TS 14 aversive treatment for psychologically disordered individuals is it inhumane Judge Rotenburg Educational Center Use of physical restraints and aversive conditioning Graduated Electronic Decelerator GED administers an electric shock o Stronger version of the original SIBIS JRC philosophy all behavior can be manipulated through a combination of rewards and punishments behavior modificaion o Zero rejection expulsion policy o All residents are subjected to the same behavior modification techniques through reward punishment regardless of diagnosis or history o Traditional psychological therapies and medication are rarely used o Punishments aversives Early on those who were severely mentally retarded and those w autism were subjected to harsh punishments pinching spatula spanking water sprays muscle squeezes Late 1980 s replaced w SIBIS a machine that delivers a shock w intention of stopping self injurious behaviors in children largely abandoned in the 1990 s Wanted a machine that delivered a stronger shock for those students who became accustomed to such a small shock led to the development of the GED o Behavioral Rehearsal Lesson Students restrained GED administered as the student is forced to do the behavior the punishment seeks to eliminate Staff threatens students and doesn t say when a shock is being administered students become extremely terrified This simply promotes further aggression fear from students YES MDRI Report Vital to pay attention to an individual s history as such punishments can do a lot of damage if administered to a trauma victim Referred to as torture rather than treatment GED administered for non problematic behaviors autistic individuals shocked for simply trying to communicate swearing disheveled appearance Behavioral programming is not sufficiently monitored and some professionals do not have the appropriate background knowledge for dealing with challenging emotional and behavioral disorders Aversive treatment cannot treat an underlying emotional disorder intellectual disability temporary alleviation of symptoms no long term results NO GED health and safety issues Restraints o Can cause abrasions o Are used simultaneously w GED sometimes o Students may be restrained for extended periods of time weeks months o Used to pressure coerce students into consenting to the GED Limitation of privileges o Food deprivation to further abuse children o Food is mashed and sprinkled w liver powder o Social isolation is promoted Maintain strict control among students Promote an environment filled with fear pain and punishment Six unexplained deaths 1986 aversives are permitted w a court ordered treatment plan Student developed a stage 2 ulcer after receiving upward of 70 shocks from GED NYSED review ultimately the effects of punishment on JRC children increased fear anxiety or aggression Take in the most difficult challenging self abusive patients GED is utilized only when positive only procedures fail and used rarely Individuals have a right to choose aversive therapy to treat behavioral problems Safe intensive behavioral therapy has freed hundreds from disturbing alternatives Works effectively for individuals for whom every other treatment has failed Two second shock to the skin feels like a pinch has no side effects and is extremely effective GED must be court and physician approved strictly regulated About the MDRI report o Authors took statements from JRC students parents affiliates and revised them or took them out of context to seem negative towards JRC o Some facts ie it originated in CA are simply not true questions the validity of the report Demonstrates testimonies from parents and students how the staff is loving caring how the GED is actually extremely effective and how JRC is successful and curing those with behavioral problems TS 5 Do we still need psychiatrists YES Promise of mental healthcare for all w federally funded community mental health centers Development of effective psychotherapies Have studied the brain extensively and how it may differ from our mind and spirit Best equipped to assess if an underactive thyroid gland is not causing one s anxiety depression or psychosis They are medical doctors take the Hippocratic oath wear a white coat understand medical terminology from other physicians direct responsibility for life and death decisions 8 years of graduate school Cost effective to combine psychotherapy AND medication There are some things psychiatrists can simply do better Move towards integrating psychiatry with primary care Profession needs to redefine itself in ways that are more responsible to the needs of contemporary society accept constructive criticism NO not an end to psychiatry but proposed changes in the way psychiatrists go about their work Psychiatry has far outstepped its bounds and has mislabeled and mistreated countless people Delusion of psychiatry is part of society Psychiatry as a way to label behaviors that are slight variants of the normal and seek to treat them with chemicals Society leads people to believe that they have a mental illness when they do not the people know more about drugs than their doctors do They should have the communication skills to explain to patients how they can overcome illnesses or to educate that their complaints are not even an illness Patients demand medications regardless of side effects even when a psychological illness is not present Drugs are addictive and patients believe these drugs fix them higher demand Proper diagnosis and treatment is virtually impossible in the chaotic environment of the inpatient unit Treat your patient as a fellow peer if there is mental illness it will present itself o Interact more and intervene less Challenge the disability system people are too demoralized to give a damn