“Adolescence strikes fear in the hearts of even the best parents,” writes journalist Maia Szalavitz in her new book Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead Books). That fear, she says, drives well-meaning mothers and fathers to send their misbehaving teens to “tough-love” programs, where they’re subjected to abusive treatment in the name of helping them.

Based on her own research, Szalavitz estimates that between ten and twenty thousand American teens are forced into “boot camps,” “emotional-growth centers,” and “behavior-modification programs” each year. The industry is unregulated, and some programs operated by U.S. companies place children in facilities outside the U.S. What tough-love programs all have in common, Szalavitz says, is the belief that teens should be made to conform to the expectations of parents and society, by whatever means necessary. Critics have accused the programs of using beatings, extended isolation and restraint, public humiliation, food deprivation, sleep deprivation, sensory deprivation, forced exercise to the point of exhaustion, and lengthy maintenance of “stress positions.” Research shows that tough treatment is not effective, Szalavitz says, and can even be harmful.

Szalavitz traces the roots of the tough-love industry back to the Alcoholics Anonymous offshoot Synanon, a 1960s treatment program for heroin addicts that evolved into a cult and was eventually shut down and discredited. She points out that incessant verbal attacks were a core component of Synanon and are now common to tough-love programs. But unlike Synanon, the latter are not for adult drug addicts. They’re for troubled teens, some of whom have never used a single illicit drug.

Szalavitz began her reporting career at the age of fourteen, writing and anchoring her own cable-access news show in Monroe, New York, an hour north of New York City. Seventeen magazine ran a story about her in 1980, projecting a successful television career for this precocious high-school student. But Szalavitz developed addictions to cocaine and heroin while at Columbia University and dropped out of college for several years before seeking help. She went on to graduate from Brooklyn College with a degree in psychology and soon began writing for the Village Voice. Szalavitz returned to television as a producer for The Charlie Rose Show on PBS, then worked with Bill Moyers on his five-part series Moyers on Addiction: Close to Home. Next she teamed up with University of Pennsylvania researcher Joseph Volpicelli to write Recovery Options: The Complete Guide (Wiley), which outlines the benefits and drawbacks of various drug-treatment options in the United States.

Szalavitz had long wanted to write about the abuse in tough-love treatment programs, but publishers showed little interest. In the end it took her more than three years to write Help at Any Cost. She conducted hundreds of interviews, spent many days poring over legal and congressional documents, made repeated Freedom of Information Act requests, and traveled to Utah, Jamaica, and Texas’s death row. The book focuses on four programs: Straight Incorporated, KIDS, North Star Expeditions, and the World Wide Association of Specialty Programs (WWASP). All but the last are now defunct, but many former staffers still work in the industry.

I have a personal interest in the subject, having been through a program that was a predecessor of Straight Incorporated in the early 1970s. [See “The Seed.”]


373 - Maia Szalavitz


Polonsky: What is a “tough-love” treatment program?

Szalavitz: It’s any program that operates on the premise that teens in trouble need to be broken down and rebuilt. The idea is that suffering is good for the soul; therefore, we will inflict suffering on them to “help” them. Sometimes people ask me, “Well, there are teen boot camps, emotional-growth centers, wilderness schools, behavior-modification programs — aren’t they each a little different?” On the surface they are, but what they all boil down to is “Let’s be mean to teens in the woods,” or “Let’s be mean to them military style,” or “Let’s be mean hippie style.”

There are some wilderness programs that claim to take a loving approach, but with so little regulation, it’s impossible for parents to know what they’re going to get. The people selling the program tell consumers what they want to hear. The parents of Aaron Bacon, a teen who died in one of these programs, had been told that North Star Expeditions used kind, gentle methods. Then their son came home in a coffin after being starved and denied medical care.

Polonsky: What exactly happened to Aaron Bacon, and why was he put into the program?

Szalavitz: By all accounts Aaron was a compassionate, highly intelligent kid, but at some point he started smoking dope and taking psychedelics, and then his grades started to sink, and he banged up the family car a couple of times. His parents also suspected that he was involved with gangs, and they were worried. North Star sold itself to them as a wilderness-adventure experience with trained therapists. Aaron’s mom thought her son might enjoy it.

So one morning at six, two men — one a 280-pound former military policeman — came storming into Aaron’s bedroom. His parents were there too, assuring Aaron that they loved him, but that he had to go with these men. They brought him to North Star in Utah and put him and a group of other boys under the care of untrained survival guides who wouldn’t let them cook their food to make it edible if they couldn’t start their own fire. They gave Aaron boots that were too small, a sleeping bag, and a backpack, and they basically starved and froze him to death over the course of a few weeks. Near the end, Aaron was so weak he was falling down and incontinent, and the guides laughed at him and called him a “faker.” It’s a well-documented case, because Aaron kept a journal, and the other boys were witnesses.

Polonsky: What about the therapists?

Szalavitz: There were no therapists. The guides were nineteen, twenty, and twenty-one years old. Among the three of them, they didn’t have a year’s experience leading wilderness expeditions. They served at most a few days in jail after Aaron’s death, and some of them even violated probation by immediately going back to work in the industry.

Polonsky: There was a boy who died in a facility in Florida earlier this year. Are there any similarities between his case and Aaron Bacon’s?

Szalavitz: Not in the particulars, but in the root cause. Fourteen-year-old Martin Lee Anderson was in a boot-camp-style program. He complained of trouble breathing and couldn’t complete his drill exercises, but the instructors thought he was faking, so they punched, kicked, and “restrained” him. When he lost consciousness, they tried to revive him using ammonia capsules, and he asphyxiated, either on the fumes or because the capsules were pressed against his mouth and nose and he couldn’t breathe.

The boot-camp instructors still maintain that they did nothing wrong because they were legally permitted to use “pain compliance.” Although the Supreme Court ruled in 1982 that agencies acting “under color of state law” may not use painful disciplinary tactics, that decision does not apply to private corporations. In addition, Florida made a special legal exception for its youth correctional boot camps, exempting them from a ban on pain compliance, which includes punches, kicks, and pressure to the head. Ironically, if parents treated their own children this way, they’d be charged with child abuse, but it’s all right for them to pay “professionals” to do it.

Polonsky: Are all tough-love programs this bad, or are you just focusing on the worst of them?

Szalavitz: Some may not be as bad as these two; I wasn’t able to research every one of them. But it’s clear the industry attitude is that troubled teens are not people in pain, but manipulative liars who deserve rough treatment. Their philosophy inevitably leads to abuse, whether it’s as mild as ignoring someone’s emotional needs or as severe as ignoring a medical condition.

Polonsky: There are hundreds of similar programs in the United States today. You focus on just four in your book. Why those four?

Szalavitz: I always knew Straight Incorporated had to be in the book, because it was the first heavily publicized tough-love program. It started in Florida, but at its peak it had facilities operating in eight states.

In Straight you spent twelve hours a day sitting on hard chairs and flapping your arm to be called on. If you didn’t get called on, you’d never advance in the program and get to go home. And when you did get called on, you had to have a good confession to make about how terrible you’d been before entering the program, or else you’d be attacked verbally. If you didn’t comply, if you didn’t pay attention, if you didn’t say what they wanted to hear or you mouthed off, they would literally throw you on the floor and restrain you, with somebody sitting on your torso and restricting your breathing, another person sitting on your legs, two more people sitting on your arms, and sometimes somebody holding down your head. This would all be done by your fellow participants, which is not the way restraint is handled in any legitimate psychiatric institution. People had limbs broken.

Polonsky: And this restraint was administered as punishment?

Szalavitz: Yes. Sometimes people were restrained from running out the door, but more often it was done as punishment for violating all manner of rules. Straight also heavily restricted access to the bathroom, so kids would wet and soil themselves. It’s all part of the humiliation strategy employed by many of these programs: an exercise of power and demonstration of the teens’ helplessness.

Polonsky: And what about the other three programs: KIDS, North Star, and WWASP?

Szalavitz: North Star, of course, was the wilderness program in which Aaron Bacon died. KIDS was founded by Miller Newton, who had been Straight’s national clinical director and a charismatic leader within Straight. He falsely claimed to be a psychologist. (He did eventually get a degree from a correspondence school.) KIDS was like Straight, only worse.

The World Wide Association of Specialty Programs is the biggest tough-love organization currently in operation. It’s similar to Straight in that you gradually work your way up by confessing and verbally attacking other teens. Their “curriculum” includes confrontational weekend seminars, where they sometimes make young girls dress up as hookers to humiliate them. Newcomers are assigned “buddies” who monitor them and have the power to punish them, even though these buddies are not staff, or even adults.

After being released from these programs, many teens immediately return to dangerous behavior, and some are so traumatized that they are unable to function in a college environment. Others can’t afford to go to college because their parents have spent their entire college fund on WWASP. The overseas programs cost about three thousand dollars a month, and the ones in the United States cost four to five thousand a month. And there are additional charges on top of that, such as for bringing the kid to the program in handcuffs.

Polonsky: What kind of teen gets sent to a place like WWASP?

Szalavitz: Anyone who has annoyed the hell out of his or her parents, who is mouthy and disappointing and maybe isn’t doing well in school or is using drugs. Many teens with depression or serious mental disorders end up there. WWASP seems to take anyone. There are no restrictions. Even a child who has never smoked pot and gets straight As will be accepted as long as the parents believe the child’s behavior requires drastic action. A WWASP official told the press that 70 to 80 percent of their students are not hard-core drug users or criminals; they just have trouble communicating with their parents. Paul Richards, a WWASP graduate I interviewed for my book, had never even smoked cigarettes. But most of the boys and girls are somewhere in the middle. Maybe they were smoking pot every weekend, or they took acid.

Polonsky: How do parents find out about these programs?

Szalavitz: In the eighties and nineties many parents were referred to them by ToughLove, a nationwide network of support groups for parents of troubled teens. The couple who founded ToughLove had written a book in which they told how they’d refused to bail their daughter out of jail, and they claimed that this was what had saved her. To its credit, the ToughLove network eventually denounced Straight Incorporated, but only after recommending it to parents for years.

Nowadays parents might get referrals from so-called educational consultants, who are not required to have licenses and who often get kickbacks from programs for giving referrals. An “educational consultant” could easily be another WWASP parent who will get a thousand dollars or a free month in the program for their own child in return for a referral. Then you have school guidance counselors and psychologists and other professionals with whom the tough-love programs cultivate relationships. And of course, if you search for “troubled teens” on the Internet, multiple WWASP-sponsored websites come up.

Polonsky: Do parents have any idea what’s really going on in these programs?

Szalavitz: Phil Elberg, an attorney who successfully sued Miller Newton and the KIDS program, liked to say that it was the parents who really belonged to the KIDS cult, not the children. In most of these programs, the parents proselytize to other parents and meet in groups and encourage each other to stay strong and be tough. If the parents weren’t convinced that tough love works, these places couldn’t operate.

There’s enormous pressure for parents to take the tough-love approach. After an article I wrote about the troubled-teen industry appeared in the Washington Post, I got dozens of e-mails from parents who didn’t want to send their children to these programs, but everybody was telling them it was the only way and that they were hurting their son or daughter by not doing it.

The ideology of these programs has increasingly become the ideology of our whole country: leniency is bad, and kindness only encourages weakness and misconduct.

Polonsky: Don’t the teens inform their parents of what’s going on?

Szalavitz: They try to, but the parents are told to expect complaints and treat them as lies or attempts at manipulation. And almost all communication is monitored, with discipline for kids who complain. Also the programs teach the kids that it’s all their fault, so most of them come out saying that. Unfortunately, that’s exactly what many parents want to hear. It’s hard for parents to accept how much harm they have done to their children by placing them in these programs. I have talked to parents who were horrified when they discovered how bad it really was. They spend years trying to make up for it. Some, however, prefer to stay in denial.

I would say the vast majority of parents who send their children to these programs are devoted mothers and fathers who would honestly prefer to have their child at home. Most would likely have chosen family therapy were it more widely available and had they known that research supported it over these programs. A large percentage of these parents are in the middle of a divorce. Their children are acting out, unhappy, and vulnerable. That’s why family therapy makes the most sense. But the parents don’t want to think the divorce is what’s causing their son or daughter to rebel or take drugs.

Many parents are simply fooled. Unless you’ve been told otherwise, you’d think these programs are run by experts who have some knowledge you don’t. Aaron Bacon’s parents are smart, well-intentioned, and kind. They were in no way negligent; they asked all the right questions, consulted all the right authorities. But they were lied to. It could happen to anybody.

Polonsky: So what happens to children after they emerge from a tough-love program?

Szalavitz: It’s not good. I’ve interviewed many street addicts over the years, when reporting on AIDS or drug addiction, and I’d say the people who’ve been through these programs are, on average, in far worse psychological shape than the addict on the street. A lot of tough-love survivors have extreme difficulty trusting people. Many have lost touch with their families and even lost their faith in humanity.

No one has done any scientific studies that follow program graduates over time, but I would guess, based on my interviews and research, that the longer a person stays in a program, the worse his or her psychiatric symptoms will be. And length of stay is not tied to recovery; it’s determined by the whims of the program, the resistance of the child, and the parents’ ability to keep paying.

Many tough-love survivors suffer from post-traumatic stress disorder [PTSD] that psychiatrists have testified in court was caused by the program. As somebody who’s talked to hundreds of addicts, I can tell you that you don’t get PTSD as a result of using drugs. I visited an inmate on death row in Texas who had been to a WWASP school. He told me that the conditions on death row were actually better. When he’d gotten out of the school, his parents had refused to see him anymore on the advice of WWASP, because he had not completed the program. He was left on the street with fifty dollars and a bus ticket. Would he have wound up on death row anyway? I don’t know.

The number of girls who come out of these programs and end up stripping or working in the sex industry is shocking. But if you consider how many of them were made to act out these roles — and told that this would be their fate — maybe it’s not so surprising.

Polonsky: You say that ten to twenty thousand kids are put in these programs each year. Surely not all of them suffer from PTSD or work in strip clubs when they get out.

Szalavitz: No, you’re right. Humans are resilient creatures. As with any unpleasant experience, a lot of people simply put it behind them and never think about it again. Responses vary even within a particular individual. At one point a person will say it was the worst thing that ever happened to him or her; at another, that it was no big deal.

Based on my observations, the people who seemed the least damaged by it were those who had decided to fake it and pretend to agree with the program’s philosophy. Another subgroup that did reasonably well were those who actually did have serious drug problems: at least they didn’t have to make up false confessions. The people who did the worst were those who didn’t have much of a drug problem going in and resisted making up stories, so they got punished.

But no one gets by totally unscathed. It’s clear from the latest neuroscientific research that uncontrollable stress is worse for you than stress you have some control over. If rats get a shock no matter what they do, they become lethargic and are more likely to get sick. But if they can hit a lever to stop the shock, even if they receive the same amount of current, they don’t have the same elevated risk of illness.

Tough-love programs are deliberately set up to induce powerlessness. Teens have no control over the stress they experience. The programs claim that if you follow the rules, you’ll be OK, but it’s impossible to follow them all. One of WWASP’s rules is that you cannot look at the opposite sex. If you’re a heterosexual teenager, you’re going to look. And staring out the window counts as planning to run away. They give you no downtime, no freedom.

Conventional wisdom about drug use comes largely from unscientific theories such as the famous “marijuana gateway effect.” Yes, almost every heroin user started with marijuana, but almost every Hell’s Angel started with a tricycle.

Polonsky: When I was an adolescent in Florida in the early seventies, I was put in a program called the Seed, which was the forerunner of Straight Incorporated. The Seed was awful, but these programs sound even worse. What happened between then and now?

Szalavitz: Straight was worse than the Seed, and KIDS was worse than Straight. Such programs tend to get more brutal over time, because the more you believe that abuse helps people, the more you’re going to abuse them.

Tough-love programs also became more numerous during the eighties because of the war on drugs. Mel Sembler, who was involved with the Seed and then cofounded Straight, takes credit for giving First Lady Nancy Reagan the idea to make teen drug use her personal cause. In 1982, after she’d been hit by scandals about her excessive spending on dresses and the White House china, Nancy Reagan needed to improve her image. So she went to visit Straight and listened to boys and girls confessing to using all manner of drugs, most of which they’d probably never touched. Shortly after that, she kicked off her “Just Say No to Drugs” campaign. Parents became more frightened of drug use among teens, and when we’re frightened we make poor decisions and are much more susceptible to social pressure. “Just Say No” convinced many parents that extreme measures were the only way to help their teenagers.

Since the Reagan years, parents have, if anything, become tougher. The ideology of these programs has increasingly become the ideology of our whole country: leniency is bad, and kindness only encourages weakness and misconduct.

Polonsky: Aren’t there any regulatory safeguards to prevent abuse at these places?

Szalavitz: Regulatory agencies in Florida knew as far back as 1978 that abuse was going on in Straight, and in the Seed before it. It was reported in the newspapers. Reluctance to shut down abusive programs has been a huge part of the problem. Regulators have taken the attitude that rather than be critical, we should be thankful somebody will actually provide a place for problem teens. Unfortunately, it’s true that if you shut all the abusive programs down, there would be few places left. There is a scarcity of decent psychiatric inpatient care and inpatient addiction treatment for those who need it.

Polonsky: What about twelve-step programs?

Szalavitz: I personally benefited a great deal from the twelve steps, but I know many people who do not. The twelve steps teach that addiction is a lifelong disease, and you have to go to meetings for the rest of your life to avoid relapse, but that’s not always true. And there is occasional overlap with the tough-love mentality. Even within Alcoholics Anonymous [AA], which is explicitly voluntary, some people take a confrontational approach.

The notorious heroin-addiction treatment program Synanon was founded by an AA member who thought that, rather than voluntarily practicing the twelve steps, people should be forced to make confessions and amends. But if you coerce people, it becomes brainwashing. Look at the first three steps: admit you are powerless; believe that a power greater than yourself can restore you to sanity; and make a decision to turn your will and your life over to that higher power. When that higher power becomes the program itself, you’re in trouble.

There is no other area of mainstream medical treatment that requires you to believe in a higher power. If a heart surgeon recommended it as a primary treatment, you would probably go to a different heart surgeon. That said, when the twelve steps are undertaken voluntarily, they can have wonderful results, because they’re essentially a recipe for figuring out what’s meaningful to you and for living a spiritual life.

There are other ways to recover from addiction, but they’re not widely available. In the case-management approach, a doctor evaluates you and helps you choose services, which might include cognitive-behavior therapy, methadone, or alternative programs like SMART Recovery, which is based on research evidence. If you’ve got no high-school education, then getting a GED might be more important to your recovery than any program or medication.

Polonsky: How did you manage to overcome your own drug addiction?

Szalavitz: It wasn’t easy. I avoided treatment for a long time because I’d heard about all these places where they try to break you down. I thought, I’m using drugs because I’m already broken. I don’t need to be broken any more. I need to be fixed! I was an oversensitive person, vulnerable and self-hating, so I was terrified of this sort of treatment. Fortunately, when I got so desperate that I did seek treatment, I wound up in a program that taught the twelve steps. There were also family-therapy sessions, in which my family members and I would talk about how my drug use had affected them. When my little brother said, “I never got to know you,” it broke my heart and made me think. The family therapy helped me see the consequences of my addiction, but it was done with respect and kindness, not through verbal attacks.

Polonsky: What got you interested in writing about tough-love programs?

Szalavitz: I knew people who’d been harmed by these programs and who hadn’t done one-tenth of the drugs that I had. The existence of abusive treatment programs had discouraged me from seeking help, so I figured it did the same to others. And it’s just wrong. My dad was a Holocaust survivor, and I was raised in a family that was passionate about social justice. These programs seem profoundly unjust to me.

Polonsky: We can’t simply leave it to teens to seek treatment voluntarily. There must be some programs out there that are not abusive, but where kids are forced to go. What do you tell a parent who is completely at his or her wits’ end?

Szalavitz: The research is very clear: In the vast majority of cases, keeping children within the family and community is far more effective than sending them away. The exception would be a teen with a genuine acute addiction or psychiatric problem — which is not the same as a “behavior problem.” For psychiatric disorders and true addictions, there are professional, licensed treatment centers. Are they accessible to everybody? No. They are expensive, and insurance often won’t cover them. But the same is true of tough-love programs, and if you’re going to spend thousands of dollars on treatment for your child, I recommend you spend it on a program that has demonstrable evidence of its effectiveness, as opposed to one that probably won’t help and may harm.

Phoenix House is the largest provider of teen addiction treatment in the country, and it does take involuntary patients. It was originally based on Synanon, but, to its credit, it has moved away from confrontational and humiliating “attack therapy.” The second-largest provider, DayTop, has a similar story. I’m not endorsing either of these programs, but at least they do not use isolation or restraint. They’re probably still too confrontational for my taste, but I don’t think they abuse kids, and they’re government funded, which means they’re regulated. Frankly, I would love to see a federal regulatory agency devoted to behavioral health. In order to use a treatment method on children, you should have to prove that it’s safe and effective. That one rule would prevent most of the abuse, if enforced appropriately.

For teens with psychiatric disorders, a mental hospital is almost always better than an unregulated program. At least the mental hospital has trained staff who understand mental illness. And just as with an adult, a teen should receive forced treatment only if he’s a danger to himself or others.

Tough love condemns other approaches as too soft, but when you stigmatize empathy and compassion and altruism, you end up with a society that says torture is OK.

Polonsky: But that’s a tough call, isn’t it? If your son or daughter stays out all night and hangs out with suspicious characters, isn’t that behavior potentially dangerous?

Szalavitz: Some parents have this idea that their children are safer locked up somewhere than they are on the street, but if the staff in that locked facility has no credentials, is hired without criminal-background checks, and gets paid minimum wage, the probability of your child being hurt there is high. On the street, if your teen has a health complaint, he or she can go to a clinic. In a tough-love program, if a kid has a health complaint, he or she is accused of faking.

Polonsky: Suppose I am shopping for a program. How can I avoid the really bad ones?

Szalavitz: The first question is: Can your child call you without supervision? If the program wants to restrict communication between you and your child in any long-term way, stay away from it. Also, does it use isolation and restraint? It shouldn’t, unless it’s a licensed psychiatric facility.

But before you even start asking questions, get your child a complete psychiatric evaluation by someone who is not affiliated with any facility or residential program. At least half of teens with drug problems have an underlying mental-health issue that will complicate recovery unless it is addressed. Many are trying to self-medicate depression.

There is also the option of outpatient treatment, which has been found to be at least as effective as residential treatment in all but the most severe cases. If your child is not injecting drugs or physically dependent on substances, residential treatment probably isn’t needed. Look for programs that are working with the National Institute on Drug Abuse or with the Center for Substance Abuse Treatment.

If residential care is needed, choose a treatment regimen aimed at teens with drug problems, and not “troubled teens” in general. Teens with addictions need to learn special skills to cope with their urges. Finally, without continuing support afterward, residential treatment isn’t especially helpful. The key to recovery is ongoing support at home. Overcoming a drug problem is like dieting: almost no one succeeds on the first try. Relapse is common and does not mean the treatment has failed.

Polonsky: Do you think there is ever any justification for the tough-love approach?

Szalavitz: No, I do not. When it comes to cruelty, I am a prohibitionist. If it actually worked, we could have an ethical debate over whether it should be allowed, but there is absolutely no evidence that it’s an effective treatment.

We need scientific research and clinical trials to determine what does work, not just anecdotes about how “this program saved my kid.” There are countless anecdotal success stories attached to worthless, and even harmful, remedies for a multitude of ailments. Conventional wisdom about drug use comes largely from unscientific theories such as the famous “marijuana gateway effect.” Yes, almost every heroin user started with marijuana, but almost every Hell’s Angel started with a tricycle. It doesn’t prove anything.

Frankly I think tough love makes the world more dangerous for everyone. You cannot teach teens to be citizens in a free society through authoritarian programs. In a climate of absolute obedience, where any creative thought is punished, children learn to be selfish and callous and to wield power arbitrarily. “Tough love” is an oxymoron. I believe love is love. There are times when you have to say no to a child and enforce rules, which can be difficult and emotionally draining, but there is never any time when you should deliberately inflict pain in the name of helping somebody. It’s hard enough to be a human being without someone adding extra pain.

There are times, too, when we need to express hurtful truths, but we can do it with kindness and respect. If somebody is using drugs and killing himself, you can say, “Look, your behavior is going to lead to serious consequences.” That’s different from calling that person a “druggie slime bag.”

Tough love condemns other approaches as too soft, but when you stigmatize empathy and compassion and altruism, you end up with a society that says torture is OK.

Parents should remember what it was like being a teen, how confusing and difficult it was, and how misunderstood they often felt. Yet, despite all the stupid choices they made, they’re still here.

Polonsky: Do you see a similarity between tough love and the abuse of Iraqi prisoners by the U.S. military at Abu Ghraib prison?

Szalavitz: Absolutely. In Abu Ghraib, they filled prisoners with IV fluids and didn’t let them urinate. In these tough-love facilities they deprive teens of access to the bathroom. Both use public sexual humiliation and isolation from the outside world. Both use techniques that are banned by the Geneva Conventions for use on prisoners of war. When we become willing to treat our own kids in ways that violate the Geneva Conventions, why would we have a problem doing the same to terror suspects?

Then there are the political connections of people in the industry. Straight Incorporated cofounder Mel Sembler is a longtime Republican donor and fundraiser, and he has always had a cozy relationship with the Bush family. He was the first President Bush’s ambassador to Australia, and under the current Bush administration he has served as ambassador to Italy, though he speaks no Italian. He chaired the campaign-finance committee for the Republican Party during the 2000 election. Florida Governor Jeb Bush is on the advisory board of the Drug Free America Foundation, formerly the Straight Foundation, which ran Straight Incorporated. Today Mel Sembler heads the legal-defense fund for Vice President Dick Cheney’s former chief of staff Scooter Libby.

Polonsky: Representative George Miller of California introduced a bill last year called the End Institutional Abuse against Children Act, which would support states in regulating residential-treatment centers and would establish civil and criminal penalties for treatment abuse. If passed, would this bill make a difference?

Szalavitz: It would be a nice start, but you can’t really regulate tough love. It’s like regulating how hard you’re allowed to kick someone. Moderation isn’t possible with abuse. Whenever a program is based on the idea that kids need to be broken down, it will be a dangerous program.

What I think would help would be to require, before placement in any program is allowed, an independent evaluation of each child by a psychologist or psychiatrist. This professional would diagnose the child and also check to make sure the parents weren’t committing a straight-A student just because he or she snuck out to go to the prom — which has happened, by the way.

I think that consumers of mental-health services in general have not demanded enough proof, even from legitimate providers. We need evidence-based care. If consumers demanded it, providers would have to start offering it, and insurers could refuse to cover any treatment that wasn’t evidence-based. And if good people stopped committing their children, the tough-love industry would shrivel. Many of the providers in this industry are just thugs and bullies who’ve stumbled on a good scam. They’re successful because people can’t believe they’re as wicked as they are.

Parents should remember what it was like being a teen, how confusing and difficult it was, and how misunderstood they often felt. Yet, despite all the stupid choices they made, they’re still here.

Treating children with disrespect and trying to humiliate them is no way to address their problems. The way we raise our kids determines what kind of society we will have and how we will treat each other. Will we be kind and considerate, or abusive and controlling? I think “Love your neighbor” is the lesson we should teach children, not “tough love.”