Cultic Studies Review, Vol. 5, No. 2, 2006, Page 96
Book Reviews
Help At Any Cost
Maia Szalavitz, New York: Riverhead Books, 2006. ISBN 1594489106 (hardcover),
$16.35. 326 pages with one appendix
There is a strong tendency for each older generation to look back at its own adolescence
with a mixture of nostalgia and embarrassment, and at each new generation of teens with a
combination of fear, disdain and jealousy. Whether we consider the flappers of the 1920s,
the beats, protesters and hippies of the ‗50s and ‗60s, the punks and stoners of the ‗70s
and ‗80s, or the slackers of the ‗90s, every generation‘s parents insist they have the most
ill-mannered, lazy, rebellious, promiscuous, drunken or drug-ridden teenagers ever. And as
surely as these teens grow up and have children, they invariably give rise to the next really
worst crop of teens, who grow up and birth the truly worst teenagers, and on and on. Just
as every new century heralds the apocalypse, every fresh crop of teenagers serves as the
harbingers of the fall of Western civilization.
The 1980s saw a dramatic shift in the American zeitgeist. Former hippies and radicals were
clamoring to join the same middle class they once abhorred. Having lost faith in big federal
social programs, government bureaucracies, and "bleeding heart" psychotherapies, they
seemed to welcome an invigorated free market that moved quickly to satisfy their
increasing need for quick answers and strong responses to difficult social and family
problems like sexual experimentation and drug abuse. If the first half of the 20th century
had its juvenile courts, social workers, and Boys Towns, the second half, and especially the
last quarter, would have its own set of ―cures‖ for the common teenager: the ―therapeutic‖
boot camp and wilderness programs. These programs claimed nearly miraculous
effectiveness with the most difficult and destructive adolescent behaviors. By mixing
techniques liberally taken from the human-potential movement with old fashioned ―tough
love,‖ they appealed to a generation of parents that came of age in the ‗60s but were no
longer enamored with free love, mind-expanding drugs, or permissive parenting.
Help at Any Cost provides a much-needed and, at times, scathing indictment of the
troubled-teen industry (TTI) that grew out of this need. While not a cultic study per se,
Szalavitz‘s work nevertheless delineates distinctly cult-like processes.
Szalavitz uses a journalistic approach to her material. The book begins with well-
documented individual stories of families subjected to a high-intensity sales pitch and
convinced of the immediate necessity of sending their children to residential ―boot camps‖
and wilderness programs. After the parents agree to enroll their children (usually at
considerable cost), the teens are taken to their programs by physically intimidating
―escorts,‖ who sometimes surprise them in the middle of the night to avoid resistance. The
programs then use extreme tactics, including forced marches and prolonged food and sleep
deprivation, to shock and induce their clients into giving up destructive behaviors. Staffed
by grossly undertrained and nonprofessional staff, and devoid of any ongoing medical
supervision, these camps abuse the adolescents in the name of ―treatment‖ while their
programs seem primarily interested in generating more business and increasing profits.
Szalavitz has done her homework well, especially in those sections in which she traces the
roots of the troubled-teen industry to Synanon, the ―tough love‖ movement, and large-
group awareness-training (LGAT) programs such as est and Lifespring. Early TTI programs
such as The Seed and Straight Incorporated are discussed in enough detail to give most
readers a good picture of their modus operandi. Szalavitz does not discuss these programs‘
philosophical or methodological connections to Dianetics and the Church of Scientology,
even though Scientology was a strong influence on the creators of both est and Lifespring.

Cultic Studies Review, Vol. 5, No. 2, 2006, Page 97
Perhaps doing that would have been overkill because Szalavitz certainly makes a clear case
for the unholy marriage of intensive adolescent treatment à la Straight Incorporated and the
controversial methods employed by LGATs and the strong-arm confrontations and group
coercion employed by Synanon. Szalavitz also presents a cogent and fascinating discussion
of how the troubled teen industry on which she reports usurps Alcoholics Anonymous‘
Twelve Steps, twisting them so perversely that they meet Lifton‘s criteria for thought-
reform programs.
The problems with the TTI, according to Szalavitz, are many. They include the lack of
external, independent regulation and the barest (if any) oversight by clinical professionals
the planned use of misinformation to literally ―scare up‖ clients the employment of highly
dramatic, manipulative, but unproven interventions and reliance on the kinds of marketing
and sales strategies that have given rise to consumer protection laws in many states. As an
example of the lattermost problem, Szalavitz points out that many parents who testified to
the effectiveness of the TTI programs received a covert ―kick back‖ in the form of reduced
fees for their own children for successful referrals of new parent clients. Teenagers may be
diagnosed in absentia by TTI staff who have little or no clinical training and credentials and
who do not use established diagnostic procedures. Parents desperate for help and frustrated
by conventional treatments such as family therapy (or who may not even have attempted
them) may be subjected to well-orchestrated scare tactics to induce compliance with the
TTI staff‘s intervention plan.
Szalavitz, an investigative reporter, is at her best tracing the main players in the TTI, how
they share similar backgrounds (e.g., in large-group awareness-training programs) and how
they close or abandon one indicted or otherwise legally troubled program only to start
another one under a different name, almost identical tutelage, and, typically, only nominally
different leadership. Their failure to change their methods or learn from their mistakes
raises the ongoing question of whether these ―treatment specialists‖ are delusional and
narcissistic ―true believers‖ or sociopaths just out to achieve power, fame, and wealth.
Veteran cult-watchers will recognize this debate as one that perennially engages journalists,
researchers, and former cultists alike.
While many of her statements might seem controversial, I suspect the sections in which
Szalavitz reviews the research on adolescent drug use and psychosexual development will
cause the greatest uproar among readers who know or have troubled teenagers. Szalavitz is
clearly in the camp that believes that the country‘s drug policies are determined by political
and cultural agendas that ignore science. She eschews the histrionics of the drug war
advocates and "Just Say No" campaigners, and attacks their uninformed and superstitious
views on drug abuse and addiction. She documents how scare tactics (such as the claim
that minor drug experimentation or even listening to ―druggie‖ music or wearing ―druggie‖
tee-shirts will inevitably lead to active addiction) have led to ineffectual and even
destructive drug-abuse programs. Szalavitz also documents, in sometimes scathing terms,
how the TTI employs parents‘ testimonies of miraculous changes, and the supportive
statements of respected leaders such as former President and First Lady George H. W. and
Barbara Bush to proselytize potential new clients. These ―facts,‖ often presented by TTI
―professional‖ staff with no addictions training or clinical credentials, may be used to
overwhelm frightened parents into enrolling not only the identified problem child but his or
her siblings, as well. As Szalavitz correctly notes, in reality the vast majority of teens who
experiment with drugs and other forms of self-destructive behaviors do not become addicts
and, in essence, ―grow out of it.‖ Even among those who do become fully addicted, the best
studies indicate that most who eventually recover do so without any formal treatment, and
without becoming involved with Twelve Step programs such as AA or Narcotics
Anonymous.1 A number of large, well-designed studies have clearly shown that supportive,
client-centered counseling approaches such as Motivational Enhancement (aka Motivational