Experts discuss appropriate interventions for patients who are victims of undue influence at the 2022 APA Annual Meeting.
“We do not live in a post-truth world. We live in the Age of Influence.”
A presentation at the 2022 American Psychiatric Association (APA) Annual Meeting focused on undue influence and the power of cults in the age of COVID-19. The panel of speakers—which included Cathleen Cerny-Suelzer, MD, of University Hospitals Cleveland Medical Center; Karen B. Rosenbaum, MD, a psychiatrist in private practice in Manhattan, New York; Ryan Hall, MD, a clinical and forensic psychiatrist and past president of the Florida Psychiatric Society; Susan Hatters-Friedman, MD, of the University Hospitals Cleveland Medical Center and Case Western Reserve University; and Steven Hassan, PhD, of the Freedom of Mind Resource Center—discussed common deceptive and brainwashing techniques used by cult leaders, and some steps clinicians should take when they suspect that a patient may be under undue influence.
A major tool in gaining undue influence—which is classified as a dissociative disorder in DSM-5: Not Otherwise Specified 300.15 (F44.89)—is disinformation. Although disinformation, like misinformation, refers to false information that is spread, the difference is that disinformation is spread intentionally. Disinformation is a common tactic used by cult leaders to indoctrinate and control their followers.
“Information control is the critical variable,” said Hassan, who was recruited to the Unification Church cult, or the “Moonies,” at 19 years old, and has worked in the field of destructive authoritarian control (undue influence) in relationships, organizations, and belief systems for more than 45 years.
As explained by Hassan’s BITE (Behavior, Information, Thought, and Emotion) Model, cult leaders control information by lying and withholding information; installing irrational fears associated with leaving or questioning the group; extensively using cult-generated propaganda while minimizing access to noncult information sources; encouraging followers to spy on other members; and using past “sins” and memory distortion to manipulate followers and abolish identity boundaries. Between information control and other mind control tactics, “a lot of times, people don’t know they’re in a cult until they leave,” Rosenbaum said.
Also important to note is the distinction between delusions and other types of strongly held beliefs. Delusion is defined within the Schizophrenia Spectrum and Other Psychotic Disorders section of DSM-5 as “fixed beliefs that are not amenable to change in light of conflicting evidence.” There are many other types of ideas, but particularly notable are delusion-like beliefs, which superficially resemble delusions but are not delusions on closer consideration. Examples of delusion-like beliefs are conspiracy theories, which are very common in today’s political landscape.
“If you did a general population survey, about half the population would believe in at least 1 conspiracy theory,” Hatters-Friedman said.
To discern whether a patient is presenting with delusions or strongly held beliefs, Hatters-Friedman suggests learning the evidence for the patient’s beliefs, whether or not the beliefs are self-referential, and whether there is overlap, while noting that these 3 criteria are not mutually exclusive.
When speaking with patients about delusions or trying to identify whether they are under undue influence, “you want to be curious, not judgmental,” Cerny-Suelzer said. Some tips for clinicians include asking open-ended questions about important relationships and formative experiences; taking a good trauma history; helping patients with decision-making skills; focusing on harm reduction when deciding how directive to be with patients; and assessing and documenting the patients’ cognitive functioning, psychiatric symptoms, and behavioral functioning. “Also make sure that, for the protection of your patients, you know what a narcissist looks like so you can help them, should they be in a situation where they’re being manipulated by somebody in their life,” Cerny-Suelzer said.
A focus on education, destigmatization, and empowerment is also key in helping patients who are victims of undue influence, according to Hassan. “You have to go back to recover and connect with a person’s authentic self and then walk slowly, understanding the techniques of manipulation,” while empowering these individuals to speak up about their experiences, Hassan said. He recommends training everyone—especially mental health professionals—in how to cure phobias, and establishing a network of trained individuals (including friends, family, former members of the same cult, and therapists) to orchestrate an ethical influence program to empower the patient to let go of phobias and other indoctrinations and think for themselves.