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.
