ICSA Today, 7, (3), 2016, 22-24

Book Review: Institutionalized Persuasion: The Technology of Reformation in Straight Incorporated and the Residential Teen Treatment Industry

Marcus Chatfield

Review by Ron Burks

To begin, I must admit bias in this review. Almost twenty years ago, while at Wellspring, I treated several former “Straightlings” and other former residents of abusive adolescent drug-treatment centers. I thought the Straight program had been discredited and the related organizations shut down around that time. However, I now know that the last Straight-connected facility was not closed until 2008, and hundreds more have taken their place.

Marcus Chatfield, a client of Straight Incorporated in the 1980s, has been researching the program informally and now academically for more than 25 years, and this work is his undergraduate thesis. Much of the text of Institutionalized Persuasion is an exposé of a corrupt organization. On the first page, we find the author’s thesis: “Abuse has been condoned as therapeutic treatment for institutionalized teens in the United States for decades” (p. 9). By the time we get to the end of the book, we find that the problem of institutional persuasion is far more pervasive than what happened at this one organization. It continues to put thousands of children at risk today.

In the first chapter, the author describes institutionalized persuasion as a technology. He gives “extreme examples showing how far some groups have taken these methods…” (p. 14). He cautions that thought reform can be used by people who do not know its potential for harm: “In much the same way fire is ‘triggered’ according to natural laws, . . .coercion is triggered by environmental and social conditions.” These conditions “seem to activate evolved human tendencies that work together as a predictable ‘technology of behavior’ (Rutherford, 2009; Skinner, 2002). Whether or not the conditions and ingredients are imposed by design or by spontaneous development, where they are present together, the technology is activated, often leading to abuse and trauma” (p. 19–20).

In the second chapter, Chatfield provides a program overview and shares his experience in Straight. His description of his daily life in Straight is horrifying. Life, every day, was humiliation, isolation from family, sleep deprivation, 12-hour meetings, inadequate nutrition, and living under the constant threat of demotion and having to start the program over.

In Straight, the 12 steps of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) were reduced to 7 steps and twisted, completely altering the experience of recovery. For example, Straight conflated the principles found in AA’s steps 4, 5 and 10. AA’s Step 4 states, “Made a searching and fearless moral inventory of ourselves”; step 5 states, “Admitted to God, to ourselves, and to another human being the exact nature of our wrongs” (italics mine). In practice, 12-step members might take these actions once every year or two in the early years of sobriety, with a sponsor, someone with several years of sobriety who works one on one with the new member. The content of the steps is considered confidential and is not shared by the sponsor with anyone else. The context is one of identification and encouragement. (“W”. 1952 pg. 46.) Step 10 “Continued to take personal inventory and when we were wrong promptly admitted it.”  This is considered a personal practice to support the serenity that is seen as necessary for sustained abstinence. Larger life problems might call for the involvement of one’s sponsor. (pp. 89-90)

The Straight version of AA’s step 4 reads, “Make a searching and fearless moral inventory of myself daily” (p 42, italics mine). AA’s step 5 was combined with step 10 to become “Admit to God, myself, and another human being the exact nature of my wrongs immediately” (p. 43, italics mine). Further, according to the author, this practice happened in a group setting, and any failure to denounce oneself every day resulted in “consequences.” Consequences included hours of public humiliation, along with sleep deprivation and a diet of peanut-butter sandwiches.

The author’s diet, sleep and toileting were strictly controlled. He was in meetings at least 12 hours every day. Communication with parents, if they were able to come to the facility on Sundays was limited to 7 minutes and could only consist of apologies for wrongs committed before coming to Straight. Any complaints would result in loss of seeing parents at all.

Unlike many works of this genre, Chatfield only briefly explores how he coped with the aftermath of the experience and how the abuse in the group affected his life. Perhaps spending 25 years researching the organization was his way of putting it behind him. I, and most of the authors who contribute to ICSA Today, can identify.

In Chapter Three, the author details his investigation into the origins of Straight. The approach to recovery Straight used was directly based on those of The Seed, which was based largely on those of Synanon. The founder, a Douglas Aircraft employee, Charles Dederich, found recovery in AA until researchers from Douglas’ subsidiary, the RAND corporation, came to a meeting and asked for volunteers for a study using LSD to help alcoholics. The author mentions the large-group awareness training (LGAT) research pioneered by Edgar Schein. Schein reverse engineered the principles of behavior change he learned from interviews with POWs who experienced thought reform during the Korean conflict. The interviews were conducted after the conflict. The goal of Schein’s research was to use thought reform to do good, to make better employees, and to reform prisoners, addicts, and alcoholics. The author infers by association that Dederich was influenced by Schein in the development of the Synanon program, but his own citations refute this association. Chatfield states that Dederich was leader of Synanon 6 months after having participated in the research on LSD. Schein published his LGAT research in 1962 (Schein, 1962), 4 years after the founding of Synanon in 1958. Dederich himself said Synanon’s methods were “brainwashing.” If Dederich was influenced by Schein’s work before he founded Synanon, we will have to wait to find out.

Chatfield used the Freedom of Information Act to seek out connections between research and funding of Straight and its predecessors. Schein’s funding, supposedly through the National Institutes of Mental Health (NIMH), was actually provided by the CIA. The CIA’s files on the founder of Synanon, Charles Dederich, Sr., a former employer of the parent company of the RAND Corporation, one of the intellectual foundations of the “military industrial complex,” remain classified to this day.

Straight, a direct descendent of Synanon, was formed by two substance-abuse amateurs with political connections. When two of Straight’s centers were sued by the American Civil Liberties Union, in the middle of an $18 million expansion fundraising campaign, their medical director, Dr. Richard Schwartz designed outcome research, which was conducted on minors who were clearly under duress. The minors said at the time they were satisfied with their treatment and the program saved their lives. Years later, they revealed to the author that they feared if they were negative about the program they would not be able to leave.

This “research,” covered next in Chapter Four, duped a governor, two presidents, Lady Diana, and beloved First Lady Nancy Reagan, who will always be remembered for her earnest but deeply flawed campaign for “Just Say No.” Political influence exercised by the founders of Straight, and the organizations on which Straight was based, managed to get regulatory rules rewritten around Straight’s practices, practices that had been condemned long before by the larger substance-abuse treatment community. When a surveyor from what is now Florida’s Department of Children and Families resisted then Governor Reuben Askew’s pressure to be favorable to Straight, he was replaced by the local sheriff.

The founders of Straight developed programs, and when unflattering reports alleging abuse mentioned above began to appear in the media, the founders hired Dr. Donald MacDonald, who later became the first Bush’s director of the Office of National Drug Abuse Policy, to conduct research. (The author used the term drug czar in referring to MacDonald, but that was the term applied to the director of the Office of National Drug Control Policy.) The author located the letter from the national director that the goal of publishing research was to “enhance the reputation of Straight,” (pg. 84). The author cites numerous critical reviews of the research that went unheeded by regulators and by the principal source of funding for the research, National Institute of Drug Abuse (NIDA). How a for-profit corporation managed to get a NIDA grant to research its own program is a subject of another study. One of the most damning critiques was a study indicating that most of Straight’s clients over the years actually did not have the disease of addiction, and many had never used drugs. In short, if clients got better, it was because they were not sick.

In Chapter Five, the author uses Straight’s own literature from the 1980s that describes the manipulative tactics he experienced. The programs hid the abusive methods in plain sight using platitudes that the uninitiated reader would never associate with the abuse. Chatfield then reviews a sample of program descriptions from among the hundreds of current programs that use the same language and, according to his research, use essentially the same methods.

Chapter Six is a review of primary thought-reform sources that could stand alone as a primer for those new to the world of cults and unethical influence. In Chapter Seven, the author skillfully synthesizes theories of thought reform using the work of Frank Salter (1998) to compare Straight’s and other programs’ methods to those used in cults.

He then uses insights from Singer and Ofshe’s (1990) work on first- and second-generation-of-interest thought-reform programs. First-generation programs used a primarily adversarial approach that became more complex over time. Second-generation programs, the approach of cults, are primarily subtly and gradually applied. Chatfield identifies Straight-style programs as first-generation programs, more like prisoner-of-war interrogation and conversion than like most of today’s cultic groups.

Using a carefully worded questionnaire that follows the same form as the Group Psychological Abuse (GPA) Scale, Chapter Eight details the pilot study of experiences of former clients of residential teen treatment centers. Chatfield asked, “Did this happen and to what extent?” He sent the questionnaire to a small number of former clients of similar programs around North America. Their “treatment” experiences occurred between 1972 and 2004. Although Chatfield admits that this study was an exercise and does not prove anything, the very small differences between responses to very specific questions from former clients who were treated in programs from around North America over a period of 32 years is astonishing enough to be a call for further research.

In Chapter Nine and Chapter Ten, the author explores the constitutionality of using thought reform for behavior change in adolescents who cannot give consent. He cites senators and psychologists who have said that the use of thought-reform techniques for reforming “drug addicted” children was appropriate if it was for their own good or the good of society. He points out that treatments used in programs such as Straight are defined in international law as mental torture (my italics, but not my word). In the United States, mental health professionals are prohibited from participating in torture of any kind, with the exception of psychologists, who, since 2003 when the APA changed its policy, can do so. If the involvement is overseen by government agencies, such as human-services agencies or the military, some participation is permitted. This information was ironic to me in that the same year the APA voted this way, I was in China, where I was told that at that time all psychologists worked for the army. The overall stance of the intelligence community at the time left the issue of torture in a gray area in the United States, open to interpretation when it was used for the good of the subject or for humanity in general. Chatfield says the American teen facilities did not employ licensed addictions professionals, who had no such leeway. Instead, staff consisted only of former clients.

His thesis widens when he shows us that the legal status of children in this country needs to match the rest of the developed world. He documents that thought-reform techniques are against the law in countries that have signed the United Nations Declaration on the Rights of the Child. The only two countries remaining in the world that have not signed the Declaration are Somalia and the United States.

In the final chapter, Chatfield lists specifics that could negatively impact the ability of adolescent treatment centers to use these methods. He admits to the complexities around actually making a difference in today’s political climate. He is nonetheless confident that change can come.

The author points out that the Joint Commission on Accreditation of Healthcare Organizations, or JCHAO, the same organization that accredits my employer and most hospitals and treatment facilities in this country, accredited Straight. This fact and that the research the author documented was criticized so heavily in chapter 4 gives the impression that the program was safe because it was nationally accredited and effective because the research said so.

The author shows how JCHAO focuses on process and avoiding mistakes in the delivery care. Strict guidelines for documenting “sentinel events” such as injuries and deaths that occur when patients are placed in restraints are an example. I have been through many JCHAO evaluations and heard directly from their evaluators that their focus was on process, not program of care. Chatfield states that JCHAO’s failure to critically address the content or practices of the Straight program opened the door to the mental and emotional abuse of adolescents in long-term, locked facilities.

This work was originally an undergraduate thesis, primarily an academic exercise that required formal organization and writing styles; it can be hard to make derivative publications work for the reader without extensive editing. Although many times this too-long book clearly needed a skilled editor, Marcus Chatfield has made a thorough, if sometimes exhaustive, case for his thesis. It is a sordid tale of emotional violence that is still being perpetrated on 30,000 adolescents in North America every day. It deserves a read and a second edition.

References

Salter, F. (1998). Indoctrination as institutionalized persuasion, its limited variability and cross-cultural evolution. In I. Eibl-Eibesfeldt & F. Salter (Eds.), Ethnic conflict and indoctrination (pp. 421–452). New York, NY & Oxford, UK: Berghahn Books.

Schein, E. (1962). Management development, human relations training, and the process of influence. In I. Weschler & E. Schein (Eds.) Issues in training, 5 (47–60). Washington, DC: National Training Laboratories, National Education Association.

Singer, M. T., & Ofshe, R. (1990). Thought reform programs and the production of psychiatric casualties. Psychiatric Annals: The Journal of Continuing Education, 20, 188–193.

Wilson, Bill (1952). Twelve steps and twelve traditions. Alcoholics Anonymous. New York, NY: AA World Services.

About the Reviewer

Ron Burks, PhD, holds an MDiv and an MA in counseling from Asbury Theological Seminary and a PhD in Counselor Education from Ohio University. He worked for many years at Wellspring Retreat and Resource Center in Albany, Ohio. He and his wife Vicki wrote Damaged Disciples: Casualties of Authoritarian Churches and the Shepherding Movement, published by Zondervan. He and Vicki now live near Tallahassee, Florida where both are licensed mental health counselors. Ron is a former president of the board of Wellspring and serves on the clinical advisory boards of both Wellspring and Meadowhaven.