Wednesday, March 20, 2013

Autism Shock Therapy Practiced In US Is Torture, Says UN Official

Emily Willingham
www.emilywillinghamphd.com
www.forbes.com/sites/emilywillingham  

Trigger warning: discussion of Judge Rotenberg Center, aversives, mistreatment of autistics

Some practices used as “therapy” for autism in the United States amount to torture, a U.N. representative says. The U.N.’s Juan Mendez is the organization’s special rapporteur on torture, and in his report examining torture worldwide, he’s called out the only facility in the United States that uses “skin shocks” to ‘treat’ people with severe mental illness or developmental disabilities, including autism. That facility is the Judge Rotenberg Center (JRC), formerly the Behavioral Research Institute. While it once was located in California and then moved to Rhode Island, the facility is now sited in Massachusetts. Mendez expresses concern in his report (p. 84) that if Massachusetts becomes too hot to hold the JRC, the center might simply relocate again, and he urges action at the federal level to end the use of such aversives nationwide.

But wait, you might say. What does shocking people have to do with autism or mental illness treatment in the United States? If you look at the science, not one thing. But the JRC is the reality. This center has been the focus of considerable controversy, especially since the release of this graphic and disturbing video of a teenager being “treated” at the center with what the JRC, in its posted response [PDF] to accusations, calls “skin shock treatments.”

The center, which a report says “brought in $55 million in revenue in the year ending June 2011,” received a warning from the U.S. Food and Drug Administration (FDA) stating that the devices the staff uses to shock patients–who wear a backpack wired to various parts of their bodies for easy zapping–violate FDA regulations. The devices, which center staff created and designated as “Graduated Electronic Decelerators” (GEDs), were approved in 1994. However, since that approval, the JRC team has jacked up the voltage on them. It has done so twice, in fact, putting them out of compliance. Their rationale, it seems, was that the original device was just too weak to hurt enough.

According to reports, some parents argue that these shocks are the only effective therapies for their children who engage in harm to self or others. But this story, “The Shocking Truth,” by Paul Kix, which appeared in Boston Magazine in 2008, describes the use of these shock aversives to punish a young girl with cerebral palsy for moaning and reaching for a staff member’s hand and as a consequence for another child who closed his eyes for more than five seconds. The story is a tough read, and there are other, unconfirmed stories from residents who have described similar experiences at the center.

Unfortunately for some ‘students’ at the center, the end doesn’t appear to be in sight. Mendez says in his report (p. 83) that while
the Commonwealth of Massachusetts Department of Developmental Services (DDS) approved regulation changes that limited the use of Level III Aversive Interventions (including skin shock), this new regulation does still allow the use of electric shocks for those students who had an existing court-approved treatment plan as of September 1, 2011 (115 CMR 5.14). Under the revised regulations, only new students in Massachusetts are protected from Level III aversives, including electric shock or prolonged restraints.
In other words, these interventions are bad enough that no one should have them administered and should be protected from them, but students who were unfortunate enough to have them in a treatment plan already are … grandfathered in for torture?

What science backs up the use of electric shocks to the skin as an appropriate way of modifying behaviors? Not much, unless you’re a rodent. First, this “therapy” is not to be confused with electroconvulsive therapy which, although controversial, is administered to patients under general anesthesia and involves electric currents to the brain to induce seizures. Case studies and some reports indicate efficacy of this extremely controversial treatment for depression and other disorders. But the kind of shock used at the JRC is called “contingent shock,” and the small group of authors, including those affiliated with the JRC, who publish on it do so in rather chilling language. An example comes from a study (abstract only) led by JRC collaborator P.C. Duker. The authors were trying to determine whether or not shocks administered to the same area would be more effective–i.e., cause more pain–than repeat shocks to different areas. Here’s what they write in their abstract:
Electric shocks were identical to those that (sic) used in clinical practice. The second shock in succession to the same location of the body produced higher pain intensity ratings than the first shock and (sic) that the third shock in succession to the same location of the body produced higher pain intensity ratings than the second shock in succession.
For most people, that escalation would be a bad thing, this heightening intensity with repeated shocks to the same place. But the authors see it differently:
Our data suggest that repeated shock to the same location is likely to be more effective to establish suppression than repeated shock to different locations.
The “suppression” references suppressing the negative behaviors the shocks are intended to stop.

The literature on “contingent shock” is sparse, at best, mostly pertains to being effective in rodents, and seems to have come almost to a complete stop at the turn of the 21st century. One would like to think that perhaps with the dawning of a new millenium, we had entered a new age of evidence-based, nonbarbaric practices to help–not restrain, seclude, or shock–those with the most intense mental disturbances or developmental disabilities and that this new insight precluded even conducting clinical studies to evaluate these “therapeutic” approaches. However, since 2002, according to a PubMed search, there has been one article [PDF] evaluating contingent shock; more specifically, the investigators evaluated its side effects. Two of the four authors cite their affiliation as the JRC, and one is Matthew Israel, JRC’s founder. Perhaps not surprisingly, the authors conclude that there are no negative side effects with this therapy.
 
Matthew Israel, also possibly not surprisingly, seems to have studied under B.F. Skinner, inventor of the Skinner box, which can include an electrified floor to shock rodents and condition them. According to a 2007 interview Israel did with Mother Jones, early aversives Israel used in his work with people included spanking, pinching, spraying water in the face, and breaking a vial of ammonia under the nose. In the interview, he says these approaches have fallen out of favor because they are ‘politically incorrect’, and he describes how he turned to shock aversives:
You do find a lot of these in the literature of the ’60s and ’70s and ’80s—more so then, because it has become so politically incorrect. What you’ll also find is the skin shock. They would use a cattle prod. My consulting psychiatrist would say, “Why don’t you use the skin shock? It’s so much cleaner.”
He developed the higher-voltage GED, he tells the interviewer, because
… some students had adapted to the GED. You can adapt to aversive conditions and procedures. The body is made that way. Odors, for example, are aversive at first, but the body adapts. That happens, unfortunately, with many kinds of punishment as well.
“Unfortunately.”

Israel left the JRC in 2011 to avoid doing a prison sentence for allegedly destroying evidence in a criminal case in which the center was accused of wrongfully administering dozens of shocks to two disabled teens. In the Mother Jones interview, he is quoted as saying that the GED4 “leaves a mark.” He says,
…in some students it creates a mark that may last for days. I can’t think of a single one (negative side effect) except that it leaves a mark.
The mark that we can see and the hidden scars we can’t both represent what the U.N.’s special rapporteur on torture, Juan Mendez, calls … well, torture. To quote Mendez:
The rights of the students of the JRC subjected to … electric shock and physical means of restraints have been violated under the U.N. Convention against Torture and other international standards.
The U.S. government appears to agree that the practice is insupportable, having been cited in Mendez’s report (p. 83) as stating:
“The use of aversive therapy by JRC has been challenged through a variety of state and federal legislative and judicial actions,” including the Department of Justice’s (DOJ) investigation into possible violations of civil rights laws, which remains open and ongoing.
Yet the JRC remains open and ongoing … and shocking. Why is that?


Previously published at blogs.forbes.com/emilywillingham.