Wk4AssignRESOURCE.pdf

TOUGH LOVE:
A Brief Cultural History of the Addiction Intervention

Claire D. Clark
Emory University

Popular media depictions of intervention and associated confrontational therapies
often implicitly reference—and sometimes explicitly present— dated and discred-
ited therapeutic practices. Furthermore, rather than reenacting these practices,
contemporary televised interventions revive them. Drawing on a range of literature
in family history, psychology, and media studies that covers the course of the last 3
decades, this paper argues that competing discourses about the nuclear family
enabled this revival. Historians such as Stephanie Coontz, Elaine Tyler May, and
Natasha Zaretsky have demonstrated that the ideal nuclear family in the post-WWII
United States was defined by strictly gendered roles for parents and appropriate
levels of parental engagement with children. These qualities were supposedly
strongly associated with middle-class decorum and material comfort. By the 1970s,
this familial ideal was subjected to a variety of criticisms, most notably from mental
health practitioners who studied— or attempted to remedy—the problematic family
dynamics that arose from, for example, anxious mothers or absent fathers. After
psychological professionals began to question the logic of treating maladjusted
individuals for the sake of preserving the nuclear family, a therapeutic process
for doing exactly that was popularized: the addiction intervention. The delayed
prevalence of therapeutic interventions arises from a tension between the psycho-
logical establishment that increasingly viewed the nuclear family as the primary
site and source of social and psychological ills, and the producers of popular
media, who relied on the redemptive myth of the nuclear family as a source of
drama.

Keywords: popular culture, addiction, intervention, confrontational therapy, nuclear
family

Senator Walter Mondale: I recall somebody said—
maybe it was you—the cocktail hour had replaced the
family hour.
Dr. Urie Bronfenbrenner: The children’s hour.
Senator Mondale: The children’s hour. Is there any
way to chart that? How do you know?
Dr. Bronfenbrenner: It is very hard to chart that partly
because of the very existence of the neglect of concern
for children and families. Nobody has even been look-
ing. We do not know what the problems are. That is
how deeply they are buried from public consciousness
or even scientific consciousness. (American families:
Trends and pressures: Hearing before the Subcommit-
tee on Children and Youth of the Committee on Labor
and Public Welfare, 1973)

During the heyday of the idyllic postwar nu-
clear family, public visions of domestic prob-
lems were rare. According to historian Natasha
Zaretsky (2007), 1973 marked a moment in
which concerns previously contained within the
home had officially spilled out into the family
therapy session, the streets, and the U.S. Senate.
After an anomalous period of postwar prosper-
ity and (according to Bronfenbrenner’s testi-
mony) the unhealthy repression and denial of
the dangers of its indulgences, middle-class
dysfunction was going public. It has not gone
back.

Alongside these 1973 senate hearings, PBS
debuted the documentary miniseries An Ameri-
can Family, a vérité-style exposé that caused
controversy by jointly disproving Norman
Rockwell and Leo Tolstoy: Beneath every iden-
tically happy American family, the series sug-
gested, is a similar mess of “laughs, tears,” and

This article was published Online First November 7, 2011.
Claire D. Clark, Department of Behavioral Sciences and

Culture, Science & History, Rollins School of Public Health
and Graduate Institute of Liberal Arts, Emory University.

Correspondence concerning this article should be ad-
dressed to Claire D. Clark, Graduate Institute of Liberal
Arts, 537 Kilgo Circle, S415-Callaway Center, Atlanta, GA
30322. E-mail: [email protected]

History of Psychology © 2011 American Psychological Association
2012, Vol. 15, No. 3, 233–246 1093-4510/11/$12.00 DOI: 10.1037/a0025649

233

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“mistakes.”1 The show chronicled an upper-
middle-class nuclear family (the aptly named
“Louds”) in Santa Barbara, California, through-
out the parents’ separation, and concluded with
their eventual divorce. With the entrance of the
Louds, the documented life of the “real” Amer-
ican family became the subject of public enter-
tainment as well as professional inquiry. While
the American public has vacillated between the
desire to view depictions of happy and unhappy
families, the psychological profession has ex-
perimented with various approaches to treating
the problems that arise in real ones. What is the
relationship between popular and professional
visions of the development of the postwar
American family?

Family historians who concentrated on the
“inward turn” and “domestic containment” that
accompanied White class mobility in the 1950s
noted TV’s role in promoting consumerism
along with idealized insularity.2 Betty Freidan
(1963) famously observed that this consumer-
ism also included psychiatric services, espe-
cially for discontented mothers and wives. In
contrast, media historians have documented
how scientific researchers and professional ex-
perts (including psychologists) used a variety of
media to “educate” the public over the course of
the twentieth century. These historians analyzed
how technological development, economic in-
frastructure, and government regulation have
influenced the content and form of psycholo-
gists’ messages.3 So far, stories that have
combined these two narratives have usually
concluded that as society became more media-
saturated, the information conveyed by media
became more spectacular, and that, in general,
this phenomenon had a negative effect on both
individual psychology and family life.

How did this argument work? Partly by sug-
gesting that the cocktail hour and the TV set
worked in concert, dulling the senses and pro-
moting interfamilial distraction rather than con-
nection. In his testimony, Brofenbrenner noted
a study that recorded audio in middle-class
homes and found that children heard their fa-
thers’ voices less than 40 times a week. In the
1950s and 1960s, family therapists increasingly
stepped in to address disequilibrium in families
rendered dysfunctional by, for example,
avoidant-dismissive mothers or absent dads. For
both left- and right-leaning historians, these
“helping” professionals only exacerbated the

problem by continuing to encourage a psycho-
logical outlook that was both self-centered and
overly reliant on the external validation pro-
moted by hyperconsumerism—what Christo-
pher Lasch (1979) later described as a “culture
of narcissism.”4 Screen-cultures scholar Lynn
Spigel (1988, 1992) describes how the physical
presence of the TV in the postwar American
household supported this psychological out-
look. Promoted as a “window on the world,” the
TV allowed families to look “out” at places and
products that represented the good life, and en-
couraged viewers to imagine similar families
across the nation who might be sharing the
experience of TV-watching in their own living
rooms. At the same time, the window metaphor
also implied that the TV might be a way for
other people to see into the once-private space
of the family home.

In the 1950s, the people who wanted to get
into the family home via TV were not, on the
whole, interested in cold war spy tactics or even
Bronfenbrenner-style observational micro-
phones. They sought to impart knowledge, not
to observe domestic behavior. TV historian
Anna McCarthy (2010) shifts the scholarly at-
tention away from the “proverbial living room
to the boardrooms of the Waldorf Astoria,”
where elite businessmen and professionals
imagined the TV set as a legitimate way to

1 The TIME magazine cover story, from which these
quotes were drawn, was titled “Show business: A sample of
one?” (1973). The invocation of the language of social
science in reference to reality-based television, as well as
the relationship between this genre and sociology and an-
thropology, is explored in Simon (2005). The changing
definition of reality television in general is explored in the
collection in which Simon’s article is featured: G. Edgerton
and B. Rose (Eds.), 2005, Thinking outside the box: A
contemporary television genre reader, Lexington, KY: Uni-
versity of Kentucky Press.

2 See Elaine Tyler May (2008) for a discussion of “do-
mestic containment” and Stephanie Coontz (2000) for a
discussion of how television promoted an unrealistic, in-
ward-looking, and nostalgic vision of the nuclear family.

3 For a discussion of the co-optation of scientific exper-
tise by the “superstitious” and sensationalistic twentieth-
century mass media, see Burnham (1987). For a discussion
of the details of the production of scientific programming on
radio and television, see LaFollette (2008).

4 On this point, Lasch agrees with Coontz and May,
though they are more concerned about the substitution of
consumerism for political action than its role weakening
individual psyches and wills (or the effect this weakening
has on the “haven” of the nuclear family).

234 CLARK

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educate, inspire, and shape democratic citizens
(p. 9). Whether sponsoring debates about deseg-
regation or demonstrations of “better living
through chemistry,” TV, in its early years, could
be used by elites for the good of the hypothetical
public. Some of these goods were unabashedly
psychological; demonstrations of group therapy
techniques, for example, were broadcast as part of
the “public service” program The Johns Hopkins
Science Review. While dramatizations of the psy-
choanalytic “talking cure” had been a prominent
feature of Hollywood films such as The Snake Pit
(1948), the initial appearance of psychological
techniques on TV was distinguished from these
cinematic depictions by their didactic format, the
prominence given to actual scientific or psycho-
logical professionals, and the intimate positioning
of the screen inside the homes of the intended
audiences who were supposedly dutifully recep-
tive of the programs’ messages.

Whether spectators were actually so dutiful is
debatable, but changes in government regula-
tion and ownership of the airwaves brought
about the end of the “American viewing pub-
lic,” which splintered into demographic “mar-
kets.” The “technocratic elites” of the postwar
period lost their monopoly (McCarthy, 2010, p.
7). As a result, station programming became
saturated with sitcoms (1970s), syndication
brought talk shows (1980s–1990s), and cable
networks introduced “reality” programming
(1990s–present). Although it has been credited
as the first “reality show,” An American Family
(1973) aired at a time when this process of
deregulation was underway, but well before the
less restrictive cable TV labor market began to
influence production. While produced and dis-
tributed under different conditions than the talk
shows and reality programs that would follow
it, the documentary series was received, both
then and now, as a prescient indicator of later
cultural and familial shifts.5 As Natasha Za-
retsky (2007) noted, beginning in the 1970s,
“fears about the fate of the family shaped de-
bates about American national decline, and
fears about the nation’s future were mediated
through the family” (p. 17). While Zaretsky
(2007) examines challenges to the trope of the
ideal nuclear family, I focus more clearly on the
conditions in which this “mediation” took place
and the roles played by the cooptation (or dra-
matization) of psychological practice in this
process. Changes in the production and distri-

bution of popular representations of psycholog-
ical practices has meant that credentialed prac-
titioners have less control about the ways in
which their methods are portrayed. Yet these
portrayals have presumably affected the profes-
sional landscape; for example, public interven-
tions are often accompanied by exhortations to
seek private psychological assistance via help
lines, self-help books, or residential rehabilita-
tion facilities. Surprisingly, a series of discussions
of these addiction interventions suggest that,
rather than contributing to the ideas challenging to
the nuclear family, TV’s distorted adoption of
psychological practices has worked to recuperate
the familial ideal of midcentury. The nuclear fam-
ily ideal was defined by Elaine Tyler May (2008)
as the unrealistic belief that “family life in the
postwar era would be secure and liberated from
hardships past”; that “affluence, consumer goods,
satisfying sex and children would strengthen fam-
ilies, allowing them to steer clear of potential
disruptions”; and that “adhering to traditional gen-
der roles and prizing material stability” was the
best path to the good life (p. 14).

The addiction intervention is a staged en-
counter that brings to the surface the tensions
that were both dulled and exacerbated by the
proverbial “cocktail hour.” Perhaps because
confrontational therapeutic techniques have
largely fallen out of favor in professional psy-
chological practice, scholars have been reluc-
tant to recognize the persistent prevalence of
depictions of the intervention as an appropriate,
if overly dramatic, therapeutic strategy. Taking
an approach that might be broadly termed “cul-
tural studies,” this paper combines cultural his-
tory’s concern with the discursive tension be-
tween the public and private spheres with a
“history of ideas” approach that traces the ap-
pearance of a concept (the addiction interven-
tion) through a series of historical moments
(Lovejoy, 1936). Rather than offering an ex-
haustive account of every representation of the
therapeutic “intervention”— or even every in-
tervention technique—this paper identifies and
analyzes key “moments” in which variations of

5 Print and television advertisements for Cinema Verite,
HBO’s April 2011 docudrama based on the series, dubbed
it “the first reality show” and opened with a series of
intertitles contextualizing the appearance of Louds within a
series of significant historical events, including the Vietnam
War.

235TOUGH LOVE: A BRIEF HISTORY OF THE ADDICTION INTERVENTION

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the psychological practice have been reenacted
in popular and televisual culture.6

Focusing on confrontational therapies and the
addiction intervention, this paper details three
instances in which the popular media’s adoption
of these techniques served to recuperate the
status of the fragmented nuclear family (both
specific and archetypal) in which the confron-
tations took place. I begin with Betty Ford’s
addiction intervention, which, 10 years after the
professional technique was generated, first
brought the concept of the intervention into
popular consciousness. I continue with an anal-
ysis of daytime talk shows of the 1990s, reading
these as a throwback to confrontational encoun-
ter therapies of the 1970s. I argue that, origi-
nally, these therapies provided a way to refor-
mulate new visions of family or to cope with the
widespread loss of long-term committed rela-
tionships; when the confrontational therapeutic
tactics later reemerged in popular culture, how-
ever, they were instead used to police, rather
than challenge, the normalized nuclear family.

In these cases, the distinctions between the
private space of the nuclear family home and
the public sphere of popular media discourse are
complicated in significant ways. Throughout
my discussion, I demonstrate that popular me-
dia has used the rhetoric of space to dramatize
the dysfunctional power dynamics of the “pri-
vate” families being represented and that this
visibility signaled the vulnerability of the ideal
nuclear family in general.7 This discussion of
space culminates in my final example, which
examines intervention-based reality shows,
such as A&E’s Intervention and TLC’s Ad-
dicted. Scenes in which families screen record-
ings of the bad behavior of the addict in crisis
literalize and affirm the trope of welcome, even
curative, surveillance introduced in the prior
popular iterations of the therapeutic confronta-
tion. I reach the conclusion that, over the past 30
years, the ideal of the nuclear family was ex-
ploited as popular culture reversed the course of
psychology’s challenges to it.

Vernon Johnson, Betty Ford, and the
Double Bind in the Nuclear Family

On Saturday afternoon, April 1, 1978, former
First Lady Betty Ford was pacing across her
home in Rancho Mirage, California, contem-
plating phoning her son and daughter-in-law in

Pittsburgh, when suddenly they appeared at her
front doorstep. What seemed, at first, to be a
pleasant surprise, then, moments later, a humor-
less April Fool’s Day joke, became an entirely
solemn “intervention.” Additional family mem-
bers assembled, along with a Navy doctor, and
seated themselves in a semicircle in front of
Ford. One by one, her husband, sons, daughter,
and daughter-in-law recounted Ford’s failures
as both mother and public figure, and connected
these lapses to her dependency on alcohol and
prescription pain medication: She slurred her
words at the ballet; she was unavailable to baby-
sit her grandchildren; she refused to come to the
dinner table when called, preferring instead to
finish her cocktail by the TV. The accumulation
of sins, delivered with accusatory compassion
by those closest to her, caused Ford to “collapse
into tears,” admit that she needed help for
chemical dependency, and accept the aid of-
fered by naval doctor Joe Pursch, head of the
Alcohol and Drug Rehabilitation Service at
Long Beach.

Later, after emerging from the facility at
Long Beach that would come to bear her name,
Ford would justify and contextualize the event
using the rationale of a particular branch of the
addiction treatment industry. Her description
became both popular archetype and the how-to
manual for the addiction intervention, a con-
frontational therapeutic technique first pro-
moted by Episcopalian minister Vernon John-

6 The dramatic mode of the intervention has expanded
from Vernon Johnson’s (1990) model, which concentrated
on alcohol and drug users in nuclear families to include
confrontations by family, friends, coworkers, and others
about “strange” addictions, inappropriate clothing choices,
real estate listings, and school lunches.

7 Academic debates on the rhetoric of space are wide-
ranging and multidisciplinary; indeed, they encompass en-
tire fields (architecture and cartography, for example). For
our purpose here, a crude summary of literature in critical
theory views space as a construction, a concept that links
more concrete “places” (such as “living rooms” or “subway
stations”) by the process of categorical “spatialization.”
These representational linkages might come in predictable
forms, such as maps, but they can also be conveyed through
language, staging, or classical Hollywood editing. Who is
granted access to particular spaces, and how they move
through them, can be indicative of other categorical power
dynamics (between people of varying races, genders, or
abilities, for example). This paper follows Jürgen Haber-
mas’s (1962) well-known distinction between public and
private “spheres,” and builds upon subsequent studies of
their gendered associations and dimensions.

236 CLARK

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son almost a decade earlier. In her autobiogra-
phy, Ford (1978) wrote, “The thinking used to
be that a chemically addicted person—whether
on pills or alcohol— had to hit bottom, decide
he wanted to get well, before he could begin to
recover; but now it’s been demonstrated that a
sick person’s family, along with others signifi-
cant and important to the patient, can intervene
to help him despite himself” (p. 281).

Although Ford’s name was already associ-
ated with one public health cause— cancer
awareness—following her hospitalization at
Long Beach, “Betty Ford” became synonymous
with addiction rehabilitation facilities. Ford’s
intervention did not occur on TV, but it was
recounted in her autobiography and later dra-
matized in a made-for-TV movie. Therefore, as
a public event, it provided a model for later
portrayals of the addiction intervention. Fur-
thermore, the narrative’s conclusion in Ford’s
successful residential treatment, and her subse-
quent support of treatment centers, implicated
the psychological profession and suggested le-
gitimacy for the intervention’s rhetoric. The
addiction intervention, and popular representa-
tions of confrontational therapies more gener-
ally, are as much about saving the ideal of the
nuclear family as they are about “helping the
addict despite himself.” Indeed, feminist
scholar and cultural theorist Helen Keane
(2002) has argued, “In spite of the concern with
the authentic inner self and its destruction by
addiction, this intervention [was] largely about
Mrs. Ford’s failure to keep up appearances and
meet her maternal and wifely duties. According
to this irrational but omnipresent fear of surveil-
lance, Ford’s lapses at both the public ballet and
in the privacy of her living room were equally
damning. The Ford family seemed to be accus-
ing her not so much of being an addict, but of
letting her addiction show and interfere with the
smooth running of their lives” (p. 83). The
smooth running of their lives takes place, mean-
ingfully, within the home, which becomes both
the subject of inquiry and the setting in which
the drama of confrontation unfolds. The scene
of Ford’s domestic intervention references TV,
both explicitly and implicitly. Ford’s recollec-
tion that the semicircle formed by her concerned
family members during her intervention re-
mains “burned in her brain” resonates with Spi-
gel’s (1992) discussion of the postwar “family
circle,” featured in popular photography as a

family of TV viewers “grouped around the set
in semicircle patterns” (p. 16). TV watching
was thus framed as a “family activity” and the
“cement” that would solidify families previ-
ously separated by the war. As Keane (2002)
explains, these familial, gendered expectations
create the drama that the staged addiction inter-
vention resolves.

Keane (2002) concentrates on the interven-
tion as it appears in a kind of classical form and
deconstructs the paradox outlined in the script
presented in Johnson’s (1990) “complete guide
for families,” entitled Everything You Need to
Know About Chemical Dependence. Keane
(2002) notes that, according to Johnson’s script,
placing the addict in the center of the semicircle
encourages scrutiny that assumes wrongdoing.
The subject of the intervention is not allowed to
“to have her own equally true stories to tell
about the betrayals, disappointments and bad
behavior” (p. 81). But Keane’s observation that
the intervention removes the complicated fac-
tors of “contradictory and conflicting versions
of reality operating simultaneously, interwoven
with webs of power, resentment and love”—and
that these factors are present in “even the most
functional of families”— has a historical prece-
dent in psychological trends in family systems
therapies that emerged after World War II.

Deborah Weinstein has argued that, during
the 1950s and 1960s, the concept of culture had
traveled beyond the disciplinary boundaries of
anthropology and sociology. The “culture con-
cept” played “an integral role in the processes
by which family therapists simultaneously de-
fined the object of their research and treat-
ment—the family—and built their new field”
(Weinstein, 2004, p. 23). Seminal family ther-
apists such as Nathan Ackerman, Murray Bo-
wen, and Don Jackson employed the concept in
a variety of contradictory ways that, Weinstein
claims, demonstrates tensions between “views
of family therapy as a conservative force for
maintaining the nuclear family or a progressive
force for overcoming social inequality.”

A comprehensive overview of the field of
family therapy is neither practical nor relevant
here, but despite their contradictory philoso-
phies, family therapists of the 1960s generated
several significant concepts about family sys-
tems that were largely ignored by Johnson and
omitted from popular portrayals of the Johnson-
style intervention. Murray Bowen (1978), for

237TOUGH LOVE: A BRIEF HISTORY OF THE ADDICTION INTERVENTION

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example, advanced the category of the “desig-
nated patient.” In Bowen’s formulation, a “des-
ignated patient”—unlike the addict in the typi-
cal intervention—should be viewed as the
symptom, rather than the sole source, of the
family’s problems. Mental health practitioners,
later associated with what was called the antip-
sychiatry movement, made similar contribu-
tions to a growing body of research that viewed
the family system itself as a source of sickness
and potential site of therapeutic intervention.
Prominent among this literature was the theory
of the “double bind,” advanced by, among oth-
ers, R. D. Laing. This theory of the double bind
argued that repeated, inescapable exposure to
messages that contradicted each other at differ-
ent levels of communication (for instance, a
parent criticizing a child for not expressing love
then withdrawing physically when the child did
express affection) might produce serious psy-
chiatric problems, most notably schizophrenia.

For example, in Laing and Esterson’s Sanity,
Madness, and the Family (1964), they argued
that many families maintain lies so strongly that
vulnerable children or individuals become un-
able to accurately discern the reality of their
situation or basic facts about the world around
them. In this formulation, neither the family nor
the vulnerable “patient” has unassailable access
to the “truth”; only the therapist does. But in a
near-nihilistic twist common to countercultural
antipsychiatry, this expertise withholds the up-
beat promises of familial homeostasis promoted
by Bowen (and, later, Johnson). Although os-
tensibly configuring the family as a legitimate
object for treatment by mental health profes-
sionals, theories like Laing’s also confirmed the
bleak suspicion, reflected in rising rates of de-
linquency and divorce, that nuclear families that
were not working should call into question the
rationale for preserving the family in general.

Although psychological ethics maintains the
confidentiality of practitioner– client sessions,
both conservative and progressive family ther-
apies (as defined by Weinstein, 2004) chal-
lenged the boundaries between the private space
of the family household and the public sphere.
Some “progressive” family therapists of the
1960s and 1970s believed that strong nuclear
families and corresponding forms of social co-
hesion could serve a protective …

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