Robert Todd Carroll
Facilitated Communication (FC)
Facilitated Communication (FC) is a technique which allegedly allows communication by those who were previously unable to communicate by speech or signs due to autism, mental retardation, brain damage, or such diseases as cerebral palsy. The technique involves a facilitator who places her hand over that of the patient's hand, arm or wrist, which is placed on a board or keyboard with letters, words or pictures. The patient is allegedly able to communicate through his or her hand to the hand of the facilitator which then is guided to a letter, word or picture, spelling out words or expressing complete thoughts. Through their facilitators, previously mute patients 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? Most skeptics believe that the only one doing the communication is the facilitator. The American Psychological Association has issued a position paper on FC, stating that "Studies have repeatedly demonstrated that facilitated communication is not a scientifically valid technique for individuals with autism or mental retardation" and describing FC as "a controversial and unproved communicative procedure with no scientifically demonstrated support for its efficacy."
Facilitated Communication therapy began in Australia with Rosemary Crossley. The center for FC in the United States is Syracuse University, which houses the Facilitated Communication Institute (FCI) in their School of Education. The FC Institute was established in 1992. 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 per video ($250 for the series).
While several studies have indicated that facilitated communication does tap into the mind of a person who heretofore had been incommunicado, most studies have shown that facilitated communication only taps into the beliefs and expectations of the facilitator. Many control studies have failed to produce strong evidence that facilitated communication works. Defenders of FC routinely criticize as insignificant or malicious those studies that fail to validate FC. Yet, it is unlikely that there is a massive conspiracy on the part of all those who have done research on this topic and have failed to arrive at findings agreeable to the FCI.
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. The program was repeated December 17, 1996, and added that since the first showing, Syracuse University has claimed to have done three studies which verify the reality and effectiveness of FC, while thirty other studies done elsewhere have concluded just the opposite.
The Frontline program 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. Furthermore, FC clients routinely use a flat board or keyboard, over which the facilitator holds their pointing finger. Even the most expert typist could not routinely hit correct letters without some reference as a starting point. (Try looking away from your keyboard and typing a sentence using just one finger held in the air above the keyboard.) Facilitators routinely look at the keyboard; clients do not. The messages' basic coherence indicates that they most probably are produced by someone who is looking at the keyboard.
Nevertheless, there are many testimonials supporting FC, namely, letters from clients who are grateful to FC for allowing them to show to the world that they are not retarded or stupid. Some of them may 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 blindness, deafness, cerebral palsy, multiple sclerosis, amyotrophic lateral sclerosis (ALS), or physical or neurological disorders, do not necessarily affect the intellect. 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 facilitators 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. Interestingly, the facilitators are genuinely shocked when they discover that they are not really communicating their patient's thoughts. Their reaction is similar to that of dowsers and others with "special powers" who, when tested under controlled conditions, find they don't have any special powers at all.
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 generally fail. We are told that is because the conditions made them nervous. These ad hoc excuses sound familiar; they sound like the complaints of parapsychologists.
Despite much criticism and many experiments demonstrating that the messages, poems, brilliant discourses, etc., being transmitted by the facilitators originate in the facilitators themselves, the FC Institute is going strong. 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 repressed memory therapy: patients are accusing their parents and others of having sexually abused them. Facilitators are taught that something like 13% of their clients have been sexually abused. This information may unconsciously influence their work. The facilitator cannot imagine that he/she is the source of the horrible charges being expressed. Neither can school administrators or law enforcement authorities who believe FC is a magical way to tap into the thoughts of the autistic or the severely retarded. With repressed memory 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? Missy Morton, an expert from the FC Institute suggests the following:
If there were evidence that facilitators were usually reporting the thoughts of their clients, there would still be concern for ensuring that 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 ensure 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 Ms. Morton's warning issued to facilitators:
This way of dealing with ambiguous communication seems hopelessly inadequate. What is needed is some way to prevent facilitators from unjustly accusing parents of heinous acts against their children. It is likely that if most of the facilitators kept reporting sexual abuses, this movement would have gotten nowhere. The grieving, hopeful parents would never put up with such abuse.
Gorman, Brian J. "Facilitated Communication in America: Eight Years and Counting," in Skeptic, vol. 6 no. 3, 1998.
Robert Todd Carroll