In 2002, Andre McCollins, an autistic 18-year-old, was restrained for several hours face-down, and electrically shocked 31 times in seven hours by a remote-controlled device for what a special-needs school described as an attack on a member of staff.
This American school's practice of using electric shocks to discipline students with severe behavioural problems has solicited renewed attention from the United Nations' Special Rapporteur on Torture.
UN Special Rapporteur Juan Mendez confirmed to Al Jazeera that he has asked for access from the US government, asking them to investigate the use of "skin shock therapy" by the Judge Rotenberg Centre (JRC).
In 2010, Mendez's predecessor, Manfred Nowak, said he believed the practice constitutes torture. "I have no doubts about it," said Nowak at that time. "It is inflicted in a situation where a victim is powerless. And, I mean, a child in the restraint chair, being then subjected to electric shocks, how more powerless can you be?"
|The GED skin shock device [Judge Rotenberg Centre]
Skin shock therapy, in which students exhibiting extreme or dangerous behaviour are subjected to electric shocks from a remote-controlled device, is legal in the United States. Twelve US states currently send their children to the JRC. Parents and a probate court judge are required to approve the treatment on a case-by-case basis.
The practice has come under fire in the past few years, and the JRC faced renewed scrutiny in April, when a video of McCollins being repeatedly shocked surfaced. McCollins' mother, Cheryl, has said the incident in question occured because her son refused to take off his jacket, but JRC lawyer Michael Flammia countered her claim by saying Andre "started off that day by attacking a staff person on the bus", and that the punishment was not applied simply because he refused to remove his coat.
The JRC, founded by behavioural psychologist Matthew Israel and based in the Boston suburb of Canton, has a "zero-rejection, zero-expulsion policy", according to its website. Many of its residents have exhibited severely violent behaviour towards themselves and others: a summary statement on the JRC website says its students include people who have gouged out their own eyes, pulled out their own adult teeth, swallowed razor blades, and attempted to strangle their parents.
The JRC has 235 students, more than 30 of whom receive skin shock therapy.
"JRC is the place of last resort," said Flammia. The typical JRC student, he explained, "has come from a psychiatric hospital, or come from another programme that's expelling them because their behaviours are so dangerous that they can't keep them safe."
Students at the centre receive individually tailored treatment programmes that include both positive and negative reinforcement. Initially, new students are offered rewards for good behaviour, but if that doesn't work, aversive shock therapy is ultimately considered. The therapy delivers an electric shock to a student when he or she exhibits undesirable behaviours such as aggression or self-injury.
Skin shock therapy
Skin shock therapy, also known as aversive shock therapy, requires students to wear either a "fanny pack" or backpack containing a battery-operated device, known as a Graduated Electronic Decelerator (GED), which is connected by wires to electrodes on the skin. The electrodes themselves are fastened onto the flesh with a fabric strap, which is connected to a metal lock to prevent students from removing them.
Staff members of the JRC then use a transmitter to activate two-second-long shocks when undesirable behaviour is exhibited. One former patient, Hilary Cook, told Al Jazeera that she had to wear the GED 24 hours a day.
Of the medical sources Al Jazeera spoke to, a majority raised questions about using skin shock therapy to treat severely maladaptive behaviour.
Dr Allison Baker, a psychiatrist at Columbia Presbyterian hospital in New York City, advocated the use of reinforcement-based procedures instead.
"There's a large evidence base to suggest that behavioural intervention programmes can be successful without the need of using aversive punishment-based procedure," she told Al Jazeera. "While the notion of a punishment-based procedure will diminish the maladaptive behaviour in the heat of the moment, you're not teaching the youngster. You're not giving them replacement behaviours and you're not giving them skills they can take with them into the future."
Baker also noted that no "rigorous peer-reviewed publication for this kind of treament" had been released in nearly a decade, though the school rejects this claim.
Brian Joyce, a Massachusetts state senator, echoed Baker's emphasis on alternative therapies. "We're successfully treating such individuals through positive interventions everywhere else in the country and throughout the world," he said. "We certainly don't need to resort to this barbaric treatment in Canton, Massachusetts."
Joyce, who says the practice is "inhumane and at times barbaric", is trying to ban aversive shock therapy altogether. He believes legislation has not yet passed due, in part, to what he says are the JRC's powerful lobbyists and deep pockets - he said that, in 2007, the centre took in $56m in revenue.
In 2011, the JRC was prevented from administering the therapy to newly admitted students, although the centre is appealing this decision.
Cook, the former JRC resident, told Al Jazeera that she is "kind of amazed" that the treatment continues to be legal. She described the therapy as "clearly a case of torture".
"I don't remember what the first thing I did to get a GED was. But I do remember what the GED felt like at the time," she said. "I was expecting a bee sting and what I got was pretty extreme pain that felt like longer than a few seconds, but was only a few seconds. It did cause me to scream and it was very intense and burned for a while afterwards. It actually left marks on me that went away after a few days, but it did leave marks."
Flammia told Al Jazeera: "Anybody who says this treatment is torture is 100 per cent wrong. It's no different than saying dental work is torture.
"If [the treatment] was taken away, they would either die or be put on drugs for the rest of their lives and they'd be comatose for the rest of their lives."
Some parents agree with Flammia's characterisation, and are convinced that the JRC's approach has saved their children from a life of misery.
Lauren Emmick, a mother of a current resident at the JRC, argued that aversive shock therapy should not be classified as torture, and credited the treatment with allowing her daughter to live a more normal life.
Emmick said her daughter Lian had been in therapy since age three and a half, and began taking medication at age six. She said Lian's behaviour was so aggressive that she had to be taught separately from the other children at the special-needs school she previously attended. "What she experienced before was torture," said Emmick. "She had been restrained so many times, both of her knees needed to have surgery."
Emmick had considered shock therapy as a last resort, but finally agreed to it after Lian had been at the JRC for five months without responding to other treatments. The therapy not only produced an "immediate" effect on her daughter, she said, but it also continues to limit her violent outbursts. "She works in the kitchen, she's got two roommates, she's in a classroom, she's learning, she's happy. I've never seen her happy. Ever."
Click here to read an interview with the JRC's lawyer, Michael Flammia.