The Shocking Truth

In the beginning there were only two students, a schizophrenic and an autistic teenager. Israel had set up his day school, such as it was, in Providence, Rhode Island, in 1971, calling it the Behavior Research Institute. He opened a residential program the following year in a wing of the schizophrenic's home in nearby Cranston. By 1975, BRI had another home in Seekonk. Two years later, Israel founded a sister branch of BRI in California. From there BRI opened residential homes in Attleboro and Rehoboth. Soon Israel had lost interest in Walden Three; he wanted to oversee his school.

They used aversive therapy at BRI. They used positive reinforcement, too: food and toys and a near-continuous stream of compliments for behaving well. But it was the aversives that drew attention. Teachers pinched students, spanked them with spatulas, stuck ammonia pellets beneath their nostrils, put them in white-noise helmets. Israel saw aversive therapy—and still sees it—as the best response to self-injurious and disruptive behavior. He almost never doped his pupils, a position he holds to this day. He believes drugs often only sate the patient; they do not solve her problems. Israel, then as now, put his trust in punishment.

It wasn't long before people wondered if that trust was misplaced. In 1979, the state of New York issued two reports from agencies that oversaw the Behavior Research Institute. Fifteen New Yorkers at that time attended the school. (New Yorkers today still account for the highest percentage of the school's student body.) The bright red buttocks and scrapes across the cheek; the plaintive cry of a student who said, "Take me home, I want to go home"; the weird, oft-repeated, and grammatically challenged cheers from teachers ("Good working without stopping")—it led the authors of one report to write that the school's "rigidly implemented" program was the "singular most depressing experience that team members have had." That was not the worst of it, though.

On July 17, 1981, at BRI's sister school in Northridge, California, staffers restrained 14-year-old Danny Aswad face-down on his bed. Aswad died in that position. The autopsy report concluded that he died of natural causes, but the state of California placed the school on a two-year probation anyway. In 1982, the state's Department of Social Services filed a 63-page legal complaint alleging abuse at the school. The complaint claimed, among other things, that BRI withheld meals; showed staff how to hide students' injuries from regulatory agencies; and, strangely, encouraged students to act out for a film crew, the footage to be used later to demonstrate how the children had behaved before BRI. Later that year the state reached a settlement with BRI in California. The school couldn't use anything more punishing than a water spray. The state also forbade Israel—who says he'd turned over control of the campus before Aswad's death—from stepping foot on the Northridge property. But this, too, was not the worst of it.

In 1985, Vincent Milletich died. The 22-year-old from Queens, New York, attended the school in Providence, as did, by that time, roughly 60 others. On July 23, for acting out at the BRI residential home in Seekonk, Milletich was restrained in a chair, his hands and feet tied by plastic cuffs, his face masked and his head helmeted, the earphones inside it emitting white noise. He suffocated in there, asphyxiation. Though BRI was not found to have caused Milletich's death, a district court judge ruled it was negligent for approving the therapy and not carrying it out with sufficient supervision.

Later that year, the state's Office for Children, which regulated the school because its residential homes were in Massachusetts, issued an order to close the Behavior Research Institute. The school appealed the closure, and countersued the Office for Children. Then a judge recommended BRI stop using aversives. Advocates for the disabled cheered the move; many of them had written to Governor Dukakis asking him to shutter BRI, but to no avail.
Without the treatment, the school said, its students seriously regressed. For Israel, this meant the therapy had been working. But others drew a different conclusion. The children "are controlled by the threat of punishment," one of the New York reports had said. "When that threat is removed, they revert to their original behaviors."

Hoping someone would see things his way, Israel brought one of his most terribly self-abusive students before Judge Ernest Rotenberg at a hearing at the Bristol County Probate Court in 1986. After Israel detailed the student's history, Rotenberg ruled that she was unable to make her own treatment decisions. And if she were, she'd choose BRI. The Office for Children and BRI settled the following year, the state agreeing to pay $580,000. Rotenberg allowed BRI to use aversives, as long as each student's treatment plan was approved by the probate court. He also appointed a mediator to hear future disputes.

But the Milletich affair, too, was not the last of the school's troubles. In 1990, BRI student Linda Cornelison died. She was mentally retarded, could not talk, and one day began clutching her stomach on the bus to school. Once there, she lay on a couch, but a nurse thought her illness was an act, according to a report later filed by the Massachusetts Department of Mental Retardation. After school, Cornelison returned to her BRI-run home in Attleboro, where staff gave her 13 spatula spankings, 29 finger pinches, and 14 muscle squeezes, and five times forced her to inhale ammonia. She died in the hospital early the next morning from complications related to a gastric perforation. Her mother said Cornelison had never had gastrointestinal problems before, according to a medical report. Though the department's report said the school "violated the most basic codes and standards of decency," it found that neither the dereliction of care nor the administration of aversives had killed her.

Some time after Cornelison's death, Israel eschewed the punishment he'd favored for two decades. He would instead use something more uniform, and far more painful.

This is the machine that led to the machine. It's called the Self-Injurious Behavior Inhibiting System (SIBIS). There are two models, the simpler consisting of an electrode and a radio transmitter wrapped by Velcro around the arm or leg. The administrator holds the control and, when necessary, presses the shock button. It feels like the hard slap of a rubber band, and lasts nearly as long: 0.2 seconds. In an academic paper on SIBIS that appeared in 1990, the authors said its shock produced an "almost complete elimination of the self-injurious behavior."

Israel's school was one of the first to use SIBIS. What Israel liked was the same thing the study's authors liked. The aversive was consistent: It delivered the same shock, with the same power, for the same duration, every time—unlike, say, a spatula spank, whose parameters were not nearly as defined. Its intent was clear: There was no chance the student would confuse the aversive with some other action. And it was discreet: The shock didn't cause the distraction, or require the manpower, of restraining someone, which meant it could be delivered in a classroom setting while other students went about their work.

The Behavior Research Institute tested the device on 29 students over 14 months. One of them was Brandon Sanchez, the autistic nephew of state Representative Jeff Sanchez. Brandon banged his head until he cracked it open. He once chewed off part of his tongue. He was a ruminator, too: He would vomit, chew the vomit, swallow it, and vomit again. The acidity was burning his esophagus; the vomiting was causing him to lose weight. Israel thought SIBIS might be the only way to save this 12-year-old's life. Brandon was down to 52 pounds.

Israel and his staff started in with the treatments. Fifty shocks became 100; 100 became 500; 500 became 1,000, and still they shocked more. Brandon wasn't responding. So, 2,000 shocks. And then 3,000, 4,000. After roughly 5,000 shocks in one day, Israel told his staff to stop.

The shocks weren't strong enough, Israel thought. He asked SIBIS's developers to increase the voltage. They refused. And that's when Israel made his own machine.