Religious trauma syndrome

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Religious trauma syndrome (RTS) is not present in the Diagnostic and Statistical Manual (DSM-5) or any DSM-5TR (Text Revision) materials, nor is it represented in the ICD-10, but it has been recognized by individual psychologists and psychotherapists as a set of symptoms, ranging in severity, experienced by those who have participated in or left behind authoritarian, dogmatic, and controlling religious groups and belief systems. [1] Symptoms include cognitive, affective, functional, and social/cultural issues as well as developmental delays. [2]

Contents

RTS occurs in response to two-fold trauma: first the prolonged abuse of indoctrination by a controlling religious community, and second the act of leaving the controlling religious community. [2] RTS has developed its own heuristic collection of symptoms informed by psychological theories of trauma originating in PTSD, C-PTSD and betrayal trauma theory, taking relational and social context into account when approaching further research and treatment.

The term "religious trauma syndrome" was coined in 2011 by psychologist Marlene Winell in an article for the British Association for Behavioural and Cognitive Psychotherapies, though the phenomenon was recognized long before that. The term has circulated among psychotherapists, former fundamentalists, and others recovering from religious indoctrination. [1] [3] Winell explains the need for a label and the benefits of naming the symptoms encompassed by RTS as similar to naming anorexia as a disorder: the label can lessen shame and isolation for survivors while promoting diagnosis, treatment, and training for professionals who work with those suffering from the condition. [4]

Symptoms

As symptoms of religious trauma syndrome, psychologists have recognized dysfunctions that vary in number and severity from person to person.

Religious trauma has also been linked to severe results such as suicide and homicide. [5]

How RTS develops

Membership

RTS begins in toxic religious environments centered around two basic narratives: "You are not okay" and "You are not safe." [6] These ideas are often enforced by theology such as the doctrines of original sin and hell. [6]

The development of RTS can be compared to the development of Complex PTSD, defined as a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape. Symptoms of RTS are a natural response to the perceived existence of a violent, all-powerful God who finds humans inherently defective, along with regular exposure to religious leaders who use the threat of eternal death, unredeemable life, demon possession and many other frightening ideas to control religious devotion and the submission of group members. [1]

Members of the LGBTQIA+ community are at particular risk of RTS and C-PTSD as they attempt, over an extended period of time, to alter their sexual orientation and gender identity to fit the expectations of authoritarian religious communities. The process of attempting to alter one's orientation can create emotionally abusive thought patterns that are prone to exacerbate the C-PTSD-like symptoms of RTS. Chronically living in fear of eternal damnation and lifelong separation from loved ones and religious communities if they fail to comply with sexual identity restrictions can induce long-term symptoms of RTS. [7] [8]

Leaving

Leaving a controlling religious community, while often experienced as liberating and exciting, can be experienced as a major traumatic event. Religious communities often serve as the foundation for individuals' lives, providing social support, a coherent worldview, a sense of meaning and purpose, and social and emotional satisfaction. Leaving behind all those resources goes beyond a significant loss; it calls on the individual to completely reconstruct their reality, often while newly isolated from the help and support of family and friends who stay in the religion. [3] [9] [10]

In addition, when violent or threatening theology, such as a belief in hell, divine punishment, demons, and an evil "outside world," have been incorporated into the basic structure of an individual's worldview, the threats of engaging the outside world instead of remaining in the safe bubble of the controlling religious community can induce further anxiety. [1] [7] [9]

As individuals identify the harm they are experiencing in authoritarian religious settings, their concerns may be minimized by the religious group itself, but they can also be compounded by society's investment in positive views of religion. [3] Institutional betrayal, first at the hands of beloved religious communities, second at the hands of a world that upholds the utility of religion rather than the experiences of religious abuse survivors, can make symptoms of RTS worse. [3] People leaving religion can experience extreme hostility from their former co-religionists. [11]

Antecedents to RTS

The development of RTS as a diagnosable and treatable set of symptoms relies on several psychological theories that provide an academic framework with which to understand it.

PTSD

Like all iterations of trauma, the development of RTS is informed by PTSD, defined in DSM V as a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, or other threats on a person's life. These events can be personally experienced, observed, or imagined. The important element is the perception of life-threatening danger. In the case of RTS, a person can be traumatized by images of burning hellfire; fundamentalist groups are noted for using terrifying stories to indoctrinate children. [12] [ better source needed ]

The experience of leaving one's faith can be an event that takes place quickly or over a period of time. Because of the overall intensity and major impact of the event, it can be compared with other events that cause PTSD. Key symptoms of PTSD are re-experiencing (flashbacks, nightmares), avoidance (staying away from places, things, and thoughts that are reminders), arousal and reactivity, and cognition and mood disturbances. [13] These symptoms are also true for many experiencing religious trauma.

Complex PTSD

Complex PTSD is a closely related disorder that refers to repeated trauma over months or years, rather than a one-time event. Any type of long-term trauma, can lead to CPTSD. The term CPTSD was originated by Judith Herman, [14] who outlines the history of trauma as a concept in the psychological world along with a three-stage approach for recovery (safety, remembrance and mourning, and reconnection). Herman outlines the importance of naming and diagnosing trauma to aid recovery, further legitimizing the need for defining RTS as resulting from specifically religious experiences. [14] Herman also describes CPTSD with the traumatic complications of surviving captivity. This is a diagnosis comparable to RTS in which RTS occurs in response to perceived captivity (see #How RTS develops) rather than physical reality.

The symptoms of CPTSD include those of PTSD plus lack of emotional regulation, disassociation, negative self-perception, relationship issues, loss of meaning comparable to RTS. Traumatologist Pete Walker sees attachment disorder as one of the key symptoms of Complex PTSD. He describes it as the result of growing up with primary caretakers who were regularly experienced as dangerous. He explains that recurring abuse and neglect habituates children to living in fear and sympathetic nervous system arousal. [15]

Betrayal trauma and shattered assumptions theory

While the traditional paradigm defining PTSD focuses on fear response to trauma and emphasizes corrective emotional processing as treatment, RTS may be better understood as a set of symptoms comparable to betrayal trauma informed by shattered assumptions theory. [2] Betrayal trauma adds a fourth assumption ("people are trustworthy and worth relating to") to Janoff-Bulman's original three: (the overall benevolence of the world, the meaningfulness of the world, and self worth). [16] Betrayal trauma theory acknowledges that victims unconsciously keep themselves from becoming aware of betrayal in order to keep from shattering that fourth basic assumption, the loss of which would be traumatic. [16]

Religious trauma can be compared to betrayal trauma because of the trust placed in authoritarian communities and religious leaders which causes harm to individuals. Betrayal trauma theory also acknowledges the power of shattered assumptions to cause trauma. With RTS, individuals are not only experiencing betrayal from family, religious community, and trusted faith leaders, they are also experiencing a shattered faith. [2] The potential extremity of feelings in relation to losing one's worldview while also losing emotional and social support to get through any given crisis can cause further trauma.

While fear paradigms tend to focus on treating symptoms of trauma through exposure therapy and attention to emotional regulation, betrayal trauma theory looks at the social context in which the betrayal occurred, placing the pathology in the traumatic event rather than the individual. [16] This affects treatment approaches and also informs the treatment for RTS.

Religious harm and trauma

The psychological harm that can be caused by authoritarian religion has been addressed by authors prior to the naming of the religious trauma syndrome. These writings have included work by psychologists and therapists (Tarico, [17] Ray, [18] Winell, Kramer & Alstad, [19] Hassan, [20] Cohen, [21] Watters, [22] Greven, [23] Moyers), and many memoirs from former believers, including former pastors (Babinski, [24] Loftus, [25] Barker, DeWitt). [26] The work of cult specialist Stephen Hassan applies to any authoritarian group that applies "undue influence." [20] Journalist Janet Heimlich, [27] in her research on child maltreatment in religious communities, identified the most damaging groups as having a Bible belief system that creates an authoritarian, isolative, threat-based model of reality.

Stress

Medical research in the area of stress and traumatic events reveals evidence of resulting disease and mental illness. The work on "stressful life events," while neglecting to specifically list religious harm or leaving one's faith as stressful events, shows very clearly how stress can activate the nervous system and cause disease. [28] Studies on animals suggest that trauma can have lasting effects on the amygdala, hippocampus, and prefrontal cortex. [29]

Adverse childhood experiences

The Adverse Childhood Experiences Study by Kaiser Permanente and the Centers for Disease Control has demonstrated an association of adverse childhood experiences (ACEs) with health and social problems across the lifespan. [30] Among the listed types of adverse experiences were physical, sexual, and emotional abuse as well as physical and emotional neglect. A case could be made that these are also frequent elements of religious harm.

According to cognitive and neuroscience researchers, adverse childhood experiences can alter the structural development of neural networks and the biochemistry of neuroendocrine systems [31] [32] and may have long-term effects on the body, including speeding up the processes of disease and aging and compromising immune systems. In a review of numerous empirical studies, it was found that child abuse is associated with markedly elevated rates of major depression and other psychiatric disorders in adulthood. [33]

In studies that find a correlation between extreme fundamentalism and brain damage, it is suggested that extreme religious indoctrination harms the development or proper functioning of the prefrontal regions in a way that hinders cognitive flexibility and openness. [34] [35]

Research on religious trauma

To date, most research on religious trauma has been qualitative research with an individualistic, experiential focus. These have been interview-based or case studies from clinical practice. [36] [37] There have been a few quantitative studies, such as Milton's survey of 295 former Exclusive Brethren members. She found that the overall measure of psychological distress was significantly higher amongst the leavers when compared to the general population.

Treatment and tasks of recovery

Mental health professionals, life coaches, and individuals practicing pastoral care have been developing approaches to treating RTS. While exposure therapy is not recommended, trauma-focused cognitive behavioral therapy, group therapy combined with one-on-one sessions, [1] trauma-informed psychoeducation, trauma processing, and grief work can all be beneficial. [15] In Winell's approach, treatment is most effective when holistic and multi-modal. That is, treatment needs to address the cognitive, affective, physiological, and relational dimensions of the person, all in a societal context. [38]

Treatment of RTS has been influenced by modern thinking about treating trauma of all kinds. [39] [40] From this "trauma-informed" perspective, it is important to recognize individual differences and locate the actual trauma in the nervous system of the individual. According to Walker, [41] importance elements of trauma recovery involve shrinking the inner critic, the role of grieving, and the need to be able to stay self-compassionately present to dysphoric affect.

In medicine, "trauma-informed" care is defined as practices that promote a culture of safety, empowerment, and healing. [42]

Group support appears to be an effective treatment for recovery from religious trauma and numerous services have developed to offer this, including professional recovery groups, [43] [44] peer support groups, [45] and online forums. [46] [47] These may be effective because 1) those in recovery have lost primary support systems of family and church, 2) social support is a primary human need and relevant in understanding the physiology of trauma, [40] and the social context of treatment helps people feel less alone or at fault.

While some liberal churches offer therapy, professional therapists take the view that treatment should be in a neutral environment, and not in a religious context. [48]

Tasks of recovery

Recovery involves assessing each symptom area for growth and exploration:

Many developmental tasks overlap with cognitive, affective, functional, and social/cultural tasks. Developmental tasks of recovery focus on recognizing developmental delay and providing necessary education in critical thinking, sexual health, mental hygiene, and socialization to allow natural human development to continue. [2]

Growing awareness

Discussion about religious trauma syndrome is becoming more widespread in the media, including major mainstream outlets [49] [50] [51] [52] and internet sources of news. [53] [54] [55] Awareness is becoming global, in terms of people seeking help and in the news. [56]

While much of the work on religious trauma has centered on fundamentalist Christianity, applications have been made to other groups such as Mormonism, [57] Jehovah's Witnesses, [58] [59] Children of God, [50] Orthodox Judaism, [52] the Unification Church, [20] and some fundamentalist groups in Islam. [60] [61] Personal journeys out of fundamentalist religion have been the subject of numerous films [62] [63] in addition to previously mentioned books and memoirs.

Further research

To recognize RTS, it is not necessary to say that all religion and spirituality is harmful. It appears that certain kinds of religion, typically fundamentalist and patriarchal, have both toxic teachings and toxic practices. The damage done is through these mechanisms. [36] Of course any religious group can also have healthy teachings and healthy practices. [64] Rather than deciding whether religion in general is toxic or healthy, a more productive pursuit would be to study the mechanisms that cause damage.

In 2019, the Religious Trauma Institute was founded by therapists Laura Anderson and Brian Peck. [65] Currently, the institute is conducting a survey on what they are calling Adverse Religious Experiences. [66] While this will provide a point of comparison to the research on Adverse Childhood Experiences, there is a need for longitudinal studies to examine actual patterns of causation.

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Rape trauma syndrome (RTS) is the psychological trauma experienced by a rape survivor that includes disruptions to normal physical, emotional, cognitive, and interpersonal behavior. The theory was first described by nurse Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom in 1974.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Religious abuse is abuse administered through religion, including harassment or humiliation that may result in psychological trauma. Religious abuse may also include the misuse of religion for selfish, secular, or ideological ends, such as the abuse of a clerical position.

Trauma bonds are emotional bonds that arise from a cyclical pattern of abuse. A trauma bond occurs in an abusive relationship wherein the victim forms an emotional bond with the perpetrator. The concept was developed by psychologists Donald Dutton and Susan Painter.

Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary modes of transmission are the uterine environment during pregnancy causing epigenetic changes in the developing embryo, and the shared family environment of the infant causing psychological, behavioral and social changes in the individual. The term intergenerational transmission refers to instances whereby the traumatic effects are passed down from the directly traumatized generation [F0] to their offspring [F1], and transgenerational transmission is when the offspring [F1] then pass the effects down to descendants who have not been exposed to the initial traumatic event - at least the grandchildren [F2] of the original sufferer for males, and their great-grandchildren [F3] for females.

The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as chronic fatigue syndrome, fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform.

Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious sickness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.

Secondary trauma can be incurred when an individual is exposed to people who have been traumatized themselves, disturbing descriptions of traumatic events by a survivor, or others inflicting cruelty on one another. Symptoms of secondary trauma are similar to those of PTSD. Secondary trauma has been researched in first responders, nurses and physicians, mental health care workers, and children of traumatized parents.

Out-of-home placements are an alternative form of care when children must be removed from their homes. Children who are placed out of the home differ in the types and severity of maltreatment experienced compared to children who remain in the home. One-half to two-thirds of youth have experienced a traumatic event leading to increased awareness and growing literature on the impact of trauma on youth. The most common reasons for out-of-home placements are due to physical or sexual abuse, violence, and neglect. Youth who are at risk in their own homes for abuse, neglect, or maltreatment, as well as youth with severe emotional and behavior issues, are placed out of the home with extended family and friends, foster care, or in residential facilities. Out-of-home placements aim to provide children with safety and stability. This temporary, safe environment allows youth to have their physical, mental, moral, and social needs met. However, these youth are in a vulnerable position for experiencing repeated abuse and neglect.

<span class="mw-page-title-main">Dual representation theory</span>

Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

Being exposed to traumatic events such as war, violence, disasters, loss, injury or illness can cause trauma. Additionally, the most common diagnostic instruments such as the ICD-11 and the DSM-5 expand on this definition of trauma to include perceived threat to death, injury, or sexual violence to self or a loved one. Even after the situation has passed, the experience can bring up a sense of vulnerability, hopelessness, anger and fear.

References

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  46. ↑ "ExChristian.Net". ExChristian.Net. Retrieved 2020-10-28.
  47. ↑ For example "Facebook Group 'Mental Health for Exvangelicals'". www.facebook.com. Retrieved 2020-10-28.
  48. ↑ Ridderbusch, Katja (6 August 2019). "Religious Trauma Syndrome: Wenn Religion krank macht". Deutschlandfunk (in German). Retrieved 22 July 2021.
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  50. 1 2 Tewa, Sophia (11 March 2017). "Life after a sex cult: 'If I'm not a member of this religion any more, then who am I?'". The Guardian.2021-06-12
  51. ↑ Fortenbury, Jon (2014-09-28). "The Health Effects of Leaving Religion". The Atlantic. Retrieved 2020-10-29.
  52. 1 2 Hagan, Ekua. "The Invisible Demographic". Psychology Today. Retrieved 2020-10-29.
  53. ↑ Tarico, Valerie (2016-04-18). "Can You Get Addicted to Religion?". Alternet.org. Retrieved 2020-10-29.
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  56. ↑ Pijamasurf. "Dejar la religión se parece a dejar las drogas" (in Spanish). Retrieved 2020-10-29.
  57. ↑ Gallacher, Claudine (2018-05-01). "Religious Trauma: What No One Tells You at Church". Post-Mormon Mental Health. Retrieved 2020-10-29.
  58. ↑ "Interesting Developments in the ex-Jehovah's Witness Community – VirusHead". www.virushead.net. Retrieved 2020-10-29.
  59. ↑ Fallon, Amy (2021-09-12). "Losing my religion: facing the trauma of leaving a faith". The Sydney Morning Herald . Retrieved 2022-01-08.
  60. ↑ "Free Hearts Free Minds". FreeHeartsFreeMinds. Retrieved 2020-10-29.
  61. ↑ "Faith to Faithless". Faith to Faithless. Retrieved 2020-10-29.
  62. ↑ Wright, John (2018-02-07), Leaving My Father's Faith (Documentary), Bart Campolo, Tony Campolo, Hemet Productions, Jux Films, Matt Dean Films, retrieved 2020-10-29
  63. ↑ Unorthodox (Drama), Shira Haas, Amit Rahav, Jeff Wilbusch, Alex Reid, Studio Airlift, Real Film Berlin, 2020-03-26, retrieved 2020-10-29{{citation}}: CS1 maint: others (link)
  64. ↑ Religion and human flourishing. Cohen, Adam B. Waco, Texas. 2020. ISBN   978-1-4813-1327-8. OCLC   1159607564.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
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