Selling Serenity.

Sometime early in 1992 I received a book about how to sue one's parents for sexual abuse. Editors receive free unsolicited books almost every day, most of which get shelved with scarcely a backward glance. This one, for whatever reason, caught my eye.

Why would an adult want to sue her or his parents for sexual abuse that happened twenty or thirty years ago? There could be legitimate reasons, starting with the obvious: an injury had occurred. But the linchpin of this particular book--as well as the flood of uncritical books, articles, and television movies about to descend on the United States--was not the kind of abuse or injury that typically fills up civil court dockets. These authors were talking about sexual abuse they claim was repressed for decades then materialized in fragments as the alleged incest survivor worked to recover the memories.

At the time the information seemed apropos for mention in Changes, the magazine for which I wrote and served as associate editor. Sexual abuse was the emerging hot topic of the day and Changes aimed to serve adults who had been brought up in dysfunctional families. I called the book's authors, a pair of lawyers in Lake Oswego, Washington, and learned that their state was about to extend its statute of limitations for sexual abuse lawsuits to allow for something called "delayed discovery." The case for making such a change in the law seemed compelling.

If what these authors and a growing host of "trauma experts" were claiming was true--and if years of child rape, torture, and forced participation in heinous acts, including murder, could be wiped from the victim's conscious memory as a survival mechanism--then existing systems of legal redress were indeed unfair. By the time memories of traumatic childhood experiences were recovered, the statute of limitations had long since expired. Thus it seemed that the very severity of the injuries was hindering victims' access to justice. Under Washington's new statute, sexual abuse survivors would have three years to sue for damages after the abuse was remembered.

The new law had been pioneered almost single-handedly by a Washington couple. After Patricia Barton recovered her memories of being molested by her father and learned of her powerlessness to sue, she and husband Kelvin lobbied state legislators for years until somebody listened. Their success in getting the law changed seemed like a grassroots victory over a system that has often been proved indifferent to domestic abuse, particularly against women and children. I spoke with the Bartons, wrote a short news story about their case, and ran it in Changes. To my lasting chagrin, I headlined the article "Abuse survivors sue perpetrators"--mainly because I could not fit the word alleged into the available headline space. But, hell, it was a survivor's magazine and I figured no one would care.

No one did. I forgot about sexual abuse survivors and their recovered memories and proceeded to work on the other dozens of stories on my plate. Along with Changes, my employer, Health Communications, Inc. (HCI), also published a monthly newspaper for addiction professionals and a magazine for family therapists interested in addiction issues. Similar to the stories of recovered memories of abuse, the topics covered in these publications attracted their share of controversy.

By the early 1990s, the 1980s-inspired "war on drugs" had lost some of its luster as a social cure-all or even as a workable idea. Highly visible figures such as William F. Buckley and Baltimore Mayor Kurt Schmoke were openly advocating a once-unthinkable strategy of legalization for at least some drugs. On the so-called demand side of the equation, a $2-billion-a-year treatment industry found itself suddenly tottering under increased pressures brought on by market saturation and managed care. Hospital-based treatment chains were going bankrupt, and those that would survive were scrambling for creative ways to fill empty beds.

Thus in the early 1990s, whether as a result of inspiration or financial need, co-dependency emerged as a watchword for mental-health consumers, as did sex addiction, workaholism, eating disorders, and original pain, among other afflictions, diseases, and dysfunctions. No one came right out and said that being a man or a woman qualified one for treatment; although one would have thought so, judging from the proliferation of books, tapes, and conferences offering help for "women's issues" and later "men's issues." With each successive wave of books came fame and popular credibility for a fairly small pool of authors, mostly therapists with master's degrees, punctuated by the occasional M.D. or Ph.D. psychologist.

Instead of setting trends through experimentation and research, however, many treatment programs appeared to follow the public's lead, offering programs for whatever issues were selling in the newly created "Addiction and Recovery" bookstore category. On the afternoon talk shows, a generation of alcoholics apologized to their children, followed by the next generation of adult children confronting their parents with traumatic memories, multiple personalities, and tales of satanic slaughter. The more popular self-help book authors--or "recovery stars," as I call them--marketed the idea that readers were sick in ways they did not realize, the more each new wave of sickness was said to "underlie" previous diseases: codependency underlies addiction; original trauma underlies codependency.

I watched these developments with fascination and a vague dread for the future. Codependency didn't come about as an outgrowth of universally accepted addiction knowledge. On the contrary, most of the addiction field's fundamental claims had been hotly debated in academic and medical journals for decades. Even today, addiction scientists can scarcely determine who is likely to become an alcoholic or drug addict, which addicts can stop on their own, and who needs what kind of treatment.

Important gains have been made in understanding the reinforcing properties of alcohol and drugs on the brain, to be sure, yet no one seems to know why some people tend to abuse substances more heavily than others, despite similar genetic makeups and social backgrounds. Without a priori knowledge of who becomes an alcoholic, existing definitions border on the tautological: If you ask the question, "Why does this homeless man drink the way he does?" and I reply, "He drinks that way because he is an alcoholic!" I have not provided an explanation so much as a restatement of what was already known: that alcoholics drink heavily and chronically, and that this individual apparently drinks in the same manner. It is equal to saying, "These furry rodents drown themselves each year because they are lemmings!" or "This man raped thirteen women because he is a serial rapist!"

Tautologies are considered meaningless because they offer no information other than what is already known. A genuine explanation might involve the biological processes that cause lemmings to migrate in the first place, or a portrait of a serial rapist's psychological world and his underlying beliefs about women. At least that would carry more weight than a label.

If medicine cannot diagnose an alcoholic on any basis other than that the person drinks entirely too much and that her or his life revolves around drinking, it is hard to see how the field has, for all of its elegant research and detailed treatment plans, evolved very much beyond tautological explanations for alcoholism and addiction. A disease diagnosis based so much on arbitrary social standards, one still riddled with controversy that can predict only what it already sees, may not represent the bedrock knowledge upon which further speculations should be launched. Yet that is exactly what happened during the late 1980s and early 1990s. Recovery authors created diagnoses with a level of certainty that the alcoholism field's most distinguished researchers do not claim for themselves even now.

If you asked a recovery star about critical reactions to the term codependency, you likely got a wise nod in reply followed by, "Yeah, but I'll bet people were saying the same thing about alcoholism in the 1930s." Meanwhile, the list of "isms" and dependencies continued to grow: religious addiction, rage-aholics, and the disease of control. From the inside it became difficult to determine whether the recovery field was making exciting discoveries (as we at HCI often wrote a bit disingenuously) or was clambering after new diseases as insurers discontinued paying for old ones.

But then recovery had always been a field of dreams. At the first conference I covered for Adult Children of Alcoholics (ACoAs) in 1987, HCI went all out and placed a merry-go-round inside the Sheraton Twin Towers in Orlando, Florida. More than a thousand conventioneers wandered the hotel ballrooms and exhibit area for three days, some of them clutching teddy bears so that their "inner children" would feel safe. I watched as adults in pajamas gathered around two HCI authors for a scheduled event called "Bedtime Stories for Adult Children."

For someone who had spent the previous eight years in heavy construction work (my philosophy degree qualified me for little else), this was admittedly a strange sight. But it was my first conference and I was thrilled at the chance to be turned loose, writing about whatever I saw fit to cover. I, too, felt a keen sense of excitement, a sense of being in on something big.

The term adult children was originally short for Adult Children of Alcoholics. It came about partly cause of the growth of what I call the expanded recovery movement: the problems and long-term effects of growing up with alcoholism. As the movement grew through skyrocketing book sales and a burgeoning treatment industry offering services for an ever expanding client base, adult children became shorthand not only for children of alcoholics but also for adults who were brought up in other types of "dysfunctional families."

I sometimes fumbled over introductions when calling strangers on the phone. I would tell people I was writing a story for Changes, a magazine for adult children of dysfunctional families. We did not mean to imply, of course, that our readers were in some way children. We were simply affirming their past so that they--and we--might all get on with a happier future.

Despite the awkwardness in attempting to describe what we were doing, these were heady times. At conferences, book authors frequently introduced each other as brave "pioneers" who had climbed many a conceptual mountain, crossed the bleakest of funding deserts, and weathered a storm of skepticism along the way. One prominent recovery star presented a slide show, complete with graduation march music and childhood photographs of founding board members of the National Association for Children of Alcoholics.

Thus we had a movement characterized by both zeal and compassion, offering a wealth of genuine insights combined with oversimplification and overdiagnosis. It was a time of quasi-religious certainties as well as bone-chilling doubts about the most fundamental concepts of trauma and repression, addiction and recovery, even the meaning of family. A national concern over drinking and drug abuse had led to related problems until it arrived at buried trauma and an epidemic of questionable recovered memories of sexual abuse.

Though many of these may seem unrelated, it turns out that the same people were present throughout the period. The same hospital chains that had treated addiction patients in the late 1980s treated patients for repressed trauma in the 1990s. And the onslaught of new illnesses to be treated, from codependency to satanic ritual abuse, conveniently came at a time when funding for addiction services had begun to dry up.

But finally the movement's march from recovering alcoholics to recovered memories was slowed by recent developments. The tide of public opinion began to turn away from the uncritical acceptance of survivor stories, no matter how deeply buried or long endured they were said to be, when advocates for the accused managed to impress upon Americans that there was another side to the story: a side that could render the phenomenon of recovered memory even more tragic than first imagined. This process, however, took several years.

Today, most experts still acknowledge the possibility that some traumatic incidents can be repressed. But they also understand that it has yet to be scientifically proved that years of continued sexual abuse can be forgotten. Meanwhile, evidence has increased that humans can produce false memories. The result has been a shifting definition of what it means to "err on the safe side." This phrase was once used by recovery-oriented therapists to explain why they encouraged their patients to recall long-hidden memories; that others (and the patient) might suffer unnecessarily if these "recalled" incidents had never happened seemed irrelevant, unlikely, and not the therapist's concern.

A flood of investigative media coverage, as well as several sizeable judgments against therapists in lawsuits brought by former patients, helped remove this attitude of indifference. Today erring on the safe side means examining the substance and background of each previously buried allegation of abuse. This entails taking into account the fertile soil that still exists for false recall in the form of popular books and films, inflated statistics of the prevalence of abuse, therapists using suggestive techniques, and a network of survivors and survivor-oriented feminists who regard the memory issue as one more example of society's unfairness to women.

I am not saying that the recovery movement--beginning with alcoholism and expanding to all varieties of family dysfunction--is solely responsible for the outbreak of very questionable memories of sexual abuse. The movement has, however, emphasized that recovery is a series of interconnected subjects beginning with addiction and mental health but encompassing unique ideas about family and spirituality powerful enough to influence an entire culture. One cannot address any part of recovery without soon encountering a larger connected body of ideas, the end of which appears almost limitless.

The idea of survivor spirituality seems to include a kind of deification of children--their innocence, honesty, and purity. Skeptics of a witchhunt, whose victims included daycare workers, were told in confident tones that "children don't lie" about abuse. But inquiring adults can signal the "right" answers about events that may not have occurred, and children--like adults--respond to these cues. The 1980s and 1990s saw many people imprisoned as the result of testimony tainted by investigator bias. Over time, the "spirituality" of those testifying began to look reckless and vindictive.

Meanwhile, treatment centers based on Alcoholics Anonymous concepts routinely advised their patients to find a "higher power" or take a "moral inventory," untroubled by the contradiction between giving such advice and providing insurance-funded treatment for medical diseases. In the late 1980s, book authors with varying credentials searched for underlying "causes" of addiction and found them in dysfunctional families, low self-worth, or that "hole in the soul" they sometimes called codependency.

By the time recovery stars and their book-buying readers became curious about the causes of codependency, the field was ripe for new discoveries. Health maintenance organizations and other cost-cutting, managed-care operations were transforming healthcare, and one of the first programs to be cut was the automatic twenty-eight-day stay in a treatment center. A wave of bankruptcies heralded the emergence of a new recovery concept called original trauma. That prospective patients could not remember this trauma, which often included years of rape and sometimes participation in heinous criminal acts, could be presented as all the more reason to dig deeper. With recovered memory came an even more fervent attachment to spirituality as a refuge from the unbelieving family.

But then how could recovery from alcoholism or incest not incorporate spirituality, given that recovery is and has always been a movement? Movements offer meaning and the keys to a new identity. How can one not be influenced over time by such self-encompassing labels as addict, bulimic, or survivor reiterated with each new comment: "Hi, I'm still John and I'm still an addict." The subtleties of these mass-produced identities and group-supplied descriptions for who we really are involves a kind of relearning of the world. The intimacy of shared beliefs, along with the reassurance of others to stay introspective and keep "working their issues," have no doubt helped many people to understand themselves better.

But when support becomes control, when spirituality becomes fundamentalism, when medical-sounding diagnoses take the place of reasoned argument and people either understand the truth or are "in denial" of it, then this sometimes admirable recovery movement has slipped a gear.

That, of course, is exactly what happened in the late 1980s as the well-intentioned machinery of broader recovery, through overreach and exploitation, began to break down despite the efforts of AA's founders to protect its organization from outside interests. Yet AA's original principle of "one alcoholic helping another" remained unbroken and sound and continues to supply meaning for thousands of twelve-step groups and others around the world. That is worth remembering--even emulating.

The recovery era was one of rapid expansion followed by a partial collapse, a thinning down, and a rebuilding. Its motives, I believe, were good. Its excesses were both ideological and financial, characterized by compassion and the zeal of a developing movement. Its leaders sought not so much to help sick people get well as to elevate wellness beyond the mundane to a serene and spiritual place. That to elevate wellness necessarily meant to shrink it, while expanding the dominion of disease, was not the kind of problem recovery experts found troubling. Instead they hailed each new wave of pathologizing description--whether of sex addiction, codependency, covert incest, or recovered memory--as an important discovery, capitalizing on it through books, tapes, workshops, and treatment services.

Personally, I was able to put aside my philosophical reservations about all this for years, so long as people were being helped and my own paychecks continued to arrive on Friday. But soon after the story about the Bartons appeared in Changes, I began to hear more and more questions regarding the accuracy of recovered memories. I talked to self-described survivors who had only recently remembered their past abuses, as well as those who had retracted their memories and numerous bewildered family members. It bothered me that HCI's authors--the recovery stars--seemed to be coming down almost unilaterally on the side of "believing the survivors" in an increasingly polarized climate. Eventually doubts about the enterprise in which we were engaged forced me to leave HCI.

Today, in considering recovery's impact on the culture, I think it is important to remember that this movement continues to give emotional support and advice to people who need it. As the commercial success of recovery appears past its peak, its essential core of one addict helping another will remain. The less fortunate aspects--overreach and arrogance, religiosity and contempt for the masses, hucksterism and emotional manipulation--will reappear in the form of some new movement. Like recovery, the new movement will carry as one of its features an attack on methods of analysis and reasoning that would expose its weaknesses. Its articulate leaders will answer questions confidently, with a sense of finality made believable by "new discoveries" that the movement will announce about the human condition. Thousands will join up to be saved, claimed, redeemed, or re-dreamed according to the new vision.

If the purveyors of the new truths in the next great social movement are like their counterparts in the old, they will manage to demonize all questions, criticisms, and doubts lodged against them. Words that have been used in the past--sin, addiction, disease, denial--may or may not be resurrected. Some catch phrase or combination of phrases will emerge and the purpose will be to dismantle dissent. By discouraging analysis, criticism, and dissent, marketers of the next great scheme to heal humanity can present their ideas as established fact, as opposed to a set of highly controversial claims.

When one completely disregards rational standards for evaluating truth claims, there is always a price to pay down the road. Some of these standards are reflected in the questions one might ask of the new claim, such as: Is the claim internally consistent; do its parts interact with each other or do they contradict each other? Are the particulars of the claim verifiable or checkable against any outside data? Do the parts of the new claim hang together in a coherent whole? These are the questions that ought to be asked whenever one sets out to "heal the human condition"--not "Will it be popular?" or "Will it sell?" and not "Does believing in the truth claim seem to help people?"

When sales determine which mental health ideas are considered legitimate, harm to consumers is inevitable. The "spiritual foundation" of AA and other twelve-step groups has always been anonymity, which sanctifies the act of seeking help for a problem or a disease. Anonymity is a kind of guarantee. It says that if you bring your problem to another alcoholic or drug addict you will be given a safe place to begin healing. Who you are on the outside is not important. As an organizational principle, anonymity implies separation from the pursuit of profit--or from anything else that would interfere with the group's "primary purpose... to carry the message to the addict who still suffers."

But profit-making institutions found their way to twelve-step groups long ago and have been exploiting the connection ever since. The profit-making end of self-help and recovery cannot be ignored. My hope is that society will learn from the recovery movement of the last two decades without repeating some of its worst errors.

As a journalist covering the recovery phenomenon, Andrew Meacham followed its evolution from grassroots self-help movement to multimillion-dollar industry. This article is adapted from his new book, Selling Serenity: Life Among the Recovery Stars, published in late 1999 by Upton Books. The author can be reached by e-mail at [e-mail].