Personal Introduction by Ellen Lacter, Ph.D. (Not included in the Noblitt’s work)
I am very excited to be able to be able to post this chapter by Randall Noblitt and Pamela Noblitt to my website, courtesy of Praeger, the publisher, and the Noblitts.
This is chapter 6 in full, with footnotes and references, from: Cult and Ritual Abuse: Narratives, Evidence, and Healing Approaches, 3rd Editionby James Randall Noblitt and Pamela Perskin Noblitt. Copyright © 2014 by James Randall Noblitt and Pamela Perskin Noblitt. All rights reserved. Reproduced with permission of ABC-CLIO, LLC, Santa Barbara, CA.
This chapter is, to my knowledge, the most thorough, scholarly, and recent review of the empirical and forensic evidence of ritual abuse. I wish every psychotherapist, psychiatrist, and traumatologist, every law enforcement and child protection official, every judge, every Family Court attorney, every person in the media, every artist, musician, film maker, and producer, would read this chapter and feel moved to let the harsh reality of the existence of ritual abuse into their personal consciousness and advocate to bring this awareness into the large social consciousness. These atrocities are unbearable and we need to stand together to demand that the systems in place to help crime victims do more to rescue these people and to heal their aching souls.
This chapter is drawn from the Noblitt’s important 2014 book, Cult and Ritual Abuse: Narratives, Evidence, and Healing Approaches, 3rd Edition. A wide breadth of perspectives are woven into this book, including the history of religion as it applies to current ritualistic practices; the social anthropology of current cultures and religions that relate to modern ritual abuse; a depth psychological analysis of how ritually abusive practices calculatedly manipulate the dissociative processes of their victims to the abusers’ advantage; the politics that have prevented the public from being accurately educated about ritual abuse, how politics have worked to limit the ability of mental health workers to recognize ritual abuse trauma and have interfered with the ability of clinicians to provide optimally beneficial psychotherapy to victims and survivors, means by which we, working together, may be able to raise awareness of the problem of ritual abuse in the mental health community, larger society, and better help victims and survivors, and the suggested introduction of a Cult and Ritual Trauma Disorder diagnosis into forthcoming Diagnostic and Statistical Manuals of the American Psychiatric Association.
My hope is that providing this chapter to the public will help to raise awareness about this issue and that readers’ interests will be piqued enough to delve into the book as a whole.
CHAPTER 6: Empirical and Forensic Evidence of Ritual Abuse 
In this chapter, we review the empirical literature on ritual abuse (RA), including research involving interviews of multiple individuals, the results of psychological testing, and surveys of RA survivors and helping professionals. The studies of children have typically relied on information obtained from their caretakers. In addition to the topic of ritual abuse, we also review the related research on organized abuse and mind control when it is clear that ritual abuse was a component theme of those studies. We begin with a brief discussion of previous literature reviews.
One of the earliest reviews was published in Valerie Sinason’s book Treating Survivors of Satanist Abuse (1994). In her chapter “A Personal Review of the Literature,” Sue Burrell summarized the accounts of books, single case descriptions, and multiple case studies as well as the literature related to interviewing and advocacy for RA survivors. Burrell noted that the material was difficult and disturbing and further complicated by the topic’s controversy. Published the same year, Kathleen Faller’s article “Ritual Abuse: A Review of the Research” (1994) provided a detailed critical analysis of the empirical studies, noting that there is corroborating evidence for some RA allegations.  A section on ritual abuse in the tome, Memory, Trauma, Treatment and the Law by Daniel Brown, Alan Scheflin, and Cory Hammond (1998) discussed selective but representative studies also concluded that some of the evidence supports RA claims. In our previous edition of Cult and Ritual Abuse (Noblitt & Perskin, 2000), we reviewed the related empirical literature and forensic outcomes. Reviews of organized abuse that include the topic of ritual abuse were published by Gough, Kelly, and Scott (1993) and more recently in Michael Salter’s scholarly paper, “Organised Abuse: A Neglected Category of Sexual Abuse with Significant Lifetime Mental Healthcare Sequelae” (Salter, 2012; Sidebotham & Appleton, 2012). These reviews made it clear that there is empirical evidence for some RA allegations. In this chapter, we provide an updated and expanded review of the empirical research.
The empirical studies of ritual abuse can be organized into four categories: (1) the frequency and credibility of ritual abuse disclosures to helping professionals; (2) suggestibility, rumor, and iatrogenesis as possible explanations for ritual abuse allegations; (3) children who have made RA allegations; and (4) adults who have made RA allegations. In addition to this overview of the empirical literature, we will discuss representative forensic cases.
In their national investigation of 270 cases of substantiated sexual abuse of 1,639 children in day care, Finkelhor, Williams, and Burns (1988) found 13% of the cases involved allegations of ritual abuse. Another of the early studies of the incidence of ritual abuse was Deborah Cole’s doctoral dissertation, The Incidence of Ritual Abuse: A Preliminary Survey (1992). She sent surveys to 1,250 mental health professionals in California in Los Angeles and Orange counties, receiving back 250 responses. Of those, 46% indicated that they had seen RA patients or patients who met at least one of the criteria that Cole listed. Given her low rate of response, it is difficult to generalize about the incidence of RA from her sample to other populations, but her contribution is primarily in asking the question and setting in motion efforts to empirically study it.
In a national survey of 2,709 clinical psychologists who were members of the American Psychological Association, the authors investigated the frequency of RA allegations made to psychologists. This study showed that within their sample of psychologists, 70% denied and 30% acknowledged seeing at least one case of “ritualistic or religion-related abuse since January 1, 1980” (Bottoms, Shaver, & Goodman, 1991, p. 6). The authors also found that among the psychologists who had worked with at least one individual with allegations of ritual abuse, 93% believed that the harm had actually occurred. This report was part of a series of five studies later published by Goodman, Qin, Bottoms, and Shaver (1994). The first study involved a survey of a stratified random sample of clinical members of the American Psychological Association, American Psychiatric Association, and National Association of Social Workers. The second study was a survey of district attorneys’ offices, social service agencies, and law enforcement agencies. The third study investigated the question of “repressed” and later “recovered” memory based on 490 cases, from which 43 were described as “repressed memory” cases and 447 were “no repressed memory” cases. The fourth study examined children’s knowledge of satanic abuse. The fifth study investigated three types of religion-related child abuse: abusive acts intended to rid the child of demons, clergy abuse, and medical neglect for religious reasons.
From the data collected in their first study, these researchers concluded that 31% of the combined sample of psychologists, psychiatrists, and social workers had seen at least one case of ritual or religion-related abuse. There were 387 child RA cases, 674 adult RA survivor cases, 171 child religion-related cases, and 234 adult survivors of religion-related cases reported. The authors stated that the adult ritual abuse cases “were consistently the most extreme” (Goodman et al., 1994, p. 4). Of the adult ritual abuse cases, 33% reported cannibalism and 28% baby breeding for purposes of ritual sacrifice. Among the adult ritual abuse cases, they found that the victims were likely to be diagnosed with dissociative identity disorder (DID). They also found that child cases were “far more likely to be disclosed to authorities or professionals, to family members or neighbors, and to be linked to corroborative evidence, but were less likely to be disclosed in therapy than adult cases” (p. 4). The authors determined that the psychologists, psychiatrists, and social workers who responded to their survey “overwhelmingly believed both the allegations of abuse and the allegations of ritual or religious elements of the abuse” (p. 6).
Their second study of district attorneys, social services, and law enforcement agencies revealed that 23 % had identified at least one case of ritual or religion-related abuse. “In general, the ritual cases with the most convincing evidence were unlike the Satanic ritual abuse stereotype” (p. 6). The authors expressed surprise that the rate of convictions in “ritual cases was almost as high as in religion-related cases” (p. 7). In their third study investigating the question of “repressed” and later “recovered” memory, they found that the “repressed memory” cases were more likely to be “ritual cases” in comparison with the “no repressed memory cases.” However, when they excluded what they called “outlier” cases, the repressed versus not repressed memory effects disappeared.
The fourth study of children’s knowledge of ritual abuse showed that “children have relatively little knowledge of Satanic child abuse” (p. 10). Their fifth study considered 271 cases of religion-related abuse. They found that in 94% of the clergy abuse, 48% of the evil ridding cases, and 23% of medical neglect included allegations of sexual abuse. They found that DID and other dissociative disorders were diagnosed in over 20% of the evil ridding and medical neglect cases. 
Bucky and Dalenberg (1992) also surveyed 433 mental health professionals in San Diego County, California, using a 50-item questionnaire. They found that mental health professionals who reported high-frequency work with RA survivors were “professionals with many years’ experience and an apparent specialization (an inference based on cases seen) in sexual abuse” (p. 237). They also found that professionals with greater training in dissociative disorders and RA were more likely to see clients that they identified with those problems.
Another survey investigated reports of sexual and ritual abuse made to British psychologists (Andrews, Morton, Bekerian, Brewin, Davies, & Mollon, 1995). The researchers collected data from 810 British Psychological Society practitioners who had seen sexually abused clients. Regarding these psychologists’ “belief in essential accuracy of reports of SRA,” 3% reported never, 54% sometimes, 38% usually, and 5% always. Fifteen percent reported that they had worked with clients reporting satanic ritual abuse (SRA). Eighty percent of the psychologists who had seen one or more individuals with a stated history of SRA believed the allegations. In a more recent British study Ost, Wright, Easton, Hope, and French (2013) collected responses to an online survey of 183 chartered clinical psychologists and 119 hypnotherapists. Among the chartered clinical psychologists, 37.9% indicated that they had seen one or more cases of individuals with satanic or ritualistic abuse. The researchers found that 24.5% of the hypnotherapists had seen one or more satanic/ritual abuse cases. Along the lines of the Andrews et al. (1995) study they asked, “Are reports of Satanic/ritualistic abuse essentially accurate?” Among the chartered clinical psychologists, 1.6% responded never, 11.5% rarely, 27.3% sometimes, 29.5% usually, and 2.7% always. The hypnotherapists answered 10.1% never, 15.1% rarely, 21.0% sometimes, 12.6% usually, and 5.0% always.
Schmuttermaier and Veno (1999) obtained survey responses from a group of counselors consisting of 74 Center Against Sexual Assault (CASA) workers, 48 psychologists, and 27 psychiatrists in the state of Victoria, Australia. They found that 70% of their respondents accepted their definition of ritual abuse and that 153 cases of ritual abuse had been identified by 26 of the counselors between 1985 and 1995. Eighty-five percent endorsed the belief that ritual abuse is “an indication of genuine trauma” (Schmuttermaier & Veno, 1999, p. 55). The researchers found no relationship between the religious beliefs of the counselors and the number of RA cases they identified. They determined that the amount of professional training on the topic of child sexual assault was significantly related to counselors’ identification of RA cases. Schmuttermaier and Veno (1999) also concluded that “Australian counselors are similar to their United States and United Kingdom counterparts in their identification and diagnosis of ritual abuse” (p. 61).
According to Jonker and Jonker-Bakker (1997), “The National Society for the Prevention of Cruelty to Children in Britain reported in its 1989 Annual Report that seven out of 66 Child Protection Teams in England and Wales were currently working with children victimized by ritualistic abuse” (p. 542). In a survey of the membership of the International Society for the Study of Multiple Personality and Dissociation, Perry (1992) concluded that 88% of 1185 “respondents reported belief in ritual abuse, involving mind control and programming” (p. 4).
An international study of helping professionals was conducted by Becker, Karriker, Overkamp, and Rutz (2008) and Becker, Karriker, Rutz, and Overkamp (2013) and is part of their Extreme Abuse Survey (EAS) research series (http://extreme-abuse-survey.net/http://extreme-abuse-survey.net/). The Professional Extreme Abuse Survey (P-EAS) is an online questionnaire with 215 questions (and 53 optional ones) that was available from April 1 to June 30, 2007. Four hundred fifty-one (451) helping professionals from 20 different countries responded to at least one of the questions. This survey shows that 86% of helping professionals who have worked with at least one extreme abuse survivor report having in their caseload at least one survivor of SRA. Some of their other findings are as follows: 61% saw clients who reported ritual abuse by clergy, 85% said the majority of adult ritual abuse/mind control (RA/MC) survivors with whom they worked were diagnosed with DID, 63% said that they always take a neutral stance regarding the truth of an adult survivor’s memories of RA/MC, 65% said that some of their clients’ reports of RA/MC were based on continuous, rather than dissociated, memories. Regarding belief in their clients’ stories, 3% of the helpers do not believe any of their clients who report RA/MC experienced ritual abuse, the rest reported belief in varying degrees concordant with the previous findings of Andrews et al. (1995) and Ost et al. (2013). There was a similar pattern where 5% did not believe any of their clients who report RA/MC experienced MC and the rest of the respondents indicated belief in varying degrees. However, because the EAS is the first survey to have explored reports of mind control, there is no comparable research to with which to compare it. Further, these findings indicated that 52% endorsed the belief that improbable events involving RA/MC might possibly have been “staged” to make victims believe they happened.
The previous study reported by Bottoms et al. (1991), and Goodman et al. (1994) criticized the psychotherapists who overwhelmingly believed the narratives of their RA client arguing that this belief was not based on any corroborated evidence. However, it is not clear that these authors asked questions or accepted answers unless they were consistent with the conservative standard of evidence used in criminal convictions that is “beyond a reasonable doubt.” Most clinicians consider clinical evidence from a perspective that is closer to “the preponderance of evidence” legal standard.
The P-EAS went into more detail examining the helping professionals’ reasons for believing their clients. These reasons included the following: significant memories of RA/MC fit logically into other aspects of the individual’s life history forming a coherent narrative (89%), the types of dissociated identities observed were reflective of RA/MC (86%), the content of creative productions (such as art, sandtray stories, music, poetry) was consistent with RA/MC (79%), certain physical and medical sequelae could be explained as having been a result of RA/MC (75%), some reports of RA/MC were based on continuous memories rather than dissociated memories (65%), significant memories were corroborated by the testimony of other individuals (47%), and the individuals presented material objects consistent with reports of RA/MC (31%). Further, 18% of the helping professionals reported that they were RA/MC survivors themselves and all of them endorsed the statement, “The individual’s memories were consistent with my own personal memories of RA/MC” (Becker et al., 2013).
These studies show that the overwhelming majority of surveyed professionals either believe RA narratives or they are open to the potential credibility of ritual abuse allegations. What would account for such a high degree of consensus? If RA claims are essentially false, then these therapists are at best misguided. Some have argued that false RA “memories” are implanted or created by inept or unethical therapists. If the patients’ allegations are essentially true, then this high degree of concurrence may simply reflect the professionals’ accurate assessment of their clients as abuse survivors.
As Becker et al. (2008, 2013) and Rutz et al. (2008) have noted, clients who make RA allegations appear to be genuinely traumatized in a manner that is consistent with their narratives, their specific psychological problems, and, we would add, their psychological testing results. In a study comparing 34 adult psychiatric patients making RA allegations with 31 patients making no such allegations, it was found that the group making RA allegations had significantly higher posttraumatic stress disorder (PTSD) scores on the MMPI-2 (Noblitt, 1995). In their study of preschool ritualistic and non-ritualistic sexual abuse, Waterman, Kelly, Olivieri, and McCord (1993) demonstrated that PTSD criteria were met for 80% of their sample of ritualistically sexually abused children as compared with 35.7% of the non-ritualistically sexually abused children. Other studies finding PTSD to be a significant component of the clinical picture of individuals reporting ritual abuse will be discussed further in this empirical literature review.
The notion that RA allegations are essentially false and the result of suggestibility and social influence has been proposed by a number of individuals (Frankfurter, 2006; Mulhern, 1991, 1994; Ofshe & Waters, 1994; Spanos, 1996). However, this hypothesis appears to reflect the authors’ subjective opinions and speculations rather than any empirical research findings. In the literature, there are no empirically proven cases of individuals falsely claiming RA allegations due to their suggestibility and exposure to social influence.  Empirical studies by Leavitt (1997, 1999) showed that patients with recovered memories of childhood sexual trauma were less suggestible than psychiatric patients without such recovered memories of child abuse. Furthermore, in other studies Leavitt and Labott (1998, 2000) found that exposure to media accounts of ritual abuse and inpatient hospital treatment with other individuals reporting sexual abuse histories did not account for the “satanic” word associations and Rorschach responses among patients alleging histories of ritual abuse compared to controls. In fact, Leavitt and Labott (1998) found that among patients with RA histories, those with lower reported media exposure made significantly more “satanic” word associations and Rorschach responses in comparison to similar patients reporting a higher degree of media exposure. This finding is consistent with our own personal observations that many survivors tend to become “shut down” and more disconnected from their abuse narratives when overexposed to this material. Like other kinds of trauma survivors, they tend to be avoidant regarding traumatic themes similar to their own lived experiences. Nevertheless, Mulhern argued that therapists who treat these patients develop their own personal beliefs about the reality of ritual abuse by attending conferences on the subject and then pass these beliefs on to their suggestible patients. However, the only study that has attempted to investigate the therapists’ beliefs about their patients’ allegations about ritual abuse longitudinally through the course of therapy shows that the therapists were initially skeptical and only later came to believe their patients’ allegations (Waterman, Kelly, Olivieri, & McCord, 1993).
In spite of the contrary research findings, some authors have speculated that RA allegations are more an artifact of suggestibility and social influence than real abuse. Jeffrey Victor (1993, 1998) described what he called satanic rumor panics. Victor argued that satanism is frightening and provocative to the general public and has been the source of numerous rumors for which he cited examples from the popular press. According to Sara Scott (2001), “much of the literature describing ritual abuse as a moral panic itself reads like a moral panic” (p. 48). This point is reiterated in Martin Katchen’s (2008) chapter, “Interrelated Moral Panics and Counter-panics: The Cult Brainwashing Panic and the False Memory/Ritual Abuse Moral Panic.” Even Philip Coons (1997), who has authored skeptical views regarding RA allegations, commented critically on Victor’s reinterpretation of RA outcries: “Unfortunately, it is impossible to tell from Victor’s cursory review of the evidence what really did happen at these 61 locations” (p. 108). Ross Cheit (2014), professor of public policy and political science at Brown University, has argued that assertions of a moral panic resulting from the allegations of child sexual abuse in day care venues is neither empirically based nor consistent with the evidence.
However, Coons (1994) contributed a study of his own on this question. He retrospectively reviewed the psychiatric records of 29 patients who had made allegations of SRA. He concluded that 76% of the patients had either dissociative identity disorder or dissociative disorder not otherwise specified but that he was unable to find any external corroboration of the SRA allegations. Three cases he labeled delusional and four were categorized as factitious. He concluded that in all but two cases “questionable” therapeutic methods were used. Weir and Wheatcroft (1995) reviewed 20 cases where ritual sexual abuse was alleged. Based on their evaluative findings, they concluded that false allegations of ritual abuse occurred in 75% of the cases and true allegations in only 25%. The primary weakness of these three studies is that they rely entirely on the subjective interpretations of the authors. The validity of the last two studies would depend on the ability of their authors to accurately diagnose ritual abuse and/or find corroborating evidence and the extent to which the data they needed to confirm any true ritual abuse was available. With no measure of inter-rater reliability, there is no way to know how reliably or accurately these investigators interpreted these data, and there is no way of knowing whether sufficient data were available to interpret.
Two other case studies merit attention, although they suffer the same methodological problems. Coons and Grier (1990) described a single case where an individual with RA allegations was instead diagnosed with factitious disorder, and Yeager and Lewis (1997) briefly presented a single case of a recanter. In the former example, one must ask whether the patient’s inaccurate reporting of particular events means that ritual abuse did or did not occur. In my opinion, the characteristic features of ritual abuse include abuse by ruse and deception. In the latter example, it should be obvious that recantation is not more intrinsically credible than an original allegation. It has been found that individuals with well-documented evidence of sexual abuse will sometimes later recant and that many recanters, particularly with RA allegations, later redisclose abuse (Waterman, Kelly, Olivieri, & McCord, 1993). Recent research on recantation among victims of violence has shown that recanting is prompted and controlled by the powerful demand characteristics that are communicated by the perpetrators of interpersonal violence (Bonomi, Gangamma, Locke, Katafiasz, & Martin, 2011).
Stafford and Lynn (2002) compared three groups of university student research volunteers who were role-playing that they had DID ( n = 33), depression ( n = 33), and normal adjustment problems ( n = 33). These role-played enactments proceeded over a series of trials, including role-played hypnosis. They found that more individuals in the DID simulating group reported more sexual and ritual abuse allegations as part of the role-played enactments. Stafford and Lynn (2002) interpreted this as evidence that there is “a fairly cohesive cultural script linking DID to a patient’s history and the use of suggestive procedures such as hypnosis” (p. 70). Although this study does give evidence that university student volunteers know about the association between ritual abuse and DID, it does not make it clear to what degree this is known by the general public. It was also not clear to what extent the volunteers role-played narratives and enactments that would have persuaded experienced clinicians to give the students psychiatric diagnoses. In fact, that did not happen in this study.
Nadja Schreiber (2000) compared 20 transcribed interviews of children from the Kelly Michaels day care case with 20 interviews from a Child Protective Services (CPS) unit in New Mexico. She concluded that the interviews of children in the Kelly Michaels case were more repetitive and leading than the CPS case. Garven, Wood, Malpass, and Shaw (1998) found that a group of 36 children interviewed with overt social influence made 58% false accusations in comparison with a group of 30 children who were interviewed with suggestive questions only.
A related contention is that some therapists and caseworkers are overly credulous about the widespread existence of ritual abuse and that they mismanage therapeutic and legal components influencing their clients with their own false beliefs. In an effort to test this hypothesis in the United Kingdom, Bernard Gallagher (2001) conducted a review of cases of suspected child ritual abuse that were identified through searches of records relating to “all referrals to police child protection units (CPUs) and social services child protection coordinators (CPCs) in eight local authority areas in England and Wales between January 1988 and December 1991” (p. 229). This investigation yielded the records of six child cases (involving more than eight children), and it assisted in identifying eight adults who alleged that they were adult survivors of child ritual abuse when claims appeared as part of the review of six child cases. Gallagher’s intent was to find out whether the agency personnel had done appropriate investigations. Gallagher (2001) concluded that:
These results indicate that agency workers raised concerns of ritual abuse very rarely, and then only following assessments which showed the cases in question to possess a number of quite ‘troubling’ features. Even after raising these concerns, agency workers tended to be circumspect, if not sceptical, as to whether ritual abuse had taken place. Furthermore, the interventions they chose to employ in respect of these cases appeared to be appropriate in terms of both method and application. (p. 238)
Another study, “Discredited Psychological Treatments and Tests: A Delphi Poll,” by Norcross, Koocher, and Garofalo (2006), did find evidence of professional skepticism about ritual abuse. The authors designated a panel of 101 “expert” psychologists who were charged with evaluating a list of 59 treatments and 30 assessment methods. One of the 89 items that they rated was “Treatments for Mental Disorders Resulting from Satanic Ritual Abuse.” The ratings consisted of a 0 to 5 Likert scale, where 1 meant “not at all discredited,” 2 was “unlikely discredited,” 3 was “possibly discredited,” 4 was “probably discredited,” and 5 was “certainly discredited.” Because the study was intended to identify discredited methods, there was a likely bias inherent in its methodology. There were two rounds of ratings. After the first round, all the members of the panel were given the results of the first round, and then they rated the methods again. The mean rating for the SRA item was 3.98 during the first round, and 4.28 after the second round. The results of Norcross et al. are inconsistent with the studies of mental health professionals cited earlier who actually interviewed RA survivors and those with expertise or experience in childhood sexual abuse. Those groups of professionals found the survivors to be credible. It is not clear how many of the experts in Norcross et al. had expertise in child sexual or ritual abuse as that was not one of the criteria for their selection in this particular study. Nor is it clear that anyone involved in the Norcross et al. panel had any familiarity with the empirical literature addressing ritual abuse as none of it was cited. The Norcross et al. findings are also inconsistent with the research of Becker et al. (2008, 2013) and Rutz et al. (2008), where psychotherapy was reported to be the most effective recovery method for RA survivors as reported by survivors, helping professionals, and the caretakers of child RA survivors.
As mentioned earlier, RA allegations are sometimes categorized regarding whether the alleged victims are children or adults at the time the allegations are made. Reports of the ritual abuse of children sometimes occur while they are still children. In such instances, it may be easier to obtain corroborating material evidence. This is especially more likely than the second case, where adults report that they were abused in childhood. Both categories have been studied empirically. Another category of ritual abuse consists of alleged abuse of adults while they are adults without any report of prior child abuse. Such reports do occasionally appear, but we don’t know of any studies of them in the literature. On the rare occasions when I have evaluated such individuals clinically, there was sometimes corroborating evidence of earlier childhood abuse for which the survivor initially was amnestic.
Those studies of allegations of the ritual abuse of children then may be further subdivided into three categories: (1) cases where ritual abuse was alleged in day care or preschool settings, (2) cases where the abuse allegedly occurred in community-based cults, and (3) cases of multigenerational ritual abuse.
Pamela Hudson (1991) assessed 24 children  in a case of alleged ritual abuse at a Fort Bragg day care center in California. Hudson found five symptoms to be present among many of the children:
1. acting out the sexual abuse (n = 13),
2. sudden extreme fear of the bathroom, bathing, washing hair (n = 10),
3. nightmares, night terrors (n = 12),
4. high anxiety disorder, separation anxiety (n = 16), and
5. temper tantrums, oppositional behavior (n = 12). (p. 8)
She also noted that among the children’s allegations were their being molested by other children ( n = 11), being molested by strangers, day care workers, or a parent ( n = 11). Hudson identified 16 forms of abuse: (1) being locked in a cage or “jail”; (2) being told that their parents, pets, or younger siblings would be killed if they told anyone of the abuse; (3) being buried in the ground in coffins which they called “boxes”; (4) being held underwater; (5) being threatened with guns and knives; (6) being injected with needles, bled, drugged; (7) being photographed during the abuse; (8) being tied upside down over a “star,” hung from a pole or hook, burned with candles; (9) perpetrators wearing black robes, masks; (10) having participated in a mock marriage; (11) being defecated and urinated upon; (12) having observed animals killed; (13) having observed torture or molestation of other children; (14) having seen children and babies killed; (15) having blood poured on their heads; and (16) being taken to churches, other day care settings, people’s homes, and graveyards for the ritual abuse. Of these, 13 children acknowledged experiencing at least one of the listed abuses, not counting the 14th. Four children reported number 14, seeing children and babies killed.
Hudson performed a second study. In order to control for the possible contagion effects that might have occurred in her Fort Bragg case, she conducted a telephone interview of 10 other families in different locations in the United States where ritual abuse had been reported. All but two were day care cases. She collected data from these interviews, which she combined with her Fort Bragg data. Thus, she had a total of 11 cases. The following abuses and corroboration were reported:
1. confinement in cage (n = 10);
2. threats (n = 11);
3. live burial in caskets, coffins, boxes (n = 6);
4. water torture (n = 7);
5. threats with guns or knives (n = 10);
6. drug injections (n = 10);
7. filming and still photography (n = 11);
8. bondage, locked in closets, hung by feet or wrists, spread-eagled over pentagrams;
9. tied onto upside-down crosses (n = 7);
10. abusers wearing masks and robes, carrying candles (n = 11);
11. mock marriages (n = 6);
12. defecation, urination, forcible ingestion of human wastes (n = 10);
13. witnessing animals tortured and killed (n = 10);
14. fake operations (n = 6);
15. children’s descriptions of the torture and sexual assault of themselves or others (n = 10);
16. evidential medical examinations: findings commensurate with sexual assault (n = 11);
17. babies, small children killed, carved up, and parts eaten (n = 9);
18. transportation elsewhere for abuse; various methods of transport (n = 10); and
19. sexual assault and terrorizing in churches, graveyards, other day care centers (n = 10). 
Susan Kelley (1992b) compared three groups of children in day care: 35 allegedly ritualistically abused children, 32 children reportedly sexually abused, not ritualistically, and 67 children without any claims of sexual abuse. She collected data from the abused children’s parents and compared the results of children with non-ritualistic sexual abuse with ritualistic sexual abuse. She found that ritualistically abused children were more likely to report more incidents, types, and severity of abuse relative to the non-ritual sexual abuse victims. She also found that ritualistic abuse was more often associated with multiple victim, multiple perpetrator encounters. On the Child Behavior Checklist (CBCL), there were more reported behavior problems and tendency toward internalizing symptoms among both groups of abused children in comparison with non-abused children, but the ritualistically abused children scored worse.
Jill Waterman, Robert Kelley, Mary Kay Olivieri, and Jane McCord (1993) did a six-year longitudinal study of 82 children who had made allegations of ritualistic sexual abuse (RSA) in the Manhattan Beach, California, area in comparison with 37 non-abused (NA) children and 15 non-ritualistically sexually abused (SA) children. A variety of standardized and non-standardized questionnaires and interview instruments were employed. They found that both the RSA and SA group reported intrusive and highly intrusive sexual abuse. Additionally, the RSA group, but not the SA group, reported “terrorizing acts that included killing of animals, death threats to the children or their families, sadistic acts and physical abuse, and ritualistic acts that included Satanic activities” (p. 64). Recantations occurred in 25% of the RSA and 23% of the SA children. This was the case, even though the perpetrator in the SA group had given a detailed confession. However, 88% of the RSA group that recanted later redisclosed abuse. The children alleging RSA had more severe symptoms than SA children with significantly more PTSD, depression, and aggressive behaviors. The RSA group showed less improvement over time in comparison with the SA group.
A case involving 172 children who made disclosures in day care in southwest Michigan was investigated (Bybee & Mowbray, 1993; Faller, 1994). Kathleen Faller gathered data from her clinical interviews with 18 of the children, and Bybee and Mowbray reviewed the cases of 106 children, including interviews by state police and records from community mental health professionals, and the Department of Social Services. Bybee and Mowbray identified 62 (58%) children who disclosed that they had been victimized and 53 (50%) children who reportedly observed others being abused, with 92% of the children who were observed being abused also disclosing that they had been abused. They found that children reported experiencing and observing acts of fondling, penetration, oral sex, sex with children, penetration of an adult, threats of harm, being hit or hurt, being given medicine or bad food, bestiality, and ritual acts. Among her sample of 18 children, Faller found “sadistic acts (100%), threats of harm and death to children and their family members (100%), use of drugs (56%), confinement (44.4%) and animal killings or injury (22%)” (p. 22). Faller wrote that when she compared the 18 children she interviewed with children who were abused by a single perpetrator in a day care center or day care home, she found that significantly “higher percentages of ritually abused children were reported to have sexual acting out problems, sleep problems, emotional problems, behavior problems and phobias” (p. 22). Faller also cited an unpublished report by Valliere, Bybee, & Mowbray (1988) of scores on the CBCL comparing the abused children with a comparable sample of non-abused children from the community with clinical and non-clinical norms. “The sexually abused children’s scores were generally comparable to those of clinical norms, and significantly higher than non-clinical norms. Sexually abused girls demonstrated improvement on the CBCL between times one and two, but the boys did not” (p. 22).
Not all child ritual abuse research is associated with day care cases. Within the literature on child abuse, there are two reports of what Faller called “community-based ritual abuse” (p. 23). She defined community-based cults as “those whose membership is contemporary and often made up of persons of various ages—children, adolescents, and adults in a particular community” (p. 24).
Snow and Sorenson (1990) wrote about 39 children who were abused in five neighbor-based cults in Utah. In four of the five cults, there were incidents of intrafamilial incest, perpetration by adolescents, and features of an adult sex ring. No adolescent perpetration was found in the fifth group. Also reported was forced sexual behavior, threats of violence, and multiple perpetrators and victims. At least two-thirds of the children described, multiple locations of abuse, pornography, ingestion or other use of excrement, the espousal of satanic beliefs, magical spells and use of occult paraphernalia, animal mutilation or killing, and the use of drugs. The abusers were generally viewed as respected members of the community, and many were religious leaders. Two of the accused adult perpetrators were convicted, and two adolescents pled guilty.
Jonker and Jonker-Bakker (1991, 1997) reported a case of the ritual abuse of children in the Netherlands. The authors described the allegations and their observations regarding this case in Oude Pekela, a small town of 8,000 inhabitants in northeastern Netherlands near the German border. Jonker and Jonker-Bakker initially surveyed the families of 90 involved children six to eight weeks after the initial disclosures. They gathered additional data from the families of 87 of these children at 2-1/2- and 7-year intervals after the first outcries had been made. They compared their later findings with clinical information that antedated the abuse and with initial survey results. They found that 20% of the children made spontaneous disclosures. The list of reported abuses included the following elements: sexual abuse, warnings to be silent, taking photographs, making videotapes, tying up children, keeping children in extreme darkness, being scratched, kicked, beaten, drugged, animals being present, animals being tortured and killed, babies being involved, babies being killed, adults being killed, chanting, forced eating of excrement or semen, and supernatural powers being claimed. “Almost one-third of the parents reported in 1989–1990 profound changes, as if they were dealing with a different child” (p. 550). The symptomatic behaviors of the children included the following: a poor sleep pattern, nightmares, night awakenings, bedwetting, genital shame, masturbation, inappropriate sexual behavior, swearing, aggressiveness, destructiveness, self-isolation, anxiety, tongue kissing, torturing of animals, fear of being locked up, interest in fire, fear of spiders, interest in devils, ghosts, the experience of words turning around, and interest in death. The three most common symptoms among the boys were the following: “poor sleep pattern (79%), waking during the night (79%), and aggressiveness toward the surroundings (83%)” (p. 550). Among the girls, “the most exhibited behaviors were poor sleep pattern (67%), anxiety, nervousness (77%), and aggressiveness towards the surroundings (87%)” (p. 550). The authors also noted, “If the Oude Pekela case had been a result of adult community hysteria rather than real children’s experiences, then the behavioral changes would be expected to escalate as a function of disclosures to adults. Instead, there was a decrease in the number of changes in behavior following disclosure.” (p. 551). In this case, two arrests were made but there were no convictions. However, Jonker and Jonker-Bakker noted that the chief of the police investigation team believed that 50% of the 64 children investigated by the police “were certainly involved.” (p. 545). A statement by the district attorney on January 21, 1988, is cited:
A total number of 98 children, 3 to 11 years old were interviewed. The statements of 62 children were used in the further investigation. Finally 48 statements of children remained, speaking of clear sexual abuse, where they had either submitted to or been forced to perform on themselves or others. Many of the children told about strong lights, lamps on poles, and seeing each other on TV. The justice ministry concluded that it was nearly sure that photographs were taken of the children. Against 18 children violence was used. The child abuse took place over a period of several months. The justice Ministry thinks that four people, two men and two women, were involved in the sexual abuse. (quoted by Myers, 1994, and cited by Jonker & Jonker-Bakker, 1997, p. 541)
Faller (1994) cited a study of intergenerational ritual abuse of children by Susan Kelley (1992a). This paper, Ritualistic Abuse: Recognition, Impact, and Current Controversy, was presented by Kelley at the San Diego Conference on Responding to Child Maltreatment in January 1992. Kelley investigated reports of 26 children from 14 families. The accused abusers were parents, grandparents, great-grandparents, uncles, aunts, cousins, and siblings. Similar to other reports, a significant number of abusers were female (45%). “Sixty-one percent of children were abused by two generations of older relatives, and 57% of cases involved extrafamilial as well as intrafamilial offenders” (Faller, 1994, p. 25). Reported abuses included “terrorizing threats and acts (89%), including having spiders or other insects placed on them, death threats (77%), making pornography (81%), threats with supernatural powers (89%), satanic reference (92%), animal killings (54%), being made to ingest drugs (92%), songs and chants (69%), and being made to ingest or touch excrement (85%)” (p. 25). Scores on the CBCL were in the clinical range for 73% of the children on total problems, 81% on internalizing, and 50% on externalizing scales.
A series of studies of reported child abuse that included ritualistic abuse were conducted among older adolescents and young adults in South Africa. In the first of these studies Madu and Peltzer (1998, 1999) gathered questionnaire data from 414 South African high school students. The students were asked retrospectively about different experiences of abuse that had occurred before age 17, including ritualistic
abuse. Eight percent reported experiences of ritualistic abuse. In another study of 559 high school students in three high schools in the Mpumalanga Province of South Africa, Madu (2001) found that 10% of the participants reported that they were ritualistically abused before the age of 17. In a sample of 722 University of the North undergraduate students 6% indicated that they had experienced ritualistic abuse before age 17 (Madu, 2002).
One of the more recent studies of the ritual abuse of children is reported by Becker, Karriker, Overkamp, and Rutz (2008) and Becker, Karriker, Rutz, and Overkamp (2013). These researchers developed an online questionnaire, the EAS that we will discuss in more detail later in this chapter. One of the three versions of the EAS was the Child-Extreme Abuse Survey (C-EAS). It was designed to gather information about abused children from their caregivers. The survey was available to take online in English and German from July 8 through October 8, 2007, and 264 caregivers from 19 different countries responded to at least one question. With 260 questions asked, the collected data were complex and extensive, and we are only able to summarize a few of the many salient outcomes here. For a more detailed presentation of their findings, see Becker, Karriker, Rutz, and Overkamp (2013).
Becker et al. (2013) asked detailed questions about the children’s’ disclosures of abuse and other physical signs of abuse. Fifty-one percent of the caregivers who responded indicated that they were RA/MC survivors themselves. The authors queried caregivers about corroboration for the RA/MC crimes, including legal responses to the disclosure. Thirty-one percent indicated affirmative legal outcomes for one or more perpetrators. One important component of the EAS questionnaires is ratings about what interventions were helpful for survivors. The researchers asked if any of a list of 33 healing methods had been used, and if they were used, to what degree were the methods helpful. Individual psychotherapy (70% indicating it was either much help or a great help), supportive friends (68% indicating it was either much help or a great help), and supportive family members (63% indicating it was either much help or a great help) were the top three most helpful healing methods. The three least helpful methods were electroshock therapy (91% indicating it was not helpful), therapeutic camps (65% indicating they was not helpful), and exorcism (64% indicating it was not helpful).
The studies of ritually abused children consistently has shown commonalities in terms of the specific kinds of abuse that were alleged, the severity of the resulting psychological problems, and the specific kinds of psychological problems seen in these children (sexualized behaviors, posttraumatic symptoms, dissociative functioning, and phobias). Now we will turn our attention to empirical studies of adult survivors of ritual abuse. We found 10 publications describing the empirical studies of adult RA survivors and their treatment (Becker, Karriker, Overkamp, & Rutz, 2008; Becker, Karriker, Rutz, & Overkamp, 2013; Driscoll & Wright, 1991; Friesen, 2000; Sarson & McDonald, 2008; Scott, 2001; Shaffer & Cozolino, 1992; Rutz, Becker, Overkamp, & Karriker, 2008; Smith, 1993; Young, Sachs, Braun, & Watkins, 1991) and five studies more specifically about psychological testing results (Leavitt, 1994; Leavitt & Labott, 1998, 2000; Noblitt, 1995) and a report on the use of a structured interview method, the Adult Attachment Interview with adult RA survivors (Steele, 2003).
Lynda Driscoll and Cheryl Wright (1991) investigated the experiences of 37 adult psychotherapy patients, who were allegedly survivors of ritual abuse. Eighty-one percent had no memory of ritual abuse before beginning therapy, and of the remaining 13%, their memories were incomplete. Dissociation was a commonly reported problem in this sample with 63% being diagnosed with DID, 34% diagnosed dissociative and 17% with “strong ego states” (p. 6). Eighty-three percent reported involvement in rituals by a relative with their fathers (63%), uncles (41%), mothers (38%), grandfathers (35%) and grandmothers (22%). Other abusers included “doctors (54%), neighbors (41%), friends of relatives (49%), church members (35%), police (27%), teachers (22%), and morticians (19%)” (p. 6). Eighty percent stated that the ritual abuse began before age six. The mean age was six. The reported physical and psychological abuses included being “forced to drink blood (84%), tied up (84%), drugged (78%), deprived of food (61%), forced to eat flesh (57%), forced to eat or drink body waste (57%), deprived of sleep (54%), and given electric shock” (p. 8). Ninety percent reported being exposed to confusing and degrading experiences. Seventy-five percent reported being “isolated, 61% ejaculated on, 54% urinated on, 38% defecated on, 50% put in coffins (46% with corpses), 44% buried alive, and 39% put in graves” (p. 8). They were allegedly coerced into silence “by threats of harm (84%), of abandonment (76%), death or mutilation of themselves (73%), death of parent or relative (57%).” Most victims reported they were threatened with supernatural powers (62%), and they were told they had been magically altered (51%) in a way that would end their lives if they ‘talked’ or disobeyed” (p. 8). Seventy-four percent said that they were forced to perpetrate.
Ninety-three percent were allegedly sexually victimized, including oral sex (89%), vaginal (84%), object penetration (81%), anal (78%). They reported sex with adults (89%), group sex 84%), with animals (62%), other children (54%), and corpses (38%). Eighty-four percent reported human sacrifice; 14 % claimed they were breeders for sacrifices.
The alleged effects of ritual abuse included problems with trust (100%) and emotional intimacy (97%). “Eighty percent (80%) mistrust family members, peers, males, and authority figures in general . . . . Over ninety percent (90%) reported chronic depression, anxiety attacks, obsessions and suicidal behavior” (p. 9). Over 80% described feelings of “worthlessness, inferiority, lack of assertiveness, and dirtiness” (p. 10). Roughly 70% state they feel “helplessness, difficulties making decisions, embarrassment about themselves, humiliation and hopelessness” (p. 10). Reported physical symptoms include headaches (90%), insomnia and chronic back and abdominal pain (75%), acute unexplained weakness (76%), catatonic spells (33%), episodic paralysis (37%), and blackouts (50%). Eating disorders included anorexia (30%), bulimia (30%), and consistently over 20 pounds overweight (70%).
Walter Young, Roberta Sachs, Bennett Braun, and Ruth Watkins (1991) studied the allegations of a sample of 37 patients reporting transgenerational childhood ritual abuse. They found that all reported sexual abuse, witnessing and receiving physical abuse or torture, witnessing animal mutilation or killings and experiencing death threats. Ninety-seven percent indicated forced drug use. Other abuses included witnessing and forced participation in human adult and infant sacrifice (83%), forced cannibalism (81%), marriage to Satan (78%), being buried alive in coffins or graves (72%), and forced impregnation and sacrifice of own child (60%). All of the patients had severe PTSD and experienced dissociative states with satanic characteristics. Other psychiatric sequelae included survivor guilt (97%), indoctrinated beliefs (94%), unusual fears (94%), sexualization of sadistic impulses (86%), bizarre self-abuse (83%), and substance abuse (62%). The authors also described corroborating evidence.
Ruth Shaffer and Louis Cozolino (1992) published another of the early studies of RA survivors. The authors interviewed 20 outpatients, 19 of whom were women and one who was male. Seventy-five percent reported abuse beginning at or before age five. All subjects reported witnessing the sacrificial murder of animals, infants, children, and/or adults. Corpses were often subjected to sexual violations and cannibalistic feasting. The majority of subjects in this study reported severe and sadistic forms of sexual abuse by multiple perpetrators (p. 188). Shaffer and Cozolino noted the similarity of psychological problems found in these outpatients and the patients described in the Young et al. (1991) study, including severe amnesia, generally poor adaptive functioning, and anxiety or depression. Intrusive recollections of ritual abuse emerged, mostly during the course of therapy that revealed a coherent narrative of a tortured childhood.
Sara Scott is a practicing psychotherapist in London who provided additional empirical findings about ritual abuse. In her article “Beyond Belief: Beyond Help?” (1993), she wrote about a television program, Beyond Belief, that aired in the United Kingdom that addressed the topic of ritual abuse. A helpline was established to deal with potential telephone calls regarding the program, and it was overwhelmed with calls. “British Telecom recorded 595 attempted calls in the first five minutes after the helpline appeared on the screen and 4500 attempted calls in the first hour of operation” (Scott, 1993, p. 245). The helpline staff were able to answer 191 of the attempted calls. Of these, almost half were related to ritual abuse. “Thirty-nine percent of all calls were from current victims or survivors of ritual abuse calling on their own behalf” (p. 246).
Scott also published a book, The Politics and Experience of Ritual Abuse: Beyond Disbelief (2001), where she described her data gathering by questionnaire of 36 RA survivors, interviews of 14, and more detailed life-history interviews with 12. In her interviews, she was careful to select individuals from different locations who did not know one another in order to reduce the risk of information contagion. Scott contributed a new idea to the discussion of ritual abuse that she calls the discourse of disbelief to characterize the various arguments that have been used to discredit survivor stories, including the moral panic and false memory constructs. She pointed out the damaging effects that such a discourse of disbelief can have on survivors whose stories are arbitrarily discredited this way. Scott combined the findings from her survey and interviews to develop a “thick” description of these survivors’ experiences. She showed how ritual abuse typically consists of multilayered traumatic experiences, including abuse by family members and individuals from outside the family in a variety of different contexts, commonly including prostitution and pornography. Another layer of the abuse consists of abhorrent practices performed in ceremonies with various demonic, mythical, or magical themes. She discussed the complex way that beliefs were expressed and enacted in the ritual groups along a continuum ranging from true believer to cynic, but also how the demands for various beliefs varied by context. A child might be expected to behave as a satanist in the nighttime rituals, but be a good Christian at other times when that behavior was required. Scott discussed the notion that the ritual participants experienced varying half beliefs and contextual beliefs, but that elements of magical thinking were often pervasively present. Other important findings included the notion of embodiment—that for participants their bodies were not their own. The repeated infliction of extreme trauma resulted in periodic loss of agency, amnesia, and a stable sense of identity. Scott discussed the relationships among ritual participants, including the sadistic use of punishment sometimes followed by rescue scenario roles. Both the punishers and the rescuers wielded great power. Scott ended her book with:
I have aimed to honour the suffering and the survival of those who entrusted their life-stories to my care, and to enable their accounts to speak directly to the arguments which have sought to disparage and ignore them. I believe that in doing so I have unsealed the closure of the debate on ritual abuse and made possible both further understanding and future interventions. (p. 194)
Margaret Smith (1993) is another researcher in the United States who presented data on 52 adults who reported being survivors of childhood ritual abuse. Ninety-seven percent reported that “at some point in their lives, they were amnestic of their ritual abuse experience” (p. 20). Smith found that perpetrators were reportedly fathers (67%), mothers (42%), grandfathers (31%), grandmothers (23%), aunts (21%), uncles (27%), non-family member physicians (33%), non-family member clergy (17%), and non-family member teachers (17%). In her study of the occupations of the family and non-family alleged perpetrators, there were physicians (35%), teachers (25%), clergy (22%), and police (15%). Sixty-five percent reported that the abuse began before age of four. The following abuses were allegedly perpetrated against the respondents: molestation or intercourse (100%), forced participation in group sex with adults (96%), being tortured (94%), witnessing or forced participation in animal sacrifice (90%), witnessing or forced participation in human sacrifice (88%), sodomy (88%), being drugged during the abuse (88%), witnessing or forced participation in cannibalism (82%), being forced to torture others (75%), child prostitution (52%), child pornography (52%), and being forced to breed children who were later sacrificed (36%). Smith also listed “other forms of abuse mentioned by RA survivors”: mental programming (21%), bestiality (17%), torture by electric shock (13%), witnessing or forced participation in dismemberment or mutilation of bodies (12%), being hung upside down (10%), being forced to kidnap children from playgrounds (8%), hypnotism (8%), having pets killed (4%), having psychic surgery (4%), and being lent to other cults (4%).
Jean Sarson and Linda MacDonald (2008) summarized their case studies of five women who described histories of ritual abuse, although Sarson and MacDonald used the term ritual abuse-torture (RAT) in describing this phenomenon. These authors emphasized the fact that survivors of RAT are not merely abuse survivors: It is more accurate to say that they have been tortured. Sarson and MacDonald identified 10 violent themes associated with these families and groups:
(a) neglect and abuse of many forms (e.g., verbal, emotional, physical, sexual, financial); (b) being terrorized by acts of violence, such as the killing of a pet and being threatened with death if she disclosed the violence and abuse; (c) human-animal violence, including bestiality and/or being “trained” to harm animals; (d) torture (e.g., physical, sexual, and mind-spirit); (e) rampageous pedophilia; (f ) necrophilic and pseudonecrophilic acts, such as drugging or choking her into unconsciousness and raping her dead-like body; (g) forced self-harming behaviors; (h) enduring horrifying acts, such as being forced to watch another child tortured and gang raped; (i) human trafficking victimization and exploitation (e.g., pedophilic and adult pornography; being used as a drug mule); and (j) forced participation in violent organized pedophilic family/group gatherings coded as “rituals and ceremonies.” (p. 420)
Some other authors, including survivors (Kadi, 1997) and mental health professionals (Schwecke, 2009), have adopted Sarson and MacDonald’s RAT terminology.
Becker et al. (2008, 2013) and Rutz et al. (2008) conducted an ambitious online international study of adult extreme abuse survivors using their questionnaire, the EAS. The survey was available in English and German from January 1 through March 31, 2007. One thousand four hundred seventy-one (1,471) people answered at least one of the 187 (and 53 optional) questions. The respondents identified themselves as residents of 31 different countries. In addition to recording demographic information, the EAS asks about recollections of abuse, the aftereffects of abuse, the personal experiences of the abuse survivors, and the healing methods that the survivors used and the extent to which these were helpful. Fifty-two percent indicated that they had been victimized by both ritual abuse (RA) and mind control (MC). Nineteen percent identified themselves as RA and 7% as MC survivors. The abuses perpetrated on these individuals were much like those reported in other studies, including sexual abuse by multiple perpetrators (79%), being caged (53%), starvation (48%), forced cannibalism (44%), bestiality (52%), being buried alive (45%), electroshock (50%), sensory deprivation (61%), sleep deprivation (69%), incest (70%), child pornography (52%), and child prostitution (46%). Among the aftereffects of extreme abuse were sleep problems (90%), PTSD (89%), survivor guilt (73%), substance abuse (48%), self-mutilation (65%), dissociative flashbacks with satanic themes (68%), and eating disorders (70%). One of the particularly useful components of this research is the data about helpful recovery methods. Among the methods that were rated as providing much help or great help were individual psychotherapy (75%), supportive friends (66%), creative writing (64%), and personal prayer/meditation (62%). The idea of prayer as a component treatment strategy is echoed in another publication that addressed spiritual approaches to recovery. James Friesen (2000) described two studies that he conducted: The first was a survey of 66 Christian therapists regarding spiritual methods they used, and the second was a survey of 102 respondents regarding the extent to which the spiritual interventions were perceived as helpful.
The literature also includes studies of the data from psychological testing administered to individuals who reported they were RA survivors (Leavitt, 1994, 1998; Leavitt & Labott, 1998, 2000; Noblitt, 1995). Leavitt (1994) found that with the exception of the paranoia scale, there were no significant differences between MMPI scores for a group of adults claiming to be RA survivors and a group of adults reporting childhood sexual, but not ritual, abuse. However, Leavitt noted that adults claiming to be RA survivors scored significantly higher on the Dissociative Experiences Scale (DES) in comparison with the sexually, but not ritually, abused control group. Leavitt (1998) compared the Word Association Test (WAT) responses of “43 patients who alleged SA in the context of Satanic cults” and 43 patients “who reported SA without allegations of SRA.” The group of RA survivors produced more responses with satanic content, and this finding was not due to exposure to this material in the hospital. In a related study by Leavitt and Labott (1998), WAT responses were compared for 60 adult inpatients who alleged they were survivors of SRA, 60 who reported sexual, but not ritual, abuse, and 150 admitted inpatients. Again, it was found that individuals reporting that they were ritually abused produced characteristically “satanic” associations to the WAT. What was more surprising was that, in spite of making significantly more overall responses, the SRA group produced significantly fewer normal or “normative” responses than either of a group of non-ritual sexually abused individuals and a non-abused group. In another study, Leavitt and Labott (2000) compared 131 participants who alleged past ritual abuse experiences, 92 individuals with sexual, but not ritual, abuse histories, and 92 non-abused women on their Rorschach inkblot responses. They found good inter-rater reliability identifying 16 responses that distinguished the SRA patients from the others. They found moderate convergence among these responses and the findings published by Young et al. (1991) regarding SRA survivors. They also studied the relationship between Rorschach satanic content, media exposure, and hospital exposure to satanic themes. They found no effect resulting from hospital exposure. Paradoxically, participants with low media exposure had the highest number of satanic Rorschach responses.
In another retrospective study, the Minnesota Multiphasic Personality Inventory (MMPI-2) posttraumatic stress disorder (PTSD) scales (PS and PK) were compared between a group of 34 adult outpatients who reported being RA survivors, and a group of 31 adult outpatients who made no such RA allegations. The results showed significantly higher PTSD scores for the alleged RA survivors on both scales (Noblitt, 1995).
Howard Steele (2003) wrote about his use of the Adult Attachment Interview with RA survivors also noting that these clients met the criteria for DID. He discussed the attachment coding and classification and its relevance to these survivors.
Legal cases involving RA allegations have been litigated in civil and criminal venues. It is important to recognize that civil and criminal laws use different standards of evidence in the United States. Civil cases rely on the preponderance of evidence in making determinations, whereas criminal cases require that the evidence be beyond a reasonable doubt. Thus, criminal cases demand more stringent evidence. Civil cases involving RA allegations have included child custody disputes, lawsuits by survivors claiming damages from their alleged abusers, and malpractice lawsuits brought against therapists for purportedly implanting false memories of abuse and at least one third-party claim against a psychiatrist alleging alienation of affection between an alleged survivor and her parents. To my knowledge, there is no comprehensive published review of these cases regarding outcomes.
Because some of these cases involve children and matters of family privacy, some of the cases are sealed by the court. Some malpractice claims settle out of court with an agreement that the terms of settlement may not be disclosed by any of the parties. Criminal cases have been easier to study empirically, but even these cases are not without difficulties in interpretation. The fact that a crime involves ritual practices may never be disclosed in the testimony or by the media. Most states do not have laws specifically prohibiting ritual crime, and therefore, the offense is typically prosecuted as some other defined crime (e.g., murder or child abuse). We discovered that the oft-repeated report that the Federal Bureau of Investigation has been studying ritual abuse is untrue when we communicated directly with the FBI about this question (See Appendix B). In spite of these limitations, some data have been collected, particularly in criminal cases of ritual abuse of children.
Faller (1994), previously cited, included data on convictions associated with the various studies of ritual abuse she reviewed. In 1997, author Michael Newton accumulated data on the sentencing of 145 defendants for criminal activities in which the ritual abuse of children was alleged. He found that at that time only 17 (11.7%) were reversed on appeal. Sixty-four or 44% of the 145 defendants pled guilty or nolo contendere (no contest). Newton argued that these reversals do not necessarily mean that the defendants were innocent. Newton found that in most instances the reversals were based on legal technicalities rather than factual indicators of innocence. Since the time Newton collected this data, more of these convicted individuals have been released from prison (de Young, 2007).
In addition to quantitative studies about ritual crime, the descriptive accounts by Carl Raschke (1990), Nick Kahaner (1988), Maury Terry (1987), and David McGowan (2004) provide further details about such cases. Nick Pisa (2007) reported on the rising satanic crime statistics in Italy, including church desecrations and murders. He cited the murder conviction of “Andrea Volpe, the Beasts of Satan ringleader, [who] was given a life sentence, while his girlfriend, Elisabetta Ballarin, 19, was sentenced to 24 years.”  Two recent cases involving ritualistic rapes by satanic cults resulted in convictions in Wales (Turner, 2011) and England (Cohen, 2012).
Another contentious topic concerns the question of whether there is an “international satanic conspiracy” that is engaging in these alleged abusive practices. Two research efforts have addressed this particular question: (1) the studies conducted by Bottoms et al. (1991) and Goodman et al. (1994) in the United States and (2) the research of J. S. La Fontaine (1994, 1998) in England.  Neither found any evidence of such a satanic conspiracy. Should one then conclude that there is no satanic conspiracy? Unfortunately, neither study disproved this hypothesis; they merely did not find evidence that met their criteria.
A serious problem in studying alleged conspiracies is that the usual methods of investigation may not be sufficiently sensitive to identify one when it is present. A case in point is the study of organized crime in the United States. The terms Mafia and La Cosa Nostra were commonly used to describe one such alleged Italian American criminal conspiracy. However, for decades the FBI denied the existence of the Mafia or La Cosa Nostra. Although the FBI recognized that organized crime existed, they had accumulated no evidence that linked any crime to any group that called itself the Mafia or La Cosa Nostra. As far as the FBI was concerned, the talk on the street about the Mafia and La Cosa Nostra was simply the reflection of contemporary legend.
Curiously, an advocacy group even arose calling itself the Italian American Civil Rights League. This group claimed that the rumors about the Mafia and La Cosa Nostra were really efforts to defame Italian American people by spreading these supposedly spurious rumors about Italian American organized crime. The primary organizer of the Italian-American Civil Rights League was Joseph Colombo, who ironically was the head of one of the “five families” of New York.
Finally in 1989, the FBI surreptitiously tape-recorded a Mafia initiation ceremony in which the words Mafia and La Cosa Nostra were used during the ceremony. Later when the participants were arrested, not one admitted that there was such an organization as the Mafia, although some admitted to other accusations of serious crimes, including murder (Pistone, 1992). This example of the investigation of organized crime in the United States illustrates how difficult it may be to demonstrate evidence of a genuine criminal conspiracy.
In my opinion, neither of the two earlier cited research efforts was sufficiently sensitive to adequately test that particular question. To say that there is no evidence of an international satanic conspiracy misrepresents the facts. There are many people who allege that they have been eyewitnesses to elements of such a conspiracy. Eyewitness reports do constitute evidence. The question is not whether evidence exists; it does exist. The question is to what extent are these alleged eyewitness reports true or credible. This question requires further study and corroboration. It is more accurate to say that the question of the existence of a satanic conspiracy has not yet been settled in the scientific and legal community and that further investigation and research is needed.
CHAPTER 6 Notes
1. An earlier version of this chapter was adapted from Accessing Dissociated Mental States (Noblitt, 1998a).
2. Also see Faller (2003).
3. Curiously, some of these authors have written commentaries that are skeptical that ritual abuse occurs very often and blame therapists for many of these “false memories.” This position is taken even though there are no objective data in existence to warrant such statements that are potentially damaging toward therapists who are currently being threatened by civil lawsuits for treating individuals who allege that they are survivors of ritual abuse. In some instances, these patients will recant and they or their families will blame the therapist for the memories of trauma. This has occurred even in cases where the trauma memories predated any treatment by the therapist in question. More curious is the failure of these researchers to integrate their own and others’ research findings with these speculations. Their citation of other studies appears to be highly selective and their interpretation of their own outcomes is inconsistent. See Bottoms, Shaver, and Goodman (1996) and Bottoms and Davis (1997).
4. We are not claiming that this is impossible. We do believe that it is possible. We simply know of no proven cases after having exhaustively searched the literature. Therefore, this hypothesis is speculative.
5. Hudson (1994) updated her original sample to 27 children.
6. Adapted from Hudson (1991, pp. 11–21).
7. For more information about this case, see Associated Press (2005).
8. One reported case was from Wales.
REFERENCES FOR CHAPTER 6:
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