Abuse of Individuals with Disabilities

Dr. Sara PlummerRutgers University

Overview

History of abuse Prevalence rate Types of abuseRisk factors Screening

History

660 BC – Ancient Greece – The Spartans threw babies born

with disabilities over a cliff It was assumed they would not be

able to adequately contribute to society

The Athenians placed unwanted infants in jars and then left them in temples for people to adopt

History Euthanasia – the intentional putting to

death of a person with an incurable or painful disease

Nazi euthanasia program initially targeted people with severe mental and physical disabilities (more than 100,000 mental hospital patients and 5,00 children with developmental disabilities were killed between 1939 and 1941)

American History Eugenics – the science that

advocates for the improvement of genetic qualities (Sir Francis Galton – Darwin)

More than 300,000 individuals in special education programs, residents in institutions with intellectual disabilities were sterilized

American History

1800’s – restrictive marriage and reproduction laws – that prohibited marriage and intercourse amongst individuals with developmental disabilities and epilepsy

Many states had laws that allowed and encouraged the use of eugenics. VA - 1924, passed the Eugenic Sterilization Act,

Act called for sterilizations based on the intent: 1. to promote an individual's health or

2. to protect the welfare of society.

American History By 1930’s over half of the states had

eugenic laws giving doctors the right to forcibly sterilize individuals deemed “unfit” to reproduce

VA test court case Buck vs. Bell (MD)Carrie Buck - identified as having

epilepsy and being feebleminded) – was committed to the Lynchburg Colony for the Epileptic and Feebleminded (asylum or institution) after giving birth to a baby girl

American History Described as promiscuous, sterilization

was seen as logical fix to end generations of the “feebleminded” and an “imbecile”

Mother and child were deemed also to have intellectual disabilities

American History

Carrie and family fought sterilization and it went to Supreme Court ; Ruling 8:1 against Carrie

Judge who wrote decision, Oliver Wendell Holmes said: "Three generations of imbeciles are enough.“ (Carrie’s mother has similar diagnosis)

End note – Carrie was raped by a family member and likely sent away to hide this fact, later she and her daughter were found to have no significant intellectual disabilities, her sister was also sterilized

American History

From 1927 – 1972 – doctors at this hospital alone sterilized more than 8000 individuals including those with intellectual disabilities and those without disabilities

American history 1941 Foster Kennedy, MD presented “The

Problem of Social Control of the Congenital Defective: Education, Sterilization, Euthanasia“ to the American Psychiatric Association He proposed the killing of “hopelessly unfit” children

with developmental disabilities by age 5 "I believe when the defective child shall have reached

the age of five years . . . that the case should be considered under law by a competent medical board." The board would be authorized "to relieve that defective . . . of the agony of living.“

This was seen as purification through extermination and a natural step in evolution

Prevalence Individuals with disabilities experience

abuse at similar or increased rates Life time rates of abuse 62% for both

individuals with disabilities and general population (Young, et al. , 1997)

In a study of physical and sexual abuse, physical rates were equal and sexual abuse was 4 times higher for individuals with disabilities (Martin, et al, 2006)

In a study of over 1000 women in family practice clinics, those who reported experiencing abuse were 2 times more likely to report having a disabilities

Prevalence Studies also suggest that women

with disabilities experience abuse for longer periods of time and by more perpetrators

The research does not truly estimate the prevalence due to lack of:

ScreeningOutreach Accessible services

No attempt to seek services since little to none are available

Types of abuse

Individuals with disabilities suffer from multiple forms of abuse

Physical, sexual, emotional, economic

Also experience disability related abuse Denying access to mobility devices Preventing them from accessing medical care Neglecting personal care Withholding medications

Examples of disability related abuse Refusal to aid in toiletingOver or under-medicationBreaking communication and

mobility devices Wheelchair, TTY, pager, prosthetic limb

Moving furniture in a home of a visually impaired person

Taking away a prosthetic limb Mistreating service animals

Examples of disability related abuseForce the person to allow them to

become the representative payee Threatening to report them to DYFS

Historically courts have ruled against women with disabilities

Threatening to institutionalize them

Risk Factors

Some suggest having a disability in this world immediately places that person at risk

Research has suggested some specific risk factors

Isolation Isolation creates a barrier to support

and services Individuals who are less mobile, and

more socially isolated have a higher likelihood of experienced abuse (Nosek et al, 2006)

Isolation can be a result of Lack of accessibilityLack of mobilitySocial isolationLack of transportation

Perpetrators

Individuals with disabilities are exposed to multiple potential abusers

This population is at risk by the sheer number of people they come into contact with

Intimate partners Family members Health care providers PAS workers Ambulance drivers

Perpetrators

Intimate partners are the most commonly identified perpetrators of domestic violence including husbands and live in partners

Perpetrators of sexual violence are most often people they come into daily contact with but not people they live with

Most often men are identified as the perpetrator

Perpetrators in Relationships Certain predatory individuals may view a

romantic relationship with a person with a disability as an opportunity for exploitation, mistreatment and abuse

An individual may specifically target individuals they believe to be vulnerable and intentionally seek out individuals they believe they can exploit, mistreat and abuse

The expectation may be that the woman will not be believed if she reports abuse Which is often the case

Less likely to resist or fight back

Perpetrators – family Family members – parents and siblings who

have limited patience or regard for the individual may become abusive

Some parental relationships become strained due to the additional needs of a child with a disability – the child is then blamed for the break down in the marriage and in turn abused or neglected

Siblings may become jealous due to the added attention the child receives as a result of the disability and may act out towards the child

Perpetrators – Service Providers PAS, Healthcare workers, group home

worker The nature of the relationship between

individual and worker is viewed as a risk factor

Ongoing contact (many hours in the home, time spent in day treatment programs, etc)

Intimate nature of contact (bathing, toileting)Blurring of boundaries (worker vs.

friend/partner) Perpetrators may enter the field in order to

specifically target this population Perceived vulnerabilities and opportunities

Dependency Perpetrators may have the role of both

partner and primary caregiver Physical, emotional and financial

dependency may increase the risk of abuse and limit one’s ability to leave

This creates a dichotomous and confusing relationship of abuser and caregiver

An abused individual will be fearful of losing their source of daily care

As a result the abused individual may feel he or she needs to compromise or accept the abuse to continue to receive the benefits of the relationship (Hassouneth –Phillips, 2005)

Learned Helplessness/Compliance

Children with disabilities may experience:Overprotection (no allowing child to

experience various things)Segregation (separation in schools) Isolation (lack of social networks)Limited autonomy (told to comply with

doctors, nurses)Creates lack of understanding of social

cues and increases potential for learned compliance as adults

The attempt to protect a child or make less of a “burden” may inadvertently facilitate situations that are potentially abusive

Learned Helplessness/Compliance Creates individuals who are overly agreeable, and accommodating

Individuals are taught to comply with other’s wishes early on in life

Creates a fear of “rocking the boat” and avoids stating one’s needs

Compliance is then over generalized to other individuals and situations in life

Lack of Identification

Abuse against individuals with disabilities often goes unrecognized

Due to nature of abuse which often targets the person’s disability

These behaviors are often not defined as abuse by state laws

The person often does not realize the behavior is abusive

Lack of identification

May not tell others for fear of disbelief People don’t want to believe this occurs

so will dismiss itThe person accused is viewed as an

upstanding citizen, may be a person of authority

People with disabilities are historically not seen as reliable sources of information

Lack of knowledge about victimization Do not know who to contact

There are not many places to go for help

System and Cultural Barriers Lack of accessible resources

Lack of accessibility Limited physical accessNo interpreters Attitudinal barriers Disability organizations in general have lack of

information and resources on abuse Lack of capacity to address issue (screening,

resources, referral) Historically attempts at seeking help has been

met with insensitivity Lack of coordinated response – disability and

DV or SA

System and Cultural Barriers

Oppression and devaluation of women with disabilities

Ableist and sexist view points Negative valuations of individuals with disabilities

Seen as less than (not the ideal female form)

System and Cultural Barriers Discrimination and oppression become

internalized Creates self devaluation and poor self

esteem Women with disabilities report overall

high rates of low self esteemThis translates in a fear of being alone Doubts another partner would want to be with

themLack of worthiness around being in a

relationship May blame themselves for the abuse

Tips for serving survivors with disabilities

Screening Always screen for abuse There remains a lack of screening across disciplines

Screening You can begin to screen all clients who you

encounter Has anyone ever hit, slapped, kicked, pushed,

shoved, or otherwise physical hurt by someone? Has anyone ever forced you to engage in sexual

activities?Has anyone ever threatened, intimidated,

coerced or manipulated you to do things you did not wish to do, done or said anything to make you feel fearful, or humiliated, overly criticized, or bullied you?

* it is important to ask about lifetime history and current history (i.e. within the last year or 6 months)

Screening Then ask disability related abuse questions

Has anyone prevented you from using a wheelchair, cane, respirator, or other assistive devices?

Has anyone you depend on refused to help you with an important personal need, such as taking your medicine, getting to the bathroom, getting out of bed, getting dressed, or getting food or drink?

Within the last year, did someone take your SSI or SSD check, a paycheck, or financial aid check without your permission, refuse to allow you to access your bank account, or restrict your use of money, a debit or credit card?