By Angela Smith, HEAL National Coordinator/Co-Founder
Merriam-webster.com defines "Survivor" as living after someone has died (i.e. family survives death of parent in obituaries), as living or existing after a disaster (i.e. someone survived an earthquake, car crash, etc.), or continuing to function or prosper despite hardships (i.e. Trump filed bankruptcy multiple times and later became president). Sources: https://www.merriam-webster.com/dictionary/survivor, http://connect.legacy.com/profiles/blogs/who-to-include-in-the-obituary, https://www.usatoday.com/story/news/world/2016/08/26/italy-earthquake-posta/89426564/, and https://www.washingtonpost.com/politics/2016/live-updates/general-election/real-time-fact-checking-and-analysis-of-the-first-presidential-debate/fact-check-has-trump-declared-bankruptcy-four-or-six-times/
Have victims of institutionalized abuse survived an industry and conditions where others have died? Yes.
One of the most documented abusive segregated congregate care youth facilities has been the Dozier School for Boys where over 100 corpses of children have been found buried in mostly unmarked graves on the property. The Dozier School was a residential "character training" program in Florida before it was finally closed down in 2011. See: http://www.smithsonianmag.com/smart-news/archaeologists-finally-know-what-happened-brutal-reform-school-180957911/ But, that's just one facility. So, what's the number?
There's no record of the number of children killed in treatment/institutional settings. The best estimate available is from the Hartford Courant, which reports: "A 50-state survey by The Courant, the first of its kind ever conducted, has confirmed 142 deaths during or shortly after restraint or seclusion in the past decade. The survey focused on mental health and mental retardation facilities and group homes nationwide. But because many of these cases go unreported, the actual number of deaths during or after restraint is many times higher. Between 50 and 150 such deaths occur every year across the country, according to a statistical estimate commissioned by The Courant and conducted by a research specialist at the Harvard Center for Risk Analysis. That's one to three deaths every week, 500 to 1,500 in the past decade, the study shows." Source: http://www.charlydmiller.com/LIB05/1998hartfordcourant11.html This was the last legitimate study by a legitimate research specialist on this issue to HEAL's knowledge and would suggest a minimum of 975 deaths of children due to restraint and isolation (3750 restraint and isolation related deaths, if we include all age groups of the study referenced) in institutional settings in the last 25 years. While the Dozier School for Boys opened in 1900 and closed in 2011 with over 100 children's dead bodies buried in unmarked graves around the facility "over the years". (Source: http://www.npr.org/2012/10/15/162941770/floridas-dozier-school-for-boys-a-true-horror-story ) So, why not go back 100 years and apply the modern statistics? That would suggest 3,900 deaths of children in institutional care as a result of restraint and isolation (not including other deaths in care, such as overmedication or medical neglect) since 1917. And, that's just the number of institutionalized kids that have died as a result of institutionalized abuse (restraint and isolation) while institutionalized. In addition, 43 adjudicated children and youths have died while in detention centers in a 4 year (2002-2005, last available data) survey of US juvenile detention centers, but, not all centers reported/participated in the study, so again, the number of deaths in detention may be much higher. (source: https://www.bjs.gov/content/dcrp/tables/juvtab5.cfm ) And, that would suggest 11 adjudicated juvenile deaths per year in detention. It is likely that even more than that have been killed in institutional settings as a result of institutionalized abuse with thousands more committing suicide after having been through that trauma. And, if you want to get really "crazy", consider this.... Let us say that at the "best" segregated congregate care facility there are 0 deaths and at the "worst" (i.e. Dozier) there have been 100 deaths due to malfeasance (restraint, isolation, medical neglect, overmedication, etc.) and take the average death toll over a 100 year period to be 50 per facility. The CDC reports there are 2,250 such facilities in the US. (Source: https://www.cdc.gov/nchs/data/nsrcf/NSRCF2010SelectedSurveyParticipants_091409.pdf ) Then, over a 100 year period, you have an average of 112,500 malfeasance related deaths, or 1,125 deaths annually in institutional care due to malfeasance, across all demographics. If 26% of those deaths are of youth (as the Harvard research suggests), then it would amount to roughly 292 deaths of youth in institutional care annually. This would make the death toll over a 25 year period for youth in segregated congregate care 7,300. But, medical malpractice accounts for 210,000-440,000 medical negligence/malfeasance deaths in the US annually according to a Journal of Patient Safety study in 2013. (Source: https://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals ) While these numbers are staggering, they do not even touch on the post-institutionalization suicides of those traumatized by abusive and negligent care in segregated congregate care facilities.
Is the segregated congregate care industry a "disaster"? Well, how does merriam-webster.com define "disaster"? A "disaster" is a sudden calamitous event bringing great damage, loss, or destruction according to https://www.merriam-webster.com/dictionary/disaster. For the individuals subjected to being terrorized in their own homes in the middle of the night, taken by strangers to an undisclosed location, held incommunicado and mistreated before earning their levels and mistreating those of lower status as a means of "progress" as defined by the behavior modification arm of the segregated congregate care industry, they may consider their experience to be disastrous or a disaster. And, arguably, it is a legitimate view to hold of an industry that even the Surgeon General claims is ineffective at best, and at worst harmful. Source: https://profiles.nlm.nih.gov/ps/access/nnbbjc.pdf (page 10 of .pdf and page 160 of document) Given the loss of liberty and dehumanization that accompanies segregated congregate care, many would argue the loss and damage to the individual is devastating and may rise to the level of disaster, when considering annual death tolls and other harms (i.e. rapes, permanent mental or physical injury, etc.), certainly suggest it is not unreasonable to see the segregated congregate care industry as a disaster to those unfortunate enough to have experienced it firsthand. So, Yes, it is a disaster depending on your point of view.
Do victims of institutionalized abuse continue to function and prosper despite those hardships? Here's where it gets tricky. Some of our fellows believe there are survivors of institutionalized abuse, but, that the majority are victims because they do not meet the third definition (the basis of the question above), and clearly are not able to function and prosper subsequent to their segregated congregate care experiences. Many of our best and brightest, including Jon Martin Crawford and Nick Romano, are no longer with us, though they showed the most promise in regards to intellect, ability, and business acumen. Many are unable to take slight criticism, shut down in the face of adversity or conflict, and cannot function in any job where they are not in control and able to avoid correction or, even guidance, in performing assigned tasks. This makes for high unemployment rates and can be understood when you look at criticism or correction as a PTSD trigger (particularly for those who experienced what is called "positive peer pressure" aka "Attack Therapy" aka "Confrontation Therapy" (in which in a group setting, an individual is targeted by the group and torn down for hours non-stop with insult after insult, correction after correction, criticism after criticism, which is clearly traumatizing and should be considered a form of excessive bullying...often being scolded for minor infractions such as not making the bed perfectly or not folding laundry per program standards...) leaving many survivors and victims, unable to function and prosper by society standards. However, "2 out of 3 ain't bad" and even if unable to function and prosper due to PTSD or related issues, defining these victims as "survivors" fits within the accepted understanding of the term "survivor".
So, what can survivors of institutionalized abuse do to better function and prosper with PTSD? First, they need to recognize their PTSD and begin learning to manage triggers and develop healthy coping strategies. There is no cure for PTSD. Trauma is both physical and mental and the body and mind are hard-wired to recognize trauma and use trauma experiences to protect the mind and body from future trauma. A trigger is an event (as simple as a look, as complex as an environment) that reminds the mind and body of the trauma and ignites a protective response which often includes hyper-vigilance (what others perceive as "over-reacting") to stop the triggering event to protect the individual with PTSD from additional harm. It is up to survivors of trauma to recognize their PTSD and to learn to manage triggers and develop healthy coping strategies to better function (and prosper) in life. Many acknowledge this is often easier said than done.
Survivors must communicate to their friends and family that they have PTSD and need their social support system to avoid triggering them to the best of their ability. Friends and family of those living with PTSD must never pressure their loved one with PTSD to get help, treatment, or the like. One reason is because "help" and "treatment" are most likely trigger words for survivors of institutionalized abuse. Friends and family must be patient and supportive of their loved ones with PTSD and let individuals with PTSD be the first to mention help or treatment and give them complete authority and empowerment to choose or refuse treatment in their own time and when they feel ready. Love is not selfish and if you truly love someone with PTSD, you will be patient and supportive, not add pressure, trigger episodes, and demand a "quick fix". There is no "quick fix". And, accepting that reality is necessary both for people living with PTSD as well as their loved ones. For tips on how to support a loved one with PTSD (and how to manage your own PTSD/triggers), visit: https://www.helpguide.org/articles/ptsd-trauma/helping-someone-with-ptsd.htm
In addition, survivors of institutionalized abuse will only be retraumatized, even in a non-abusive institutional setting, if reinstitutionalized according to the report by the Anna Institute available here: https://www.theannainstitute.org/Retraumatization%20with%20chart.ppt. So, if you want your troublesome family member with PTSD to "go away and get help" so they aren't such a bother, you are triggering their PTSD and actually creating setbacks to their recovery. It is of vital importance when helping and supporting anyone with PTSD that you be patient, a good listener, and make the person with PTSD feel safe and empowered. Once they feel safe and empowered (confident to accept or refuse any assistance without feeling like they are disappointing their support system when refusing unhelpful or harmful treatment or triggers), loved ones with PTSD may seek help for learning to better manage triggers or develop healthy coping strategies. But, until they feel safe and empowered, any pressure, demands, or the like will only make matters worse. This is one reason HEAL does not recommend treatment to survivors of institutional abuse. We believe that every survivor must come to that decision in their own time and on their own when they feel safe and ready to accept or refuse treatment or help without fear of reprisal or judgment from family members who, often mistakenly, believe that there is help to be found in the mental health industry. However, we do suggest that survivors with PTSD begin to learn about PTSD, managing triggers, and healthy coping strategies so they can progress towards a more functional and prosperous life.
PTSD sufferers who are not survivors/victims of institutionalized abuse, may find various treatments and treatment settings helpful. This, unfortunately, is not so with survivors of institutionalized abuse, particularly in "therapeutic" settings, where any similar setting is a major trigger of their PTSD. It is a heartbreaking reality that institutionalized abuse makes getting legitimate help damaging and next to impossible for survivors. But, there is hope... Survivors of institutionalized abuse can recognize their PTSD, learn about managing triggers, and adopt healthy coping strategies. It all begins with feeling safe. And, a survivor is only going to feel safe when they don't perceive any threats. Perceived threats act as triggers and therefore cause setbacks. It is important to give voice to those small feelings of apprehension when interacting with others so the triggers don't compound into flashbacks and outbursts. For example, many survivors of institutionalized abuse would prefer a corner table or booth when going out to eat. They prefer to have their back to the wall in such a situation and a "bird's eye view" of the entire establishment. But, because they often don't feel empowered (or feel embarrassed or ashamed --which they shouldn't), they remain quiet when going out to dinner and sit in uncomfortable and awkward silence in such situations, sometimes having a violent outburst over "nonsense" and leaving the situation in a fit of hostility, leading to more feelings of shame and embarrassment. You don't have to announce to the world that you have PTSD and special needs. You simply need to say to the host (in the restaurant example), "I would prefer a corner table. I would be more comfortable with a bird's eye view of the restaurant." Hosts and waiters are happy to accommodate such requests and I've never had a problem getting my needs met by voicing them simply in any given situation (with the exception of while enrolled in segregated congregate care). So, there are ways to learn to communicate your needs simply, manage your triggers, and develop healthy coping strategies. If you feel triggered, give yourself permission (empowerment) to walk away from a situation that is making you uncomfortable. This includes ending calls that may be triggering for you. If your family is pressuring you to get "help" and that is a trigger, tell them they are triggering you and that you do not feel safe when they say those things. Share with them the guide here: https://www.helpguide.org/articles/ptsd-trauma/helping-someone-with-ptsd.htm. And, let them know that just because they don't yet understand PTSD, they can still learn how to help you and that it doesn't help at all when you are triggered.
Compassion, empathy, love, patience, and a willingness to meet the needs of loved ones with PTSD is the best medicine. And, survivors can actively create a safe space for themselves and in their relationships while developing confidence (empowerment) to voice their needs and manage their triggers effectively. Without that feeling of safety, healing and progress are not possible. And, that's where it must begin.