Clark (1977) reported that 58% of cultists suffered from previous emotional or personality disorders, Galanter et al. (1979) reported that 39% had previous serious psychopathology, and most recently Sullivar (1984) reported 44% having prior emotional troubles or crises (pp. 96, 97). Furthermore, Doress and Porter (1978), Levine (1980), and West and Singer (1980) have all suggested that leaving the cult does precipitate the return of any such pre-cult conflicts and problems.

Family problems. The ex-cultist has to deal with previous familial conflicts he avoided through cult conversion and a new set of problems related more specifically to his cult conversion. Schwartz and Kaslow (1979), for example, have suggested that parents receive their returning children with a mixture of joy and anger, or confusion regarding the sense of rejection precipitated by their offspring's preference for the cult family. These parents also tend to revert toward overprotectiveness the "caretaker urge" (AFF, p. 77) to reassure themselves that their offspring will not return to the cult. Singer (1984, p. 80) labeled the resulting feeling of constantly being watched by family and friends the "fishbowl effect."

Concluding Diagnostic Comments

Atypical Dissociative Disorder

Those suffering from cult-induced dissociation, i.e., those still mental members (or captives) of extremist cults, should, with few exceptions, receive a DSM-111 diagnosis of atypical dissociative disorder (300.15). This would include those individuals who have physically left those totalitarian group but still retain the same mind set that they had while in the group, e.g., rigid defense of its doctrines, beliefs, and practices and/or continuation of its practices (such as extensive chanting).

Multiple personality. In a myriad of ways the cultist dissociative disorder resembles the multiple, or split, personality (DSM-111 #300.14). While such a comparison and differential diagnosis should be the topic of extensive research in itself, some shorter observations are definitely in order.

First, many similarities can be seen in the etiology of the two disorders. Of the "many roads to a split personality" which Beahrs (1982, pp. 98-99) lists, only the childhood history of having had "imaginary playmates" would appear to be ruled out, and even then a common denominator would be a heightened ability to enter hypnosis. Like the split personality, the road to the cult personality disorder often occurs through or involves "avoiding mental friction" and "escape from responsibility" (cf. Anthony, Robbins & McCarthy, 1980; Conway & Siegelman, 1978; Cox in Hopkins, 1978; Enroth, 1979a; Furlong, 1981; Hunt, 1980; Isser & Schwartz, 1980; Lasch, 1979; Levine & Salter, 1979; Maleson, 1981; Roche, 1979; Salzman, 1966; Schwartz, 1979, 1981; Spero, 1977, 1980), "amnesia and abdication of control" (regarding the latter cf. Ash's analysis of the "ego regression theory" of cult conversion 1983, pp. 63-71), "hypnotic negation of sense of self" (cf. Lifton's "logical dishonoring of self, 1961, pp. 76-79), and "environmental factors and developmental history" (i.e., double-bind communication used by both cult-vulnerable family systems and extremist cults as well; cf. "Personal Vulnerability" family factors above).

Beahrs has postulated that everyone has simultaneous multilevels of consciousness with corresponding ego-states, although all but one usually stay hidden, i.e., unconscious. In a healthy person the conscious part-self is like the executive or conductor of a finely tuned orchestra (p. 7), gently guiding his many subordinate part-selves. In someone with a dissociative disorder, the orchestra Is in disarray. The ego-states battle for executive control. The boundaries between them become more rigid, exhibiting a more restricted flow of inter-part information (pp. 8, 67). The cult dissociative disorder would fit this model in that the cult may lure out one previously latent child ego-state (cf. pp. 134, 138) and, through an alliance with this ego-state, overthrow the prevailing executive (adult) ego-state in a coup d'etat. What emerges is a dictatorial control with rigid amnesic barriers which limit, rather than enhance, the individual's power for action (i.e., dysfunctional splitting that is a symptom, not a skill; pp. 67, 81).

The two primary differences between the cult dissociative disorder and the multiple personality center upon extension and sudden shifts in executive control. While the cult personality disorder is a pathology of dissociation and extension/dedifferentiation (especially between self and others), the split personality generally reflects no ego deficit in differentiation. And while the multiple always demonstrates "sudden shifts in executive control among personalities" (p. 86), the cultist's (child ego-state) executor remains firmly in control, reinforced through symbiotic extension with the cult outside. However, this "control" is actually dubious, since the price for this alien reinforcement of power is always deference to the cult leaders.

Figure 4 visually summarizes the differences between the mystical experience, the cult dissociative disorder, the multiple personality, and the borderline and narcissistic personality disorders.