Perhaps surprising to those who would insist on a gentle approach to rehabilitation, some of the people in these groups recover from their addictions, an outcome often attributed to strength of personal desire. But common “cult” stereotypes have also dogged these groups and led to suspicion of financial exploitation. Since the Korean War, alternative movements from Communism to the Hare Krishnas have been accused of brainwashing—namely, of imposing an alien identity on unwilling members, who then become prey to a nefarious purpose. Although the phenomenon of brainwashing has been academically discredited, this “cult” narrative perseveres, and it’s attached itself to these unlicensed rehab groups largely because of their practice of confiscating participants’ documents.

But those who would further exoticize the rehab techniques may not be aware of relatively recent parallels between these groups’ shaming rituals and those of a much less stigmatized group: pre-Vatican II Roman Catholic monastics. Prior to mid-20th century reforms, purposefully humbling verbal and physical rituals were relatively common in convents across the world, as many popular ex-nun memoirs relate. For example, in her memoir Through a Narrow Gate, the one-time nun Karen Armstrong recounts a special penance in which she was compelled to crawl beneath the table at mealtime to kiss the sisters’ feet, with their “bunions” and “taste of boot polish.”

Such practices have dwindled in recent years, out of concern for negative emotional consequences and an increased emphasis on developing personal independence. Even so, these rituals occasionally resurface—in the mid-1990s, for instance, the cloister of the famed televangelist Mother Angelica reinstituted the custom of public self-accusation.

Thus, some unlicensed rehab groups appear to have independently reinvented time-honored Christian methods, developed to help a person conform to some ideal: For monasteries, the ideal is a humble, Christlike person obedient to divine will; for rehab groups, the ideal is a reformed individual cured of his or her addiction.

Tellingly, rehab groups and monasteries both attempt their transformations within the context of all-encompassing environments—the “total institution” setting described by the sociologist Erving Goffman in his classic 1961 book Asylums. Personal identity is formed over the course of a lifelong give-and-take conversation with society, Goffman asserts, but this process is accelerated in the regimented 24/7 milieus that range from mental asylums and jails to boarding schools and convents. Hence, the multi-week confinement of addicts in dilapidated buildings may be a low-rent version of a long-standing approach to shaping character.

That said, this same social environment gives justifiable cause for concern, especially over the organizations’ potential for intra-group violence. Within the hermetic and socially intense context of a total institution, behavioral norms can form without checks and balances from the outside culture, and may shift more easily towards the harmful. Research indicates that large-scale violence of the kind found at Jonestown or Waco depends on apocalyptic, “us vs. them” ideologies in addition to isolation—but total institutions like 24/7 rehab centers can produce smaller-scale violence. For example, two teenage members of upstate New York’s reclusive Word of Life Christian Church were severely beaten during a tribunal turned violent this past fall; one died from his wounds.