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 shocko 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 policyo 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 usedo 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 GEDo Behavioral Rehearsal Lesson Students restrained/GED administered as the student is forced to dothe 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 studentsYES (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 donot 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?- GED = health and safety issues- Restraintso Can cause abrasionso Are used simultaneously w/ GED sometimeso 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 childreno Food is mashed and sprinkled w/ liver powdero 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 aggressionNO- 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 reporto Authors took statements from JRC students/parents/affiliates and revised them or took them out of context to seem negative towards JRCo 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 problemsTS 5: Do we still need psychiatrists?YES- Promise of mental healthcare for all w/ federally-funded community mental healthcenters- 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 criticismNO: 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 itselfo Interact more and intervene less- Challenge the “disability” system  people are “too demoralized to give a