Wednesday, May 20, 2009

When Extreme Measures Become Ordinary

A little while ago, Robert Dziekanski, a Polish man visiting his mother in Canada, was tasered by the RCMP several times and died. This has sparked major debate about whether or not police should be allowed to taser people.
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.)

Friday, May 01, 2009

Not Always Malicious

There are a lot of parents who, directly or indirectly, end up causing great harm to their children. There are a lot of children who grow up feeling betrayed by the people who should have been most on their side.
A lot of people assume that parents who cause lasting psychological harm to their children are just simply bad parents. Either they, for some reason, want their children to suffer, or they just don't care. Either way, they're bad people.
But in reality, it's not nearly that simple. Maybe there are some parents who really, truly don't love their children, but they're much less common than you might think. Most parents who hurt their kids actually love those kids and want the best for them, just like the more successful parents - but somehow, something goes wrong.
Maybe they're faced with a problem they don't know how to deal with. It could be that they think their children need something when they really need something else, like a parent who honestly doesn't know that shaking a baby can cause brain damage, or that 5 year olds can't be left unsupervised all day. Or they hold certain stereotypes about a group of people, and then suddenly discover that their child is a member of that group. Maybe they think one thing is going on with their child, and then find out that they're wrong and the consequences of their mistakes are serious.
Maybe they put their children in a situation without understanding what was really going on there. Who would have guessed that it's not all right to leave the boy with Uncle Ernie? Parents don't know everything. And they might not recognize the signs, when their kid is trying to tell them that something's wrong. Or maybe the child isn't trying to tell them - xe thinks they know already, or can't/won't help, or something terrible will happen if xe doesn't just put up with it, or maybe the child doesn't realize what's happening to xe is wrong.
Or maybe the parents have their own problems, and these problems are so serious and hard to deal with, leaving them without the resources they need to be good parents. Maybe their emotions keep bubbling up out of control, and when the child does some minor little thing, they can't restrain themselves and they hurt the child even though they know it's wrong. And they're sorry afterwards and they resolve not to do it again, but as long as they don't deal with the underlying problem, it will happen again. And maybe they don't know how to seek help, or they think they can handle it, or they're too afraid to seek help, or there's just no help to be found. So they're caught in this vicious cycle, and they can't find the way out. And the more often it happens, the more ingrained it becomes, until only something drastic can stop it.