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Bill Ahearn, Ph.D., BCBA-D

Bill Ahearn Ph.D., BCBA-D

Torture or treatment?

Skinner felt punishment was the cause of many ills in society.

Last night on ABC's Nightline, a story (http://abcnews.go.com/Nightline/shock-therapy-massachussetts-school/story?id=11047334) was aired on the Judge Rotenberg Center (JRC). JRC is a controversial facility that serves individuals, including a number of persons with autism, with severe problem behavior. What makes this facility controversial is its heavy reliance on punishment delivered via electric skin shock and other forms of aversive stimulation. The new angle on this story is that an official from the United Nations, Manfred Nowak, states that the procedures used at JRC constitute torture. Nowak is a human rights lawyer who has focused on torture and has been involved in investigating practices used on terrorism suspects at Guantanamo Bay. I'll have comments on JRC's practices and Nowak's expertise on evaluating treatment procedures for severe problem behavior below but I want to start with one major problem I had with the story.

At one point a close association is made between JRC's practices and B.F. Skinner. Yes, JRC founder, Matt Israel studied with Skinner, and received his Ph.D. from Harvard. However, Skinner's views on punishment would lead you to believe that he would be uncomfortable being seen as an advocate for the use of punishment. Skinner felt punishment was the cause of many ills in society. In Science and Human Behavior (1953) Skinner states:

"The commenst technique of control in modern life is punishment. The pattern is familiar: if a man does not behave as you wish, knock him down; if a child misbehaves, spank him; if the people of a country misbehave, bomb them...All of this done with the intention of reducing tendencies to behave in certain ways...In the long run, punishment, unlike reinforcement, works to the disadvantage of the punished organism and the punishing agency." pp. 182-3.

In many of Skinner's other writings he describes the problems generated through punishment in educational environments and society as a whole in addition to explicitly detailing the problems with punishing the behavior of an individual. So what are the effects of punishment according to Skinner? Again in SHB Skinner says, "An immediate effect in reducing a tendency to behave is clear enough, but this may be misleading. The reduction in strength may not be permanent." An interesting, later in that very section (Does Punishment Work?), states, "The fact that punishment does not permanently reduce a tendency to respond is in agreement with Freud's discovery of the surviving activity of what he called repressed wishes." As an aside, Skinner may have referred to Freud's theories as rife with explanatory fictions but he also was not shy about pointing out some of the strengths of Psychoanalytic theory. This was likely due to the common assumption of determinism in these perspectives.

The first effect of punishment is "confined to the immediate situation." This effect is, at least in part, due to the "competing effect" of the aversive stimulation we call the punisher. A second effect generated by punishment can be characterized as a conditioned emotional response. When the person is in the situation in which the punished response has occurred in the past, guilt, shame, and/or anxiety occur. Such emotions (which the Radical Behaviorist considers behavior and not causes per se) may also serve to suppress the punished response. The third effect of punishment is very important. This third effect involves the direct reinforcement of any behavior that produces escape from or avoidance of the conditioned emotional response and the punisher. Herein lies the problem.

"If punishment is repeatedly avoided, the conditioned negative reinforcer undergoes extinction. Incompatible behavior is then less and less strongly reinforced, and the punished behavior eventually emerges. When punishment again occurs, the aversive stimuli are reconditioned, and the behavior of doing something else is then reinforced. If punishment is discontinued, the behavior may emerge in full strength." SHB, p. 189

This is not mere speculation. This account of the process of punishment is built upon work by Skinner, Estes, and a number of other behavioral researchers. Punishment is a procedure that involves ongoing behavior that is then exposed to aversive stimulation. Unless the cause of the ongoing behavior is identified and effectively treated, punishment will likely need to be in effect forever for suppression of the problematic behavior. Skinner would not be an advocate of the consistent and systemic use of punishment. The story on Nightline makes an unfortunate, and perhaps unintended, association between Skinner and the use of painful aversives.

That said, there are situations in which problem behavior is life-threatening and does not respond to standard protocols of functionally analyzing problem behavior and implementing function-based treatments (see my previous posts related to this topic; http://www.psychologytoday.com/blog/radical-behaviorist/201001/self-harm-or-request-help; http://www.psychologytoday.com/blog/radical-behaviorist/201006/is-restraint-always-abuse). In these cases do we throw up our hands? No, but as stated in Sidman's Coercion and its Fallout (1989), "To use punishment occasionally out of desperation is not the same as advocating punishment as a principle of behavior management." When punishment is used, either there must be a good reason to use it, like desperate straights, or there are mechanisms in place for removing the punishment contingencies.

JRC may be an institution that many despise. Many have attempted to shut JRC down, including MA State Senator Brian Joyce, who appears briefly in the Nightline story. There has been legislative efforts to ban aversives in Massachusetts for over 20 years. They have consistently failed as there are many proponents of JRC who have vocally supported the agency. Though I certainly have misgivings about the use of painful aversives, I will not comment on the behavioral programming for any individual without thorough knowledge of the presenting problem and the process for developing an intervention. Each of JRC's clients who are exposed to these procedures have the treatments cleared by the person's caregivers and have court approval. If someone wants to question the use of painful aversives at JRC, they certainly have justification to do so because these are extraordinary procedures. To determine whether there is an appropriate treatment, however, would require someone who is an expert in the management of severe problem behavior (this person would also need to be independent of JRC). Here's where I'll state that Manfred Nowak is not properly qualified to make the statement that JRC's procedures are equivalent to torture.

I do not intend to be perceived as an advocate of JRC. I am not. There have been many troubling stories that have come out in the media such as, a case that I believe is still under investigation, in which a former client delivered information to JRC staff that was stated to have led to the delivery of multiple skin shocks to two current clients. It is best to allow the proper authorities to decide whether JRC's practices are appropriate. However, I also want to clearly state that there are situations in which aversive interventions are necessary. Banning them outright is not the solution. Regulating them properly for the very few situations in which they are necessary is the more humane alternative.

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