The Ritual Abuse of Children: Clinical Features and Diagnostic Reasoning BARRY NURCOMBE, M.D.,
AND
JURGEN UNUTZER, M.D.
Abstract. A case of alleged ritual sexual abuse is presented. Clinical recognition and diagnostic reasoning are discussed. After a brief account of modem satanism, it is concluded that, although the evidence for the occurrence of ritual abuse is sketchy, a high index of suspicion is appropriate. 1.Am. Acad. Child Adolesc. Psychiatry, 1991, 30, 2:272-276. Key Words: sexual abuse, ritual abuse, satanism, children. Do satanists terrorize children? Sensational allegations of ritual abuse typically divide audiences into scoffers and scandalmongers. However, numerous reports of such practices have appeared in the media; informal communication suggests that a number of clinicians have been involved in cases of this sort. It is time to share information on the matter and to make some cautious speculations. After a case history that exhibits many of the phenomena of ritual abuse described by others (e.g., Gould, 1987), this paper will essay a description of the clinical presentation and psychopathology of ritual sexual abuse and discuss diagnostic reasoning in such cases. Since there have been allegations concerning satanic practices in several reported cases, an account of modem satanism will also be included. Case History
When she was found to have the physical signs of sexual abuse, Hillary, a 5-year-old child, was removed from her parents, placed in a foster home, and referred for treatment to a community mental health center. Six months later, Hillary’s behavior remained so disruptive that parent visits were suspended, and the child was transferred to a second foster mother who had been specially trained to care for emotionally disturbed children. One year after the state had assumed custody, Hillary was referred by the Department of Protective Services for a forensic evaluation concerning the advisability of resuming parent visits. The child’s caseworker alluded to the fact that Hillary had described bizarre sexual experiences to a psychotherapist and to her two foster mothers. Accordingly, the evaluator (B. N.) interviewed Hillary and her foster mother (each twice) before reviewing extensive documentation and videotapes provided by the department. Hillary was an animated child who related to the interviewer in a overfamiliar, immodest, somewhat controlling manner. Asked why she lived in a foster home, she said, “Mommy and Daddy won’t talk because they didn’t go to a therapist.” To the request that she draw her family doing something together, she depicted her parents and responded Accepted June 15, 1990. From the Division of Child & Adolescent Psychiatry, Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN. Reprint requests to Dr. Nurcombe, Vanderbilt Child and Adolescent Psychiatric Hospital, 1601 23rd Ave. South, Nashville, TN 37212. 0890-8567/91/3002-0272$03.00/00 1991by the American Academy of Child and Adolescent Psychiatry.
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to a direct question by saying that they were “thinking of doing something bad. When, later in the interview, three anatomically explicit dolls (a male and female adult doll and a female child doll) were placed on a sofa, Hillary immediately looked under their pants and dresses, accurately noting their “penis” and “vaginas.” She bent to smell the genital area of the adult female doll, saying, “It smells like a mommy. You smell it. What does it smell like?” She volunteered that her parents had “touched me where they wasn’t supposed t o - o n the vagina,” and she spontaneously demonstrated with the dolls how they did so. She volunteered that her parents had made her drink blood from a dog her father had killed. The dog, she said, had belonged to a neighbor called “Carl.” At this point, she became upset by and preoccupied with a small scratch on her finger. She noted that the interviewer had a blister on his finger and a bone in his wrist. She commented that Jesus was “nice” in contrast to “bad people” who kill others by “cutting their heads.” She then recounted how a person called “Frank” had a cut a man called “the Fireman” on the hand and choked him. In the second interview, using office chairs to simulate an automobile, Hillary enacted a scene in which a mother who was driving a car shouted harshly at a “little baby” doll. She spontaneously enacted a scene in which a mother doll touched the genitals of a female child doll, and a father doll assaulted the mother and daughter. Opening her legs, she reclined on a table in the office and remarked. “My Daddy puts his penis in other peoples’ body.” She volunteered that he had put his penis in her vagina and that she did not want to visit her parents anymore because they were mean. Later, while playing with toy cowboys and Indians, she was startled by a toy Indian brandishing a tomahawk. She exclaimed, “Knives don’t protect you, they kill people. . . , A man killed a fireman with a knife (demonstrating stabbing in the chest). One time a man killed a horse with a knife . . . on his body, his neck.” She also mentioned a man called “Instrument” who “got killed.” Interviews with Hillary’s foster mother yielded a profile of a child who, when transferred to her care 6 months before, had been clinging, often terrified, prone to attacks of rage when she was thwarted or criticized, overfamiliar with strangers, unable to concentrate, and retarded in language and conceptual development. Approximately 5 months after arriving at the first foster home, Hillary had spontaneously alleged that a family friend and neighbor called “Carl” had ”
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sexually abused her, and that her father had done so subsequently. At the second foster home, Hillary claimed at different times that her father had told her he was Satan and that he would hang her on a cross if she told a judge about what he had done to her; that she feared the devil would take her “down below”; that a neighbor called “Carl” had put his penis into her, made her drink dog’s blood, and placed rats on her body; that her father had put “garbage’ into her vagina and forced her to drink blood and urine; that her mother had taken photographs while Hillary urinated on her father; that her father had taken photographs while her mother performed cunnilingus on her; that her father had “pee-peed” in her mouth; that she had given her father “Koolaide” while her mother danced; that her mother and father had dressed in witch and devil costumes; and that people wearing ‘‘plastic heads” representing Disney characters had been present while her parents were dancing. This information emerged spontaneously, in piecemeal fashion, typically when Hillary was dining or being bathed. The foster mother said that, at the time of the assessment, Hillary continued to have severe tantrums precipitated by minor limit setting, especially before and after parent visits, and that she remained terrified of knives and weapons, depictions of the devil, and being confined. Medical records from the first 2 years of Hillary’s life revealed numerous visits to a hospital emergency room for chronic diaper rash, recurrent diarrhea, and malnutrition. Departmental records noted that, after neglect had been alleged when she was 1 year old, the child had been placed in temporary custody; however, she was subsequently returned to her parents. The case was reopened when Hillary was 4 years of age, after repeated formal complaints of child neglect or abuse. Eventually, Hillary was removed from parental custody when pediatric investigation revealed scarring and dilation of her vaginal introitus. The physician had specially noted the child’s unusual passivity during the pelvic examination. Interviewed separately and together, Hillary’s parents accepted the diagnosis that their daughter had been sexually abused but maintained that the perpetrator was a neighbor (“Carl”) and that the mother had been unable to prevent Hillary from going to his apartment. They ascribed the ritualistic elements of the story to a television horror series (“Freddy’s Nightmares”) that Hillary watched and to her ‘‘craziness. Hillary’s emotional disturbance, they concurred, was due to long-standing harassment of the family by child welfare authorities. The father described his very disturbed childhood. Both his parents were alcoholics and neglected him, and he was taken into state custody at the age of 5 years. After two unsuccessful placements in foster homes, he spent 10 consecutive years in public inpatient psychiatric care. In the course of the interview, he revealed an unexpectedly wide knowledge of “charismatic mysticism” through which, he said, the leaders of cults seek to attain spiritual power and dominance over others. He, himself, explicitly rejected ‘‘false prophets” and vehemently professed fundamentalist Christian beliefs. The mother described a childhood characterized by con”
J . Am.Acad. Child Adolesc. PsychiatT, 30:2, March 1991
flict with her mother, parental divorce, a socially isolated adolescence, and conversion to born-again Christianity as a young adult, after a disillusioning sojourn in a hippie commune. Both parents said they had had little experience with the opposite sex before marriage and that they had been drawn together by a common interest in popular religious music and horror movies. When interviewed together with her parents, Hillary was excited and hyperactive. She domineered her mother, on two occasions sending her to “time out.” The parents loaded Hillary with gifts (for a recent birthday), ostentatiously read children’s prayers to her, and pressed her to tell the doctor how she had been sexually abused by “Carl.” At no time during this interview did she exhibit fear of her parents; in fact, she appeared to be closer to her father than to her mother.
Recognition of Ritual Abuse Ritual abuse adds a new dimension to the maltreatment of children. It can be defined as the sexual molestation of children, usually by multiple perpetrators, in conjunction with rituals that ceremonially invoke magical or supernatural powers. This abuse may also involve the terrorization and intimidation of victims in order to prevent them from disclosing the maltreatment. In a national study of child abuse in day-care centers, Finkelhor et al. (1988) discovered 36 cases of sexual abuse in which investigators detected bizarre ritualistic elements. Ritual abuse has also been described by Gould (1987) and Kaye and Klein (1987). Child victims of ritual molestation exhibit nonspecijk signs of stress (e.g., somatic symptoms, sleep disturbance, hyperactivity, learning problems, tantrums, anxiety, depression, regression, and daydreaming), together with specSfic signs of sexual molestation (e.g., urogenital, anal, or perineal trauma or infection; precocious sexual play or talk; precocious sensuousness or seductiveness; undue familiarity or immodesty toward strangers; abnormal passivity during pelvic examination; dissociative tendencies; and the complaint of having been sexually molested). In addition to the above signs, victims characteristically manifest phenomena connoting bizarre rituals (Gould, 1987). For example, a child may speak of ingesting human or animal parts or body fluids, of drinking “Koolaide” or potions, or of the exsanguination, sacrifice, and mutilation of animals, infants, or adults. The child may be fearful of or preoccupied with drinking or losing blood, being killed to provide blood, being urinated or defecated upon, or urinating or defecating on others. A preoccupation with insects, animals, cemeteries, monsters, witches, devils, vampires, demons, evil spirits, crosses, crucifixion, curses, colors, or occult symbols may be evident; the child may be convinced that a demon is inside him or her, watching every move. The child may incant or dance ritualistically, sing songs with a “you better not tell” theme, or speak of being photographed or filmed. A striking association is the description of perpetrators or observers impersonating cartoon characters (e.g., Sesame Street, the Flintstones, or Wilt Disney). Conventional authority figures (e.g., policemen or firemen) may also be 2 73
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present. Themes of bondage, confinement (e.g., fear of being locked in a closet), possession, abandonment by parents, punishment (e.g., by crucifixion), abduction, or death and rebirth may also be expressed in conversation or repetitious play.
Diagnostic Reasoning Clinicians involved in cases of this type must navigate the dangerous strait between denial and gullibility. In a number of investigations, overzealous interviewers have apparently obscured the truth by coercive or suggestive investigative techniques. Other clinicians have dismissed victims’ stories as preposterous, indoctrinated, or the product of contagion. Indeed, there is a serious risk that the remembrances of patients with polyfragmented multiple personalities could be inadvertently shaped by clinicians invested in the satanic origin of the disorder and by the growing popular literature on the subject (e.g., Smith and Pazder, 1980).Clinicians about to embark on the forensic evaluation of cases of suspected ritual abuse should also be aware that satanists may be prepared to intimidate those who would testify against them. In the example of Hillary’s case history, what are the features that support the validity of the allegation that this child has been ritually abused? The clinical reasoning that follows illustrates the exclusion of alternative explanations and is followed by a detailed analysis of the features of a case to determine if their configuration is consistent with ritual abuse. 1 . The Exclusion of Alternative Explanations Hillary shows no signs of the thought disorder that would be associated with a delusional state, a rare condition at this age. There is no evidence of the kind of dependency upon a deluded older person that would be associated with folie d d e n . There is no suggestion of the epidemic panic associated with the imitation of other children who have similar symptoms; and no indication that coercive or suggestive investigative techniques have been employed in order to elicit information from the child. Confabulation of this type is unheard of in a 5-year-old; a child so young would be unable to concoct and sustain a deliberatefabrication of this degree of complexity, Has the child been confused by observing horror movies or pornography? If so, why has she directed her allegations at the parents? In short none of the plausible alternative hypotheses stands up.
2 . Indicators of Neglect and Abuse In this case, the physical signs of sexual abuse were detected along with a telltale passivity during the child’s examination. Moreover, early physical neglect was documented along with a reversible delay in language and social development. At the time of the evaluation, Hillary exhibited physical overfamiliarity, a precocious interest in body parts, and a severe behavioral disturbance consistent with childhood post-traumatic stress disorder (sleep disturbance, emotional distress on reexposure to experiences presumably resembling the original trauma, excessive fears, and episodes of rage and self-injury when thwarted). 2 74
3 . Specific Indicators of Ritual Abuse Hillary is afraid of being killed or crucified, is fearful of guns, knives, and blood, and is terrified of being abducted by kidnappers. She has made repeated allegations that animals were sacrificed, of irregular sexual activities with adults, of being photographed during these experiences, and of the presence of observers dressed as Walt Disney characters. 4 . Content Validity
The child’s story has apparently emerged spontaneously (although it could have been shaped during psychotherapy). It has been consistent over time and is internally logical. Hillary’s affect was appropriately anxious as she told her story. However, it should be noted that, probably as result of psychotherapy, Hillary uses adult language when describing body parts, an observation that mitigates, to some degree, the validity of her statements.
5 . Contextual Validity The child’s allegations originally emerged piecemeal but spontaneously,without coercive or suggestive interrogation. There is no plausible motivation for fabrication or confabulation, and the situation is not one in which indoctrination would be hypothesized (unless one were to suspect the two foster mothers of conspiring with the Child Welfare Department in order to secure custody). There is no evidence for the group contagion from which suggestion or imitation typically arises. In summary, the most probable alternative explanations do not hold water, and virtually all the clinical features of the case are consistent with ritual sexual abuse. Evolution of Modern Satanism The history of satanism has been described by Cavendish (1967). The word Satan, which is Hebrew for “adversary,” appears first in the Old Testament and was translated to Greek as diabolos (“accuser”), which is the origin of the English word “devil. ” In Christianity, the devil developed into the supernaturalenemy of God and mankind. Reversing the values of true Christians, devil worshippers extol lust, pride, strength, force, vengeance, and the exertion of power over nonbelievers. They believe the devil will ultimately overthrow the Christian God and return in triumph to heaven. In order to propitiate Satan, his devotees make offerings of sexuality, pain, and human and animal sacrifice, hoping thereby both to invoke the powers of darkness and to arrogate to energy of life. Through the Black Mass, the congregation seeks to impropriate the power of Satan, arrogate the mystery of Christian ritual, and deride conventional religion. Thus, sacramental wine becomes urine or semen to be quaffed from purloined chalices, satanic priests put on obscene vestments, and black candles are burnt around a naked woman who is prostrate on an altar before an inverted crucifix. Today’s satanists can be conveniently classified into a number of groups: pop satanists and “dabblers,” formal satanic church members, white witches, sexual deviates, and orthodox core satanic cells. .I Am. . Acad. ChildAdolesc. Psychiatry,30:2,March1991
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Pop Satanism and ‘ ‘Dabbling” This term refers predominantly to adolescent ‘‘dabblers” who, alone or in groups, are attracted to the contemporary vogue for satanic chic. Satanic dabblers tend to be preoccupied with rock music, occult jewelry and cosmetics, tarot cards, Ouija boards, and “Dungeons and Dragons.” King (1988) reports an association between “heavy metal” rock (the lyrics of which often glorify satanic worship), the occult, destructive behavior, substance abuse, promiscuous sexual activity, and violence. Isolated instances of homicide and suicide have been reported; for example, the serial killer, Ramirez, declared satanic beliefs. Though probably a passing craze, pop satanism is widespread and has important clinical implications, particularly since introverted, depressed, or alienated youth are likely to be enthralled by its promise of mysterious power. There have been reports of animal sacrifices and cemetery desecrations by groups of “dabblers,” but there have been no reports that dabblers have been involved in child abuse.
in treatment for multiple personality disorder. The current understanding of satanic ritual abuse is a reconstruction based on the independent reports of these two groups of victims (e.g., Gould, 1987; Kaye and Klein, 1987; Kelley, 1988). The fragility of such witnesses indicates the need for caution; nevertheless, although firm conclusions would be premature, a high index of suspicion is appropriate. Apparently, ritualistic sexual abusers sometimes wear costumes (e.g., Walt Disney, Flintstone, or Sesame Street characters; or policemen, policewomen, firemen or firewomen). The purpose may be either to render the child incredible or to implant dissociative identities. These socalled “triggers” may be activated later in life with the aim, for example, of rendering a “breeder” adolescent compliant to impregnation (by means of which fetuses or infants can be obtained for ritual sacrifice). In effect, systematic terrorization is employed in order to induce psychological dissociation and state-dependent learning and to sequester traumatic memories in the form of multiple dissociated personality fragments.
Formal Satanic Church Worship Groups such as the Church of Satan and the Temple of Set have a formal membership, distribute newsletters, and claim to abjure criminal activity. Though evidently in decline, satanic churches have had considerable influence on “dabblers” through such books as The Satanic Bible (LaVey, 1969).
Conclusion What is the prevalence of ritual abuse and how often is it associated with orthodox satanism? Some authorities suspect the existence of a widespread underground network of covens; others suggest that, although some exist, there are few true satanic cells; whereas many are convinced that the whole issue is a form of national hysteria engendered by cynical talk-show hosts and gullible clinicians. Even if one were to accept the existence of orthodox satanism, it is not possible at this point to distinguish orthodox satanic abuse from the satanic ingredients of sexual deviation and child pornography, except to suggest that, as a lucrative international industry, child pornography is probably more common than orthodox satanic abuse. There are too many questions to close the book on this vexatious matter, questions that will not be answered until pornographic sex rings and satanistic cells are penetrated by law enforcement professionals. Nevertheless, it is tempting to conjecture that there is a grain of truth in several points of view: that ritual abuse occurs most commonly in the context of child pornography; that orthodox satanic abuse does occur, though rarely; and that the sensational nature of such allegations has induced some clinicians to employ inept interviewing techniques. As a result, these clinicians have unwittingly indoctrinated suggestible witnesses or, worse still, muddied the waters when the original allegations were valid.
White Witchery White witches are not secretive. They worship the earth and moon goddesses, identify with feminism, and practice a benign form of wicca (white magic) (Luhrmann, 1989). Sexual Deviation and Pornography Sexual deviates secretly cloak pedophilia, sadomasochism, urolagnia, fetishism, or necrophilia in a travesty of satanic ritual, photographing or videotaping their activities for private delectation or commercial distribution. It is not clear whether the satanic elements are introduced in order to add spice to the proceedings, to intimidate children, or to discredit victims if they should seek to disclose the abuse. In a number of recent cases, children appear to have been recruited by pornographers from day-care centers (Finkelhor et al., 1988; Kelley, 1988). Orthodox Satanism Orthodox satanists are supposedly organized in secret cells known as “orders,” “grottoes,” or “covens.” Shielded by public disbelief, satanic groups are thought by some law enforcement officers to constitute a far-flung underground network. Whether or not this is so, there is sufficient correspondence among different reports of ritual abuse to suggest that several widely dispersed centers are in communication with each other. Even if these groups exist, it is not certain that they are involved in the maltreatment of children. Clinicians who have described satanic ritual abuse have elicited their information from alleged child victims or from adult females J . Am. Acad. Child Adolesc. Psychiatry, 30:2,March 1991
References Cavendish, R. (1967), The Black Arts. New York Putnam. Finkelhor, D., Williams, L. M., Bums, N. & Kalinowski, M. (1988), Sexual Abuse in Daycare: A National Study. Final Report. Durham, NH: Family Research Laboratory, University of New Hampshire. Gould, C (1987), Satanic ritual abuse: child victims, adult survivors, system response. California Psychologist: 1-5. Kaye, M. & Klein, L. (1987), Clinical indicators of satanic cult victimization. Paper presented at the Fourth International Conference for the Study of Multiple Personality Disorder, Chicago. Kelley, S . J. (1988), Responses of children to sexual abuse and satanic
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ritualistic abuse in day care centers. Paper presented at the National Symposium on Child Victimization, Anaheim, CA. King, P. (1988), Heavy metal music and drug abuse in adolescents. Postgraduate Medicine, 8 3:295-304. LaVey, A . S . (1969), The Satanic Bible. New York Avon.
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Luhrmann, T. M. (1989), Persuasions of the Witch’s Craft: Ritual Magic in Contemporary England. Cambridge, MA: Harvard University Pr. Smith, M. & Pazder, L. (1980), Michelle Remembers. New York Congdon & Lattes.
J . Am.Acad. Child Adolesc. Psychiatry, 30:2,March1991
AND
JURGEN UNUTZER, M.D.
Abstract. A case of alleged ritual sexual abuse is presented. Clinical recognition and diagnostic reasoning are discussed. After a brief account of modem satanism, it is concluded that, although the evidence for the occurrence of ritual abuse is sketchy, a high index of suspicion is appropriate. 1.Am. Acad. Child Adolesc. Psychiatry, 1991, 30, 2:272-276. Key Words: sexual abuse, ritual abuse, satanism, children. Do satanists terrorize children? Sensational allegations of ritual abuse typically divide audiences into scoffers and scandalmongers. However, numerous reports of such practices have appeared in the media; informal communication suggests that a number of clinicians have been involved in cases of this sort. It is time to share information on the matter and to make some cautious speculations. After a case history that exhibits many of the phenomena of ritual abuse described by others (e.g., Gould, 1987), this paper will essay a description of the clinical presentation and psychopathology of ritual sexual abuse and discuss diagnostic reasoning in such cases. Since there have been allegations concerning satanic practices in several reported cases, an account of modem satanism will also be included. Case History
When she was found to have the physical signs of sexual abuse, Hillary, a 5-year-old child, was removed from her parents, placed in a foster home, and referred for treatment to a community mental health center. Six months later, Hillary’s behavior remained so disruptive that parent visits were suspended, and the child was transferred to a second foster mother who had been specially trained to care for emotionally disturbed children. One year after the state had assumed custody, Hillary was referred by the Department of Protective Services for a forensic evaluation concerning the advisability of resuming parent visits. The child’s caseworker alluded to the fact that Hillary had described bizarre sexual experiences to a psychotherapist and to her two foster mothers. Accordingly, the evaluator (B. N.) interviewed Hillary and her foster mother (each twice) before reviewing extensive documentation and videotapes provided by the department. Hillary was an animated child who related to the interviewer in a overfamiliar, immodest, somewhat controlling manner. Asked why she lived in a foster home, she said, “Mommy and Daddy won’t talk because they didn’t go to a therapist.” To the request that she draw her family doing something together, she depicted her parents and responded Accepted June 15, 1990. From the Division of Child & Adolescent Psychiatry, Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN. Reprint requests to Dr. Nurcombe, Vanderbilt Child and Adolescent Psychiatric Hospital, 1601 23rd Ave. South, Nashville, TN 37212. 0890-8567/91/3002-0272$03.00/00 1991by the American Academy of Child and Adolescent Psychiatry.
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to a direct question by saying that they were “thinking of doing something bad. When, later in the interview, three anatomically explicit dolls (a male and female adult doll and a female child doll) were placed on a sofa, Hillary immediately looked under their pants and dresses, accurately noting their “penis” and “vaginas.” She bent to smell the genital area of the adult female doll, saying, “It smells like a mommy. You smell it. What does it smell like?” She volunteered that her parents had “touched me where they wasn’t supposed t o - o n the vagina,” and she spontaneously demonstrated with the dolls how they did so. She volunteered that her parents had made her drink blood from a dog her father had killed. The dog, she said, had belonged to a neighbor called “Carl.” At this point, she became upset by and preoccupied with a small scratch on her finger. She noted that the interviewer had a blister on his finger and a bone in his wrist. She commented that Jesus was “nice” in contrast to “bad people” who kill others by “cutting their heads.” She then recounted how a person called “Frank” had a cut a man called “the Fireman” on the hand and choked him. In the second interview, using office chairs to simulate an automobile, Hillary enacted a scene in which a mother who was driving a car shouted harshly at a “little baby” doll. She spontaneously enacted a scene in which a mother doll touched the genitals of a female child doll, and a father doll assaulted the mother and daughter. Opening her legs, she reclined on a table in the office and remarked. “My Daddy puts his penis in other peoples’ body.” She volunteered that he had put his penis in her vagina and that she did not want to visit her parents anymore because they were mean. Later, while playing with toy cowboys and Indians, she was startled by a toy Indian brandishing a tomahawk. She exclaimed, “Knives don’t protect you, they kill people. . . , A man killed a fireman with a knife (demonstrating stabbing in the chest). One time a man killed a horse with a knife . . . on his body, his neck.” She also mentioned a man called “Instrument” who “got killed.” Interviews with Hillary’s foster mother yielded a profile of a child who, when transferred to her care 6 months before, had been clinging, often terrified, prone to attacks of rage when she was thwarted or criticized, overfamiliar with strangers, unable to concentrate, and retarded in language and conceptual development. Approximately 5 months after arriving at the first foster home, Hillary had spontaneously alleged that a family friend and neighbor called “Carl” had ”
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sexually abused her, and that her father had done so subsequently. At the second foster home, Hillary claimed at different times that her father had told her he was Satan and that he would hang her on a cross if she told a judge about what he had done to her; that she feared the devil would take her “down below”; that a neighbor called “Carl” had put his penis into her, made her drink dog’s blood, and placed rats on her body; that her father had put “garbage’ into her vagina and forced her to drink blood and urine; that her mother had taken photographs while Hillary urinated on her father; that her father had taken photographs while her mother performed cunnilingus on her; that her father had “pee-peed” in her mouth; that she had given her father “Koolaide” while her mother danced; that her mother and father had dressed in witch and devil costumes; and that people wearing ‘‘plastic heads” representing Disney characters had been present while her parents were dancing. This information emerged spontaneously, in piecemeal fashion, typically when Hillary was dining or being bathed. The foster mother said that, at the time of the assessment, Hillary continued to have severe tantrums precipitated by minor limit setting, especially before and after parent visits, and that she remained terrified of knives and weapons, depictions of the devil, and being confined. Medical records from the first 2 years of Hillary’s life revealed numerous visits to a hospital emergency room for chronic diaper rash, recurrent diarrhea, and malnutrition. Departmental records noted that, after neglect had been alleged when she was 1 year old, the child had been placed in temporary custody; however, she was subsequently returned to her parents. The case was reopened when Hillary was 4 years of age, after repeated formal complaints of child neglect or abuse. Eventually, Hillary was removed from parental custody when pediatric investigation revealed scarring and dilation of her vaginal introitus. The physician had specially noted the child’s unusual passivity during the pelvic examination. Interviewed separately and together, Hillary’s parents accepted the diagnosis that their daughter had been sexually abused but maintained that the perpetrator was a neighbor (“Carl”) and that the mother had been unable to prevent Hillary from going to his apartment. They ascribed the ritualistic elements of the story to a television horror series (“Freddy’s Nightmares”) that Hillary watched and to her ‘‘craziness. Hillary’s emotional disturbance, they concurred, was due to long-standing harassment of the family by child welfare authorities. The father described his very disturbed childhood. Both his parents were alcoholics and neglected him, and he was taken into state custody at the age of 5 years. After two unsuccessful placements in foster homes, he spent 10 consecutive years in public inpatient psychiatric care. In the course of the interview, he revealed an unexpectedly wide knowledge of “charismatic mysticism” through which, he said, the leaders of cults seek to attain spiritual power and dominance over others. He, himself, explicitly rejected ‘‘false prophets” and vehemently professed fundamentalist Christian beliefs. The mother described a childhood characterized by con”
J . Am.Acad. Child Adolesc. PsychiatT, 30:2, March 1991
flict with her mother, parental divorce, a socially isolated adolescence, and conversion to born-again Christianity as a young adult, after a disillusioning sojourn in a hippie commune. Both parents said they had had little experience with the opposite sex before marriage and that they had been drawn together by a common interest in popular religious music and horror movies. When interviewed together with her parents, Hillary was excited and hyperactive. She domineered her mother, on two occasions sending her to “time out.” The parents loaded Hillary with gifts (for a recent birthday), ostentatiously read children’s prayers to her, and pressed her to tell the doctor how she had been sexually abused by “Carl.” At no time during this interview did she exhibit fear of her parents; in fact, she appeared to be closer to her father than to her mother.
Recognition of Ritual Abuse Ritual abuse adds a new dimension to the maltreatment of children. It can be defined as the sexual molestation of children, usually by multiple perpetrators, in conjunction with rituals that ceremonially invoke magical or supernatural powers. This abuse may also involve the terrorization and intimidation of victims in order to prevent them from disclosing the maltreatment. In a national study of child abuse in day-care centers, Finkelhor et al. (1988) discovered 36 cases of sexual abuse in which investigators detected bizarre ritualistic elements. Ritual abuse has also been described by Gould (1987) and Kaye and Klein (1987). Child victims of ritual molestation exhibit nonspecijk signs of stress (e.g., somatic symptoms, sleep disturbance, hyperactivity, learning problems, tantrums, anxiety, depression, regression, and daydreaming), together with specSfic signs of sexual molestation (e.g., urogenital, anal, or perineal trauma or infection; precocious sexual play or talk; precocious sensuousness or seductiveness; undue familiarity or immodesty toward strangers; abnormal passivity during pelvic examination; dissociative tendencies; and the complaint of having been sexually molested). In addition to the above signs, victims characteristically manifest phenomena connoting bizarre rituals (Gould, 1987). For example, a child may speak of ingesting human or animal parts or body fluids, of drinking “Koolaide” or potions, or of the exsanguination, sacrifice, and mutilation of animals, infants, or adults. The child may be fearful of or preoccupied with drinking or losing blood, being killed to provide blood, being urinated or defecated upon, or urinating or defecating on others. A preoccupation with insects, animals, cemeteries, monsters, witches, devils, vampires, demons, evil spirits, crosses, crucifixion, curses, colors, or occult symbols may be evident; the child may be convinced that a demon is inside him or her, watching every move. The child may incant or dance ritualistically, sing songs with a “you better not tell” theme, or speak of being photographed or filmed. A striking association is the description of perpetrators or observers impersonating cartoon characters (e.g., Sesame Street, the Flintstones, or Wilt Disney). Conventional authority figures (e.g., policemen or firemen) may also be 2 73
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present. Themes of bondage, confinement (e.g., fear of being locked in a closet), possession, abandonment by parents, punishment (e.g., by crucifixion), abduction, or death and rebirth may also be expressed in conversation or repetitious play.
Diagnostic Reasoning Clinicians involved in cases of this type must navigate the dangerous strait between denial and gullibility. In a number of investigations, overzealous interviewers have apparently obscured the truth by coercive or suggestive investigative techniques. Other clinicians have dismissed victims’ stories as preposterous, indoctrinated, or the product of contagion. Indeed, there is a serious risk that the remembrances of patients with polyfragmented multiple personalities could be inadvertently shaped by clinicians invested in the satanic origin of the disorder and by the growing popular literature on the subject (e.g., Smith and Pazder, 1980).Clinicians about to embark on the forensic evaluation of cases of suspected ritual abuse should also be aware that satanists may be prepared to intimidate those who would testify against them. In the example of Hillary’s case history, what are the features that support the validity of the allegation that this child has been ritually abused? The clinical reasoning that follows illustrates the exclusion of alternative explanations and is followed by a detailed analysis of the features of a case to determine if their configuration is consistent with ritual abuse. 1 . The Exclusion of Alternative Explanations Hillary shows no signs of the thought disorder that would be associated with a delusional state, a rare condition at this age. There is no evidence of the kind of dependency upon a deluded older person that would be associated with folie d d e n . There is no suggestion of the epidemic panic associated with the imitation of other children who have similar symptoms; and no indication that coercive or suggestive investigative techniques have been employed in order to elicit information from the child. Confabulation of this type is unheard of in a 5-year-old; a child so young would be unable to concoct and sustain a deliberatefabrication of this degree of complexity, Has the child been confused by observing horror movies or pornography? If so, why has she directed her allegations at the parents? In short none of the plausible alternative hypotheses stands up.
2 . Indicators of Neglect and Abuse In this case, the physical signs of sexual abuse were detected along with a telltale passivity during the child’s examination. Moreover, early physical neglect was documented along with a reversible delay in language and social development. At the time of the evaluation, Hillary exhibited physical overfamiliarity, a precocious interest in body parts, and a severe behavioral disturbance consistent with childhood post-traumatic stress disorder (sleep disturbance, emotional distress on reexposure to experiences presumably resembling the original trauma, excessive fears, and episodes of rage and self-injury when thwarted). 2 74
3 . Specific Indicators of Ritual Abuse Hillary is afraid of being killed or crucified, is fearful of guns, knives, and blood, and is terrified of being abducted by kidnappers. She has made repeated allegations that animals were sacrificed, of irregular sexual activities with adults, of being photographed during these experiences, and of the presence of observers dressed as Walt Disney characters. 4 . Content Validity
The child’s story has apparently emerged spontaneously (although it could have been shaped during psychotherapy). It has been consistent over time and is internally logical. Hillary’s affect was appropriately anxious as she told her story. However, it should be noted that, probably as result of psychotherapy, Hillary uses adult language when describing body parts, an observation that mitigates, to some degree, the validity of her statements.
5 . Contextual Validity The child’s allegations originally emerged piecemeal but spontaneously,without coercive or suggestive interrogation. There is no plausible motivation for fabrication or confabulation, and the situation is not one in which indoctrination would be hypothesized (unless one were to suspect the two foster mothers of conspiring with the Child Welfare Department in order to secure custody). There is no evidence for the group contagion from which suggestion or imitation typically arises. In summary, the most probable alternative explanations do not hold water, and virtually all the clinical features of the case are consistent with ritual sexual abuse. Evolution of Modern Satanism The history of satanism has been described by Cavendish (1967). The word Satan, which is Hebrew for “adversary,” appears first in the Old Testament and was translated to Greek as diabolos (“accuser”), which is the origin of the English word “devil. ” In Christianity, the devil developed into the supernaturalenemy of God and mankind. Reversing the values of true Christians, devil worshippers extol lust, pride, strength, force, vengeance, and the exertion of power over nonbelievers. They believe the devil will ultimately overthrow the Christian God and return in triumph to heaven. In order to propitiate Satan, his devotees make offerings of sexuality, pain, and human and animal sacrifice, hoping thereby both to invoke the powers of darkness and to arrogate to energy of life. Through the Black Mass, the congregation seeks to impropriate the power of Satan, arrogate the mystery of Christian ritual, and deride conventional religion. Thus, sacramental wine becomes urine or semen to be quaffed from purloined chalices, satanic priests put on obscene vestments, and black candles are burnt around a naked woman who is prostrate on an altar before an inverted crucifix. Today’s satanists can be conveniently classified into a number of groups: pop satanists and “dabblers,” formal satanic church members, white witches, sexual deviates, and orthodox core satanic cells. .I Am. . Acad. ChildAdolesc. Psychiatry,30:2,March1991
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Pop Satanism and ‘ ‘Dabbling” This term refers predominantly to adolescent ‘‘dabblers” who, alone or in groups, are attracted to the contemporary vogue for satanic chic. Satanic dabblers tend to be preoccupied with rock music, occult jewelry and cosmetics, tarot cards, Ouija boards, and “Dungeons and Dragons.” King (1988) reports an association between “heavy metal” rock (the lyrics of which often glorify satanic worship), the occult, destructive behavior, substance abuse, promiscuous sexual activity, and violence. Isolated instances of homicide and suicide have been reported; for example, the serial killer, Ramirez, declared satanic beliefs. Though probably a passing craze, pop satanism is widespread and has important clinical implications, particularly since introverted, depressed, or alienated youth are likely to be enthralled by its promise of mysterious power. There have been reports of animal sacrifices and cemetery desecrations by groups of “dabblers,” but there have been no reports that dabblers have been involved in child abuse.
in treatment for multiple personality disorder. The current understanding of satanic ritual abuse is a reconstruction based on the independent reports of these two groups of victims (e.g., Gould, 1987; Kaye and Klein, 1987; Kelley, 1988). The fragility of such witnesses indicates the need for caution; nevertheless, although firm conclusions would be premature, a high index of suspicion is appropriate. Apparently, ritualistic sexual abusers sometimes wear costumes (e.g., Walt Disney, Flintstone, or Sesame Street characters; or policemen, policewomen, firemen or firewomen). The purpose may be either to render the child incredible or to implant dissociative identities. These socalled “triggers” may be activated later in life with the aim, for example, of rendering a “breeder” adolescent compliant to impregnation (by means of which fetuses or infants can be obtained for ritual sacrifice). In effect, systematic terrorization is employed in order to induce psychological dissociation and state-dependent learning and to sequester traumatic memories in the form of multiple dissociated personality fragments.
Formal Satanic Church Worship Groups such as the Church of Satan and the Temple of Set have a formal membership, distribute newsletters, and claim to abjure criminal activity. Though evidently in decline, satanic churches have had considerable influence on “dabblers” through such books as The Satanic Bible (LaVey, 1969).
Conclusion What is the prevalence of ritual abuse and how often is it associated with orthodox satanism? Some authorities suspect the existence of a widespread underground network of covens; others suggest that, although some exist, there are few true satanic cells; whereas many are convinced that the whole issue is a form of national hysteria engendered by cynical talk-show hosts and gullible clinicians. Even if one were to accept the existence of orthodox satanism, it is not possible at this point to distinguish orthodox satanic abuse from the satanic ingredients of sexual deviation and child pornography, except to suggest that, as a lucrative international industry, child pornography is probably more common than orthodox satanic abuse. There are too many questions to close the book on this vexatious matter, questions that will not be answered until pornographic sex rings and satanistic cells are penetrated by law enforcement professionals. Nevertheless, it is tempting to conjecture that there is a grain of truth in several points of view: that ritual abuse occurs most commonly in the context of child pornography; that orthodox satanic abuse does occur, though rarely; and that the sensational nature of such allegations has induced some clinicians to employ inept interviewing techniques. As a result, these clinicians have unwittingly indoctrinated suggestible witnesses or, worse still, muddied the waters when the original allegations were valid.
White Witchery White witches are not secretive. They worship the earth and moon goddesses, identify with feminism, and practice a benign form of wicca (white magic) (Luhrmann, 1989). Sexual Deviation and Pornography Sexual deviates secretly cloak pedophilia, sadomasochism, urolagnia, fetishism, or necrophilia in a travesty of satanic ritual, photographing or videotaping their activities for private delectation or commercial distribution. It is not clear whether the satanic elements are introduced in order to add spice to the proceedings, to intimidate children, or to discredit victims if they should seek to disclose the abuse. In a number of recent cases, children appear to have been recruited by pornographers from day-care centers (Finkelhor et al., 1988; Kelley, 1988). Orthodox Satanism Orthodox satanists are supposedly organized in secret cells known as “orders,” “grottoes,” or “covens.” Shielded by public disbelief, satanic groups are thought by some law enforcement officers to constitute a far-flung underground network. Whether or not this is so, there is sufficient correspondence among different reports of ritual abuse to suggest that several widely dispersed centers are in communication with each other. Even if these groups exist, it is not certain that they are involved in the maltreatment of children. Clinicians who have described satanic ritual abuse have elicited their information from alleged child victims or from adult females J . Am. Acad. Child Adolesc. Psychiatry, 30:2,March 1991
References Cavendish, R. (1967), The Black Arts. New York Putnam. Finkelhor, D., Williams, L. M., Bums, N. & Kalinowski, M. (1988), Sexual Abuse in Daycare: A National Study. Final Report. Durham, NH: Family Research Laboratory, University of New Hampshire. Gould, C (1987), Satanic ritual abuse: child victims, adult survivors, system response. California Psychologist: 1-5. Kaye, M. & Klein, L. (1987), Clinical indicators of satanic cult victimization. Paper presented at the Fourth International Conference for the Study of Multiple Personality Disorder, Chicago. Kelley, S . J. (1988), Responses of children to sexual abuse and satanic
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ritualistic abuse in day care centers. Paper presented at the National Symposium on Child Victimization, Anaheim, CA. King, P. (1988), Heavy metal music and drug abuse in adolescents. Postgraduate Medicine, 8 3:295-304. LaVey, A . S . (1969), The Satanic Bible. New York Avon.
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Luhrmann, T. M. (1989), Persuasions of the Witch’s Craft: Ritual Magic in Contemporary England. Cambridge, MA: Harvard University Pr. Smith, M. & Pazder, L. (1980), Michelle Remembers. New York Congdon & Lattes.
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