Confessions of an Operant Intrusionist

Like many of my colleagues, I emerged from graduate school with a solid academic background in behavioral analysis. I had learned a great deal about the contingency management of behaviors. Upon graduation, I put all my knowledge to work, believing all my strategies were innovative as I put my abilities to the test in working with persons with intellectual disabilities.

Having spent a significant portion of my professional life training crisis teams to “control” outbursts of aggression; designing time-out rooms that met the technical requirements of state licensure and Medicaid standards; refining techniques for “take downs” and “basket holds”; and writing behavior “management” plans that used four staff persons to conduct an overcorrection procedure of two-hour duration, I now look back with a great deal of sadness and regret. I was doing what I was trained to do, doing what was state of the art at the time. I did not know better. In the “institutions” where I worked, I was surrounded  by men and women engaged for endless hours in self-injurious behavior, lying on bare terrazzo floors in their own excrement.

I saw untold numbers of people injured by the aggressive behaviors of their peers, behaviors that were allowed to go unchecked for whatever reason. By doing something that would prevent self-injury, aggression and property damage, I had the opportunity to show that I cared for each of these individuals.

Like many others, what I failed to understand at that time was that my response to the inappropriate behaviors became, at the very least, a contributor to the maintenance of that very behavior. In some cases, my “intervention” may have been the primary cause. It was a vicious circle.

I was dealing with men and women who lived in stark and barren environments, persons who were denied even the basic opportunities for choice and decision-making. Neither I nor other staff ever asked them whom they would like to have assist them in their most private moments of being bathed or assisted with their toileting functions.

We did not seek to know what foods a person preferred. Rather, we as clinicians were satisfied that the food placed before the group met their nutritional requirements as assessed by the dietician.

The persons with whom they shared the ward or residence were “placed” there. We did not think to ask, “Would you like this person as your housemate?”

Schedules of reinforcement were designed and applied by behaviorists like myself to control those behaviors that we thought undesirable. Furniture was purchased, clothes provided, activities scheduled, and so on–all without the input and involvement of the person affected.

Many of the places in which I delivered my professional services had the air of displaced persons camps. No one seemed to be “at home.” Everyone was in transit, awaiting an opportunity to move to a new place, a new home, a new life.

Looking back, it should have been obvious that a person residing in an environment that denies all opportunity for choice and control lives a life of anomie. This means: “If my life has no value, if my life has no meaning, I will behave in a way to cause your life not to have meaning or value either.” The person living in anomie has “no name” and “no law,” as the term indicates. He is not likely to care about me or my professional concerns, or even my futile attempts to show him that I am acting out of a sense of compassion and obligation.

Anomie is not, by any means, a phenomenon restricted to environments where persons with intellectual disabilities live. We saw anomie in Los Angeles, in the early summer of 1992. We saw a crowded community in which men and women felt they had no control over their lives, no power to make decisions that would influence their destiny. Those citizens, suffering the day-to-day life of urban anomie, behaved in ways to cause the lives of others to have no meaning or value–buildings were burned and looted, violence and rioting flared.

The men and women served in those big state facilities, as well as those who “moved up” to small, scattered site group homes, did not burn our buildings or rob us of our belongings. They did, however, demonstrate behaviors that caused the lives of the people around them to diminish in value. The anomie they suffered took its toll on everyone–a great toll.

I now think about all the effort expended in an attempt to control the behavior of others, when what was really needed was an opportunity–many opportunities–for those individuals to control their own destinies, to have a say-so, to have a life!

Ironcially, the “treatment” caused the disease. The “therapeutic” environment–with its schedules, menus, assignments, programs, structure and anormalized rhythms–caused the very behaviors that I was so fervently trying to eliminate. In hospital parlance, “nosocomial infections” are those illnesses that are contracted in the hospital. A woman may enter the hospital for removal of her appendix and come out with a serious staph infection. The disease is caused by the treatment environment. Likewise, nosocomial behaviors emanate from the intended habilitative environment.

Aggression, stereotypical behaviors, self- injury and property destruction are not symptomatic of an intellectual disability. These behaviors are a person’s response to an insensitive and controlling environment an attempt to communicate unmet needs, especially the need to have a say-so.

What then, as a behaviorist, is my response to all this? I spent several years developing a systematic approach that can be shared with others to support appropriate behaviors in persons we serve and support. The approach is called “Universal Enhancement.” Simply stated, it says that people who have the opportunity to develop significant and valued relationships in their lives are more likely to increase their potential to have meaningful and valued lives. It says that people who have the opportunity to engage in preferred and meaningful activities with those valued others–choir, bike riding, work, walking, cooking, and so on–increase their opportunity to be free from anomie.

The goal of Universal Enhancement is to increase the opportunities to have valued relationships and personal belongings and the opportunity to make choices in one’s life, thus precluding anomie and preventing the nosocomial behaviors I worked so hard to “man- age” and “control.” Even more exciting is the power of Universal Enhancement to help a person have a life. Expressions of anger are often communications of unmet needs. People want to have a life. As a result of my struggle with those I was attempting to “habilitate,” I think I now understand.

The application of Universal Enhancement is not easy; it is a life- long effort. It requires creativity and, most importantly, a belief that the men and women whom we support, regardless of their capabilities, can, with the provision of appropriate supports, participate as full members of our shared community. It is that participation that pro- motes the opportunity to develop meaningful relationships with others and enhances the lives of all people, regardless of IQ, disability, age, race, religion or status in life.

The words and ideas of a number of my colleagues appear in this book. In some Tales and other passages, language that may be considered inappropriate today has been left unchanged in order to maintain the integrity of that person’s original writing. The basic messages contained in those sections remain timeless and significant.