Troubled: The Failed Promise of America’s Behavioral Treatment Programs

by Kenneth R. Rosen

An award-winning journalist’s breathtaking mosaic of the tough-love industry and the young adults it inevitably fails.

In the middle of the night, they are vanished.

Each year thousands of young adults deemed out of control—suffering from depression, addiction, anxiety, and rage—are carted off against their will to remote wilderness programs and treatment facilities across the country. Desperate parents of these “troubled teens” fear it’s their only option. The private, largely unregulated behavioral boot camps break their children down, a damnation the children suffer forever.

New York Times journalist Kenneth R. Rosen knows firsthand the brutal emotional, physical, and sexual abuse carried out at these programs. He lived it. In Troubled, Rosen shares more than his experience of lockdown and its aftermath as he unspools the stories of four graduates on their own scarred, faulted journey through the programs into adulthood. Based on three years of reporting and more than one hundred interviews with other clients, their parents, psychologists, and health-care professionals, Troubled combines harrowing storytelling with investigative journalism to expose the disturbing truth about the massively profitable, sometimes fatal, grossly unchecked redirection industry.

Not without hope, Troubled ultimately delivers an emotional, crucial tapestry of coming of age, neglect, exploit, trauma, and fraught redemption.

Genres: Nonfiction, Psychology, Mental Health, Parenting, Audiobook, Health, Education

253 pages, Paperback

First published January 12, 2021

About the author

Kenneth R. Rosen has written for the New Yorker, the New York Times Magazine, VQR, and the Atlantic. He spent seven years at the New York Times, his hometown newspaper, and now divides his time between northern Italy and Massachusetts.

Reviews

[Diane S ☔ · Rating 3 out of 5]

3.5 I grew up on the Northwest side of Chicago, a neighborhood filled with many children my own age. Some of us, like myself went to Catholic School, others the public school. Discipline in Catholic school was maintained by a system of guilt, fear and corporal punishment. The public school threat was if one didn't behave, cut classes, they would be sent to Montifiore, a school for troubled children. This is my long winded way of explaining why I have no direct knowledge of the programs mentioned in this book.

Rose, who was once a participant in one such program, shares his own experience, but also the experience of four others. Wilderness programs, survival camps, last resort schools, are programs with little or no oversight, often coupled with untrained counselors. These places of last resort are extremely lucrative. The details shock, often I couldn't understand how the tactics they used are supposed to be effective and too often the scars they leave are permanent.

An eye opening book, personal stories and a look at a mostly unregulated industry. The desperation of parents of whom Rosen is not unsympathetic, but there has to be a better way. The cost is high both financially and in destructiveness, mentally hard to overcome. Heartbreaking really.

[Lisa | Read Between the Spines · Rating 2 out of 5]

I have a background in a parallel field so I found this book of interest. Specifically, I wrote my master's thesis on the children's mental health care system, particularly when it touches kids in states' care. This means that I am much more familiar with the "above board" mental and behavioral health programs rather than those not covered by insurance which are discussed in this book. But I have heard about these shady, unregulated "treatment" options that Rosen discusses on NPR.

I had some major issues with this book. The first being that the author has personal experience, and therefore, a lot of bias on this subject. That does not preclude someone from writing a book, but I do expect a nonfiction author to take this into account. Second, the author has no credentials in health care or mental and behavioral health. This was readily apparent in the writing and some of what he presents as facts. This book also lacks citations. I realize that the author is a journalist who may not use these regularly, but they are desperately needed. I think this would have eliminated some of the incorrect information that is presented and the fact it is misleading. For example, this book discusses Cognitive Behavioral Theory (CBT) and Dialectical Behavioral Therapy (DBT) more than once and misrepresents it. The writing truly distorts what CBT and DBT are and makes it seem like these are non-mainstream and harmful, when this is far from the truth. Some text also implies that therapists use The Secret in providing therapy which is honestly unheard of. Perhaps that is what was used in the programs he attended, but he is then not taking into account the fact that most of the programs do not have licensed therapists. 

I recognize that this is an uncorrected proof, and that being said, I think this book needs substantial editing before publication. The transition from personal narratives to facts is rough and makes it more difficult to tell what is opinion versus fact. I think with some rearranging this material, the book can better frame the personal stories with factual information and introductions. In addition, there are some technical writing issues such as failure to introduce an acronym before using it. 

Overall, I think this book has potential if the issues discussed above are addressed. However, as it stands, I would not recommend it.

Thank you NetGalley and Grand Central Publishing for providing me with an ARC ebook in exchange for my honest review.

[Brianna · Rating 4 out of 5]

As someone who has spent just under a year in a residential treatment facility in my teens, I had to jump and request a copy. My time in treatment is not dissimilar to what was presented in Troubled – forced to adapt to the rules of the program, but not actually receiving “real world” help.
Troubled follows the lives of four “troubled kids” through their stays at different treatment programs (be it residential, or wilderness). Rosen manages to capture the duality of these types of programs through his reporting and interviews with clients. Some find at least a place to disconnect from outside stressors/abusive environment long enough and get the help they need. Others manipulate an imperfect and sometimes traumatic (read: physically/mentally/sexually abusive) system in order to make it out in one piece.
I appreciate Rosen taking the time to show us what life AFTER these programs looks like. Hint: it’s rarely glamorous.

Thank you to NetGalley and Little A publishing for an ARC in exchange for an honest review.

[Rick Wilson · Rating 4 out of 5]

One of the major problems I’ve noticed with trauma is that it messes with your memory. The emotional charge of a traumatic event blurs things together. Swirling those memories into each other like paint dripped into a bucket. Days disappear, weeks feel like months. It’s like trying to put a harness on a greased otter, It keeps squirming and twisting under your grasp. And as someone who has experienced trauma, it makes it difficult to ultimately heal.

A second awful truth about trauma is that that blurring of memory and emotional dysregulation makes it very difficult to communicate your experience to others. For some events there is a societal shorthand that can be used. We’ve heard enough well told stories about war and domestic violence that people have a sort of archetype you can rely on to tell your story. Unfortunately for the type of trauma described in this book there isn’t really an easily understood analogue.

I went to boarding schools just like were described here. Owned by the same parent company, Aspen. Where are the author spent around a year, I spent three. It’s a very complex emotional damage that these places instil. Somewhere between the stories you hear about people escaping a cult, with the gaslighting and constant manipulation of the truth. Prisoner of war stories, where people are turned against each other in order to keep them complacent and manageable. And the manipulation present an extended domestic violence situation, with cycles of reward and punishment. But ultimately it just feels like there isn’t the language available to accurately describe what happens.

So Rosen, in attempting to describe the industry and damage these places cause, did not give himself an easy task. He set out to document and explain a very complex form of institutional abuse, and the resulting a long-term PTSD that stems from being abused by those who are supposed to “fix” you.

I think Ken ultimately misses the mark. The book starts and stops. The pacing is rough. The narrator seems unreliable or distracted. When dealing with psychological issues he relays partial information that as a reader seemed to be of dubious validity. Cite some sources dude. At one point he describes self harm as a “release.” Which, having known multiple people who’ve engaged in regular self harm, is definitely one component but nowhere near the full story.

How do you describe the insidiousness of not allowing children to hug during a time when they’re forming some of their most fundamental cornerstones of attachment and long-term relationship building? How do you describe the effects of having to regularly “snitch“ on your peers in sanctioned attack therapy groups at a time when you’re learning to relate to and trust your peers? And that’s if everything goes well at these places, to say nothing of the fact that staff are regularly under trained and wholly inappropriately screened to be around impressionable children. During my time I saw threats of violence from the supposed “adults” in the room. I and others were regularly called “worthless” and told that our parents had “given up on us.” I saw drugs (tranquilizers) given as punishment, i saw a student’s arm broken for failing to obey staff commands. It’s taking me almost a decade to get to a place where I feel comfortable talking about it, I know many others who will never get that chance because they’re no longer with us.

This is disappointing because I want a good book about this industry that I can point people towards. I, and many others I know who have survived similar places, seem to be hoping to be heard and seen. One of the things you learn in these programs is a blind deference to authority. The power dynamic grinds you down. Your experience doesn’t matter. Your compliance is all they’re after. Good authors can bring life into a experience to help you be able to explain your experience to others. They give you a voice to speak your own truth through. You can borrow their vocabulary and voice in order to understand your own truth. Sadly this book is not it.

[Tiffany · Rating 2 out of 5]

Troubled by Kenneth Rosen is a nonfiction book about different programs for troubled teens. The author himself went to a "scared straight" type program when he was a teenager. He focuses on three types of programs: wilderness, boarding school, and more restrictive residential treatment.

He chooses to tell the stories of four individual teens who go through these various programs. Their stories were very compelling and illuminating to read. However, that's where my praise for this book stops. His writing is poor, his opinion incredibly biased, and he presents his opinions without facts that back him up. His thesis is, "This book hopes to show that in many, if not all, cases these programs do more harm than good." After reading this book, I do not believe that. I was convinced that these programs need to be overhauled, that the adults who run these programs need more training and more regulation.

One reason he says these programs should be ended is the death rate. He points out deaths that occurred during the programs. Some were due to drugs, some suicide, and others were caused by the adults restricting food allowances. However, after teens died from the lack of food, regulations were put into place requiring a minimum of 1800 calories to prevent that from occurring again. Additionally, these are teens who were doing drugs, self harming, prostituting themselves, and engaging in other risky behaviors. I think a factor to consider is how many would've died regardless.

Another of his arguments is that he thinks "he would've grown out of it." and thus his parents shouldn't have sent him away. It is possible of course, but many parents intervene because they fear the real damage their children could do without getting help. Again, drug use, prostitution, and committing other crimes are all things that would have long-term negative consequences and it is incredibly naïve to think they'll just outgrow it.

He says near the end of the book that parents of unruly teens ask him if he benefited from the programs he was sent to and he ponders whether it helped him. He writes, "Far as I can tell, I never really shed that troubled past. I still steal things or shoplift from time to time though I call it 'casual liberation.' I drive recklessly. I disrespect authority figures. I make risky financial decisions. I test the limits of my family's patience." At another part he includes information that he has spent time in jail for attempted armed robbery and attempted murder of his girlfriend. I'm baffled as to why he included that information because it definitely undermines the idea that he would just "grow out of it."

Lastly, the bias made this difficult to read. He only mentions at the end that one of the four teens whose story he tells was a friend he met during his time in a program. At the beginning, he said he chose these four because their experience best summed up the experience. Additionally and more importantly, he would state an opinion, only to follow it up with contradictory or confusing facts. Here's an example: "In many studies, clients have indicated that wilderness therapy was productive for them during and immediately after it and the rest of their treatment. Interviews have shown that the clients usually did not continue to develop in the years after wilderness treatment, aside from the usual maturation of the adolescent brain and personality. Because a patient is swiftly reintroduced to their old peer groups, they shed any skills learned while in therapy. The transition is abrupt, and the tools learned in the wilderness are lost outside of a controlled environment. Yet the experience does not derail them socially, which may be the best benefit to a swift return."

Another example of him providing contradictory information was about a survey parents filled out after consulting whether or not to try wilderness therapy. "The group, divided into those who had enrolled their children and those who had decided against the wilderness and residential track, showed a remarkable difference in outcomes among the children. Fifteen months after the initial call with the consultant, those who were admitted to a program showed few signs of the behavior that got them sent away. Those who instead stayed home and attended regular therapy or community sessions were still 'dysfunctional'." So here he provides at least anecdotal evidence from the parents that this program works better than not doing it. This book was full of examples like this.

The last example I'll share is one he included from a Facebook post written by a "survivor" of one of these programs. "Overall, I do believe that the Program has helped change my life and has been a major influence in the way I think and act today." This directly undermines the idea that these programs cause more psychological harm than good.

Overall, this book is biased, poorly and confusingly written, and doesn't succeed in convincing me that these programs should be shut down. While he highlights problems that I do think need to be addressed, he never convinces me that these programs should be entirely eliminated. I do not recommend this book to anyone. I give the book two stars for at least including the compulsively readable anecdotes and thank Netgalley for an early copy. This book is published on January 12, 2021.

[Vicki Willis · Rating 3 out of 5]

This book explored what happens at wilderness camps and reform schools for troubled teens. It is written by a man whom spent time there in his youth. He wrote about then experiences of different individuals and gave updates on their lives today.
Though some of the happenings at these camps was suspect it was shocking to me that they are also unregulated. Desperate families send there children there and there doesn't seem to be a good success rate.
Overall the book was depressing because it didn't offer any suggestions or hope to save troubled teens.

[Gregory Ashe · Rating 2 out of 5]

Meh. I read it because our youngest is currently in a wilderness therapy program and will soon be moving to a therapeutic boarding school. I feel bad for the author for what he went through, but a lot has changed in the decade+ since he and the other teens about whom he writes were in their respective placements.

I also think that he over-generalizes. He complains that the success rates touted by these programs are just anecdotal; but so are his failure rates. Take a car--a Mercedes is an excellent car. Does that mean that people won't have horrible experiences with individual Mercedes? No. But does that mean Mercedes (or Lexus, or Honda or whatever) is a horrible brand? Also no.

I think a lot has changed. Most notably is the ability for current and prospective parents (and their children) to communicate on social media (for example, a number of different Facebook groups). Yes, it is true that some kids have bad experiences at particular placements. But these appear to be more one-offs (not to disparage the negative experience) and not reflective of the program. Unless, of course, scores of parents and their children have been lying to us. And I also think that the legal system (i.e. class action lawsuits etc) is doing a better job in 2020/2021 than it was in 2007-2009 to close down the truly bad places (using the car analogy, similar to what happened to the Pinto's with the exploding gas tank).

Anyhow, in sum, you have to read this book with a grain of salt. It is completely unreflective of our child's current experience in wilderness and the scores of conversations--oral and via text message--we've had with parents of children currently in, or recently graduated from, wilderness, residential treatment centers, or therapeutic boarding schools.

Or maybe I'm just trying to make myself feel better before sending our child to the next placement...

[Erin Matson · Rating 2 out of 5]

Residential behavioral programs for teens are a black box, representing a shadowy, expensive, unregulated world where young people who are struggling are whisked away, vulnerable to new traumas. While Troubled presents a disturbing view of what goes on inside those programs, I found myself disappointed in the book as a whole.

It’s a book that could have been really good but never landed on the right structure or angle. I found myself wishing for the author, Kenneth R. Rosen, to share his personal experiences within these programs, rather than lightly alluding to them every 50 pages or so. The structure of providing four stories of people who found themselves forced into this world offered some, but not enough, depth of experience to feel acquainted with what these programs do and do not deliver. The author does not consider alternative points of view, and doing this weakens his argument. Upon reading this book it is obvious treatment programs for youth need more regulation and yet he doesn’t explore what that could look like or how to get there.

Had he written this as a memoir or as a novel of interlacing stories, he might have had an astonishing book; as it sits, Troubled feels like an odd pastiche of one-sided, shallow arguments, narrative, and repressed memoir.

[Rosie M. Banks]

This is going to be very high on my to-read list. I just read the New York Times articles for this, and I am really excited to read this book.

I never knew that these types of programs ever existed, and it honestly shocks me that people think that the way to deal with "troubled teens" is to ship them off to wilderness programs. That will never work, teenagers aren't some foreign species, they are regular people.

Anyway, I need to get my hands on a copy of this. I am super excited to read it.

[Fionnuala · Rating 3 out of 5]

I liked what Rosen was doing here, telling the stories of four people who went through various types of program, and then catching up with them afterwards to see how their lives turned out. The depressing results speak for themselves, and it was a very close and intimate look at how such treatment programs do far more harm than good. This is an incredibly bleak book and the stories really speak for themselves; it's impressive.

However, I think if you read this book as your first foray into the subject, there would be some issues. I went into this book barely a week after finishing Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, which is an intensely thorough look at the subject. Had I not read that, I think a lot of context would be missing in this one. While I would have still managed to work out the central message, because it's blatantly obvious, I think I'd be missing out on several vital pieces of context, such as how deeply intertwined all these places are; how they're nearly impossible to shut down because they'll just spring up again; how many people pop up in various programs under different names to try to edge around controversy; how parents are often manipulated and deceived into thinking these programs work; the many deaths and the resulting lawsuits and often the total lack of justice. Some of these things are mentioned in passing, but many are not. And while the argument is clear, there are some areas where Rosen quotes people saying the direct opposite, in that the program helped them and they wouldn't be who they are without it. This isn't really expanded upon; while it's a valid experience, in a book that's so obviously against the programs it seems strange to represent this view without really looking into it.

I think this book assumes prior knowledge, and if you have it, great. I'd recommend it in that case, because it's a really close look at personal stories, and it's genuinely harrowing. If you don't have a background knowledge, I wouldn't recommend starting with this one. Read Help At Any Cost first, and then come back to Troubled. It adds a lot so long as you have a foundation.

[Lynn · Rating 4 out of 5]

A journalist who as a teen was sent to a residential school by his parents for “incorrigible” behavior goes back to look at programs in operation and looking at the experiences of fellow adults who attended them. He finds very disturbed adults who can’t function without police and prison, mental hospitals, etc to this day. The adults describe harrowing experiences in the programs and he recalls his own. But did they help at all?

[Tom Fornoff · Rating 4 out of 5]

Having had first hand experience with teen wilderness programs and therapeutic boarding schools I felt compelled to read this book. It's hard to read ... the stories told by the author are brutal and much worse (I think...I hope) than anything my daughter went through. I'm glad to have read it. I appreciate how the author mostly reports the stories of others, but also shares the mixed feelings about his own experience in such programs. There are many more questions than answers...but worth exploring.

[Caroline · Rating 4 out of 5]

I really enjoyed this. It was a very good format and though there were some sections that were very textbook-y, it was an engaging way to learn more about something I knew very little about. Some strong language and the topic overall is VERY dark.

[aga · Rating 3 out of 5]

Mam mieszane uczucia, bo jest to ważny (i wstrząsający) temat, ale o ile przedstawione historie czytało się dobrze, tak mam wrażenie, że autor we fragmentach "od siebie" był stronniczy i momentami próbował ten przemysł i te schematy usprawiedliwiać.

[Jennifer · Rating 3 out of 5]

This could have benefitted from some editing but was still fascinating and unbelievable that this whole industry exists without any oversight

[Meaghan Thomas · Rating 1 out of 5]

I wanted to like this after hearing him on NPR. I appreciate some of the light he's bringing to the issue, but his advocacy falls short when you actually read the book. As someone who went through abusive kid reform programs more than two decades ago in Idaho, Dominican Republic, Indiana and Canada, this book was a huge let down. Perhaps he has a way to go on his journey until he can write about this in the way these stories deserve to be told. I wrote a book but haven't published it because of the same issue I have. Or perhaps he didn't pick the ideal survivors to write about. It's disjointed, often trailing and judgmental. He makes sweeping statements and undermines the abuse that goes on at these places (I know, I was at a place he mentions in the book). He makes an attempt at the end to provide more context into where he is in his journey, but it comes off poorly and it comes too late. It seems he wrote this book while totally disconnected from it. Dissociation is a tool a lot of us have used to cope with our complex-PTSD from childhood trauma. Not sure if he has PTSD, but it wouldn't surprise me if this book is hard to read because he was dissociated when he wrote it. Just really unsettled by the way these programs and kids come off in the book.

[Sara Broad · Rating 4 out of 5]

"Troubled" by Kenneth Rosen is a book about behavioral treatment programs in the United States as told through the lens of various participants and Rosen's own experiences. I had always known about behavioral treatment programs, but I was not of the different styles of behavioral treatment and the sheer amount of programs available in the United States. What this book highlights, for me, is that most of the students profiled were dealing with severe, ongoing trauma, yet they were "treated" using methods that weren't actually helping them by people who are not always guaranteed to be qualified under the law. I was both surprised and also not too shocked that we have let these often expensive fly under the radar, especially when stories of abuse and mistreatment are rampant. This book had me saying wow to myself many times, and I suggest reading it to learn more about these programs and their effects on participants.

[Jeff · Rating 5 out of 5]

Tragic. Rosen uses case studies of four particular people and their experiences with wilderness re-education camps (and residential, boarding school style similar institutions) to paint a truly tragic picture. On an anecdotal basis, these camps seem horrifying in an Orange Is The New Black kind of way - an in depth look at the what really happens to some individuals. For what it is - these anecdotal experiences with a few claims backed up with the barest of bibliographies - it really is a strong read and a needed one. However, I would welcome a much more comprehensive, and cited, further examination along the lines of Radley Balko's Rise of the Warrior Cop or Michelle Alexander's The New Jim Crow. Because this particular topic, based on the strengths of these particular anecdotes, seems to warrant such an investigation. Very much recommended.

[Ann Campbell · Rating 2 out of 5]

The topic of this book really interested me. I live in a state that has a lot of these teen military schools/wilderness programs. I would have liked to learn more about them, and I'm sure they are incredibly shady. However, this book is so poorly written, unorganized, rambling and biased that you can't even follow who is in what program at what time, much less learn anything about their history, practices and long-term effects. I don't understand how this book was even published in the shape its in. Someone needs to write this book, just not this author.

[Crystal]

While I was never engaged in the sort of treatment in this book even on psych wards/hospitals, including adult psych wards, there are certain abusive behaviors from staff (including staff that is not educated in how to treat people with mental illnesses) that are largely normalized and seen as one's own fault for (previous) misbehavior. In the unregulated world in this book this sort of abuse prevails. Though I do wish this had been a memoir because I think the fact the author is not educated on mental illness undercuts Troubled.

[Jennifer Schultz · Rating 3 out of 5]

Read if you: Want to know more about the disturbing and largely unknown side of residential treament programs for "troubled teens."

Librarians/booksellers: Purchase if titles about youth issues are well-received. This is an engrossing, compelling, and unfortunately, largely tragic read. However, it is an important read.

Many thanks to Little A and NetGalley for a digital review copy in exchange for an honest review.

[Laura · Rating 2 out of 5]

The issue I take with this book is that it is written as nonfiction when the author has too much bias on the topic to write something nonfiction. I would love to read something similar from a more objective and factual point of view.

[Alex · Rating 3 out of 5]

Full disclosure: I received this book in a giveaway in exchange for an honest review. (Thank you!)

Troubled by Kenneth Rosen is a fascinating look into an area of mental health treatment that I never would have known about otherwise. And it isn't pretty. I can't say that I'm surprised there are so-called treatment programs that cost tens of thousands of dollars a year and prey on struggling families. But I was shocked to learn that such intensive "treatment" programs (for minors, no less!) are almost completely unregulated, can operate without a single evidence-based treatment, and require no training or qualifications for employees. The lack of accountability is scary. The manipulation, neglect, and abuse detailed reminded me of the behavior of the guards in the Stanford prison experiment at times. To me, this was worth the read just to learn more about these (horrifying) programs and get an idea of what teens actually go through there.

That said, there were definitely some issues. My biggest gripes were the author's bias, the lack of any sort of in-text citations, and some questionable arguments. I know that we're all influenced by our experiences and it's impossible to create something 100% free of bias, and I understand that this book is more about giving us an inside look into these programs through first-person accounts. I don't expect a research article. However, there are some places where it's reasonable to expect a citation or a more sound argument. Here's one example:

She knew that one out of every two hundred students who entered Swift River or similar programs would relapse, making her twenty times more likely to die before turning twenty-nine than any of her peers who had never attended a residential program. (110)

I have two problems with this:

1. The citation issue. This is very specific and clearly comes from an outside source. Sources are listed at the very end of the book in the order they appear, but there are no superscripts or other indicators in-text, and it isn't always as obvious as this example. That makes it difficult to identify every piece of information that comes from an outside source. And that makes it more difficult to find the relevant study in the back of the book since the reader can't easily determine how far through the list of sources they are. If I want to look critically at that study, its methods, the organization that funded the research, etc., it's going to take way more work than necessary to do that and make sure the information is trustworthy. For less ambitious readers like myself, we're likely to just assume that any line without a source that seems questionable is questionable, and that perception weakens a lot of the arguments presented.

2. The third variable problem. Quotes like this suggest that the residential program is responsible for relapses. That could very well be true, especially for those who are traumatized during treatment. However, the information that readers are presented with shows a correlative, not causative, link. We don't know anything about the control group. If the control group isn't also comprised entirely of people with mental health conditions, trauma, behavioral challenges, substance use disorders, etc., it doesn't prove anything. Relapse could be way more likely due to those mental health and behavior issues (or genetic or environmental factors for that matter), regardless of whether people have been in residential treatment or not. I'm not sure if Rosen glosses over this issue because of bias, lacks the knowledge to identify the problem in the first place, or both. Regardless, overlooking the possibility of a third variable really weakens the argument, and this is a recurring problem.

The other thing I wanted to touch on is the tone. The blurb says "not without hope," but I fail to see where the hope is. I saw abuse, trauma, self-destruction, and plenty of people who never recovered from the problems that started in their youth. But I didn't read any happy endings. I didn't find a call to action. I didn't see any suggestions about how to reform these programs and protect minors, nor did I learn about more constructive treatment alternatives to promote that do help to rehabilitate struggling teens. This is a heavy book, which is natural considering the subject matter. I don't have a problem with that. But it doesn't make sense to present a book as hopeful (or at least not hopeless) when it's not.

Overall, I'm glad I took the time to read this--and grateful I got the opportunity in the first place! Reading people's accounts of what they experienced in these programs was truly eye-opening. I just think Rosen's argument about these behavioral treatment programs at large would have been stronger with more revision.

[Liralen · Rating 3 out of 5]

Troubled dives into the world of wilderness programmes and boarding schools designed to 'rehabilitate' 'problem' children.* Rosen spent time in these programmes, and while at best they didn't help—he spent years in and out of such programmes and jail—he eventually found his way to a different life. In Troubled, he goes back in to tell the stories of some of the people who have been through such programmes, and to make some sense of it all.

These programs were known for their exploratory approach to therapy, which amounted to a brutal, forced redirection of wayward teenagers. They focused on breaking us down, but as one former client told me, "They were never as good as building us back up." (6)

I've read a handful of other books about similar institutions, some more evidently problematic—or abusive—than others. (It is, for reasons unknown to me, something that I find intriguing.) This isn't my favourite—it feels a bit scattered, and as though Rosen still, at the end, can't decide what to make of the programmes. He has a tendency to lump all such programmes together, making it hard to tell whether he thinks there are any that are either 1) effective or 2) non-abusive but also just how abusive he takes the (toxic end of the) programmes to be. (Like, you have to think that programmes in which people are routinely sexually abused—described in this book, for example—or forced to eat their own vomit should be considered unilaterally toxic, and yet I don't think he wants to come down quite so determinedly.) I'm also curious about how many such programmes do have licensed therapists, etc. (many of the clearly toxic programmes do not), and how the outcomes differ with those programmes.

I wonder whether a coauthor might have been useful here—the writing's fine, and Rosen having personal experience with this world is useful, but it also means that he doesn't always have a distance that would be valuable.

*If you're not familiar with such programmes, here are a couple articles Rosen mentions in the references:
Life and Death in a Troubled Teen Boot Camp
Loving Them to Death

[Madam Hexe · Rating 3 out of 5]

For disclosure, I received this book in a digital giveaway. Behavior modification programs, “scared straight”, and other residential “therapeutic” programs have a controversial history in the US. This book is comprised of the personal stories of a few different individuals who were forcibly enrolled in such programs, their experiences and abuse during the programs, and how their lives turned out afterwards. All of them suffered this complicated gaslight relationship with their program. They are indoctrinated enough to believe “I am a bad person, I deserved this, it helped me” while simultaneously understanding the further harm these programs caused their deviant adolescent behavior.

The author is also a so-called survivor of these programs. His own complicated feelings towards his multiple stints and following years of substance abuse, violent crime, and jail time, leaves the reader not with a call to action on the existence of these programs, but with the same kind of lost and uncertain feelings about them.

Were these peoples lives fractionally better after ? Did it help? Did it handicap their social development through rigid isolationism and structure so that returning to society successfully was impossible ? Did the continued and escalation of deviant behavior after the program signal failure? Is the high suicide rate among program survivors proof of their damned lives ?

The author does not conclude because he is struggling still with the answers. I liked this book, and the abuse described isn’t heinously graphic although still upsetting and the dismal outlook of the individuals showcased tints the book with hopelessness. This isn’t a professional psychological review of wilderness program effectiveness but a small memoir of a few who recalled their time institutionalized.

[Tim Sullivan · Rating 3 out of 5]

A good examination of an often unreported and unregulated industry. The residential institutions sound horrific, yet at times the author flip-flops and gives them some credit. That's where he loses me. He took three or more years to write this book, in that time I think he could've sone some extensive surveys to find out if they really do work.

A few things: The author dismisses Cognitive Behavioral Therapy. Actually, CBT is very affective and is scientifically proven to be affective in changing behavior.

The brothers, Mike and Mark, lost my sympathy and empathy near the end of the book. The elder one is a stone-cold sociopath, with or without drugs. He has no feelings for anyone and mocks others all the time. His younger brother is just a hopeless addict. While their father did get imprisoned for fraud, their home life wasn't horrific; their parents weren't awful. They're just two very bad, selfish, and I'd go as far to say somewhat evil kids. I'm not sure the residential programs helped them; I'm not sure anything would help them. They grew up middle class in America not on the run from Boko Haram in Nigeria. After hearing of their latest fight (the elder wanted to kill someone), their recent injection, their stealing, lying, etc., I was done with them.

The young women portrayed in the book had a much steeper climb due to their horrific upbringings. It's sad they didn't get the help they needed.

Finally, near the end, the author doesn't sound like a good guy. He talks of his past, but still the little thrills he gets today. I wasn't impressed. The book is a solid effort, but it's all over the map ... much like the characters in it.

[Susan · Rating 4 out of 5]

While definitely not an unbiased book, Troubled is an enticing read from start to finish. Rosen is a good writer, and he weaves together personal narratives and facts about these programs for troubled teens to form an entirely unflattering picture. He does acknowledge the lack of help available in our society for parents who need it, and that not all the programs are the same. That said, it seems clear that he does believe they all do some sort of harm to the kids sent to them, and that their for-profit nature and lack of genuine governmental oversight makes them all at risk for being a breeding ground of child abuse and trauma. The people he focuses on in the book are uniformly miserable adults, but they're alive, which seems to be an accomplishment for the graduates if many of these programs-- many die from suicide and drugs within their first decade of adulthood-- and that's the real question that is never answered in this book- if these programs worked, would so many of their alumni wind up dead/addicted/miserable, or were these teens already on their way to that end? Dis these places help at all, or did they simply add more trauma to already damaged children? Readers will finish the book still not entirely sure because the author- himself a graduate of these programs- still doesn't seem sure himself. Overall, a compelling read. 4 stars.

[Christie Bane · Rating 3 out of 5]

This book is boring and I do not know how it got on my To-Read list. It’s about how wilderness therapy, residential treatment facilities, etc for kids with substance abuse and emotional problems don’t really work. I was expecting horror stories about terrible things that happened in these places, but there was very little horror in here. It wasn’t stories like “I was raped by my counselor” or “my classmate was lost in the woods and died of exposure;” it was more like “they didn’t let us have our phones,” and “no one told me how long I would be there.” The author’s point seems to be that these programs all claim to work but none are documented to actually work, and lots of kids who attend them end up dead at a young age. This is not really interesting. It’s sad that so many people die young, but that goes with drug use and emotional problems in general, not just in people with those problems who go to therapy programs. This book was well-written but needs some more drama or substance or something.

[megan · Rating 5 out of 5]

Troubled recants the stories of four adults who were sent by their families to the "troubled teen industry" - wilderness programs, residential treatment facilities, and lockdown facilities that advertise themselves as last resorts to change behaviors and alter life trajectories. Rosen's own story is woven in to the narrative as he shares pieces of his own experience both with these programs and of his life afterward. Without shying away from the truth, Rosen highlights not just the emotional trauma that these children suffer, but the physical and sexual abuse that runs rampant at these so-called schools. We are ultimately shown that that while their families may be desperate, and the programs they attend may offer some hope to the children they harbor, there is an ultimate cost that often goes overlooked, unnoticed, and unaddressed.

After finishing Troubled, I can sincerely say I'm surprised it doesn't have a higher rating here - easily one of my top reads of the year.

[Elettra Pauletto · Rating 5 out of 5]

This is a beautifully written book. It talks about teenagers undergoing residential treatment programs, but it's ultimately a personal story. It shows the universal through the particular, which is exactly what I look for in a piece of nonfiction, and fiction for that matter. The particular in this case is five teenagers (including the author) who experienced events they never should have lived through. I came away feeling like I had gotten to know these people. The description of their characters was intimate, the scenery was vivid. Reading this book felt as effortless as watching a movie, but the best part was that I was granted access to the lives of others in a way that is not often achieved in nonfiction. I felt like I got to know new people and I got to learn something new about what goes on in the teenage mind. I now have two young children, and I think that information is going to come in handy.