Why So Much Abuse Is Allowed to Continue in Residential Care

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Experience of a Stanley Milgram patient at Yale University in the early 1960s

The stories are beyond horrifying: an autistic boy crushed to death by a “restraint” gone awry; a disabled woman’s diaper pulled aside as she is raped; an elderly woman left to lie on a urine-soaked box spring for six days after being beaten.

In two of the nation’s largest states, major media investigations this spring revealed hellish conditions in institutions for the disabled: The New York Times exposed ongoing violations, including physical and psychological abuse, in state-run homes for the developmentally disabled, while the Miami Herald uncovered similar tales of maltreatment and neglect in assisted-living homes for the elderly.

Both investigations found that the operators of these institutions were able to inflict harm with impunity, repeatedly violating the rights of their residents — in some cases, killing them — while being paid millions of dollars by the government for their “care.” Worse, when such abuses were exposed, the homes were not shuttered but simply advised not to do it again.

Why is it that institutions are able to get away with the kind of torture and abuse for which parents or other caregivers would be incarcerated or otherwise prevented from ever perpetrating again? This is a question that has haunted me for a decade as I’ve investigated similar instances of abuse and neglect in programs for “troubled” teens. Several factors interlock all of these cases. If we want to stop the abuse, all of them need to be addressed.

(More on TIME.com: Teen Program in Supreme Court Case Forces Girls to Do Lap Dances)

 Provide Redundant Checks on Power. Intensive oversight is needed for any institution that cares for people who are made so vulnerable — either because of their own disabilities or because the institution restricts contact with the outside world — that they can’t call relatives or police for help. We like to think that caregivers will behave well when their charges can’t fight back. However, the natural tendency of such power is to corrupt.

Consider the infamous Stanford Prison Experiment in which some healthy adult volunteers were designated as prison guards while others were assigned the role of prisoner. Within days, the “guards,” who were given complete control over their “prisoners,” began humiliating and abusing the inmates, taunting them and restricting their freedom more than was necessary — simply because they could.

The researcher in charge, Stanford’s Phil Zimbardo, had to end the study early. His participants were not the only ones who abused their power. He found that he himself had identified so strongly with the guards that he dismissed a prisoner’s plea for early release as “manipulation”; he responded not as a psychologist responsible for the health of his study participants, but as a prison administrator who cared more about his institution.

(More on TIME.com: Interview with Phil Zimbardo:  What Makes a Hero?)

More recent studies have shown that when people are made to feel powerful, they are more likely to cheat and break the law. They are also more likely to come down hard on the same violations by those with less power, a phenomenon seen in cases of institutional abuse.

Institutional settings also create hierarchies that make people more likely to “just follow orders.” This was demonstrated explicitly in yet another example of institutional abuse at the Judge Rotenberg Center in Massachusetts, which houses autistic children and those with other emotional and behavioral problems. There, caregivers inadvertently created an almost perfect real-life replication of another notorious psychological experiment: Stanley Milgram’s obedience research at Yale.

The Rotenberg Center has been long known for using electric skin shocks as a form of discipline. One summer night in 2007, an anonymous caller ordered the staff at 2 a.m. to wake two boys.  Then, they were to deliver dozens of shocks as punishment for their inappropriate behavior, which had allegedly occurred earlier in the day. The staff, assuming that the caller was a legitimate supervisor, complied without question. The incident left one boy in the hospital with second-degree burns. (An investigation would later reveal that the caller was a fraud.)

(More on TIME.com: Viewpoint: In Wake of Founder’s Arrest, ‘Shock School’ for Autistic Children Should Be Shuttered)

Similarly, in Milgram’s experiments, two-thirds of participants, following orders from an “authority” — a man dressed in a white coat — delivered what they thought were dangerous electric shocks to a victim (actually an actor), ramping the voltage higher even after the victim appeared to have had a heart attack.

The 2007 incident at Rotenberg finally brought down the center’s founder, who now faces criminal charges. But despite this and years of activism against the center by advocates for the disabled, the program remains open. Since institutions create imbalances of power that naturally tend to make even the best staff abusive, internal ombudsmen and other systems that provide multiple checks on power need to be available to represent the voice of the people living there.

Require Frequent, Surprise Inspections. Government inspections of residential institutions need to be frequent and unannounced. In one case I covered, one state performed unannounced visits while another warned the institution that inspectors were coming: guess which state found abuse?

Reduce Stigma. Another key factor that permits maltreatment is stigma. In my research trying to understand why abusive programs were able to continue operating after dozens of people had gone public with their stories of harm, I found a commonality in every case.

Operators of teen boot camps and tough love boarding schools tended to dehumanize the residents: in every instance, teens who spoke out were labeled “liars” or “manipulators.” Their tales of abuse were not to be believed because they were not credible witnesses.

(More on TIME.com: Increasingly, Internet Activism Helps Shutter Abusive ‘Troubled Teen’ Boot Camps)

Although the developmentally disabled and the elderly are typically seen as more “innocent” than troubled teens, the same dehumanization still occurs in settings where they are abused. People who are diagnosed with a condition that is commonly stigmatized are often viewed with mistrust or skepticism — more so than are those who care for them — because the disability itself is seen as disgusting or frightening. Consequently, when they try to speak up about abuse or neglect, their claims are often dismissed as unjustified “complaining” or “exaggeration.”

Stigma also gives cover to those who provide abusive services to vulnerable people. Regulators and the public tend to be so relieved that someone is willing to work with “those people” that the abusers are given the benefit of the doubt when complaints about abuse or neglect arise. When stigma and dehumanization cloud the picture, it is hard for abuse to be seen for what it is.

Pay for Safe Care. Finally, it’s not surprising that these abuses are coming to light now during a financial crisis. It costs money to run institutions that aren’t abusive and to regulate them effectively. When drastic budget cuts are made, corners are cut, too, and it becomes easier for staff to downplay abuse and neglect.  With less oversight, however, abuses then escalate to the point where they result in deaths or other severe harm that is undeniable.

If we want the elderly, disabled and others living in institutions to be safe and well cared for, we need to value them both emotionally and financially. That’s not what’s going on now.

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