Nursing Clio is pleased to speak with Claire D. Clark, an assistant professor of Behavioral Science and History at the University of Kentucky. Claire’s new book, The Recovery Revolution: The Battle Over Addiction Treatment in the United States, traces the marketing of therapeutic community (TC) addiction treatment from its origins in Synanon, a controversial California commune. The Recovery Revolution shows how “ex-addict” TC activists transformed mutual aid into both a product and a powerful political symbol that ultimately supported the impossible dream of a drug-free America.
Jacki: Claire, I have a confession to make: I feel quite ashamed that as a medical historian, I had never heard of Synanon before. But after reading your book, it becomes clear how influential this group was in modern-day addiction treatment. How did you come to choose Synanon as a focal point for the book and why do you think people have sort of forgotten about them, as opposed to other groups like Alcoholics Anonymous?
Claire: When I started graduate school, I had never heard of Synanon either (I later discovered there was quite a lot of literature on the organization from the perspectives of religious studies, memoir, and journalism). I came to the history of medicine from a background in media and cultural studies, and went to graduate school with vague plans to study “therapeutic culture,” which I had narrowed — somewhat — to a focus on addiction treatment and recovery by the time of my application. It quickly became evident that covering the entire history of addiction treatment in America was going to be impossible to do in the course of a single PhD program.
When I learned about Synanon during my first year in grad school, I realized that it could be a good entry point for discussing various treatment eras and movements throughout history. That’s because Synanon’s early campaigns in the late 1950s and early 1960s revived a Victorian “moral” model of treatment (which reigned in the late 1800s), commodified and made confrontational the sharing process that characterized twelve-step groups (which were growing in prominence throughout the 1940s and 1950s), and challenged the limited treatment establishment of the day, which consisted of a few psychiatric hospital programs and the federal “Narcotics Farms” in Fort Worth, Texas and Lexington, Kentucky.
More importantly, although Synanon ultimately turned inward and devolved into a violent cult — which is how it is generally remembered today — some of the people in recovery who left or fled Synanon founded other treatment centers called therapeutic communities (TCs) and became influential players in debates about drug treatment and policy at the end of the twentieth century. The book uses TCs as a lens through which to examine those debates.
Jacki: One thing I found fascinating is your discussion of Synanon and race and gender, especially in the midst of the Civil Rights Movement in the 1960s. Can you talk a little bit about that?
Claire: I think there’s still much more to be written about that! The notion in contemporary recovery circles — that addiction doesn’t discriminate, and therefore recovery can be a great leveler in which people from different demographic groups learn to identify with one another and find common ground and support — has its origins in the 1960s. One of the key points in the book is that the 1960s are a moment in which a kind of identity politics begin to develop in relation to people in recovery (at the time, they identified as “ex-addicts” or “ex-alcoholics”). In recent decades, the “recovery movement” has re-interpreted the twelve-step tradition of anonymity as meaning that people can speak publicly about being in recovery as long as they don’t explicitly identify as being members of a particular recovery organization.
The history of “ex-addict” advocacy of the 1960s and 1970s suggests that there can be drawbacks to using personal recovery stories as a platform for treatment advocacy: it places a tremendous burden on people who may already be in a fragile psychological state, and it may encourage the public to view addiction and recovery through the counterproductive narrative of sin and redemption. Perhaps the greatest danger is that personal stories can be co-opted to serve almost any political agenda or treatment approach. Testimonials from people in recovery don’t necessarily lead to more progressive or humane drug policies — they can also be used to bolster arguments in favor of punitive approaches such as imprisonment or abusive therapeutic tactics.
Jacki: In telling this story of addiction treatment in the United States, you draw upon a rich amount of sources — traditional archives, visits to treatment centers, and oral histories — I was wondering if you could discuss your methodology and maybe the benefits or difficulties in accessing and then using these sources?
Claire: Of course. The book primarily focuses on the way addiction treatment was marketed by treatment advocates and then received by people in positions of authority throughout this period. I found that marketing tropes that had origins in Synanon were taken up by players on both the political Left and Right.
The focus of the book is on how addiction treatment was sold, not on which treatment model objectively “works.” Analyzing an ad campaign is not the same thing as endorsing a product; the chapters about the marketing of treatment are, tellingly, titled “Selling Synanon,” “Selling the Second Generation,” and “Selling a Drug-Free America.” I was thorough in the use of sources because I wanted to feel confident that the tropes about the TC treatment model could be traced through different treatment centers, stakeholders, and across time periods (qualitative researchers sometimes call this “saturation.”) Perhaps most importantly, I saw that time and again, people who were in recovery played an active part in shaping messages about addiction treatment, both behind the scenes and on the public stage.
None of the archives or treatment centers I consulted reviewed the manuscript as a condition of granting permissions. When I think about the book today, I can imagine writing one history that is much more laudatory, and another that is much more critical. I came to believe that preserving the primary source material so that other questions could be explored in the future was even more important than the history I chose to write.
I view the recovery movement as a social movement; the book demonstrates how recovery revolutionaries ultimately made concessions, as disempowered and stigmatized groups often do, in exchange for political support and legitimation. But there are other viewpoints that could be used to interpret this story and, as is the case with all recent history, more material will hopefully be discovered, explored, and preserved. I’m looking forward to seeing how other researchers take the topic in different directions.
Jacki: Is there any particular story or interesting anecdote from your research that didn’t quite make into the book?
Claire: There are a couple. The book has been criticized for not recounting Synanon’s decline into violence, which I avoided in an attempt to prevent the book from being read as an institutional history of the rise and fall Synanon — of which there are already many in existence. I encourage people who are interested in that history to check them out.
The book could also have been more richly biographical or have probed more deeply into the backstories of TC leaders. But I felt uncomfortable taking that approach, especially since, through my research, I became critical of the ways in which the intimate details of the lives of people in recovery could be placed in the service of other narratives.
I want the people who took part in this history to retain ownership of their life stories, and I hope they’ll continue to articulate their perspectives in oral histories, archival collections, documentaries, and memoirs. But The Recovery Revolution primarily uses quotes from treatment leaders to illuminate public debates about the nature of addiction or the value of particular treatment approaches, rather than the life stories or psyches of treatment advocates.
Jacki: What’s next for you in terms of your research?
Claire: Right now, I must admit, I’m pretty exhausted with treatment history. I started my career as an educator and am thrilled to be in a faculty position where I spend most of my time on teaching and educational programming. I’m particularly interested in finding ways to integrate the study of the humanities and health sciences, and am currently working on producing teaching resources and research for instructors working at the intersection of those areas.