Last night (Dec. 2, 1994), I watched a news report about a new therapy for people with "psychological problems." The therapists interviewed seemed to have no idea what they were doing; nevertheless, they "knew" they were helping their patients. This particular therapy has a fancy name but in short it involves making the patient move his or her eyes back and forth, hither and thither, while concentrating on their problem. The therapist waves a stick in front of the patient and the patient is supposed to follow the moving stick with his or her eyes. Testimonials from satisfied customers were reported. For example, a patient who had not been able to sleep for more than three hours at a stretch since her service during the Gulf War testified that the therapy cured her: now she can sleep through the night.
One therapist offered the suggestion that the rapid eye movements sent signals to the brain which somehow tamed and controlled the naughty part of the brain which had been causing the psychological problems. The television station provided a nice visual of a cut-away head with sparks flying in the brain. Finally, the anchorman warned us not to try this at home, that only licensed mental health professionals were qualified to give this kind of therapy. Of course, the person who developed the therapy is rich now. She's sold her method to others who are doing the same in turn, training more therapists.
[Note: a reader has notified me that this therapy is known as "E.M.D.R, which stands for Eye Movement Desensitisation and Reprocessing. (Trust me, I'm a psychologist!). This therapy, according to the advertisements for it, requires special 'supervised training for full therapeutic effectiveness and client safety.' Apparently if you do the course, you have to sign some paper undertaking not to teach others how to do it." David Willshire.]
How many times has this story been repeated? And how many times has a critical investigation of these stories of miracle therapies yielded the same results: the evidence for the therapy consists entirely of anecdotes, and uncontrolled or poorly controlled observations. All feed upon human misery and hope. Yet, many are started and advocated by basically decent people with a genuine desire to help others and a genuine belief that they are making a great contribution to the alleviation of human misery. They know so because they see successes every day. They see patients able to do things they could not do before therapy. They see the hope in the eyes of parents who bring their children in for help. Skeptics and critics are evil ones, trying to deprive the world of truth and goodness and light. When controlled experiments are done which fail to validate the claims for the new therapy, the ad hoc hypotheses pour forth faster than the cures. The independent investigators were "hostile," or the patients couldn't demonstrate their newfound powers and abilities because testing made them too nervous to perform. Such has been the case again and again and such is the case with facilitated communication (FC).
What is facilitated communication? Here is a description of FCT (facilitated communication training) given by several of its defenders:
Facilitated communication training is an educational technique intended to allow people who cannot speak or sign to access communication devices. One person (the facilitator) provides support to the arm, wrist or hand of another person who is thus enabled to control their pointing sufficiently to point to pictures, words or letters.Who would need such assistance? People who cannot speak or whose speech is highly limited and who cannot point reliably, including the mentally retarded, the autistic, and those with cerebral palsy.
The center for FC is Syracuse University, which houses the Facilitated Communication Institute in their School of Education. The FC Institute was established in 1992, and it conducts research, provides training to teach people to become facilitators, hosts seminars and conferences, publishes a quarterly newsletter and produces and sells materials promoting FC, including a six-part video series for $50/video ($250 for the series). The FCI even maintains a gopher site on the internet.
There have been numerous critics of FC, including Gina Green, Ph.D. (Director of Research at the New England Center for Autism, Southboro, Massachusetts, and Associate Scientist at the E.K. Shriver Center, Waltham, Massachusetts) and Howard C. Shane, Ph.D. (Director of the Communication Enhancement Center, Department of Otolaryngology and Communication Disorders at Children's Hospital, Boston, and Associate Professor of Otolaryngology in the Harvard Medical School.) A very damaging, detailed criticism was presented on PBS's "Frontline", October 19, 1993.
Despite the criticism and the numerous experiments demonstrating that the messages, poems, brilliant discourses, etc., being transmitted by the facilitators originate in the facilitators themselves, the FCI is going strong, as are plans for its fourth major conference in May of 1995. The theme of the conference will be on new developments in facilitated communication.
With support groups all over the world and a respectable place at a respectable university, there is little chance that FC will soon fade away. Those within the FC movement are convinced FC "works." Skeptics think the evidence is in and FC is a delusion for the most part. It is also a dangerous delusion. Critics have noted a similarity between FC therapy and trauma-search therapy: patients were accusing their parents and others of having sexually abused them. With trauma-search therapy the evidence emerges when a "repressed memory" is brought to light or when a child is interrogated by therapists trained to treat sexually abused children. There is overwhelming evidence that many repressed memories of sexual abuse, as well as many "memories" of interrogated children originate in the minds and words of therapists who suggest and otherwise plant them in their patients' minds. Similar findings have been made with FC: facilitators report sexual abuse and their messages have been used to falsely charge parents and others with sexual abuse of mentally and physically handicapped persons.
The criticisms of FC as another therapy leading to a witch hunt, turning decent parents into accused molesters of their handicapped children are not without justification. How is one to defend oneself against an allegation made by someone who can never be interrogated directly? An accuser can only deal with the facilitator (or two facilitators). 1 If there were evidence that facilitators were usually reporting the thoughts of their clients, there would still be concern for insuring the rights of the accused were not abused. But as the evidence is overwhelming that in most cases of FC, the facilitator is reporting his or her own thoughts, the effort to insure against false accusations should be enormous. Yet, those in the forefront of the movement indicate how trivial they take the problem to be when they focus on problems of ambiguity. Here is a warning issued to facilitators:
Facilitated communication is never as fast or as fluent as normal speech. Messages tend to be short, even telegraphic, and may omit grammatical bridges. It is not always clear what message the person is trying to get across with the words he or she has spelt out.It is likely that if most of the facilitators kept reporting sexual abuses this movement would probably have gotten nowhere. The grieving, hopeful parents would never put up with such garbage. But since most of the facilitators do not report abuses, but rather recite poems, carry on high level intellectual conversations, or simply communicate, parents are grateful to discover that their child is not hopelessly retarded but is either normal or above normal in intelligence. FC allows their children to demonstrate their intelligence; it provides them with a vehicle heretofore denied them. But is it really their child who is communicating?The message may be incomplete;
One person spelt out MY FATHER IS FUCKING ME - clear enough,you would think, if the facilitator hadn't carried on to get MY FATHER IS FUCKING ME AROUND.
The message may be telegraphic;
One person spelt MY FATHER FUCKING CUNT and meant MY FATHER IS A FUCKING CUNT
The message may be inherently ambiguous;
One person spelt MOMSEXBOYFRIENDME, which can be read either MOM SEX BOY FRIEND ME or MOMS EX-BOYFRIEND ME. These are different messages (and neither of them is clear).
The letters or words chosen may not be those that the student really intended. 2
When facilitators have been tested under controlled conditions (where others besides the defenders of FC have set up the experiments), they fail miserably. When a discipline can only get good results when believers do the experiments and bad results when non-believers do, then it seems reasonable to believe that there is something incompetent about the experiments of the believers. The Frontline program, for example, showed facilitators allegedly describing what their clients were viewing, when it was clear their clients' heads were tilted so far back they couldn't have been viewing anything but the ceiling. When facilitators could not see an object which their client could see (a solid screen blocked each from seeing what the other was seeing) they routinely typed out the wrong answer.
What about the testimonials? The letters from clients who are grateful to FC for allowing them to show to the world that they are not retarded or stupid? Are they fakes? Maybe. They may, however, be from people who have been genuinely helped by FC. It seems that the FCI treats the retarded, autistic and those with cerebral palsy. I have had several students with cerebral palsy. As students, they have been no better and no worse than most of my other students. They have used assistants who helped translate their communication for me. Usually, the student had a card (with letters or words or pictures) on his or her lap. The student would point to letters or words and sometimes speak; the assistant would translate for me. Anyone familiar with Helen Keller, Stephen Hawking or Christy Brown knows that cerebral palsy does not affect the intellect and that there is no necessary connection between a physical handicap and a mental handicap. We also know that such people often require an assistant to facilitate their communication. But what such people do to help the likes of a Hawking or a Brown is a far cry from what those in the facilitated communication business are doing.
It may well be that some of those helped by FC suffer from cerebral palsy and are mentally normal or gifted. Their facilitators help them communicate their thoughts. But the vast majority of FC clients apparently are mentally retarded, diagnosed as being autistic. Their facilitators appear to be reporting their own thoughts, not their patient's thoughts. What is shocking is that when the facilitators discover that they are not really communicating their patient's thoughts, the facilitators are genuinely shocked. They are similar to others with "special powers" who, when tested under controlled conditions, find they don't have any special powers at all (James Randi's tests of psychics and dowsers come to mind).
If FC worked one would think that it would be easy to test by letting several different facilitators be tested with the same client under a variety of controlled conditions. If different "personalities" emerged, depending on the facilitator, that would indicate that the facilitator is controlling the communication. But, believers in FC claim that it only works when a special bond has been established between facilitator and patient. It is interesting that the parents and other loved ones who have been bonding with the patient for years are unable to be facilitators with their own children. FC needs a kind stranger to work. And when the kind strangers and their patients are put to the test, they fail. But that is because the conditions made them nervous. These ad hoc excuses sound familiar; they sound like the cries of psi experimenters.
How can one be sure that when one of the kind strangers starts typing things she is not typing her own thoughts, consciously or unconsciously? I don't think you can. In most cases, it probably doesn't matter. What does it matter if someone who has never read a book or had a book read to him starts writing Shakespearean sonnets? Where's the harm? What does it matter if someone who has never learned to read or write can suddenly write publishable essays? Where's the harm? What does it matter if someone you love and have cared for since birth suddenly accuses you of doing unspeakable things he or she couldn't possibly even understand? There's the harm, the unspeakable harm.
reader comments
Love your home page. . . the Skeptic's Dictionary. . .SavvySearch.
I am a psychologist in NY. Graduate of SUNY Buffalo. I've become more skeptical over the years. I always used to enjoy Mark Crystal, James Randi and others debunking persons with claimed psi powers in the next lab.
I co-ordinate psychologists who work with the mentally retarded. I am in a battle trying bring some sanity to the apostles of Facilitated Communication, and other crazy fads....I often don't feel I am articulate or persuasive enough. At the same time, I keep trying to come up with treatments that can be empirically validated, primarily behavioral.
Interestingly, the psychologists I work with are the most skeptical and resourceful clinicians working at the agency.
The power of these people is scary.
Keep up the good work. . .
2 Oct 1996
You said of Facilitated Communication: "When facilitators have been tested under controlled conditions they fail miserably."
See Michael J. Salomon Weiss, Sheldon H. Wagner, and Margaret L. Bauman, "A Validated Case Study of Facilitated Communication," Mental Retardation Vol. 34, No. 4, 220-230, August 1996.
Extract: "The experimenter in the protocol (the first author) had been a consultant for Kenny's school program for approximately one year prior to Kenny's introduction to facilitated communication. It is noteworthy that the experimenter was originally quite skeptical about facilitated communication, as can be seen from the following newspaper account: Michael Weiss, a clinical psychologist who has worked with developmentally disabled children in New Bedford, is also concerned [about facilitated communication]. "There's a rich tradition in how we judge whether something is true.... It gets reviewed by peers and has to pass a certain standard," he said. "What I'm unnerved about with the facilitated communication people is that there's almost a refusal to adhere to this standard." Asked why he thinks Dr. Biklen and company won't do such studies, Dr. Weiss replied, "What rings true in my ears is that the thing is a bloody hoax. (Experimental technique, 1992)" Weiss then went on to test it, did a study, and got positive results.
" Abstract: The case of a 13-year-old boy with autism, severe mental retardation, and a seizure disorder who was able to demonstrate valid facilitated communication was described. In three independent trials, short stories were presented to him, followed by validation test procedures with an uninformed facilitator providing physical support to the subject's arm. In Trials 1 and 3, several specific answers were provided that clearly indicated that the young man, not the uninformed facilitator, was the source of the information. Moreover, some responses seemed to imply that the subject was employing simple inferential and abstract reasoning. This case study adds to the small, but growing number of demonstrations that facilitated communication can sometimes be a valid method for at least some individuals with developmental disabilities."
There's also a larger study in the same issue of Mental Retardation, also recording positive findings.
Well; does that count as an instance of a facilitator tested under controlled conditions (*where others beside the defenders of FC have set up the experiments*) who did not fail miserably? If not, what would? If so, does that open a crack to make the arguments?
The basic point I'm trying to get across is that yes, if you put forward a proposition that goes against the accepted laws of physics then you're probably wrong. However, if you put forward a proposition that goes against the accepted laws of psychology you'd have to write them first.
Remember, we are talking about people who refer to FC as "...an inappropriate challenge to professional belief systems.." (Howard Shane). And those professional belief systems are pretty rigid. If you're not a member of one of those professions, FC doesn't sound particularly out of line.
Here's one basic starter, from Australia.
"A Rationale for the Use of Facilitated Communication Training
1. Many people with severe communication impairment (SCI) know more words than they are able to say.2 People with SCI who know more words than they are able to say may be able to expand their expressive communication by using alternative and augmentative communication (AAC) strategies.
3. Many people with SCI have hand function impairments which affect their ability to write or use manual sign or make selections from communication displays.
4. Some people with SCI and impaired hand function can use AAC equipment which does not require hand skills to expand their expressive communication. Some people with SCI and impaired hand function cannot use such equipment, either for practical reasons (because they walk, for example, and need less bulky devices) or because of the nature of their neuromotor impairments (because, for example, they have impulsivity).
5. People with SCI and hand function impairments who cannot use other AAC strategies may be able to use their hands to access communication aids if their hand function impairments are remedied either temporarily or permanently.
6 For some people with SCI, facilitation can provide a temporary remedy for hand function impairments affecting communication aid use, and when used as part of a structured teaching program may result in a permanent improvement in hand function."
Not exactly witchcraft.
Chris Borthwick
reply: No, not witchcraft. I don't deny that many people are helped by facilitators. I mentioned above that I have had students who use facilitators. I also noted that it is well-known that there is no necessary connection between a physical handicap and mental ability. It is not my intention to suggest a priori that no research in this area will prove fruitful. I think, however, that this is an area where self-deception and wishful thinking can be especially invasive.What parent would not want their child to be "normal?" I believe it is imperative that those doing research in this area propose a testable theory of FC. Someone needs to address the issue of how FC occurs, especially since it seems that physical communication between patient and facilitator cannot be happening in many "documented" cases of FC. It is not enough for science to provide a few case histories, or even a grand study indicating statistical improbability of chance explaining away one's therapeutic successes. An explanatory mechanism is needed. Until then, FC studies may not be witchcraft, but they cannot be considered much more scientific than, say, testimonials regarding golf aids or weight reducing programs.
further reading
Green, Gina, "Facilitated Communication: Mental Miracle or Sleight of Hand?"
If with a second facilitator the message is confirmed in detail then it may be taken as confirmed that an allegation has been made." Disclosures of Abuse through Facilitated Communication: Getting and Giving Support," Missy Morton, Facilitated Communication Institute Syracuse University Division of Special Education and Rehabilitation, May 1992.