I finished Joseph P. Shapiro’s book No Pity: People with Disabilities Forging a New Civil Rights Movement last night. I liked this book. It covers quite a bit of disabled history and does so with a wide range of disabilities, including blindness, ALS, autism, mental retardation and physical disabilities. I wanted to read this book after seeing it in the legal section in a bookstore, flipping to a page about the Behavior Research Institute, and thinking that it sounded just like the Mother Jones magazine expose I had just read. (And as it turned out, when I researched it, it was; the center changed its name to the Judge Rotenberg Center).
I’m torn between debating this particular problem on ethical reasons, or siding with parents, who do need a last-resort option for children and adults who yank their own hair, bang their heads, or engage in any other violent behavior. The parents do need respite and an option of somewhere to put their children where they will be safe. Shapiro addresses this issue first by showing a job center where people with temper tantrums can work. He reports that due to positive intervention on the job, the temper tantrums eventually subside.
During the time the author examined this center in the 1980’s, it used a device to electrically shock students who misbehaved — reportedly about the voltage of a rubber band slapped across you. Students could also be pinched, spanked with a spatula, slapped, have portions of food withheld or — and here’s a chilling part — restrained with their heads between their knees, masked, and with white noise helmets on their heads.
Now addressing this issue is tricky. Food rewards for proper behavior are a part of public school special education for some students. So that makes sense. Restraints are allowed in at least one center I know of, as well as time-outs. So here’s the thing. A shock device like that would probably be not very painful, but a reminder, equivilant to (and I hate to say it) training your dog. And students particularly sensitive to noise and touch would hate these punishments. All right. But let’s review. Let’s assume the students engage in behavior that is threatening to themselves (throwing chairs, banging their heads, biting their fingers severely etc.) So. In a prison, inmates engage in behaviors that can be harmful to others (rape, murder,etc.) and they are in prison to rehabilitate them.
In the Mother Jones expose (August 2007, http://motherjones.com/politics/2007/08/school-shock), the voltage of the device had increased to about the strength of a bee sting — according to the reporter, like a whole swarm at once. Shapiro predicted this in his book, saying that the school was like a giant Skinner box, principles that the school extended to not only the students but also to supervisors as well.
Well, Shapiro points to the students doing tedious work on computers. (Now some tedious work on computers might not be tedious for them, and I’m hoping this is not one of those false-education things). So a man protests by verbalizing and taking his hands off the computer. When he is pinched, he complies. When he tries to get up from his seat, he is instantly thrown to the floor and held there until he complies and goes back to work. Now this makes me wonder. How long and how often are the breaks? Does this person need a different schedule or is everyone on the same one? Is this person known to immediately engage in violent behavior to himself or others upon getting up? Also, the student attempted communication which was appropriate to express that he wanted to stop.
And lastly, if you worked in an office and decided to take your coffee break early, would your boss body slam you?
So the students engage in difficult, hard-to-control behaviors. Shapiro notes that if the students are subject to a system of rewards and punishments for their behavior, then the supervisors get rewards for how they respond. What this could potentially mean (and scientifically, according to Skinner’s priniciples, it does) is that the more a supervisor rewards (or punishes) a student, they get a vacation. They are rewarded for something good they did, and they will do more of it because of this reinforcement. So, for example, shocking or restraining a student will bring you good things. Think of the Stanford experiment: students became jailers or prisoners; those with the power quickly engaged in excessive force. In Milgram’s study, people were asked by a doctor in a white coat to shock a person, and to up the voltage when asked. It was proven that when asked by a person in authority, the subjects would up the voltage to the point of death, despite protesting, if they were asked to by someone in authority. What they didn’t know is that the person being shocked was an actor.
Interestingly, Shapiro notes that the supervisors in this case had newly-acquired college degrees. They were entry-level. Hmm…
Intrigued by this, I decided to look further into the school. Who is right? The parents, who could be admittedly desperate if local schools have not been able to help, or the school with its system of rewards and punishments? Hard to tell. For instance, if you swat your two-year-old, but also reward them most of the time, their bad behavior will eventually stop. This is according to Skinner’s principles, like a rat pushing a lever when rewarded and going away from it if they’re shocked
But if you hogtied your two-year-old, put a mask over their head, white noise over their ears — well, all right, maybe you remove the mask and earphones, but maybe not – and you can leave them restrained lying down by the legs and arms for minutes, hours or intermittedly days, until they do what you say — how fast do you think Social Services will be called? I can bet if your child reported that you did this for even two minutes, they would be taken away.
Even if parents are right that the reward and punishment system works for their children — and I believe for some it likely does — there is an interesting parallel here. http://www.boston.com/news/education/k_12/articles/2007/12/18/prank_led_school_to_treat_two_with_shock/ has an extremely interesting story. A prank call, believed to be from a former student, pretending to be a supervisor, resulted in shocks. The two boys involved were woken in the middle of the night, shocked 77 and 29 times respectively — this article says this did not result in medical treatment and caused no injuries. That’s interesting. Just as a principal would never ask for the identity of a teacher who wanted a student seen, neither did these people — which makes sense. In a parallel, if you slapped a student 77 times, lightly, which did not result in injury, wouldn’t that be considered highly excessive? In historical terms of institutions, weren’t restraints, cold water showers and beatings used to subdue inmates or force them to work in the fields or at menial tasks (admittedly with more violence)? (Shapiro refers to the cold water showers in his book as punishment at the center, though I’ve found it nowhere else).
A video on Youtube, which appears to be an NBC news report http://www.youtube.com/watch?v=-aUIhWmDPeI states that the 77 shocks were given over a three hour period. Hmm. The news report also refers to the punishment as “shock treatment” which I believe is actually electroshock therapy, and not what is being done here. But still…three hours. Isn’t that a very long time for punishment of any kind to continue? What if this was beating a student with a stick or something else for three hours, ever so often, or dripping water on them for three hours? Even if the punishment occurred intermittently for three hours, it means that for that time period (I assume) the student expected punishment, even during those times when it did not actually occur. They anticipated and received punishment for an extended time. Longer than most schools or homes, even if they are allowed to use physical punishment, would be permitted to use it. If nothing else, it seems physically and emotionally abusive just for the length of time involved.
But…hmm…what does this sound like? Someone in authority told you to do something that involves shocks to another person, and you did so because you believed them to be in authority.
Milgram’s study, anyone?
And also, assume that you might be restrained to a chair in a upright position, where you might be able to see your watch. That’s good. But what if you are restrained in a prone position and unable to see your watch, or if you have no inherent sense of time, no idea of how long things last? How long would the punishment seem then? If the shock device must be approved by the courts and parents, as a last-resort punishment, why is it being used for minor things like having an untidy appearance or asking for a tissue? And swearing. Sometimes I wish the report would include context. If swearing is a sign of escalating anger problems, then there might be a problem. Otherwise swearing is not harmful to anyone. Should it have the same punishment as another action that is? And if you assume that at least a percentage of students might have sleep problems to begin with, since they are special ed. During the three hours in the middle of the night you are being punished, then, you are not sleeping. What will that do your behavior the next day? Seems that could get into a cycle.
http://www.msnbc.msn.com/id/22730838/ continues the story, saying that the punishment did result in first degree burns for one of the students. The center’s videotape of the above incident, which the center was ordered to keep for the court, was destroyed at the center, due to worries about the privacy of students. Huh. Makes sense you’d want to protect student privacy, but shouldn’t the tape be taken and enter into the chain of custody like any other evidence? Doesn’t the chain of custody exist so that evidence doesn’t disappear? The article says when an investigator asked for a copy of the tape, the center declined, and were merely told to preserve a copy for criminal investigations of abuse.
…And they didn’t.
And in this case, what constitutes a legal definition of “injury?” Obviously, you can be physically hit or otherwise punished without causing bruising or cuts. But are these considered injuries? They are not lasting injuries in the sense of broken bones. The legal definition of injuries changes over time — for instance, in the 1800’s, it was legal to beat your wife, and your children. If bruising or blood occurred, that was all right, within your rights as a member of the household. A first degree burn involves redness, minor pain — like a sunburn, without blistering. It heals within 5 to 7 days. So if we assume that small burns occurred where electrodes were located, which could have been in multiple areas, each of which took 7 days to heal, during which time, there was pain, is that an injury? It’s not an injury in the sense of broken bones, but still…it’s not something that’s going to go away shortly after the punishment ends either.
Let’s assume that, by mistake, you received burns on the back, arms, and stomach. Let’s also assume that electrodes were moved around to prevent burns. If you were given 5 shocks, maybe only 2 of those places result in very small burns at the site of electrodes. Since first degree burns can hurt mildly when exposed to air and movement, let’s also assume ointment was applied by the school’s nurse. So you are treated — and because you have only 2 burns, doing relatively well. (Or in most cases, it seems, you may never get burned at all, anyway). But suppose you have the 77 shocks. How many of those result in burns? Can you for example lie on your stomach, back or side, without having burns touch blankets or your clothes?
On page 152, Shapiro notes rewards which include hugs, merry-go-round rides and other fun activities. On page 153, however, he reports that one student received “over one thousand physical punishments” over three days. Granted the punishments Shapiro lists sound relatively minor, but still I tried to calculate that. 1000 punishments over 3 days, if my calculations are correct, would be something like 333 punishments per day, however minor. I wanted to break that down per hour but couldn’t figure out how. So, does that mean, someone stands beside you, and waits to punish you? Wouldn’t that be emotionally stressful?
What I think is interesting about this is that even inspectors did not care for what they saw or what children reported to them. http://boston.com/news/daily/15/school_report.pdf has an extremely interesting report about this. Inspectors found that despite the school’s claim of rewards, few were observed, punishments were put to use more often, that students were discouraged from interacting with each other or with staff; that special education and training was not adequate; that at least one student placed there for vocational services was not getting any such services. The study also found that students could be forced to engage in behavior that resulted in their being shocked (called a Behavior Rehearsal Lesson), and that delayed punishment was used (being woken up for punishment due to something the cameras saw earlier that day).
The problem with that (aside from ethical concerns) is that punishment is supposed to be immediate. Say you have a two-year-old and you swat him and tell him it’s for something he did three days ago that you just remembered now. Will the message get through? No. Because it’s removed from the behavior. In addition, I’m assuming that many students are low-functioning, which is likely not the case, since some were apparently interviewed. If you take someone with a mental age of three with head banging under stress, and you subject him to these conditions, and punish him for head banging, what’s going to happen? Well, likely more stress and head banging, especially if they are unable to verbalize that they want to stop a task or go home.
A positive reward system was in place with the awarding of tokens for the absence of the bad behavior, which could be exchanged for toys. In the public school system, smiley faces, food, praise are similar token rewards. The only problem with this is that the report notes on page 18 that positive behaviors were not rewarded at all. Visits to psychologists must be earned by writing a letter and paid for with tokens. This makes me wonder. First of all, obviously students shouldn’t be able to pester doctors constantly, but shouldn’t communication be a goal instead of a privilege? If you don’t earn any tokens because you have exhibited poor behavior, that means you may never earn the right to talk to the psychologist, and you may have the most need. And also, if whining, nagging etc. are behaviors which can result in punishment, what happens if you have a legitimate complaint? What happens if you are unable to write? Is an alternative provided?
Also, restraints as punishments seems a bit outdated. Restraints are now being phased out of nursing homes because of this use — even if they were used appropriately to hold constricted muscles in place, keep someone from falling out of bed, or enable them to ride in a wheelchair. Without seat belts, some people would be unable to ride in a wheelchair. This, I believe, is an appropriate of restraints. Also, restraints could be used if you show an immediate threat of harm to yourself or to others, but not as a punishment. Restraints-as-punishment are destroying actual medical need for restraints.
The report said that “Students in classrooms were docile and compliant and did not attempt to socially engage, either verbally or with eye contact, anyone in the rooms. This was also apparent in the residences visited by the team. Staff indicated, on at least three occasions, that it was unsafe to allow students to socialize because in the past students had plotted against staff.” (page 25; italics mine). “…in fact requires that the students not attempt social interactions with staff or classmates as part of their behavior programs.” (page 24). Now assuming this people have inherent social skills difficulties, isn’t that a bit odd?
The report stated that community and social skills were not taught. Some students were not allowed to attend school. Work was apparently so repetitive that students would continue to tap keys for computers, even if the computer was frozen. The report stated that shocks could be administered for non-destructive behaviors like nagging, swearing, untidy appearance, and in one instance, requesting a tissue after sneezing. Students could be restrained and repeatedly shocked.
The Behavioral Rehearsal Lesson makes sense in theory: like a social skills lesson, reinforce what should not be done, instead of what is proper. In practice, however, it sounds like shock is used for both demonstrating the bad behavior, and for refusing to demonstrate it (not following instructions, but an actually good rewardable response. Page 9: “GED skin shock and restraint are also used together when the Behavior Rehearsal Lesson (BRL) is practiced on a student. The BRL is used when a student exhibits a high risk, low frequency behavior. As described by a JRC staff person, during a BRL, the student is restrained and GED administered as the student is forcibly challenged to do what the procedure seeks to eliminate. If the student attempts to pull away he receives a GED skin shock; if the student attempts to follow through with the high-risk behavior he receives multiple GED skin shocks at closer intervals.” Shock was also applied for demonstrating an alternative good behavior (page 19).
Hmm…they punish you more for doing a bad behavior, which you were forced to do. Other examples of the BRL were also frightening: “It was reported by a JRC staff member that one of the BRL episodes involved holding a student’s face still while staff person went for his mouth with a pen or pencil threatening to stab him in the mouth while repeatedly yelling “YOU WANT TO EAT THIS?” The goal was to aversively treat the student’s target behavior of putting sharp objects in the mouth.” (page 19).
Besides a obvious problem of this as an educational tool, look at this as a social model. Is the student alone or with peers at the time? Aside from scaring the crap out of any student, what is the person in charge demonstrating? That’s right: how to stab someone. Since a social model would be used to teach skills in classes, this demonstrates to someone with mild-severe retardation or emotional problems the type of behavior you would never want to encourage.
And also is this dignified for the student? Obviously students have held on to some troublesome behaviors when most none-special ed students have discarded them at their age, but what if you applied the same technique to a preschool classroom? And how is the no-head-banging rule reinforced? Does someone bang your head?
Page 18 also has a frightening concept: “JRC has a policy on modifying contingencies due to the special “pleading” of students. Part of the treatment program for students involves deliberately setting up unfair or mistaken directions or decelerative (application of a skin shock with a GED device) consequences for the students. The student is expected to handle these unfair situations successfully and not ‘plead’ or appeal to a psychologist or clinician regarding his/her treatment. In instances where the student “pleads” to the psychologist or clinician, there are consequences imposed on the student.”
Gotta love that. The student is set up resulting in punishment and if they attempt a grievance to anyone in charge, they are punished more. Although this would diminish unwarranted complaints to staff, what this means is the student’s right to seek help should they need it, is automatically forfeit. Any legitimate complaints should there ever be an actual abusive problem, is assured punishment, and discredited. How many complaints make up a “plea”? One or two? How about perservating on the subject?
Let me play around with this a bit. Let’s assume that the staff set up this policy for a good reason — constant complaints (let’s face it “Daddy, Mommy spanked me,” doesn’t work as an excuse in family either) — and that it is, as it would be in a family, a method to maintain proper authority over children or those in custody. (Obviously, you don’t want the child to play one adult against another). So, for the first time in 20 years, let’s say, an actual isolated single incident of abuse happens to three students. I’m pulling diagnoses out of thin air, here. Let’s assume one student, Andrew, 22, is a compulsive liar, unable to understand reality as it actually happens, has an above-average IQ, and gets violent towards others (hitting, shoving, threatening to stab them, etc.) The second, David, 15, is learning disabled, constantly utters harmless complaints (this student hit me, that student took my toy car, etc. when these events occur) but has anger management problems and difficult to control tantrums. The third, Michael, is low-functioning, has a limited vocabulary, and bites through his tongue and arms due to frustration. But he is diagnostically incapable of lying, and is truthful. So, the incident occurs. Andrew’s behavior gets worse and he spouts angry accusations against everyone, becomes violent and must be restrained for the safety of himself and staff. David utters his usual constant complaints, but no one listens to him, because he constantly does this for minor incidents. Michael cries a lot and says three words to a doctor: “She hit me.” So, by school policy, are all three students punished the same, even though the second was telling the truth, although it was ignored due to overexposure, and the third had never lied before? Now obviously overexposure can result in a lack of investigation — such the recent refusal of a security guard to call 911 for a schizophrenic patient because of patients’ frequent waste of 911 resources — but look at the complaints of Alzheimer’s patients, say. If an Alzheimer’s patient complains and becomes upset and reports an incident of rape, hitting, restriction of food by family members, etc.,police or social services investigate. Assuming the person does not engage in so many numerous reports that resources are clogged and investigation must be refused — is the person routinely denied investigation on the sole basis of the fact that they may actually believe the event happened when it did not? Because they have the potential to become violent? Because by virtue of their disability the incident could be exergarated? No — unless they have called so many times, they are refused help, I would say elder abuse is investigated — even though the person’s disability raises issues about its validity. In fact, if investigation is refused on disability alone than I would say that was illegal. If the investigation is found to be false, well and good, and obviously resources needed for other things shouldn’t be spent on this, but still….If the investigation proves false, do the people in charge automatically pinch or slap the individual for lying or take away privileges such as TV? Are the Alzheimer’s people believed by police only because they were once young and competent individuals, and only disease and age have made them this way? I’m just playing around with this idea, but still…
Thinking of this another way, look at dog training. For treats to reinforce good behavior, some food can be withheld from the dog so that she is not overfed. The treats can then be given as a reward. For punishment, the dog can be smacked lightly, scolded, sprayed with cold water, sprayed in the face with ammonia, or have a electric collar attached to keep them away from the fence. The collar emits small, non-harmful shocks. Sound familiar? Works for the dog. The dog’s behavior improves over time, combined with rewards such as praise.
But what if you do the same thing to your dog? Granted, some people alpha-roll their dogs, a controversial and dangerous thing to do, since the dog believes in this stomach-up position can result in death. But let’s say as punishment you drag your dog to the fence repeatedly, over the course of several hours. Each time the dog gets a shock. So what? It doesn’t harm the dog. Maybe you restrain your dog, grabbing it by the collar in order to do this, or maybe you don’t. Maybe you pen your dog in the “dead zone” of the fence so that they are shocked remotely, but are unable to leave the area. The shocks cause the dog’s behavior to improve, right? But if the dog is overexposed to these shocks by extended punishment, the dog will either improve, hate you, or become apathetic — docile, depressed, and easier to handle. Is this truly then a non-harmful technique? Not the collar itself, but the manner in which it was used? The offense the dog committed could have been a single offense.
Does the punishment fit the crime — even if the inspectors at the school saw only one example that happened while they were there?
“One student’s behavior plan indicated that the student is to be rewarded when he does not react to a staff member preparing to or administering the GED to another student, implying that this student may be having collateral effects when peers receive skin shock consequences.” (page 26). This statement is one of the last statements to end the report. Earlier the report defined collateral effects as anxiety, depression, etc. It’s interesting that they use this term, military in origin, to describe this. http://en.wikipedia.org/wiki/Collateral_damage defines collatral damage two different ways, but essentially it is the unintended friendly fire of one’s own troops, or the unintention harm or death of civilians while targeting the enemy.
Should the collateral damage observed by the inspectors (whether it is actual or assumed) be regarded as a kind of damage — an injury? Granted, all children and adult there would have a Human Committee and IEP to offer protection to them. But are extreme apathy, depression, anxiety and fear as a result of educational techniques a form of damage?
Now the thing that’s interesting here is this is a population who very likely has a higher incidence of seizures and people are applying electricity to them, albeit low voltage. Electroshock therapy, as this is compared with, is higher voltage and induces seizures, where this does not. But, is applying electricity to the head and limbs of special ed students a safe thing to do, even if it must be parent- court- and medically approved?
If you put a mask over a prisoner’s head so that they couldn’t see, restrained them in handcuffs, provided them with a source of the same music over and over, and did something physically to them which was aversive, what would that be called?
The inspector’s report had very little positive to say about the center. Whatever the parents responses, and the need for an appropriate school, it’s intriguing that the investigators were so negative. Shapiro, in his book, foresaw the rising use of the shock device — that more and more students were placed on it — and that the voltage would eventualy increase.
I glanced through the school’s website, which has several photographs. The place looks nice, has a large rewards store, midway and playground, and field trips but does show lots of students at computers. Although the rooms are brightly colored and cheerful, some of them would make me not want to stay in them due to conflicting paint colors, floor patterns etc. Before and after pictures of students, showing that head-banging and other severe self-inflicting injuries were healing, is a good sign. They have several parent and ex-student testimonials. I will not argue if the minor punishments or shock are effective or humane. I do wonder however if some of the practices are. For instance, the report on the school stated that students were set up. Is tricking a student inclined to inspire them to trust you? How are students discouraged from interacting with other people — (the report does say that students asked questions of staff, and the responses were caring) — so perhaps it’s only that talking or other interaction is discouraged during school while being taught, as is normal practice. Maybe it means that students are not allowed to interact socially with staff, as in treatingthem as friends? But maybe not. The report needs context, but some of the things it outlines are frightening anyway, and it seems to me, reduce the dignity of the student, whatever the intention was. If you have to effectively tie someone up for the sole purpose of punishing them for an activity that took place earlier — even if that activity was life-threatening — it happened earlier, and if punishment must take place, it does not necessarily mean that the student is acting in a harmful way now and has a direct need to be restrained. That right there is worrisome.
Well, given that I have now sidetracked this book review, I will have to continue it at a later time. As a fiction writer, this provides me with wonderful material. As something that is occurring to disabled individuals, it does however have the potential to be very troubling.