When Extreme Measures Become Ordinary
In the neurodiversity community, there has been a great deal of outrage at the practices of the Judge Rotenberg Center, which treats children with serious behavior problems by various methods including contingent electric shocks as punishments.
Another issue for the neurodiversity community is the use of restraints to deal with behavioral crises in disabled children, highlighted recently by a news report and a GAO report on the dangers of restraints, including deaths from restraints.
Tasers, contingent electric shocks, and restraints are all risky procedures, with a high probability of causing physical and/or psychological trauma. At least two of those three are believed to have killed people or contributed to their deaths. They're not intended to kill or cause serious harm, and they don't necessarily have that effect on everyone, but the risk is there. That's why all three have people wanting to ban their use.
But their supporters all make the same argument: in extreme cases, when the stakes are really high, these measures may be better than the alternative. If it's a choice between shooting someone and tasering them, the taser is certainly safer. If it's a choice between a child self-injuring to the point of extensive scarring and using contingent electric shocks to train that child to stop that behavior, the electric shocks are probably better. If it's a choice between that same child killing themselves with self-injury or being in four-point restraints, the restraints are probably better. There are few, if any, people who oppose using these extreme measures in such extreme situations. In those cases, the risk of harm caused by those extreme measures is less severe than the alternative.
In theory, it's easy to say that these techniques should be used only in extreme cases. It's easy to say that you shouldn't taser a man multiple times because he picked up a stapler, or give contingent electric shocks whenever a student swears at you, or hold a child facedown on the floor to stop her from wiggling a loose tooth (all those are described in the above links). And it's also easy to draw a distinction between those cases and the extreme situations where those measures are justified. But in practice, what do we see? Time and time again, extreme measures are introduced for use in extreme situations, and they end up getting used for minor altercations.
I think what we really need to do is figure out why this keeps happening. What is it about giving someone an extreme tool that makes them start using it when it's not necessary, and how do we change that?
A big solution that comes to mind is better training. I worked one shift at a suite where two severely autistic kids were being cared for by three shifts of staff, and my training consisted entirely of getting advice from a more experienced staff member as I did the work. No formal training whatsoever, and I was dealing with these kids right away. I didn't know a thing about those two kids and how they communicated, and my prior experience had also consisted of hands-on work with no actual training. In that kind of situation, is it really surprising that people misuse the tools they're given?
Then there's job stress. Working with people showing extreme behavior - whether it's as a police officer, a medical professional, a caregiver, or whatever - is very stressful. Especially when you're doing this for eight hours. Hiring more workers, giving stress reduction services and such to the workers you do have, paying them better so they can afford to arrange their own stress reduction - there are ways employers can reduce stress, and those things should reduce abuses.
And empathy. It's hard to know how to build empathy, but if you have empathy for the people you're trying to manage, that makes a big difference. Note that if you don't have empathy for them, you're not necessarily a bad person. If you're dealing with someone you don't really understand, who is attacking you or doing horrifying things, it's very easy to lack empathy for them. Having people who are dealing well with the same sort of issues that are overwhelming their clients is a great way to ensure empathy, but those people can be hard to find. There really should be more research into training methods that help build empathy for the clients. (One little note: subjecting the employees to a controlled, consensual version of the same measure they should use in extreme situations doesn't work. That's like having sex to find out what it's like to be raped - the context is totally different.)