Interview with Ron Garrison on Restraint and Seclusion

Today’s guest author is Emma Van der Klift. Emma is a neurodivergent speaker, author and activist. Diagnosed as Autistic as an adult, she has embraced the diagnosis with a sense of relief, recognition and confirmation. Like many other autistic girls and women, she did not recognize her experience as represented in the common societal narratives. Emma believes that her experiences as a so-called “disruptive student” gives her a unique perspective on the issue. Emma holds a Master’s degree in Conflict Analysis and Management from Royal Roads University and is certified as a mediator and negotiator through the Justice Institute in Vancouver.


We are sharing an interview from Emma Van der Klift’s book Talk to Me: what educators (and others) can learn about de-escalation from hostage negotiators,” a must read on the subject of restraint and seclusion.  

The following is the partial transcript of an interview with Ron Garrison in early 2018. Mr. Garrison is a retired educator with experience at all levels of the educational sector. He holds a master’s degree in school safety and has been an expert witness in more than eighty-five cases involving restraint and seclusion.

Question: Ron, can you give us a brief recap of your legal work and, specifically, your expertise about restraint and seclusion?

Ron: Sure. I was a student intern at Napa State Hospital in 1968 and a special education teacher through the 1970s. During the 1980s and 1990s, I worked for an American federal government organization that focused on institutional safety and security. After some time and a lack of continuing grant funding, this profession morphed into private practice, and I became an expert witness in civil litigation. At the end of my career, I had rendered expert legal opinions in eighty-five lawsuits throughout the United States.

Question: Are you a lawyer? How did this work relate to our topic here today on restraint and seclusion?

Ron: I am not an attorney but an expert witness lawyers rely on in court to support their cases. Some of those eighty-five lawsuits involved my expert opinions that assisted injured party plaintiffs with their litigation, and some of those cases involved restraint and seclusion.

Question: So before we get into the details, what did you learn from your experiences as an expert witness regarding restraint and seclusion?

Ron: Simply put, when many educators, support workers, or family members are in a situation where an individual has become aggressive, self-injurious, or even what is sometimes called noncompliant, they feel like they need to control the situation. They don’t know what to do, so they resort to coercive tactics like restraint and seclusion. Although this seems to solve the problem in the short term, in the long term, it actually makes the problem far worse. I believe that using restraint and seclusion is a form of torture.

Question: OK, let’s begin by exploring the connection between torture, restraint, and seclusion. To do this, I want to play the devil’s advocate and put forth some of the arguments that are often used to justify the use of seclusion and restraint. For example, many people believe certain forms of torture may be necessary at times—for example, in times of war or civil unrest. Are these approaches effective?

Ron: One would think so from all of the ideas and images our society is exposed to, both in fictional and nonfictional media representations. But in my opinion, and in the opinion of many others, torture is never useful, nor is it effective. Consider just one modern example, Abu Ghraib. Not only were the techniques used at Abu Ghraib overwhelmingly condemned as unethical, cruel, and inhumane, but also they didn’t work!

These strategies are supposedly used to cause pain and humiliation as a way to change behaviour, but it’s also vital to recognize that restraint and seclusion are essentially torture as well. So whether restraint and seclusion are used during wartime or in a so-called therapeutic context, restraint is still restraint and seclusion is still seclusion. If it is deemed to be torture in one context, you cannot claim that it is a therapeutic intervention just because you’re trying to use it in a different context.

Question: You just talked about nonfictional media representations. Can you give us some examples of the fictional representations you mentioned?

Ron: Popular media from A Clockwork Orange to Star Wars to Orange Is the New Black show a variety of torture and coercive techniques as major plot devices in their stories. These torturous practices include shock, deprivation, “force” lighting, and chemical restraints, among others, and are used in various ways to dramatically capture the attention of the viewers. Unfortunately, when people watch movies and TV, they can come to believe that these aversive and coercive techniques are effective in gaining control over a person or situation and should be used in some circumstances—except, of course, on ourselves!

Question: I get that watching restraint and seclusion in movies and on TV can lead a person to believe these techniques are effective. But when you’re in court, how do you go about convincing the same juries that may have seen these films and been led to believe this is the best way to respond to crisis situations that restraint and seclusion are ineffective and harmful?

Ron: Simply by changing perceptions through the use of evidence. As I said before, restraint and seclusion are often used as torture techniques, and they’re still being used even though it has been conclusively shown that they’re ineffective and harmful.

They are harmful not only to the person being tortured but also to the person doing the torturing. Darius Rejali writes in his book Torture and Democracy that, “organizational torture yields poor information, sweeps up many innocents, degrades organizational capabilities and destroys interrogators.” We know that watching abuse also affects bystanders.

Question: How does watching abuse affect bystanders?

Ron: There are many studies I can cite: Gregory Janson and Richard Hazler found that repetitive abuse affects bystanders and victims in similarly serious ways at the time the events occur and also later in life. In this context, Darius Rejali describes how a torturer’s work apparently never ends. “Memories of applying pain to others tick like a time bomb,” Rejali says. In their book Violence Workers, Huggins and Zimbardo write, “Torturers suffer from insomnia, hyper-sensitivity, nervousness, emotional problems, alcoholism and potential suicidal behavior.” And in another study by Hazler, this time with JoLynn Carney, their conclusions suggest that for bystanders who witness abuse and bullying, stress, trauma, PTSD, damaged relationships, and social mistrust inevitably follow.

When you actually look at the empirical and qualitative evidence about the outcomes of restraint and seclusion, it’s clear that these interventions do not achieve any desired behavioural or therapeutic goals. In fact, restraint and seclusion do just the opposite and can lead to deadly consequences.

As an expert witness, I wrote opinions and testified in court in front of juries, arguing that there is a causal link between torture, restraint, and seclusion. Those opinions, of course, were based on fact-based studies like the New York Psychological Association’s Task Force. They found, for example, that some of the techniques described as “aversive behavioral interventions” not only constitute corporal punishment but also are included in literature on torture.

Question: I know you have done research looking at the effects of restraint and seclusion on the human brain. Can you talk about this?

Ron: Apart from causing significant emotional pain and trauma, experiencing restraint and seclusion damages the person’s brain. You see, when we use restraint, seclusion, or other forms of aversive interventions, we flood that person’s brain with powerful stress hormones.

Some people assume that using coercion or threatening punishments and pain will create so much stress in the person that they will comply with whatever is being demanded of them. It is also assumed that those stress hormones will go away once the punishment ends and that there will be no lasting neurological damage to the person. This simply isn’t true. The stress hormones that flood the brain are extremely powerful and cause long-term brain injury. Dr. Shane O’Mara at Trinity College, Dublin, finds in his research that these stressors substantially compromise memory, mood, and cognitive function.

It’s important to note that this is true not only for the one being punished but also for the one doing the punishing, and to the bystanders as well, albeit to a lesser degree.

Question: But couldn’t it be argued that this neurological damage is simply the result of the overuse of such methods?

Ron: No. Any time we use these strategies, trust and relationships are undermined, and damage occurs. And there’s another complicating factor. Unfortunately, it is widely assumed that the people who administer restraint and seclusion will be trained to know when to stop, assess, and calibrate what they are doing, and to come from a supportive therapeutic mind-set.

We presume that the staff will be sensitive, calm, and supportive and work in accord with any agency protocols. However, in the vast majority of cases, this simply isn’t true. In the cases that I’ve testified in, most of the educators and staff that have restrained or secluded individuals have reported being angry, panicked, and in a state of extreme stress.

I’ve studied the research extensively, and it is accurate to say that restraint and seclusion are very rarely done in a calm and thoughtful way; it is almost always an angry, knee-jerk reaction that comes out of the educator’s or staff person’s panic and loss of control. To say this another way, restraint and seclusion are rarely simply interventions; they are almost always part of a fight.

Question: Given the brain research you’ve been quoting here, I’m going to assume that even if restraint and seclusion were used with calmness, that wouldn’t really change the physiological outcomes. Would that be fair to say?

Ron: Yes, and that’s also a fair criticism of programs that teach practitioners and educators how to physically restrain individuals. Quality preventative care is rarely addressed by restraint intervention programs because emergency restraint often becomes physical abuse and a fight for control where calmness and reasoned judgment are nearly impossible to achieve.

Question: So, to summarize what you’ve said up to now: Restraint and seclusion can be understood as forms of torture many of us have learned from movies and TV that restraint and seclusion are effective ways of gaining control of a difficult situation these approaches do permanent neurological damage, and they’re often expressions of panic and hostility. Is there anything else you’d like to add to the list?

Ron: Yes. Restraint, seclusion, and other aversive techniques are not only wrong and harmful but also completely ineffective at bringing about any positive outcomes. Restraint and seclusion don’t teach; they traumatize. They depersonalize the individual being secluded or restrained as well as the person doing the restraint or seclusion. They typically compromise neural functioning, impair memory, modify mood, and often produce both psychological and physical damage. All of these effects make learning virtually impossible.

But in addition to being wrong, harmful, and ineffective, restraint and seclusion are also incredibly dangerous. I worked as an expert witness on several legal cases involving the deaths of individuals who were restrained by staff.

Question: There is ample evidence that restraint and seclusion programs are harmful and abusive, yet I know sometimes people choose to ignore the research and the experts.

Ron: That’s correct. In the legal world, if you’ve been given notice either through precedent or prior knowledge, and choose to ignore that notice, a lawsuit can get very expensive for both the individual and the institution. I learned over the course of my career that being an expert witness for a court action had much more of an impact on individual and institutional change than merely being a consultant.

Question: We know these approaches don’t work and are harmful. Are there examples of more effective ways to work with people who may be endangering themselves or others?

Ron: Our mutual friend Herb Lovett gave an interview for the Minnesota Disability Law Center where he told the story of a young man who broke glass by going through windows until one day a staff member asked him a question no one else had thought to ask: “Why do you go through windows?”

He said he didn’t know why he did it, but breaking glass was important to him. Staff encouraged him to find his own solution to the problem, and he came up with the idea of taking jelly jars, wrapping them up in newspaper, putting them in a paper bag, and stomping on them. He continued to break glass but did so safely.

Instead of staff wrestling with him and trying to physically prevent him from breaking glass, the resolution to the issue was to ask him about the meaning of his actions, then ask him to explore solutions that didn’t humiliate him or result in harm.

So the takeaway here for staff and educators is this. You might ask yourself, “What do I really want to accomplish here?” Then ask the client or student to help you figure it out. We don’t do that often enough. Most of the decisions about interventions are made without the participation of the individual involved. Herb points out that when we ask people and listen closely to their responses, the solutions often become apparent. It isn’t always words we’re listening to. Many people who don’t speak find other ways to communicate with us, and we simply need to slow down and notice what they’re trying to tell us.

Question: Why do you think we don’t ask or listen to people?

Ron: Unfortunately, in today’s world, what we want are “140 character” responses, relationships, and schemes to get the job done quickly so we can move onto some other task.

Question: OK. Are there other alternatives to restraint and seclusion? I’m sure in your legal opinions you had to mention other options and choices.

Ron: Sure, over the years there have been many respectful and effective alternatives to restraint and seclusion. But what’s important to remember here is that there are often multiple reasons why people become noncompliant, aggressive, or self-injurious. These are the things we need to spend more time exploring.

For example, activist Amythest Schaber, on her YouTube channel “Ask an Autistic,” talks about how sensory overload, anxiety, and general life stress led her to engage in self-injurious behavior. Ruth Siegfried talks about how it was vital for staff to give a man they were supporting an exceptionally big boundary when working with him (see Chapter 9).

Many people working in the area of trauma-informed support like Dave Hingsburger from Ontario, Ruth Meyers from Minnesota, and Karyn Harvey from Baltimore talk about how the effects of trauma or PTSD can lead to aggressive or self-injurious behaviour. So it’s vital that we try to figure out what is leading to that behaviour before we decide on the best way to support that person. Otherwise, we end up following a one-size-fits-all approach to behavioural support.

Question: What can educators do to be proactive in the way they support people?

Ron: Educators and support staff need to take the time to ask the person about their own stories. “Who are the people you really like to see?” “What makes you happy?” “What makes you angry?” Answers to these questions can yield extraordinary insights like, “I miss my brother,” “I like to go outside,” or “I don’t like to be bossed around.”

Question: In your experience, what should educators and support staff be thinking about as they are supporting someone?

Ron: When we look at alternatives to restraints and seclusion, it’s absolutely vital that we look at what we do before the situation erupts. We need to pay attention to three things:

  • We need to help a person feel safe.
  • We need to develop a trusting relationship with them.
  • We need to give them as much control over their own lives as possible.

If we focus on these three things, then it’s far less likely that we’ll be in a situation where we’re tempted to use restraint or seclusion. In order to do this, we need to take the time to talk to and get to know the student. In addition, we need to take the wishes and concerns of the individuals seriously. But above all, we have to remember that restraint and seclusion are not legitimate interventions; they are forms of torture. They specifically destroy what you need to be building up: safety, trusting relationships, and autonomy. Aversive and coercive interventions like torture, restraint, and seclusion destroy one or more of those important needs.

Question: Any concluding thoughts?

Ron: Historically, we have done a terrible job listening to those we serve. Restraint and seclusion are not about listening or caring; they’re about power and convenience.

I want to sneak in a favorite quote from astrophysicist Ethan Siegel. “Physics has shown us time and time again that our human views of what’s logically consistent or preferred are terrible guides to understanding the Universe. Better to ask the Universe itself, and listen to the answers it gives us, no matter how counterintuitive they may be.”

I bet you never thought there could be so much overlap between astrophysics and personal support!


Talk to Me: what educators (and others) can learn about de-escalation from hostage negotiators” is available on Amazon.

Authors

Categories People, Restraint, Seclusion
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