Taking Ritual Abuse Concerns to the Public: Reality and Perception in the Media

Pamela Perskin, Executive Director

The International Council on Cultism and Ritual Trauma

PO Box 820279

Dallas, TX 75382

(214) 712-2984 voice mail

rabuster@aol.com

www.iccrt.org

What is Ritual Abuse and why should it matter to me?

We read our daily paper or hear on tabloid quasi news programs about lurid occult ceremonies involving heinous acts of sexual depravity, worship to Satan, human sacrifice, and we are incredulous.  How can this be happening in the most technologically advanced country on the planet?  What could be the agenda of the individuals making such allegations?  The media tend to make such reports tongue in cheek or with the suggestion that the real victims of these accounts are not the so-called casualties, but the accused perpetrators.  And the real perpetrators, these explanations allege, are those who put such ideas in the heads of obviously suggestible and fragile individuals: mental health professionals, vindictive parents (usually mothers) attempting to obstruct the relationship between their children and estranged spouses, over-reactive child protective services caseworkers, paranoid police officers, or overzealous clergy looking to strike a blow against the devil’s work.  And we are left to ponder, whenever these reports surface, what’s really going on here?

Cults and ritual magic are a part of our history.  Almost every culture carries the legacy of occult belief systems and practices. [1]   Many of these practices have survived the centuries and continue to exist and thrive, secreted not only from the mainstream of society, but from the conscious awareness of many of its victims. [2]   How and why this occurs is open to speculation.  The explanation that I find most credible is that such rituals are at the root of a complex system of exerting control over certain individuals, particularly children, whose vulnerability can be exploited by predators who derive gratification from their exercise of such control.  Reduced to its simplest level, rituals accompanied by extreme, deliberate, controlled trauma are utilized to condition the victim of these acts to experience dissociation of identity.  Subsequently, the resultant altered mental states are trained to enact specific roles designed to perpetuate his or her own victimization by disconnecting the abusive experiences from conscious awareness.  Ultimately, this disconnectedness can manifest itself in a variety of behavioral, emotional, physical, and/or psychological problems.  It is when these problems become evident and overwhelm the individual that police, clergy, social services, and mental health professionals enter the picture.  And herein lies a problem.  Because of the complex array of symptoms the victims of such experiences can exhibit, and because of the subjective nature of the observations that may support the suspicion that ritual abuse is a factor in the development of such symptoms, accurate appraisal and intervention is unlikely.

Allegations of Ritual Crime

A few years ago, several individuals contacted us regarding a criminal case in a small east Texas town involving allegations of malevolent ritual activity.  Fifteen minor children, all part of an extended family, reportedly had been taken into the custody of Child Protective Services in response to allegations of child abuse that were supported by physical examination.  As the children became acclimated to their environment and secure that they were protected, they began to reveal details about the nature and extent of their abuse that included physical, emotional, verbal, sexual, and ritual elements.  Some of the children were too young to have developed adequate language to describe their experiences, but those that were able to do so reported sexual and ritualized activities that were beyond their capacity to invent.  It is notable that these children were, for the most part, reared in a rural and unsophisticated environment and lacked exposure to cultural influences such as television that might have accounted for some of their allegations.  However, two adult women, aunts of the outcrying children, testified to their own childhood experiences of sexual and ritual abuse which they reported to be a tradition passed down throughout the generations. 

One of the older children, a boy of approximately nine years of age, graphically described a particularly horrible event involving the abduction, rape, ritual murder and cannibalization of an area teenager who had disappeared without a trace.  His report was confirmed by others among the children who identified the adults who participated in the act.  The children’s accounts were believed to the extent that the district attorney in their community called upon the state attorney general to appoint a special prosecutor to investigate the children’s stories.  The prosecutor and his investigative team, officers of the Department of Public Safety, interviewed the children, investigated the sites where the children alleged they had been abused and the young girl had been murdered and discovered evidence they believed corroborative of the children’s reports.  The adults implicated were arrested and indicted by the grand jury.  At least two of the alleged perpetrators confessed to their participation in the crimes the children reported, and one of these individuals passed a lie detector test that confirmed the children’s story.  The area newspaper warned of Satanic cults operating within the community and area clergy decried Satanism from their pulpits.

When the children implicated an area police officer as one of the participants in their abuse as well as the murder of the area teen, there was a shift in the management of the case by the Attorney General's office.  The children were removed from the foster homes where they had found security, acceptance and safety and placed in an institution several miles away.  The Child Protective Services caseworkers who had intervened and removed the children from their abusive homes were taken off the case and forbidden to interact with the children further.  The special prosecutor and his investigative team were dismissed and replaced by a team from the state attorney general’s office.  Subsequently, numerous problems in the investigation ensued including the inexplicable loss of evidence, the reidentification of remains found at the site of the alleged abuse, and the theft of six boxes of files pertaining to the case from the police station. 

Ultimately, despite the confessions of two of the alleged perpetrators, the indictments were dropped and the suspects released.  The children were returned to their families of origin and have reportedly recanted their stories.  The accused perpetrators engaged in lawsuits against the special prosecutor, his investigative team, and the Child Protective Services caseworkers.  No sign of the missing teenager or her body has been found. 

This case was lost and the children left unprotected because of a host of mistakes in the investigative process and misunderstandings regarding the nature of ritual traumatization by the state Attorney General’s office and the court.  Although the caseworkers and investigators intervened with the best of intentions, the manner in which both the Child Protective Services personnel and the special prosecutor’s investigators interviewed the children was deemed suggestive.  And because the investigative team utilized imprecise language and engaged in depictions of the motivations of the alleged perpetrators that are impossible to substantiate, they left themselves open to harsh criticism by the Attorney General’s office and others.  Finally, the children’s ultimate recantation fueled the speculation that their stories had been suggested or coerced by overzealous Child Protective Services caseworkers and the special prosecutor’s office who were motivated by a close-minded religious agenda opposed to alternative belief systems.  

This story illustrates some of the problems that arise in cases where allegations of ritual abuse occur.  Many of these problems are a consequence of imprecise and inaccurate language, poorly defined terms, politically based assumptions, religious orientation, and lack of objective and scientific oversight.  Thus, these problems may be remedied by establishing (1) unifying language based on legally and scientifically acceptable definitions, and (2) objective criteria to identify and adequately intervene in circumstances of ritual abuse.  However, the establishment of legally and scientifically acceptable definitions and objective criteria is a politically charged task.

Our first step toward the establishment of universally acceptable definitions is to provide for an objective and scientific environment in which to frame our language.  Free of the influences of cultural and religious values and dependent primarily on empirical evidence, this setting would provide the laboratory in which we could develop and incorporate ideas about how to best express the experiences victims describe.  Unfortunately, no such environment exists.  There is no way we can completely disconnect ourselves from our history, nature, culture and beliefs.  However, we can emulate the scientific model and apply scientific principles to minimize the biased interpretation of the reports and the psychological and behavioral ramifications we observe. 

Defining Ritual Abuse

There is some disagreement within the mental health community regarding the legitimacy of the term “ritual abuse.”  Some believe that the term is too emotionally charged, religious, and unscientific.  Using the term “ritual” connotes religious context for many.  Some have proposed alternate phrases such as “organized abuse,” “sadistic abuse,” or “structured abuse.”  I prefer the term ritual abuse for two reasons.  Firstly, that is the term introduced and used by many of its victims.  Secondly, it is more accurate and less ambiguous than the alternatives.  My co-author, Randy Noblitt and I define ritual abuse as abuse that occurs in a ceremonial or circumscribed manner and where the abuse causes traumagenic dissociation and/or establishes or reinforces control over dissociated states already in existence.  This rather simple and unembellished definition appears to satisfy in concrete terms what its alleged victims and perpetrators report.  The term, ritual trauma, does not make the assumption or the judgment that the experience was abusive, but does involve the assumption that the experience was traumatic (e.g., the sun [gazing] dance of North American Plains Indians.)  We define ritualistic abuse as being like ritual abuse, but not all the above criteria can be proven or demonstrated.  (For example, there may be evidence of a ritualistic killing where only the body is found.  The possibility that dissociated states may have been created or controlled during the criminal act is unknown.)

Some ritual abuse may occur within a cult or cult-like setting.  But exactly what is meant by a cult?  It is said that all religions started out as cults.  If you were to ask the man on the street his definition of a cult, he would likely tell you that it described anyone’s religion other than his own.  There are actually many types of cults.  The following classification of destructive cults is reproduced from the book, Cult and Ritual Abuse: Its History, Anthropology, and Recent Discovery in Contemporary America, co-authored by Randy Noblitt and me.

1.         Destructive religious cults are associated with a particular religious practice, belief or system of rituals and may be further subdivided as follows:

a.         Destructive apocalyptic cults promote fear and paranoia along with unfounded predictions that the world is about to end.  Destructive apocalyptic cults may be distinguished from apocalyptic religions in that the former utilizes abuse, exploitation and mind control methods.  Examples would include the Branch Davidians, Order of the Solar Temple and Aum Supreme Truth.

b.         Destructive pre-industrial cults meet the criteria for destructive cults and also embody the traditions of pre-industrial cultures (e.g., African and New World vodoun and Santeria sects).  Although some such religions may be considered destructive cults, one should not automatically assume that all are.  Again the criteria of abuse, exploitation, and mind control are essential to defining a cult as destructive.

c.         Destructive demonic cults meet the criteria for destructive cults and also promote the worship or reverence toward a malevolent deity, spirit or principle (e.g., Satanism, Luciferianism) or those cults which use others’ fears of demons to manipulate or control them.

2.         Fraternal organizations which meet the criteria for destructive cults.  These groups are often secret and may also espouse particular philosophic, religious, or sociopolitical ideals (e.g., the Bizango of Haiti, the Egbo, or Leopard Society of West Africa, and various subgroups within Masonry and other quasi-Masonic groups may meet these criteria).

3.         Destructive sociopolitical cults would include the Ku Klux Klan, Aryan Brotherhood, and Neo-Nazi groups.  I would include the Christian Identity movement here even though technically it is a religion.  However, it is not clear that the religious aspects of the Christian Identity movement are as cultish as are their racist values and politics.

4.         Organized crime groups which function as destructive cults exist for the primary purpose of supporting criminal activities where there is a need for utilizing mind control procedures because of the nature of the crime (e.g., child prostitution and pornography may require such mind control procedures if the perpetrators are to produce children who appear to be enthusiastic about the sexual activity which would normally be aversive to them).  Even though coercion is presumably commonly used in criminal groups I don’t think it would be appropriate to categorize all crime organizations as cults.  However, when there is evidence of trauma-induced dissociation and programming, I would classify such a group as a destructive cult.

5.         Government and intelligence-related destructive cults refer to the alleged organized use of cult mind control procedures surreptitiously conducted by individuals within government agencies (e.g., CIA) to further their purposes of intelligence gathering and the facilitation of other secret operations.  Unfortunately, the United States government has allowed itself to become enmeshed in a complex organization of secret information and procedures which would allow unethical or illegal activities to occur without the knowledge of the general public (e.g., the Iran-Contra affair, the Watergate break-in, the use of United States citizens as guinea pigs for radiation research, etc.).  Furthermore, because of the existence of what is called Sensitive Compartmented Information within the various national security and intelligence agencies, it is possible to have secret information and operations to which other individuals with Top Secret security clearances have neither access nor the capacity to scrutinize.  Essentially the intelligence community is “dissociated” because of the way in which information has been “compartmented.”  Given this network of government enforced secrecy it may be difficult or impossible to fully or accurately assess many of the complaints of abuse made by survivors.  Nevertheless, these reports should be seriously investigated.

6.                   Experimental destructive cults are groups that conduct coercive mind control research, typically without the victim’s consent.  An example would be the work of Donald E. Cameron, M.D., a past president of the American Psychiatric Association.  Donald Cameron conducted experimental mind control research on unsuspecting psychiatric patients in Canada that was funded by the CIA.

Cult abuse can be defined as any abuse perpetrated by a cult.  Cult abuse is similar, but not identical, to ritual abuse.  The differences between these two definitions are that cult abuse does not necessarily cause dissociation of identity, and ritual abuse is not necessarily always carried out in a cult.

             (Noblitt & Perskin, 2000, pp. 215-217.)

Ritual Abuse: Sprit or Science?

Because of the nature of ritual abuse and its frequent incorporation of occult symbolism and theology, there may be a tendency to misidentify it as a religious or spiritual issue rather than a criminal one.  Ritual abuse is often popularly referred to as Satanic Ritual Abuse, an expression that implies assumptions that sometimes cannot be substantiated and thus create obstacles to appropriate scientific or criminal investigation.  It is necessary to recognize that when we hear the term, “satanic,” we may not know whether this term refers to a religious doctrine (Satanic) or a philosophical orientation (satanic.)  This is an important distinction because in the United States of America, freedom of religion and freedom of choice are constitutional rights and we are expected to respect the choices of others.  It is only when these belief systems are coercive and abusive in a manner that violates the law that we have an obligation to intervene.  In order to maintain scientific objectivity in this matter, it is necessary to exercise a position of religious and spiritual neutrality.  Our legal system demands accuracy, and language that deviates from literal and supportable fact may seriously damage an otherwise reasonable legal argument in a court of law.  Therefore, identifying this type of abuse as being Satanic in origin may create impediments to successful prosecution.  There is no evidence that all ritual abuse is based on satanic principles.  In fact, there is no proof that any ritual abuse is specifically Satanic.  Individuals who identify themselves as Satanists frequently declare that their belief system does not include non-consensual abusive activities or involve children.  And individuals who identify themselves as victims of such abuse frequently deny that satanic principles are at the foundation of the ritualistic elements.  Some elements associated with Satanism may be present in some cases of ritual abuse.  In such instances, it would be more accurate and correct to refer to these types of occurrences as ritual abuse with Satanic themes.  Such terminology clarifies that the alleged ritual abuse survivor describes the abuse as having satanic themes but does not necessarily imply that either the survivor or the interviewer blames the abuse on a Satanic cult.  On the other hand, if there is evidence that a Satanic cult is involved in the abuse of an individual, that should be clearly stated.

In some cases, what is described as satanic is really only quasi-satanic at best.  Observations and communications with individuals who allege themselves to be survivors of ritual abuse have led to the realization that what they are ultimately describing is a dualistic belief system wherein elements of conventional western religion are incorporated with non-traditional, esoteric beliefs and behaviors.  They describe an essentially Gnostic world view in which the material world is corrupt and imperfect and which can be transcended only by embracing both light and dark, good and evil.  The available anthropological and historical literature supports this view.  Such dualism is not limited to Gnostic and Neo-Gnostic groups.  For example, Vodoun rejects applicants who are not first and foremost, good Catholics, a principal that has been observed, yet misinterpreted for many years. 

An amusing illustration in a sociological aspect was provided by a Haitian native.  When asked what the distribution of the different religious beliefs in Haiti is, he replied without hesitation:  “ 70 percent Catholics, 20 percent Protestants, and 95 percent Voodoo.”  (Spiegel & Spiegel, 1978, p. 320) 

Thus, it should not be surprising when individuals alleging themselves to have been ritually traumatized frequently identify their perpetrators as having been upstanding citizens, community leaders, and even clergy.  It is also not surprising when such allegations are made that the ostensible victim is seldom believed.

Blaming the Victim

            A few years ago, a woman was referred for psychological evaluation and treatment by the court arising from allegations by Child Protective Services that her children had been ritually abused.  The woman had discovered that her children were being sexually and ritually abused by her husband, their father.  She removed the children and herself from the home, contacted the police, and instigated divorce proceedings.  The children’s father admitted to having abused the children and, in fact, announced that he had once been a member of a “Satanic cult.”  He was ultimately convicted of child abuse and sentenced to prison.  The children were placed in foster homes by Child Protective Services pending a thorough investigation of the mother, even though the children all reported that she had never been part of the abuse and that indeed when she discovered it, she took immediate steps to protect the children.  However, the mother was discovered to suffer from Dissociative Identity Disorder and reported her own childhood history of ritual abuse at the hands of her parents.  She claimed that she had been helped through the healing process through her Wiccan beliefs.  As a consequence of her disclosure of her alternate religious practices, she was denied all but supervised access to her children while they were in foster care.  Conversely, her parents, the children’s grandparents who the mother alleged were perpetrators of abuse against her in childhood, were granted unlimited and unsupervised access to the children, presumably because of their standing in the community and their religious allegiance to more conventional Christian beliefs.  The court required that the mother embrace a conventional western (Christian) religion before she would be allowed to regain custody of her children.  While this requirement was a clear violation of her constitutional rights, she had neither the time nor energy to fight the system and in her desperation to reunite her family, she made a formal conversion to a mainstream Protestant denomination.  Her children were returned to her primary custody three years from the time of their removal, although CPS maintained a presence in their lives for several years thereafter.

Science versus Superstition

            Although science traditionally tries to distance itself from religion, it is even more sensitive to separating itself from what appears to be founded in the occult.  Thus the serious study of ritual abuse allegations has met with significant resistance within the scientific community.  With few exceptions, mental health professionals who accept the concept of ritual abuse and its psychological ramifications appear motivated by their Christian beliefs and incorporate these beliefs in the evaluation and treatment process.  This trend has proven both beneficial and detrimental to the investigation of the validity of ritual abuse allegations.  On the one hand, individuals who may have otherwise failed to obtain any sort of treatment or support for their debilitating psychological symptoms have found a network of mental health care providers who are willing to address their patient’s unusual complaints.  On the other hand, the religious elements of the treatment process may have the undesirable effect of triggering the patient’s past traumatic experience and dualistic orientation.  Furthermore, therapists who employ a theological perspective in their diagnosis and treatment of individuals alleging ritual abuse experiences run the very real risk of acting outside their professional expertise and creating exposure for additional liability. 

Recently, a psychiatrist was accused of having damaged a patient by incorporating elements of the Catholic exorcism ceremony in his treatment of her after the Catholic diocese denied his request to have a Catholic priest perform an exorcism on the patient.  Although the patient was clearly dissociative and believed that she was demonically possessed, the prevailing legal opinion was that this belief was actually a symptom of her psychological disorder that the patient was being unrealistically and inappropriately supported in this belief by her physician.  The psychiatrist’s malpractice insurer agreed to a settlement of the case for over two million dollars. 

Science versus Psycho-babble

            One central problem in the development of a viable language to describe the experience and symptoms of survivors of ritual trauma is the ambiguity often inherent in the language of psychiatry and psychology.  For every possible symptom, diagnosis, and treatment modality, there are countless theoretical alternative interpretations.  With so little agreement between mental health professionals in general, the lack of a cohesive language to address this specific subgroup is not surprising.  And it is possible that the imprecise nature of the language of psychotherapy in general is at the heart of the public’s mistrust of psychology that has fostered the creation of backlash organizations such as the False Memory Syndrome Foundation.  We have all heard the complaints regarding the use of “psycho-babble” and the lofty language applied by the psychotherapy community to the most mundane of human experiences.  What is needed is the development of clear, precise, and objective definitions to meaningful terminology in order to clarify communications between professionals, patients, and the public.  However, with various individuals and schools of thought jockeying for positions of supremacy within the profession, such a unifying solution is unlikely.  Yet, the area of diagnosis and treatment of ritual trauma is relatively new and sufficiently small to allow for the establishment of a common language while it is still in its infancy. 

Revictimization by an Uniformed and Unsympathetic System

            The process of investigating, diagnosing, and treating ritual abuse is difficult and problematic.  Patients reporting or demonstrating symptoms consistent with the experience of ritual abuse frequently allege that family members abused them in childhood.  They frequently become too psychiatrically disabled to work.  They are often caught up in destructive relationships.  They are often poverty stricken and without sufficient financial resources to provide for adequate psychological care.  They are often self-mutilatory, suicidal and sometimes, homicidal.  Their problematic symptoms and subsequent life difficulties may be overwhelming to their supporters and health care providers to the extent that the patient is under the constant threat, real or imagined, of abandonment.  Given the complexity of their psychiatric symptoms, their emotional fragility, their typical financial hardship, and their societal impact, these individuals represent one of the most needy groups of psychiatric patients.  Yet it is for these very factors that they are frequently denied the most basic services. 

            A middle-aged, unemployed female approached a well-known private psychological practice requesting pro bono services.  The therapy team agreed to assist her therapeutically as well as assist her in negotiating available community and federal social resources.  The patient, a college graduate and career woman, had been in a ten-year marriage at the time her symptoms became intrusive on her relationship and career.  The patient became incapable of long-term employment due to her dissociation of identity that interfered with job performance.  She sought psychiatric care and after years of consultations with numerous mental health professionals, various diagnoses, a variety of medications, and frequent hospitalizations for suicide ideation and suicide attempts, she was referred for electro-convulsive shock therapy (ECT).  Her marriage subsequently failed and she lost her financial and emotional support, insurance benefits, and access to the private health care sector.  She attempted to find employment and was fired from a series of menial jobs for inappropriate behaviors directly related to her diagnoses (including Borderline Personality Disorder, Dissociation of Identity, Depression, Panic Attacks, and Post-Traumatic Stress Disorder.)  She became virtually homeless and resided in a series of shelters and temporary accommodations offered by various friends, acquaintances and fellow congregants of her church.  Because of her poverty, her only medication resource was now the county Mental Health Mental Retardation facility manned by psychiatric interns with little or no training in dissociative disorders.  The patient was committed to a state psychiatric facility on two occasions.  She felt unable to turn to her parents for assistance for, although financially well off, their assistance was contingent upon the patient residing in the family home and ceasing her pursuit of psychological treatment for her symptoms.  The patient was advised to apply for Medicaid and Social Security Disability, but was unable to complete the complicated procedures for obtaining assistance.  The psychologist’s staff assisted the patient in completing the Social Security application process and provided corroborative history and psychological reports to support the patient’s diagnosis and current level of functioning.  The patient was denied Social Security benefits, which is typical of the experience of many psychiatrically disabled applicants.  The patient was referred to an attorney specializing in Social Security appeals who provides services on a contingency basis (to be paid directly by Social Security, 25% of retroactive benefits upon successfully securing of subscriber benefits.)  She was advised that the appeals process could take upwards of 18 months before a determination was made.  The patient was subsequently denied Medicaid because she was unable to demonstrate corroboration of her disability by the Social Security Administration.  The psychologist’s office was able to secure food stamps and to assist the patient in obtaining a more stable living environment by acquainting a sympathetic local church with her predicament.  The patient was also referred for pro bono medication consultation with a private psychiatrist who was able to provide the patient with appropriate medications through various drug company policies that assist in providing needed medications to indigent or otherwise needy patients.  The patient was seen individually three times a week and attended two group therapy sessions each week to assist her in maintaining stability, refraining from self-harm and developing more appropriate coping strategies.  Hospitalization was not an option unless the patient became actively suicidal or homicidal due to state and county hospital overcrowding.  Ultimately, the patient was approved for Social Security Disability and Medicare.  However, she left therapy when her family offered to buy her her own house and her current condition is unknown.   

Developing a Diagnosis of Cult and Ritual Trauma Disorder

            Given that (1) a large number of mental health professionals perceive ritual abuse to be a genuine problem experienced by some patients, (2) these patients exhibit many common characteristics, and (3) there is some external corroboration for the patient's allegations, it is clear that objective empirical criteria warrant a diagnostic category relevant to this phenomenon.

But there are other reasons to justify a separate diagnostic category for ritual abuse.  It should be noted that although the phenomenon of ritual abuse shares features and characteristics with other established diagnoses, no single DSM category, nor any combination of DSM labels, completely accounts for the collection of symptoms experienced by ritual abuse victims.  In order to provide reliable clinical diagnoses and advance clear research outcomes, objective diagnostic criteria are needed.  Some skeptics claim that the current allegations of ritual abuse are mere fabrications of therapists' and patients' fantasies, or they are simply delusional material, or are part of manipulative or attention-seeking interactions.  If this is the case, then clear diagnostic criteria will aid in determining the extent to which ritual abuse claims are in fact genuine phenomena versus features of factitious, delusional or other disorders.  Such distinctions are not only important for appropriate clinical diagnosis and treatment, but also to lend further clarity to the growing number of legal cases in which mental health professionals are asked to provide forensic evaluations.  The lack of distinct, empirically validated criteria for distinguishing genuine ritual abuse from other diagnoses could result in courts failing to remove children from abusive environments or in innocent defendants going to prison in misdirected criminal cases.

            Once we recognize the need for this diagnosis, then we can begin the task of selecting appropriate terminology for describing and defining the diagnosis.  We need to specify: (1) the distinctive and diagnostically significant characteristics of the disorder, and (2) appropriate labels for the syndrome and its defining characteristics. The following is an example of how such a diagnostic concept might be expressed in a DSM-like format.

309.82  Cult and Ritual Trauma Disorder [3]

Diagnostic Features

The essential feature of Cult and Ritual Trauma Disorder is clinically significant distress or functional impairment with either:  (1) disturbing or intrusive recollections of abuse, or (2) the presence of involuntary dissociated mental states, either or both of which are the result of ritual (circumscribed or ceremonial) abuse.  Dissociated mental states may take the form of unwanted or intrusive dissociated alter identities, trance states, automatisms, catalepsy, stupor, or coma or coma-like states.  These dissociated mental states may appear in a spontaneous manner or they may be triggered by particular stimuli or cues or by the individual’s experience of distress.

                Ritual abuse consists of traumatizing procedures that are conducted in a circumscribed or ceremonial manner.  Such abuse may include the actual or simulated killing or mutilation of an animal, the actual or simulated killing or mutilation of a person, forced ingestion of real or simulated human body fluids, excrement or flesh, forced sexual activity, as well as acts involving severe physical pain or humiliation.  Frequently, these abusive experiences employ real or staged features of deviant occult or religious practices, but this is not always the case.  Some reports of this phenomenon indicate that the abuse may occur outdoors, in a residence, day care, laboratory or hospital setting as well as other locations.  Ritual abuse may occur in a group setting, but occasionally it is perpetrated by an individual.

Associated Features and Disorders

Associated descriptive features and mental disorders.  Evidence of psychological trauma is usually present and many individuals with Cult and Ritual Trauma Disorder also exhibit some symptoms of Post-traumatic Stress Disorder, if not actually meeting the criteria for this diagnosis as well.  Intrusive and often fragmentary memories of abuse, alternating terror and emotional numbing, nightmares, amnesia, anxiety, panic, flashbacks, phobic avoidance, and signs of increased arousal are often present.  These individuals typically report chronic depression, often with cyclical characteristics.

                Dissociation of identity is a feature of Cult and Ritual Trauma Disorder, and Dissociative Identity Disorder or Dissociative Disorder Not Otherwise Specified, are frequently concurrently diagnosed.

.               Features of Borderline Personality Disorder are also often exhibited and occasionally individuals with Cult and Ritual Trauma Disorder will also experience brief psychotic episodes, sometimes with auditory or visual hallucinations.  More commonly these individuals experience or act out strong self-destructive urges including attempted or actual suicide and self-mutilation.  Frequently there is a strong desire to injure the self in a manner that produces blood (e.g., “I have to see blood”).  Sometimes the individual will report a desire to taste, touch, or smell their own blood.  Chronic and unmodulated anger and sometimes rage alternate with other mood states to create the impression that the individual is unpredictable in mood and unable to manage anger.  Strong feelings of dependency alternate with social aloofness.  Narcissism and self-hatred are frequently experienced separately and together.

                In children (in addition to the above) motoric hyperactivity, impulsivity and problems in attention and concentration are seen at a rate that exceeds the baseline for children without psychiatric disorders.

Associated laboratory findings.  Individuals with Cult and Ritual Trauma Disorder typically show evidence of psychological trauma and dissociation on psychological testing.

Associated physical examination findings and general medical conditions.  There may be scars from self-inflicted injuries or physical abuse.  Somatic symptoms with or without objective medical findings typically include headaches, gastrointestinal, and genito-urinary complaints, but other reports of physical pain may be present.  In some cases, physical pain will not reflect a current injury but will be a psychological component of implicit memories (e.g., “body memories”) associated with previous abuse.  These individuals also frequently show evidence of mild neuropsychological impairment that in some cases may result from a history of head trauma.  Others have argued that psychological trauma in childhood may cause mild neuropsychological deficits in some individuals (e.g., van der Kolk, 1987) but further research is needed to clarify this question.

Prevalence

The prevalence of Cult and Ritual Trauma Disorder is unknown due to a lack of reliable information.  The alleged secrecy associated with ritual abuse may make the accurate tabulation of such statistics difficult or impossible.

Course

The clinical course of these individuals is typically chronic with periodic exacerbations and sometimes partial remission of symptoms.  Some of these individuals report that they continue to participate in ritual abuse either as a victim, a perpetrator or both, typically while in a dissociated state.

Familial Pattern

A history of sexual or ritual abuse is frequently reported among family members.  In particular, transgenerational victimization is a commonly indicated pattern, consistent with the familial trends associated with non-ritual sexual abuse of children.  However, the extent to which ritual abuse is a transgenerational phenomenon is presently unknown.  Features of dissociation are also frequently seen in family members.

Differential Diagnosis

Cult and Ritual Trauma Disorder must be distinguished from Delusional Disorder and other psychotic disorders where delusional beliefs are better able to account for the reports of abuse particularly when it can be demonstrated that the allegations of abuse are false.  However, there are also cases where these diagnoses can exist concurrently with Cult and Ritual Trauma Disorder, particularly when corroborating evidence of such abuse exists in an individual who is also exhibiting delusional or other psychotic symptoms.  Cult and Ritual Trauma Disorder must be distinguished from Malingering in situations where there may be forensic or financial gain and from Factitious Disorder where there may be a maladaptive pattern of help-seeking behavior.  The possibility of suggestibility should also be evaluated and ruled out as a possible alternative explanation for the individual’s reports of ritual abuse.

Whoever Controls the Language Controls History

            One of the most disturbing observations regarding the language of ritual abuse that has been developed thus far is that the language applied to such experiences has come almost exclusively from the survivor and backlash communities.  The survivor community has provided such terminology [4] as “ritual abuse,” “programming,” “triggering,” and “accessing.”  The backlash community has contributed such terms as “recovered memory therapy,” “false memory syndrome,” and “parental alienation syndrome,” although these terms do not apply exclusively to the area of ritual abuse.  The treatment community has been dangerously reactive and passive with respect to both their patient’s claims and the assault on their professions by backlash organizations.  It has become commonplace for the media to report on unethical practices by “recovered memory therapists” who routinely destroy families by implanting false memories of horrific experiences.  The media, television, radio and print journalism, serves as both arbiter and catalyst for the ongoing debate regarding the veracity of ritual abuse allegations and claims of recalled accounts of childhood abuse.  Unfortunately, the media appears to uncritically accept and promulgate the version promoted by the most effective lobby, regardless of evidence in its support.  Terms such as “recovered memory therapy,” “false memory syndrome,” and “parental alienation syndrome,” permeate the scanty literature on modern day accounts of ritual abuse. 

            Kenneth Lanning, an agent of the Federal Bureau of Investigation, authored the monograph, Investigator’s Guide to Allegations of “Ritual” Child Abuse, in which he wrote, “There is little or no evidence for . . . organized satanic conspiracies,” (1992, p.40.)  Individuals and organizations taking the position that ritual abuse allegations are false have subsequently adopted this claim.  It is interesting to note that from the time of its creation in 1908, the FBI was invested with the investigation and prosecution of the elusive Mafia, to which a large portion of crimes ranging from extortion, to gambling, to bootlegging, to murder were attributed.  Because of an extensive and effective lobby by a coalition of Italian-American advocacy groups and other individuals and organizations, the FBI was unable to substantiate the existence of the Mafia until 1989, when a Mafia initiation ceremony was audio-taped by undercover agents.  Previously, in order to facilitate prosecutions despite its inability to specifically identify a criminal entity called the Mafia, the FBI broadened its focus by targeting “organized crime” as its primary agenda.  This raises the question of why, when there are thousands of individuals alleging ritual abuse, some of which have resulted in arrests, confessions, criminal convictions [5] and civil litigation, the FBI, or specifically Agent Lanning, clings to the position that there is no evidence of widespread satanic ritual abuse.  In truth, there may be no evidence of an “organized satanic conspiracy,” but there is all manner of evidence in support of crimes against people and property that have occultic or ritualistic elements [6] .  If the FBI could alter its language in order to justify its investigations into the Mafia, it seems a small thing to reconsider the terminology it applies to investigations of crimes that contain ritualistic elements.

            Considering the history of crimes against children and the traditional denial with which society has responded to such allegations, it is not surprising that reports of ritual abuse against children and others are frequently discounted.  There appears to be a greater societal interest in protecting the illusion that our children are safe, that families are inherently good and decent, and that danger comes infrequently and only then at the hands of demented strangers.  In reality, most individuals reporting histories of ritual abuse allege that the abuse occurred within the family.  And while there are periodic reminders that families do not always protect their own children and may, in fact, represent the greatest threat to children’s safety and life, it is evidently too painful for the public to accept the probability that some children are regularly and deliberately abused within their family unit.  Nevertheless, this is a harsh reality we must all be willing to face if we are ever to be able to fully protect children or to comprehend and address the sequelae of such abuses. 

            Several years ago, I was contacted by a woman in another state requesting advice regarding her four foster children, siblings who had been removed from their family of origin by the state due to chronic abuse and neglect.  These children, ranging in age from 18 months to six years, demonstrated extremely maladaptive behaviors.  They had poor vocabulary and limited capacity to communicate.  They had no apparent experience with proper hygiene.  They could not identify or manipulate eating utensils.  They were fearful of water, certain foods, and the night.  The children were violent with each other and other people.  They had uncontrollable rages without apparent cause.  They were all sexually self-abusive.  Upon physical examination, all four children were diagnosed with genital herpes.  The boys suffered from impacted bowels and scarring of their rectums.  All four children had scars all over their bodies, most of which appeared to have been the result of deliberate injury.  The three older children talked about being tortured by people in black robes. 

            None of this information had been revealed by the Department of Social Services caseworkers responsible for transferring the children's care from the state to the foster family.  The foster parents were frightened, anxious, concerned and confused.  They wanted to help these extremely needy children, but were at a loss as to how to accomplish this.  They contacted the International Council on Cultism and Ritual Trauma to obtain information about ritual abuse and to gain some insight into its effects.  This telephone conversation evolved into several more between the foster family and this organization and eventually, we were able to assist the family by providing an onsite evaluation of the children, the therapeutic foster home, and the available resources.  We visited the family, interviewed everyone involved including the foster family, DHS caseworkers and administrators, and ancillary helping professionals.  The children were psychologically evaluated the and their records of previous psychotherapeutic interventions were reviewed.  In addition, the children's histories, the manner in which they came to the attention of DHS caseworkers and the mechanisms by which their care was being funded by the state were all researched.  What our investigations revealed was evidence of a conspiracy designed to shield various county and state agencies from liability for negligence and fraud. 

A review of the family history revealed that the children's mother had been the subject of investigations by the DHS as a victim of child abuse and neglect perpetrated against her by her parents.  This child was evaluated by a DHS staff psychologist who diagnosed her as marginally retarded and disoriented to person, place and time.  His notes from his meeting with her reflect her report of hearing voices in her head that directed her behavior.  She was under DHS supervision when she became pregnant with her first child at age 15.  Between the ages of 15 and 20, this young woman had four children by four different fathers, at least one of whom is likely to have been a close family member.  Despite this young girl's age and legal status at the time of her first pregnancy, no intervention was made on her behalf to educate her in either birth control or child care, or to assist her in improving her living situation.  This young woman continued to reside in the home of her parents along with her children, exposing this new generation to the same neglectful and abusive environment in which she was raised.  DHS caseworkers did continue to observe the family and did intervene on the children's behalf as they observed neglectful conditions, including lice infestation in all the children, malnourishment, unhygienic conditions, etc.  The children were removed from the mother's custody on two occasions during which they were placed in foster care while an effort was made to educate the mother in order to repatriate the children.  These attempts failed and the mother’s parental rights were finally terminated, at which time the children were placed with their third foster family, who had an interest in adoption. 

The children's bizarre behaviors led to psychiatric hospitalizations and placement with therapists in the community to pursue outpatient psychotherapy.  During the course of their therapy, the children revealed more and more details of abuse, including sexual abuse in their second foster home and in their family of origin.  However, the three therapists engaged in these children's care never made a report to law enforcement as mandated child abuse reporters.  Furthermore, the therapists appeared unqualified to address the children's behaviors and emotional distress and the children subsequently deteriorated under their care.  When the foster parents repeatedly complained about the failure of these mental health professionals to address the children’s reports, the therapists were asked to resign from the case by a supervising psychologist contracted by DHS to supervise distribution of services.  The therapists subsequently wrote a letter of termination in which they blamed the children’s symptoms and deterioration on the foster mother’s overprotective position.

The children required additional supervision by paraprofessionals called High Risk Interventionists (HRI).  The HMO charged with the administration and dispersal of Medicaid funds funded the children’s psychotherapy and high-risk interventionists.  Our investigations revealed that this HMO also operated the HRI program and in effect, subcontracted the children's care to their own agency resulting in hundreds of thousands of dollars paid to itself.  In the meantime, few of the dollars allocated to the foster family and the children were actually delivered.  Furthermore, the case supervisor employed by the HMO was the same psychologist who years before had worked for DHS and had been the professional who evaluated the children’s biological mother. 

What we learned is that the professionals involved in the care of the children were motivated more by self-interest than in concern for the well being of the children.  In the meantime, the foster parents engaged in a concerted effort at recognizing and understanding their charges' psychological, emotional, physical and educational problems and succeeded in creating a highly effective integrated program to address these concerns.  Now, several years have passed and the children have been adopted by their foster family.  But the effort to provide for these children's therapy and safety needs continues to be a struggle between the adoptive parents and the county and state agencies controlling their funding.  And for this, we would have to ask, "Why?" 

Throwing Out the Baby wit the Bath Water

            Why is there so much resistance to assisting these and other child victims?  Why is there such a contentious environment when victims, children and adults abused as children, make an outcry?  What motivates individuals to organize into lobbying groups with the intended purpose of impeaching the testimony of abuse victims and vilifying their advocates?  What are the politics behind such machinations?  There are several possible answers to explain this disturbing trend.  One possibility is that there is truly a conspiracy of individuals and groups who perpetrate against children and other vulnerable people using ritual abuse as a mechanism of control and containment.  Some of these individuals are likely to have infiltrated various areas of society including child protection, the court system, law enforcement, government, military, the media, etc., resulting in a vast cover-up.  A second possibility could be that the reality that children are being systematically tortured and betrayed by their families and trusted others is so frightening and painful to the majority of people that they are in denial of this possibility.  And in order to accommodate the accounts that allege that such things can and do happen, society has “killed the messenger” by blaming the epidemic of reports of child abuse on the mental health professionals and child advocates who attempt to intervene.  

            The resulting attack on mental health professionals has been devastating to both the profession and to individuals desperately in need of psychological services.  Therapists under constant threat of litigation have been forced to amend their treatment style and even the manner in which they document patient claims.  For example, in the interest of protecting patients from potential harm by recording claims that could be self-incriminating if records were subpoenaed, therapists routinely made vague or sketchy notes, interpretable only by themselves.  Now, to protect their own professional status, therapists are taking a more self-protective stance.  Fewer hospitals are providing inpatient programs that address the special needs of this patient population, increasing the danger to patients and society.  In response to growing allegations against mental health professionals, licensing boards are altering and adjusting rules of practice.  As a consequence of civil suits brought against therapists for “implanting false memories” of abuse, malpractice insurance carriers are increasingly limiting coverage for the treatment of certain types of psychological disorders.  Consequently, fewer mental health professionals are willing to see patients alleging ritually abusive experiences or demonstrating symptoms of dissociative disorders.

What is clear is that something is happening that results in sometimes disabling psychological illness that impacts on the individual, the family, and society.  How we respond to the resultant crisis is a measure of our collective character.  Will we ignore the outcries of people in pain in order to embrace the comfort of denial?  Or will we confront our worst nightmare, acknowledging the worst threat to children may be our own reluctance to admit that the dark secrets of our ancestors survive today?  

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