Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, November 27, 2012

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 18th 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 20th 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.  



18 comments:

  1. The Fifth Estate produced an investigative video entitled "Out of Control," available online (http://www.cbc.ca/player/Shows/ID/1386471229/). It's devastating and damning.

    This case is horrific. And, sadly, it's one logical outcome of the way many staff in institutions treat "noncompliant" children/teens (who may or may not be mentally ill when they're first institutionalized, but certainly are driven to illness and disorders by their treatment).

    I made myself watch the Fifth Estate video to witness the atrocities done to Ashley Smith in the name of order and control. But I would, at points, stop breathing, seeing what they did to a *child*: the depiction of the use of the "Wrap" (perhaps the best euphemism ever invented for a form of torture), complete with helmet, was certainly one of those points.

    This treatment is not far removed from what many children suffer in foster care when their caregivers are more interested in demanding obedience/compliance, cooperation, and happiness from them than in allowing the human being in their home and care to display a full (and highly understandable, if not always predictable) array of feelings, behaviors, and beliefs that are an expression of the difficult life they have lived.

    You are so right, Jean, about the abuses visited upon children in the name of treatment or rehabilitation---or in Ashley Smith's case, not even doctored so nicely. Simple and brutal incapacitation.

    At a senseless cost, she thwarted the institution's attempt at total control. I don't want to valorize her death. She deserved assessment, diagnosis, and treatment---and no more than the 3 months of incarceration that was her initial sentence as a juvenile. But she outsmarted her captors. They tried to put her into, essentially, a locked-in syndrome. And they failed. That the only action left to her was suicide is our failure, not hers.

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  2. I find it interesting that you attribute the lines from the folk ballad "Tom O'Bedlam" to Shakespeare. What is your evidence for this?

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    1. Nah, you don't find it interesting,you find it incorrect, and by golly you're right. I've mixed that Tom up with the one Edgar in King Lear pretends to be. I will fix this..

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  3. Not to get off topic, but I am just reading about this young woman and I watched the link that Marianne posted. What really struck me was where were the parents? If she were only supposed to serve one month, how could it have gone on for soooooo long? Why are they asking for a review of her time in the federal facility? Didn't they know what was going on?

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    1. This information is all supposed to emerge from a series of hearings to take place after the first of the coming year. I hope there will be some answers forthcoming.

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  4. Wendy, perhaps this report by the New Brunswick Ombudsman and Child and Youth Advocate on the services provided to a youth involved in the criminal justice system will help answer some of your questions: http://www.gnb.ca/0073/PDF/AshleySmith-e.pdf

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  5. loved the bit about if this happened at the hands of some terrorist group, we'd all applaud her, but if if she resists "us" that way, it's unforgivable (paraphrase...). That's the point. Our systems of punishment are those types of things that are unacceptable when others do it, but OK for us. I'd like to point out that if she had done something more heinous to get herself incarcerated in the first place, the story of her abuse in prison wouldn't get any traction, except from the most liberal of us. Apparently the things we do in the name of punishment are only crimes if our victims aren't criminals.

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    1. Very true-- and as Guantanamo shows, we've even blurred the distinction between criminals and enemy soldiers.

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    1. Thank you, Sunday.

      It seems pretty awful to say that anything about this ghastly situation is "interesting", but I would like to know more about the fact that the man Jeff Bell called this "more torture than treatment". Thus suggests that someone has represented to him that such actions toward a child can be done as a from of "treatment"-- though he may have heard that in some other case rather than this one.

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  7. Yes, Jean it is "interesting"...and seems to share some similarities with the types of abuse cases we have been seeing with adopted children in the news...no?

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    1. Absolutely. People seem to think that adoption is a category unto itself, but it shares many characteristics with the step-parent scenario.

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  8. http://fullcomment.nationalpost.com/2013/02/21/christie-blatchford-ashley-smith-and-jurors-blocked-from-answers-about-mystery-of-who-her-real-family-was/

    "It would be helpful, the juror said, if Ms. Smith could fill in the blanks: Ashley was confused “about her nephew being her brother and her sister being her biological mother. … Is that true? Was she confused?”

    Again, Dr. Carlisle jumped in.

    “What was in Ashley’s mind, what she knew, is relevant,” he said, “but the fact of it is not. We must not ask Coralee what the fact of that matter is.”

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  9. I don't seem to be able to get to this link-- can you help?

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  10. Now I got to it-- don't know what the problem was. But,how very strange! How can anyone expect to get to the bottom of this, and figure out if anyone was culpable, if some information is off limits? I suppose the answer is that they don't expect to.

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  11. Perhaps they didn't intend to - or rather, intended not to.

    Here's a link to a story about a woman with undiagnosed mental illness who survived the prison system:
    http://ca.news.yahoo.com/ashley-smith-could-very-easily-090002030.html

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  12. It's hard to avoid that conclusion,isn't it?

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