Noblitt and Perskin appear to have three primary goals in writing their
book. First, to present ample evidence to suggest that ritual abuse has
been practiced cross-culturally throughout the course of history.
Second, to suggest that altered states of consciousness, historically
referred to as “possession” in many religious traditions, are actually a
dissociative phenomenon which includes Multiple Personality Disorder
(now referred to as Dissociative Identity Disorder [DID] in DSM IV).
Finally, the authors contend that Cult and Ritual Trauma Disorder should
be considered a new diagnosis.

Noblitt and Perskin offer an extensive examination of the historical and
anthropological background of various religions, cults, and fraternal
organizations, to substantiate that traumatic rituals have been used for
centuries to produce altered states of consciousness. Whereas in some
cases these altered states have been viewed as “sacred,” in many others
the purpose was to establish control over other people. The authors’
assertions are carefully documented and their footnotes provide much
additional information. Their survey includes African-derived cults
such as Vodoun, Santeria, and Palo Mayobe; “New World Cultures”
including the Incas, Mayans, and Aztecs; Shamanic traditions; and
Gnosticism. They note that Christianity has a long history of belief in
demonic possession and of the use of exorcism or deliverance to expel
these evil spirits or demons. Noblitt and Perskin point out that alter
personalities may present as malevolent or demonic; but from a secular,
scientific viewpoint they do not agree that these are actually “demons.”
They also present a list of fourteen similarities between DID and
possession phenomena.

Noblitt describes himself as a “skeptic,” by nature and training,
and his acceptance of MPD came slowly. He describes the treatment of
his first diagnosed case of MPD, who turned out to be a ritual abuse
survivor. This became a disconcerting trend in his practice as he saw
increasing numbers of MPD patients who turned out to have a ritual abuse
history.

A chapter on cult programming describes the programming process as, in
many respects, an uncomplicated procedure based on classical operant
conditioning. However, this uncomplicated programming can wreak havoc
in the patient’s personal life and in therapy since the patient can be
triggered, or accessed, by various stimuli outside of their awareness.
These destructive programs may lead to self-harm or even suicide, or may
draw the patient back into the cult. Words, phrases, sounds, hand
signals, visual cues, and touch are some of the triggers that may induce
a trance state. The authors note that patients from different cults in
different parts of the country demonstrate the same or similar
programming at the most basic level.

The last section of the book is devoted to the contemporary problems and
politics associated with the field of ritual abuse. These issues
include the effect of cutbacks in public funding for mental health as
well as the impact of managed care on the treatment of DID patients who
often require intensive long-term care. This section describes the
authors’ own experiences with the media and touches on the media’s
apparent bias against dissociated memories and ritual abuse which the
authors allege has created a general disbelief and even some ridicule in
our society. The authors are particularly concerned as to how this bias
might impact patients who were told, as part of their abusive
programming, that no one would believe them if they told, and, who now
feel further victimized by cultural disbelief.

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

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

Ross states that his purpose in writing Satanic Ritual Abuse was “to
establish that good clinical work requires a balanced perspective, free
of the limitations imposed by adherence to either end of the ideological
continuum.” He identifies these two extremes as the “skeptics” and the
“believers” in ritual trauma. Ross belabors this point throughout the
book to such an extent that his historical review and treatment
suggestions appear almost secondary. The book concludes with an
Afterword by False Memory Syndrome Foundation (FMSF) Scientific Advisory
Board member, Elizabeth Loftus, Ph.D.

Initially, Ross describes the historical and social background of
various destructive cults, sects, and secret societies throughout
history which may be connected with Satanism and ritual abuse. This
review covers some of the same material as the Noblitt/Perskin book and
is not intended to be exhaustive. However, the review sufficiently
establishes the probable existence of ritual abuse as a historical,
cross-cultural phenomenon. Ross places special emphasis on the Nazi
Holocaust and the Catholic Inquisition, devoting an entire chapter to
the latter.

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

There is some confusion as Ross moves back and forth addressing both
ends of the continuum of belief regarding ritual abuse. Throughout much
of the book he appears to describe ritual abuse as a reality and then
appears to be attempting to convince skeptics of this reality. For
example, he describes five levels of Satanism, ranging from “isolated
criminal deviants” up through “orthodox multigenerational Satanic cults”
and points out there have been successful prosecutions in every category
except the last one. However, moving to the other end of the continuum
he offers “alternative hypotheses” to the ritual abuse claims. Although
Ross’ intention is to be “neutral,” he often appears to come across as
equivocal and, at times, even contradictory.

Ross further states that among the approximately eighty SRA cases he has
worked with that “in none of these cases has the reality of the
memories been objectively verified” and in some cases the memories are
clearly false. He suggests “for the sake of discussion” that perhaps
only ten percent of SRA memories may be true. Although Ross
acknowledges that this is not a scientific estimate, he repeats it later
in the book.

The strongest part of Ross’ book is his section on treatment. He
emphasizes that treatment should be based on general principles of DID
therapy, with little variation for ritual abuse survivors. He provides
a list of ten rules of therapy which address limits, boundaries, and
ethics. He provides illustrations of what may happen if these rules are
violated. This illustrations are helpful, and reminiscent of Ross’
early book, Multiple Personality Disorder. In this current book, he
seems to favor a more problem-oriented treatment utilizing cognitive and
internal family systems therapy. He specifically addresses some of the
common problems in therapy and how to deal with them such as double
binds, suicide attempts, and other self-destructive behaviors. He seems
equivocal on the subject of cult programming. He believes the
“deprogramming” model which some therapists employ disempowers the
client; however, he acknowledges that “the psychotherapy of
traumatically implanted programming is arduous and difficult, no matter
how it is framed.”

Ross provides valuable information on treatment techniques. In
reference to the management of counter-transference he emphasizes the
importance of the therapist’s taking care of him or herself. He
recommends a neutral stance toward the veracity of the patients’
memories. His clinical picture of a ritual abuse survivor includes
diagnostic indicators, and provides many useful suggestions for dealing
with hyper-complex personality systems, and alters who claim to be
“satanic” or demons.” Ross also discusses how to identify and correct
cognitive errors, how to deal with post-traumatic hyper-arousal, and his
use of “fractionated abreactions” in which memories are recovered in
stages at a controlled rate. He points out the importance of balancing
memory work with a focus on current problems.

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

After evaluating this syndrome, Ross concludes at the other end of
continuum with an Afterward by Dr. Elizabeth Loftus. Not surprisingly,
Loftus focuses on Ross’ arbitrary ten percent estimate and takes it a
step further–she suggests that perhaps only ten percent of the elements
in the memories of these ten percent are factual. For example, the
patient may have accurately remembered a scene from her childhood but
the directly abusive aspects of the memory may not be true.

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

In her Afterword, Loftus does not appear to indicate that she is open to
either compromise or serious dialogue–which is Ross’ plea throughout
his book. So it is surprising that Ross would allow his book to close
with this rather summary dismissal of the basic tenets and principles
which he has so carefully elaborated.