Unlearn shocking behaviors
By CLARENCE J. SUNDRAM
First
published: Sunday, July 16, 2006
New York has been sending students with
mental retardation, autism or emotional problems to out-of-state
facilities that use electric shocks, withholding of food and other
painful and humiliating actions as a means of changing behavior that
they consider harmful, dangerous or undesirable.
The State Board of Regents has
recently placed tighter restrictions on the use of so-called
"aversive therapy," which also includes "hitting, slapping,
pinching, kicking, hurling, strangling, shoving, deep muscle
squeezes" and other similar actions.
It is appalling that there are any
circumstances under which educators can engage in such conduct. Of
the many factors that contribute to the endemic problem of abuse and
neglect in facilities serving people with mental disabilities,
perhaps none is more important than an essential lack of respect for
the common humanity we share.
The labels we attach to people and
their behaviors are often the first step in distancing "them" from
"us" and for tolerating for "them" attitudes, conduct, policy,
practice and even laws that we would find abhorrent if applied to
"us."
It is essential that public policy be
clear in its prohibition of physical and psychological abuse,
including the intentional infliction of pain and humiliation under
the guise of "aversive therapy."
When we permit, and indeed require,
staff to hit, slap, pinch, shock, spray with noxious inhalants, deny
food or otherwise inflict pain, degradation and humiliation, we
weaken and confuse this message that ought to be communicated
clearly, consistently and unequivocally.
The license to shock, hit and hurt
becomes a self-fulfilling prophecy. Like parental beliefs in the
need for physical discipline in child-rearing, programs that believe
that people need to be shocked, hit and hurt to change their
behavior will find justifications for doing so. They invite an abuse
of authority and power struggles between children and staff in which
children invariably risk being tortured or tormented into
submission.
This means of trying to change
behavior can become a contagious coping mechanism for over-stressed
staff. Once staff are authorized to hit or shock residents,
initially in response to behaviors that are characterized as
dangerous, there is a continual tendency to broaden that
authorization to other conduct, including so-called "precursor
behaviors," until the entire focus of the program becomes the use of
pain to achieve control.
Programs that believe such conduct is
abusive and abhorrent will and do find other nonharmful ways to
manage and change the same behavior.
In 30 years of experience in
monitoring programs for people with a variety of disabilities in New
York and elsewhere, I have been struck by the wide diversity of
clinical approaches in responding to similar problems.
Some psychiatric hospitals make heavy
use of mechanical restraints and defend them as absolutely
necessary; others serving a similar patient population hardly use
them at all. Some have a high rate of seclusion; others don't even
have seclusion rooms. When questioned, clinical professionals
explain this diversity as flowing out of their own values about how
people should be treated.
The same is true of the use of
painful and humiliating aversives. While there are tens of thousands
of people with mental disabilities in institutions across America,
and many hundreds, if not thousands, have severe maladaptive
behaviors, only a small handful of programs subject their residents
to sanctioned abuse in the name of treatment.
History is full of abuses of human
rights in the name of benevolence. There seems to be an inexorable
process whereby the objects of our pity become the subjects of our
concern and, ultimately, the victims of our coercion.
Some may argue for a hands off
approach by government, especially since parents are often involved
in and consent to the program of aversives including the infliction
of pain. This argument must be examined with caution.
Having listened carefully to parents
who have been traumatized repeatedly by every eviction of their
child from programs that could not cope with severe maladaptive
behaviors, I am deeply sympathetic to their plight. They are
understandably desperate for help and often find traditional
programs unresponsive to the special needs of a child, or
unavailable to them. Any program that welcomes their child at such a
time is like a prayer answered.
In their desperation, parents have no
bargaining power and must consent to the treatment regimen proposed,
with the understanding that their lack of consent will also doom the
admission. Their consent is often not fully voluntary because they
have no other choice. What parents are often promised, by people
with impressive degrees and credentials, is results, that "we care
enough to do whatever it takes for as long as it takes" to deal with
the problem behavior.
The seductive argument in favor of
the infliction of shock and pain to change behavior is that it
works, at least for as long as the pain or the threat of pain is
present. So might torture, but it is hardly a reason for a civilized
society to tolerate it. Like torture, the change in behavior is
temporary, while the wound to the human dignity is lasting.
The Legislature is considering
whether to ban the use of such aversives outright. New York can do
better than spend approximately $200,000 per child annually to send
over 170 students out of state to endure a regime of unrelenting
abuse. Surely our educators have the knowledge and skill to develop
innovative and nonabusive educational programs (and create jobs)
here in New York.
Our legislators and educators ought
to be clear and unequivocal that we do not tolerate abuse no matter
who prescribes it, what they call it, or what label they attach to
the victim.
Sundram is president of Mental
Disability Rights International. His e-mail address is cjsundram@
alumni.ksg.harvard.edu.
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