Can Deprivation Be Justified?

Abstract

“buy” better mental health seems to be a good bargain. One can argue that restricting such a procedure, if it is known to be effective, is the more important ethical problem. The Minnesota guidelines do not attempt to balance the nature of procedures against probable outcomes. Indeed the description in the Lucero article of “operantconditioning techniques” suggests that behavior therapy in the acceptable professional sense was not being practiced in Minnesota at all. The incorrect application of such terms as “aversive reinforcement” and “deprivation” supports this suspicion. The following items might be considered in further attempts to draft more adequate guidelines: . Behavior therapy is not a simple bag of tricks that can be used without special training. All applications of behavior therapy should be carefully supervised by a skilled professional who will be held responsible if the procedures are abused by subprofessional personnel. Most ward physicians are not qualified to develop behavior-modification programs and should not do so without additional special training or access to expert consultation or both. S The effectiveness of a behavior-therapy technique must be demonstrated. Behavior therapy, unlike most other therapeutic approaches, generally requires that behavior change be rigidly recorded throughout therapy. It is unethical to continue to apply procedures that obviously are not effective with specific individuals. The same standards must be applied to deprivation that makes positive reinforcement possible. For instance, delusional speech makes adjustment outside the hospital difficult or impossible. If food deprivation far short of a threat to the patient’s physical health is necessary to eliminate the behavior, then the ethical course of action would seem to demand that deprivation be considered. . It is unprecedented in considering professior al ethics to insist that a whole class of techniques of proved effectiveness be prohibited because the techniques can be misapplied. Yet the Minnesota reconimendations state flatly that “Deprivation is never to be used.” It is more appropriate to be concerned with abuses than with labeling a particular class of therapeutic activities undesirable. Behavior-therapy techniques should not be immune to ethical guidelines applicable to other aspects of professional practice. On the other hand, there is no ethical justification for limiting an entire therapeutic area because of misunderstanding or lack of familiarity.