Rebirthing therapy, a controversial treatment for reactive detachment disorder, has been banned in the US state of Colorado one year after it resulted in the death of a 10 year old girl.
Candace Newmaker died during a 70 minute session in which she was wrapped from head to toe and surrounded by pillows. Despite the girl's cries that she was suffocating, the therapists continued to push her in an attempt to simulate uterine contractions. The episode had been videotaped and was used in court against the therapists, who were convicted of reckless child abuse resulting in death and sentenced to 16-48 years' imprisonment.
The law, known as Candace's law, was signed by Colorado governor Bill Owens last week.
Candace had been diagnosed with reactive detachment disorder, a psychiatric illness thought to be caused by the failure of normal bonding with a parent or care giver during infancy. The disorder shares some features with post-traumatic stress disorder and borderline personality disorder. People at risk include adopted children and those who have been institutionalised. Though uncommon, it is being diagnosed with increasing frequency, and 40 centres around the United States have sprung up specialising in its treatment. The disorder is often treated by psychotherapists and social workers rather than by psychiatrists. It is listed under "other disorders of infancy, childhood or adolescence" in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
The disorder is characterised by difficulties in establishing and maintaining trusting relationships and by emotional disturbances in social situations. It starts before the age of 5 years. Symptoms include failure to establish eye contact, persistent lying and stealing, poor impulse control, cruelty to animals, and a seeming lack of conscience. Both inhibited and disinhibited types occur. The inhibited type avoids tactile contact, is resistant to comforting and is hypervigilant, while the disinhibited type may be engaging and form superficial relationships with strangers.
Conventional treatment for the disorder relies on intensive psychotherapy with the patient and family, as well as "holding therapy" in which the patient is hugged, held, and cuddled by the therapist and care giver(s).
In the case of Candace Newmaker, "rebirthing therapy" was used. Traditional rebirthing therapy is itself a fringe treatment and was developed in the 1970s by Leonard Orr, a psychotherapist. It is predominantly a breathing technique and rarely lasts more than 15 minutes.
The therapy used on Candace Newmaker was a variant designed to simulate the birth process and is a type of regression therapy. Her therapists, social workers Connell Watkins and Julie Ponder, and two assistants restrained the girl. Ultimately, they crushed her with a combined weight of 304 kg, continually taunting her and exhorting her to squeeze through and be reborn. When Candace Newmaker was unwrapped she was cyanotic and apnoeic. Cardiopulmonary resuscitation was started but the girl died the next day. A postmortem examination gave the cause of death as asphyxiation.
The new Colorado law will ban all psychotherapies from using active restraint.