Cult and Ritual Abuse

by Ann S. Earle, C.C.S.W., B.C.D.

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Ann S. Earle, C.C.S.W., B.C.D., is a psychotherapist in private practice in the Chapel Hill and Charlotte areas of North Carolina. She specializes in the treatment of abuse, trauma, and Dissociative Disorders.


Cult and Ritual Abuse: Its History, Anthropology, and Recent Discovery in Contemporary America. James Randall Noblitt and Pamela S. Perskin. Westport, CT: Praeger Publishers, 1995.

Satanic Ritual Abuse: Principles of Treatment. Colin Ross, M.D. Toronto: University of Toronto Press, 1995.

Given the current trend in our society to discount ritual abuse allegations, it is perhaps no coincidence that there has been a dearth of information on this topic for professionals who treat ritual trauma.

However, two new books, both released in the fall of 1995, help fill the gap in the literature: Cult and Ritual Abuse by Dr. James Randall Noblitt and Pamela Perskin and Satanic Ritual Abuse by Dr. Colin Ross. These books are among the very few that have been written by professionals who actually treat ritual abuse survivors and related disorders. They both address the political issues in this area of treatment but differ in how to deal with it.

James Randall (Randy) Noblitt and Pamela Perskin appear to have three primary goals in writing their book. The first is to present the ample evidence that ritual abuse has been practiced cross-culturally throughout the course of history. Second, to suggest that altered states of consciousness, historically referred to as "possession" in many religious traditions, is actually a dissociative phenomenon which includes Multiple Personality Disorder (now referred to as Dissociative Identity Disorder in DSM IV).

Finally, the authors contend that Cult and Ritual Trauma Disorder should be considered a new diagnosis.

Noblitt and Perskin offer results of their extensive examination of the historical and anthropological background of various religions, cults, and fraternal organizations, which indicate that traumatic rituals have been used for centuries to produce altered states of consciousness. Whereas in some cases these altered states have been viewed as "sacred," in many others the purpose is to establish control over other people. Their assertions are carefully documented and they include a great deal of interesting information in their footnotes.

Their survey includes African-derived cults such as Vodoun, Santeria, and Palo Mayombe; "New World Cultures" including the Incas, Mayans, and Aztecs; Shamanic traditions; and Gnosticism. Christianity too has a long history of belief in demonic possession and the use of exorcism and deliverance to expel these evil spirits or demons. Noblitt and Perskin point out that alter personalities may present as malevolent or demonic but from a secular, scientific viewpoint they do not agree that these are actually "demons." They present a list of 14 similarities between MPD (DID) and possession phenomena.

Case histories from Dr. Noblittís practice appear in most of the chapters providing contemporary examples of historical material. He also describes his own personal and professional evolution as a psychologist who started out specializing in phobic and anxiety disorders. While working on an Air Force base in England he began seeing many patients diagnosed as Borderline Personality Disorder. He discovered, as many other clinicians have, that these patients often had a history of childhood trauma. Noblitt describes himself as a "skeptic," by nature and training, and his acceptance of MPD came slowly. He describes the treatment of "Susie," his first diagnosed case of MPD, who turned out to be a ritual abuse survivor. This became a disconcerting trend in his practice as he saw increasing numbers of MPD patients who turned our to have a ritual abuse history.

The authors leave the treatment process for their second book. However, they do have an interesting chapter on the subject of cult programming; programming is, in many respects, an uncomplicated procedure based on classical operant conditioning. However, it can wreak havoc in the patientís personal life and in therapy. The patient can be triggered or accessed by various stimuli outside of their awareness. These programs are very destructive, leading to self-harm or even suicide, or drawing the patient back into the cult. Words, phrases, sounds, hand signals, visual cues, and touch are some of the triggers used to induce a trance state. The authors note that patients from different cults in different parts of the country have the same or similar programming on the most basic level..

The last section of the book is devoted to the contemporary problems and politics associated with the field of ritual abuse. This includes the effect of cutbacks in public funding for mental health as well as the impact of managed care on the treatment of these patients who often require intensive long-term care. This section also touches on the media bias on the topics of dissociated memories and ritual abuse which has created a general public disbelief and even ridicule. The authors describe their own experiences being manipulated by the media. They are particularly concerned about how this affects patients who were told, as part of their abusive programming, that no one would believe them if they told, and now feel further victimized by cultural disbelief.

Noblitt and Perskin recommend a new diagnosis of Cult and Ritual Trauma Disorder. They present their proposed diagnosis in the usual DSM format. They contend that there is no other established diagnosis that completely accounts for this disorder. For example, although many survivors have a dissociative disorder, there are others who do not. Similarly, not all survivors meet all the criteria for Post-Traumatic Stress Disorder. The authors assert that this new diagnosis would assist in providing a more accurate evaluation and treatment plan, advance the establishment of empirically validated criteria for research purposes, and lend greater clarity to forensic evaluations involving ritual abuse.

Noblitt and Perskin conclude with an analysis of the critics and skeptics or ritual abuse, whom they refer to as "nihilists" and "revisionists." They present ten separate arguments supporting the existence of ritual abuse, most of which are further elaborated and documented in the book. They ask: "Why do critics of this subject have to stretch reason and distort facts to make their point, given the serious consequences that may result if this kind of activity is occurring in actuality?"

Cult and Ritual Abuse:
Its History, Anthropology, and Recent Discovery in Contemporary America
by James Randall Noblitt, Pamela Sue Perskin

In Satanic Ritual Abuse, Dr. Colin Ross makes it clear that he has a dual purpose in writing his book: "to establish that good clinical work requires a balanced perspective, free of the limitations imposed by adherence to either end of the ideological continuum." He identifies these two extremes as the "skeptics" and the "believers" in ritual trauma. Ross belabors this point throughout the book to such an extent that his historical review and treatment suggestions appear almost secondary. The book ends with an Afterword by False Memory Syndrome Foundation advisory board member, Elizabeth Loftus, Ph.D.

In the beginning of his book Ross describes the historical and social background of various destructive cults, sects, and secret societies throughout history which may be connected with Satanism and ritual abuse.

This review, which covers some of the same material and the Noblitt/Perskin book, is not intended to be exhaustive but is more than sufficient to establish the probable existence of ritual abuse as a historical, cross-cultural phenomenon. Ross places special emphasis on the well-documented Nazi Holocaust and Catholic Inquisition, devoting a whole chapter to the latter.

A key concept that Ross refers to throughout the book is the "Psychology of Satan." He discusses the historical context and psychodynamics which gave rise to a belief in Satan. He points out that the split or "dissociation" of God and Satan has led to repression of the evil principle which is then projected out onto another person, group, or entity; a process that occurs in both the individual psyche and in the culture. Ross also sees the polarization between "believers" in ritual abuse and "extreme skeptics" as a contemporary example of this psychology of Satan.

There is some confusion as Ross moves back and forth addressing both sides of the continuum. Throughout much of the book he appears to describe ritual abuse as a given reality and tries to persuade skeptics of this. For example, he describes five levels of Satanism, ranging from "isolated criminal deviants" up through "orthodox multigenerational Satanic cults" and points out there have been successful prosecutions in every category except the last one. However, moving to the other side of the continuum he offers "alternative hypotheses" to the ritual abuse claims. He further states that among the approximately 80 SRA cases he has worked with "in none of these cases has the reality of the memories been objectively verified" and in some cases the memories are clearly false. He suggests, "for the sake of discussion" that perhaps only ten percent of SRA memories may be true.

Although Ross acknowledges that this is not a scientific estimate, he repeats it later in the book. Unfortunately, this is the kind of information that critics are apt to take out of context. Although Rossí intention is to be "neutral," he often comes across as equivocal and at times even contradictory.

The strongest part of Rossí book is the section on treatment. He emphasizes that treatment should be based on general principles of MPD therapy, with little variation on ritual abuse survivors. He provides a list of ten rules of therapy which address limits, boundaries, and ethics. He provides illustrations of what may happen if these rules are violated. This is very helpful and reminiscent of Rossí earlier book, Multiple Personality Disorder.

In this current book, he seems to favor a more problem-oriented treatment utilizing cognitive and internal family systems therapy. He specifically addresses some of the common problems in therapy and how to deal with them: i.e., double binds, suicide attempts, and other self-destructive behaviors.

He seems equivocal on the subject of cult programming. He believes the "deprogramming" model which some therapists employ disempowers the client.

However, he acknowledges that "the psychotherapy of traumatically implanted programming is arduous and difficult, no matter how it is framed."

Ross provides valuable information on treatment techniques. In reference to the management of counter-transference he emphasizes the importance of the therapist taking care of him or herself. As noted previously, he recommends a neutral stance toward the veracity of the patientís memories. However, he does describe the clinical picture of a ritual abuse survivor, including diagnostic indicators, and provides many useful suggestions for dealing with hyper-complex personality systems, and alters who claim to be "Satanic" or "demons." He also discusses how to identify and correct cognitive errors, how to deal with post-traumatic hyper-arousal, and his use of "fractionalized abreactions" in which memories are recovered in stages at a controlled rate.

He points out the importance of balancing memory work with a focus on current problems.

After returning once again to the question: "Is Satanic Abuse Real?", and pointing out that Satanism can be a cover for more mundane problems, Ross ends by addressing the extremes of denial and skepticism. He provides a history of the False Memory Syndrome Foundation. He states that there is "technically no such syndrome as ĎFalse Memory Syndromeí (FMS)."

After criticizing the FMS theory, Ross ends his book at the other end of the continuum. FMSF advisory board member Elizabeth Loftus is given free reign to respond in her Afterword to the book. Not surprisingly, Loftus jumps on Rossí arbitrary ten percent estimate and takes it a step further: she suggests that perhaps only ten percent of the elements in the memories of these ten percent are factual. For example, the patient may have accurately remembered a scene from her childhood but the directly abusive aspects of the memory may not be true.

Loftus dismisses Rossí information related to the veracity of ritual abuse with a single sentence, which in essence states that just because bad things have occurred historically, and there are bad people who continue to do bad things, this does not prove that ritual abuse is a reality. She similarly dismisses all of Rossí treatment recommendations in a few sentences; suggesting that the best way to treat MPD is to simply "ignore the alters" and they will disappear.

Loftus does not show any indication that she is open to a serious dialogue, or that she is willing to compromise, which is Rossí plea throughout his book. She is very consistent with the FMSF party line; this is not surprising to anyone familiar with her position and prior assertions.

However, it is surprising that Ross would allow his book to end with an attack on the basic tenets and principles which he has so carefully elaborated.

Satanic Ritual Abuse : Principles of Treatment
by Colin A. Ross, Elizabeth F. Loftus

THE SODIUM AMYTAL INTERVIEW
James Randall Noblitt, Ph.D.

The sodium amytal interview is described in the literature as an effective diagnostic and treatment modality for dissociative disorders (deVito, 1993; Putnam, 1989; Ross, 1989). Horsley (1943) who invented the term "narcoanalysis," reported a zero mortality rate in over 2000 chemically mediated interviews. Sodium amytal, which is known chemically as sodium amobarbitol, is a barbiturate which, when administered intravenously, produces a relaxed and sleepy state in the subject.

While in this state the patient tends to become more talkative, uninhibited, and spontaneous with what appears to be less guarded and defensive speech and behavior. Sodium amytal is not "truth serum" and individuals can lie or otherwise report misinformation under the influence of this barbiturate. However, individuals with dissociation of identity typically respond with overt symptoms and signs of their dissociative disorder including flashbacks, abreactions, and visual imagery with narratives by the patient in alternate dissociated identity states.

This procedure provides an opportunity for clarifying the possibility of a diagnosis entailing dissociation of identity (e.g., dissociative identity disorder, dissociative disorder not otherwise specified) when the symptom pattern is otherwise equivocal or would benefit from further internal corroboration. In most cases after the interview is completed, the patient reports a sense of having gained new information about his or her dissociative disorder.

Generally, the interview is not conducted merely for information gathering, it also has therapeutic value. The calming effect of the medication provides an emotional analgesic, (1) assisting the patientís coping with traumatic images and memories, (2) minimizing the risk of retraumatization by the therapy process, and (3) desensitizing the patient to the traumatic material.

The sodium amytal procedure is not only helpful for clients who believe that they have been victimized but it also may be useful in assisting perpetrators who have dissociated their acts of violence (Melton, Petrila, Poythress, & Slobogin, 1987). In my own practice, the sodium amytal interview is not directly utilized for the purpose of "memory recovery." The sodium amytal procedure merely allows the client to explore his or her experience while in a dissociated state.

Although memory is one kind of experience, an individualís experience may also consist of sensations, perceptions, fantasies, thoughts, beliefs, emotions, etc. I do not attempt to convince a patient that any of his or her experiences are memories versus fantasies. Ultimately this is a determination that is the patientís responsibility to make by sifting through the evidence of his or her own experience. In any case, if a patient feels traumatized by fantasies or memories, this trauma experience must be resolved in order for the patient to experience wellness. In the more than 200 sodium amytal interviews I have conducted, there have never been any complaints of adverse side effects. The majority of patients undergoing this procedure report that it was beneficial to them. None of these patients has ever expressed any regret for having participated in the sodium amytal mediated sessions.

However, the sodium amytal interview is no panacea and it is important for the practitioner to explain to the patient the limitations inherent in the procedure. It is essential that appropriately trained medical personnel administer the medication in a medically appropriate environment. Of equal importance is insuring the protection of patient and clinician alike via informed consent and detailed releases. Sodium amytal is another valuable tool in the treatment of dissociative disorders.

References
deVito, R.A. (1993). "The use of amytal interviews in the treatment of an exceptionally complex case of multiple personality disorder." In R. P. Kluft & C. G. Fine (Eds.), Clinical perspectives on multiple personality disorder (pp. 227 - 240). Washington, DC: American Psychiatric Press.

Horsley, J.S. (1943). Narcoanalysis. New York: Oxford Medical Publications.

Melton, G.B., Petrila, J., Poythress, N.G., & Slobogin, C. (1987). Psychological evaluations for the courts. New York: Guilford.

Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.

Ross, C.A. (1989). Multiple personality disorder: Diagnosis, clinical features, and treatment. New York: Wiley.

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