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While many psychologists agree with Israel that aversive therapy can work as a last resort in a very few cases to control dangerous behaviorsâthe school contends that the skin shocks are almost 100 percent effective in reducing thoseâthere's less consensus on whether a method like skin shocks can really cure someone.
Israel's theory is that by shocking to discourage dangerous behavior, the therapist buys time to use positive approaches that teach patients how to control themselves. But evaluating whether the school has succeeded with students is difficult because they arrive with such different talents and troubles. Higher-functioning studentsâthose with normal IQs but severe emotional problems, who constitute about half the schoolâcan have normal lives: The center's website features testimonials from kids who have joined the Marines, or have been the first in their family to complete high school, or have even gone on to college.
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Other students are severely mentally retarded or developmentally disabled, and have no such prospects. "They're never going to be normal, fruitful taxpayers, but they can have some dignity and happiness," says Israel. A student named Caroline, who is in her thirties and has lived at the facility for more than 20 years, still wears a protective helmet and requires one-on-one staff monitoring, but JRC staff consider the fact that she's still alive a measure of success. Slaff's son Matthew also remains at JRC. He has stopped banging his head and can take vacations with his mom, but he still hurts himself sometimes, and still wears the GED.
Shear says he and his wife only visit their daughter once every six weeks or so; he doesn't know how long Samantha will be there. He does know the limits of optimism. "She'll never be cured of what she has. Her mental capacity will never approach that of a normal person," he says. "I believe that the GED will eventually come off her and she'll be able to maintain control of her behavior and be happy because she's not hurting herself or crying all the time."
Shear believes Samantha has already come a long way in her time at the Rotenberg Center. "I mean, when we went up last time," he says, "she was actually happy."
But after visiting the Rotenberg Center this spring, New York state inspectors concluded that "the background and preparation of staff is not sufficient," that JRC shocks students "without a clear history of self-injurious behavior," and that it uses the GED "for behaviors that are not aggressive, health dangerous, or destructive, such as nagging, swearing, and failing to keep a neat appearance." What's more, the inspectors said, the program for withholding food raised health concerns, and the classroom instruction was substandard.
Israel says the inspection was conducted by psychologists biased against his methods. But the New York report is just the start of JRC's current troubles. The Massachusetts agency (all JRC's operations have been located in the Bay State since 1996) that licenses JRC will inspect the school in coming months to see if requirements it imposed after a 2003 visit have been met. A separate Massachusetts agency has referred an allegation of abuse at JRC to local police; the claim is that the GED burned a student. Meanwhile, a Long Island mother whose son Antwone was treated at the JRC has sued her local school board and the center for using aversive therapy that allegedly caused the boy "serious physical injuries and mental anguish." At the same time, the New York legislature is considering a new bill that would ban skin shock outright on New York students.
Then there are the Regents regulations, which were prompted by the spring inspection. They prohibit all aversive stimuli but permit certain limited exceptions. Israel says the New York rules would tie his hands by restricting the skin shocks to kids who are endangering their lives or othersâ preventing shocks in cases of "health dangerous" behavior. The rules also bar automatic shocks. A group of JRC parents who agree with Israel went to federal court this summer to stop the imposition of the new rules on their children. The case is still pending, but the judge did block some of the rules temporarily for the students whose parents sued. Israel says that other New York kids who are no longer getting skin shocks are regressing.
But if that's true, it only fuels Israel's critics who say that all he's doing is hurting kids, not curing them. "This isn't a bell ringing. This is somebody getting an electric shock. It hurts them, so they stop," says Beth Haroules, a staff attorney at the NYCLU. "But if you take away the pain device, they haven't learned to stop what they're doing."
Even the center's aggressive methodsâ like automatic shocks and behavioral rehearsal lessonsâhave some scientific support. But the endorsements are cautious, and limited only to cases where painful techniques are the only hopeâand where they work. Experts note that there is a "slippery slope" risk with aversives: If they work for a very serious behavior, why not use them for a slightly less serious one? And then there's the question posed by partial success: If skin shocks reduce a behavior but don't eliminate it, do you keep shocking for months, years, or even decades? The scientific process of peer review could address some of these questions. But many practitioners admit that when it comes to aversives, pure science isn't the only issue. The ethical limits on how to use science are also in play.
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