Joseph Kelly spent 14 years of his life in cults. There were two of them, both New Age-influenced, “large group awareness” cults based in Philadelphia, where he went to college. Kelly recalls forming a deep, intractable attachment to the cult lifestyle. For years, he overlooked the fact that meditation was prescribed as the solution to every conceivable problem. Even when he brought unspecified legal action against his first guru, Kelly stayed in thrall to the second one, instead of disavowing cults altogether. He finally questioned his loyalties when he realized that his inability to levitate was making him distressed.

Since 1989, Kelly’s been able to call himself an ex-member, the term he prefers over “cult survivor.” Today, as a cult intervention specialist, he leads seminars and workshops for fellow ex-members, mostly under the auspices of the International Cultic Studies Association, where he works as a thought reform consultant. Put another way, Kelly helps ex-members adjust to life without a guru, and a significant part of his job entails teaching them how to be patients and form appropriate relationships with healthcare providers.

“Ex-members describe leaving a cult, and their lives afterwards, as walking through a spider web,” Kelly says. “The cult teachings cling onto you. This can have a huge impact on how they perceive the medical profession itself, and on what they consider scientifically valid.”

Cults might seem like a relic of the mid–late 20th century, when fringe groups like the People’s Temple (Jonestown), the Manson Family, Heaven’s Gate and Rajneeshpuram commanded attention with their bizarre rituals and tragic, sometimes terrifying, final acts. But cults haven’t fallen out of existence; they’ve just evolved. Modern-day cults vary in their belief systems, power structures and ritual practices. Most of them keep lower, less outwardly wacky profiles than their forebears, opting to hide behind normal clothes and build followings the same way everyone else does — on social media.

Experts disagree over how many cults are active, as well as how to draw the line between a cult and a quirky association or religion. One thing they do agree on is that people who leave cults (meaning groups that ex-members themselves classify as cults) face distinct, poorly understood and often overlooked healthcare challenges.

In the past three decades, a niche field of cult aftercare has emerged to support the recovery of ex-members, which means both helping ex-members get the physical and mental treatment they need and teaching clinicians how to provide it. Specialists include ex-members like Kelly, who’ve successfully reentered society themselves, as well as academics, medical doctors, criminologists and clinical psychologists. Some of them form service organizations, like reFocus, a cult aftercare nonprofit that connects ex-members with specialists and support groups in every state, Canada and the U.K. The common goal of cult aftercare is to help people who’ve left cults rebuild their lives, a process that includes reclaiming personal agency in healthcare.

It’s not clear how many people are part of cults at any given moment. Cultic population estimates are broad and varied: The International Cultic Studies Association claims that 2.5 million U.S. citizens have joined cults since the 1960s, while some experts insist the number is much higher.

There’s also no universally accepted definition of a cult — the ICSA resists defining the term or publishing a list of recognized cults — but a number of experts have defined cults as “groups that often exploit members psychologically and/or financially, typically by making members comply with leadership’s demands through certain types of psychological manipulation, popularly called mind control, and through the inculcation of deep-seated anxious dependency on the group and its leaders.”

Kelly specializes in working with ex-members of what he classifies as New Age cults, which operate under the thumb of a guru or mediation leader, and sometimes a second-in-command disciple. Members of these groups engage in constant meditation and/or prayer, follow rigorous diets and generally lead lifestyles bound by an exacting set of rules.

“Ex-members have to be trained to accept that they, not someone else, are in charge of their own bodies, minds and health, because the cult takes away all that responsibility,” Kelly says. “They’re given back the reins to their lives, and that can be very confusing and alarming.”

For many ex-members, going to the doctor isn’t merely another to-do item. It’s a frightening or even traumatizing ordeal, but an ordeal that’s nonetheless necessary, particularly for ex-members of cults that withhold or delay medical care. There are both religious and non-religious cults that use denial of care or persuasion against seeking care as a way to isolate members from the outside world. Cults often teach members that all basic needs, including the need for healthcare, are met by the cult’s practices. Alleged paths to healing might include prayer (i.e., faith healing), meditation, extreme diets or mystical rituals. To seek outside help is to betray the cult and reject its belief system.

“A lot of my work is helping people put aside magical thinking and replace it with critical thinking, so [they can] develop skills for seeking useful, fact-based healthcare.”

Cult aftercare, Kelly says, involves compensating for neglect and tending to the physical and mental effects of cult practices, such as ailments brought about by outlandish, unbalanced diets, injuries incurred during devotional tests and open psychological wounds left over from mind control.

“Doctors have to express clearly to ex-members what they are able to do and what they are not able to do, because the ex-member just came away from a situation where their leader could do anything, was perfect,” says Marie-Andrée Pelland, director of sociology and criminology at the Université de Moncton in Canada. Pelland has worked with ex-members and psychologists who treat ex-members for years. “The doctor needs to be sure that the patient understands a health problem in basic scientific terms,” she says, “because in the cult, a health problem could have any sort of explanation,” mystical or otherwise.

One obstacle keeping ex-members away from exam rooms and fainting couches is mistrust. Most cult members are trained to be wary of authority figures. As a result, they’re often resistant to modern medicine but receptive to quackery, making them easy targets for bunk healing fads.

“A lot of my work is helping people put aside magical thinking and replace it with critical thinking,” Kelly says, “so that they have some underpinning to help them develop skills for seeking useful, fact-based healthcare. Of course, it’s really hard for ex-members to trust doctors, especially psychiatrists, because psychiatrists are always a target of guru-healers.”

For therapists, doctors or any other type of healthcare provider, Pelland offers the following blunt assessment: “A doctor is there to help, but in the end, it is the ex-member’s process.” In turn, it’s the doctor’s responsibility to treat each ex-member as a unique case, and not to assume that this patient is a brainwashed zombie who can’t take part in their own healthcare. “Doctors are like any other people,” Pelland says. “They have preconceptions about what is a cult, but those must be set aside. Everybody knows Jonestown, but not all cults are Jonestown.”

Healthcare providers may have trouble just getting ex-members to talk about their former cults, but the details of their cult experiences are relevant to their medical needs. “Doctors are hesitant to step into the area of belief — that’s a no-go zone for them,” Kelly says. “But the impacts of the belief system can be dramatic and have a deep effect on the choices the patient is making, even after they leave the cult. A doctor needs to have some basic knowledge of the cult — of what people ate, what they did all day, how they treated their bodies, and to know that even the physiology of the patient has been determined by the cult’s ideology.”

Sometimes, health problems are what drove ex-members into cults in the first place. “I do encounter people who got involved with healing groups after being diagnosed with cancer or another serious illness,” Kelly says, “people who subsequently die early, unnecessarily, because they ignored real medical advice when they were in the cult.”

To complicate things further, ex-members might also look to doctors as replacement leaders, while simultaneously distrusting their medical advice.

“Ex-members almost always have the desire to find another group or another leader or ideal, and they can hop from doctor to doctor looking for a new authority figure,” Pelland says. “Sometimes they construct their identity through their relationship with their therapist or doctor. The doctor can become the new god.”

The cultic spider web once clung to Matthew Remski, 47, at every turn. Remski is a Canadian-American writer, yoga instructor and anti-cult activist who’s been in two cults. After leaving the second one, he began the long road to recovery. The first step was relearning how to form and sustain healthy relationships. “I needed to reconnect with my family and former colleagues,” Remski says. “That was really hard.”

Years after leaving the second cult, Remski still resisted mainstream medical care and psychotherapy, out of fear that he would transfer what he calls an “authority wound” to the therapist. In other words, he worried that a doctor would become his new guru. Other lingering injuries turned up in unexpected ways.

“I didn’t use soap or shampoo for about 10 years after leaving,” Remski says. “I knew my body odor was offensive to some; part of me was ashamed and part of me was indignant. I now understand hygiene failure as a symptom of major depressive disorders, but there was something else at play in my belligerence. Both of the cults I was in preached disembodiment, bodily disgust. [One cult] went so far as to teach that the body isn’t real.”

“Years ago, we thought we as therapists had to act the same way as the cult — you know, kidnapping the person, harsh deprogramming, etc., like in the movies. But we know now that ex-members have to retrain themselves for the world.”

In addition to the difficulties ex-members encounter in all healthcare scenarios, there’s a subset of challenges specific to mental healthcare. Pelland tells psychologists working with ex-member patients to be prepared for a difficult and at times bizarre therapeutic dynamic, one that requires enormous patience and clarity.

“The therapist has difficulty understanding the ex-member’s experience, because the complexity of the mind control is outside the therapist’s training,” Pelland says. “So the therapist becomes at first more like a spectator. Ex-members have a lot of trouble finding therapists who understand them.”

One effect observed in ex-members, called floating, describes a phenomenon whereby an ex-member is caught between their original pre-cult identity and a second persona developed as a coping response to the cult environment. In practical terms, Pelland explained, this means a doctor might face the need to treat two patients — one ready to get back to reality, the other still strapped into the cult mindset. In general, cultic mind-control has been compared to the psychological process underpinning domestic abuse.

No two cults are exactly alike, and no one recovery path is a fit for all ex-members. Some benefit from a one-on-one sessions, while others get more out of group therapy.

People who’ve been in healing-centered cults, especially those that emphasize extended periods of isolation, meditation and fasting, are already well-versed in therapeutic practices and their dynamics, because they’ve spent time immersed in daily, hours-long therapy-like scenarios. While this may make a therapy-based transition back into the world easier for some ex-members, it can also turn them into jaded customers. Furthermore, because traditional outpatient talk therapy is typically limited to one hour-long session (or two sessions, maximum) a week, mainstream psychological treatment can seem inadequate and superficial.

“The gap between the kind of caring and support they felt they were getting in the cult and [what they then get from a] psychiatrist is enormous,” Kelly says.

The majority of healthcare providers who specialize in cult aftercare also consider participation in a support group to be a necessary part of treatment, as York University psychologist Robert T. Muller explains in an article for Psychology Today. For an ex-cult member, however, joining a new group can feel like a cult experience redux. That’s why, Muller argues, it’s important to make sure that no support group created for ex-members in any way resembles a cult gathering. To keep the environment as un-cult-like as possible, a mental health professional will co-lead a group alongside an ex-member, who acts as “an observer, guide and consultant.”

Another complication stems from disagreement over methodology among experts. The “snatch and deprogram” approach supports immediate, sometimes forced removal from the cult (by family members who hire cult extractors) and rigorous, relentless negation of cult doctrine, performed by professional deprogrammers. There’s also what might be most easily described as the therapeutic approach, which focuses on slowly rebuilding well-being and independence through psychological counseling. Both approaches have their champions and detractors, and neither has proven to be error-proof or wholly effective.

Because “deprogramming” costs a lot of money and entails the capture and detention of cult members, many families hoping to rescue loved ones from the clutches of cults opt for exit counseling. This begins with gradual reconnection to the cult member; once trust is reestablished, it continues with ex-members and their families attending joint therapy sessions.

Pelland supports an integrated approach to post-cult care, one that doesn’t belittle the ex-member’s former (or current) beliefs but still preserves clear boundaries between client and therapist. “Years ago, we thought we as therapists had to act the same way as the cult — you know, kidnapping the person, harsh deprogramming, etc. Like in the movies,” she says. “But we know now that ex-members have to retrain themselves for the world, because any argument they hear from an authority figure after the cult is suspect to them. Instead of being ‘deprogrammed,’ ex-members have to find the answers themselves.”

That’s how Remski reentered society — gradually and on his own terms. Still, the process was bumpy. What sticks with Remski most, years later, is how cult membership robbed him of joy. “It’s taken me a decade to feel enchanted with my life,” he says. “Ex-members need sources of re-enchantment as much as they need medical and psychological care.”

Efforts to rebuild his sense of self were impeded by his poor physical state. “I was malnourished,” he says. “Both groups advocated a strict vegetarian diet, which could have been fine but for the intense amounts of labor each group demanded, which I believe led me to over-consume sugars and caffeine in lieu of protein.”

Even his base cognitive functions were in disarray. Remski had gone from being an acclaimed novelist to someone who struggled to grasp language. “I remember being on the Toronto subway and trying to read advertisements on the wall and wondering why they seemed to be written in Polish.”

As with many ex-members, it took a medical emergency for Remski to abandon cultic thinking once and for all. “I was hospitalized for a life-threatening blood clot,” he says. “Also, my current partner had delivered our first son via a near-emergency caesarean. Both of those profound experiences helped bring me back into a secure relationship with authoritative caregivers. They showed me that real networks of care exist.”