Help at Any Cost, by Maia Szalavitz


In the Acknowledgements, author Maia Szalavitz notes that “writing a book like this is a deeply emotional experience.” That’s evident in reading it. Szalavitz really tries to keep her prose restrained and professional, but there are times her outrage shows through.

It isn’t just writing a book like this but reading a book like this that can be a “deeply emotional experience.” It hits a lot of hot button issues of mine, things that I deeply care about and/or that rise to or near the level of phobias of mine. It’s about the gross mistreatment of children, horrific violations of autonomy, and abuses that are administered self-righteously and cheered on by many, perhaps most, third parties (which I have always found much more frustrating than run-of-the-mill atrocities that almost everyone agrees are condemnable and that even the perpetrators usually know at some level are wrong).

Reading this book is enraging, and it’s also painful and scary if you empathically put yourself in the shoes of the victims.

The topic of Help at Any Cost is “tough love”-style programs for wayward youth.

These are sadistic, and highly profitable, cults that kidnap and imprison children in totalitarian facilities that inflict levels of physical and emotional abuse that would violate the Geneva Conventions if done to prisoners of war. Incarceration in these facilities is most often used as punishment (though the euphemism “treatment” is typically used) for drug use—though that can be merely suspected drug use—or really for just about any behavior adult authority figures find undesirable or suspicious. Parents—some of whom have at least a general idea of the philosophy of these places and agree that their children need to be dealt with very harshly for their own good, and some of whom have little clue how hellish these places are but are misled and manipulated—agree to turn their child over to the abusers, and indeed pay through the nose for the privilege of doing so.

The first such group was the infamous Synanon (though there’s some slight overlap of philosophy with Alcoholics Anonymous and other earlier entities), which was founded in 1958. This was followed by many similar outfits, including The Seed, Straight, and the World Wide Association of Specialty Programs. As Szalavitz explains, what has happened over and over is that some program like this comes along, makes outlandish, completely unproven, claims of effectiveness in treating drug and alcohol abuse and other life problems, is welcomed by many who are convinced that it’s about time we “get tough” with addicts and their ilk rather than coddle them, gains some support as well from courts and elected officials, either for ideological reasons or as a result of very generous campaign contributions (almost always to Republicans, but with exceptions—Synanon itself achieved a certain amount of credibility in leftist circles by supporting the Black Panthers and other radical or counterculture groups), makes boatloads of money, suffers bad publicity for its abusive practices that accumulates until enough people have turned against it to make it no longer profitable or get it in serious legal trouble, and collapses, after which pretty much the same people regroup as some other virtually identical program with a different name, and the process repeats itself.

One point that Szalavitz drives home is that there simply isn’t any good—or really even mediocre—scientific evidence that these harsh programs succeed in their goals. (Alleged goals I suppose I should say, since they often are very successful in terms of what appear to be the real goals: Lining certain people’s pockets, and giving them an outlet for their sadism.) Instead it’s all anecdotal: “Our son was impossible to deal with. His drug use was out of control. But after going through the program at Kick-Their-Ass-Until-They-Renounce-Drugs-For-Life, he’s back to the sweet, loving child he used to be!”

Not that things in the social sciences, especially the efficacy of therapies and methods of counseling and such, are typically provable in some strict, unambiguous sense, but the lack of evidence for the “tough love” programs is worse than the norm. There are some approaches to drug abuse, say, where the evidence is at least promising. For example, you might be able to say: “There have been a small number of studies of such-and-such form of therapy that appear to have satisfied the criteria for being taken seriously scientifically. Taken together, they show that 40%-45% of drug users of a certain type who receive this therapy stay off drugs for at least a year, compared to about 25% of drug users in the general population that appear to be relevantly similar and don’t receive this therapy.” But there isn’t even that much evidential support for the “tough love” approach.

And this is not an area where a “maybe” is any good. The bar for how compelling the evidence of effectiveness needs to be to justify these programs should be (at least) extremely high, because you also need to take into account, one, that in addition to the consequences the program is supposedly attempting to bring about (stop using drugs, stop running away, stop having sex, whatever) there are various other consequences (e.g., you just gave the money that could have put your child through Harvard to his jailers instead and now you’re broke), and, two, there is something inherently wrong with torturing children—it isn’t only right or wrong depending on whether it “works.”

Most of Help at Any Cost consists of stories of a small number of the people who have been severely mistreated and in some cases permanently damaged at the hands of these programs. That is to say, most of it is anecdotal.

So is it guilty of having the same fault it attributes to the programs themselves? Mostly not. I mean, it is in the sense that it attempts to sway readers by telling emotionally powerful stories that tend to elicit empathy. But the burden of proof to show effectiveness is on the proponents of a given technique. If you were to write a strictly non-anecdotal book on the other side, what could you really say beyond “There’s little or no non-anecdotal evidence in favor of this technique.” I suppose you could then summarize any studies that have failed to show positive results, and point out the flaws in any that purport to support the technique. But you’d probably have a very short, very dry book.

Besides, if your claim is “These programs work,” then anecdotal evidence of program participants who were somehow better off at the end of a program than they had been entering it is pretty close to worthless. Whereas even though anecdotes alone aren’t much better at establishing “These programs don’t work,” they can be very strong evidence for the claim “Some children have been tortured in these programs,” which is certainly worth knowing.

So why is anecdotal evidence of effectiveness not significant? Besides the fact that in general anecdotal evidence is not much valued in science, the main reason in this case is simply because, as Szalavitz points out, improvement in behavior is common as people grow up. That is, you can’t very well make a causal inference from the fact that Katie used drugs before spending months or years in some abusive mind control program and didn’t use drugs after, to the claim that going through that program is what got her off drugs, given that it’s not at all unusual for people like Katie to use drugs at some point in their youth and then cease doing so as they mature, regardless of whether they are incarcerated by one of these outfits or not.

It can be hard to believe when it’s a teen in your own family that’s experimenting with drugs, becoming sullen or rebellious, breaking rules they never used to break, getting in trouble in school, shoplifting, following every idiot teenage fad that comes along, or whatever, but people often outgrow the dumbest or most reckless things they do at age 13 or age 16. Not always of course—there’s no guarantee they won’t stay the way they are now, or get even worse—but it’s a lot more common for the trend to be toward improvement with the passage of time and the gaining of experience and maturity. And it’s not as if the “tough love” programs provide a guarantee for parents who aren’t satisfied to hope that their child happens to be in the majority that improves without radical intervention like that. That’s just it: what non-anecdotal evidence there is about these programs indicates that their rates of success are equal or worse than the option of doing nothing, and inferior to various other kinds of counseling and such.

So why do people believe in these brutal “tough love” programs, if they are not supported by solid evidence? Many reasons, some of which I’ve already touched on.

I would say that first off many people are predisposed toward authoritarian solutions, and thus are receptive to the claims of these programs. Think of religious fundamentalist families or military families for instance (not all of them of course). They often have the mindset that obedience to authority figures, including children’s obedience to parents, is one of the most important of virtues, and that where necessary it should be brought about through breaking any rebellious spirit with harsh consequences (“spare the rod, spoil the child”). Forcing an uncooperative child into one of these programs is motivated similarly to forcing him into military school. It’ll “teach him some discipline.”

Even for parents who are more reluctant to arrange to have their child tortured, they might go along with it when the riskiness of the path their child is on makes them feel urgency, if not panic, and they believe they’ve run out of other options. This in part stems from the sensationalism of the media and other sources—definitely including the salespeople from these programs—that tends to make parents overestimate the dangers of childhood misbehavior. Especially when we’re talking about the kinds of middle class and above folks who tend to be exploited by these very expensive programs, their high school daughter smoking pot and consistently lying about it—as disappointing, infuriating, and frustrating as that can be—is very, very unlikely to result in her committing suicide, living on the streets and turning tricks, becoming addicted to heroin, ending up in prison, or any of the other scary stories they’ve heard.

Yes, some troubled teens certainly do ruin their lives with drugs and such and never recover, but the numbers indicate that it’s far less likely in a given case than the understandably concerned parents probably think, and that therefore the “Oh my God, we have to do something!” reaction that leads to choosing to put a child in the equivalent of the Abu Ghraib prison is not justified.

Of course there are also many parents who have no clue just what their child will be in for in one of these programs. It’s not that they think this level of brutalization is a necessary evil, as some parents do, but that they think they’re choosing something else entirely.

There are also various conventional sales techniques that explain some of why people are persuaded of the merits of these programs. For example, the fees charged are astronomical (even though the costs are typically very low). Rather than being a disincentive, paradoxically this can psychologically incline people in favor of a program. “As severe as my child’s problems are, I want the best!” where it’s natural to think the most expensive is the best.

If anything, this factor becomes even stronger once the commitment is made. Given a choice between believing that you spent your life’s savings on a program that was enormously beneficial for your child versus believing that you gave your life’s savings to a bunch of slick talking con artist sadists who proceeded to then abuse your child in unspeakable ways, in which direction do you think your subconscious would incline you?

Then there’s the aforementioned anecdotal evidence. In the abstract, anecdotal evidence may not sound important (and scientifically it’s not), but think of how powerful it can be when your family is one of the “anecdotes.”

This is relevant to not only why many parents believe in these programs, but indeed why many of the victims themselves do. There are many kids who are utterly out of control and at war with their parents when they enter one of these programs, and then when they’re released they’re gentle as a lamb, and eager to hug their parents and thank them for putting them in this program that has so changed their life for the better.

This kind of experience not only can make believers out of people, it can make fanatical believers out of them. Based on some stories in the book, but also much that I’ve read online on this topic (including posting forums that talk about this book), there is a real fervor for these programs, and a fierce hatred for anyone like Szalavitz who would ever question them, and I have to think a lot of that comes from personal experience. “BreakTheirSpirit saved my son’s life! I’ll be damned if I’m going to let any of these troublemakers who’ve never lived through what our family lived through knock it!”

But even if the parents are convinced by their children’s changed behavior, why are the kids themselves sometimes just as insistent that the program they went through is a wonderful thing? Surely they know they just did and said what they learned they had to do and say to make the torture stop.

A term like “brainwashing” is sometimes thrown around too loosely, but this is a case where it’s applicable. There’s a lot of psychology research—about “reeducation” prisons in places like Communist China and North Korea, the “Stockholm Syndrome,” etc.—that indicates that some people who are treated horrifically come to side with their captors. This can happen even more readily with troubled teens, who one would expect are below the average of the general population as far as emotional maturity, self-confidence, will power, experience with coping with previous traumatic experiences, etc.

So, yes, for a time they resist, and then for a time they fake going along. But fake it long enough and, for some, it eventually becomes real. Especially since the people running these programs aren’t going to be satisfied with faking, any more than O’Brien was satisfied with Winston Smith faking in 1984.

There’s also a similar process of cognitive dissonance at work here as with the parents. In the end, you can believe “My parents placed me in a situation where I would be tortured. I lost many years of my youth to the most unimaginably brutal incarceration, which did me no good whatsoever. Ultimately I was too weak to resist and so I cooperated and did everything they required to stay on their good side, including torturing newer prisoners the way I had been tortured,” or you can believe “My parents love me and made the very difficult but right decision to put me through something I initially didn’t realize was good for me. I’m sure it was never as hard as I perceived it in the beginning, and soon enough I understood that it was actually good for me, and that therefore when I treated newcomers the way I had been treated this was good for them too. I’m grateful that my parents and the people at the program never gave up on me, because this experience has changed me for the better.”

Obviously not everyone is going to convince themselves of the latter, but many will, because that’s the world they’d rather live in, that’s the “positive thinking” option.

I know I really haven’t yet mentioned much as far as the specific horrors that occur at these facilities. To be honest, I think some of that is a reluctance to bring those specifics back to mind enough to write about them. As I noted at the start, for someone of my values, my past, my phobias, etc., this is emotional, difficult subject matter. I respond to this stuff the way most of the population would respond to detailed accounts of six year olds being raped. (Well, in terms of being upset by it. Most people also respond to things they disapprove of to this degree with a desire for revenge or a desire for the perpetrators to suffer as much as possible, whereas my commitment to nonviolence and Gandhian principles has greatly diminished any such tendency toward rage and “returning evil for evil” in me.)

These programs and their facilities are typically run by people with little or no background in psychiatry or any related profession (after all, pretty much anyone can hang up a shingle and label themselves a “therapist”—think of all the New Age quacks and such that do so), rarely any medical or other postgraduate degree, and often no college degree at all. They are typically staffed by people paid minimum wage or less, sometimes literally hired off the street, obviously with no special education or training, and yet they are the ones providing the “therapy” (i.e., inflicting the punishments), though the facilities are structured such that a lot of the enforcement comes from the inmates on each other.

The philosophy is one of totalitarian control of every aspect of the inmates’ lives. There is no privacy, including in the bathroom (when they’re even given permission to use the bathroom). There is virtually no contact with the outside world. On the rare occasions correspondence is allowed with family, outgoing letters are read and censored, and parents are strongly influenced to be as cold as possible in their responses (“you have to be cruel to be kind”). Furthermore, parents are told repeatedly that absolutely anything their child claims that isn’t a hundred percent positive, certainly including any alleged abuse, is the kind of lies and manipulation that druggies invariably attempt.

The inmates are required to be maximally obedient down to the smallest ritualized detail—the way they walk, the way they sit, everything. They are given just enough food to stay alive and kept sleep-deprived, further sapping their strength and any capacity to resist.

They are forced to spend hours in special group “therapy” sessions, where they sit in a circle in the required posture in uncomfortable chairs, and scream accusations and insults at each other, working themselves into a frenzy and waving their arms about maniacally in the mandatory manner. They are required to confess any and all misdeeds and weaknesses, and whatever they confess is deemed insufficient and they are browbeat to come up with more and more. (Of course in that situation a lot of it they just make up.) Anyone who does not behave as commanded—sitting properly, confessing, joining in the verbal attack mob, etc.—is yanked out of their chair and forcibly thrown to the ground, and pinned in an uncomfortable position with one or more people atop them, possibly where it’s difficult to breathe, for an extended period.

Other punishments include hours, days, or more in a solitary confinement cell little bigger than a coffin. (One is described in the book as three feet by three feet.)

Anything confessed is then used mercilessly to humiliate the inmate. For example, revealing a traumatic episode where you were molested as a small child means enduring for the remainder of your incarceration incessant insults and taunting from staff and fellow inmates about how you initiated it yourself and enjoyed it, and what a fag that proves you are, etc.

Little or no medical attention is available to inmates no matter how desperately it is needed. Anyone ever claiming to need such attention is deemed to be faking, regardless of how strong the evidence is otherwise. (Numerous deaths have occurred in these facilities that could have been prevented with appropriate medical care, or better yet if the torture and starvation and such that killed them hadn’t occurred.)

There is no autonomy, no freedom, no dignity at all; the whole idea is to utterly destroy the person to where they’re nothing but a quivering blob of dependence and obedience. And then from there, in theory, you can “build them back up” into whatever you want, typically a very straight-laced, non-drug using, humbled teen who expresses nothing but love and gratitude toward his parents for entering him into the program, and who will always speak favorably about the program to others in the future. (Indeed, many of their extremely poorly paid employees are former inmates who have been so thoroughly broken that they don’t want to leave, and want to continue furthering the goals of the cult.)

Again, think of Winston Smith at the end of 1984.

Among the atrocities are the sales techniques. Besides the scare tactics directed at parents (if you don’t pay to put your child in this program, they’ll end up homeless and strung out on drugs and be dead in less than a year), one of their most appalling tactics is to rope in siblings. That is, once one child in a family is incarcerated, they go back to the parents and explain that what they learned from the child indicates that their sibling is at serious risk as well, and that as far as any possibility of their child returning home in the future, that simply cannot be allowed as long as there is this sibling in the household who will only drag them back into their former lifestyle. So the sibling needs at the very least to be “evaluated,” said evaluation being a quick pro forma interview with the verdict invariably being that, yes indeed, they too need to be in the program.

Typically the sibling is even less of a “troubled teen” than the original inmate, but the family has so much invested by now emotionally and financially that they succumb to the pressure and allow another of their children to be kidnapped and tortured for months or years.

OK, that’s enough. My blood is boiling enough.

One obvious question is how can this possibly be allowed, how can this be legal?

There are a number of factors. One, the people who run them, as mentioned, are typically very well connected politically, especially with Republicans and conservatives. Their generosity toward the right politicians means law enforcement will typically look the other way, regardless of the atrocities they are informed of.

Two, the parents and even former inmates who complain are a small minority. Mostly the victims of these programs continue to believe in them, for reasons discussed above. So for the state to step in and shut them down or force them to change how they operate would require paternalistically overriding the wishes of most of the people they’ve victimized.

Three, they locate themselves in jurisdictions that for religious or other reasons are least likely to have a problem with their harsh methods, such as Utah, or often in foreign countries beyond the reach of U.S. law.

Four, it’s simply a fact (and I say an outrage) of U.S. law that children have nothing remotely close to the rights and civil liberties that adults do. It’s no exaggeration to say that what occurs in these facilities would never pass muster in an adult prison (it would be deemed a blatant violation of the Constitutional provision regarding “cruel and unusual” punishment), but in the case of minors there is a very high presumption that if their parent or guardian chooses something for them, then the state is not going to step in and interfere with that.

As I mentioned earlier, a topic like this is more infuriating to me than atrocities that almost everyone agrees are atrocities. I mean, if this were a book about the Manson Family’s crimes, then at least you could read it knowing that virtually the whole world is on your side in condemning them. But with this stuff, you’re contending not just with the horrors themselves, but with the fact that a large portion of public opinion and the law sides with the torturers, often with enthusiasm.

Not that the law never comes down against these programs. As detailed in the book, there have been court cases that they have lost, and cases that never went to trial because large settlements were paid to avoid their doing so. Generally in fact, as mentioned above, these programs have a finite life span: they flourish for a while, then gradually the scandals and media exposés accumulate and they come out on the wrong side of one or more major lawsuits, and they shut down.

The problem is, they almost always then simply reopen with another name—the same people, the same brutal methods, the same scam.

I want to be sympathetic to the parents that turn their children over to people like this, I really do. Certainly I understand that they rarely come to such a decision unless they’re dealing with a very difficult, painful, traumatic situation with a child they love, and/or they’ve been grossly deceived and manipulated. And so I am sympathetic, to a degree. But I’m sympathetic only to about the same degree that I try to be compassionate and sympathetic to even the most violent of criminals and such that commit acts I regard as heinous.

These are people who turn their child over to sadists to be tortured. I know there are factors that lead them to do that—other than just that they’re “evil” people—but only in the sense that there are factors that lead mass murderers and terrorists and Klansmen and so on to do what they do. As I mentioned, I’m a Gandhian and I’m not about hating and using violence against violence or any of that. So I have compassion and empathy for the believers in “tough love” and wish them no ill, but only in the same way I do for other people I think have made terrible choices in life that have resulted in great suffering.

But what about the paternalism issue? Sure, I think these programs are horrible, but what if the parents freely choose to incarcerate their child in one of these facilities, and what if after the fact the child insists it turned out to be for her own good and she’s glad it happened? If even the victims are in favor of what a program does, does some third party, including the government, have the right to oppose it?

Yes, for at least three reasons.

One, these programs are typically deceptive in how they are marketed. Szalavitz notes, for instance, that a brochure for one of the prisons located in the Caribbean includes photos of happy teens on jet skis, encouraging parents to think they’re sending their child to some resort. Any kind of contract agreed to as a result of that kind of deception is void.

Two, there’s a difference between agreeing to undergo torture and someone (in this case parents) agreeing for you. Even if parents rightly have some degree of say so over what happens to their kids, there have to be limits on that, and surely torture is on the wrong side of any place that that line can be reasonably drawn.

Three, retroactive consent isn’t good enough, again especially in the case of something as severe as torture. You can’t kidnap and incarcerate me in the most brutal of conditions for years, even if in the end I say I’m OK with it. That only provides an incentive to make sure the maltreatment is so severe and so overwhelming as to bring about brainwashing.

I put a huge value on autonomy. I wouldn’t endorse the kind of extreme coercion detailed in this book even if it succeeded in doing what it claims, and even if the retroactive consent were genuine and not a product of brainwashing.

Szalavitz closes Help at Any Cost with an Appendix of advice for parents of troubled teens. Because even if you come to agree that the “tough love” programs are an unacceptable, blatantly abusive option, given that you still are going through a very difficult time with your child the natural next question is “Then what do we do instead?”

She has some sensible suggestions, and discusses approaches that have at least some evidential support, but frankly if that entire section were replaced with a shrug and an “I have no idea,” it would still be a no-brainer that the one thing you shouldn’t do is pay a fortune to sadists to brutally break your child’s spirit.

Painful subject; good book.


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