Events Leading to the Death of Ashley Smith

Ashley Smith was a 19-year-old Canadian girl who died while incarcerated in 2007. She placed a ligature around her own neck, and it appears that guards, who were aware of her action, waited outside her cell until she was unconscious before entering. This story is told at http://www.canada.com/opinion/op-ed/mental+health+system+failed+smith/7549496/story.html

and at www.cbc.ca/news/canada/story/2012/10/31/ashley-smith-inquest-scope.html. Ashley had originally been incarcerated when in her early teens she apparently threw crab apples at a mailman who she believed was withholding mail deliveries. As she repeatedly rebelled against incarceration, her actions were judged to qualify her for further imprisonment in the adult system.

John Sainsbury’s op-ed piece, linked above, addresses some of the abusive treatment that sparked Ashley’s continuing resentment and refusal to capitulate. Most of her time was spent in solitary confinement, a device well-known to destabilize even the best-balanced personality, and one intentionally used in brainwashing and other efforts to “break” prisoners. Frequent transfers from one institution to another made it impossible for her to have any sense of familiarity or security, whether in her physical or her social environment. Had Ashley been the captive of kidnappers or hostage-takers, we would all be admiring her heroism and ability to maintain her integrity under pressure; as her experiences occurred at the decision of national authority, we see her named as a delinquent and criminal whose suicide was a result of mental illness and perhaps general contrariness.

There are all too many points that need consideration in this story. I am going to comment on only one of them--  the use  in Ashley’s treatment of the “wrap”, a blanket-like body restraint that is both uncomfortable and terrifying for its victims, but which continues to be used because of claims that its effects are “therapeutic”. “Wraps” or “cocoons” can be and often are used punitively under the mask of “treatment” for noncompliant behavior, as other forms of restraint can be. When restraint methods are used without documentation or later debriefing of staff, a possible pattern is for a staff member who is annoyed by a patient or prisoner to taunt the person until he or she responds violently, then to use restraint in retaliation.

Beliefs in the therapeutic value of restraint have been promulgated by a few psychotherapists, notably Ronald Federici and Dave Ziegler. In the form of the “Body Sock”, an all-over pressure garment, public schools, like one in Tampa, FL, have used “wrapping” to quiet children and have not considered it necessary to inform parents of this practice. In a post a few days ago, I mentioned the use of the “papoose board”, intended to restrain children during essential dental and medical procedures, but used “off-label” to treat/punish temper tantrums.

Those who claim that physical restraint is therapeutic sometimes cite the use of swaddling as an effective way to calm young infants, but in generalizing to older people they make the same error that would occur if they suggested a milk diet for adults. Proponents of restraint also often refer to the “squeeze machine” created for her own use by Temple Grandin, the well-known, high-functioning autistic professor of animal husbandry. Grandin noted that as a child she observed farm animals being held in a restraining device and found it calming when she was “squeezed” in the same way. Important point, though: Grandin could start or stop her experience of restraint absolutely at will. But no one offers children, patients, or prisoners the option of seeking or leaving restraint as they choose. They cannot avoid or stop the restraint until their captor makes a decision--  which may or may not be based on how the restrained person acts. It’s not inconceivable that a person feeling distressed might find it comforting to feel full-body pressure that can be adjusted or stopped as is desired. If there were good evidence that such pressure is therapeutic, we would need to consider that, no matter how implausible it may seem when we imagine the experience. However, without evidence, and going on empathy alone, most of us would agree that restraint we cannot control would be experienced only as a fearful punishment.     

Why would anybody claim that physical restraint and body pressure could have therapeutic benefits? I would suggest that there are historical reasons that go back to the use of the strait jacket and the “wet pack” (wrapping in wet sheets) to treat distraught patients. These were without a doubt more humane and therefore more therapeutic than keeping the mentally ill shackled in cells where the public could gawk at them--- or than the “brave bracelets strong, sweet whips, ding dong, and wholesome hunger plenty” described by Tom o' Bedlam.

At about the same time as the movement toward more humane treatment of the mentally ill in the late 18^th century, there were also new suggestions about human development that emphasized sensory experience as the shaper of mental growth. On the one hand, this perspective led to effective methods of educating blind and deaf children. On the other, however, it established the belief that sensory stimulation could solve many mental problems. In the 20^th century, this approach was formalized by the occupational therapist A. Jean Ayres, whose recommendations of touch and vestibular stimulation have never been well-supported by systematic evidence but have been adopted by educators and therapists. Ayres’ views on “sensory integration” became the basis of the “Body Sock” and other “wrap” methods, --  which unfortunately lent themselves all too readily to being used as punishments (certainly not the intention of Ayres).  

Horribly, it is possible for frustrated, possibly ill-trained teachers, mental health staff, or guards to take a technique intended to do good and to use it in the service of their wishes to retaliate against noncompliance. A case in point is the present use of solitary confinement, a technique introduced by Quaker prison reformers who felt it would give prisoners the opportunity to think through their attitudes and become penitent while in the penitentiary. This seems unlikely to us today only because we now know how solitary confinement can be used for harm.  When will we become aware that in spite of all claims of therapeutic benefit, restraint is used primarily as punishment, and used at the whim of those with secret power on those with no defense?

Whenever this occurs, it will be too late for Ashley Smith and many others.