New Page 2

Rotenberg Center: TREATMENT or TORMENT? A Canton center’s therapy for mental illness - shocks and food deprivation - is staunchly defended and bitterly attacked

By TOM BENNER
The Patriot Ledger
July 29, 2006

Rodrigo Torres has earned a trip to the Big
Rewards store at Judge Rotenberg Education
Center in Canton to pick out a treat for behaving
well. The school adheres to a system of rewards
for good behavior and punishments, including
shock therapy, for bad behavior.

(LISA BUL/The Patriot Ledger)

CANTON - For desperate parents, it’s the treatment of last resort, and it works. For critics, it’s a torment bordering on torture. The Judge Rotenberg Education Center in Canton is the only special needs school in the country that uses skin shocks to condition students, and those critics are working through legal and legislative channels to shut it down.

For 35 years, the center has used ‘‘aversive therapy’’ to treat young people with the most severe mental illnesses, people who at times will mutilate themselves or injure others. Nearly 75 percent of the center’s 234 residents are subject to jolts of electricity to the skin or ‘‘food deprivation’’ if they act inappropriately.

The school’s use of skin shock prompted a legislative effort this year to ban aversive therapy in Massachusetts, and an ongoing investigation by education officials in New York state, which sends a large number of youngsters to the school.

Those efforts have done nothing to diminish the commitment of the center’s professional staff, who argue that aversive therapy has no permanent impact and is a much better idea than doping people up with powerful antipsychotic drugs.

‘‘The therapy saves lives and turns lives around, but it generates this controversy,’’ said Dr. Matthew Israel, 72, who founded the school after training at Harvard with psychologist B.F. Skinner. ‘‘But how can you stop using something that is so helpful to parents and to children?’’ said Israel, who remains the dominant figure at the school.

Some facts about the Rotenberg Center:

—The center’s two buildings are on 15 acres off Route 138 in Canton, and they are brightly decorated with cheerful and colorful art. The students live in 46 residential homes in Randolph, Holbrook, Canton, Stoughton and communities south to Attleboro. They are bused to the school each day.

—While the goal is to integrate residents back into regular schools in their communities, some of the clients don’t make that step and stay at the center for extended periods of time.

— About 75 percent of the current residents are under the age of 21. The residents are predominantly - 70 percent - male.

—Tuition at the nonprofit year-round school is steep - $210,000 a year for each resident, which is generally covered by the school districts from which they hail or by a variety of social service agencies for older residents. New York sends 151 people to the school, at an annual cost of about $31 million a year.

—Some 1,000 employees work at the school and its residential homes. They have 680 video cameras and 50 digital video recorders to monitor what is going on at the school and homes.

Israel started the school in 1971 in Providence, eventually moving to Canton and renaming it after a Bristol County judge who approved a settlement under which the state of Massachusetts paid $580,000 after unsuccessfully trying to close the school. That state effort came after the death in 1985 of a 22-year-old who suffered a seizure while restrained and forced to listen to static noise.

Three Massachusetts agencies - the Department of Mental Retardation, the Department of Education and the Department of Early Education and Care - now license the school for educational and residential programs.

The school adheres to a system of rewards for good behavior and punishments for bad behavior, a philosophy that stems from Skinner’s behaviorist theories. The rewards are tangible - CDs, access to game rooms, special foods and the like. But rewards alone sometimes are not enough to change the behavior of people with severe mental illnesses or profound retardation, and that’s where aversive therapy comes into play for about 80 percent of the center’s residents.

Roughly 65 percent of the students are subject to skin shocks and they wear backpacks or fanny-packs carrying the electronic shock equipment. Wires run under their clothes to their arms, legs or torso, where sensors emit a two-second shock every time a student is caught doing something wrong.

The shocks are measured in milliamps - a thousandth of an ampere. Three milliamps, the low end of the range used at the center, is a fraction of 1 percent of the shock delivered by a Taser pistol. If you go to a doctor’s office and get electric stimulation to relieve muscle or joint pain, you’re getting 1 milliamp.

The high end of the range used at the center is 45 milliamps, slightly less than 5 percent of the jolt delivered by a Taser. Only a handful of students get that sort of shock.

School officials acknowledge that the shocks hurt. They liken it to a bee sting, or getting a tattoo, or touching a hot stove.

They also admit it’s an unusual treatment, but they don’t think it’s cruel. Students at the school are weaned off medications, which school officials consider far more harmful than skin shocks.

‘‘Stop and think about the medications that these kids were on before they came to us, and how aversive that is for them,’’ said Dr. Patricia Rivera of Stoughton, the school’s assistant director of clinical services.

‘‘A lot of these kids are drooling, they can't even stay awake during the day to work on their academics, they're still hurting themselves or others, but that’s not aversive to a lot of people,’’ Rivera said. ‘‘I don't understand that, how some people think that’s not aversive.’’

The center is generally the last stop for students after a desperate regimen of medications, other special needs programs or psychiatric hospitalization. Students are mostly teenagers, but the center’s population ranges from 8 to 46. Some students suffer from autism or mental retardation, while others from emotional or behavior problems.

‘‘Some students bang their heads to the point of brain damage, they poke their eyes, they eat their own fingers, they break their bones,’’ Israel said in an interview this past week. ‘‘We had one student who had detached retinas and was blinding herself and punching her face. We had a student who bit off the end of his tongue and bit a hole in his cheek. We’re the only place that’s available to treat those students.’’

‘‘Food deprivation’’ is the term used at the center for another negative response to uncontrolled behavior. It involves denying ‘‘preferred foods’’ to misbehaving students, instead giving them a ‘‘nonpreferred’’ meal of bland food sprinkled with liver powder to make it look less appetizing. In some cases, even that ‘‘nonpreferred’’ meal is denied.

‘‘Skinner’s original work used food as a reward; all the work with the animals was done with food rewards,’’ Israel said. ‘‘Food is one of the best rewards of all, and in order to make it work, you have to have a little bit of deprivation.’’

Skin shocks weren’t used at the school until 1990. Before that, aversive therapies included spanking, pinching, muscle squeezing, the use of a water squirt or vapor spray gun and aromatic ammonia.

But the invention in 1989 of remote skin shock equipment led Israel to conclude that skin shocks are less harmful and intrusive than inflicting direct pain such as spanking.

Israel felt the skin shock device invented in 1989 wasn’t powerful enough to have an effect on students. So he designed a stronger model called the ‘‘GED,’’ or graduated electronic decelerator.

Two large sculptured dogs with lighted collars watch over the entrance to the school’s main administration building, and upon entering visitors are greeted by stars hanging from a high glass-atrium ceiling and colorful paintings, sculptures and flowers.

‘‘We made it a point to really try to make the environment attractive, colorful and upbeat,’’ said Israel, a fine arts major as a college undergraduate. ‘‘That’s also one of the most enjoyable parts of running the program.’’

Students arriving at the Rotenberg Center are not initially exposed to skin shocks, but they are told that misbehavior may lead to wearing a backpack and skin shocks. Multiple devices are used for students who try to disconnect them.

In every case, the school must get approval from a guardian and a probate court before administering the shocks.

‘‘If they don’t respond well to (positive reinforcement) and continue to hurt themselves or hurt other people, we go forward with the court process, which includes getting the guardian’s permission and getting the court’s permission,’’ Rivera, the assistant director of clinical services, said.

When students show signs of improved behavior, they may eventually be ‘‘faded’’ - first to wearing a smaller fanny pack equipped with a GED, and then to not receiving skin shocks at all.

Rewards for good behavior include sitting in massage chairs, favorite snacks or other foods, picking out CDs, DVDs or other prizes at a reward ‘‘store,’’ or playing in an arcade-like lounge with pool tables, video games and a popcorn machine.

‘‘We’re constantly being criticized for the use of aversives,’’ Israel said. ‘‘It’s really the responsible approach to make as powerful a reward program as you can, and then bring in the aversives when the rewards themselves are insufficient.’’

Aversive therapy traces origin to Pavlov’s salivating dogs

It all started with Pavlov’s dogs. Russian psychologist Ivan Pavlov discovered through his experiments that by ringing a bell, he could condition his dogs to associate the bell’s sound with feeding time, and they would begin to salivate. The 1904 Nobel Prize winner opened up new branches of experimental psychology and the school of thought called behaviorism, or behavior modification.

B.F. Skinner became a major proponent of behavior modification in the United States, using aversive therapy - rewards to encourage desirable behavior, and negative reinforcement to punish undesirable behavior - in animals and human beings. The Harvard-trained psychologist’s famous Skinner box demonstrated that rats could be taught to press levers to obtain food.

Dr. Matthew Israel, who founded the Judge Rotenberg Education Center in 1971, did his doctoral thesis under Skinner at Harvard University. Strongly influenced by Skinner’s research into conditioned response, Israel maintains that skin-shock therapy has no lasting side effects, and is a proven method to teach positive behavior.

‘‘What we do is so much less intrusive than medications which can ruin your body for the rest of your life, or these time-wasting timeout procedures or emergency takedowns,’’ Israel said. ‘‘Sure it’s painful for two seconds, but there are no side effects to worry about.’’

Israel maintains that human beings by their nature learn from both positive and negative experiences.

‘‘People have such a strong dogmatic position about the use of punishment that they’re not willing to weigh the benefits against the risk,’’ he said.

Israel also feels that JRC - the shorthand way people at the Rotenberg center identify it - is an easy target for critics, including state Sen. Brian A. Joyce of Milton, who is pushing legislation to ban aversive therapy in Massachusetts.

‘‘The typical headline is ‘torture versus tough love.’ They love the word torture,’’ Israel said. ‘‘People like Sen. Joyce are repeating wild accusations and falsehoods that have no basis.’’

Israel calls the school’s critics ‘‘well-intentioned people who believe themselves to be advocates for the welfare of children, but they are unable to look at this in a scientific way, or come up with alternatives that are safe and less intrusive.’’

Skin shocks are administered for self-mutilating behaviors such as head-banging and eye-gouging, or aggression against others.

Israel maintains that the skin shocks have a high success rate, reducing problem behaviors in students by 95 percent, and substantially reducing the need for mind-altering medications.

More about the Judge Rotenberg Education Center

—Student population: 234, ranging in ages 8 to 46

—156 students receive skin shocks for misbehavior

—34 students are on food deprivation programs

—169 are school-age students and 65 are 22 or older

—163 are male, 71 are female

—Median stay: Two years

—Dress code for school: Collared shirts and ties for boys; no jeans and appropriate-length skirts for girls

—Tuition: $210,000 a year

—Revenues: $52.5 million

—Salary of school founder Dr. Matthew Israel: $334,000

—Location: Two buildings on 15-acre campus on Route 138 in Canton, monitored by 680 video cameras and 50 digital video recorders

—46 residential homes in Attleboro, Mansfield, Rehoboth, Norton, Randolph, Stoughton, Holbrook and Canton.

—School operates year-round

Tom Benner may be reached at tbenner@ledger.com.