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School of Shock : Rotenberg Center Director Matthew Israel Responds

Fri Oct. 5, 2007 2:00 AM EDT

(See Mother Jones' response)


Matthew Israel

Every surgical, dental or medical treatment involves discomfort, risks or costs on the one hand, and expected benefits on the other. For most persons a reasonable approach is to weigh the discomfort/risks/costs against the potential benefits in deciding whether to undergo or approve the treatment. In the case of certain treatments, however, there are some persons who, for religious or philosophical reasons, are unwilling to weigh the negative aspects of those treatments against the potential benefits. These persons view the treatment in question as Wrong with a capital "W," regardless of the potential benefits the treatment might produce. For example, Christian Scientists oppose the use of medical interventions, and Scientologists oppose the use of psychiatric drugs, regardless of what potential benefits may ensue.

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Opponents of behavior modification treatment that involves aversives (sometimes referred to as "aversive therapy") are similarly unwilling to weigh the discomfort, risks or costs associated with aversives against the potential benefits—even when those benefits could be lifesaving, life-improving or life-extending. Such persons prefer to brand aversives as "Wrong," refusing to recognize them as part of a relatively new behavior modification treatment procedure2, and many of them sometimes do whatever they can to prevent anyone else from using them. It is clear from Ms. Gonnerman's article that she is one of those persons.

Ms. Gonnerman is so intent on indicting the Judge Rotenberg Center ("JRC"), the only special needs school in the country that offers this form of therapy, that she violates the normal journalistic ethics of presenting both sides of a controversial issue. Out of a total of 265 column inches that her article occupies, only 15 inches (six percent of the article) presents any of the benefits of JRC's treatment. Even those few accounts of parents (characterized as "desperate parents") or students who speak positively about JRC are presented with snide comments, disparaged by unfavorable observations or reported in the least favorable light possible. For a more accurate picture of JRC, the reader is encouraged to consult Ms. Gonnerman grossly misrepresents JRC's treatment. The treatment is overwhelmingly based on an innovative, unique and comprehensive system of rewards and behaviorally-designed educational procedures that feature self-instructional software that each student accesses through his or her own computer. The treatment eliminates or minimizes the use of psychotropic drugs—a form of treatment that is far more dangerous and intrusive than anything done at JRC.

Aversives, in the form of a brief, two-second skin shock to the surface of, typically, the arm or leg, are added to this treatment for only certain extremely difficult-to-treat behaviors of that have failed to respond to positive-only treatment in the student's previous placements as well as at JRC. The procedure feels like a hard pinch and, unlike the heavy and often ineffective psychotropic drugging that this procedure typically replaces, has no negative side effects. Rewards and educational procedures alone are tried for an average of 11 months at JRC before JRC considers the addition of aversives. In addition, the use of aversives has to be pre-approved, on an individual basis, by the child's school system (through the IEP process), the parent, a physician, a psychiatrist, a human rights committee, a peer review committee and a Massachusetts Probate Court judge.

Currently, only a minority of JRC's school-age students receive skin shock as an aversive and even in these cases its use is very infrequent, less than once per week in the average case. In many cases the student progresses so well with this treatment that the aversives can eventually be removed entirely and the student can be returned to his/her local school system.

Ms. Gonnerman devotes extensive space at the very beginning of her article to the stories of two students whose parents became dissatisfied with JRC and withdrew their students (a routine event in every residential school). No comparable space is given to the hundreds of students whose parents are thrilled with the changes in their children that JRC was able to accomplish and that no previous program was able to achieve. Ms. Gonnerman also devotes space to the fact that during JRC's 35-year history, a few students have died from natural causes that had nothing to do with the treatment they received at JRC. The only apparent purpose of this inclusion is to cast negative aspersions on JRC that have no basis in fact. The reader is not told that JRC has a unique no-rejection, no-expulsion policy that means it accepts students who have pre-existing, life-shortening medical conditions.

Ms. Gonnerman reports on the views of a few psychologists who are opposed to JRC's treatment. No space is given to the many psychologists who admire JRC's work and who wish their own agency had the ability to provide the treatment procedures that JRC is able to offer. Ms. Gonnerman publishes anonymous critical comments made by some former employees of JRC, eight of whom she interviewed. One of these was probably Greg Miller, a disgruntled former employee who appeared with Ms. Gonnerman on National Public Radio , a piece that was stimulated by her article. Mr. Miller worked enthusiastically for JRC for three years during which he failed to raise any objections to JRC's treatment to anyone. If he had seen anything abusive and failed to report it while employed at JRC, he violated his duty to report any suspected abuse to the appropriate state agency. After three years of employment, he was disciplined for insubordinate actions and then promptly resigned. No space is given to the hundreds or thousands of current or former staff members who have positive things to say about JRC.

The reader is not told that JRC is the only program in the country that is able to offer effective, lifesaving treatment to students with severe self-abuse and aggression or that other programs that try to serve such students, but which are unable to serve them successfully, often expel those students and refer them to JRC for successful treatment (see here).

Ms. Gonnerman objects to JRC's use of aversive therapy to treat the self-destructive or aggressive behaviors of "higher functioning" special needs students who have the ability to speak and interact normally. Yet these students are often the most eloquent defenders of this therapy; many credit it with saving their lives or turning their lives around in a positive direction. Why prevent such youngsters from benefiting from this therapy just because they have relatively normal cognitive functioning? Normal adults can obtain aversive therapy from a psychologist to treat behavior problems such as excessive smoking, gambling or eating. Why should special needs students with normal cognitive functioning be unable to obtain aversive therapy for their particular behavior problems?

Ms. Gonnerman quotes from an inaccurate report by the New York State Education Department, but does not tell the reader that it was prepared as part of a campaign to deny New York students the possibility of benefiting from aversive therapy—a campaign that is currently being challenged in federal court by 50 JRC parents from New York State. She also fails to note that three Massachusetts agencies have investigated JRC and found no support for the major findings of that report. Ms. Gonnerman objects to the fact that effective behavioral treatment requires aggressive treatment of the earliest recognizable stages of problematic behaviors and of the behaviors that typically precede problem behaviors ("antecedents") even though those behaviors may, if viewed out of context, appear to be benign. This practice is comparable to the need to provide early detection and treatment for cancer and other serious diseases. The early forms of such diseases may look benign, but if left untreated can grow into life-threatening forms. The same is true of certain seriously problematic behaviors.

And, most important, Ms. Gonnerman fails to put the risks/intrusiveness of aversive therapy with skin-shock into proper perspective. Behavioral treatment with skin shock at JRC involves a brief, two-second period of discomfort that has no significant side effects. It is a procedure which, when combined with a program that is overwhelmingly based on rewards and educational procedures, enables JRC to take students off of all psychotropic medication, give them an education for the first time in their lives, and give them and their parents hope and optimism for their future where none had previously existed.

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