Some Call It Torture, but a New England School Says That Its Therapy Is Taming Autistic Students
updated 04/14/1986 AT 01:00 AM EST
•originally published 04/14/1986 AT 01:00 AM EST
Not any longer. And now, say Claudia and her husband, Leo, it's their turn to be vocal—vocal, that is, in defense of the school they feel has redeemed their son's life. BRI is under attack from the Commonwealth of Massachusetts, which has an interest in the school because its students are housed across the border in Massachusetts. For the past six months, over the clamorous objections of virtually all the parents of the 64 students at the school, the Massachusetts Office for Children has been trying to reform BRI, claiming that it is straight out of the Dark Ages, an operation closer in spirit to the Marquis de Sade than to Mother Teresa.
At issue is the proper treatment of children and young adults with severe cases of autism and other brain disorders who are a danger to themselves and an embarrassment to others, children who masturbate in public and slap and scratch themselves to the point of drawing blood. At issue, more specifically, are the so-called physical "aversives"—or punishments—that BRI's staff of 141 dispenses on a routine basis as a means of modifying the students' behavior. As conceived by Dr. Israel, the institute is grounded in the idea that people, even those whose actions are frequently involuntary, can be taught socially acceptable behavior through the application of a system of rewards and punishments.
This is not a new idea—credit goes to Harvard psychologist B.F. Skinner. It became a public controversy last summer when Vincent Milletich, a 22-year-old autistic youth from Queens, N.Y., lost consciousness at BRI while undergoing aversive therapy and died several hours later at a hospital. Milletich, who was known to suffer seizures, was apparently bound at the hands and feet at the time he had an attack; he was also wearing a helmet that blocked his vision and bombarded his ears with the static-like sounds called white noise.
The medical examiner listed asphyxiation as the likely cause of death but did not suggest any link to the aversive therapy. The Bristol County district attorney, however, is seeking an inquest to determine the cause of death. Like the parents of all students, however, the Milletichs had signed a form agreeing to the use of aversives. Enter the Massachusetts Office for Children, which issued an emergency order demanding that BRI end its program within three weeks. "There was excessive use of physical punishments," says Mary Kay Leonard, director of the OFC. BRI immediately turned to the Division of Adminstrative Law Appeals, which ruled that BRI could continue to operate but that no physical aversive procedures could be used, pending hearings. Two months ago, moved by petitions from parents of students at the school, a judge said that aversive therapy could be resumed with five especially troubled children who appeared to have regressed after several months without the treatment. (One of the children had reportedly been trying to swallow poison.)
Dr. Israel says that the death of Milletich "has created a black cloud over our head." Yet the truth is that, since its founding in 1971, BRI has seldom operated under azure skies. The idea of punishing children—pinching them, shackling them, spraying them with water, forcing them to behave "properly" in order to get food—has not sat well with many people, including experts on autism. An idealist who studied under Skinner in the '50s, Israel feels that he and his school have been grossly misunderstood. The average BRI student, he points out, has already been turned out of four other programs for the severely disturbed. For him, the institute is the end of the therapeutic road, beyond which, says Israel, lies the jungle of the state medical hospital. Israel says that if his critics really want to see cruel and unusual punishment, they should visit a state institution unannounced and take a look at the overmedicated zombies there. Drugs, he says, are not used at BRI, and no one is turned away. "No matter how big, how old, how disgusting the student, we won't say no."
For the majority of these people, the learning objectives are modest, focusing on basic language skills and personal hygiene. Israel claims that all his charges have shown at least some improvement—due in large part, according to Israel, to the fact that they receive far more rewards than punishments. Most students stay at BRI two or three years before moving on, generally to group homes in the larger community. During this time they become familiar with a remarkable assortment of rewards and punishments. To receive rewards the students "contract" with the staff to behave in a specified way; they agree, for example, to refrain for a period of time from pulling out their hair. When they meet the contract, they are set loose in the "Big Rewards Store," a wonderland of children's amusements filled with juke boxes, talking cola dispensers, cotton-candy machines, hot-dog makers and video games. It's when they fail to match the contract that the Fun House turns into what some consider a House of Horrors.
There is a hierarchy of aversives at BRI. For simply mumbling at the wrong time, a student may receive a token monetary fine or get misted with water from a bottle. It's at this point that BRI starts to get in trouble with its critics. In addition to the white noise treatment, instructors apply what they call the automatic vapor spray, during which the student is forced to sit in a small booth. Shackled in soft plastic cuffs, he wears a helmet that blasts him with white noise and sprays his face with a cold water vapor. Often an ammonia pellet is shoved beneath his nostrils just before the 15-minute process begins in earnest.
For these and other ingenious approaches, Israel was savaged by the Boston Phoenix, a weekly newspaper that referred to him as "Doctor Hurt." He has run into some flak from his colleagues as well. Robert Bowles, president of the National Society for Children and Adults with Autism, thinks Israel means well but finds his methods deplorable. He believes that BRI is not bringing autistic children to health but merely controlling them through fear. Anne Donnellan, an expert in behavioral disabilities and an associate professor at the University of Wisconsin, likens Israel and the parents who support him to the late, infamous Rev. Jim Jones and the gullible flock who followed Jones to Guyana and suicide in 1978. "They're desperate people," she says. "The parents at Jonestown gave their kids a drink laced with cyanide and they also believed it was best for their children."
BRI parents think that Anne Donnellan and other critics are hysterics. "We're not horrible and sadistic," says Robert Flanagan of Port Washington, N.Y., former chairman of Western Union, whose severely autistic son Chris, 29, has been at BRI for eight years. "Any parent who's ever punished his child has worried about whether it's the right thing to do. We thought BRI's program might work when we sent Chris there, and we were right. Chris has been doing marvelously. We knew the only alternative to BRI was the state institutions, where Chris would be sodomized, beaten and—if he were lucky—held in a strait-jacket. They're torture palaces." Flanagan accepts that some outsiders are genuinely horrified by BRI's tactics, but as the father of an autism victim, he takes a very different view. "Dr. Israel's program is a blessing," he says. "The progress the children have made is all that counts."