196. EXPOSING the Troubled Teen Industry: How it Scams Parents & Harms Teens feat. Maia Szalavitz

Jul 22

listen to this episode:

Today's guest is Maia Szalavitz— an award-winning author and journalist. She first advocated against the Troubled Teen Industry in her 2006 book, Help at Any Cost, and has since written several New York Times articles and appeared in the 2024 Netflix documentary, The Program, to discuss this dangerous industry further.

In this episode, we discuss:

+ The history of the troubled-teen industry & what it looks like today

+ What proper mental health care for teenagers should look like

+ Why teens with substance abuse or behavioral issues can't succeed in troubled teen programs

+ My personal troubled-teen industry experience

+ The real reasons why parents are sending their kids away to treatment programs

+ The dangerous accountability model behind many troubled teen programs

+ The unethical ways that troubled-teen programs earn massive profits

+ The trauma that troubled teen survivors face due to these programs

+ Regulations that could eliminate these programs for good

+ so much more!

Mentioned In The Episode…

+ The Program

+ Help at Any Cost

+ New York Times article

+ Trails Carolina article

+ Maia's Website

+ Unsilenced

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Maia: one of the things that is absolutely horrific is that people who come outta these places almost never wanna seek any mental health care again in their life. And they truly may need it because now they probably have PTSD on top of whatever they had before. , that's one very bad outcome. , another is that, They are from their family because oftentimes the family has been told to expect reports of abuse and not believe them.

Hello, hello, you guys. Welcome to a really exciting episode of She Persisted. We have a really incredible guest today, and this is part one of a three part series where we are talking about the trouble teen industry. This is not the first time that we've touched on this on the podcast. I will link the past episodes we've done that kind of dive into this area and industry.

I've had peers on that were in the trouble teen industry with me. I've had on a few experts that are really working in the advocacy area. And then I'll also link an episode with Dr. Justin Mohat where we talk about evidence based treatment programs and how to find an ethical, compassionate, and effective treatment program that is not in the trouble teen industry.

So you're probably like, that's a lot of conversations. Three more episodes after that is also A lot of time we're investing in this topic and it's one that's really important to me because I was in the trouble teen industry for 14 months as part of my treatment journey and It's something that I've been doing a lot of work to process, to terms with, and cope with since I've started the podcast.

I actually started the podcast while I was still in the Troubled Teen Industry, the last month that I was in that program. And you're probably like, if you were in the Troubled Teen Industry, you weren't able to actually start a podcast. And I can, like, do a solo episode about my experience, and I can dive into all the funny parts of that, like getting the website blocked, and all the things.

Bye! Bye! But, yes, I was at a therapeutic boarding school in Montana called Chrysalis, we talked about that and a little bit about my experience in this episode and this conversation with Maya. But, there's going to be a solo episode coming up where we talk all about my experience and I give you guys kind of a rundown what it was like being in the trouble team industry, what it was like to then leave that industry, and they call it kind of like waking up and becoming more aware of what I had been told about some of those experiences, and what was accurate and what wasn't, and what is actually necessary for treatment, and what was just a lie, like having to have custody signed over.

So We're gonna get into that in a future solo episode and you'll get to hear all about my experience at Chrysalis and also what I've done after the fact to kind of try and heal from that and, and cope with the emotions that arise because it is a really big experience to navigate. But I'm really excited for this episode to come out this week, and I waited and chose this week for a couple of reasons.

One is that Maya interviewed me for a New York Times op ed about the Troubled Teen Industry, which was such a huge, crazy, exciting moment, and that will of course be linked in the show notes. But it was just really incredible to be able to Share a little bit of my experience and she paired it so beautifully with a really interesting case study in new jersey of different ways that we can get teens help without feeding into this industry And it was just such a incredible full circle really exciting moment And so that is one of the reasons why this episode is coming out this week because we recorded it a long time ago The other reason is that we have a second episode second interview as part of this series with Katherine Koopler.

She is the director of the program, which you probably saw on your Netflix homepage at some point because it was in the top Netflix shows when it came out. And this is just such an incredible documentary. I talked about it on Instagram, but she did such a beautiful job. Describing the industry, really making it accessible and easy to understand for people that aren't familiar with the Trouble Teen industry, because it's the craziest network of people and programs, and she just did a really incredible job distilling that into a really powerful and moving show.

But she also spoke to the survivor experience, and what it's like to fully go through a program and put your head down and, comply to get out, and what it's like to leave. And not ever had that experience in the program where you're like, this isn't right and this is wrong and I'm going to push back on it. But like that fight or flight survival mode is to just do what you're told and put your head down. And so what it's like after the fact to be like, Wow, all these things that I thought I believed and thought were right were actually really unethical and really not okay, and I wasn't listened to when I tried to Speak about that experience and so I'm really excited for that conversation.

We're recording this next week. And so you guys are gonna have really incredible People on She Persisted. One is Maya Salavitz. She is this week's episode. I'll give you her bio in a second. She is an expert in almost any troubled teen documentary, you'll see. She has just done so much incredible journalistic work, and her book is incredible.

We talked about in this episode. And then Catherine, who you'll also hear us mention in this episode, is obviously the director of the program, which has been really, really great. One of the biggest, if not the biggest, troubled teen documentaries to date and it really touched a lot of survivors. It went super viral on TikTok and it was really a very healing experience for me to watch that.

So if you're curious about the troubled teen industry or you're a survivor yourself, definitely watch that documentary. It's on Netflix. It's called The Program. And then you get me. You're stuck with me again. We're going to do a solo episode and talk about my experiences. this is going to be the first time that I've ever really dedicated an in depth episode just talking about my whole experience and my emotions and feelings about these things.

I've done a couple of interviews on other shows where I've touched on it or thrown in Q& A's like what I think about therapeutic boarding schools or weighed in in conversations, but I've never done like a full breakdown deep dive. Um, Solo, so you're gonna get that from me and then we're back to normal programming and of course you guys are gonna get monday Minis, which are just normal, episodes not all about the trouble teen industry, but I really hope you guys Enjoy this series because it's a cause that's really really important to me , and as you'll hear Maya and I talk about, there's 5, 000 programs in the United States, 120, 000 teens in there at any given time, and it's a multi billion dollar industry. This is not just one program. This is not a handful of teens. It's extremely widespread. We also talk about this, over 350 children have died in these programs.

And so it's really no joke. It's a really important cause. And what's so sad about this is these are teens that they just need help. They need support. And they've done that brave thing in a lot of scenarios of asking for help or their parents are doing anything to try and get them support. And they're just completely taken advantage of.

And so. It's a really, really sad situation that could be so easily solved with more regulation, and Maya has a really interesting idea of how we can get to that point, which you'll hear in this conversation. And then the last thing I'll mention before I introduce Maya is that Unsilenced. org is a non profit that is really at the forefront of all of this advocacy work, and bringing regulations to these programs.

helping different survivors navigate lawsuits, helping connect survivors, with others that have been at their programs. If you want to learn more about this industry or get involved, Whether it's reading about different survivors experiences or understanding which different members of Congress are pushing for regulation in the industry, unsilenced.

org is a great place to start. and Meg Applegate is the founder of UnSilenced and she's also a survivor of chrysalis, and so she is just absolutely incredible and doing incredible work at UnSilenced. And Meg will come on the podcast. We want to film in person, so someday, somehow, it's going to happen.

so unsilenced. org for more resources and information. And then Maya Salvitz is on the podcast this week.

She is a neuroscience journalist and she covers drugs, addiction, and public policy. She has a number of books out, but the one about the trouble teen industry is called Help at Any Cost, and that will be linked in the show notes. She is both a New York Times best selling author and a contributing opinion writer for the New York Times, which you can read the article where she interviewed me linked in the show notes.

She's also written for numerous publications including Time, Wired, Elle, The Nation, and Scientific American. And her 2006 book, Help at Any Cost, which I just mentioned, was the first to expose the damage caused by tough love youth treatment and help spur congressional hearings. She is absolutely incredible.

I loved this conversation so much, and like I said, she is truly one of the, the most prominent experts in the community that is working to bring awareness and regulation to the trouble teen industry So it's just such an honor to have her on the podcast And I know you guys are gonna learn so so much from this conversation. So let's dive in and survivors I know this is a heavy episode.

So if anything comes up you have any thoughts you want to share your Opinions after listening, please don't hesitate to send me an email or a DM. All the information is in the show notes. So longest intro ever, but let's dive in.

Sadie: well, to get things started, for people who haven't watched the program or haven't read your book about the Troubled Teen Industry, can you give a little bit of context and background into your career and how you became such a voice for this cause, and this research?

Maia: Sure. So, , the Troubled Teen Industry is this sort of collection of boot camps, wilderness programs.

Therapeutic or emotional growth, boarding schools, behavior modification programs, residential facilities, wilderness centers, all of this kind of stuff. And the commonality in the troubled teen industry is that the facilities are residential in that they are away from where the teenager lives. And the abuse is the treatment.

, the. The idea is that we will break you down in order to fix you, and that this is a perfectly appropriate goal to deal with everything from rebellion to autism. In reality troubled teen is not a diagnosis and breaking people down creates PTSD more reliably than it does help anybody.

Sadie: Yeah, It is still so surprising to me that more people aren't aware of the troubled teen industry because we see the numbers, we know how many kids have gone through these programs and yet, It's not something that's commonly understood.

So, for people that are like, Okay, maybe I've heard of a program, maybe I've seen this on TikTok. Can you give some context to this industry? It has a very interesting history with regard to how it came to be, and kind of just explaining how this popped up, because we obviously have evidence based mental health treatments, we're moving in a great direction as a field, but we still have a huge number of programs that are really on the other side of things.

So can you kind of explain for people that are like, I don't know how we came to be here, I'm not familiar with this, , what people should know?

Maia: Sure, so , we do not have the equivalent of an FDA for behavioral health. So if I want to start Maya's kicking your butt treatment for addiction or ADHD or whatever, I can do that and I don't have to prove that kicking your butt is a successful therapy.

And so this is basically how we ended up in this mess. We really don't have a mental health care system for teenagers. We know that there are evidence based approaches that can be effective, but they are really, really difficult to find. And over the years, through the whole drug war, we've developed this kind of alternative, punitive approach.

Often centers on drugs, but then gets expanded to, oh, we can use this to make gay kids straight, or, oh, we can use this for depression, which, again, not true. So, But this industry has sort of capitalized on the fact that there really isn't any way for parents to know what good treatment is for addiction, for drug use, for all of these things that parents might be worried about, , it's just a wild west out there.

And so we really need to regulate. These facilities, and if we did, most of them wouldn't exist because they do not provide evidence based care for teenagers or anybody.

Sadie: Yeah, you mentioned, , initially that abuse really runs rampant in these programs, and we see that they're, it's not always as horrific as it has at times, like, conversion camps aren't as, you know, prevalent.

Some of the early programs have gotten shut down, but there are still so many programs. And today, an article just came out confirming, , the death of a kid at Trails Carolina. And so it's something that's happening to this day. There are tens of thousands. Yeah.

Maia: The, the fundamental problem Is that we don't have a good mental health care system.

We don't have a good addiction or drug problem treatment system. We just don't have good care for teenagers and Into the Void steps this business, which claims that by abusing your child, we can fix them. And it's really important to emphasize that in these places, the abuse is the treatment because historically people have claimed that, Oh, you know, it's a few bad apples or, Oh, you know, these kids are just whining and complaining or, Oh, they don't want to do the tough work of therapy or any of this stuff.

But the tactics that are used in what I call the troubled teen industry are by their nature, abusive. The. Keeping people out of contact with the outside world, food deprivation, sleep deprivation, very rigid schedules, rules that are so complex that nobody can avoid breaking them. Incredible punishments that are way out of line for whatever the behavior is.

A lot of use of restraint and isolation. And. A tax therapy where the idea is to tell you you're a bad person and tell you horrible things about yourself. And this is supposed to be honesty. And the participants are taught that being honest is saying bad things about other people. And that this is good and healthy.

And that if you want to help your friend, you should tell them, yes, you look fat in that. Or whatever kind of thing, , that you think would be, you know, the most inappropriate basically. , and so, you know, it's really about using shame to create conformity. And so there are residential facilities for youth that do not do this, but it is very difficult to tell.

Which ones those are, because these ideas are so prevalent, and because there is no requirement to not do this stuff, and because the staff is often very poorly educated, because if you were to actually provide evidence based care, You would have to employ much more trained people, and you would not be able to make a profit.

Sadie: Yeah. What do you look for, like if you were a parent at this point, and you were looking for a program, what questions would you be asking? What red flags would you be

Maia: I would not be looking for a program, because the reality is that for every single mental health condition and for addictions, The best way to treat people is generally at home.

, and again, there are some exceptions. , some severe addictions. , cases where a child has been through multiple foster homes and has extreme PTSD and is a danger to themselves or others. , but short of that, The idea that sending your child away to fix them is the way to deal with teen mental health problems is just false.

Essentially what we know about what works best across the spectrum for a lot of different conditions is family therapy. and that's with the kid at home. It may need to include antidepressants, for example, if the kid has depression. Or specific, , Trauma treatments, if that is an issue for the child or specific things for ADHD or specific things for being on the autism spectrum, whatever the thing is, there are specific things that, , can be done to help that child, , cope better, but what's typically going on when a kid is sent to these places is that their parents are getting divorced and they are acting out. And I sort of have this joke that if you're getting divorced and your kid is acting out, you should go to boot camp. , which of course they don't like, the, the reality is that kids are very, very sensitive to what's going on within the family.

And a lot of time. What's going wrong between a child and their parents has to do with the fact that Adolescence is difficult. Parents don't want to let go of control. The kids are hormonal or whatever and They need new ways of communicating and family therapy often helps with that. Now when kids are using drugs There are some complexities here, but the reality is that the vast majority of kids who take drugs do not get addicted, and although they may do scary things, the vast majority of them, so long as they stay alive, are going to be fine.

, now this doesn't mean that teenagers can't have addictions or that we shouldn't worry if there are, you know, severe signs of problems. but the idea that, Oh my God, my kid's smoking pot. I want to protect them from moving on to fentanyl. So I'll send them to a place. That actually is more likely to result in harm because when you send a child from their home environment where very few people are doing these sorts of things and concentrate them in a situation where most of the kids have some kind of problem.

You will end up introducing the pot smokers to the kids who are doing the more serious drugs and then you will make the problem worse because now they know where to get them. Also, in these places, they sort of tend to tell the child, okay, you have the disease of addiction and you're going to have it for the rest of your life.

So therefore, you must be abstinent from everything forever. And they're like, and I didn't even get to try the good stuff. you know, it, it creates a backfires sort of effect. If your kid is smoking pot and drinking to the point where, you know, they're passing out or they are, , just stoned all the time and not doing anything, , that's a problem.

What you want to do to work on that is help them within their own environment to realize for themselves why this is a problem. And this is much more effective. with individual counseling because that way you're not exposing them to more troubled peers and you are also, giving them the opportunity to work out for themselves what's going on.

Because oftentimes when teenagers are using drugs and almost always when teenagers have severe problems Mental health and trauma are involved. So, for example, a kid who is, you know, getting plastered every day, there's a reason for that. It's not just because alcohol hijacked their brain. It's because they are depressed.

They can't fit in socially. They just lost a parent. They are extremely anxious. They are trying to achieve something with this drug use. It may not look rational from the outside, but you have to understand it from the inside if you're going to be able to intervene successfully. And I mean, if kids have gotten to the point where they are doing extreme behaviors around drugs, they have got to the point where that has become a habitual behavior.

And when that happens, it is hard to change. If you just think about something like, , trying to change your exercising or your eating, like, nobody does it perfectly overnight. Everybody misses the workout. Everybody eats the donut, you know, It is hard to change habitual behavior problems, especially when you are using that behavior to cope.

And if you don't have alternative ways of coping, you're not going to solve that problem. And so you have to recognize that this will not change overnight. And that kids are going to do dumb stuff. So what we want to do is minimize the harm that they're exposed to when they're doing the inevitable dumb things that kids are going to do.

Okay. And, I think when you look at a lot of our attempts of prevention, like they scare the heck out of parents, but the kids are often like, Oh, that sounds interesting. You know, it's just like the teenage brain works differently. And this is a good thing because you have an extraordinary capacity to learn and to innovate and to move society forward.

That, you know, once your brain is sort of like, I have this brain that is now very highly tailored to my expertise on addiction, it's not so good at math, , if I were still a teenager, I might be able to, and perhaps with laborious effort at this point, I might be able to, get really good at math.

, but there's reason that the adolescent brain is the way it is and we shouldn't just demonize it. We shouldn't just. see this as like, kids are dumb, you know, it's like, I say it jokingly, they're gonna do dumb things because when you look at it from a mature perspective, some of those risks are insane.

And when I think of some of the risks I myself took, I'm like, Oh my God, how could you have done that? Like, you could have died. but you know, my brain is a lot more mature now. , and I. Thankfully, survived, , some really rough stuff. And I think what we need to do in order to really help teens that are acting out or misbehaving or just struggling is with empathy and compassion and evidence, figure out what's going on.

And work with them where they are. , if you do that, first of all, you're not going to do harm. , and second of all, , you will most likely be able to significantly help.

Sadie: Yeah. So many things. , I loved what you said. Like, mental health challenges don't happen in a vacuum. Treatment can't either. I think that's a message that should be intuitive and for some reason it's not.

I think about my own experience of going to treatment and it's like you were saying the extreme outlier where I was locally hospitalized four times in a year. I did outpatient twice. I did the PHPs twice. I did outpatient DVT two times. We did family therapy, in group therapy, all the things. like, harmed myself, all those things where it's like there was no other option and we were working with the best of the best and getting as much support as possible and some of these behaviors are so hard to change, like you're saying, especially when you only have those coping mechanisms and you're not in a position where you've learned other ways of tolerating distress.

And I was really lucky with one program, 3 East at McLean. They do evidence based, compassionate work with the family is so involved with that. My parents flew every week to do the parent groups. We visited every weekend, called them every day, like all the things where it's family's very involved, but I was able to be in a different environment where.

It was like I'd been so conditioned with how I coped and responded to things at home that having that less stressful environment for a very short period of time. I was there way longer than most people. It was 14 weeks. Most people were four to six. , and then it's the next step. And this is where it's like, you want your kid to succeed.

And McLean doesn't have long term programs because it's like, They know the evidence doesn't support that, and it's like, the next step isn't clear, and then you get into this really challenging situation, and it was really interesting being in the troubled teen industry because I was such a rarity, everyone else I knew came from wilderness, a couple came from home, and it's like you're saying the things that I was exposed to We're wild.

I have never done drugs. I never drank before I went to treatment. I was just a really sad, depressed kid and didn't know how to validate my own emotions and ask for help and be vulnerable and so much shame and all the things. And then you're surrounded by all these other mental health challenges.

And that was one of the reasons why I started the podcast, because it's like, if you're a team that's doing well, no one's talking about how they're maintaining their. mental well being. But if you're struggling, you are in a vacuum of other people that are struggling and it's all feeding off each other.

And there's no other teen being like, it gets better, I've done this. There's adults, but of course as a teen you're like, you don't get it. , it's not the same thing. And so, That was a big goal for the podcast because that is such a challenging dynamic, especially when you're in those treatment environments, but yes, I loved so much of what you said.

I am wondering if you have any theories about where this desire and messaging and urge comes from with parents to either send kids away or for us to like treat normal teenage behaviors because this is I assume a newer phenomenon. This wasn't happening hundreds of years ago. No. , but like why is it their discomfort?

Is it like, we didn't do this?

Maia: Well, I think they're, yeah. Yeah. I think there's a number of things going on. , one of them is the rise of economic inequality, which means that people in the middle class are completely panicked that their kids are gonna fall out of the middle class. , and so, this just strikes fear into the hearts of parents, you know, we want you to go to a good school, blah, blah, Because, the economy is seriously scary and we have created no safety net. , so, part of it is that. , another part of it is just that because parents Feel like they might have caused the problem. They have a lot of shame And so like, if your kid has cancer you call your aunt at phone catering and you do all the stuff that is going to Help you find the best care With this you're searching in the internet in the middle of night and like this is why parents, you know get , the other part of it is that, psychiatric medication is complex and a lot of parents are like, I don't want to drug my kid, which is obviously understandable and you should obviously not use drugs unless you have to.

, and so there's, there's a lot of fear around that and, these places tend to like prey on that because they're like, well, we're not going to labor your kid. We're not going to drug your kid. So what ends up happening is that, , this whole sort of alternative thing sells itself to parents.

Now, the uglier thing that goes on is that. America worships youth and parents are sort of pushed to be like jealous. Their kids are young and hot and enjoying everything and we're not anymore. You know, we're cranky and this becomes a battle over control and there is this desire to punish that is unconscious that sort of filters into this, you know?

, and so. Like, that jealousy, which of course you are not allowed to acknowledge, , really kind of poisons some of this stuff, and poisons relationships in some ways, and, makes the generation gap sort of worse, and so I think that is also a part of it. So you've got all that in with this, very toxic individualistic ideology.

Because what these programs are teaching you is that everything that happens to you is your fault. , everything you chose to do that, , you chose your parents, some of them even argue. Or, you know, you chose to be raped is absolutely crazy and wrong. but what it does is it absolves the perpetrators because you chose to be abused.

And it means that everything that goes wrong is your fault. So it's like, if you get hurt, you need to take accountability. Exactly. And it's like, no, that is wrong. that is the complete opposite of what most trauma survivors need. Especially when you're talking about sexual abuse. I mean, I have talked to people.

Who, you know, and unfortunately this is like a sort of bad off hue of 12 step programs, but unfortunately in the A. A. Big Book. There's this whole thing about, taking accountability for your actions and like looking at what was my part in sort of all the things that, , are on your moral inventory.

And oftentimes that moral inventory is just kind of a life story. And so they're like, what are you resenting as well? I resent my parent for raping me. Okay. What was your part in that? No. Oh, no, and this was because it was like written by rich white men who their resentments were somebody was a jerk to me or I didn't make enough money rather than I was actually a victim.

But applying that to teenagers is really crazy because so many times, you know, I mean, yeah. Like. Everybody can be a little jerk sometimes. , but, , most of what's going on is not the child's fault and , they should not be accountable for it. They shouldn't be making amends to their parents.

their parents should be making amends to them often. So, it, just becomes very toxic and that ideology is itself abusive. And it is sort of this real exaggeration of this American idea that we're all responsible for our own fate in every possible way. And economic conditions don't matter if you work hard enough.

And you know what? That is not true. obviously working hard can definitely benefit you. , but there's lots of other ways things can go wrong and there's lots of ways where, You are not empowered to make a difference. You get lucky and, not acknowledging the role of luck and the role of just chance in where we end up, means that we blame poor people for being poor and praise rich people for being rich when in fact, That's not about virtue.

Sadie: Yeah, the accountability letter is such a insane experience and everyone I spoke to who went to wilderness did one. It was also the first thing, like the very first phase where you get off orientation and safety at the boarding school. And you write this accountability letter, you have to read it to your parents.

And I remember like, taking accountability for being depressed and anxious. And it's just such a strange experience to look back on. And it's like you're saying that the shame that it induces and also Now, as a psychology student, when you think about how we attribute our experiences and challenges, it's most effective to say these were external circumstances, they were specific to this situation, and this is temporary.

And the trouble team does the complete opposite. They say this is internal, this is on you, it is global, it will apply to every situation, and it's gonna last forever. And so even when you just think about the mental consequences of teaching people to think like that You're teaching them to be catastrophizing.

I mean, it's like The health outcomes are bad, the mental, like everything becomes a disaster. It's, it's insane to think about. , yeah. And it's so divorced from everything we

Maia: know. Yes. About what works to help you. Like, you know. With people with depression, what do they need most of all? Love. Connection.

Support. Community. Validation.

Sadie: Yeah.

Maia: and sometimes antidepressants. Yeah.

Sadie: Yeah.

Maia: Because I think what's important to know is that like, sometimes you're in that state for a chemical reason, and it's not anything you did or whatever. You have a gene or your gene was triggered by some kind of trauma or whatever it is.

Yeah. The bottom line is, without chemicals, you're not going to get out of that state. And, you know, we don't like that to be true. We think that, you should be able to do everything with therapy or whatever. But the reality is, like, having personally experienced depression and having personally experienced just sort of being neurodiverse in a strange way.

without antidepressants, I am a person who is so vulnerable to the environment, , that I don't function well. And that I think everybody hates me. And I do all these things just to feel okay. and thankfully I can get that chemical support from, you know, Prozac and Welbutrin and not heroin.

, but when I have not taken medication, I have had an extremely hard time and this does not make me bad or lower or any less moral than somebody who like, Conquers their depression via cognitive behavioral therapy,

Sadie: The outcomes show that CBT alone and medication alone aren't as effective as doing both together.

And yes, we're over prescribed as far as Gen Z. But for severe depression, the evidence shows that it works and it works well, especially when combined with talk therapy. I would love to talk a little bit about the economics because this is one of the most mind blowing things and also objectively people can be like that's crazy, why aren't we talking about this?

These programs are so expensive and like you mentioned they have a really low bar for hiring people which is how they are able to turn a profit. Can you kind of speak to how this works? That they're charging so much. But they pay staff so little, the living conditions are so horrible.

Can you kind of just explain that side of things? I mean, yeah, sure. Yeah.

Maia: One of the great virtues of using abuse and neglect as treatment is that they are cheap to do. In the wilderness, you don't even need a facility. All you need to do is hire a few guys off the street, send them into the wood. You don't need to pay for food because, you know, the kids can eat lizards.

I mean, literally, in Utah, they have in their regulations a certain number of calories that are required, , for kids to be given when they're in the wilderness. If you don't know that you have to feed the kids, I think you shouldn't be in the business of dealing with kids. You know what I mean?

Like, it's not okay. I certainly get that if somebody voluntarily wants to go into the wilderness and, you know, conquer mountains. Have so much fun. Go for it. But you should make that decision. Right. You should be doing that as a challenge and this is the way our stress system works.

Like, if you are sort of. Challenging yourself and, , doing a thing that you chose to do. the stress is so much different than if you were forced and powerless and, under somebody else's control. and so. Anyway, , yeah, so it is really, cheap, you just hire people at minimum wage, you don't require any training except you get them to train each other, you, get the bare minimum facility, , because, the bad conditions are a selling point because, it's helpful to, harm people and to make them live in deprivation.

like a sleeping bag and

Sadie: a tarp, no, no structure, just sleeping bag and a tarp will be fine. Yeah. Yeah, it's just crazy. And so, I mean, Some places, you build your own backpack, you whittle your own spoon, like, no expenses here.

Maia: Yeah, no, and even the places that do have facilities, they make them as bare bones as possible, and they put multiple kids in the same room, on very cheap food, Maybe there's a psychiatrist on call?

Maybe? but, you know, most of the staff doesn't even have to have a high school education. And yet they charge as if they're running hospitals. Yeah. And so they charge. Out of pocket. Yeah. and I mean, this goes back to the addictions field where, the model of, you know, the 28 day inpatient rehab, that was a hospital model.

And so like. you could charge thousands of dollars a day because it's a hospital. It's expensive to run, But the actual care that people were getting were sitting in 12 step meetings and being given lectures about, you know, this is the only way to recover, , and, 12 step meetings are free.

know, the, the lectures are free. You can just, run the thing on the computer or a TV. , and you're not being seen by doctors every day. You are being charged as if you were being seen by doctors every day. You're being charged as if you're getting therapy from a licensed person every day.

Maybe you would get therapy from a licensed person in a group once a week. and it's the same kind of model. It just, focuses on the bottom line.

Sadie: Yeah. No, you have to think about, like, I was hospitalized in an actual hospital and there's five to six nurses at any time for maybe 15 kids.

The psychiatrists multiple come through every night. You're meeting with them. A social worker is meeting with you every day. Therapists are running three to four groups a day. You're being checked on every 15 minutes. You're being given medications, security guards, and so on. It's expensive because you have so many people that are very qualified to do this and doing it from an evidence based perspective and even just from a legally, like, ethically perspective where they're checking all their boxes and doing all the things they need to do.

The troubled teen industry, we saw a psychiatrist, maybe once a month, he came in from a local town, spoke to people for five minutes, and that was the entirety of the medical thing. One of the therapists was a life coach. Like, it's absolutely unreal. Did your

Maia: parents, so your parents sent you to this place after you'd experienced the evidence based treatment?

Sadie: Yeah, because there wasn't really a clear next step and I'd struggled so much at home. And so they were aware that I could continue my school kind of side of things at a therapeutic boarding school while also getting support. They did the tours, they asked all the questions, they definitely saw some where they were like, She's not going there and this one is like the best of the worst because no one's died They hadn't been sued until recently and what's it?

Chrysalis,

Maia: okay. Yeah, it's in

Sadie: Eureka. And , it was started by people that used to work at Montana Academy , yeah,

Maia: and so were you allowed to talk to your parents

Sadie: without supervision in there? You , nope. It was, you would earn the privilege of a five minute supervised social call once a week.

After about three months, prior to that, you would only talk to him in family therapy. And my parents are very, like, on things, so sometimes they would be talking to therapists, being like, what is happening? What's the plan for the entire session? So I wouldn't get to speak to them. , you could write letters that were read and faxed by staff that had no business reading what we, you were doing and what was happening.

And so, no, it was absolutely a privilege that was controlled and absolutely something that was supervised and censored. And they fought to, like, not have a child abuse hotline in their houses. They publicly were like, kids will just say things to get out of treatment, which is not what the research shows.

Maia: And also, like, my feeling on that is, if a kid is so unhappy that they're saying stuff to get out of treatment, your treatment ain't working.

Sadie: Yeah, yeah. I remember being at McLean and being like, I don't want to be here, but I know this is what I need to do to get, like, I was very much like, this is hard, and I wish I was at home.

It wasn't crossing my mind to say, these things because it was working and even though it was hard and a lot of work and emotional and challenging, it was something that was necessary because I had hit rock bottom with being so depressed and anxious and ineffective with all the coping skills.

Maia: Yeah, no, and I mean, what's, what's just so terrible about is you would probably been fine at home. , but, , the, the other thing is like, one of the things I say if people ask me, Oh, well, how do you find a good place? Can your kid talk to you with no supervision from the day one?

Sadie: Yeah. And I

Maia: don't think any of the bad places allow that.

Sadie: , yeah.

Maia: And, the other thing that I think would be essential in order to fix the situation would be to require an absolutely independent evaluation of the child before they can be sent to any facility. Mm hmm. and this person cannot have any affiliation with any residential anything.

Mm And they need to be able to evaluate the child, evaluate the family, and really figure out if this is, you know, , advisable.

Sadie: Yeah. You've spoken to a lot of survivors when kind of doing your research and painting a picture of what this is. Industry is like, can you speak at all to the after effects and the kind of trauma and experience that survivors go through and because you're recovering from recovering basically?

Maia: Well, I mean, one of the things that is absolutely horrific is that people who come outta these places almost never wanna seek any mental health care again in their life. And they truly may need it because now they probably have PTSD on top of whatever they had before. , that's one very bad outcome. , another is that, They are estranged from their family because oftentimes the family has been told to expect reports of abuse and not believe them.

And one of the things that's really essential in recovering from trauma is being accepted into the community and being believed about what happened. And, though, I mean, one of the really painful things when I was writing that book, like, I was often the first person that believed these kids. And , that is terrible. , and you know, some families never recover from it. So there's that. But beyond that, and even worse, is that there are enormously high rates of suicide and overdose. And we don't know exactly how elevated because nobody has done a study. I mean, I'm hoping that out of the program, they have all the records, they could potentially fund a study if they can get somebody, working on a PhD to do it.

But a study

Sadie: going to grad school and I want to find someone who would be open to doing that. So,

Maia: fingers crossed. Yeah. Well, keep me posted because Yeah. any one of those programs, if you have a complete list of the patients. And you can just track them down and see what happened. , I guarantee you that the rate of suicide and overdose is probably at least twice what it is in a matched group of equally troubled kids who did not get sent.

, and probably worse than that. I mean, when you look at the stuff from the Family Foundation School, , which Liz Ionelli has tracked, mean, 50, 60, something like that, suicides and overdose, , Catherine, , from the program is tracking, , suicides and overdoses from Academy and Ivory Ridge, again, enormously elevated.

And, you know, when you think about it, like a lot of the kids who went into these places did not do any drugs. And did not, you know, I mean, they had depression or ADHD or any of these things. Or maybe they were, binge drinking or what did she have, like one Mike's Hard Lemonade or something like that?

Yes! totally normal teenage stuff. And then they come out and have, experiences of addiction that are just crazy. Like most people, in my experience of interviewing survivors. A lot of them, go through a period for maybe a year, six months where they're completely compliant and just kind of infantilized and just do as they're told because they're terrified of being sent back.

Then they often go through a period where they do absolutely crazy binges. , unfortunately, a lot of women, , end up in sex work or stripping, , professions, which again, can be totally fine if you choose that for yourself, but if you have been coming out of a place where you got, like, lined up and had boys yell slut and whore at you, which, this happens in some of these places, , is it surprising that Paris Hilton ends up making this sex tape, you know, , when you know the backstory here, it's just awful and misogynistic and , again, there are certainly people who choose to go into sex work for reasons that have nothing to do with this, but when you have been in a sexually abusive situation and you go into sex work, there is likely a problem there.

, and you know, the other horrible thing is that. Oftentimes, parents have spent the college fund on these places, and so Or put themselves

Sadie: in so much debt. Yeah,

Maia: yeah, exactly. And so now, the kid can't go to as good a school as they would have gone to, , and, you know, maybe they can't go to school at all.

, also, the education that kids get in these places tends to be terrible. and this is often why I'm surprised that like, you know, upper middle class parents would stand for that level of education. I sort of understand why they might be conned into the abuse, but if, you know, no actual teachers, like you're learning from a computer, I mean, I imagine they're going to have a harder time getting away with this now post pandemic.

Like, let me know about it. How bad remote learning is for so many people, this is not preparation for college, and oftentimes what happens is the kids are so, emotionally destroyed by what has gone on, that they can't function, and they end up dropping out, and end up, you know, getting in college debt that they can't pay because they, don't finish, and, you know, all of these, it's just awful.

, so you got everything from broken family to suicide to, , overdose and worsened addictions and sex work. I mean, it's just, it's not a pretty picture. And what I think is beginning to change is that I think they're going to start to be vulnerable to lawsuits.

, because like, for example, , what Catherine found at Ivy Ridge, all those records, the video, , it's very hard, you know, they're not going to be able to deny what they did. , but also just, know, previously when people were not aware of the trouble teen industry, what you would have is, A person would try to and they'd be like, well, look, the kid's doing fine, so therefore it worked.

Or, oh, look, this kid's a drug addict, you can't believe anything they say, so it's not our fault. And so that is why, like, with the exception of Phil Elberg, most of these cases, , did not result in settlements for parents or, you know, I mean now they've also been conned by a bunch of lawyers that like actually took cases and didn't do anything with them where they could have probably won.

, but, again, there needs to be standards and it needs to be the case that you can sue these places for malpractice when they commit malpractice, which is pretty much every day.

Sadie: Yeah. My last question for you is related to that, which is, what do we do? Obviously, the regulations are increasing.

These programs are becoming confined to very specific states that have very specific regulations, if you can kind of speak to that, but also, like you're saying, legally, these cases are now having precedents that we can look at, , and building kind of a case for this being a pattern of behavior. There was also a congressional hearing that happened after you released your book, and they pulled from a lot of your work, but what do you wish would happen with this industry, whether it's like an FDA for treatment, , is it, they get sued, because They, a lot of the times they'll get sued, they'll shut down, open with the same people and a new name.

So like, what do you think needs to happen?

Maia: I think you need to ban people from an industry, , if they have, , work at a place and been shown to have engaged in abusive practices. Like, you would take people, kids away from them, from their parents for doing some of these things.

Sadie: Yeah. ,

Maia: why shouldn't people get a second chance to work with children, , when they have at the very least looked the other way in an environment where severe abuse was occurring?

So The people that did this, the people who ran these places should be in jail, and the employees should be banned from working in this field, period. and this is why you need federal regulations, so they can't move from state to state, and you know, okay, so maybe they will go outside of the United States, but at the very least, then you can warn parents, don't send your kid outside the country because the regulations aren't there.

, so, that's one thing. I do really think that, like, if you're going to claim that you can treat depression, ADHD, any diagnosable disorder that you have to provide treatment that is a standard of care for that disorder. And if you don't. You shouldn't be allowed to sell your services that way. I mean, the fact that these places can call themselves emotional growth or therapeutic boarding school and they don't actually have therapy for the conditions that they claim to treat, this Or they're treating

Sadie: like impulsivity or self esteem, which are not conditions.

Maia: Exactly. I mean, the thing is, nobody needs residential treatment if they don't have a diagnosis. , and if they do have a diagnosis, they need treatment for whatever the diagnosis is, not troubled teen treatment. , so, it's like, I can't set up my cancer center. Without, you know, I'd have to have an MD, I would have to, like, have, training, I'd have to do a fellowship, like, there's all these things that I'd have to do before

Sadie: I could, like, You'd have to , jump through so many hoops to even, like, get chemo, there's so many things you have to do.

Yeah,

Maia: The same thing should be true for mental health care. It shouldn't be that complicated. Now, I get that it is harder to regulate speech than it is to regulate a drug, but professional speech has been regulated. And, we recognize that conversion therapy, many states have now banned it.

, and if we can do that, we can ban therapies that are not proven. I think, again, you will always get people trying to go for loopholes. , and you need to work to minimize those. But I think if we educate parents and regulate stuff appropriately, nobody's going to go for this.

, you know, I do think there is this minority of parents who actually want their kid to be abused. , and that is a whole different story. Dealing with them is going to be a very different thing than dealing with the 80, 90, 95 percent of people who were conned into, you sending their kids to such places.

one of my main goals with the book, and we're hopefully going to be putting out a updated edition, , one of my many goals, , Is to just have parents know, because informed consumers will not do this. the vast majority of parents want what's right for their kids. , you know, they may be annoyed with them.

, they may be having communication issues, whatever, but most parents want the best for their kid, and they would not do this if they knew what was actually happening.

Sadie: Yeah, well, you have a number of books out. Everyone, I'm sure, is going to want to keep an eye out for the updated edition. Where can people find you, read your books, read your articles, all the things?

Maia: Sure, so, , , my website is MaiaSZ, that's N A I A S Z, like zebra. dot com, , and so you can see the info on my books and sort of the latest stuff with me, , on there. I am also a contributing opinion writer for the New York Times. And so roughly once a month I have a column in there about, , various things along these lines.

, and yeah, I'm hoping to, you know, sort of work more, , in this area because It's so great to see that, we're finally getting some attention. , when I first was writing Help at Any Cost, which is the name of my book on the troubled teen industry. when I was first writing it, I would, you know, go to a cocktail party or whatever.

And you're in a little group, two, three people. And in that group, there would inevitably be someone who had themselves gone to one of these. They knew somebody who went. , they knew a parent that sent their kid, because this is a huge kind of underground thing that we've just never talked about.

And we really need to talk about this now, especially because, you know, Gen Z and just, , in general, we just went through this pandemic, , and that was an enormous stress on the entire society. And stress is what. You know, especially severe stress is what turns predispositions to mental illness into actual condition.

And so we're dealing with a lot of it. Like, we've never dealt with it well. And, the brain is part of the body. We expect our body to get ill many times in our life. Why don't we realize that the brain is not an exception to this, right? that like, it is quite common to have anxiety, depression, all these things, and that's not just, you know, pharmaceutical marketing.

The reality is that, of course, it's common, and you think the brain's gonna be exempt from everything? Like, why would that be? so we have to learn to do this better, and I really think, you know, , we know so much more, and we know, , if a kid is, like, Seven or eight, and they're kind of sad, and they're interpreting the world in a negative way.

Like, if we can intervene then, not labeling them, not nothing, but just be like, Hey, what are you thinking? How are you thinking about that? And look at like, Maybe that's just your head. Maybe it's not really that way. Maybe you're just seeing it in a different way. Like the more you can do sort of cognitive stuff with people before they grind that groove into their brain with the false nature that they may or may not have, , the, you know, the easier it is.

we can prevent this stuff, but we have to do it right. And we have to not be like, Oh, you're a depressed kid. So we're going to like label you. And, now you're never going to be able to change. , but yeah, so I do think there's a lot of stuff that can be done and, and that, despite the fact that we have a lot of challenges, , we also have a lot more information than we used to have about what worked.

Sadie: Yeah, I agree. People are talking about it a lot more, and I think at least now the conversation has shifted, and I, I hope that parents that have felt shame because they sent their kids to these programs and didn't know what was gonna happen, that 98%, that they're, they were victims as well, and they were Scammed out of money and lied to and, , I, I really hope that there's a lot of grace for survivors and parents alike in this process and that people speaking out really does bring change, , to the industry.

I agree. Okay, perfect. Well, thank you so much. This was incredible.

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