"There are individuals whose lives are at stakebecause of their behaviors," Israel says indefense of the treatment.

Israel tells stories of patients who came toBRI beating their heads against tables and walls,attacking others and forcing themselves to vomituntil they were nearly starved to death. Thesepatients were controlled else where only by heavydoses of mind-altering medications, he says.

"Unless you realize that this can belife-saving, it's easy to make aversive therapyseem like some kind of unusual treatment," Israelsays.

Most patients come to BRI as a lastresort, Israel says. New York regulations requirethat a student fail out of ten programs before heor she is eligible for BRI.

But BRI's critics dispute this. StephenSchwartz of the Center for Public Representation,which has represented parents in claims againstBRI, alleges that some patients have not failedany previous programs and could function well atother institutions.

In addition to its use of aversives, BRI has anelaborate plan of incentives.

Students who perform well are rewarded withvisits home, with trips to local restaurants orwith play money which they may spend at a schoolstore. And Israel says part of the school iscalled Hope Academy, where punishments andrestraints are not used.

According to Israel, the punishment-rewardsystem works to stop self-mutilating behaviorbecause patients who self-mutilate are seekingattention or expressing unhappiness with asituation.

When patients start to hurt themselves, peopleoutside BRI generally let them stop whateverprovoked the episode, Israel says. At mostschools, this phenomenon occurs when a studentgets out of doing lessons by reverting to aself-abusive behavior which makes the teacher stopclass.

"If you're willing to do just what the studentwants, you don't need to use aversives," Israelsays. But the student may not learn anything, headds.

Opponents of BRI's techniques have a slogan:"Pain teaches pain."

Israel dismisses this slogan. But Caryn S.Driscoll, director of the Quincy-based Amegoprogram that treats similar patients, says the useof pain can encourage self-abuse in some patients.

"Some enjoy the feeling--that's the hardest,"Driscoll says. "We try to determine why people areself-abusing."

Driscoll also says there are alternatives tousing aversives.

"You'll hear a lot that the only alternative toaversives is drugs," Driscoll says. "[But] goodprograms in the Commonwealth [of Massachusetts]don't use drugs as a treatment."