In the age before television, people looked for entertainment in some strange places. One was psychiatric hospitals, which came into vogue when the famous London hospital known as Bedlam opened its doors to visitors in the 16th century. The official reason for asylum tourism was moral improvement: witnessing the misery of “lunatics” was supposed to show people the fate that awaited them if they over-indulged in vice or emotional excess. Those who didn’t need to be scared sober would gain by feeling sympathy for the afflicted, as such tender emotions were thought to refine a person’s character. By the 19th century, visitors also cited educational and aesthetic rationales: to learn about the treatment of mental illness and to appreciate the well-designed institutions where healing took place. But underneath these lofty sentiments lay baser motives. Wrote one 18th-century tourist of Bedlam:

On holidays numerous persons . . . visit this hospital and amuse themselves watching these unfortunate wretches, who often give them cause for laughter.

In other words, crowds came to mock the inmates and enjoy spectacles of shattered humanity. There was nothing ennobling in their pleasure, just the cruel excitement of watching a freak show.

Though asylum tourism officially ended early in the last century, we shouldn’t conclude that we’re more enlightened now, as its basic impulses survive in reality television. No, we don’t send reality TV crews into psychiatric hospitals, but, outside of hospitals, people with mental illnesses make regular appearances on shows such as Cops and Dr. Phil, exciting the same blend of shock and amusement that lured Bedlam visitors for three centuries. But reality TV producers pay a price for training their cameras on the mentally ill, enduring regular criticism and even an occasional lawsuit. Fortunately, there’s one group of “lunatics” that reality TV can exploit without anyone batting an eye: people struggling with addiction

It doesn’t matter that six in ten people with addiction also suffer from a mental illness or that even most of the non-ill have histories of trauma severe enough to make a serious addiction, with all its problems, preferable to unbuffered awareness. These facts are well-documented in scores of peer-reviewed studies, yet public opinion continues to regard addiction as a poor lifestyle choice with a simple, obvious fix. A person can’t quit schizophrenia or Alzheimer’s, the thinking goes, but can quit heroin or alcohol, so throw some popcorn in the microwave because it’s time to watch the self-inflicted lunacy on Intervention.

One enthusiastic fan is humorist David Sedaris, who wrote a valentine to the show for The New Yorker in 2017.[1] Mr. Sedaris is the quintessential Intervention viewer, and I mean “quintessential” in its full alchemical sense. He is the most refined of viewers, the philosopher’s stone who turns the lead of the ordinary viewing experience into the gold of literature. At the same time, he is a typical fan, and it’s his typical fandom that he presents for the amusement of his readers, the elite sophisticates who subscribe to The New Yorker. He expects them to find his lowbrow enthusiasm so droll that he won’t have to strain for laughs, just mention a few shocking instances of addict behavior.

In one example, Mr. Sedaris marvels at footage of a drunk woman defecating on a car. Does he say anything witty about the woman? No, he expects the educated, urbane New Yorker reader to laugh at the mere idea of addicts defecating on cars while cameras are rolling.

“Did you catch me on TV?” I imagine them saying to their friends. “Wasn’t it incredible when I shit on that car?”

The title of Mr. Sedaris’s essay is “Why Aren’t You Laughing?” Only three columns in, and I believe I have an answer for the author. He is laughing, however, laughing at the poor woman who defecated on the car, and I can’t see a lick of difference between his amusement and the 18th-century laughter at the zany antics of the mentally ill.[2]

For those who have somehow missed Intervention, let me describe the series, while the rest skip ahead to the next section. Each episode normally features one or two people suffering from an “addiction.” My quotation marks reflect an ongoing debate about how far to extend the concept of addiction, with Intervention an enthusiastic member of Team All the Way. On the show, addictions range from heroin to shopping to rage, but the majority of episodes feature substance abuse, with alcohol tops and heroin a close second.

Episodes follow a strict sequence. They begin with a little preview and the promise that the addict[3] has been fooled into participating in a fake “documentary on addiction.”[4] Then the scene is set, starting with slides of the addict’s town or city. For a moment, the addict appears in a positive light; then the background music grows ominous, and the addict starts to drink or brawl or shoot up or whatever. (Throughout the show, the background music is loud and very bossy.) White letters on a black screen mention alarming facts; then the letters blur and disappear as though electronically rubbed out. A relative predicts that, without help, the addict will die.

The music turns sweet again to accompany a bulletin board of childhood photos. Shown wholesome snapshots in chronological sequence, we learn that the addict was a happy baby and an exceptional child. At some point in the sequence, often in the teen years, the music darkens again and an unsmiling photo appears. Something bad happened, we learn, something that got the addiction rolling, maybe not right away but eventually.

After that, for most of the show, the camera cuts back and forth between extreme addictive behavior and loved ones’ concern or anger or exasperation or anguish over the addictive behavior. Occasionally, there is also footage from the addict’s “diary cam.” The producers try to arrange at least one family gathering during filming, especially for addicts who do not live at home. Conflict usually ensues.

Overall, there’s a lot of ostentatious substance abuse and impairment. For a population that is often secretive and ashamed, the addicts of Intervention seem remarkably exhibitionistic about their habits. Commenting on the alcohol episodes, YouTube viewers regularly note incongruities between the amount consumed and the drinker’s behavior, which is often flamboyantly intoxicated after modest intake.[5] At any rate, we see a lot of over-the-top behavior, far more than is necessary to establish the existence—and the nature—of a problem. It really does go on and on: addicts shooting up, staggering around, babbling nonsense, weeping, screaming, fighting, passing out, vomiting, urinating in bushes, and, of course, defecating on cars.

All of this drama leads up to the intervention, when loved ones gather to ambush the addict with an ultimatum: go to treatment right now or face consequences. The consequences, worked out in advance, usually involve cutting off material and social support, even though research shows that such coercion diminishes the prospect of long-term recovery. Orchestrating the whole process is a professional interventionist, a former addict who works in the recovery industry. Interventionists use their own histories to justify a “tough love” approach that bears an uncanny resemblance to bullying.

The intervention scene begins 45 minutes into the hour-long program. In a hotel meeting room or other neutral space, the loved ones wait with the interventionist. In their hands are letters they have written to the addict. The letters range from positive and loving to hostile, nasty, self-absorbed and incoherent. As the addict approaches the hotel to wrap up the fake documentary, the interventionist fires up the loved ones with a pep talk. Then the door opens, launching the first crisis: will the addict stay for the intervention or run away? Most stay, but a few bolt, chased by cameras. Eventually the addict is coaxed back to the intervention and planted on a sofa next to whoever is likely to cry the most.

Accompanied by violins (yes, really!), letters are read, and tears are shed, most by people other than the addict, who is usually angry or withdrawn. The letter-reading process does not always go smoothly; readers ad lib, and arguments sometimes break out. The addict may bolt here, too, requiring a producer or the interventionist to broker a deal to get the addict back to the intervention. More often, after a couple of letters, the interventionist starts asking whether the addict will agree to treatment. This is the second crisis, more protracted than the first but also more dramatic. Some addicts don’t take much persuading; others fight before giving in. A few refuse. If the addict agrees too easily, the scene is edited to create more suspense.

When the addict says “yes,” happy music plays, and everybody hugs. Accompanied by a nurse, if necessary, the addict boards a plane bound for a treatment facility far away in a nice, warm place. Next, we see the entrance to the rehab, which always looks very appealing, like a resort with no guests. A staff member greets the addict by name; then addiction experts sketch out the treatment regimen, which always seems very cutting-edge and tailored to the specific needs of the addict, even if it’s really just a lot of 12-step meetings.

The last scene in each episode shows the former addict looking plumper and better-groomed at the end of a few months in rehab. The addict shares four or five recovery platitudes, each filmed in a different beauty spot around the treatment facility. Finally we read what has happened since the episode was shot, which isn’t always smooth sailing. Nonetheless, episodes tend to end on a positive note with “So and so has been sober since” and a date that is at least a few months in the past.

From beginning to end, Intervention is deeply Manichean; everything is very good or very bad. The town where the addict lives is good. Postcard-y pictures, tourist views: this is a nice place. Where the addict hangs out is bad: a filthy room, a seedy street, a car filled with garbage. The addict looks bad, but the loved ones look good: gorgeous hair and makeup, gorgeous, flattering light. Talking directly to the camera, they even have a blue penumbra around their heads, too faint and diffuse to be a halo but definitely halo-adjacent. They are the sober, caring people (even if they don’t behave that way), and they look great. The addict, by contrast, is messy and unflatteringly lit. No penumbra for the addict.

The clash of good and evil is the drama of Intervention. It’s an epic battle in which the forces of good (loved ones, the interventionist, the recovery industry) fight for the life and soul of the addict against the forces of evil (addict friends, addict lovers, the drug itself). The language of war is everywhere, especially in the pep talk before the intervention, when the interventionist rallies the forces of good with a battle speech full of martial metaphors. Conflict, drama, ultimate stakes: these are how the series convinces viewers that it’s more than just lurid voyeurism, the 21st-century equivalent of ogling the “lunatics” of Bedlam. It’s a series with a mission: to raise public awareness about addiction and to inspire addicts to seek help for their problem.

To find the good Intervention has done, I went looking for actual viewers—other than David Sedaris, of course. I sat down at my computer and searched the exact phrase “after watching Intervention” to see what kinds of ideas and actions the series inspired in real people. Here are the results. After watching intervention:

• Nick Stifel decided that anyone who calls him alcoholic is “just a big ol dweeb.”
• Zach Bye rambled about crystal meth during a guest-host stint on ESPN radio.
• Ryan O’Connell felt better about himself until he decided that the show was exploitative and gave off a “creepy Christian vibe.”
• Kim Kardashian was inspired to executive-produce an Intervention-style documentary on mental health.
• herocious relapsed.
• Ryan McMahon couldn’t get laid.
• lonelyworld lay awake thinking about resemblances between herself and an addict’s mother.
• Angry Black Bitch wrote a letter of intervention to Michael Jackson.
• Ruya wondered about an intervention for a gamer.
• Blackjedireturns compared his porn addiction to a heroin addiction.
• [Deleted] saw his/her/their OCD as an addiction.
• Cassie121290 worried about being given Dilaudid for a C-section.
• Calden J. resolved to stop giving money to panhandlers.
• Andrew Liszewski actually stopped giving money to panhandlers.
• Thenessa Mack-Palmer bought food for a homeless man who did not panhandle.

In other words, no one sought help, one person relapsed and one person minimized his own problem drinking. The rest either reframed their own problems as addiction or gave off Bedlam-visitor vibes (Bedlam-marketer vibes, in the case of Kim Kardashian), and the only behavioral change was in how three viewers treated panhandlers.

In my small, unscientific sample, no people with addictions were helped, one was hurt, and one may have been hurt. Looking further online, I found that many heavy drug users are big fans of the show. Reasons for watching vary, but a common one is to see users who are worse off than they are. Watching the amped-up impairment onscreen, they feel reassured that their own habits are not so bad, their own lives relatively intact. Viewer Nick Stifel, in other words, has lots of company.

I did find one woman who claimed, in an article on The Fix , that Intervention helped her get sober. There are hundreds more, however, who report that the series reinforces their addiction. A post on a subreddit dedicated to opiates summarized the appeal succinctly. Wrote Someone_Who_Isnt_You:

Intervention is like drug porn for me. Whenever I watch it, I only watch the parts where the person is high. I skip the whole backstory crap where you see how the person was like before drugs. I definitely skip the intervention. I usually watch the show when I am sober because I feel no need to when I’m using. Ironically when I’m sober, I’m more drug-obsessed than when I’m using.

Others love watching Intervention while they’re using. In a Reddit thread titled “Does anyone else get high and watch Intervention?” the count was twelve “yes” and one “no” when wsvance replied:

Hell yes. I started doing opiates at my uncles house (he since passed). We would snort several oxys, sip on wine, and eat cake and sonic blasts while laughing at people get into an emotional wreck. All while nodding out into an opiate induced bliss. Fast for[ward] years later, it’s not so funny as it used to be.

Many heavy drug users hate the show, not for promoting sobriety, which most hope to achieve, but for promoting outmoded treatment methods such as intervention, rather than more effective, more humane, and more scientifically-grounded methods. They condemn the use of suffering people as entertainment and the general lack of access to care that makes families willing to trade their privacy for something very few can afford: 90 days in rehab. And they loathe that Intervention increases the stigma of addiction by casting for shock value then implying that addiction alone is the cause of participants’ criminal, abusive, bizarre, or antisocial behavior. As Timjob4 said on Reddit, “This makes us all look bad.”

Whether they love Intervention or hate it, many people with addiction empathize strongly with the people who appear on the show. Perhaps the most dramatic example is a viewer who runs a fan site called Intervention Directory. In 2015, after more than three years building the elaborate site, she shared her story of growing up with parents addicted to multiple drugs and developing an alcohol use disorder. At the turn of the millennium, she sought treatment and spent seven years sober in A.A. before relapsing hard. At the time she shared her story, she had been back at the booze for ten years, describing herself as “much better at being an alcoholic than I was before.” In 2018, she posted to the site that she had quit drinking again but stopped mentioning sobriety milestones after five months. Even if she hasn’t resumed drinking, by her own account she spent six years building a monument to Intervention while in active addiction, which seems to belie the notion that the series helps addicted people deal with their drug problems.

In fact, I think it more often hurts. In Intervention, the demands of reality television exaggerate the “conversion model” of recovery—a model in which everything hinges on “hitting bottom” and dramatically surrendering to rehab, where addicts are reborn as better, truer versions of themselves. Many episodes of Intervention seem to end with such a miracle, as, within five minutes of airtime, a hostile, incoherent, unkempt dope fiend or dipsomaniac becomes an attractive, clear-eyed, articulate sober person. Such miracles may be good television, but they don’t reflect the messy, halting experience of dealing with a serious addiction, especially one complicated by mental illness. They set a high bar for viewers who are struggling with such addictions and create unrealistic expectations for their families. Moreover, I believe they encourage addicted viewers to wait for the miracle, rather than make more modest changes right now that could improve their lives and perhaps initiate gradual–but lasting–recovery.

Real recovery from addiction is rarely a conversion experience; it’s messy learning, fits and starts, making what you are now a little better, stumbling then trying again. Sometimes it means using medication, which is frowned on by advocates of the conversion model. It doesn’t make good television; as importantly, it doesn’t make money for an industry built on the conversion model. And Intervention is, as much as anything, an extended advertisement for that $35 billion industry–and, now, the intervention industry as well.

Intervention hurts people with addiction in other ways too, starting with the cinematography it borrows from porn, which has grown more evident since the series returned in 2015 after being cancelled two years earlier. This feature is most conspicuous on episodes devoted to illegal drug use. Injections are frequent and often rendered in extreme close-up, with trickling blood at the injection site. Lines are snorted and bowls smoked in slow motion, sometimes from multiple camera angles, prolonging and aestheticizing the process. These are techniques used in porn’s famous “money shots,” and, in some episodes, such shots number in the dozens. Meant to horrify/titillate the modern Bedlam visitor, they beckon people who use, once used, or might use the substances involved. Wrote a former user about Intervention:

I’ve been clean now for 3 yrs. and I have to be honest, it is a HUGE trigger to watch someone shooting dope or smoking crack. As a multi-drug user nearly every episode would be difficult to watch. I do see the “shock” value they may try to present to the viewers but I’m sure the story can be presented without the graphic drug use being shown. That’s how I began to use drugs. Observing others.

If Intervention doesn’t help viewers, does it at least help the people whose suffering it exposes? Intervention Directory cites the series’ own claim that 60 percent of its subjects remained sober as of 2013, but no one actually knows if this unprecedented success rate is even close to accurate.[6] Most comments on the site are extremely skeptical, given that the usual success rate for 12-step-based treatment is five to ten percent, but perhaps the dubious celebrity of having appeared on Intervention furnishes additional incentive. It’s certainly true that some series veterans have built a brand around their transformation and might lose support if they returned to drug use. So I’m prepared to believe that the series has a higher success rate than the average stint in rehab.

Yet the minute I find myself willing to concede that Intervention may occasionally do some good in the world, I’m brought up short by another example of where its real interests lie and how devastating they are to people with addictions. This past May, there was a doozy of an episode dedicated to a pair of heroin-addicted brothers whose whole family (including the blue penumbra’d mom), turned out to have the same problem. The number of injection close-ups in that episode was staggering, self-injection alternating with partner-injection. (If you doubt the resemblance to porn, that episode alone will convince you.) But the most horrifying part of the episode was not the cinematography but what the interventionist and the show’s producers did to a cousin of the brothers.

The cousin turned out to be the only heroin-addicted family member who had actually done something about his problem. He was using medication-assisted therapy, and had been off heroin for about a year, which is a big accomplishment, especially given his extremely screwed-up family and the economic desperation of his community in Paterson, NJ. But he was obviously struggling to hold onto his gains, as the crew recorded him saying during the pre-intervention that the painful, often adversarial process “makes you want to get high.” Inexplicably, the interventionist enlisted his help to find his missing cousins, touring the places where people used and dealt heroin, places he had avoided for the past year in his effort to stay clean. She even sent him alone into several places while she waited in the car. When they returned to the intervention, the crew watched him assist his uncle by preparing a dose of heroin for him and injecting his arm while they filmed the money shot.

He slipped after that, not surprisingly, which made him sick because of the medication he was taking, and the shame on his face as he admitted the slip and explained why he was so sick was, hands down, the most painful moment I have witnessed on Intervention. Did the interventionist take responsibility for what she and the crew had done? No, she was all “tough love,” as usual, pushing to add another intervention to the episode’s record total. That a series supposedly dedicated to helping people with addiction would not only fail to help someone already in treatment but actively sabotage his recovery to amp up the drama makes clear that thrilling viewers trumps human needs and that the only kind of recovery that matters is the all-or-nothing, bottom-hitting, miraculous kind. The kind that now makes so much money hedge funds are buying up treatment facilities.

Intervention will be back next month with brand new episodes in a new-ish format capitalizing on the so-called “opioid epidemic.” I won’t be watching, and I really hope you won’t either.

[1] David Sedaris, “Why Aren’t You Laughing,” The New Yorker, June 19, 2017, 30-35.

[2] The essay continues in a more serious vein, treating the author’s mother as an Intervention subject who fails to get sober. It’s cruelly descriptive and judgmental, though her alcohol use disorder developed long after he left home and barely affected him except to make him fret that alcohol may have compromised the sincerity of her long-distance cheerleading.

[3] My use of the word “addict,” rather than “person with addiction” reflects Intervention’s perspective, not my own. And when I say “drugs,” I include alcohol.

[4] That the “documentary on addiction” ruse remains successful after 19 regular seasons is doubtful. One subject (season 15’s Kaeleen) devoted most of a YouTube video to insisting that she had been fooled, but the episode itself captures evidence that she knew she was on Intervention. A woman who keeps tabs on the show (more about her later in the essay) claims that ten people knew for sure they were on the show and many more probably knew.

[5] Yes, after many years of excessive drinking, reverse tolerance can develop. It’s a sign of liver damage, and it happens when the scarred liver cannot produce the enzymes necessary to break down alcohol so that it can be eliminated from the body. The result: more alcohol remains on board, meaning more intoxication with fewer drinks. If that’s what’s happening on Intervention, it’s evidence of a very advanced alcohol use disorder, and a show with an educational mission should say so. More likely, subjects are simply acting drunker than they are.

[6] The 2015 film The Business of Recovery revealed that inflating (or simply making up) success rates is common practice in the increasingly lucrative drug treatment industry.