7/12/2010

False Dilemmas and Strawmen over Shocking the Disabled

There's plenty that I find disturbing about Matthew Israel and the Judge Rotenberg Center. With the recent outcry by the UN and the Nightline program focusing on the allegation that the skin shocks that more than half of the clients at the center receive are effectively torture, the Rotenberg Center is back in the news. The Massachusetts Senate is set to consider the center yet again, but according to the Boston Herald, "a procedural move by Republicans prevented a pair of related bills from being placed on Tuesday’s calendar."

Parents who are fans of the shock treatment have been enough to derail past attempts to outlaw the skin shock therapy in Massachusetts. One of the proponents is Rep. Jeff Sanchez  who has a nephew who has received the skin shocks (Boston Herald). According to the Boston Herald, "Sanchez wondered why proponents of Joyce’s bill haven’t expressed “the same level of fervor and passion” about doctors who prescribe psychotropic drugs to kids."

Most of us recognize that this is an attempt to redirect attention. Medicating children and young adults has no equivalence to shocking them or to making the clients live with the constant threat of being shocked. The Herald reports that "Some lawmakers who have agreed to submit to the shock described searing pain." There's a reason people don't react passionately about a doctor medicating patients but do over direct care staff with three weeks of training shocking kids for antecedent behaviors like raising their hand or getting out of their seat. Huge difference between the two and it's just utter bunk to raise the issue.

 Israel, in his 115 page defense (found on main page of his site), rather than responding matter-of factly, chooses to engage in emotionalism and false dilemmas. He writes: "Some well-intentioned, but misguided, anti-aversive advocates object to the use of certain types of aversives, such as the skin-shock aversiveused by the Judge Rotenberg Educational Center (“JRC”)." Note, the italics are his. There's nothing misguided about this, though. And most behavior analysts would absolutely condemn Israel's idea of aversives. Calling them aversives is too kind a word (just scroll down to the bottom of this post to see his idea of appropriate aversives that are non-shocks).

The Behavioral Analysis Association of Michigan (BAAM) provides this information on punishment and a milder form of the shock system (the one that Israel decided wasn't effective, so he invented his own more powerful systems):
 
"Good behavior analysts know that people who deliver punishment become punishing by association. Sometimes "time out" might be used for serious behavior problems. But even this is a form of extinction. A good behavior analyst will use time-out only for short periods, no more than a few minutes at most, and even then very judiciously. Time-out might consist of nothing more than removing learning materials and attention for a few seconds. In very rare and serious cases of severe head banging, a device called SIBIS might be used. SIBIS provides an brief, annoying shock to the leg when the wearer hits his or her head sufficiently hard. SIBIS is highly effective, sometimes reducing head banging to zero in one or two trials. It is considered a treatment of last resort, and its use is heavily regulated and remains controversial even within the behavior analytic community. Responsible applied behavior analysts never use it without also having a good program of positive reinforcement for functional behaviors, and a plan to fade SIBIS (or any kind of punishment) is essential. Behavior management using positive reinforcement is now so effective that programmed punishment of any kind is not very common."

Israel writes:

"Under state and federal law, non-disabled individuals have the right to choose aversive therapy to treat behavioral problems such as smoking and drinking. Preventing disabled persons from the opportunity to avail themselves of aversive therapy for their own behavior problems, would be an invidious discrimination against disabled persons."

Right, I didn't realize that smokers and drinkers were buying his GED device and administering shocks varying between 15 and 5 milliamps. Who knew that not letting these disabled people get zapped was discriminating against them? After all, the direct care staff can repeatedly administer the 2 second shocks; there's no mechanism to keep them from repeatedly shocking the clients:
"The report, by the Department of Social Services, reveals a 15- year-old boy from New York was present when employees administered dozens of shocks to two other students on the instructions of a prank caller posing as a supervisor.
The other two victims were a 19-year-old from Halifax, who was shocked 77 times, and a 16-year-old from Virginia, who was shocked 29 times." (Feb 9, 2008)
Israel argues that there are only two choices for his clients: the skin shocks or "the deadly grip of sedatives, restraint, seclusion and institutional warehousing." And yet, many of his clients are long term clients. Sounds like institutional warehousing to me. Plus, they're still being physically restrained. Those didn't go away. In fact, the victim who was shocked 77 times was being physically restrained at the time. Gosh, at least they aren't medicated, though, right? No, instead, some of them are shocked for YEARS. If it works so well, then why are they still being shocked? Why do they still have to live at the Center, where the ratio of staff to clients is nearly five to one:

"Currently, JRC’s staff of approximately 1000 employees serves 215 special needs children and adults who have a variety of psychiatric diagnoses and educational labels, including developmentally disabled, emotionally disturbed, and conduct disordered."

Last week, I wrote at Respect For Infinite Diversity and Scientific Blogging on the questions that keep growing as Kathleen and I look into the center and its history. I've included the post below.


Kathleen and I have been spending a fair shake of our time looking through the interwebz at the whole Judge Rotenberg Center issue. There are hundreds of pages of materials to go through, and heck there's 115 pages just from Israel's response to the UN outcry and Nightline report.
 For Israel's take on the history of the center, you can read his interesting article at his site. Israel writes:

"In this respect, JRC is like a medical hospital. The goal of most medical hospitals is to return the individual to good health and to a normal living situation outside the hospital; however, in order to reach that goal it may be necessary to do some highly “abnormal” procedures within the operating rooms and in the emergency and intensive care wards of the hospital." 

Does the JRC do that, though? How many clients leave, all better? The responsible thing to do would be to compare the JRC to other residential facilities, what restraints, aversives, and positive reinforcers they use.

The problem is that Israel's client base appears to have shifted (page 4  of the report) over the years so that it now consists more of emotionally and behaviorally disturbed than autistic or ID clients. And, so far, there doesn't appear to be enough transparency in how many graduate and leave, and how many new clients they get.
Israel seems to go on and on about not warehousing, but if 5 of his 6 "success" cases are decades later still at the JRC, they are not success cases.

None of his aversives in his power points (which don't appear to have been shelved, from what I can tell) can be used on clients in Texas facilities for the disabled. They can't be used on inmates in a jail. If he still places clients in restraints (and he does) and then while in the restraint (and he does) has them shocked, this is, at best, problematic. The pinches, presses, spankings with spatula would all be considered abuse if done by a staff member. Restraints, including chemical restraints, are being restricted as well. Times are changing (that's for damn true, as Thelma would write).

And Israel thinks that it's perfectly legitimate to do a trial run on a kid so he knows what the result will be if he acts up:

"Preventive use. In the case of a few of our students, we successfully employed a preventive treatment, called behavioral rehearsal lessons. In this procedure, the student practices the initial phases of a problematic behavior and receives a GED application when he/she does so."


If you've got a backpack on at all times, and you can be shocked for any behavior deemed an antecedent behavior (and it's direct care staff doing the shocking), you've got a powerful incentive to behave. The question becomes is this an ethically acceptable way to maintain compliance, through fear? My moral perspective is that it is not. If you clamp down tightly and make every single privilege (involving food choices as well) contingent on desired behavior, you're also ruling through fear. It doesn't even appear to use the science available regarding reinforcement schedules or on fostering internal motivation. So, do these students, if they leave, know how to behave without the heavy hand of Israel and his staff?

They send the remotes to shock and the backpacks home with the parents. How is that okay? Parents in control of the clicker and able to give their child repeated 2 second shocks. Is anyone monitoring that? The court may approve the shocking, but are they reviewing every shock administered? Is anyone?  And apparently, despite the safeguards of giving the client a lawyer and psychologist, the court rarely rules against the shocks, because if the individuals were competent, of course they'd choose to be shocked. Not by a long shot, is what I'm thinking.

We know that abuse of the disabled occurs in residential facilities and a better job of cracking down on those abuses needs to occur. Cameras can help. But the JRC has cameras and the young man was still put into a restraint and shocked at least 77 times, all while the cameras rolled and staff milled around. Of course, the center then destroyed those tapes despite being ordered to preserve them.

The JRC represents one institution. Maybe there are successes there.  Maybe the center isn't any worse than others that house the emotionally and behaviorally disturbed (and a smaller proportion of autistic clients). But maybe the swank digs and opulence simply better hide a rotten core. I don't know. I honestly don't.

 But I know it serves as a beacon to society to really consider the ethics involved in caring for the most severely disturbed individuals in our society, and extending it out, the most severely disabled. It's a human rights issue. We should each have the right to not live in fear. I'm not certain that any of those there really have that. It's pretty powerful to have more people with a backpack on than not and to know that if you don't fly straight you can have a backpack, too. And that someone with three weeks worth of training can decide whether and when and how often to shock you.

What is the Justice Department doing on this? How much inspection is occurring?  Parents insisting that the shocks have saved their children doesn't mean much. I've read far too many parents who write just as passionately that vaccines damaged their kids, that Soma or FC has recovered them. Anecdote in the place of evidence is meaningless white noise, you know, like Israel uses as an aversive.


 from here


It seems that questions are all I have, but we'll keep digging. 

1 comment:

Lyn said...

it's just so warped that this is allowed.