Undercover Care: The abuse

[neilstone40]

Just watching this on BBC 1 as we speak. I'll come back later with some more comments on it but it's amongst some of the most shocking and horrendous stuff you're ever likely to see on TV.

I know this happens more than most people realise and have sadly even witnessed some such abuses myself but it never fails to make me feel sick and angry all at the same time.

Here's a link with some information

http://www.bbc.co.uk/news/uk-13548222

A specialist residential hospital in Bristol is being investigated by police after secret filming by BBC Panorama found a pattern of serious abuse.

Winterbourne View treats people with learning disabilities and autism.

Andrew McDonnell, a leading expert in working with adults with mental disabilities, labelled some of the examples captured on film "torture".

[neilstone40]

Here's the link to the full documentary on BBC iPlayer...

http://www.bbc.co.uk/programmes/b011pwt6

Truly shocking and disturbing stuff with a catalogue of failures in addressing the abuse that's was clearly endemic within this home.

I was watching this wanting to intervene by climbing into the TV and tackling the staff myself. My thoughts were less than charitable and more inclined to giving them some pain of their own than having a quiet word...

I admire the self control of the investigator for having the presence of mind and self control to be able to film the abuse to ensure it was recorded and evidenced (as previous attempts to 'whistleblow' had never been followed up).

I'm not sure I could have been controlled enough not to have intervened at the time, even knowing that recording rather than directly intervening appeared to be the only way to bring the abuse to an end.

I've witnessed more abuse than I'd ever have imagined was possible but have always been in the position of being able to make a 'protective intervention' at the time. I've always made a point of following these things up and would never knowingly leave someone at risk.

How anyone could give out such abuse and or be complicit in covering it up is beyond me. If you do a job which involves caring for someone, surely the minimum qualification is actually giving a fuck in the first place.

Some of the worst abuses I've witnessed have predominantly been in people's own homes perpetrated by spouses, relatives or carers although I've also seen the type of abuse that was featured in this documentary.

I really hope these people are prosecuted as far as the law allows and that watching this documentary encourages people to take action when they witness or suspect abuse.

Sometimes the worst thing you can do is nothing at all...

[Silly Sausage]

I missed it last night, but intend to watch it at some point in the next few days.
I worked at a care home for a few weeks back when I was in catering, and the very fact that they would feed the elderly folk the cheapest, shittiest food was annoying enough.
I can't say that I knew anything about the carers or what went on at the home itself, although these cases of abuse seem to be horribly common.

[Cath B]

I stopped watching after ten minutes or so.

The story is currently the first item on the BBC news.

[Cath B]

Just watched it all now.

Horrendous.

[DMB]

I think to be honest that there is a sizeable minority of people who enjoy having power over the powerless and get some sort of kick from sadistic behaviour. Obvious examples are to be found among prison guards in many totalitarian regimes. Sometimes, of course, torture is applied deliberately by the regime, but all that is necessary for it to occur is for the guards to have a free hand.

If we look at slave owning at times when few people questioned it, some slave owners treated their slaves humanely and others treated them abominably, even when it was against their economic interest to do so.

[DMB]

Apparently the TV programme has had an effect:

http://www.independent.co.uk/news/uk/crime/four-arrested-after-panorama-abuse-investigation-2291712.html

[Clivedurdle]

I's sorry, there is more than enough known about how we treat each other, especially in formal settings. Oh the following argument fails a Godwin - we do know about this because of the Nazis.

It is called institutionalisation, and in fact attracts people who like to use power on others, like a honeypot or a strange attractor.

Macpherson said the Met was guilty of institutionalised racism. I formally propose that all social services, health, hospitals, care homes, nursing homes their inspecting bodies like CQC and their professional and training bodies are so institutionalised they do not even realise it.

Might as well bring in the Daily Mail - what are we doing promoting people who are so institutionalised they cannot apologise?

http://www.dailymail.co.uk/news/article-1382235/NHS-rewards-bosses-1-200-excess-deaths-scandal-hit-hospitals.html
We know how to do it properly - for example The Young Ones Mariella Frostrup.

And I hope this is not institutionalised into oh we must help people with learning difficulties, but we at last plan properly to close all institutions - including prisons.

http://clivedurdle.wordpress.com/2010/02/11/a-talk-for-international-day-of-disabled-people-chelmsford-dec-2009/

I wish to propose that excellent map making will solve many issues we face as disabled people.

I want all disabled people:

• to be aware of the issues that affect their lives
• to record them in their own voice
• to use available technologies to map these issues, present these issues to others and negotiate appropriate solutions
Being or becoming a disabled person leads to serious complexities and issues of management – one study found a disabled person had to navigate between 27 different people and organisations to get the solutions they needed.

Any disabled person by definition is a highly experienced project manager and director, negotiator and problem solver. Disabled people have very high levels of experience, skills, attitudes and knowledge to build fulfilling lives.

There are very real issues of institutionalisation to be tackled.

If it can go wrong, it will, especially around disabled people....

It is the system stupid.

[neilstone40]

This goes far beyond the notions of simple institutionalisation and right into sheer brutality and sadism. There is a certain level of 'gaoler mentality' that had been particularly evident in some psychiatric hospitals for example but this case is so much more than that.

These issues occur not just within what some would refer to as 'institutions' but within the wider community. The worst abuses I have ever encountered have been the ones which have happened in people's own homes.

Whether relatives, carers, spouses or just those who choose to exploit the most vulnerable people in our society, it's not about the building rather than it's about the people.

I have witnessed or discovered abuses in people's own homes which would compare to the sort of torture methods used in Guantanamo or worse. People being tied to beds, deprived of food or water, regularly physically assaulted, deprived of medical care, etc.

As well as deliberate and wilful abuse, some of the saddest cases I've ever experienced have involved informal carers (i.e. relatives or friends rather than professional care supports) who have by lack of understanding or misguided action been guilty of indirect abuse or neglect.

One example (which I've seen on several occasions) is people with dementia being secured to beds, chairs or wheelchairs in an attempt to protect them or limit their movement. What I have witnessed has ranged from handcuffs, ropes, cable ties to less overt methods such as removing walking aids, angling chairs into a reclining position or using vari-tables (adjustable tables) as a physical barrier. Often these are done with what is believed to be good intentions but also out of frustration by people struggling to support someone in the community.

The abuses recorded in last night's documentary made me feel physically sick. This something you can never fully detach from despite anything you have previously witnessed(if you can then you're clearly on another planet).

This was wilful abuse allowed to develop and continue by failure of managers, qualified staff, directors as well as the regulatory body. These were people being used for entertainment by bored and disinterested staff.

Do these scum reserve their sadism just for work or could I suggest that it would suggest a concern about their character and ethics that extends beyond their chosen profession.

That's not about institutionalisation, it about sadistic, evil dangerous people who would exploit vulnerable people for their own amusement regardless of the location.

Their actions overshadow and undermine the excellent work which is being down by informal carers as well as health/social care staff. Much more important though is the immeasurable effect is has on the welfare and quality of life of those whose vulnerability should ensure their care is paramount.

[Clivedurdle]

Institutionalisation is not a neat and tidy concept as you seem to be portraying it!

The examples you gave - the people did not invent their behaviours brand new - they had come across them somewhere. People behave in institutionalising and dependency creating ways towards each other all the time. But if our main examples where we learn from are hospitals, prisons, homes, we only learn flawed dependency creating institutionalising ways.

We first of all need to acknowledge that our first reaction to crises is often some form of control, and we have myriad common examples of how to do that.

But there are other non violent enabling ways. The snag is these are not common. Countries that do not allow children to be hit have got a lot of this right - Finland comes to mind. Yes, no one is perfect, but they are orders of magnitude better than we are.

This isn't a bad apple issue. Institutions exert control by definition. We learn how to behave because of them, and assume they are normal.

The place in Bristol is some form of assessment unit and is a registered hospital costing £3500 per week. I saw no evidence of basic care and support planning, working as a team, all the basics.

How do you assess someone when they are not in their own environment? And the people there did not seem to be particularly challenging.

It is the system stupid!

[Clivedurdle]

This was wilful abuse allowed to develop and continue by failure of managers, qualified staff, directors as well as the regulatory body.

That is institutionalisation!

(if you can then you're clearly on another planet).

Don't just get mad, get even! And that means forensically analysing what is going on.

Redmond O Hanlon Congo described - there other examples - chimpanzees hunting. Not pleasant. He also described some human behaviours. Also not pleasant.

There are some extremely unpleasant behaviours in Islam - I think those are also examples of institutionalisation - continual repetition of stuff and behaviours since childhood, irrational reinforcements like strange clothes and weird eating rituals like ramadan and prohibitions like dogs are unclean.

This is a huge problem but it won't be resolved if we don't get the analysis right.

[Clivedurdle]

http://www.amazon.co.uk/States-Denial-Knowing-Atrocities-Suffering/dp/0745623921

Congratulations to Stanley Cohen on winning the American Society of Criminology′s International Division Award for outstanding publication of 2000–2001 for States of Denial!
′With images of disaster and atrocity raining down on us from every quarter, it′s hard not to resort to a balming fatalism. Sociologist Stanley Cohen′s timely book about how people and societies deny information which is too disturbing or threatening serves as a brilliant corrective ... This is how scholarship should be – zesty, engaged, witty, and always accessible.′ Anne Karpf, The Observer

′Cohen is original, wise and essentially optimistic ... [He] looks towards a practical utopia where "a deep shame of passivity" would become a mobilizing norm of social life.′ Victoria Brittain, The Guardian

′The sociologist Stanley Cohen, who spent many years in Israel before continuing his academic work in Britain, offers one key to why wars happen, why peace settlements do not take, and why terrible conflicts are ignored or dealt with ineffectively. His new book stresses how central denial is in conflict, indeed in all human life. The concept is well known, but Cohen′s careful building up of the detail of denial in its many forms is truly illuminating. He leads the reader to the conclusion that it is denial that is "normal" and an ability to see the truth and act accordingly which is rare, whether in individuals or in governments.′ Martin Woolacott, The Guardian

′[a] brilliant and important book.′ Anne Karpf, Jewish Chronicle

′Stan Cohen masterfully exposes the intricate matrix of forms of denial ... Artfully crafted and beautifully written, States of Denial is certainly not an easy read: it forces us to confront our blind spots and rationalizations. After the twentieth century no serious intellectual can afford not to tread this book and absorb Stan Cohen′s profound insights.′ TIKKUN

′Over a period of several decades Cohen has made a series of original and provocative contributions to the field of criminology . This book offers a rich contribution to criminology of a much broader scope, one more in tune with an era of increasing globalization. It explores in a profound way the pervasive resistance to confronting some of the worst crimes of our time.′ Choice

′In an exceptionally wide–ranging treatment of the topic, Cohen′s timely book traces multiple forms of the denial of distant suffering. He analyses denial through through the rich literature of its expression, including cognitive psychology and psychoanalysis, social and political sources, the reports of witnesses and bystanders, legal theory and literary texts.′ Anthony Elliott, The Australian

′Ignorance is bliss. But Cohen knows it is not. The details of denial are shocking to read ... [but] Cohen looks beyond despair towards a more honest way of living. He calls it the possibility of "living outside the lie", the phrase used by former Czech president Vaclav Havel. This isn′t easy to achieve, he concedes, but that shouldn′t stop you from trying.′ Sydney Morning Herald

′This is a pathbreaking and comprehensive study of how political actors, civic groups, and private citizens manage to know and not know about the atrocity and suffering around them, a rare book whose practical value for activists and officials is as great as its contribution to scholarship.′ Eric Klinenberg, Le Monde Diplomatique

′It would be hard to deny that denial is ubiquitous these days, but few have tried to survey the topic as comprehensively as Cohen does here.′ Lynne Segal, Radical Philosophy

′How do we deal with the unthinkable? How do the perpetrators of horrors justify their actions to themselves and to society? And to what extent is a bystander a perpetrator? These are basic, painful questions that need to be confronted directly – which is what Stanley Cohen resolutely does in this book. Rating: very good.′ New Internationalist

′Few topics can be so painful to contemplate as the modes of avoidance we construct to protect ourselves from what we do not want to know. Stanley Cohen guides us through this labyrinth in a compelling study that is cool, thorough and analytic, yet also passionate and riveting, and, remarkably, infused with sympathetic understanding for the forms of denial that are a foundation for "every personal life and every society", but must be faced honestly and overcome. It is an impressive achievement. To read and ponder it is an unsettling experience, but a very valuable one.′ Noam Chomsky

′This is an exceptionally important book, because it asks difficult and painful questions and answers them with that rare combination of tenacity and modesty which Stan Cohen has made his trade mark. The question of denial is at the very centre of the question of why human beings find being virtuous so difficult. States of Denial is the most rigorous attempt to analyse our various strategies of denial and I am sure that this book will become the starting point for all future debate on the subject′ Michael Ignatieff

′States of Denial is thoughtful, profound, engaging, disturbing, knowledgeable and comprehensive. Cohen reveals, modestly but thoroughly, a mastery of a vast amount of scholarly and journalistic work. It′s a remarkable book ′ Howard Becker

′...as fine a product as any scholar might reasonably wish for. The book is sociological while at the same time an exercise in social psychology...a very good book about many things.′ British Journal of Sociology



′This book presents the case history of human denial. It is disturbing but gripping reading, a tonic of truth for us all.′ Journal of Medicine,Conflict & Survival

′States of Denial deserves a wide readership. It is testament of Cohen′s brilliance both as a sociologist and as a writer that he manages to deal with a broad and difficult topic in a manner that is both comprehensive and deeply engaging.′ The Howard Journal of Criminal Justice

"In an exceptionally wide–ranging treatment of the topic, Cohen′s timely book traces multiple forms of the denial of distant suffering. He analyses denial through the rich literature of its expression. including cognitive psychoanalysis. Social and political sources, the reports of witnesses and bystanders, legal theory and literary texts." The Australian

"A remarkable new book that hits the nail on the head page after page after page. It should be compulsory reading for the political class in Northern Ireland, players of historical games and experts in ′whataboutery′." Leader

" This book compels readers to look at their own responses and judge their own behaviour when faced with the atrocities and suffering of others." Criminal Justice Matters

"States of Denial presents a highly differentiated understanding that includes an appreciation of the value of denial alongside recognition of its perils, the goals of the book are excruciatingly important, and the results are a rich source of insights and concepts. This is compelling moral sociology, among other things, and will be an important starting point for the future research." American Journal of Sociology

"This is a passionate work, with a fierce commitment to humanity and to the need for societal and personal transformation to resist the denuals which permit atrocities to flourish. Good for the corporate soul." The Round Table



"The exhaustiveness of Cohen′s review of cases and theories, the constant shifts and linkages between the micro and the macro level, and, above all, the rigour and insightfulness of Cohen′s own theoretical framework make the book a ′must′ for social scientists. More generally, the nature of the subject matter makes the book a ′must′ for any person who is willing to break free the forms of denial inherent in any society." European Journal of Social Theory



"This is a noble tract for our times, written by a modest, honest man." British Journal of Criminology



"To say that States of Denial is exceptionally important, impressive or remarkable is to understate the enormity of this book′s achievement. Stanley Cohen′s deeply disturbing study of the ways in which people and states react to knowledge about the suffering of others is an oustanding piece of scholarship."Jacqueline Tombs, Stirling University, UK

"This book provides an excellent introduction and exploration of the concept of denial. It examines the concept of denial in such a thorough and all–encompassing manner that the reader is forced to examine their own behaviours to atrocities and suffering. It is easy to read and well researched."Patricia Kingori, University College, London. Medical Sociology News

"Denial is a difficult and thought–provoking area. Cohen certainly allows the reader to reflect on the concepts and apply them to current issues. I would therefore recommend this book to professionals working with clients who are in some form of denial" Dr Carol A. Ireland, The Psychologist

"States of Denial [is] a quite brilliant examination of the human capacity, or incapacity, to handle disaster and tragedy." Laurie Taylor, The Humanist

Victoria Brittain, The Guardian
Cohen looks towards a practical utopia where "a deep shame of passivity" would become a mobilizing norm of social life.

First Sentence
One common thread runs through the many different stories of denial: people, organizations, governments or whole societies are presented with information that is too disturbing, threatening or anomalous to be fully absorbed or openly acknowledged....

[neilstone40]

Institutionalisation is not a neat and tidy concept as you seem to be portraying it!

I wouldn't say I have attempted to oversimply the concept Clive. You'll remember I'm sure from many previous discussions we've had on very closely related subjects that my concept of institutionalisation is different to you're but no less complex. Your concept relies on institutionalisation being linked to communal living where mine suggests that it can apply in the community too.

I've have seen people institutionalised and regimented in their own home by carers and relatives. In short, it not just about the building...

The examples you gave - the people did not invent their behaviours brand new - they had come across them somewhere. People behave in institutionalising and dependency creating ways towards each other all the time. But if our main examples where we learn from are hospitals, prisons, homes, we only learn flawed dependency creating institutionalising ways.

There's nothing much new under the sun when it comes to human behaviour. People don't need to have witnessed someone else treating someone cruelly to learn how to do it. Children lash at out other children without having being taught how as it runs deeper than just emulation.

Of course people do emulate others, particularly if, as illustrated last night, a senior carer is one of the main abusers and qualified staff seem to turn a blind eye. It then becomes almost accepted practice until someone either doesn't take part of challenges the methodology.

There is more to progress though than tearing down buildings in the hope that abusive behaviours will disappear as quickly as soon as the brick-dust settles.

We first of all need to acknowledge that our first reaction to crises is often some form of control, and we have myriad common examples of how to do that.

Not always so...

Having a strategy in place before the event, proper training and qualified staff, appropriate assessment and intervention strategies, theraputic interventions rather than lock-down, accessible activities and freedom of choice.

Personally I don't seek to control any crisis I see, if anything I'd rather understand some of what's happening before intervening rather than just being reactive.

But there are other non violent enabling ways. The snag is these are not common. Countries that do not allow children to be hit have got a lot of this right - Finland comes to mind. Yes, no one is perfect, but they are orders of magnitude better than we are.

I agree violence is seldom as solution and certainly 'violence' should never be a solution in a residential setting. There are other forms of interventions available, particularly the type which are designed to prevent and circumvent behavioural issues rather than simply reacting to them.

I'm sure Finland may be ahead of us on many things but I'm sure their suicide and depression rates are higher (14th highest compared to our 49th place) plus they invented an assault rifle that resulted in their soldiers continually shooting each other by accident as they left off the trigger guard so it could be fired while wearing snow mittens. If you look hard enough you'll find pros and cons everywhere

This isn't a bad apple issue. Institutions exert control by definition. We learn how to behave because of them, and assume they are normal.

What you define as institutions can often allow greater freedom and opportunities for activities, self expression and personal fulfilment than living at home for many people.

I've never suggested that they fit every possible need but they are often the only viable option for some people (do we have a deja vu smiley or did I just imagine that I'd seen one before)

The place in Bristol is some form of assessment unit and is a registered hospital costing £3500 per week. I saw no evidence of basic care and support planning, working as a team, all the basics.

I didn't see any of that either although the focus was on the abuse so they're unlikely to break away from that to demonstrate care plans being reviewed or have a look at the lunch menus.

On the other hand, the place looked utterly bleak, had little personalisation, the staff looking utterly disinterested and display no empathy for the residents, there didn't seem to be any particular activities evident and little thought shown in consulting with residents about their environment or life choices. It was nothing short of depressing and a sad indictment of the inferior and substandard care establishments that should no longer exist.

In saying that, the documentary didn't set out to be a holistic examination of the state of YPD (Young Physically Disabled ) care provision, rather it was focussed on the abuse.


How do you assess someone when they are not in their own environment?

Err, communicate with them maybe? Ask them questions, speak to relatives, carers and care providers. An assessment can still be done when someone is outside their own environment although may miss some of the difficulties they would experience in that environment.

By 'own environment' I take it you mean their own home? Not always possible in the case of young physically disabled persons if their home situation has broken down or their parents are too old or frail to provide the level of care and attention they may need. Physically disabled people have very different issues to care of the elderly, particularly when it comes to informal carers.

And the people there did not seem to be particularly challenging.

Again, it was a snaphot and focused on the abuse. Having spent a lot of time in YPD units as well as supporting people at home, their behaviour can often be very challenging and if it's a young, fit strong person can be difficult to address, especially for anyone with limited insight or training.

Conversely it can also be an extremely rewarding area of work and many people I've worked with have been demonstrably very affectionate as well as the simple delight of seeing someone smile when they're happy, feel secure or have achieved something simply remarkable.

When you see someone who may struggle to use cutlery using a fork and the elation they display, an action we take for granted can be a wonderful and lifechanging success for them. We shouldn't ignore the good work because of the abuses.[/QUOTE]

It is the system stupid!

Are you suggesting that the abusers are blameless then as they are as much victims of 'the system' as the victims?

I sincerely hope not.

We can go back to experiments such as the Stamford Prison experiment etc to see the many factors that affect human behaviour but at some point people make a choice as to how they treat others or what they will turn a blind eye to.

The failures here were on too many levels to be simply an environmental or systematic factor.

[Clivedurdle]

Don't know why but it feels like we are misunderstanding each other. Just because something is systemic does not mean individual actors lose responsibility. Nuremberg defence?

[neilstone40]

Don't know why but it feels like we are misunderstanding each other. Just because something is systemic does not mean individual actors lose responsibility. Nuremberg defence?

If anything I'm just trying to clarify what you were meaning. I didn't believe that's what you meant but felt the need to be certain before making further comment. I've heard far too many people try to blame their environment or the prevailing culture for their actions rather than take responsibility for their own conduct.

I'd hazard a guess that we're equally disgusted at what this documentary has exposed and would both do anything in our power to ensure this kind of treatment is eradicated. I'd also suggest that we agree that the most vulnerable people in our society deserve much better care, freedom of choice and support than they're currently receiving.

We may disagree on how this can be achieved and what the way forward entails but sometimes it's worth highlighting where we are in agreement.

[Clivedurdle]

Might be because gestalt is one of my favourite words!

[neilstone40]

Might be because gestalt is one of my favourite words!

My favourite word is shibui although mine is probably irrelevant to the discussion:D