The discovery of seven persons who suffered serious psychiatric disturbances after participating in a self-help program called Erhard Seminars Training has prompted three psychiatrists to alert their profession to the possibility that the experience may have devastating effects on some people.
Six of the seven developed psychotic reactions, some of them life-threatening, at the time or soon after the training, popularly called est. The training is intended to enhance self-awareness and uses authoritarian and confrontational leaders to achieve its goals.
The psychiatrists, writing in the March Issue of the American Journal of Psychiatry, emphasize that their case reports do not and cannot establish a cause-and-effect relationship between the est experience and a psychotic aftermath. But they say that ''the spread of the est 'movement' and the gravity of the cases that have come to our attention contribute a sense of urgency and importance to the communication of these preliminary findings.''
As one of the authors, Dr. Leonard L. Glass, said in an interview, ''We don't know if more people become psychotic after est than after riding on the F train.'' In a psychotic state, people become detached from reality and cannot distinguish real from unreal.
However, Dr. Glass, who is assistant psychiatrist at McLean Hospital in Belmont, Mass, said that, based on studies of encounter groups with a similar type of leadership, ''there's enough possibility of a real connection between est and psychotic breaks to cause us to want to alert psychiatrists and psychologists.'' But he added, ''It would be premature to warn the public directly that est may be hazardous to their health.''
More than 83,000 Americans have gone through the est experience since it began five years ago, each paying $250 to sit through two weekends - a total of 60 to 70 hours - of self-awareness training by an authoritative leader who ridicules them and attacks their self-esteem. The sessions are conducted in hotel suites nearly every weekend in a half dozen major cities. Est trainees must sit for as many as 10 hours without eating, smoking, going to the bathroom or leaving the room. Many have been reduced to tears; others have fainted or rolled on the floor; some have vomited.
Dr. Glass, former director of the emergency service at the Langley Porter Neuropsychiatric Institute in San Francisco, and two former colleagues, Dr. Michael A. Kirsch and Dr. Frederick N. Parris, describe five of the seven cases in the Journal report. The two others, discovered subsequently, will be published in a later report.
The cases include a man who in the course of the training developed a grandiose self-image and manic behavior, attempting to breathe underwater and do other hazardous feats that prompted his wife to call the police and have him hospitalized. Another man who believed he was ''possessed'' and had hallucinations severely injured himself putting his hand through a window he insisted was ''unreal,'' and a third armed himself with bow and arrow and pistol and was shot in a fracas with some men on a street corner.
Five of the seven persons the psychiatrists describe had no previous psychiatric illness or treatment. But after the est-related reaction, three required psychiatric hospitalization, and all but one received psychiatric treatment.
Two have suffered continuing psychosocial abnormalities long after the initial psychosis subsided. One man's wife says he acts like a ''robot'' since he attended est, and another man has been withdrawn, insecure and unable to resume his earlier level of social interaction despite weekly psychotherapy for more than 14 months, the psychiatrists say.
The training does not purport to be psychotherapeutic, but rather is described by its founder, Werner Erhard, a former management consultant, as an attempt to strip people of the mental and emotional ''trappings'' imposed on them by the outside world and to teach them to accept themselves and take responsibility for their lives, rather than blaming others for what they are.
Some psychiatrists have judged est to be a helpful experience, and a few have even encouraged their patients to take the training. However, others are wary of est's assaultive techniques and possible effects on people who cannot function normally without their accumulated defenses.
''The defense apparatus helps people to cope and enables many to lead successful lives,'' Dr. Glass observed. ''Some people have more defenses than they need, and est perhaps could help them get rid of the excess baggage that stands in the way of personal growth. But in testing people's defenses, est doesn't differentiate between those that are adaptive and those that are maladaptive.''
He added, ''Est also doesn't necessarily consider psychotic breaks as bad things, but instead may sometimes view them as an important growth experience.''
Dr. Glass cited a study of encounter groups by Dr. Irving Yalom of Stanford University that showed that when the group leader was very commanding, confrontive and assaultive, group participants were more likely to suffer psychiatric disturbances than with more benign leaders.
It made no difference what belief system the leader espoused, Dr. Glass said. The increased risk of psychiatric damage was related only to the style of leadership. Dr. Glass pointed out that this same authoritarian style is used by est leaders.