Excerpted with permission from Dissociation: Clinical and Theoretical Prespectives, ed. Stephen J. Lynn and Judith W. Rhue, published by Guilford Publications, Inc., 1994. Prolonged environmental stress, or life situations profoundly different from the usual, can disrupt the normally integrative functions of personality. Individuals subjected to such forces may adapt through dissociation by generating an altered persona, or pseudo-identity (West, 1994).

The three clinical pictures described below may be seen in recent converts who experience destabilization to the point that they drop out before a more fixed pseudo-identity is formed. They may also be seen after a pseudo-identity is formed but is subsequently destablized, even after departure from the cult.

1. "The Floater" Nothing distresses parents and loved ones more than witnessing a recovering, former cult member begin to "float." Floating is a dissociative phenomenon that is best described as a sudden switch back to the pseudo-identity, a regression which is most commonly triggered by certain sights, sounds, touches, smells, or tastes in everyday life that were ubiquitous and salient stimuli in the cultic milieu. Characteristically, floating occurs in cult members who have left the group of their own accord, have received incomplete counseling, or are still in the beginning phases of counseling. A former member who floats after phoning a cult member may, as a result, even return to the cult.

Jennifer, a college graduate, had served as a teacher overseas for 7 years with a well-respected religious organization. She then returned to the United States and joined a different church. Gradually, she and others of the congregation became entranced by their charismatic pastor. Over time, Jennifer began to believe ideas and to practice behaviors that previously would have been unthinkable to her. Despite her previous fundamentalist Christian beliefs regarding ethics and morality, Jennifer repeatedly engaged in illicit sexual activity with her cultic pastor, who told her that it would make her "more spiritual." No amount of persuasion by friends and family could convince her that the group or its teachings and practices were unhealthy. She eventually agreed to counseling, but only to convince her parents and friends that the cult was in fact healthy and that their fears were unfounded.

Initially Jennifer presented a rather robotic picture to her therapist. Her affect was flat and her speech was mechanical, as were her bodily movements. She exhibited clinical signs of dependency, anxiety, and depression. After many daily sessions, one day the therapist said something that shifted Jennifer away from her pseudo-identity. In the following session her affect and bodily movements were no longer stilted, and she began to express some of the doubt and pain that were appropriate to the reality of her experiences in the cult. In short, the "old Jennifer" began to re-emerge. The change was dramatic. Needless to say, Jennifer's parents were much encouraged.

A few days later in a group therapy session another patient said something critical about Jennifer's cult leader. The therapist watched Jennifer's eyes lose their focus. She stared off into space. Criticism of the leader apparently served as a trigger for her automatically to recite the programming that she had received in the group: that is, to defend the leader against all criticism. Subsequently, Jennifer required 5 to 6 hours of continuous disc ussion in which the therapist reviewed with her the cult leader's abusive and unethical behavior. With this cognitive exercise, Jennifer's frozen affect began to thaw again. She has since remained free from the cult, is now married with one child, and works as a school teacher.

2. "The Contemplator" Dissociative trance-like symptoms are often seen in members of cults or sects in which contemplative exercises are practiced, such as chanting or meditation. "Speaking in tongues" may also produce this effect.

Sabrina was a member of a martial arts sect for a number of years. Her parents became concerned about progressive behavioral and personality changes, together with her gradual estrangement from the family. Eventually Sabrina sought counseling when she began to experience significantly distressing symptoms. She was found to be suffering from a major depressive distressing symptoms. She was found to be suffering from a major depressive [Image] episode, with predisposing passive dependent and schizoid personality characteristics. Her therapist noted that sometimes Sabrina would begin to stare, her eyes would become unfocused, and she would become unaware of her surroundings. The therapist would literally have to call out her name several times in order for Sabrina to reorient herself as to time, place, person, and event. With Sabrina, there were no apparent cues or triggers for these trance-like states. When she entered these states she would find herself automatically engaging in some of the activities that had been a part of her martial arts training. Over the course of several weeks of therapy, Sabrina's episodes of contemplative dissociation diminished. In time, they disappeared entirely.

Sabrina was fortunate. In some cases, contemplative dissociation is very resistant to modification. Former cult members who have practiced chanting and meditation for hours a day over a period of many years may require special rehabilitation or extensive therapeutic measures.

3. "The Survivor" Certain dissociative symptoms are frequently evident in persons who have survived severely traumatic events. Herman (1992) notes that victims of incest, rape, terrorism, concentration camps, and cults share common responses to trauma, which may include feeling disconnected or detached from their selves or their surroundings (depersonalization, derealization), psychophysiological hyperarousal, intrusive memories of the trauma, and/or emotional and behavioral constriction.

Our clinical experiences with former cultists confirm that they may develop symptoms similar to those seen in victims of imprisonment, torture, incest, physical abuse, or rape. In about 25% of our cases, cults are found to have perpetrated sexual and physical coercion and other abuse, including the inculcation of fear, terror, or dread. Further, cults are seen to exploit group dynamics for social control, and to employ specific techniques to induce altered states of consciousness. It is interesting to note that one study of former cultists (Martin, Langone, Dole, & Wiltrout, 1992) revealed no significant differences in the MCMI between those who had been subjected to sexual and/or physical abuse, and those who did not report an abuse history. While usually the case, apparently neither brutal treatment nor confinement is necessary to produce the survivor type of clinical picture, as illustrated in the following case.

Charles was a graduate of a large state university. His parents enjoyed a solid marriage. His father was an anesthesiologist. Charles had joined a Bible study group while at the university and after graduation he, along with many of the group's members, moved to be closer to the leader of the group. These Bible study members found themselves part of a small, cultic rural compound that advocated white supremacy, militancy, and belief in demons as the source of virtually every problem. The leader advocated a series of extreme measures to rid the cultists of their demons. These measures included long and arduous fasts, beatings, physical threats of death, prolonged verbal abuse, isolation, public confession, and almost constant shaming and humiliation. Charles was subjected to all of these methods to exorcise his demons. His parents, fearing that he might be dying from the fasts, contacted the local police and had their son seen by a counselor. Charles was later referred for more extensive counseling in a residential setting.

At first appearance Charles was gaunt, his eyes were sunken, and he stared into space incessantly. He was listless and passive, resembling a Holocaust survivor. Although Charles was no longer in the cult, he had come to believe that he was indeed hopeless, wicked, and demonized. Clinically, Charles suffered from a depressive illness with obsessive compulsive features. He also met the criteria for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of Acute Stress Disorder and Brief Reactive Dissociative Disorder. His dissociative symptoms included trance-like states, derealization, depersonalization, psychic numbing: "I feel nothing; I feel dead." In addition, Charles experienced fear, intrusive recollections or flashbacks, hopelessness and, despair. Charles received daily intensive psychotherapy for more than 5 weeks. He was also prescribed fluoxetine, an antidepressive medication. By the time Charles left the treatment center he had gained weight and was no longer depersonalized, numb, or feeling a sense of despair. He continued in outpatient therapy for nearly a year. Currently, he is performing very well as a graduate student and was recently married.

Treatment Strategies

Patients showing clinical pictures of the subtypes described above may require special treatment strategies. Suggestions about these include the following:

1. Treating the "Contemplative." Dissociative and other symptoms resulting from contemplative cult processes may continue to be problematic in treatment long after other cultic symptoms have improved. Contemplative symptoms can include inability to concentrate relaxation-induced anxiety, and dissociative phenomena such as automatic lapsing into meditation or chanting, or trance-like states. Ryan (l993) found that one of the most effective methods to remedy the "spacing out" is physical exercise. Exercise may also help to alleviate other contemplative symptoms, such as lack of awareness of bodily sensations, muscle tension, fatigue, and the association awareness of bodily sensations, muscle tension, fatigue, and the association [Image] of these with emotional dysfunction or distress. Other helpful techniques include identifying aspects of the environment that create stimulus overload, slowly building up reading stamina by setting a timer and thereby gradually prolonging reading time, and learning to counter magical thinking through a specific series of reality checks.

Dissociation has been viewed as a phenomenon that is associated with subcortical areas of the brain (West, 1967; Putnam, 1989). To a certain, though lesser, degree the cognitive processing problems ex-cultists experience resemble difficulties encountered by some head trauma or stroke patients. Therefore, as with patients who have known neural lesions, selected cult victims may benefit from the employment of structured linguistic remediation. Some patients report that such methods, which focus on memory, concentration, linguistic encoding and decoding, are very helpful in reducing various types of dissociation. Specific exercises include: (1) reading several paragraphs aloud to the patient and asking him to restate the ideas expressed in the passage, (2) asking questions pertinent to the sequence of the content read to the patient, 3) asking the patient to analyze the story or to repeat it, and 4) inviting the patient to respond to sentences that require an expression of opinion relevant to the content. The clinician should note latency of responses, the need for clarification of the task or topic, the patient's memory for details, problems in his ability to focus and concentrate on the task, and deficits in expressive verbal skills.

Since altered states may result from a narrowed focus of attention and a limiting or restricting of external stimuli (as occurs in many cultic environments), awareness training in the visual, auditory, and aesthetic modes can be helpful. For example, by encouraging clients to name all the different sounds they hear in 30 seconds, and then all the colors and shapes they see in a room, the therapist reinforces awareness of sensory stimuli that a dissociative state may have diminished or even (in the case of a trance) abolished.

Various mnemonic devices for remembering details needed to engage in everyday activities can be taught to a former member so that he can better recall, for example, the five or six items he recently purchased at the grocery store. Daily readings of newspapers, magazines, or short stories can be useful as well, particularly when the patient interrupts the activity at regular intervals to check his recall ability and his awareness of the present environmental situation.

2. Treating the "Floater." Typically, a former member floats, or returns to a pseudo-identity state, as a result of a trigger that can be visual (i.e., seeing a book written by the cult leader), verbal, physical, gustatory, or even olfactory. To defuse the trigger, it must be identified and the cultic language or jargon associated with it examined. Words that are given unique or idiosyncratic meaning by the cult should be correctly redefined by showing the client the dictionary definition of the word. Sometimes merely concentrating on crossword puzzles and other word games can help a patient to diminish or prevent floating (Tobias, 1993).

The immediate or crisis treatment for floating involves orienting the patient sharply to present reality with respect to time, place, person, event, and self. It may be necessary to remind him repeatedly that he is no longer in the cult, to encourage him to engage in conversation, and to review facts that promote the experience of being himself in the here and now. Crisis treatment should also include a review of why he left the cult and the problems associated with it (e.g., exploitative or criminal behavior). Patients should be encouraged to make notes and list the reasons why they left the cult, along with personal and social problems that ensued from their cult experience. If they cannot reach their clinicians when episodes of floating occur, they can review their notebooks until the floating stops or they receive help.

Generally, floating is diminished by a thorough and comprehensive counseling process. The more the former member learns about the cult, and the more he is helped to understand the negative impact the cult has had on him, the less likely he will be to experience episodes of floating. If these episodes persist, more rigorous methods -- similar to those employed in treatment of major dissociative disorders -- may be required.

3. Treating the "Survivor." People forced by manipulative cult leaders to engage in and/or witness heinous acts often manifest symptoms of PTSD. Nightmares, intrusive thoughts or images, fearfulness, and various psychosomatic malfunctions are common reactions. However, the formation of a pseudo-identity is not necessarily associated with specific traumata, and the symptoms that cult members experience after they leave the cult may not be exactly those which meet the diagnostic criteria for PTSD. Nevertheless, the cult experience itself, and the process of disengaging from the cult, inevitably involve some degree of trauma to the person. The picture of a concentration camp survivor may result. To promote a full recovery from the sequelae of cult membership, the therapist should help the former member to learn about the dynamics of cultic groups and to understand how individuals in such situations can be induced to behave in ways highly deviant from their previous patterns, or to fail to behave in ways that were previously characteristic. Therapy should focus on "detriggering" and "reframing" the traumatic incidents that continue to affect the former member via educative strategies, cognitive-behavioral techniques, memory work, and dynamically oriented psychotherapy, as indicated.