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Pain Compliance and the Judge Rotenberg Education Center: Campaigning for Better Practice

This article discusses the recent Supreme Judicial Court ruling allowing electric shock treatment to continue to be practiced at the Judge Rotenberg Center.


Image shows a young person looking fearfully over their shoulder at an adult standing behind them, with a series of boxes attached to their belt. The boxes have images of students on them, which correspond to the electric shock devices attached to each student's bodies. The boxes contain the remote control which activates the electric shock devices.
Image Credit: Larry Sultan

The Judge Rotenberg Center in Massachusetts has been the subject of controversy since the 1970s. Throughout its history, it has been criticised for Human Rights abuses and aversive punishments for children, young people, and adults with autism spectrum condition (ASC), learning disabilities, and ‘problem’ behaviours. Today, it remains the only institution in the United States that applies electric shocks to correct undesirable behaviours using archaic graduated electronic decelerator (GED) devices strapped to students’ bodies. At Studio 3, we do not believe in any form of punishment for behaviours, and continue to campaign not only for the reduction but the eradication of restrictive practices. The fact that these devices are still being used on vulnerable individuals is a Human Rights violation, and cannot be tolerated within the caring profession where our role as educators and supporters is to better understand and protect individuals in our care, not to punish them or try to make them conform to neurotypical ideals of ‘good behaviour.’ This article will look briefly at the long history of abusive practices at the Judge Rotenberg Center, discuss the recent Supreme Judicial Court ruling allowing electric shock treatment to continue to be practiced, and question why such practices are allowed to persist in modern times.



A Brief History


The Judge Rotenberg Center began its life as the Behavior Research Institute, founded by Matthew Israel in 1971. A student of the father of Behavioural Psychology, B.F. Skinner, Israel believed in aversive ‘treatments’ for undesirable behaviours, which ranged from self-injurious behaviour to ‘non-compliance,’ such as not following commands. Since its inception, there have been many complaints and legal cases brought against the institution for abusive practices, and six students have died of preventable causes. Shocking footage emerged in 2012 as part of a legal case showing a pupil being restrained face-down on a restraint board for 7 hours and shocked 31 times. The institution has a long list of behaviours which are targeted by the electric shocks: in this instance, the restraint and subsequent shocks were administered because the pupil refused to take off his coat.


In another instance, 7 staff members were fired following a prank call to the institution claiming to be from a member of staff informing those on-shift that 2 pupils needed to be shocked for ‘misbehaviour’ earlier in the day. Based on this, on-shift staff members woke 2 pupils from their sleep and shocked them up to 77 times whilst their arms and legs were restrained. This resulted in second degree burns for one individual.


The school has since been condemned for violating the United Nations Convention Against Torture (Pilkington, 2018):

“The use of electric shocks to control the behavior of children inflicts pain and suffering that at least rises to the level of cruel and degrading treatment and in some cases is definitely torture. That is prohibited by state, national and international law.”


Present Day

In March 2020, the use of electric shock devices was banned by the FDA to treat self-injurious or aggressive behaviour. This decision was appealed, and it was determined that the FDA could not ban the use of electric shocks where it had been approved for medical use. Therefore, in cases where electric shock treatment had already been allowed by a judge or healthcare professional, this practice was allowed to continue. In September 2023, the Supreme Judicial Court of Massachusetts ruled that the Judge Rotenberg Center can continue to use electric shock devices on its students after claims by JRC lawyers and parents of students at the school that it is a ‘lifesaving, court approved electric stimulation device treatment’ (Pierson, 2023). Despite campaigns against the use of the method since 1985, The Judge Rotenberg Center is the only institution where electric shock therapy is still sanctioned in the United States.


In 2022, a task force set up by the Association for Behavior Analysis International (ABAI) sought to study the use of contingent electric skin shock (CESS) in order to inform a position statement about its use. As part of this report (Perone et al., 2022), the JRC was investigated due to being the only institution still practicing CESS. Their report found that, as of July 2022, there were 52 adults aged 26-59 authorised by law to receive electric shocks at JRC. These CESS treatment plans do not require the consent of the individual, and a student may wear multiple GED devices simultaneously, receiving shocks in different parts of their body without knowing where the pain will land. Treatment plans can be approved for up to 15-20 years, despite regulations stating that they should be reviewed yearly. They also found no evidence that treatment plans were faded over time; CESS application can last between 5 – 20 years, and in fact the intensity of the shocks and number of devices often has to be increased to maintain effectiveness.



Aversive Punishments

Aversive consequences for behavioural treatment are a controversial topic. Whilst these can range from denying an individual a preferred object to applying a physical punishment, they can be extremely harmful to the well-being of individuals. The use of punishment to modify a person’s behaviour is not something we agree with here at Studio 3. The philosophy of our practice hinges around understanding why a person may need to engage in a behaviour to self-regulate, or to communicate need to their supporters. Whilst there are some extreme cases where preventing self-injury or violence to staff or other vulnerable people is necessary, most ‘challenging’ behaviours are perceived as such due to a societal focus on other people’s behaviours.


In addition, the argument that electric shock treatment results in behaviour change in the long term is a nebulous one. The Judge Rotenberg Center itself states that some individuals may require CESS treatment for up to 15-20 years, indicating that the shock treatment has no longevity for behaviour change. In many instances, the intensity of the shocks administered needs to be increased to maintain effectiveness (Perone et al., 2022). Some individuals are reported to have habituated to the GED-4, a device created by the JRC which delivers the most powerful electric shock available. There can also be a delay of up to 30 minutes between the behaviour and the application of CESS, which calls into question whether an individual can even comprehend why they are being punished in order to change their behaviours accordingly.


Whilst the school claims that the electric shocks (which they describe as ‘contingent skin shock for severe problem behavior’ on their website) are used to prevent pupils from injuring themselves or others, and are only administered in extreme cases where the alternative would be dangerous restraint methods, many former pupils have spoken out against the school’s approaches. Jennifer Msumba, a former pupil, has spoken extensively about her treatment at the school, saying, ‘It felt like I was being punished for being born.’


The JRC claims to use ‘compliance’ as a ‘treatment goal,’ claiming that ‘students are given a variety of demands and tasks to perform throughout the day, are rewarded immediately when they comply, and lose privileges if they refuse.’ This punishment and reward system can result in loss of privileges when ‘problem behaviors’ are displayed (JRC, 2023). So-called problem behaviours can include: ‘Health Dangerous (includes self-abusive actions such as hitting self); Aggression; Destruction; Noncompliance (such as refusing to follow a learned direction); Major disruptive behaviors (such as screaming, stealing, touching others without permission); and Educationally and Socially-Interfering behaviors; Inappropriate Verbal Behaviors’ (JRC, 2023). Under these parameters, staff could administer punishments on the basis of non-compliance for a person engaging in any behaviour that they feel is undesirable. Indeed, the JRC states that, ‘If a particular student needs more than these seven standard categories, additional categories are created.’ Essentially, what this means is that staff can determine what is desirable or not, and have complete control over what behaviours should be rewarded, and which punished.


This adheres to the medical model of disability, whereby autistic individuals and people with learning disabilities are forced to conform to neurotypical standards of behaviour. Behaviours like stimming, which may be necessary to self-regulate, can be punished under this regime, denying individuals essential coping mechanisms. The medicalised language used by the JRC attempts to justify the practice of electric shocks as a treatment procedure, sending problem behaviours into ‘remission.’ Our view at Studio 3 is that so-called ‘problem’ behaviours are actually a sign of extreme distress and trauma, and that there is no place for approaches which involve re-traumatising individuals and making them more distressed.


The International Coalition Against Restraint and Seclusion (ICARS) recently stated that there is evidence of shocks being administered ‘not just for discouraging undesired behaviors but for the actions that precede the undesired behaviors’ (Lodestone, 2021). Evidence that CESS is being used not to mitigate risk of injury to students or staff, but to correct and change behaviours, confirms the concerns of autistic advocates and individuals across the globe – that this method is neither therapeutic nor ethical. Eliza Hunt, lead organiser of ‘Stop the Shock Coalition,’ has frequently spoken out against the practice of CESS as being disproportionate to the behaviours being punished (Ruhalter & Rath, 2023):

‘The JRC contends that they only use this for dangerous behaviors, but at the same time, they also say that certain actions like standing up is, for certain individuals, an indication that they’re going to be violent.’

It is inevitable that where restrictive practices are allowed to persist in aversive cultures, staff will inevitably fall into the ‘slippery slope to abuse,’ whereby restrictive practices become the first resort, not the last resort (McDonnell et al., 2014).


Where restrictive and aversive practices are normalised, the degree of lasting harm and trauma they cause to individuals is minimised by staff. Whilst people may believe they have no other choice and that they are using restrictive practices as a ‘last resort,’ this is rarely the case in reality.



Pain Compliance

It is essential that practitioners and organisations in the caring industry speak out against aversive practices such as pain compliance, restraint, and seclusion. Many former pupils have confirmed that the electric shock devices are incredibly painful. The recent task force interviewed 4 pupils at the school who, as of July 2022, were receiving CESS. All four students stated that the electric shocks were painful to receive, and the majority said that they did not want to receive them. One resident, unsolicited and without prompting, asked the task force members to remove them from JRC.


The inhumane practices at JRC have been widely spoken against by many individuals and organisations across the globe.

The Autistic Self-Advocacy Network (ASAN) have been leaders in the ‘Stop the Shock’ campaign against JRC. A recent survey from NeuroClastic asked the public how they felt about the use of electric shock as a punishment for disabled adults (2023). The responses include:

'I think that it's abusive and torturous and should be banned at all costs.'
'Absolutely horrified and prepared to do anything in my power to make it stop.'
'It is grossly inhumane. Electroshock should not be used as a “therapy”, nor should any type of aversives.'

The results of a recent ICARS poll on X (formerly Twitter) demonstrates that 96.8% of parents who voted would not like their child to be subject to any of the practices being used at JRC, not just CESS.

We cannot stress enough the importance of listening to lived experiences in order to inform against abusive practices such as these. Dr Damian Milton has spoken extensively against aversive practices which seek to alter behaviours. In a Studio 3 web conference, Damian spoke about his opinions on aversive practices and punishments in the caring industry (Milton, 2020).


In addition, Professor Andrew McDonnell, CEO of Studio 3, has spoken frequently about his views on punishment (McDonnell, 2018):

‘In my work I am often asked about the role of punishment to correct behaviours. There is no doubt that sanctions and negative consequences can have an impact on the behaviour of children and adults. But what do people learn in these circumstances? Our role is to encourage self-regulation rather than imposing external controls.’

It is clear that the focus on control and compliance at the JRC violates the Human Rights of the children and adults being supported, and is both inhumane and untherapeutic. Punishing stressed and traumatised individuals for engaging in behaviours that they need to engage in in order to self-regulate has no place in caring environments. Attempts to alter behaviour that is perceived to be disruptive, ‘bad,’ or not typical, merely forces conformity and asserts control over vulnerable people. It is our role as educators, supporters, and carers to understand why a person may need to engage in certain behaviours, and to constantly question our own beliefs around behaviour. Punitive systems such as these which use punishment/reward schemes and restrictive practices can not only re-traumatise individuals, but also create a lack of self-agency and independence that is essential for well-being. By inflicting physical and psychological pain, supporters destroy the ability to form safe and therapeutic relationships with individuals, which is the key to supporting individuals to lead thriving independent lives, supported by their community.


Compassion and empathy are essential, which is why there is an urgent need for a unified approach from autistic advocates and professionals determined to enact change and permanently ban the application of aversive and out-dated treatments such as CESS. In 1979, Dr William Bronston said of JRC that the school used an ‘unrelenting pursuit of traumatic interventions’ against its most ‘powerless and undefended’ students (Summers, 2021). That this still rings true today, more than 50 years later, should be a wake-up call for organisations and individuals around the globe to ensure that these practices are not allowed to continue.



References

Judge Rotenberg Center. (2023). Behavioural Treatment. Judge Rotenberg Center [Online]. Available from: https://keyfeatures.judgercblog.org/behavioral-treatment/.


Lodestone, A. (2021). Autistic Advocates and Behavior Therapy Industry Professionals Join Forces to #StopTheShock. International Coalition Against Restraint and Seclusion [Online]. Available from: https://againstrestraint.com/2021/08/26/autistic-advocates-and-behavior-therapy-industry-professionals-join-forces-to-stoptheshock/.


McDonnell, A. (2018). Negotiate Don’t Punish. LinkedIn [Online]. Available from: https://www.linkedin.com/pulse/negotiate-dont-punish-andy-mcdonnell/?utm_source=share&utm_medium=member_ios&utm_campaign=share_via.


McDonnell, A., Breen, E., Deveau, R., Goulding, E. & Smyth, J. (2014). How nurses and carers can avoid the slippery slope to abuse. Learning Disability Practice, 17(5): 36-39. doi: 10.7748/ldp.17.5.36.e1516.


Milton, D. (2020) Applied Behavioural Analysis and the autistic community: time to listen. In: Are We Asking the Right Questions About Behaviour? Studio 3 Web Conference [Online].


Neuroclastic. (2023). Judge Rotenberg Center – Responses. Survey Monkey [Online]. Available from: https://www.surveymonkey.com/results/SM-2TSVC9G99/.


Perone, M., Lerman, D., Peterson, S. & Williams, D.C. (2022). Report of the ABAI Task Force on Contingent Electric Skin Shock. ABAI International [Online]. Available from: https://autisticadvocacy.org/wp-content/uploads/2022/11/CESS-Task-Force-Report-09-28-22.pdf.


Pierson, B. (2023). Massachusetts top court allows electric shock therapy for disabled patients. Reuters [Online]. Available from: https://www.reuters.com/legal/massachusetts-top-court-allows-electric-shock-therapy-disabled-patients-2023-09-07/.


Pilkington, E. (2018). 'It's torture': critics step up bid to stop US school using electric shocks on children. The Guardian [Online]. Available from: https://www.theguardian.com/us-news/2018/nov/16/judge-rotenberg-center-massachusetts-electric-shocks.


Ruhalter, K. & Rath, A. (2023). Electric shock therapy is still allowed in one Mass. treatment facility. Advocates say change is long overdue. GBH News [Online]. Available from: https://www.wgbh.org/news/local/2023-09-11/electric-shock-therapy-is-still-allowed-in-one-mass-treatment-facility-advocates-say-change-is-long-overdue.


Summers, J. (2021). The Shocking School. Boston Review [Online]. Available from: https://www.bostonreview.net/articles/the-shocking-school/.



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