Punishing Patients into Compliance is Not Treatment. It is Abuse.
Punishing patients into compliance is not treatment. It is abuse.
Behavioral change should not be a measure of success in pain, neurodivergence, and mental health.
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Ableism perpetuating.
The mindset that fixing someone's behavior fixes their disability perpetuates the belief that the only problem with people disabled by mental and physical pain is the disruption to their outward productivity. The pain and suffering of the patient are not a concern at all. This directly enforces the idea that the only way for a disabled life to be good is for the person to "overcome" their disability. In other words to not be dependent on other people or mobility aids, and to do something "productive."
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A thought experiment
One day at work a man comes and burns a circle on your arm. You scream, cry for help, and stop working to go get and apply ice. You go to the police for help.
The policeman says "Oh, no problem. I have helped lots of people in situations like this, they aren't bothered by these men anymore. They are back to work just like before."
It sounds great, you invite the policeman to your work the next day. He comes. When the man comes and burns you he does nothing. "Ahhh what the hell!" You scream, "Why didn't you stop him?" You get up to go get ice. The policeman pushes you back into your seat and says "It's just a small burn. Police violence is dangerous. The real problem here is you are disrupting your colleagues and not doing your work."
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The next day the policeman is there again. This time when you are burned you muffle your scream but still cry and go to get ice. He berates you for crying and holds you down in your seat.
By the end of the week, you don't cry or try to get up anymore when the man burns you. You know there is no point. Sometimes you make a small noise or tear up and the policeman reprimands you. The policeman proclaims "my work here is done."
"But the man still burns me!" You say. "But you are not bothered anymore." He counters, "your work is getting done just like before, you don't cry or yell. Problem solved. If you are still bothered and wanting to get ice I can stay another week."
What do you do?
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Possible reactions
Rebellion - You could rebel, refuse to give in to the policeman. But he will just stay and make your life miserable as long as you do. Eventually, you will probably lie just to make him leave.
Submission - The most common "success" reaction. You submit and say the treatment worked so that it will stop.
Acceptance - Some people may accept the policeman's treatment. They may have a higher pain tolerance and be able to deal with the burns. They may really appreciate keeping their job. They may be strongly against police violence.
Note that all of these reactions lead to the policeman eventually "succeeding" in "fixing" your problem.
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Reality check
This story is a metaphor:
The man burning you is chronic pain, mental illness, or the need to stim/self regulate / ticc etc.
Getting ice represents accessible coping strategies such as actual ice or heating pads, Tylenol, distractions, a hug from a friend, stimming, taking time alone, etc.
The policeman is the doctor. They could stop the man burning you (aka administer pain killers) but instead choose behavioral "treatment." Places doctors like this are often found include Applied Behavioral Analysis, Psychiatric Facilities, and Pain or Activity Rehabilitation Centers.
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Note the policeman's two excuses for not helping also have real-world analogs:
"It's just a small burn" represents gaslighting.
In reality, the sentence would be something like "it's just in your head" "don't overreact" "the pain can't hurt you" or "sitting still is easy."
"Police violence is bad" represents all-or-nothing attitudes towards pain medication.
Yes, police violence can be a bad thing, but in this case, stopping someone from actively burning someone else is good. Similarly, opioids and other pain medication can be addicting or dangerous. But if prescribed for chronic pain by a doctor they can be lifesaving.
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In reality acceptance of these programs generally rests on a few beliefs
-Persuasion by gaslighting into believing the pain / mental illness / neurodivergence is the patient's fault
-Internalized ableism prioritizing outward productivity and functionality over subjective happiness and pain relief
-A fear of prescription medication or behaviors outside the norm
-Placebo effect causes patients to legitimately experience subjective improvement
Note that people with less severe conditions or conditions more subject to the placebo effect are much more likely to respond with acceptance over rebellion or submission.
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Find a new policeman.
The real-life solution to these programs and doctors is to avoid them. To not go to them in the first place and to seek out doctors who will treat pain, mental illness, and neurodivergent by working with the patient to internally improve rather than focusing on outward behavioral changes. Note that this can still come in the form of therapy especially for mental illness and neurodivergent. This therapy will just be focused on finding better-coping skills and less disruptive outlets rather than bottling up your problems.
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Takeaways
Abusing patients into pretending they are better is extremely effective at producing the behavioral changes doctors desire. Therefore, behavioral metrics are not a good indication of whether someone's health has improved or not. Training people like dogs works, but that doesn't make it okay. Even without a direct person doing the abuse, our society pressures chronically ill and neurodivergent people to act "normal" and hide their pain and differences. Programs such as ABA, psych wards, and pain rehab clinics often just serve to push down the stubborn or severely affected patients who are not adequately subdued by society at large. These programs are ableist by default and desperately need elimination and/or reform.
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TW: Medical Abuse
Abuse is not treatment. But it is effective. That is what is most terrifying about Applied Behavioral Analysis for Autism, Psych Wards, and Pain or Activity Rehabilitation Clinics.
Punishment is a very effective motivator. We have known this for millenium. In the past mental asylums were meant to lock up and punish the mentally ill than to help them, with the added bonus of terrifying anyone from showing any outward signs of mental distress.
These mindsets that mental illness, neurodivergence, and invisible illness are problems that society needs to fix have not gone away. You see it in studies whose metrics are compliance. Where molding behavior is valued and patient experience dismissed.
It may now be unacceptable to say "we are going to force you to behave like you are normal" but it is still the common place to say "if you are a responsible patient you will do this 'therapy' to improve your 'functionality'". There may be a surface-level choice involved but the pressure to conform is the same it has always been.
The problem with punishment as treatment is it is extremely effective. Patients go back to work, they increase their activity, they start engaging with their hobbies, they make eye contact etc. But it is all a fragile balancing act being held together by stress fear and trauma. It will often fall apart again and when it does all the patient has learned is not to trust the people who try to help.
The way these programs punish varies, they may…
-Restrict freedom / imprison
-Verbally abuse
-Threaten
-Use electric shocks
-Purposefully trigger pain
-Purposefully trigger distress/panic
-Withhold medication or mobility aids
And so much more...
All of this is abuse. The result of abuse is trauma. Can that trauma sometimes look like progress? Yes. Is it? NO.
What is the answer to these programs? Awareness. Survivors speaking out. Parents standing up for their kids. But most of all the boycott and closure of these programs. These programs are not the answer and so long as they are enclosed programs that promise to "fix" everyone who goes through them they will resort to abuse.
