April 27, 2016; Legal Reader

A few weeks ago, NPQ published an article about a protest by advocates for people with disabilities at the White House. Their chant was, “Our homes, not nursing homes and “disability rights are human rights.” These rights are abrogated in secure or restrictive institutions of all kinds, but this particular story is an appalling example of just how long even the most outrageous violations can go on in the shadows with no effective redress.

The front page of the website of the nonprofit Judge Rotenberg Center in Canton, Massachusetts, reads, “See for yourself how we are different….” Indeed it is different, in that it still, after decades and much evidence that the practice is unnecessary and counterproductive in terms of behavior, uses shock treatments to maintain order in its residential facility for young people with disabilities.

Now, the Food and Drug Administration has issued a 124-page report that proposes that shock treatments be banned outright, an outcome that has been sought by advocates for years. (See here or here and here, as well as here.) This last link is from the Washington Post, which describes the center’s methods in one case of an autistic 18-year-old:

Andre had already tried two other residential schools, including one where another student sexually assaulted him, to overcome his tendency to break things or hit people in rage attacks. Twenty months later, in October 2002, Cheryl received a terrifying call from a center employee, who told her, “Andre had a bad day.” Earlier in the day, a staffer told Andre to take off his jacket. When he said no, another staff member pressed a button to activate the electric-shock machine attached to Andre’s body with taped electrodes. Andre screamed and threw himself under a table. Four adults dragged him out, and strapped him, facedown, into four-point restraints. Over the next seven hours, Andre was shocked 31 times with a device that emits 45.5 milliamps of electricity—a shock more than 15 times as powerful as the stun belts designed to incapacitate violent adult prisoners. Staff members recorded the reason for each shock—all but two entries on his recording sheet list tensing up or screaming. In the surveillance video, Andre can be heard pleading for staff members to stop. At the Rotenberg center, in Canton, Mass., this is called treatment.

The device being used is the brainchild invention of the founder of the center, psychologist Dr. Matthew L. Israel, who believes that exposure to painful stimuli, or “aversives,” reduces or eliminates undesirable behavior. Israel trained with B.F. Skinner. The so-called “graduated electronic decelerator” (GED), provides a shock stronger than police stun guns. The center, which opened in 1971 as the Behavioral Research Center, has been controversial for its use of “aversives” for decades—in fact, it was renamed in 1986 for a judge who helped block its forced closing.

In a United Nations report on cruel and inhumane medical treatments worldwide, published in 2013, the JRC was singled out as a human rights violator under a UN anti-torture convention. The center pooh-poohs the reports of torture, saying that the shock could be likened to a hard pinch or bee sting.

The FDA report, which was the product of a hearing held a year ago, states:

When considering the reasonableness of the risk of illness or injury posed by a device in a banning proceeding, FDA also considers the state of the art. Notably, the use of aversive conditioning in general, and ESDs [electrostatic discharge] in particular, has been on the decline for decades; only one facility in the United States still uses ESDs for SIB [self-injurious behavior] and AB [aggressive behavior]. This decline is due in part to scientific advances that have yielded new insights into the organic causes and external (environmental or social) triggers of SIB and AB, allowing the field to move beyond intrusive punishment techniques such as aversive conditioning with ESDs. Moreover, punishment techniques (which include the use of ESDs) are highly context-sensitive, so the same technique may lose effectiveness simply by changing rooms or providers. The evolution of the state of the art responded to this limitation by emphasizing skills acquisition and individual choice. The evolution is also due in part to the ethical concerns tied to the risks posed by devices such as ESDs, especially regarding the application of pain to a vulnerable patient population. In light of scientific advances, out of concern for ethical treatment, and in an attempt to create generalizable interventions that work in community settings, behavioral scientists have developed safer, successful treatments.

There are, in fact, some parents associated with the center who uphold the use of ESDs—but should society allow it when other interventions are available?—Ruth McCambridge