A harrowing look at out-of-control treatments for out-of-control teens

Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids

The Baltimore Sun/February 19, 2006
By Maia Szalavitz

Maia Szalavitz's brisk investigation of America's so-called "tough love" treatment programs, which bill themselves as the last hope for out-of-control, drug-taking teens, would be the stuff of a bad TV movie if it weren't so smart, well-researched and evenhanded.

The title alone evokes alarm: Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids. There's an entire industry that thrives on whipping uncooperative teenagers into shape? The notoriously unregulated billion-dollar business - comprising tough-love wilderness programs, boot camps, behavior modification, residential treatment and "emotional growth" boarding schools - promises frazzled parents, most of whom have tried just about everything else, to cure their reckless, often impossible teenagers of drug taking, binge drinking, running away, you name it.

Generally speaking, the programs cost an arm and a leg - some are comparable to the tuition at an Ivy League university - and feature unrelenting emotional attacks, sleep and food deprivation, lack of privacy, public humiliation and other accepted tough-love measures designed to turn a rebellious kid into an altar boy, weeping with respectful gratitude upon being released into the arms of his grateful family at the end of the program.

Journalist Szalavitz, a researcher for Bill Moyers and a senior fellow at stats.org, a media watchdog group that monitors the reportage of science and statistics, begins her book with a well-drawn history of this peculiarly American phenomenon. The cult-like rehab programs of the 1960s and 1970s, like Synanon and est, with their aggressive, confrontational tactics, morphed in the 1980s into the Nancy Reagan-sanctioned Straight Inc., the first program to focus exclusively on teenagers. In the 1990s, wilderness boot camp programs rose up to take the place of Straight. "The history of tough love repeatedly finds one version becoming 'controversial' and contracting while another, superficially different but essentially the same, expands to replace it."

Indeed, like some kind of odious rash, one program closes down while another pops up down the street; the day after Straight closed in Orlando, Fla., a similar program called SAFE rose up and took its place. The four tough-love organizations the author examines - Straight Inc., North Star wilderness boot camp, the World Wide Association of Specialty Programs and the KIDS program - are but a handful of the several hundred such programs operating in the U.S. (or run by Americans for Americans in foreign countries).

Although the author is quick to point out that all of them can claim hundreds of success stories, they are also responsible for a number of egregious errors that have resulted in irreversible losses. After all, a kid can swear off pot and get a job; he can't come back from the dead.

The most agonizing account is that of the death of 16-year-old Aaron Bacon, who died of an easily treatable ulcer after weeks of staggering around the Utah wilderness under the supervision of North Star. The boy, who'd lost 23 pounds in 20 days, was accused of being a "faker" and "gay" when he complained of stomach pains, and was punished by having his food and sleeping bag taken away. Aaron's parents tried unsuccessfully to bring North Star to justice, but the main players were charged with negligent homicide and never served any jail time.

The larger question, of course, is how these programs continue to thrive. Why don't the bad press, the occasional harrowing death of a child, ugly court trials and lawsuits, and the fact that the Justice Department has come out against youth boot camps work their marketplace magic and create less demand?

Szalavitz is at her best explaining the odd wrinkles in the human psyche that account for desperate parents paying through the nose for strangers to treat their children worse than death-row inmates, and the way in which survivors of horrific ordeals tend to value the experience merely because they survived it. Her evidence is clear that the incarcerated teens are brainwashed, but so are their parents, who come to believe that their last recourse is a tough-love program, without which their child will die.

If there's a weakness in this otherwise fine, muscular narrative, it's Szalavitz's somewhat feeble contention that most bad kids simply outgrow their badness if given the chance. She provides some statistical documentation that most reckless teens end their heavy drinking and drug use by their mid-20s - which can provide only cold comfort to perpetually exhausted, hysterical parents with an out-of-control 14-year-old. You can practically see the New Yorker cartoon now: Mr. and Mrs. At-the-End-of-Their-Ropes sit watching TV while in the background Junior tries to burn down the house. "Don't worry, hon, in 10 years he'll grow out of it."

One of the pitfalls of constructing such a convincing, powerful argument against a problem is the obligation to then offer a solution. To her credit, Szalavitz does better than most; she's dutifully listed an appendix for parents of troubled teens, which includes basic information on other options.

Still, in the wake of her searing research, staggering facts and utterly heartbreaking stories of death by abuse, statements like, "The federal government should mandate that behavioral treatments for kids be proven safe and effective before they can be sold" can only be met with, well, something a teenager might say: "Yeah, good luck with that."