Help at Any Cost

Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids’ is a 2006 non-fiction book by science journalist Maia Szalavitz analyzing the controversy surrounding the tough love behavior modification industry. Szalavitz focuses on four programs: Straight, Incorporated, a copy of the Straight Inc. program called KIDS, North Star wilderness boot camp, and the World Wide Association of Specialty Programs and Schools.

She discusses the background, history and methodology of the troubled teen industry, including techniques drawn from attack therapy, Erhard Seminars Training (est), and Synanon, all of which are highly controversial. She uses first-person accounts and court testimony in her research, and states that no evidence exists proving that these programs are effective. The book also includes advice for parents and an appendix with additional resources on how to get responsible help for teenagers.

Teenagers have been participating in tough love behavior modification programs since the 1960s. Many of these programs take place in the wilderness in the style of military recruit training (also known as boot camps) and the teenagers are subjected to rigid discipline, including mandatory marches, physical abuse, solitary confinement, and deprivation of food and sleep. These programs have little to no oversight from the United States federal or state governments. Teenagers’ claims of abuse at these facilities have not been investigated because the programs are not regulated.

In the current market, some of these programs cost parents over US$2,000 per month. Szalavitz discusses the history of the troubled teen industry and its origins in a controversial group founded in 1958 called Synanon. Synanon claimed that it could cure addiction to heroin, and its methodologies such as attack therapy, forced confessions, and imposed powerlessness spread throughout the United States. After a rattlesnake was placed in the mailbox of an attorney suing Synanon, the group’s founder was convicted of conspiracy to commit murder. Synanon later went bankrupt, but Szalavitz maintains that it influenced organizations related to the troubled teen industry. In addition to Synanon, Szalavitz argues that the tough love teen industry was influenced by other controversial groups with confrontational tactics including Werner Erhard’s Erhard Seminars Training, also called ‘est.’

Szalavitz notes that according to a 2004 statement released by the National Institutes of Health, teen programs using ‘fear and tough treatment’ are not successful and evidence shows that they can worsen existing behavioral problems. Many of the children that enter these programs suffer from mental illness, and already have a history of prior trauma and abuse. Szalavitz uses first-person accounts from teenagers that participated in these programs, and asserts that the programs have potentially serious negative consequences, including post-traumatic stress and deaths.

An emotional story in the book recounts the death of 16-year-old Aaron Bacon. Bacon suffered from a treatable ulcer, and died after being out in the wilderness in Utah for weeks while in the care of the group North Star. Bacon lost 23 pounds (10 kg) in 20 days, but was called ‘gay’ and a ‘faker’ when he complained of abdominal pain, and was punished by North Star supervisors—his sleeping bag and food were taken away from him. The individuals responsible for Bacon were charged with negligent homicide, but did not serve any jail time. In addition to these first-person accounts, she also incorporates court reports and testimony in her research. Szalavitz highlights controversial practices used by these tough love teen industry programs which the Geneva Convention banned as being too extreme for prisoners of war.

In a review of the book in the journal ‘Cultic Studies Review,’ psychologist Steve K. D. Eichel pointed out that Szalavitz contrasts the troubled-teen industry (TTI) with multisystemic therapy (MST), motivational interviewing (MI), and cognitive-behavior therapy (CBT), but that she fails to note that ‘success rates for these interventions are still disappointingly low.’ In a review in ‘Mother Jones,’ Nell Bernstein highlighted the sources given for parents at the back of the book, commenting: ”Help at Any Cost’ winds up with an appendix that helpfully outlines ‘evidence based’ alternatives to the tough-love approach.’

‘Help at Any Cost’ succeeded in bringing attention to deaths related to medical neglect and child abuse in the troubled teen industry. In 2007, the United States House Committee on Education and Labor of the United States House of Representatives held a full committee investigative hearing chaired by Representative George Miller on ‘Cases of Child Neglect and Abuse at Private Residential Treatment Facilities.’ The Government Accountability Office presented findings from an investigation into the troubled teen industry, and parents of teens who died under care of these organizations testified at the hearing. Maia Szalavitz attended the hearing as well.


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