I. A report of cases. L. L. Glass, M. A. Kirsch and F. N. Parris. This is the first case report in the professional literature of psychiatric disturbance following est training. Five patients, only one of whom had a history of psychiatric disturbance, developed psychotic symptoms including grandiosity, paranoia, uncontrollable mood swings, and delusions.
Further work is necessary to ascertain the factors that determine outcome in est.
M. A. Kirsch and L. L. Glass. Two additional cases are reported, and the combined case material is discussed in terms of group and psychodynamic theories. The authoritarian est leadership style may mobilize in trainees an overdetermined and pathological reliance on identification with the aggressor. Such a mechanism may be central to the production of psychiatric casualties, particularly in individuals with defective ego boundaries. Future controlled research is necessary to ascertain the rate of occurrence of psychiatric disturbances associated with est and to test the authors' hypotheses.