What Really Happens at Alsana / Castlewood Treatment Center for Eating Disorders??
A brave former patient shares her experience in this powerful piece about her experience at Castlewood from a recent stay (long after Mark and Lori left).
When I first arrived at Castlewood Treatment Center, in St. Louis, MO, only a few years ago, I had no idea that I was stepping in to what I would come to consider a cult. I often look back now and wonder how I didn't see it sooner, how I could be so stupid as to fall for it, but I am slowly starting to realize that it wasn't my fault. I was exceptionally vulnerable and, in my opinion, they took advantage of that.
Of course, before arriving at Castlewood I had heard the stories. The somewhat infamous lawsuits that Castlewood had gone through a few years prior to my arrival. It’s hard to not know about the lawsuits, a quick google search and the information is right there. But, like many others, I had dismissed them. The information contained in the articles that talk about the lawsuits seems so incredibly unbelievable. False memories? False DID diagnoses? It’s really easy to dismiss. So, as Castlewood prided themselves on treating trauma and I had a trauma history I decided to reach out to them for help anyway. But dismissing the lawsuits was my first mistake. What I should have thought is “why would I risk going to somewhere with such heinous allegations when there are so many other facilities out there.” Yes, the people at the center of the lawsuits, Mark Schwarz and Lori Galperin were gone, but what I didn't realize was that people that had worked at Castlewood at the same time as Mark and Lori, people like Jim Gerber, the current clinical director, and Nancy Albus, the CEO up until a few months ago, and Dr. Kevin Miller, a current staff psychiatrist, would step in to fill the roles left vacant by their departure.
So where do I start. How do I possibly explain to you what my time at Castlewood was like? The dangers don't necessarily hit you in the face the minute you walk inside. I didn't see them, although with the benefit of hindsight I realize that maybe I should have. But when you make a decision to enter any sort of treatment facility you do so because you have hit rock bottom. Because you are so vulnerable and beaten down and desperate for help. It’s not like going on a vacation. You go to somewhere like Castlewood to literally try to save your life, so from the very beginning you are vulnerable, willing to overlook things that you otherwise may not have. I remember for me, before entering Castlewood the first time, I gave myself a pep talk. I made a conscious decision to commit wholeheartedly to the treatment. To be open to it, to comply, to put my fate in the hands of the staff. Because they were supposed to be professionals and I was dying. Looking back this was a huge mistake on my part, but I don't blame myself for it. I needed help and they were supposed to help me.
But instead of helping me they took advantage of my vulnerability and used it to make me completely dependent upon them. See Castlewood manages to inspire extreme loyalty amongst their clients. I have actually never seen the kind of fierce loyalty that I see in Castlewood clients at any other treatment center (and yes I have been to more than one). Former and current clients are so fiercely loyal that they believe that no one can possibly save them and treat their eating disorder except for Castlewood. St. Louis is filled with former Castlewood clients who picked up their entire lives and relocated to St. Louis to be closer to Castlewood. I could probably list around 50 people who have done this. Left their old lives behind and moved to St. Louis for no other reason than Castlewood. Clients cycle in and out of Castlewood over and over and over again. While this isn’t necessarily uncommon amongst the eating disorder community, its more extreme at Castlewood. Clients who have had double digit admissions are still allowed to readmit. At some point a treatment center needs to ask whether the program they offer is actually working for a client and has a responsibility to refer them somewhere else, but Castlewood never does this. What’s even worse is Castlewood contributes significantly to this readmission problem by having clients spend so long in treatment they forget how to exist outside of it. I know of numerous clients who have spent over a year at a time inside Castlewood. Long stays are more the norm than not.
Anyway, back to me. My first clue that something was not right should have been my very first night there. Sitting at the kitchen table during the nighttime snack when a middle aged client appeared, dressed in custom made baby clothes, carrying a sippy cup and stuffed animal, sucking their thumb and suddenly nonverbal. I was informed that this client had DID (formerly known as multiple personality disorder) and that currently one of their “little children alters” was out. I had had enough experience in my own life and enough education in the field of mental health to know what DID was. I had also read the book Sybil (which has since been discredited). So at least I somewhat understood what was happening. But I still watched in amazement as clients and staff alike fussed over this client like they were indeed a toddler, filling their sippy cup with milk, talking baby talk to the client and referring to the client by another name.
DID is listed in the DSM-V (a book listing all mental illness diagnoses and symptoms etc) and is therefore still considered a mental illness. However, following my experiences at Castlewood I did some research. The psychological and psychiatric communities are split as to whether DID actually exists. Some believe it does, others do not. But they do agree on two very important things. Firstly, DID is one of the rarest mental illnesses affecting an extremely tiny percent of the population. Most clinicians, even those that specialize in trauma, go their entire careers and are lucky if they see a single case of DID. Secondly, DID does not present like it has been described in books such as Sybil and movies. It is actually far subtler and if it does exist, is merely an extreme form of dissociation.
So why am I telling you this. Because the client I met that night acted exactly like what you would see in a movie portrayal of DID. This is important to note because this client was not the only one I met with a diagnosis of DID throughout my time at Castlewood. To date, I have met 14 people that have been diagnosed with DID by either Jim Gerber, Dr. Kevin Miller or Emily Williams (a former staff member of Castlewood). 14 people in the one place, diagnosed by the one group of clinicians with an exceptionally rare mental illness. Most importantly, every single one of them present exactly like how DID is depicted in the movies and not how DID is actually believed to present amongst the psychiatric community. Watching these clients “switch” between their very public and very outspoken personalities was like watching the movie Sybil on repeat. In fact, people “switching” became so common to me that I didn't blink an eye when a grown adult started babbling like a baby mid-sentence, or suddenly jumped up and started ranting like a teenager, or speaking another language. It was, unfortunately, my normal.
To give you an example of what I am talking about, I can’t help but think of the day the six year olds had a scheduled playdate. At this point in time there were three clients in with me (3 out of 10) that had been diagnosed with DID and all of them had a “6-year-old alter.” So they arranged a playdate for after group one day during our free time. This day, as I sat in the kitchen working on an assignment, three 20-30 year olds ran around, screaming in high pitched baby voices, playing with toys, and interacting with direct care staff like they were the supervisory parents. It was like something straight out of a movie. Ironically, one of the main problems with DID, as described in actual psychology textbooks and articles, is that the person with the disorder doesn't have control over the “other personalities” and therefore the dissociation causes havoc as “other personalities” just do whatever they want. Yet all three clients with DID were able to schedule a playdate for younger “personalities” well in advance and “switch” right on schedule.
Actually, this control over when clients “switched” occurred frequently. One time one client’s primary therapist allowed an entire group to be devoted to an eight-year-old alter. Of course, the 8-year-old “popped” out right on schedule and “went back inside” the minute group was over. Another time the staff took clients on an outing to build a bear and it was like a kid alter paradise. Extremely embarrassing for those of us that refused to be diagnosed with DID and didn't necessarily want everyone at the mall to know we were with a treatment group. I feel crazy as I sit here and write this. Words like “alter,” “switching” and “went back inside” flowing frequently onto the page. Who would ever believe this? But it’s true. I witnessed all of this. I am so familiar with interacting with DID clients that talking to a 3-year-old inside a 33 year old's body is as common to me as taking a shower. Any client that has been to Castlewood knows exactly what I am talking about. They too will have had conversations with children inside adult bodies, they will have referred to the same human by multiple different names or watched groups of adults chasing butterflies together while wearing 6-year-old clothes and squealing like children. To people that haven’t been inside Castlewood this sounds insane. To clients, this is just another day in the life of Castlewood Treatment Center.
I was never diagnosed with DID while at Castlewood but it wasn't from their lack of trying. Rather, I knew enough about myself to know that I did not and never had DID. Dr. Miller was the first person to suggest to me that I had DID. Dr. Miller is a psychiatrist with whom each client is scheduled a thirty-minute appointment each week for medication management. However, he is usually running at least an hour behind because he doesn't just do medication management. He does Internal Family Systems Therapy, or IFS, which is the primary therapy used by all staff at Castlewood. IFS is a completely non-evidenced based therapy which assumes that people are made up of “parts.” These parts can be anything, from anger to happy to guilty to shame etc. etc. Here’s the problem. Whenever a client feels an emotion, they are asked to identify which “part” it is. Let’s say, for the sake of this description, that it’s an angry part. Once the client has identified that it's the angry part they are then asked “how old they feel when in that part.” Usually, if its anger the client is guided towards an age in the teens. Then the client is asked what memory that part holds. This memory always refers to something in the client's past, an instance of abuse or a painful time etc. They are then asked to visualize the part, and have a conversation with this part inside their head. This forces the client to separate from the emotion and imagine it as a separate person within their head. For a client that is malnourished, medicated, vulnerable, tired, emotionally drained etc. this can easily turn into a pseudo DID. Think about it – IFS literally assists the clients in creating different people with different ages and different stories and memories inside of their head. Every single client at Castlewood is strongly encouraged to do this, create different people of all ages inside their heads, multiple times a day. To slip into believing that these people are real and that one has DID is not only very easy but also, evidently, very common amongst Castlewood clients (again I know 14 people with “DID” and that number continues to grow). All a person has to do is give each part a different name and “DID” is born.
While all therapists do IFS, Dr. Miller is one of the worst, because he not only does DID but also actively implants false memories as well. I never liked my sessions with Dr. Miller and so was always pretty resistant to talking to him. But even after I told him I didn't want to do therapy with him he would force me into it by refusing to discuss my medications until I did it. It didn't matter how many times I repeated the word no, he would pressure me and ignore my “no” until I gave in. I needed medications so I really didn't have a choice. He would ask me to close my eyes and visualize horrible things like murdering the person who hurt me (I do have a trauma history that I knew about before entering Castlewood) even though I told him I didn't want to hurt this person. He wouldn't listen to me, would insist that I was angry with the person and just wasn't acknowledging it and then would describe the ways in which I was supposed to visualize myself murdering this person. He would also outright suggest that some sort of abuse had happened to me at a certain age when I knew it hadn’t and told him as much. He would tell me I had just forgotten about it but that he was pretty sure that some person in my life had done x, y and z to me. Then he would tell me how I felt about it (even though I still insisted it didn't happen). His descriptions were graphic and detailed. Again, I was lucky. I had enough awareness of myself to not listen to him. Others weren’t as lucky as me.
He tried to diagnose me with DID on at least four separate occasions that I remember. Each and every time I told him very clearly that I did not have it. But to this day I don't know whether it is in my medical file or not. He wasn't the only one that tried to suggest to me that I had DID. Jim Gerber made a similar suggestion and devoted an entire group to trying to convince me I had DID. My primary therapist also tried to diagnose me with it. It is easy to think that because so many mental health professionals were telling me I had DID that I was simply in denial and do in fact have DID. But I do not. Since leaving Castlewood I have been assessed by multiple other mental health professionals, all who concur without hesitation that I show not one single sign or symptom of DID. But the only reason I didn't listen to them at Castlewood was because I had previous knowledge around what DID was and what the symptoms were. Had I not had the knowledge I have no doubt that I would have simply taken them at their word and believed the diagnosis. After all, they are the mental health professionals, not me.
But, like I said, DID diagnoses at Castlewood are plentiful. As are false memories, or what Castlewood describes as “recovered repressed memories.” I have also done some research on repressed memories and again the community is split as to whether they exist. What evidence there is suggests that repressing significant traumatic experiences is not possible. Yet it seems like every second client at Castlewood “recovers” memories while there. I could name at least 20 clients I know personally whom “recovered” memories of abuse whilst at Castlewood. Not surprising given Dr. Millers “helpful” suggestions and the frequency of the DID diagnosis. See once someone believes they have DID they go looking for a traumatic history, as DID is known to form because of severe childhood trauma (again not completely accurate). So the client is willing to believe almost anything. I saw so many clients walk in to Castlewood with no trauma history and no dissociative symptoms and walk out with DID and a horrific extensive trauma history.
Castlewood contributes to this even further by glorifying trauma. Trauma stories are in clients faces almost every waking minute of every day. Almost every single group is devoted to a client reading aloud a written assignment that details a traumatic incident in extreme detail. The more severe the trauma, the more special treatment clients receive, in the form of many different accommodations ranging from special meals to being excused from unpleasant events such as family week etc. Clients constantly try to one up each other and compete to see whose trauma is the worst. It’s not their fault. Castlewood encourages it through the aforementioned special treatment. In fact, trauma is so highly valued at Castlewood that in one group a client broke down sobbing because she didn't have a trauma history and wanted one.
Because of the extreme emphasis and focus on trauma and the fact that it comprises 99% of every client’s day, clients with legitimate PTSD (and those with false memories) are in an almost constant state of flashback. I actually believe this is another way that Castlewood makes clients more vulnerable, by making them worse, in order to convince them that they can’t recover without Castlewood’s help. At any given time, there is a client either rocking back and forth in a ball on the floor or screaming and shaking or running from some room in a “flashback.” One time, during a break from groups I was sitting outside and there were 6 other clients outside as well. There was suddenly this unexpected clap of thunder and all 6 of the other clients dropped to the ground like soldiers under enemy fire on the battlefield. Covering their heads, screaming as if someone was killing them. Direct care came sprinting outside with handfuls of frozen lemons (a permanent fixture in the Castlewood freezer for dealing with the constant flashbacks). It was a scene I will never forget. I am in no way making fun of legitimate PTSD and flashbacks. As someone with experience in both, they are horrible. However, one needs to ask themselves whether within a treatment center supposed to be helping clients cope with PTSD symptoms, 6 clients all dropping to the ground in unison, is a sign of trauma treatment or complete negligence. My belief is it is the latter. Castlewood pushes people with trauma histories so far outside of their window of tolerance that they become completely unable to care for themselves. Trauma treatment is supposed to do the opposite. While it is not supposed to be fun, clients are supposed to remain at a level they can tolerate so that they can learn to manage the symptoms. But Castlewood’s philosophy is to find the worst part of the client’s trauma and then push and push and push, under the guise of “the client would never be able to do this work in outpatient.” In fact, all it does is break the client. When I discharged from Castlewood I was so emotionally broken from the “trauma treatment” they had put me through that I struggled to stay afloat. This may be another reason client’s go in and out so much.
I wasn't diagnosed with DID and I didn't recover false memories, so it might be easy for one to think that I wasn't hurt by Castlewood but this is not at all the case. I was luckier than a lot but I was still hurt. For example, the IFS concept of dark energy has really affected me. The way Castlewood explains dark energy it basically means that when you are assaulted you take on some of the perpetrators energy and essentially form a part within yourself that is like the perpetrator. Castlewood’s use of dark energy is actually what first made me start to realize that something wasn't right there. I was in a session with my primary therapist and I was talking to them about how an abusive person in my life was demanding that I contact them immediately. I mentioned to my therapist how I was sick of being controlled and told what to do by this person so I wasn't going to contact them until I was ready. Basically I was standing up to this person by not dropping everything when they told me to. My therapist looked at me and it was like I could actually see a light go on in her eyes, like she finally understood something about me that I was yet to understand. I was confused by this look since I thought that me taking some control back was actually progress and a good thing that I was doing to take care of myself. My therapist said “dark energy.” By this point I knew what the term meant but I didn't understand what she meant by it in this current situation so I asked her to explain. She told me that by refusing to drop everything and obey this person and contact them immediately, I was acting as abusive towards this person as they had been towards me (for the record this person physically hurt me more than once). My therapist went on to tell me that while this person had been hurting me I had “created a part within myself as abusive as this person was” and was now acting from that part. This didn't sit well with me at all. Refusing to immediately stop my life and bend to this person’s wishes was actually a huge step forward for me. I had been controlled by said person for a long time and this was the first time I had stood up to them in any capacity. But instead of seeing this, my therapist accused me of being as abusive as this person had been to me.
Sadly, this was not the only time this happened during my time at Castlewood. In fact, it became a rather frequent event, not just with me but with every client there. Ask anyone who has been to Castlewood what the term “dark energy” means and they will not only know but be able to tell you how they hold the dark energy of abusers within themselves. Looking back, I believe Castlewood use this term and this tactic to make clients even more vulnerable and dependent on them, as well as to avoid any challenges to their therapy tactics or anything that goes on within the facility. Anyone at Castlewood who discloses a history of abuse eventually is told that they have taken on their perpetrators dark energy and are now acting like them. For example, there was a couple of times that myself or one of the other clients would express anger towards something, we were always told that that was our “dark energy” or, in other words, abusive part of ourselves expressing the anger. To tell victims of abuse that they have an abusive part has, as you can probably imagine, devastating consequences. The shame that being told you are exactly like the worst person you have ever met paralyzes you. They are very convincing in their explanations and examples of how you have an abusive part and you begin to believe it. This shame makes you feel like the worst person alive. What’s even worse is that you feel like you have no control over it. Because they describe it in such a way that it seems as though the “badness” from the person who hurt you has infected you and you cannot help but be as abusive and horrible as them. Thinking about it now I realize what a clever tactic it is on Castlewood’s part. By convincing clients that there is this part of themselves that is exactly like the monster that hurt them so badly, it makes clients so ashamed. Now these clients have this horrible secret and, for me at least, I felt like I could never tell anyone about it because I would be admitting to being an abusive monster. But Castlewood doesn’t just inform of this part, instead they follow it up with reassurance that they do not judge you and even though there is this abusive part of you they don't hate you like you hate yourself and they can help you. They gain extreme loyalty from clients this way. Think about it. What client who believed they had this monster part inside them would risk telling anyone outside of Castlewood or going to a different therapist/facility and disclosing this, when Castlewood already knew and didn't hate them for it and told them they could help? No one. I know that when I actually believed this I knew I could never tell anyone outside of the Castlewood system because they wouldn't understand and they would hate me. Other therapists didn't know about IFS or dark energy. They would just think I was admitting to being an abusive monster. So I had to stay with Castlewood because they were the only ones that could help me. Like I said, its clever in a really manipulative, creepy, unethical, damaging way.
Dark energy is not the only tactic Castlewood used to convince me there was something else wrong with me. They also use the concept of transference to do this. In general, transference refers to when you project an issue onto someone or something else. Like, for example, if I had had a rough day and been fired at work and I came home and yelled at my husband I would be transferring my feelings of anger from my boss onto my husband. There is some legitimacy behind the concept of transference, however not the way Castlewood uses it.
Every negative feeling one experiences at Castlewood is viewed through the lens of transference. For example, there were some clients that I simply didn't click with, or who annoyed me for some reason. Given that 10 strangers are thrown together in to live in close quarters 24/7 I would think that being annoyed by someone else or not clicking with someone else is pretty normal. However, each and every time I expressed anything like this I was told that it was transference. That I didn't like this client because I saw in her what I was ashamed of in myself. Essentially, they found a way to convince me that people who I was annoyed by or didn't like for some reason were the same as me. If you think about this, it again causes shame. To believe that you are like everyone whom you don't like makes you not like yourself. Again, a pretty clever tactic on Castlewood’s part.
However, I think the worst response that Castlewood staff give to any type of challenge, question, doubt or issue brought against either an individual staff member or the program in general is to spin the situation so that they are victims. This happened more than once but a good example of this is one time when I was informed by my primary therapist that my insurance company was threatening to cut, meaning that they would no longer cover my treatment and I would have to discharge. Being somewhat assertive and not afraid to stand up for myself I decided to call my insurance case manager and discuss the issue with her. I figured that it might help if I advocated for myself, explained to the case worker directly what my symptoms were and why I needed to stay in treatment. So, during a break I called my insurance company and spoke to my case worker. However, when I spoke with her and told her that I had been told that they were going to cut she was surprised. She told me that my insurance company had no intention of cutting at that point in time and that she had not told anyone at Castlewood this. Obviously I was confused. But when I disclosed that I had called my insurance company to my primary therapist she gave me this look like I had stabbed her directly in the back. She seemed so hurt. She asked me why I would go behind her back and why I didn't just trust her to deal with it. I was really confused, I thought advocating for my own treatment with my own insurance company was a good proactive thing to do and didn't see how it had anything to do with not trusting her. But my therapist and two other therapists told me that by calling my insurance company I had severely hurt and betrayed all the Castlewood staff. They told me that I had no right to not trust them, that I had acted sneakily by going behind their backs and checking out what they were telling me and that I was in the wrong. Then they told me that I had “perpetrated them.” Yes, those exact words. That they were victims and I was the perpetrator and I had perpetrated them like previous abusers had perpetrated me. Because I had called my own insurance company to discuss my own treatment.
I wish I could tell you that this was the only time a staff member at Castlewood told a client that they had “perpetrated” them but it actually happened quite frequently. It really sold the whole dark energy thing. Can you imagine what happens to a victim of abuse when they are accused of being a perpetrator? The shame just about destroys you. You feel so incredibly broken that you would never dream of leaving Castlewood and pledge to do every single thing the staff tell you to do and never question them again. Because obviously you are a horrible person and they are the only ones that can help you. It's the final nail in the Castlewood coffin so to speak.
I wish I could say this was everything but it’s not. It's a summary of my experience in an extremely dangerous, damaging and unethical treatment center. For every story I have written here I have 100’s more like it. I have no idea why Castlewood is still allowed to be in business. My best guess is that they are really great at covering up what is going on there. Firstly, many clients never realize that the memories they recovered or the diagnoses they received are incorrect. Secondly, the shame that those working at Castlewood manage to instill within each and every client is significant and a damm hard thing to overcome; I should know, I’m still trying. Finally, Castlewood staff are proactive when it comes to covering their asses. For example, a little while ago a couple of reviews appeared on the Castlewood Facebook page saying similar things to what I am saying here. Within a day or so the review section on the page was removed. But, what is even worse, is that I heard through friends that around that same time Castlewood established a new rule whereby Castlewood staff are no longer allowed to diagnose anyone with DID, but instead are supposed to refer to outside providers if it is suspected. However, I’ve heard from clients that are currently there that all this means is that they will receive an official diagnosis of “dissociative disorder” and be told by Dr. Miller, Jim or another staff member that they have DID but it just can’t be written in their official chart. Regardless, I don't know for sure whether this rule was established to combat the accusations in those reviews or not, but the timing is exceptionally suspicious and the rule is nothing more than for show.
In conclusion, while I have a lot of fear about writing this, the truth needs to get out. Castlewood need to be stopped. How many more people have to have their lives destroyed before this treatment center is shut down? Too many have already been hurt, myself and my friends included. Enough is enough.