School of Shock : Rotenberg Center Director Matthew Israel Responds

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School of Shock School of Shock By Jennifer Gonnerman Food deprivation. Isolation. Electric shocks. Inside the taxpayer-funded program that treats American kids like enemy combatants. Sidebars • Nagging? Zap. Swearing? Zap: New York's Investigations of the Rotenberg Center • Why Can't Massachusetts Shut Matthew Israel Down? • The Cult That Spawned the Tough-Love Teen Industry • Experts on Self-Injurious Kids Challenge Dr. Israel's Methods • What Works for Troubled Teens? Photo Essay on the Rotenberg Center Primary Sources TOOLS E-mail article Print article BACKTALK E-mail the editor RELATED ARTICLES Camp Fear

(See Mother Jones' response)

Without aversive therapy, the alternatives, for many of the students who are referred to JRC, are being heavily drugged with life-shortening and medically dangerous psychotropic medications,3 being warehoused in institutions or jails without receiving any treatment at all, being confined and/or frequently restrained in padded isolation rooms, bouncing in and out of psychiatric hospitals with no improvement, killing or maiming themselves or others with their own self-abusive behaviors or aggressive behaviors, or simply ending up homeless on the streets.

More Detailed Response
Jennifer Gonnerman's article "School of Shock" (Mother Jones, September/October 2007) is a biased and misleading account of the Judge Rotenberg Center ("JRC") that is best characterized as a hatchet job. Ms. Gonnerman persuaded JRC and the Parents of the JRC students to allow her to come to JRC and observe the school and the students by very cleverly and falsely pretending to be sympathetic to the cause of the JRC students and their parents. She asserted that she had read all the letters from the parents on the JRC web site and had cried while reading them. In addition, she represented that the article she was writing would be published in the New York Times Sunday Magazine, a magazine that has a reputation for printing serious, balanced, non-sensational articles. The Times even flew a very artistic photographer and assistant from San Francisco to do the photography. After the article was written it did not appear in the Times. When we asked Ms. Gonnerman why, she said the Times had rejected it because it was not of sufficiently national interest.

Now that we have seen the article, it seems more likely that the Times rejected the article as a biased, unfair and misleading hatchet job. Ms. Gonnerman has shamefully exploited the severely disabled JRC students and their parents. She ignores or glosses over JRC's treatment successes, all the evidence that supports the use of aversives, and the plight of its students before attending JRC. The many court victories won by the JRC parents to preserve the JRC treatment program are a matter of public record and should have been investigated by Mother Jones before the magazine printed Ms. Gonnerman's fallacious article.

This type of a dishonest article could have been written about any topic, no matter how benign. Ms. Gonnerman could have written such a negative article about freshman life at any university, for instance. She could write about the cramped and cluttered conditions of the dormitory, the terrible food, the homesickness, the late nights with little sleep, the incredible long lines at the registrar's office and the bookstore, the overcrowded classrooms, the high tuition, and the exposure to underage drinking. She could also add lies to further sensationalize her story, as she did with the JRC article, by reporting that most students cry themselves to sleep because they are so depressed and many are dangerously gaunt due to the bad food. Ms Gonnerman could make college sound like a horrible, abusive place by not mentioning all the positive aspects of college life—for example, all of the interesting subjects the students learn about, the exposure to talented and fascinating professors and other lecturers, exposure to the arts, learning how to do research and write on a college level, learning about and choosing a career, meeting and getting to know fellow students from around the world, meeting the people who will be friends for life, and learning how to live independently from their parents.

This distorted report of college life is similar to the distorted report of JRC that Ms. Gonnerman created. A fraudulent article about college life is not as harmful as a distorted report on JRC, however, because many people have attended college and will know right away that the article is dishonest. What makes Ms. Gonnerman's article so harmful and exploitive is the fact that only a tiny fraction of the population has had any exposure to severe behavior disorders. In order to understand JRC in its proper context, the following points must be made, none of which were explained in Ms. Gonnerman's article.

1. It is well documented in scientific articles and in court findings that some special needs children and adolescents have behaviors that are so self-abusive, aggressive or destructive as to be life-threatening and self-maiming. Consider, for example, just one type of behavior—self-abuse. Some special needs children referred to JRC have shown self-abusive behaviors such as banging their head to the point of brain damage, biting off their own fingertips, pulling out their teeth, vomiting and refusing food to the point of starvation, biting a hole through their cheek, biting off part of their own tongue, scratching their heel to the point of blood, bone infection and eventual death, breaking their own arm, cutting off their own earlobe with a scissor, running into moving traffic, punching their eyes causing detached retinas and blindness, pulling out their hair to the point of baldness, swallowing X-Acto knives, and cutting their skin with a knife so often that the skin becomes too tough to suture.
2. Children with such very severe problem behaviors usually cannot be successfully educated in public schools. When a public school encounters such a student, the school will refer the student to a psychiatric hospital or to a nonpublic, special needs school where the student is often not effectively treated. Instead, the student is usually drugged into a stupor. If students are given high enough dosages of psychotropic drugs, these drugs will sedate them so much that the students are incapable of hurting themselves or anyone else—but such students are also incapable of participating in education or even communicating with their family. These drugs also have many debilitating side-effects including kidney damage, liver damage, tremors, obesity, and lock jaw and many effects are permanent. Unfortunately many so-called experts in this field will refer to this drug stupefaction as a treatment success.
   
   Other so-called effective treatments for severe behavior disorders that JRC has seen in the histories of newly admitted students include lobotomy, removal of teeth (for severe biters), constant seclusion, constant mechanical restraint, and many others that experts refer to as "more humane and effective" alternatives to JRC's aversive therapy procedures. The lack of effective alternatives and the sheer cruelty of drugging a child into a near coma is why parents turn to a non-public, special needs school such as the Judge Rotenberg Educational Center that is specially equipped to manage and educate the student, and has a proven track record of saving students from the ravages of constant heavy sedation. A real journalist would have mentioned these facts and, more importantly, investigated why the anti-aversive experts are hiding the fact that there are no effective treatment alternatives for severe behavior disorders. A real journalist would have asked why the JRC students have, prior to coming to JRC, spent so many wasted months or years sedated in a psychiatric ward and why their parents had to fight to get their child out of a psychiatric ward and into a special needs school such as JRC. Finally, a real journalist would have investigated why schools and clinicians fear being blackballed if they use, or admit to using aversives. As a result of this fear, children are forced to suffer with untreated painful behavior disorders, to receive no education and to have no social life of any kind.
3. Most nonpublic, special needs schools that try to educate and treat such students use rewards, education and positive-only procedures. Unfortunately, studies show that positive-only treatment procedures are effective in only 6o percent of the cases at most and cannot handle the most severe behavior problems.
4. Actually, although most nonpublic, special needs schools pride themselves on using "positive-only" treatment procedures, the truth is that such programs really do use aversives without calling them by that name. In other words, such schools use hidden aversives such as these:
   • Five to eight staff members wrestle the student to the floor, each time he/she is aggressive, and hold him/her there until he/she stops struggling. The procedure could last an hour or more. This is a procedure that JRC is able to eliminate entirely whenever it is able to use effective aversives such as the two-second skin-shock procedure.
   • If a student is aggressive, staff members may grab the student and take him/her, against his/her will, into a "time-out" isolation room and leave him/her there for a specified period of time. This is a procedure that JRC never uses.
   • Staff members may hold the student tightly (manual restraint) each time he/she is aggressive and thereby prevent the student from doing anything at all.
   • Staff members may grab the student forcefully by the shoulder or arm and squeeze hard while giving the student a so-called "physical prompt" to engage in a certain action.
   • Staff members may force the student to engage in some physical action against the student's will over and over. This is called "overcorrection" or "positive practice" but it will only work to decelerate a behavior if it done in a manner that is aversive.
5. JRC does not use hidden aversives such as these preferring, instead, the more honest course of using fully-disclosed and more effective aversives such as skin-shock.
6. The typical nonpublic, special needs school will, in addition to the use of such hidden aversives, have a psychiatrist prescribe large quantities and a wide variety of psychotropic drugs to students with severe behavior problems. If a student is given enough drugs, he or she will essentially be put into a drug-induced stupor for much or all of the day. Such medication can be so drugging that the student may not be able to recognize his own parents and might fall face-first into his food at mealtime. Unfortunately, for some students even large quantities of drugs are insufficient to control their aggressive or self-abusive behaviors. By contrast, JRC's policy is to avoid totally, or at least minimize, the use of psychotropic medication.
7. For some students the typical nonpublic special needs school may find that if the school places no educational or behavioral demands on the student, the student will refrain from aggression, self-abuse or destructive behaviors. If this is the case, such a school may choose to solve the problem by essentially "warehousing" the student—i.e., keeping the student safe and adequately fed, but not undertaking any serious attempt to educate the student or change the student's behaviors.
8. In extreme circumstances, the typical nonpublic, special needs school might do things such as call in the police to handcuff the student when he or she is aggressive, or send the student to a psychiatric hospital. JRC never calls in the police to deal with aggressive or otherwise disruptive students and JRC is an effective alternative to psychiatric hospitals.
9. In the case of certain students with case-hardened problem behaviors, the school may try all of the above procedures—positive-only procedures, hidden aversives, seclusion, restraint, drugs, warehousing, calling in the police and sending the student to a psychiatric hospital—and may find that none of them are successful in controlling the student's problem behavior. In addition, the school may at some point simply tire of seeing the student continually harm the school's staff members, other students, and property. At that point many such schools will expel the student. Sometimes, however, some students are aggressive even to their own parents. Consequently, at that point the parents, may even be unable or afraid to allow the students to come home. This leaves the parent with essentially no options. Such students are then left to live in the street, to languish in homeless shelters, to bounce in and out of psychiatric hospitals again or to commit some offense and be jailed. These students, i.e., those who are expelled from such schools that use positive-only treatment procedures, are the ones that are referred to JRC, where they finally can receive effective treatment.
10. Before JRC uses aversives with any student, only positive and educative procedures are employed for an average of 11 months to try to change serious problematic behaviors. The positive procedures that JRC employs include many rewarding and educational procedures. The extent and variety of the reward systems at JRC will not be found at any other program. They include the following:
    • an all school arcade-type reward lounge
    • a retail store in which students can purchase desired items for themselves or others
    • a reward corner in many of the classrooms in which the student can relax, watch tv, play games, etc.
    • a reward box in many classrooms containing items that students can earn through their behaviors
    • a reward afternoon once per week that features a barbecue and games; (6) frequent field trips used as rewards
    • electronic game devices in each bedroom
    • opportunities to order food out from local restaurants
    • internet usage
    • a student discussion board
    • various sports activities, etc.
11. JRC's positive and educational procedures alone are currently effective with about half of its school-age students. For the other half, however, positive and educational procedures need to be supplemented with the use of a brief aversive. The most effective aversive available is a two-second, harmless shock to the surface of the skin, typically of the arm or leg. It is extremely effective. For example, in treating aggression, we are able to accomplish a 95 percent reduction in 96 percent of the cases, within a matter of weeks. As a result, students can begin to receive an education and benefit from positive programming for the first time in their lives. Unlike drugs, the treatment has no significant side effects and the treatment can be discontinued for many students as their behavior improves. Parents and students describe the improvement as life-saving.
12. There are many safeguards at JRC to make sure that the skin-shock procedure is used carefully, professionally and properly. They include prior parental consent, prior individualized court authorization (the judge appoints an attorney to represent the child's interests in this process), prior approval by a Human Rights Committee and a Peer Review Committee, clearance from a physician and a psychiatrist to insure that there are no medical contraindications, etc. More information about these safeguards may be found on JRC's website.
13. Only a minority (43 percent) of JRC's school-age students are currently receiving skin shock treatment. And for those who are being treated with skin-shock, the average student receives only one application per week. More information about the frequency with which skin-shock is used at JRC may be found on JRC's website.
14. To summarize:
    • JRC treats severe problem behaviors of special needs children and adults who have failed in every other program that has been tried with them.
    • Programs that use "positive-only" treatment procedures expel students with really severe behavior problems and these students are often then referred to JRC.
    • JRC removes students from psychotropic drugs and applies a highly consistent behavioral program of positive rewards and educational procedures for an average of 11 months before considering the use of any aversive.
    • If rewards and educational procedures alone prove to be insufficiently effective, they are supplemented, when necessary, with a two-second shock to the surface of the skin, used as a corrective consequence for the problem behavior.
    • Before employing skin-shock, JRC obtains consent from the child's parent and individualized approval from a probate court judge, a physician, a psychiatrist, a peer review committee and a human rights committee.
    • JRC's skin-shock procedure is extremely effective, has no significant side effects and can be removed entirely in many cases as the student's behavior improves
    • JRC's positive behavioral program is so effective that the skin shock procedure is currently being used for only 43 percent of JRC's school-age students
    • JRC's treatment enables its students to do the following: stop taking harmful psychotropic drugs; avoid restraint, seclusion, warehousing and takedowns; avoid having to be placed in psychiatric hospitals or arrested by police for aggression and other destructive behaviors; start learning in school for the first time in their lives; avoid death or self-maiming by receiving effective and rapid treatment of self-abusive behaviors; have hope and optimism for their future where previous there was none; and enjoy the company of their parents and family for the first time in years.

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