Oct 31, 2013

Who ya gonna call? Gurubusters!

The Age

October 31, 2013

Amrit Dhillon


In the endless fight against superstition and fakery in India, campaigners for rationalism have to use every trick in the book to beat so-called holy men at their own game.
Standing in front of the schoolchildren at Desu Madra Secondary School in Mohali, in the Indian state of Punjab, Satnam Singh Daun spreads his props out on the table: scarves and money that vanish, cards, powders that burst into flames, some rope, matches, vials, cotton wool. He looks like a magician about to start a show at a child's birthday party.
But the tricks are not for entertaining the children. Daun is using them to expose the godmen, gurus, astrologers, charlatans, soothsayers, palmists, charm sellers, quacks, and humbugs who are so popular in India.
The children, seated on the ground in the bright sunshine and humidity that follows a monsoon downpour, listen intently to Daun as he pours scorn on superstition. He performs the same tricks that are used by holy men to exploit the gullibility of Indians and project themselves as possessing supernatural powers - making money disappear or turning 100 rupee notes into 500 rupee notes, producing ash from nowhere, swallowing fire.
''It's because they are too stupid to become teachers, doctors or scientists that godmen become astrologers to fool people,'' Daun says.
''They want you to use amulets and trust in the stars instead of using your reason. These holy men are holy fools tricking you. Be rational, use your minds,'' says Daun, as a rooster in the school grounds crows on cue as if to say ''hear hear''.
Daun is one of three men in Mohali known as ''gurubusters''. He is talking to the schoolchildren, accompanied by his two colleagues, to teach them to spurn superstition and be rational instead.
Daun is short and stocky and works as an Amway agent. His co-gurubuster Harpreet Rora is a slight, fresh-faced young man who works as a journalist. The third is the founder of the Mohali branch of the Indian Rationalist Association, the burly and avuncular Jarnail Singh Kranti, a retired primary school teacher. From a tiny office, using their own funds and their spare time, the endearing threesome, loyally supported by their wives, launch blistering broadsides against India's influential godmen. This is the headquarters of a lonely mission: promoting the supremacy of rationalism.
Superstition is a multimillion-dollar industry in India. From the poorest to the richest, the predisposition to superstition is embedded in the neural pathway of most Indians. Choosing a spouse, fixing a wedding date, getting a job, trying for a baby boy, curing an alcoholic husband, reviving a failing business, curing an illness, ending a factory strike - all these problems require a visit to a holy man, who is paid a fortune for his services.
The propensity to believe that some mystic will solve your problems runs across the social spectrum. Former prime ministers have consulted bead-wearing astrologers on the most ''auspicious''' date for a general election. Bollywood stars offer tributes at the shrines of mystics to ensure a box office hit.
Given their preference for discretion, wealthy Indians prefer to have a guru dedicated to their family; sometimes he lives with them so that he can be available at all times.
''I have total faith in my guru. He can cure cancer. I have seen it. I come away after an audience with him feeling light and blessed,'' says New Delhi garment exporter Rocky Verma, who has just asked his guru to suggest a date for his son's engagement.
Talk to the wives of tycoons and it becomes clear their faith in their family guru is blind. New Delhi art collector and gallery owner Renu Modi is married into the famous Modi business family and she is totally dependent on her guru, Swami Chandra. ''We do not make any major decision without first consulting him,'' she says.
On Delhi's Prithviraj Road, home to many business moguls, Madhushree Birla, the wife of a scion of the Birla dynasty, sits in a living room full of priceless artefacts and talks of how she relies on Patrick, a Christian faith healer from Goa who she says can cure cancer.
''My faith in him stems from the day my brother and sister-in law were involved in a horrific car crash near Nasik. My brother had broken ribs and my sister-in-law suffered serious internal bleeding.
''Two minutes after they crashed, they were still lying there stunned but just beginning to realise what had happened when Patrick called them on the phone. He had seen everything that had happened and he knew what injuries they had suffered even though he was far away in Goa,'' she says.
This is the kind of belief that Daun likes to pour his vitriol on. As the morning sun rises higher in the sky, he ignores the heat and starts getting into his stride, asking the schoolchildren, ''Has any holy man ever invented a medicine or an airplane? Can he stop any of you dying in a road accident? How can he help you do well in exams and get a good job when he himself is nothing but a failure?''
Standing behind Daun is his wife Neeraj. She hands him something. Daun pops a burning ball of fire into his mouth, eliciting gasps from the schoolchildren. Then he shows them that it is only burning camphor, which cannot hurt his mouth. He dips his hand into burning oil, unscathed, showing them later that he had pre-soaked his hand in oil as insulation.
At the end of the talk, the children troop out to join their classes, having promised Daun that they will never again succumb to superstition. When they have finished handing out leaflets, the energetic gurubusting triumvirate pack their props, mount their scooters and head off to another assignment at another school to educate children on the importance of being rational.
The Indian Rationalist Association was founded in 1949, with the good wishes of British philosopher Bertrand Russell. Its first members belonged to the educated elite. It has rarely had more than 100,000 members - mainly teachers, students and professionals - but they have been vigorous in publishing pamphlets and deriding the Indian penchant for superstitious nonsense.
Over the decades, its branches have tried to inculcate Indians with a scientific temperament through debate, talks, ridicule, humour and challenges. Much of their time is spent performing the tricks that self-styled holy men love to perform to convince Indians of their special powers and to garner billions of rupees from their credulity.
''Their press conferences are hilarious because they consume fire, levitate (a trick requiring a blanket and two hockey sticks), walk on coals (the skin doesn't burn if you walk fast enough) and make statues 'weep' (melting a layer of wax covering a small deposit of water),'' says Mumbai journalist Neeraj Gaitonde. ''It's the only way to destroy the blind belief in their special powers.''
Some charlatans are more creative than others. One used to impress the crowds by ''creating'' fire by pouring ghee (clarified butter) onto ash and then ''staring'' at it until the mixture burst into flames. Rationalists-turned-detectives found that the ghee was glycerine and the ash was potassium permanganate and the two spontaneously combust a couple of minutes after they are combined.
India's rationalists love to challenge quacks. When the well-known television guru Pandit Surinder Sharma boasted on television in 2008 that he could kill another man using only his mystical powers, Sanal Edamaruku, president of the Indian Rationalist Association (who is currently in hiding in Finland, but more of that later) took up the challenge and invited the guru to kill him on prime-time television.
The guru agreed and appeared on television performing sundry rituals intended to kill Edamaruku. Millions tuned to the show. The hocus pocus went on for some time. The holy man ruffled the rationalist's hair, pressed his temples and mumbled incantations. Several hours later, Edamaruku was still alive, cheerfully taunting the frustrated killer.
Edamaruku, a former journalist, became a rationalist activist when he was 15 after seeing a local athlete with blood cancer die because her family refused medical treatment, preferring a faith healer. Now he lives in Finland, having fled India after the Catholic Church in Mumbai filed a complaint against him in April 2012 under the country's blasphemy law. If convicted he would face three years in jail.
The case concerned a crucifix dripping water at a Mumbai church. Edamaruku discovered the dripping was caused by a leaky cistern that was causing water to seep through the wall onto the crucifix. He reported his results on television and criticised the Catholic Church for being ''anti-science''. When the church filed a case against him, he fled.
Not so lucky was Dr Narendra Dabholkar, a prominent anti-black magic campaigner in Pune, near Mumbai, who was murdered on August 20. Known for his lifelong campaign against superstition, Dabholkar, 70, was gunned down during his morning walk.
Dabholkar estimated that several hundred women are killed every year after being branded ''witches'' by so-called godmen. He also pointed out many children also were killed as part of ''human sacrifices'' ordered by godmen to resolve their followers' problems.
Indians were shocked at the murder; some were equally surprised to discover that Dabholkar had been lobbying the provincial government of Maharashtra to approve the Superstition Eradication and Anti-Black Magic Bill to make superstitious practices illegal.
Despite receiving several death threats from right-wing Hindu groups, Dabholkar refused police protection. These groups believed he was targeting their religion and not condemning superstition in all religions.
However, the evidence suggests Hindu charlatans predominate (Hinduism in the largest religion in India), partly because there is no organised structure to the religion nor an established hierarchy, making it easy for anyone to set himself up as a guru offering spiritual advice.
Invariably, the majority of the controversial godmen who end up in the news for amassing millions, owning fleets of Mercedes and Audis, for being involved in prostitution rackets or are charged with sexual abuse or rape, are Hindu.
Just last month, a leading godman called Asaram Bapu was arrested on charges of sexually assaulting a 15-year-old. Yet, seeing their godman behind bars has done little to dent the faith of his supporters.
''These godmen are like Jekyll and Hyde. They do a lot of social and community work initially to become popular before they start gratifying themselves,'' says Dr Indira Sharma, president of the Indian Psychiatric Society.
''They help with marriages, school admissions, medical treatment. So when they are charged with an offence, their supporters are not affected because they want to continue getting that help and it's in their interest to protect the godman.''
The Mohali gurubusters, always cheerful and energetic, have so far not received any threats.
''We won't stop, particularly when it comes to educating children,'' says Harpreet Rora. ''We want children to become ambassadors of change. They have to go home and tell their parents to stop their nonsense.''
The cost of superstition in India is high. All over the country, hanging in shops, homes, workshops and vehicles, are small bunches of green chillies and lemons tied together to ward off the evil eye and bring good luck. Fresh bunches are hung every day.
''Do you know that Indians spend 104 million rupees ($2.4 million) every year on buying chillies and lemons?'' says Jarnail Singh Kranti.
''At our local hospital, they have an astrologer on hand to 'help' patients if the medical treatment fails. This must stop. We must start relying on science and logic to move into the modern world.''
It is in the interests of Indian politicians, he adds, to keep Indians mired in superstition so that the poor don't start asking, ''Why are we poor?''
Before closing the shutters on the office, he points to a large poster hanging on the wall. It offers a reward of 2.3 million rupees ($39,000) to any godman who can perform any one of 23 acts, including standing on burning cinders for half a minute without blistering his feet; reading the thoughts of another person; making an amputated limb grow even one inch through prayer, spiritual powers, using holy ash, or giving blessings; walking on water; getting out of a locked room by divine power; or converting water into petrol.
As he reads out the list, Kranti chuckles. ''We don't have 2.3 million rupees. But we're not expecting anyone to win so we're pretty safe,'' he says.
Amrit Dhillon is a Delhi-based writer.

Oct 29, 2013

Assam governor welcomes proposal for 'world-class' university

TNN | Oct 29, 2013, 04.33 AM IST

GUWAHATI: Governor Janaki Ballav Patnaik has welcomed a proposal to open a world-class university in Assam. The proposal was put forth by Maharishi Vidya Mandir Schools Group chairman Brahmachari Girish Chandra Varma. 

Patnaik assured Varma that the state government would extend necessary assistance to execute the proposal. His assurance came during the inauguration of the Maharishi National Cultural Meet-2013, organized by the group here on Saturday. 

Varma recalled the proud moments of a meeting between Patnaik and Maharishi Mahesh Yogi when Patnaik was the chief minister of Orissa. He offered to open the world-class university in Assam for propagating the ideals of Maharishi Mahesh Yogi along with imparting modern education. He emphasized on the importance of education based on transcendental meditation to remove negative energy from society. 

The governor urged students to imbibe the age-old education system of India for their spiritual, moral and academic development. He also asked students to develop a rational mind and to accept any fact or statement only after testing the same with reasoning and rationality.

Oct 26, 2013

Remembering David Sullivan On the remarkable life of the subject of “The Man Who Saves You from Yourself"

David Sullivan, the subject of my recent Harper’s feature, “The Man Who Saves You from Yourself,” died suddenly on the evening of October 11. I’d last spoken with him eight days earlier. Sully was utterly himself: hilarious, warmhearted, and bubbling with wild stories. We talked about the state of the California prison system, which he knew intimately from visiting clients for various murder cases he was investigating. He explained that the prisons have fallen under the control of the Mexican drug gangs, with the complicity of the guards, many of whom are Mexican nationals. But that’s a story for another time.

I told him, as I had many times before, that I regretted not being able to write about his life at greater length in my essay. By focusing on his investigations into religious cults, I had to exclude his investigative work in places like Juárez and Medellín, which had involved the world’s most powerful drug cartels; his adventures in North Africa in the early Eighties; and the decade he spent living in Brazil and Peru, during which he managed a nightclub in Rio de Janeiro, ran a language school in the Serra do Mar mountains, attended Candomblé ceremonies, and participated in Ayahuasca-fueled vision quests with Peruvian Indians.

There were countless other astounding episodes, many of which could not appear in print without putting him in physical danger or violating confidentiality agreements. It would take a book, or a series of books — a globetrotting tale of adventure, a hardboiled true-crime volume, a psychological drama, a Bildungsroman — to honor the richness of his life. I had been consoled by the fact that, several months ago, David had signed a contract to publish his memoir. He had just begun to work on it with the writer Joshua Jelly-Schapiro when he died.

He was excited about the Harper’s story, but it wore heavily on him. It was difficult for him to speak openly about subjects that he had kept private for decades. But when he did begin to speak, he was entrancing. David was a born storyteller. The transcriptions of my interviews with him run to nearly two hundred pages. (Readers interested in hearing David tell some of his stories in his own words can listen to a talk he gave at the Commonwealth Club in 2010.)

On the day that he died, he sent me a note about the Harper’s essay. He had received the issue the night before. He remained anxious about the story, he wrote, but he was appreciative and happy that it was out in the world. It is cheering at least to know that more stories will soon be published about David. Writers were drawn to him, and in the days and months ahead, the stories they tell about David will help to memorialize his brilliance, humanity, and generosity. I believe I speak for all of his friends when I say that I’ve never met another person remotely like David Sullivan.

Despite his cynicism about cults, David had a deeply spiritual quality to him. He empathized with people who were victimized by cults because he himself sought, in Saul Bellow’s phrase, “knowledge of the higher worlds.” When he attended prayer circles, religious meetings, and communes of every conceivable variety, he did so in a spirit of curiosity, and even yearning. This was why charlatanism infuriated him. He took it personally. Long after he succeeded in rescuing a client from a cult, he would continue to pursue the organization and its leader, often for years, on his own dime. David Sullivan did not only save lives. He raised everyone around him to a higher state of grace.

The Man Who Saves You from Yourself Going undercover with a cult infiltrator

Harper's REPORT — From the November 2013 issue "The Man Who Saves You from Yourself Going undercover with a cult infiltrator"
By Nathaniel Rich

Nobody ever joins a cult. One joins a nonprofit group that promotes green technology, animal rights, or transcendental meditation. One joins a yoga class or an entrepreneurial workshop. One begins practicing an Eastern religion that preaches peace and forbearance. The first rule of recruitment, writes Margaret Singer, the doyenne of cult scholarship, is that a recruit must never suspect he or she is being recruited. The second rule is that the cult must monopolize the recruit’s time. Therefore, in order to have any chance of rescuing a new acolyte, it is critical to act quickly. The problem is that family and friends, much like the new cult member, are often slow to admit the severity of the situation. “Clients usually don’t come to me until their daughter is already to-the-tits brainwashed,” says David Sullivan, a private investigator in San Francisco who specializes in cults. “By that point the success rate is very low.”

Sullivan became fascinated with cults in the late Sixties, while attending Fairview High School in Boulder, Colorado. It was a golden age for religious fringe groups, and Boulder was one of the nation’s most fertile recruiting centers, as it is today. (There are now, according to conservative estimates, 2 million adults involved in cults in America.) “You couldn’t walk five steps without being approached by someone asking whether you’d like to go to a Buddhist meeting,” says John Stark, a high school friend of Sullivan’s. Representatives from Jews for Jesus and the Moonies set up information booths in the student union at the University of Colorado, a few miles down the road from Fairview High. Sullivan engaged the hawkers, accepted the pamphlets, attended every meditation circle, prayer circle, shamanic circle. When the Maharishi Mahesh Yogi led a mass meditation session at the university, Sullivan was there, watching from the back of the lecture hall.

Read compete article at Harper's 

Oct 24, 2013

Money and magic: Madonna's huckster kabbala guru

Arthur Green
September 30, 2013

Philip Berg, who died last week, retooled kabbala as a cultish, superstitious self-help movement - but his commercial success and celebrity following hardly enhanced the reputation of Jewish mysticism.

Some two hundred years ago, just as Jewish emancipation was moving into high gear, Judaic scholars developed a new concept called mainstream Judaism. (Classical Hebrew has no way to express such a notion.) The mainstream was created in order to exclude anything that modern westernizing Jews might find embarrassing in Judaism. This meant, first and foremost, the entire mystical tradition.

Now, two centuries later, Jews are scrambling to reclaim this lost part of our legacy. Many factors come together to create this resurgence of interest in kabbala and Hasidism. The general Western quest for exoteric spiritual truths, the effect of the Gershom Scholem-led academic effort to make the sources accessible, and the unique character of Jewish history in the past 70 years have all played a role. Few people doubt any more that great power and profundity are to be found within these texts and traditions; the 19th-century notion that the kabbalists were mere obscurantists, rebels against the light of reason, has been mostly set aside.

The question is not whether, but how, to reclaim this part of our heritage. What is the best of the kabbalas teaching, and what might well be left behind? How do we retool a religious language conceived in the Middle Ages to inspire the religious lives of contemporary seekers?

Philip Berg, founder of the Kabbalah Centers, who died last week in Los Angeles, had a clear answer to those questions. It turns out, Berg discovered, that modern Western people, living in a seemingly skeptical and enlightened age, are just as frightened and insecure as our ancestors were back in the ghettos and mellahs of centuries ago. They will tie red threads around their wrists, drink specially blessed bottles of kabbala water, and buy sets of books they cannot read, all as talismans against the evil eye. This most popular level of kabbala, verging close to magic, he also discovered, could be a great commercial success. Wrapped up in a garment of self-empowerment and personal growth teachings of the sort one can find in airport bookstores, and combined with a dose of enthusiastic new-age piety, it could be a source of endless seminars, retreats, and programs that people would pay hefty fees to attend.

Berg, an ordained Orthodox rabbi, was indeed a student of kabbala in a serious way. He came out of the school of Yehudah Leib Ashlag (1886-1955), a Polish Jew who settled in Jerusalem in the 1920s and revived what was left of the old, mostly Sephardic, kabbalistic heritage. He had some interesting ideas, including a tendency toward communism in his social views. His essential teaching is that we humans need to return energy to its single divine source, to become givers rather than receivers in the cosmic economy. It was this radiating of divine energy that kabbala was to help one achieve. But Ashlag dived headlong into the endlessly complex morass of latter-day kabbalistic symbolism, where the great ideas tended to get lost in the myriad details of the system.

Berg, a second-generation disciple of this school, saw a way to turn it into a self-help teaching. The more superstitious pieces, never much to Ashlags liking, were picked up from other kabbalists. Berg, with the help of his wife and sons, engaged in a tremendously successful marketing campaign and brought this heady brew to the attention of Hollywood personalities, among many others, capturing headlines that expanded their market ever farther. He scandalized Orthodox kabbalistic circles by opening his teachings to both women and gentiles, unheard of in their world. Critics assumed, however, that this bit of liberalism was mostly a commercial decision. His movement, perhaps getting beyond his own intent, even saw its form of kabbala as transcending Judaism altogether, becoming a religion of its own.

As the movement expanded and the commercial stakes grew higher, there were accusations of cultish behavior and mind control coming from former disciples who had left Bergs circle. At the same time, there were others who claimed to have been helped by his teachings, to have found real religious community within the centers precincts, and to have attained great spiritual growth. Some said that Judaism was first made attractive to them through Bergs approach and they then had moved on toward a deeper and more learned connection to the tradition. None of these claims can be ignored; religious movements are always complex in the effects they have on different personalities and people coming to them with different sets of needs.

In recent years, with Berg crippled by a stroke, the centers have also faced charges on the fiscal front and in general seem to have seen better days. Most of the Hollywood personalities have come and gone. In retrospect, it would be fair to say that while the Berg enterprise surely increased the fame of kabbala, and may have been beneficial to some seekers, it did not enhance the reputation of Jewish mysticism among the worlds spiritual traditions. Kabbala does indeed contain great wisdom and a proper popularization of its teachings could have much to say to our world. We denizens of the first world especially need to be taught that there are some worlds above us, and learn how to become givers rather than just receivers or consumers. Religion has no more urgent task. But the job still needs to be done, and without the commercialization and hucksterism that too often made it appear seamy rather than profound.

Arthur Green serves as rector of the Rabbinical School and professor of Jewish philosophy and religion at Hebrew College in Newton, Mass.


Oct 23, 2013

Do You Believe in Magic? Topol, Offit on Alternative Medicine

Eric J. Topol, MD, and Paul A. Offit, MD

In this edition of Medscape One-on-One, Eric J. Topol, MD, and Paul A. Offit, MD, discuss Offit's new book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine. In his book, Dr. Offit takes a look at the billion-dollar, unregulated supplement, vitamin, and alternative medicine industries.

October 2, 2013

Editor's Note: Introduction 
Dr. Topol: Hello. I am Dr. Eric Topol, Editor-in-Chief for Medscape. We have a great session of Medscape One-on-One today with Dr. Paul Offit, who is the head of the Infectious Diseases Division at the Children's Hospital of Philadelphia (CHOP).

He has written a very interesting book that takes on the whole supplement, vitamin, alternative medicine, and complementary medicine era. It's really a delight to be able to welcome Paul to Medscape. Welcome, Paul. It is great to be with you.

Dr. Offit: Thanks, Eric. Thanks for having me.
Positive Reaction to a New Book

Dr. Topol: Back in June, you published the book Do You Believe in Magic? What has been the reaction so far?

Dr. Offit: It has been overwhelmingly positive. It is surprising, actually, certainly from academics or those interested in communicating science or health to the public, it has been embraced. People are glad that somebody stood up and tried to explain this in a reasonable way. But not surprisingly, I have also gotten some pretty negative responses because, in a sense, I have attacked the church of vaccines and dietary supplements, and that belief system has been defended by some. 

Exploring Linus Pauling's "Dark Side"

Dr. Topol: You have taken on an industry that takes in almost $40 billion a year -- just immense -- and it has a lot of constituents. I just finished your book. I thought it was excellent, and I learned a lot from you and the research that you did. You had a whole section on Linus Pauling,[1] and obviously he was a legendary scientist. But it seemed like he went over to the dark side -- that is, he believed in magic. Was he really the one that ushered in this era of all the alternative medicine and the vitamins? Or was it actually already there before Linus Pauling?

Dr. Offit: Well, certainly the notion of alternative medicine has been around for 5000 years. Things like acupuncture or using plants as medicinals have been around forever. I think what Linus Pauling did was give birth to the notion that megavitamins -- meaning these large quantities of vitamins greatly in excess of the recommended daily allowance -- have a vast array of beneficial activities. They could cure the common cold. They could cure cancer. They could prevent aging.

He gave that its impetus because he was a brilliant man. He is the only person ever to win 2 unshared Nobel prizes. In many ways he launched the fields of molecular biology and evolutionary biology. He received a Nobel Prize in chemistry as a very young man because he was able to formulate these secondary structures for proteins. He was amazing.

He was a rigorous, thoughtful scientist, and then something happened to him in his mid-60s. Maybe it was just the sin of hubris because he had been so right for so long, where he believed that his notions about megavitamins were correct even when study after study showed that they weren't correct.

Dr. Topol: I was amazed about how he was only 30 when he got the Nobel Prize in chemistry, but it seemed like he snapped along the way. Then, because he was so highly regarded, that had a big impact on American culture.

The Oprah Effect

Dr. Topol: Another part of the story that seems to have had a big impact in the United States is the Oprah effect of creating monsters, if you will -- although you didn't use that term, I don't think. But there are 3 physicians that she kind of brought to the floor. We are going to talk about celebrities in a minute, but Oprah brought 3 physicians to the forefront: Mehmet Oz, Andrew Weil, and Deepak Chopra. And it seems like all 3 of them, as you reviewed in your book, had a big amplification of their impact -- if not even the beginning of their stardom -- with Oprah. Do you want to comment about that?

Dr. Offit: Oprah has a tremendous stage, and she has been very good about many things -- especially, for example, getting this country to read more than they would have otherwise. She is a sympathetic figure who likes to promote people whom she views as potential victims, and in that way she has been very good.

But with regard to science and medicine, she has been pretty awful. She was on the cover of Newsweek with a picture that made her look frankly a little crazy -- and it read just that.[Editor's note: The cover story of the June 8, 2009, issue of Newsweek was "Crazy Talk: Oprah, Wacky Cures, & You."] It was sort of Oprah's crazy science. She gave birth to Jenny McCarthy in many ways and Jenny McCarthy's notions that vaccines could cause autism. And she has given birth to Deepak Chopra -- certainly launched Deepak Chopra and such people as Mehmet Oz -- and she likes at some level the guru phenomenon.

I think that is what Oz and Chopra and Weil all have in common. They sort of present this notion of medicine as a guru, sort of, "Listen to me." And medicine is not that. I mean, science is viewed by some as distant, technological, and cold. What people like Oprah, and like Oz, Chopra, and Weil, do is imbue their medicine with a kind of spirituality. It becomes a matter of them and their personality rather than the data, which is always a little dangerous.

Dr. Topol: Why do you think they are so successful? Is there just this extraordinary need to have the wise leader and the spirituality? Is there a craving for that out there? What do you think is the real underpinning?

Dr. Offit: I think that is it. I don't know if you remember the TV show Star Trek, but there was the doctor on that show -- Bones McCoy. He would take this scanning device, and he would scan up and down, look on that device, and that was the diagnosis. It was immutable. It was clear. There wasn't any question about it, and that is just not medicine.

With medicine, we certainly will know far more 100 years from now than we know now. There is much about medicine that stymies us, but that is not these guys. People like Oz and Chopra and Weil have a certain surety and immutability that I think is very attractive because the fact is that medicine does have limits, and yet that is all we have right now. They sort of go to a level beyond that, and I think that is extremely attractive.

People will say you can't trust science because, for example, one study will show one thing, and then that study will be shown to be incorrect. And you and I would argue that that is good. That means that science is self-correcting. We can take a textbook and throw it over our shoulder without a backward glance as we get more and more information, but to some people that mutability and fluidity is viewed as disconcerting. They want something that is surer, and these people provide that in their books. You look at Andrew Weil's books. He tells you how to be a friend, he tells you how to make low-fat salad dressing, he tells you how to live your life -- and that is attractive.

A Look at Fish Oil

Dr. Topol: You gave a pass to certain things in your book, which I was a little surprised about. For example, you were kind to fish oil. And you probably saw the big paper in the New England Journal of Medicine ? It was a big Italian study that showed that fish oil didn't do anything for preventing heart disease. Would you revise? Would you be a little tougher on fish oils if you were to get the most updated information, or do you still think there is a place for fish oil?

Dr. Offit: Absolutely. Harper Collins is the publisher; it is a big publisher. This book was written a year and a half ago, so it takes a while to get those books out. I absolutely would revise it, and there were some recent studies that showed that at least the antioxidant part of omega-3 fatty acids actually could increase your risk for such things as cancer, so I absolutely would revise it. That is the problem with books -- they are written at a specific point in time.

The Confusion Over Vitamin D

Dr. Topol: I'm with you. I know full well what you are alluding to there -- the delay. Now what about vitamin D? You were kind of positive about some indications for vitamin D. But there is a lot of confusion about what should be a population level of vitamin D that is good for people. Do you have any comments about that particular supplement?

Dr. Offit: Suddenly we are all vitamin D deficient, and the level has changed and now the normal range has been revised so that everybody seems to be vitamin D deficient. Certainly, vitamin D is of value for the child who is exclusively breastfed. The mother doesn't get outside very much. The child doesn't get outside very much. Absolutely, vitamin D is of value there. Otherwise, regarding bone thinning -- the use of vitamin D plus calcium -- I think the data just aren't clear. They are certainly not compelling, and I think 10 years from now we are going to look back and ask, "What is this vitamin D craze?" and be past it.

Dr. Topol: You know, out here in California, my patients come in and they typically have a list of 20 or 30 supplements and vitamins that they're taking. Some of it I have never heard of -- just ridiculous stuff. But invariably, they are taking high doses of vitamin D, and typically they're taking vitamin E, which as you point out is harmful. So it is pretty scary what goes on out there.

Chelation Therapy for Coronary Disease

Dr. Topol: Now another trial that is new since the book came out is the chelation trial for coronary heart disease, and a lot of us felt that it was kind of crazy to put National Institutes of Health (NIH) money, big money, into a chelation trial. But that was reported in JAMA, and it created quite a stir a few months back. What are your views about chelation for prevention of coronary disease?

Dr. Offit: I think there are no data to support its use. I think it is clear that certainly chelation can be harmful. I mean, the Centers for Disease Control's (CDC's) Morbidity and Mortality Weekly Report [2]has reported a handful of children and adults who have died owing to chelation therapy because chelation therapy can chelate calcium, which is important for electroconductivity of the heart, and there have been heart attacks from this therapy. And certainly children with autism who have been treated with chelation therapy have died because of chelation therapy.

So if you look at that chelation trial -- which surprisingly was published in JAMA, given the inferior quality of that study -- it really didn't isolate the one variable they meant to look at: chelation. There were a number of variables in that study, and I think as a consequence it was a useless study. It was a lot of money that was wasted. I think that the consumer should say that at this point and for right now, there are no data to support the use of chelation and there are no clear benefits, although there certainly are clear risks. I would argue that the risks outweigh what are at best theoretical benefits.

Dr. Topol: As you pointed out, there were a lot of other things in the chelation mix that were administered to study participants. And they had a lot of issues with that trial.

Resveratrol: Looking for the Fountain of Youth

Dr. Topol: Now one thing that you didn't get into -- and this has had a much more scientific story with the study by David Sinclair and the group at Harvard[3] -- is resveratrol and its effect on antiaging. Thoughts about that one?

Dr. Offit: The antiaging industry itself is about a $6 billion-a-year industry. It is a huge industry. The notion that we can in some ways turn back the clock has been something that has been attractive to us ever since the days of Ponce de Leon. We are always looking for the fountain of youth, and we do live longer than we used to, but the reason that we live longer than we used to has everything to do with the way that we live and nothing to do with the way that we age.

We have had vaccines. We exercise more. I think we are more careful about our diet, about eating more fruits and vegetables, and trying to avoid stress. All of that has contributed to our living longer, and I think that you can take this entire antiaging industry and say that it has contributed nothing to why we live longer.

I wrote this book because there are about 54,000 dietary supplements on the market; I wanted to find things for which there was clear evidence that they were of value, and so I came up with, for example, folic acid for the pregnant woman. I think you can argue that melatonin actually is of value at some level regarding insomnia. There are even some data that St. John's wort is maybe of value for someone who is mildly depressed. The problem with the industry, though -- and this is what I had trouble getting around -- is that it is unregulated. So you may have a study that shows St. John's wort as having value in mild depression, but it is hard to compare one study with the next because the label that is on the bottle may in no way accurately reflect what is in the bottle because it is unregulated.

What's Really in the Bottle?

Dr. Topol: That is a key point. A number of years ago in The Lancet,[4] you may recall, and I think you referenced it in the book, there was a very nice randomized trial of glucosamine for knee osteoarthritis. But the problem, of course, is that the preparation that was used in the trial -- the one positive trial -- you would have a hard time finding that particular preparation and dose because, as you say, it is an unregulated industry.

I didn't know the background about how unregulated the industry is until I got into your book. I found it fascinating that this cartel of vitamin supplement companies came together in Santa Barbara and put out this big campaign with Mel Gibson [featured in commercials]. That was amazing to me. I really learned a lot about Sen Orrin Hatch (R, Utah) [and his role in the Dietary Supplement Health and Education Act of 1994 (DSHEA).[5]] Can you comment about the politics and the background that has prevented the US Food and Drug Administration (FDA) from having their rightful oversight of this humongous area of health and medicine?

Dr. Offit: It is exactly what you would think it is. Because it now is almost a $34 billion-a-year industry, there are a lot of people making a lot of money, including big pharmaceutical companies. Pfizer bought Alacer recently, which is probably the biggest maker of megavitamins in the United States. Hoffmann-La Roche has been a player in the megavitamin and supplement game since the 1930s.

People have this sort of false notion that there is big pharma on one side and then on this other side, there are just a group of people who want to make natural products, and that they are being made by elves and old hippies on mountainsides. That is not the way that it works, and not surprisingly, when you have a big industry, which at least up until the early 1970s was unregulated, initially the interest by the FDA was to regulate the megavitamin industry -- because they felt that there was no clear evidence that giving vitamins at 150% or more of the recommended daily allowance was of value, and they worried that it would be harmful. At the time, there weren't data to show that it was harmful. Now there are. Now there are more than 20 studies to show that if you take large quantities of vitamin A or vitamin E or beta-carotene, which is a vitamin A precursor, you actually increase your risk for cancer and increase your risk for heart disease.

I believe that if this were a regulated industry, there would be a black box warning on these megavitamins, and this is a problem. I will give you another example. I walked into a GNC store about a week ago and bought a vitamin E preparation that said "natural vitamin E" on the front. On the back, it said "3333% of the RDA" (recommended daily allowance). That is 33 times the recommended daily allowance.

This one capsule was about maybe half the size of an almond. Almonds are an excellent source of vitamin E. You would have to eat 1650 almonds to get what was in that 1 capsule. How is that a natural thing to do? I think if people saw this for what it was, they would be suspicious, and they should be more suspicious about what the word "natural" means.

The industry has been able to keep the FDA at bay, and I don't see this changing anytime soon. So not only do we not know what the potential harms of these products are, not only do we not know that a lot of these claims are simply false claims, but we don't even know what is really in those products. I mean, what is on that label may in no way reflect what is actually in that product.

Look at what happened with this vitamin-maker called Purity First. Purity First, a few weeks ago, had all of its products recalled by the FDA. They made 3 products. They made vitamin C. They made a multimineral preparation, and they made a B-complex vitamin preparation. What happened was there were 25 women in Connecticut who started to develop symptoms of increased hair where they didn't want hair to be, deepening of the voice, and loss of menstrual cycles because they were inadvertently taking anabolic steroids. Anabolic steroids had contaminated those preparations. How does that happen? And yet, when it was taken off the market, the CEO of that company said, you know, it is just big pharma trying to shove out the little guy.

Their vitamins were contaminated with anabolic steroids. Just imagine if vaccines were inadvertently contaminated with anabolic steroids. You would never hear the end of it, but here somehow it all gets a free pass.

Dangerous Side Effects of Little Consequence

Dr. Topol: But Paul, what I don't understand is that you have got large randomized trials published in the highest-impact, most highly regarded journals that take down, like you said, vitamin E, beta-carotene, and vitamin A for various things -- and yet no information goes to the public. There is no oversight. How is this going to get fixed? This is really a very sorry state, don't you think? And you just reviewed another poignant example.

Dr. Offit: You know this better than anybody. I mean, when Vioxx (rofecoxib) was eventually clearly shown to increase one's risk for heart attacks, you knew it. The FDA regulated Vioxx. They put out media releases, and ultimately that product was taken off the market.

Here, because the FDA really doesn't have oversight, they are really only in a reactive mode. When will they get to the point where they take vitamins off the market because they have clearly been shown to be a problem? I don't see it happening until the FDA regulates them, and until the consumer gets smarter and says, "I want to know what I am buying. I want to know whether or not these claims are real or whether there are harms that are in this product. I insist that the industry be regulated."

But that is not how people think about these products. They think about this as their medicine -- their specific, own personal medicine. I can walk into the GNC store and shrink my prostate and reduce my stress and boost my immune system. I don't want the government telling me about this, even though what the government may tell you if they regulated it is that these aren't what they claim to be and the harms are not apparent, but they are there.

Dr. Topol: We are just laying out the facts-- the facts from rigorous research, which set this straight -- and that is the one thing I would have loved to have seen toward the end of your book: recommendations on how we can fix this mess that we are in. That's OK. There is a lot there.

There are a few other things I want to touch on with you. This is just great to have the chance to interact. Now let's talk about the Lyme disease stuff you write about. You called out former Attorney General Richard Blumenthal, who now is a senator of Connecticut, [about his actions on Lyme disease]. I don't know if you saw the New York Times editorial saying that he is introducing further legislation on this.[6] Do you want to comment about how chronic Lyme disease is just kind of intermixed with this tough topic? You had a whole chapter on it.

Dr. Offit: Well, in a better world, obviously politicians wouldn't get involved in science. I think when Orrin Hatch gets involved, and as has former Rep Dan Burton (R, Indiana), we basically had champions of the alternative medicine industry. It should never be about that. It should always be about the data. Is the science there to support a claim? Is the science there to support safety? In a better world, that should be the only thing that we look at.

Blumenthal became very sympathetic, for whatever reason, for those who believe that, despite treatment for their Lyme disease -- or even in those who never had Lyme disease -- that these chronic symptoms were because of this so-called long-term Lyme or post-treatment Lyme disease, which we now know doesn't exist. I think he really did a lot of harm to those people. It certainly meant that there were a lot of people who received antibiotics far longer than they needed to and suffered the consequences of long-term antibiotic therapy, or worse, these crazy kinds of therapies that are associated with this made-up disease, chronic Lyme. I think this is probably an area that is unique in the alternative medicine world. Usually where alternative medicine thrives is where medicine has little to offer.

For example, we don't know the cause or causes of autism. Clearly, we don't have a clear treatment for autism. There are certain cancers, such as pancreatic cancer or brainstem glioblastomas, for which we have very little to offer. That is often where you will see the alternative therapist -- the charlatan, frankly -- step up and say, this is what your doctor doesn't want you to know, this is what the pharmaceutical companies don't want you to know, but we have a treatment.

What is unique about chronic Lyme disease is that they basically made up a disease: "You can have chronic Lyme even if you live in a state that doesn't have ticks that carry Lyme bacteria." So they sort of broadened their market and then used some of these therapies -- malaria therapy, for example -- and that was criminal.

Alternative Medicine and Celebrities

Dr. Topol: We have covered the politicians and the doctors. The last topic we didn't really touch on too much was the celebrities. You called out 2 major ones: Suzanne Somers and Jenny McCarthy. At one point, you even ask why the public is so into Suzanne Somers when there is a really good resource like Siddhartha Mukherjee, an oncologist, who wrote a wonderful book on cancer, The Emperor of All Maladies. Why can't the public have a go-to figure who is trustworthy and knowledgeable, rather than somebody who just invents facts and has an immense impact through media support? Why can't we get this thing straight?

Dr. Offit: I think we tend to trust celebrities and their message because we feel that we know them. Celebrities have been selling products since the beginning of time. Because you see them on the big screen or you see them on the little screen, that familiarly breeds a certain level of trust. We don't know scientists. Name a famous scientist in the past 10 years whom people would know by sight. I don't think we could name one, so that is it.

Siddhartha Mukherjee is a Rhodes Scholar. He trained at Cambridge and then Harvard. He has an expertise and experience in cancer. He wrote a Pulitzer Prize-winning book that really explained cancer for the general public, and yet he is not the person the media go to when they are trying to explain cancer; it is Suzanne Somers. And who is she? She was Chrissy on Three's Company. She was the promoter of the ThighMaster. That is what recommends her to this, and it is sad, but it has always been true. I don't see that changing.
Dr. Topol: And Jenny McCarthy now is going to be on The View and have undue influence. She has already hurt so many kids with the autism vaccine myth -- it's just endless. How are we going to take the reins on this problem? Is there any solution in sight?

Dr. Offit: I don't think The View was ever the Algonquin Round Table, but this is pretty bad even for them. It's a little depressing. I am going to predict that she actually doesn't say much. I think that the antivaccine movement, at least as represented by her, has really lost a lot of steam lately, and this may sound a little counterintuitive, but I think Andrew Wakefield really hurt them. It is not only that he was wrong; it is that he misrepresented data and was wrong, and I think a lot of people were put off by that.

Meditation and the Placebo Response

Dr. Topol: I am not sure that the whole world knows about that whole Wakefield story, but it is nicely reviewed in the book. Now I want to ask your opinion.

We here in San Diego are very close to the Chopra Center. Deepak Chopra, MD, is up in Carlsbad, just a few miles away. He wanted us to use our digital medical tools to understand the physiologic response to meditation, and so we are going to do a study with various sensors (not only EEG but also vital signs and autonomic nervous system metrics, such as galvanic skin response and heart rate variability -- the whole shooting match) to see what happens with meditation. I kind of like that, because we are going to get some objective data, and that is what this field is missing. Do you think that it's OK that we are going to embark on that kind of study?

Dr. Offit: I think it is important. The one thing that changed my mind in writing this book was that when it was originally conceived and written, it had a different title. It was called "Quacks: How They Hurt Us and Why We Let Them." I changed it, and you have seen the last chapter of the book. I talk a lot about the placebo response and the physiology of the placebo response. And because it is real, I think in many ways it is physiologically based.

Can we learn to relieve symptoms with our own endorphins? Can we learn to upregulate and downregulate our own immune system, release our own dopamine, and affect our own mediators of stress, which can have broad negative effects? Yes, I think that is all true, and it is all studyable, and that is why I think that what you are saying is so important. I think Mehmet Oz, for example, will go on his show and will talk wondrously about acupuncture, which no doubt benefits people, and it may be because they are learning how to release their own endorphins.

We don't have to look to the gods to explain these things. We can look into ourselves and try and figure out the physiology so that we can then learn to evoke these behaviors at lowest risk, lowest burden, and lowest cost. I think that is important.

Dr. Topol: The last thing I wanted to ask you about was indeed the placebo effect, because that story is just so rich, and obviously it is not just endorphins and dopamine squirts. You can tell a patient, "I am giving you a placebo," and people get better even when knowing that it's a placebo, so there seems to be a whole science of placebos. Why aren't we actually just calling it placebo and giving placebos in our medical practice and studying it more?

Dr. Offit: First of all, we used to. I am old enough to remember my pediatrician coming to my house -- Dr. Milton Markowitz, who eventually became dean of Connecticut's medical schools and is a very smart man. I remember looking through his big black bag, and he had a bottle in there of these small pills. I asked him what they were, and he said that they were sugar pills for people who were going to get better anyway who just needed to feel that they were taking something. And I thought this was great, because in my little doctor's kit at age 5 I also had sugar pills, so I thought, I am well on my way.

You are right. I think the question is, is it ethical to deceive, and at some level I think the answer is yes. I think we do it all the time. At Children's Hospital of Philadelphia, when we give medicines, we often will say, "We really think this is going to work for you." I think that is part of it. We wear white coats with red lettering. We have big fancy equipment that makes interesting noises. I think people come in with an expectation of therapy, and that goes a long way toward being therapeutic.

I wish we had a word that was different from "placebo," because when people hear that word, they think it is dismissive -- that it is just all in their heads. But in fact it can very much be in their bodies, and so I think it is all worthy of study.

Dr. Topol: This has been so much fun to talk to you about your book. Thanks for all the hard work and research you did to put that together. I give you a lot of credit. I think the whole medical community should be indebted because you have taken on vaccines, the antivaccine movement, and now with this project you have taken on a tough, tough area. Hopefully this will somehow spark some improvement; there is a lot of improvement that could be had here. Thanks a lot, Paul. I really enjoyed the discussion with you.

Dr. Offit: Thank you, Eric. I appreciate you having me on.

Dr. Topol: Well, that is it for Medscape One-on-One today. We're really indebted to have Paul Offit with us, and we will be back with more hopefully interesting looks into various topics that will be pertinent to medical practice and the health of our population in the times ahead. Thank you.

Oct 13, 2013

Mental Health Issues in Cult-Related Interventions

ICSA will conduct a special event in Philadelphia from 10:00 AM to 4:30 PM on Sunday, October 13, 2013. The event will take place at the Sheraton Philadelphia University City (36th and Chestnut St.).

In this special event, cult intervention specialists and mental health professionals will discuss their roles in helping families and former members, in particular how they work together and how they differ. 
Among the questions to be examined are:

  1. What assessment criteria should be considered to determine the appropriateness and feasibility of cult-related interventions? 
  2. What criteria should be considered to determine the appropriateness of mental health consultation and/or treatment? 
This event should be useful to former members of high-control groups or relationships, families concerned about an affected loved one, and helping professionals whose assistance is sometimes sought by families and former members. 
Speakers include some of the leading "exit counselors" and mental health professionals in this field, including (see “People Profiles” link on www.icsahome.com for biographical data): 

  • David Clark 
  • Steve K. D. Eichel, PhD, ABPP 
  • Lorna Goldberg, MSW, LCSW, PsyA 
  • William Goldberg, MSW, LCSW, PsyA 
  • Steven Hassan, Med, LMHC, NCC 
  • Joseph Kelly 
  • Arnold Markowitz, LCSW 
  • Patrick Ryan 
  • Daniel Shaw, LCSW 
  • Joseph Szimhart 
We hope you join us! 

Please tell others and donate if you cannot attend.  Thank you.

Oct 10, 2013

Attacks on Peripheral Versus Central Elements of Self and the Impact of Thought Reforming Techniques

Richard Ofshe, Ph.D. and Margaret T. Singer, Ph.D.

This paper analyzes the literature concerning the use of massive social pressure to substantially modify a person's worldview. The use of "coordinated programs of coercive influence and behavior control" in China and the Soviet Union as well as in American cultic, "growth," and psychotherapy organizations is considered. Special consideration is given to the centrality of the aspects of a person's identity, which are denigrated and undercut in coercive influence and control programs. It is suggested that the technology of this sort of influence has developed well beyond what was employed in the Soviet Union and China. Applications in these cases were largely for the purpose of extracting confessions and carrying out political "thought reform." The development in technology reflects a focusing upon central rather than peripheral aspects of a person's self and the use of techniques, often borrowed from clinical psychological practice, to neutralize a person's psychological defenses. Evidence is reviewed which suggests that there is a risk factor associated with exposure to the type of influence tactics used by some organizations that attempt thought reform.

We are addressing an unusual topic—the technology of influence programs used to conduct thought reform and to effect extraordinary degrees of control over individuals. The programs to be described below depend on selecting, sequencing, and coordinating numerous influence tactics over periods of time that can extend from days to years.

In this paper we will address two matters. The first is an historical review of the influence techniques employed in "first" and "second generation of interest" influence and control programs. By first generation of interest programs we refer to Soviet and Chinese thought reform and behavior control practices studied twenty to thirty years ago. Second generation examples are of programs which are either currently operating or have been in existence during the last decade. We will suggest that the two categories of programs differ in the sophistication of the interpersonal and psychological influence tactics they employ.

The second concern of the paper is the presentation of a theoretical analysis of one of the principal differences we find between first and second-generation programs. The difference is in the manner and degree to which a person's self-concept is destabilized in the course of attempts to gain influence and attain control over an individual. Attacking targets' evaluation of self is a technique present in both older and newer programs. We suggest, however, that the focal point of attack on targets' self-conception is an important difference between the programs. In older programs, attacks on the stability and acceptability of existing self-evaluations were typically focused on elements we classify as peripheral. Newer programs tend to focus on elements of self we classify as central.

Peripheral elements of self are defined as self-evaluations of the adequacy or correctness of public and judgmental aspects of a person's life (e.g., social status, role performance, conformity to societal norms, political and social opinions, taste, etc.). We define as central elements of self, self-evaluation of the adequacy or correctness of a person's intimate life and confidence in perception of reality (e.g., relations with family, personal aspirations, sexual experience, traumatic life events, religious beliefs, estimates of the motivations of others, etc.).

We assume that peripheral and central elements vary in their emotional significance, with central elements having far greater emotional arousal potential than peripheralelements. The basis for this assumption rests on conventional clinical psychological understanding of the significance of early childhood experiences, emotional development, defense formation, and ego strength. That is, reality awareness, emotional control, and basic consciousness are at the core of the self. Social roles reflect later and less core learnings in human development. We propose that influence and control programs which manipulate central self-evaluations are likely to have more powerful and profound effects on targets than programs which focus on the manipulation of only peripheral elements of self.

We suggest that attack on the stability and quality of evaluations of self-conceptions is the principal effective coercive technique used in the conduct of thought reform and behavior control programs. By attacking a person's self-concept, aversive emotional arousal can be created. By supporting positive self-conceptions, painful arousal can be avoided or reduced. In the programs we have studied, the ability to generate or reduce aversive emotional arousal is used to punish or reward targets. Non-conformity is responded to with attacks on the target's self conceptions while agreement to demands for ideological acceptance and behavioral compliance are rewarded with support for positive self-conceptions.

Historical Context
During the last decade there has been a dramatic renewal of public and academic interest in the procedures and effects of "coordinated programs of coercive influence and behavior control." That is, programs designed first to induce radical changes in facets of a person's worldview (e.g., beliefs about a political philosophy, scientific theory, psychological theory, ethical philosophy, etc.), and subsequently to generate great conformity to organizationally specified prescriptions for behavior. The combined effects of (1) acceptance of a particular world view, (2) establishment of effective procedures for peer monitoring, including feedback about an individual to the controlling organization, and (3) the use of psychological, social, and material sanctions to influence a target's behavior, can render a person a highly deployable agent of an organization (Ofshe, 1980; Whyte, 1976).Over a generation ago, studies of coercive influence and behavior control programs began to appear. They described the power of these programs to influence cognition, behavior, and the mental health status of program participants. The topic was reported and studied under names such as "brainwashing" (Hunter, 1953), "thought reform" (Lifton, 1961), and "coercive persuasion" (Schein, 1961).

Recently renewed interest in the topic can be traced to the actions of various "new religions and social movements" (Glock and Bellah, 1976). Public concern has been about the recruitment activities, apparent personality changes, and emotional disorders found in some recruits, and the culturally distinct lifestyles associated with membership in some groups. Some of these organizations and communities were founded or rapidly expanded during the later 1960's and early 1970's. Beginning in the early 1970's, claims were made that some of these organizations were conducting programs of "coercive influence and behavior control" (i.e., "thought reform, "brainwashing," etc.).

Not all the "new religion," "growth," or "radical psychotherapy" organizations have been alleged to employ techniques of "mind control" or "coercive influence and behavior control." Some organizations, however, have been centers of controversy for more than a decade, and they have given rise to grass-roots reactions and substantial media attention as early as the mid-1970's.

General public awareness of "cults" came through news reports of numerous bizarre crimes and acts of terrorism committed by members of some now infamous organizations. Through these reports, the public became somewhat educated as to the extraordinary social organization, practices, and techniques of influence employed by the leadership of the groups associated with the crimes.

Starting in 1909, with the several brutal murders committed by Charles Manson and his devotees (Bugliosi and Gentry, 1974; Watkins, 1979), the string includes the 1973 Symbionese Liberation Army kidnapping and conversion of Patricia Hearst (Hearst, 1982); a 1977 murder spree carried out by Mormon polygamy sect leader Ervil LeBaron and hisfollowers against their Mormon opponents (Bradlee and Van Atta, 1981); an October 1978 attempted murder by rattlesnake engineered by Synanon leader Charles Dederich (Mitchell et al., 1980; Ofshe, 1980); the November 1978 mass murder/suicides in Jonestown, Guyana conducted at the direction of People's Temple leader Jim Jones (Reiterman and Jacobs, 1982); an attempt by members of a faith healing cult to bomb a sheriffs department in Arizona (Trillin, 1982); a 1982 infant's beating death caused by his parents acting in conformity to their cult leader's theory of childrearing (Zito, 1982); widely publicized accusations of child abuse following from alleged conformity to the visions of a leader of a Vermont commune called the Northeast Kingdom Community Church (Bearak, 1984); and, most recently, allegations of child abuse carried out for years at a nursery school reported to have used techniques of psychological terrorism to prevent children from revealing their experiences (L.A.. Times, 1984).

First Generation of Interest Programs
The modern literature on the intentional use of coercive influence and control programs starts with reports of prisoner interrogation and retraining in the Soviet Union, China, and North Korea. Studies of these "first generation of interest" programs are consistent on several points no matter what descriptive label the authors used (Chen, 1960; Farber et al., 1956; Schein, 1961; Schein et al., 1960; Segal, 1957). Although significant physical abuse was frequently a part of the influence method, it was not uniformly so (Hinkle and Wolf, 1956; Lifton, 1961; Rickett and Rickett, 1957). Even when physical abuse was used, the primary mechanism for accomplishing behavior control was that of interaction between the target and those who could sanction the person materially and socially. In addition to small material rewards, the target's interaction partners controlled the only available source of feedback as to what was socially correct in the new society. Hence, they controlled the target's only source of external feedback upon which new self-evaluations might be based.

Interaction partners typically possessed superior knowledge about both the substance of the ideology to which the target was being exposed and the behavior rules advocated by thecontrolling organization. Interaction partners were sometimes the target's organizational superiors (jailers, officials, etc.). More often, they were ideologically advanced but organization status equals who became the target's peer group. Targets often developed strong emotional ties with peer group members. These individuals came to know the target's personality and history exceedingly well.

The setting within which the influence system was operating sometimes included prison confinement of targets, but more frequently did not (Hinkle and Wolf, 1956; Whyte, 1976). In prison settings, initial conformity to demands for participation in interrogation sessions and conformity to prescribed patterns of interaction with power holders (jailers, organizational superiors, or cellmates) was instrumental to cessation of gross punishment. In non-prison settings, participation was usually obtained without having to resort to physical abuse, although it was often obtained from persons knowing that imprisonment was a possible consequence of resistance (Whyte, 1976). In settings such as revolutionary universities, initial participation in the indoctrination process was usually voluntary since the experience was viewed as instrumental to transforming Chinese society or to personal upward mobility.

In all settings, participation, conformity, and demonstrations of apparently genuine change or zeal were rewarded. In the harshest settings, rewards would include some seemingly minor but contextually significant material advantages (Segal, 1957). In all settings (with the possible exception of P.O.W. camps) peer or jailer social support, acceptance, and friendship also followed incremental changes in the prescribed direction.

The role of peer interaction in the creation and manipulation of guilt and associated emotional states is acknowledged as crucial in understanding how a target's behavior was shaped (Lifton, 1961; Schein, 1961). The target's peers did the principal work in this shaping. They had two tools with which to mold the individual.

Targets could be subjected to various forms of punishment by peer groups. Although punishment might be physical, most often it took the form of group criticism of the individual's past or present social beliefs and behaviors. The target's peers could withdraw support, isolate him or her, and subject the target to seemingly endless negative feedback regarding deviations from proper ideological positions and prescribed behavior. In these criticism sessions, the target faced precisely those individuals on whom, due to circumstances, he or she was totally dependent for external validation of social identity. Peers acted in concert and aggressively criticized the target from a fixed standard of evaluation. Their focus was on any degree of deviation from absolute conformity to theoretical ideals of ideological understanding and behavior.

It was required that individuals make public to others within the group their life stories. This included prior social experience, family history, and family position. They were also obliged to reveal acts which, by the new moral code of the nearly new society, were deemed transgressions. The group's access to the target's social and political history provided a basis for inducing guilt in the individual for acts which, by the old society's standards, were proper or tolerable. The group demanded that the target acquire a sense of guilt with respect to previously privileged social position and previously acceptable actions. The target was also required to offer appropriate expressions of guilt and display remorse before peers would accept professed contrition regarding past transgressions.

First Generation Program Casualties
That the arousal caused by group criticism was punishing and harmful to targets is supported by reports that this procedure was capable of producing symptoms of severe psychological disturbance in some targets (Hinkle and Wolf, 1956; Lifton, 1961; Strassman et al., 1956). Although it might be argued that psychological distress was to some extent caused by physical abuse and deprivation, reports of responses directly related to physical abuse components of the influence process are lacking. Knowledge of the potential for physical abuse was probably a factor in the target's estimate of the threat potential of the controlling organization. Physical debilitation due to the effects of poor diet and other health factors should also be viewed as a context factor which, at least, reduced the individual's ability to cope with stress. It is probably reasonable to describe alltargets of these influence programs as (1) physically and emotionally stressed as well as (2) extremely apprehensive if not terrorized due to awareness of the ever-present and often arbitrary use of punishment power by the controlling organization (Farber et al., 1956; Gaylin, 1974). As reported below, however, neither physical abuse nor deprivation was necessary for the influence process to cause psychiatric casualties.

Reports of rates of severe psychiatric disturbance have not been published. There is general recognition of the ability of all versions of the influence procedures to induce personal confusion, disorientation, and variously described psychological disturbances in targets (Hinkle and Wolf, 1956; Schein et al., 1960; Schein and Singer, 1962; Strassman et al., 1956). In revolutionary university and cadre training schools, there was no period of physical abuse prior to participation in small group interaction. Typically, these programs were entered voluntarily.

Revolutionary university and cadre training experiences are reported to have produced the highest rate of dramatic psychopathological response of any of the systems under discussion (Hinkle and Wolf, 1956). The stress of struggle groups, peer pressure, constant surveillance together with the requirements of self-exposure and self-accusation regularly resulted in psychological breakdown. Lifton (1961) reports that influence pressures at revolutionary universities often resulted in psychotic breaks of unspecified severity. At cadre training schools, the majority of students ultimately reached the point at which they went through an emotional crisis associated with tears and depression … A religious fervor and a feeling of "conversion" frequently accompanied this emotional breakdown (Hinkle and Wolf, 1956, p.167).

After the development of fervor, "a fair proportion of students suffered one or more relapses of fears and doubts" (Finkle and Wolfe, 1956, 168).
Although the evidence is limited, it suggests that physical brutality or deprivation, even when combined with interpersonal coercion, did not regularly cause emotional breakdown or psychotic episodes. There is a notable absence of reports of frequent psychotic breaks among American military prisoners and among imprisoned Westerners in China. When dramatic, emotional reactions are reported, they invariably occur in violence-free settings in which targets are coerced by peers who are their intimates (Hinkel and Wolfe, 1956, 160).

The inference consistent with these reports is that psychological disturbance is more likely to be induced when targets of the influence process actively participate in group-based interaction and have been induced to tell the group about their histories and sentiments. One explanation for the relationship is that public exposure of even moderately intimate aspects of self permits peers to continually manipulate the target's emotionality. Peer group members have the ability to focus their criticisms on significant aspects of the target's self and to repeatedly arouse guilt and anxiety.

In these programs, it appears that aversive arousal, coupled with peer rejection, became the driving force through which the target was coerced. Through this procedure, conformity to behavioral demands was obtained. Targets, motivated by a desire to avoid further social/emotional punishment, learned to perform according to role prescriptions defined by the organization. The peer group's ability to immediately punish resistance, through members' abilities to arouse and sustain anxiety and guilt, permitted the organization to avoid the use of physical punishment except under rare circumstances. Social and psychological punishment by peers became the workhorse of the system. For many individuals this process induced psychological breakdown.

"Second Generation of Interest" Programs
We term as "second generation of interest" those examples of coercive influence and behavior control programs which are currently creating public concern. They can be distinguished from "first generation" programs in several ways. One of the significant differences is that the organizations and residential communities within which programs are carried out lack the power of the State to command participation. Further, they lack the right of the State to back demands for compliance and conformity with the use of force. This results in a radically different method of generating the initial involvement of targets with "second generation" organizations.

The method typically relies on capitalizing upon some area of overlap between the interests of the target and the advertised activity or service of the organization. The point of overlap may involve anything from an exercise program, treatment for psychological or physical ailments, growth programs for personal development, the realization of superhuman abilities, or an interest in affiliation with a spiritual or social movement.

In order to conduct a coercive influence and behavior control program, an organization must obtain both psychological dominance over an individual and a considerable measure of power in the individual's life. The second necessary element, actual power, is often attained in newer organizations by making the target's continuing relations with intimates and friends, as well as economic security, contingent upon continuing membership in the organization.

The initial phase of recruitment often involves an organized "seduction" period during which affective bonds between recruiting agents and the target are developed (Bainbridge, 1978; Of she et al., 1974, 1980; Taylor, 1978; West and Singer, 1980). During this period, targets are encouraged to believe that the organization can provide a service they desire or that it is committed to goals they value. The strength of developing bonds is continually tested against demands for increasing involvement and deference to the demands of the controlling organization.

Influence tactics figure in the development of a target's dependence on an organization in at least two ways. Direct social pressure may be used to induce a sequence of decisions leading to the establishment of power relations which enable an organization to coerce an individual. Depending on the basis for the apparent interest overlap between the organization and the individual, enticements to accept the authority of the organization and to conform to its lifestyle rules may come from promises to achieve a cure for a longstanding problem, to improve the individual, to develop a career for the target with the organization, or through the availability of a ready-made community into which the target may fit. The target is confronted by people seeming to be genuinely interested in his or her well-being. Recruiters, whatever their sentiments, act as agents of the controlling organization and ease the target along the road to dependence.

Often, initial acceptance of the authority and rules of the organization leads to structural and material changes in the individual's life which render the target increasingly dependent on continuing membership. For example, targets may be induced to move into a communally organized residence, accept employment in an organization's business, leave school or contribute whatever economic assets they control. Given these sorts of commitments, rejection by the organization would entail loss of job, residence, and investment.

In addition to material and structural changes, the ability of the organization to increase its relative power over the individual's life depends upon shifting the target's social and emotional attachments to individuals who have accepted the organization's authority and rules. For this reason, when being recruited to some organizations, individuals find themselves recipients of great affection, displays of interest, and virtually endless invitations to group functions. Targets are often expected to involve their families with the recruiting organization. Family members, once involved, are subject to the same influence process as was the original target. This may lead to family members' becoming more committed to the organization than to the relative who first brought them in.

With increasing time and emotional commitment to a new group, it is obvious that a target's network of organizationally independent intimates and friends will atrophy if for no other reason than decreasing contact. If an organization requires proclaiming a viewpoint that seems bizarre when baldly stated (e.g., expectations of acquisition of superhuman powers, the new order is at hand, etc.), or if the organization requires highly assertive or unusual demeanor, targets are liable to discover difficulties emerging in relations with friends or family members who no longer understand them.

An organization will have maximized its structural and social power over a target if it succeeds in introducing changes into the person's life such that the individual's intimates are all subject to its authority and the organization controls the target's income, employment, capital, and social life. Under these circumstances, a person threatened with expulsion is threatened simultaneously with being cut off from many of the major social supports upon which stability of identity and emotional well-being depend. The controlling organization can create this level of extreme threat since the individuals who matter most to the target are subject to the organization's authority and will reject the person if the organization does so.

If an organization succeeds in shifting a target's social ties to other organizational members, it gains the potential to bind the person to the organization in a fashion which far exceeds the binding power of investments, job, and residence. Immersed in a social world in which peer esteem and disapproval are dispensed for conformity to community norms, an individual will find that community standards become the only standards available for self-evaluation.

Common attributes of programs of coercive influence and control are strict rules inhibiting private expressions of disagreement with community or company policy. It is also often expected that members will make frequent public expressions of agreement with policy and acceptance of community norms. One reason for the widespread existence of such rules is their restraining effect on the formation of political opposition within the group (Ofshe, 1980; Selznick, 1960).

In addition to inhibiting organized opposition, the elimination of the expression of counter-authority sentiments and demands for public displays of agreement with community standards have additional effects. These are the elimination of evidence of the validity and very existence of alternative standards for judgment within the group. Promoting displays of agreement with management policy reminds observers that others in the group accept management directives. A person introduced into a community operating with these requirements for inhibiting criticism and displaying agreement finds pervasive reinforcement for particular aspects of behavior and for verbal expressions which are consistent with community positions.

Once the target chooses to interact with peers, the only available medium for communication is in group determined modes of thought and expression. When community-approved terminology is employed, the target gets approval. When other vocabularies or concepts are employed, the target is criticized and shunned. Through dispensing approval or criticism and isolation, the organization encourages the target to employ the appropriate terminology and to find merit in aspects of the community position. The target is, in a special fashion, being acculturated to a new world. The target is not ordered explicitly to conform to community rules. As the process of reinforcing and punishing the target's statements proceeds, the cumulative effect is to restrict the target's expressions to community-approved forms.

An individual immersed in a world in which communication is strictly limited must either remain aware of the difference between private beliefs and permitted public expression or, somehow, come to reconcile public expression with private self. If an environment that permits peer interaction only in terms of certain values and beliefs, it is likely that even a person's statements about what he or she actually values will eventually be molded into the contours of the controlling environment. This leaves the person in the position of surface conformity with perhaps private disagreement.

Having to participate for an extended period in an environment in which an individual must, on a daily basis, use a given ideology and set of customs as the basis for integrating action with the behavior and conversation of others can have a powerful cumulative effect. Because the reinforcement structure of the environment is arranged to shape behavior, participation in the environment will create a history of activity which, when reviewed, would normally tend to lead the individual to conclude that perspectives and values consistent with these activities are indeed his or her own (Bem, 1972). In some groups, there is considerable attention given to pointing out to the individual that conformity to group standards is, by definition, voluntary. That is, there is pressure to publicly agree that action is voluntary.Peripheral self-evaluations are also likely to be manipulated through the same mechanisms of community control. Since community-defined values and standards are the basis on which peers and management dispense approval and disapproval, these standards organize virtually all feedback to the individual. If the target is to exist in the community, he or she must conform to community rules even if they are not privately accepted. Once again the target is faced with the problem of integrating public conformity to one set of standards and private disagreement. The target must either remain aware of the discrepancy between personal standards for self-evaluation and community standards, while behaviorally conforming to community standards, or accept community standards as his or her own. Constantly faced with this demand, it is likely that targets will abandon personal standards in favor of those of the controlling environment. Relinquishing these standards relieves the target of the constant burden of being aware that there is, in a sense, a secret and disapproving private self judging the performance of the person's public self.

The effects we describe are not easily produced or maintained. We suspect that if the environment is to approach even temporary realization of these effects on cognition and self-evaluation, rules about expression of dissent from community positions must be successfully enforced. If targets are able to share with one another their private doubts and reservations, the principles of the reinforcement structure are violated. Knowledge that others maintain private standards different from supposed community consensus, will support independent judgment. If a target were to discover that many of those who participate in the criticism of the target's deviant actions actually shared the target's disagreement, the genuineness of the criticism would be destroyed and the punishment value of the activity significantly reduced. If, however, a target lacks even occasional external support for doubts, it is seductively easy and conflict-resolving to, at some point, literally abandon old standards by creating the rationalization that "I now understand" the correctness of the community's viewpoint, or even that "I don't understand it, but I will trust the community and conform."

Although it is theoretically possible to maintain a double standard of public conformity and private disagreement indefinitely, there is evidence that even in prisoner populations, at least temporary attribution to self for beliefs and values demanded by captors was common. A substantial part of the interest in "first generation" programs of influence and control was caused by the unexpected reactions of non-Chinese released from thought reform camps and returning POW's. For at least a short period after their release, many former prisoners expressed sentiments seemingly reflective of the ideology of their captors. Although these sentiments were rapidly shed upon release from captivity, their attitudes and judgment standards were very much biased by their experiences.
Unlike attitude changes as ordinarily treated in the literature, the sort of shift to the community's position we are describing does not seem to result in stable cognitive reorganization or even stable attributions to self as the source of beliefs. Persons fully involved in the controlling environment may maintain that they "believe" the group's ideology and that they freely accept it. It is often the case, however, that after terminating membership, and therefore being removed from the constant support and coercion present in the environment, seeming belief and confidence in the ideology of the group rapidly erode. This often leaves the person in a state of considerable confusion since he or she can no longer understand the basis for prior conformity to the group's standards.
Rather than conceive of the shift towards conformity standards during residence in the group as the result of attitude change, it may be more fruitful to view the shift in behavior as the result of direct suppression of aspects of the person's self. Once separated from the reinforcement structure of the environment and, therefore, lacking constant group pressure to refrain from acting upon or even entertaining deviant thoughts, old viewpoints, and standards for evaluation may reassert themselves. This reassertion may be surprising to the former group member and may cause the member to doubt that the group's ideology was ever believed.

Milieu Control
First and second generation programs differ in the extent to which they effectively use milieu control as an influence tactic. Milieu control in first generation programs was extensive over an environment which was distinct from the target's usual environment. Whether it was a prison, training center, or re-education camp, it was a special place at which targets resided for defined periods. While in residence, targets could be obliged to participate in special activities and subjected to close monitoring. The social organization of these environments could be, and was, designed to foster cognitive change in targets. The milieu was, however, merely a temporary place for the individual and the persons with whom the target interacted. They had concerns for one another which were limited to their common, relatively short-term, residence in these special places with their limited and special goals.

Second generation programs often far exceed this level of milieu control by expanding the size of the milieu which is controlled and the length of time it is to be the target's milieu. Expansion of the milieu involves including within it a greater range of the target's life activities while still maintaining a high level of control over all activities. One method for accomplishing this is to establish residential communities within which family, occupational, educational, spiritual, and social life is conducted. In these communities all aspects of life can, at least in theory, be defined for residents, and residents can be subject to peer group monitoring as to conformity on any and all of these aspects. In effect, unique worlds are created within which people often expect to live their entire lives. With expectations for lengthy residence and total involvement, it is not surprising to find that residents are under pervasive pressure to accept the standards of the society as their own.

Control in such a world comes in two ways. One is in the power of leadership to specify precisely what will be the values and norms of the environment. The second source of control in the community is the power to choose how and when to utilize methods of coercive influence to promote conformity to chosen beliefs and policies.

Techniques of Coercive Influence
As with first generation programs, second generation programs employ procedures which undermine self-confidence and manipulate a target's emotional arousal to motivate learning and for purposes of behavioral control. Unlike first generation programs, second generation programs tend to rely on the target's already established standards for judging guilt and performance. They tend to direct their efforts at magnifying awareness of guilt or inadequacy by focusing the target's attention on memories of stressful and emotionally significant events in his or her past. The result is often a dramatic increase in anxiety and the creation of a strong need to resolve it. Since participation in these activities is typically promised to result in relief from emotional problems or in improved performance, targets of second generation programs are likely to participate fully.

The cause of existing emotional or physical problems or inferior performance is often explained as the result of particular "improperly" experienced events or inadequate behaviors in the target's past. For example, one growth program alleges that imperfect vision is caused by a person's having refused to "see" something in the past. Others claim that all of a target's interpersonal problems are caused by unexpressed feelings associated with childhood events. As a method for rapidly curing problems allegedly caused by particular past events, some organizations advocate recalling memories of traumatic or difficult events and attempting to "fully experience" and express all associated emotions. Supposedly, the full expression of the emotion associated with the event will immediately cure the target's current problems. This theory rationalizes inducing the target to focus attention on emotionally difficult past events and justifies the organization's use of any available techniques to promote intense emotional arousal.

Some second generation programs rely heavily on peer group techniques, similar to encounter groups, but with a focus on intimate rather than peripheral topics. Other second generation programs employ more sophisticated emotion-arousing tactics. Techniques used in clinical psychotherapeutic practice are often appropriated to the programs. Hence, much of what has been learned about the management of emotional experience in the practice of clinical psychology and psychiatry is brought into play as a method through which to cause the target to experience intense emotion.

Given a target's initial willingness to participate, a range of exercises can be used to generate intense emotional arousal. For example, in some cases meditative and hypnotic techniques are used to accomplish arousal. In some programs, targets in trance states are induced to imagine hypothetical events and react to them with full emotional expression. The hypothetical circumstances might involve a disaster or the realization of the target's greatest fear. In other instances hypnosis is used to induce targets to recapture the details of an event such as rape or a parent's death scene. Using simple hypnotic techniques, some programs manipulate targets into fantasizing events from "past lives," the moment of their conception or other memories they expect now to be available to them. Through the use of hypnosis and suggestion targets can be led to supposedly re-experience moments of intense emotion from their pasts or even from their imagined "past lives."

Similarly, some groups employ emotional flooding techniques, the stripping away of psychological defenses, and provide elaborate emotion-evoking exercises. Targets may be expected to engage in role-playing exercises and replay scenes from their pasts. They may be expected to role-play themselves or others, now acting out what they "really-felt." In all such exercises there is an expectation that what the target will discover is a strong emotion underlying the character's behavior and the target is expected to express this emotion.
Often the arousal techniques used by second generation programs are linked into sequences which have a "marathon" character. That is, the intensive indoctrination portion of the organization's system for managing new participants may continue for a weekend or for as long as a month. In some instances, the organization may stretch the intensive indoctrination period over a span of several months with short breaks between portions. The effects of repeatedly employing techniques for generating intense arousal should not be overlooked. There is likely to be an interaction between the frequency of raising of psychologically stressful topics and the strength of the target's response. For example, if stress experience disturbsa target's sleep cycle, the person's ability to control subsequent stress responses will likely deteriorate as fatigue increases. As fatigue and disorientation increase, the effects of the techniques used to generate arousal are likely to increase.

Given the initial desire of targets to benefit from involvement with the training organization and the ability of the organization to manipulate the target, peer group, and environment to provide targets with experiences that can be interpreted within the framework of the organization's theory, it is not surprising that targets can be significantly influenced (Bem 1972; Schacter, 1965). For example, one mass "training organization reports that fully 25% of those who begin the organization's first course are subsequently induced to become unpaid labor and recruiters for the organization. As a method for preparing targets for long term residence in a "therapeutic" community, one psychotherapy cult subjected targets to a several-week-long period of emotional stress. Another organization prepares targets for long-term involvement through early extensive hypnosis training and exercises directed at the recovery of stressful moments from the target's past.

Given a theory that asserts that cure, transformation, or enhanced functioning follows from fully experiencing stressful events and fully expressing emotions associated with these events, if a target is not cured, transformed, or improved, the reason is obvious. The target must have failed to fully experience the event or to have fully expressed the associated emotions. Therefore, until the target acknowledges relief from whatever emotional problem or deficiency prompted initial interest in the program, he or she may be required to repeat the exercise of locating and "reliving" difficult life events. Even if the target is willing to agree that he or she is "fixed," the organization may not always allow the target to claim transformation. In some organizations, when an individual's productivity goes down, or when the person is inadequately enthusiastic, it is assumed that the further release of supposed problem-causing emotion is required. The person is obliged to undergo more of the group's curative exercises.

Second Generation Program Casualties
We believe that in the course of seeking to gain power over the individual through the use of arousal states as influence techniques, some programs may have the effect of unleashing more anxiety and emotion than the person can tolerate. Traumatic events, about which the target has successfully established defenses, may be recalled in such a way as to neutralize the person's established method for handling the emotion related to the topic. Stripping a person's defenses in this manner may have devastating consequences.
Often the procedures used to accomplish emotional arousal are applied simultaneously to large groups, or when done on an individual basis follow a fixed format. When done in either fashion, there is no possibility of monitoring the content of the experience remembered by the target. When the event recalled is something such as childhood physical or sexual abuse, rape, the death of a parent, or an action about which the target is particularly ashamed, fully experiencing the emotion associated with the event may prove quite overwhelming.

Judging from reports of studies of targets of both first and second generation influence systems, long periods of exposure to the surveillance and interpersonal control procedures necessary to maintain high levels of conformity can induce a state of at least temporary confusion and disorientation when the controlling system is withdrawn (Hinkle and Wolf, 1956; Lifton, 1961; Singer, 1978, 1979, 1986).

There is a growing suspicion and slowly accumulating evidence that the practices of some spiritual or psychological "growth" programs which, in our opinion, can be considered examples of second generation influence programs, have a significant potential to induce far more serious damage than disorientation. Clark (1977, 1978) reports that long term involvement can lead to transient problems for those whose histories suggest that they were normal prior to involvement and can exacerbate problems for those with histories of psychological difficulties. Reports by Glass et al., (1977), Kirsch and Glass (1977), Higgit and Murray (1983), and Haaken and Adams (1983) suggest that some psychological"growth" programs which depend heavily on the manipulation of unusual body states' and emotional arousal have the potential to induce psychiatric disturbances. Glass et al. and Kirsch and Glass report on seven casualties of a mass "training" program. Five casualties were diagnosed as schizophrenic, three with paranoid symptomatology, one was manic-depressive, and one was diagnosed as having a depressive neurosis. Only one of the seven had a previous history of disorder. All seven patients presented symptoms during or shortly after completion of the program.

Peripheral and Central Elements of Self: Psychodynamic Commentary
Second generation programs of coercive influence and behavior control appear to directly attack the core sense of being—the central self-image, the very sense of realness and existence of the self. In contrast, the attack of first generation programs is on a peripheral property of self, one's political and social views. The latter views could be seen as mere wrong learnings imposed from the outer world, for which there could be easy substitutions. The inner person, the self, was not the focus of attack. The newer programs can make the target feel that the "core me" is defective. Alter the self or perish is the motto. Thus intense anxiety can be engendered about the worthiness and even the existence of the self. The self is under attack to merge with and identify with the offered new model. Feelings of personal disintegration can be induced. For many, there is a temporary to more lasting identification with the contents, demeanors, and prescribed behaviors advocated by the program's operators just as there was with the first generation programs. It also appears that attacks on the central elements of self may have certain grave and not yet fully determined effects.

The self-elements threatened by second generation programs are those which have grown out of experiences and feelings generated in deeply intimate relationships and emotionally charged transactions over the person's lifetime. These are the elements of the historical, experiencing self which has feelings dating back to early childhood. Coping with emotions over the years shapes the development of specific psychological defense mechanisms used by the person for handling emotions from past and present interactions. The central self has to cope with resonating to memories of experiences of intimacy, intense affective states, family relationships, sexual experiences, and traumatic life events. These central self-elements define the inner, private domain in which emotions, past and present, are experienced and dealt with and where that special sense of self experienced as "me" is located. Psychological coping and balance is maintained through the central self's ability to monitor and control emotions stirred up by reacting to and providing interpretations for both outer and inner perceptions and through judging what is real.

First generation program attacks focused on peripheral elements of self. They constituted a degree of attack on the psychological stability of the person far different from second generation attacks on central self-elements. Attacking a target's confidence in the rightness of political opinions and appropriateness of social class position may have caused humiliation, embarrassment, and punishing emotional arousal. It may even have been life-threatening. We do not mean to imply that such treatment did not evoke strong emotional reactions in those so treated. Rather, we want to contrast the hypothesized difference in impact of having one's own political background attacked and the attendant distress caused thereby, with the impact of having one's core psychological stability and defense mechanisms stripped away as can be done by the techniques used in second generation programs.

We suspect that this sort of stripping of a person's central coping mechanisms is the key to understanding the reason for psychological casualties in these programs as well as understanding why some programs are able to cause such a rapid and apparently dramatic acceptance of the program's advocated ideology. Apparently for some persons, bypassing traditional coping mechanisms by inducing them to vividly recall or relive events of great emotional significance can create a psychologically powerful experience. For some, the experience appears to be sufficient to induce psychological decompensation.

For those not so overwhelmed by the experience, we suspect that it creates circumstances in which the easiest way to reconstitute the self and obtain a new equilibrium is to "identify with the aggressor" and accept the ideology of the authority figure who has reduced the person to a state of profound confusion. In effect, the new ideology (psychological theory, spiritual system, etc.) functions as a defense mechanism. It protects the individual from having to further directly inspect emotions from the past which are overwhelming. The person is then able to focus attention on some intellectual abstraction rather than on details of the distressing events themselves.

1. The phrase "coordinated programs of coercive influence and behavior control" is introduced to escape any suggestion that this form of influence and social control depends upon the unique historical circumstances under which it was previously studied. Further, and of equal importance, our introduction of a new term is motivated by a desire to separate this analysis from some of the connotations which have become associated with the terms "thought reform," "coercive persuasion, n and "brainwashing."
"Brainwashing" is the least satisfactory of the common names for the phenomenon. It conjures up, at least for the non-professional reader, ideas of mindless automatons deprived of their capacity for decision-making. "Thought reform" is a more neutral term but has an historical connotation linking it to a range of attempts to propagandize, indoctrinate, and re-educate as well as coercively influence and control China's population after Mao's revolution. As generally used, "coercive persuasion" connotes a substantial reliance on physical abuse and imprisonment. It is a term developed to describe procedures used on U.S. and U N. military personnel who were captured during the Korean War.
2. The only available experimental evidence relating to the ability of group pressure to cause psychological casualties is reported in Yalom and Lieberman (1971). In their study of short duration, 30 hour encounter group experiences, a 9.4 per cent casualty rate was found. Casualties were not associated with all varieties of encounter group experience. Casualties occurred in groups in which leaders focused upon individuals, were authoritarian, and acted in an intrusive, confrontative, and challenging manner.
3. Our analysis of second generation programs is based on research and clinical work exceeding two decades, if our separate experiences are totaled. We have interviewed well over one thousand individuals, or relatives of individuals, who were formerly or currently involved in different coercive influence and behavior control programs. We have studied casualties of various programs, and have conducted participant observation field research and direct observation studies of different programs. Because of issues of confidentiality of informants and court-ordered silence, as well as the controversy surrounding many of the programs we have studied, we are being deliberately opaque as to program identities.
4. Not all second generation programs are used to influence and control targets for lengthy periods of time or to lead individuals to become completely deployable agents of the organization with which they become involved. Some organizations tend to involve people as agents used to sell commercial programs to others. For the purposes of this paper we are drawing primarily on programs which involve targets for lengthy periods of time and often include either communal residence or near isolation from relationships from non-group members.
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Originally published in Cultic Studies Journal, Volume 3, Issue 1, 1986 Spring/Summer.