‘Shock’ School Trial: Where Is the Evidence that Abuse Helps Treat Autism?

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The video is brutal: a young man, pinned face down in four-point restraints, receiving 31 electric shocks over the course of several hours that convulse his body with pain. But this is not Guantánamo or Syria. The electric shocks were delivered in Massachusetts, at the Judge Rotenberg Center (JRC) for autistic, emotionally disturbed and developmentally disabled youth. JRC is currently the only place in the U.S. that is legally permitted to provide this so-called aversive therapy.

Although the Rotenberg Center fought for years to suppress the video, it recently became public as part of a lawsuit filed against the center by the parents of the victim, 18-year-old Andre McCollins. Closing arguments in the case are expected on Monday.

If the plaintiffs’ attorneys did their job, a large settlement against JRC should be forthcoming: res ipsa loquitur (the thing speaks for itself) would seem obviously to be the relevant principle here. But, unfortunately, unless the judgment is big enough to bankrupt the program and shut it down for good, the torture of troubled teens will continue, as it did after other similar cases were settled.

But while the video is horrifying, I find other facts about JRC to be even more disturbing. Together, these facts make an airtight case for shuttering the program, which is opposed by all of the major autism and disability rights organizations and has been called torture by the United Nations special rapporteur on torture.

The first problem is that JRC has been allowed to conduct its skin shock “therapy” for more than four decades, with little more than anecdotes to support its effectiveness.

The center claims that using skin shocks, which are comparable in pain intensity to a bee sting, can help control severe self-injurious behavior like head-banging and cutting, without use of medication. (A reporter who tried the device, however, compared the feeling to “a horde of wasps attacking me all at once.”) On its website, JRC also argues that its punitive approach is twice as effective as using rewards to change behavior, even for the most severe cases.

But over the 40-odd years that it has been operating, JRC has never published a single randomized controlled trial demonstrating the superiority — or even lack of inferiority — of its methods, compared with standard therapy, in a peer-reviewed journal. The research it has published in the scientific literature has all involved case studies: basically stories of less than a dozen patients in each paper who were not randomly selected and whose outcomes were not compared to those of similar patients receiving less torturous treatments.

The FDA would not approve any drug with this sparse a scientific record, let alone one that caused pain as its intended effect. Unfortunately, however, talk and behavioral therapies aren’t regulated and don’t have to meet any scientific standards before they are marketed, even if they are clearly risky.

Of course, many parents of children at JRC have become strong advocates for the program. They believe that the JRC’s approach — barbarous as it may look from the outside — is the only thing that has helped their children avoid self-injury and participate in school. They tell compelling stories about children who had been so dangerous to themselves that they’d caused brain damage, now being able to sit at a computer and learn.

I’d be much more convinced by these claims, however, if I hadn’t already heard similar stories told by dozens of parents of children in other abusive treatments and subjected to quack remedies — ones that are known to be either ineffective or outright harmful or both. The reason the FDA’s approval rules for drugs and other therapies it regulates exist at all is because such extraordinary anecdotal evidence can make useless or dangerous treatments appear to work miracles.

I’d also be less skeptical if JRC admitted only children with the most severe self-injurious behavior, rather than advertising the program broadly as a solution for any teen who is simply “failing in school or refusing to attend or stuck in psychiatric or correctional setting.”

However, I admit that even if JRC limited admissions and had 10 published peer-reviewed randomized controlled trials proving the superiority of its techniques to drugs and positive behavioral treatments, I’d still be loath to recommend it. The most insurmountable problem with JRC involves the corrupting influence of power — especially when that power is wielded in the context of infliction of pain as “helping.”

Virtually all situations in which vulnerable people are under the complete power of others — such as that which exists at JRC — are prone to cultivate abuse: we hear again and again about abuses in nursing homes, prisons, homes for the disabled and teen treatment centers. As Lord Acton once said, absolute power corrupts absolutely.

(MORE: Why So Much Abuse Is Allowed to Continue in Residential Care)

The principle was first made vivid by psychologist Phil Zimbardo in the notorious Stanford Prison experiment. Within days, healthy people who had been assigned to play the role of prison guards began abusing those who were assigned to be prisoners.

Basically, ordinary people placed in positions of authority without checks or balances will tend to drift towards abusive practices. And they will also tend to “just follow orders” even when those orders involve escalating abuse, as another famous social psychology experiment once showed. At Harvard, researcher Stanley Milgram got dozens of normal people to administer a series of increasingly painful shocks to another human being (actually an actor making pained noises in another room), simply by having a man in an authoritative white coat encourage them to continue. The shockers escalated the pain even though they were told that the shocks could be potentially deadly.

A 2007 incident at JRC illustrates the issue perfectly. A former resident placed a prank phone call in the middle of the night to one of the program’s sites, pretending to be a supervisor. He ordered the staff member who answered to phone to rouse two teens from their beds and deliver dozens of shocks to them, claiming that they’d misbehaved earlier.

For three hours, six staff restrained and shocked the innocent victims — even though the shocks weren’t in the treatment plan, even though they’d never talked to the so-called supervisor before and even though the other residents protested vigorously that no bad behavior had occurred.

When you train people to believe that painful punishments are an acceptable way to control the behavior of others, it’s hard to prevent this kind of harm. Despicable behavior comes to seem acceptable, not worth questioning.

This is especially the case when — as has also happened at JRC — when your staff is not as qualified as it should be. The less educated the staff is about effects like those seen in Zimbardo’s and Milgram’s research, the more likely they are to accidentally replicate it.

Indeed, there are now at least a half-dozen documented cases of programs that use aversive treatments becoming actual cults, in which the program director has gained so much power over the participants and their parents that he can even command bizarre behavior among them, like kidnapping and partner-swapping.

I covered one particularly stunning instance of this in my book Help At Any Cost: How The Troubled-Teen Industry Cons Parents and Hurts Kids. In that case, the director of the KIDS program in New Jersey ordered teens to beat each other, restrain people for hours without bathroom access and had parents and teens kidnap people over 18 who were legally allowed to leave if they fled. He even continued to run program meetings underground after it lost its license. This man wasn’t outside the mainstream either: he had previously directed the anti-drug program that First Lady Nancy Reagan had called her “favorite.”

Rotenberg’s founder and long-time head, Matthew Israel, was forced to step down last year after facing criminal charges for trying to destroy video evidence of the 2007 incident. Perhaps without his leadership, the center will wither naturally, or perhaps a combination of legal settlements and public outrage will finally end this sad story.

What I hope will bring an end to Rotenberg, however, is simple human compassion and the public’s demand that extraordinary claims should require extraordinary evidence — especially when the claims advocate using physical pain to control our most vulnerable children.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.