Blogging Against Aversives – a little late

Mike Reynolds at uppity disability dot net has been the driving force behind the “blogging against aversives” campaign that began yesterday and is spilling into today.

According to Mike, the Massachusetts legislature is hearing a number of bills aimed at curtailing the use of so-called “aversives” at the Judge Rotenberg Center (JRC).

“Aversives” – for those fortunate people visiting this site who know nothing of such things – is a nice clinical sounding term that hides the harsh reality of practices involving the infliction of pain, deprivation and humiliation to control the behavior of children and adults with various disability labels.

I wrote an entry about a campaign to pursuade the American Psychological Association to condemn these practices, bringing its position into line with its opposition to politically-motivated torture back in October. Sadly and predicably, there has been no useful response from the APA, last I heard.

Professionals like the power they have and are reluctant to yield it, especially to those that the power is focused on. The real issue with “aversives,” they’ll say, is proper oversight and safeguards. But they’ll refuse to draw any clear bright lines in terms of what those “safeguards” should be and what can be declared outright inhumane and unacceptable.

Below is an excerpt from a discussion from bit.listserv.autism in 1995. The person whose publicly available words I’ll be sharing is Tom Linscheid, who introduced himself to the group this way:

While I am new to this list in terms of being an active participant, I have occasionally monitored postings with special interest in the opinions of parents, especially regarding the issue of “aversives”. I was involved in the development of SIBIS and published some of the original research on it as well as the use of contingent electric shock for the treatment of rumination as far back as the 1970s so I have to put my two cents worth on the aversives issue.

Note to readers – the SIBIS was an early shock device that was much less painful than the device currently employed at the JRC.

Exercising this rare opportunity to ask an “authority” on aversives a question in a public forum, I challenged Linscheid (who had talked about the importance of safeguards and professional oversight) if he could give us a professional opinion as to whether a highly publicized incident at the JRC could be justified as “therapeutic.” It involved the delivery of some 5000 shocks to one individual in a 24-hour period. This was his response (Due to some glitch with google groups, this link takes you to the second post in a two-post thread. Simply click on the first post which you can see at the top of the page and you’ll be able to access the original email message):

As to the issue of 5000 shocks in one day and my unwillingness to comment on that and whether “behavioral theory” supports that. Again, behavior analysis as a science is involved with the demonstrations of functional relationships between behavior and environment. Knowledge of behavioral principles can be “applied ” in many forms without changing the theory. Electricity is electricy regardless of how it is used. The relationships between resitence, current flow and voltage are not changed by whether they are applied for good or evil. So again, the question of
5000 shocks in one day is a question of application not of theory.

If the question is, can 5000 shocks a day ever be justified as an application, let us look at a couple of senarios. The first hyothetical situation; the baseline rate of a severe self-injurious behavior is 20,000 per day, when we begin to treat the behavior with contingent electric shock, the rate is 4000 the first hour, then 1000 the second hour and then the behavior does not occur for the remaining 22 hours of that day. I can see where this may be considered acceptable by many, especially if the behavior continues at a very low or zero rate over subsequent days and weeks.

Senario number two. The baseline rate is 5000 per day and once treatment starts there is no change over the course of the entire day and therefore the person receives 5000 shocks. In this situation, continuation of the treatment is not justified because it is not effective.

My point in not commenting on the newspaper article is that I did not know the circumstances of the treatment case, especially as to baseline rates and rate of behavior accross the day. Without this information it would be hard to answer the question of whether the reported number of shocks was justified. If I were the parent of the person described in the first scenario, I would be happy and relieved that my child was no longer engaging in SIB 20,000 times a day, as the parent of the person in the second scenario, I would be dismayed that the treatment didn’t work and that my child had to receive 5000 shocks.

The point is, without the knowledge of baseline rates and rates of behavior during the treatment day, it is not possible, from my point of view, to either support or not support the application of 5000 shocks in one day. If you are opposed to contingent electric shock as a treatment then knowledge of its effectivenss is irrelevant and you will be opposed regardless of details. I do certainly agree that when numerous aversive stimuli are administered in one day, the therapists are accountable for justifying the practice but I do not agree that it is automatically a bad practice – it depends on many factors, not just the number. I hope the above scenarios help to point out why I think such decisions are best left to parents, clinicians and oversight committees and why it is difficult to have a blanket statement about things such as maximum numbers of shocks etc…
(emphasis added)

If you managed to wade through that dry, clinical discussion of the torture of people with disabilities, you’ll find that the answer Dr. Linscheid gave was that there are no absolute standards or prohibitions to be made when it comes to clinical judgment. It’s really not so different from the verbal gymnastics and resistance to oversight when of those who advocate “harsh interrogation techniques.” They share a distaste for the word “torture” and resist clear bright lines regarding acceptable behavior. They also share a belief that basic standards of human rights and decency don’t necessarily apply to all people. –Stephen Drake