In the late 1990s, I was asked to interview a group of female mental patients who had been raped on their state psychiatric ward by other patients. I traveled out to Nebraska to interview these women and to prepare my testimony. My planning sessions with their lawyers were fascinating–but not as moving as my meetings with the brave women themselves. The institutional abuse of our most vulnerable citizens in state care remains a crucial and unresolved problem.

I would welcome other such similar stories and even more: The remedies and just conclusions.

No Safe Place

By Phyllis Chesler

After a devastating car accident that left her permanently bedridden and in need of around-the-clock care, Andrea X became a long-term patient at the Laurelwood Convalescent Hospital in North Hollywood, California. Paralyzed, unable to speak, eat, or control her bowels or bladder, she also lost the ability to summon help when she needed it. But she could still smile, and register pain and discomfort. In 1982, her family was unable to understand why Andrea suddenly became very restless, whimpered a lot and cried more. But then they also hadn’t understood why, against their wishes, Andrea had recently been moved to an isolated room where she was attended only by male aides.

Then Andrea missed two periods, at which point it was discovered that this totally incapacitated woman, a patient in a state convalescent home, was pregnant. Finally, staff understood why Andrea’s feeding tube had been mysteriously disrupted several times. Andrea’s family sued and won a $7.5 million jury award. But in 1993, an appeals court ruled that the “failure for the facility to provide security” did not constitute “professional negligence.” In doing so, the court reversed the original verdict, sent the case back to the trial court, and ordered that “each party bear its own costs on appeal.” Eventually, the case was settled out of court for less than a million dollars. One can only ask: Just what would constitute “professional negligence?”

Clearly, Andrea did not — and could not — consent to sexual intercourse. Totally disabled and trapped in her own body, she was raped in a convalescent home charged with her care. Are crimes not prosecuted when they occur on state property? Or when the criminal is acting on behalf of the state? Is the state above the law?

In 1986, a part-time program aide alleged that a female resident at the DePaul Mental Health Services, Inc. in Churchville, New York had been raped. What action was taken? The aide was fired. When she brought a retaliatory discharge action against her employer, the Monroe County Supreme Court ruled that her firing was not based on this incident.

In 1992, in Pendleton, Oregon, Cathy Neely, a former patient at the Eastern Oregon Psychiatric Center, brought a civil rights action alleging that her right to personal security had been violated by the center’s staff, who failed to protect her from being sexually assaulted by a psychiatric aide. Before Neely, in October of 1988, a female patient at the same center had filed charges against the same aide, alleging that “Jess Terry had put his hands down her pants, fondled her vaginal area and her breasts and told her that he had seen her lying naked in bed at night and wanted to jump in with her.” An in-house committee was convened — one that failed to question the patient’s mother, chaplain or treating psychologist. Not surprisingly, the committee found “no evidence to substantiate the charge.”

In March of 1989, a second patient also accused Terry of “putting his hands in her pants and his finger in her vagina,” and of “fondling her breasts.” A second hearing was held at which three additional patients testified that Terry “came on to” female patients. Both the treating psychologist and a patient who witnessed the incidents in question testified for the woman. Again, the committee concluded that “that there was no evidence to substantiate the charges.” This time, however, Terry was issued a written reprimand for “poor judgment” and put on his own good behavior. He agreed never to be alone again with a female patient.

Yet from May through June of 1990, Terry “made sexual remarks and innuendos, grabbed Neely’s breasts and kissed her while she was using the bathroom, unzipped his pants and exposed himself, rubbed her vagina, lay on top of her, and told her to cooperate.” Neely finally won the right to a trial against the superintendent of the psychiatric center, and reached a financial settlement before trial — perhaps because there were records on file which showed that prior to her allegations, two other female patients had made similar accusations against Terry. The in-house committee also found Terry guilty of a sex crime and fired him.

One might conclude that a woman — a psychiatric patient especially — will not be believed unless at least five other women independently claim that they too have previously been sexually assaulted by the same man, at least two treating psychologists find her “credible,” and the institution officially documents her allegations and does not misplace or destroy the records.

If so, this bodes well for an upcoming class action suit which has been brought in federal court against the highest ranking officials of Nebraska’s Department of Public Institutions. The four named female plaintiffs range in age from 19 to 62 years, and are mentally ill and/or developmentally disabled. This in itself is surprising, because once someone is labeled “mentally ill,” whatever she says will either be used against her, or will not be believed.

From July 1991 through July 1994, the four women stated they were repeatedly and savagely gang-raped by the same three male psychiatric inmates at the Hastings Regional Center (HRC) in Hastings, Nebraska. They were also beaten, kicked, bruised and further threatened by their rapists. The rapes were reported immediately, consistently, and repeatedly by the victims and by other patients. The staff kept a record; they also discussed the attacks with one another. Despite all this, the women received treatment only for their physical injuries, and their attackers went unpunished.

Incredibly, the staff instead disciplined the women for reporting and protesting their rapes! The victims — not their attackers — were put on ward restriction (no group activities, no outdoor walks) ostensibly “for their own safety,” placed in isolation rooms, and often tied down, both hand and foot, in leather restraints, for days at a time. In effect, they were tortured for having been gang-raped. Tied down, restrained, isolated, these women experienced terrifying flashbacks of earlier abuse, which may have contributed to their mental illness in the first place.

“High-functioning, exploitative males were placed in the patient population with highly vulnerable females,” charges Omaha attorney Bruce Mason, who filed the suit along with Shirley Mora James and Tania Diaz, both attorneys with Nebraska Advocacy Services. The suit alleges that many staff members were “deliberately indifferent” in allowing the “pattern of rapes and sexual exploitation to continue,” particularly for women who had been sexually assaulted as children or in their earlier lives. The attorneys say that by allowing the attacks to continue, employees created an “inherently dangerous” environment for the women.

The Nebraska women, extremely courageous to pursue legal vindication under the circumstances, are asking for monetary damages and demanding structural changes in the way HRC operates.

Across the country, disabled or sick women, who are considerably less able to protect themselves from rape than the average woman, are subjected to brutal sexual assault, either by the staff employed to care for them, or by male inmates, from whom they are not adequately protected. Invariably, the nation’s private and public mental institutions, hospitals, convalescent homes and other treatment facilities look the other way or shrug off the attacks as consensual sex — even when that is impossible — or they deny the rapes outright. All too often, so do America’s courts. If able-bodied women have a difficult time getting their testimony accepted in rape cases, imagine the legal horrors facing the handicapped or mentally ill.

Sadly, this isn’t new. Remember Willowbrook State School (1952-1975) — the infamous Staten Island, New York facility that made national headlines because instead of treating its inmates, it warehoused them out of sight, brutalized, broken. What you probably didn’t hear about (since Geraldo Rivera didn’t expose this sexual underbelly during his investigation of the school) was the routine sexual abuse of inmates by other inmates and by low-ranking staff. At Willowbrook, non-mentally retarded teenage girls, whose families had them incarcerated for “uppity” sexual behavior, were sometimes raped by other inmates and staff. When they were impregnated, they were given abortions, or they gave birth to infants who were whisked away for adoption. You didn’t hear about it, because then, like now, such abuse was apparently acceptable or overlooked — and because well-meaning whistle-blowers on the staff were terrorized into silence or early retirement.

Since Reagan’s infamous budget cuts, mental institutions in America, particularly state facilities, have barely been able to make ends meet. Poorly designed, tended, staffed and managed, asylums can be gruesome places in which to be confined or work. All too often, wards — and patients — reek of urine or feces. Relatives of inmates have long complained that clothing, books and magazines, even food purchased to supplement low-quality institutional meals, are frequently stolen by aides. A major reason for this may be the meager salaries paid to entry-level employees. In many cases, such aides make only minimum wage, and are expected to work long hours in environments that would depress even the most stable of us. Now it seems, sex on demand with patients — who are forced into compliance because chances are good that no one will believe them — has become a job perk.

Male psychiatric patients are not safe either. For example, one highly intelligent, but chronically schizophrenic man, who was hospitalized long-term in a Georgia facility, was anally raped so many times by male aides that he finally asked his family if he was a man or a woman.

Over the years, I have interviewed many psychiatric patients who have reported being raped in facilities across this country, both by staff and by other inmates. Women’s physical injuries were sometimes so severe they required hospital treatment — but despite this, employees rarely filed police reports, and almost never restricted the rapists to their wards or transferred them to institutions for the criminally insane. No action was taken by the authorities. In fact, employees often concluded that whatever had happened, if anything, was probably “consensual sex,” and that the women had “wanted” it.

But such patients are, in various ways, incapable of either consenting to sex or defending themselves against their rapists. Sarah X had been a severely abused child, whose parents committed her as a teenager after she’d tried to run away. Her relatives rarely visited her, but when Sarah turned 21, they allowed physicians to perform a lobotomy. After having her brain mutilated, she was heavily — and perhaps wrongfully — medicated for more than 25 years.

In an interview, this woman described her rapes as “bad things like in a bad dream in which bad boys hurt me and raped me. It was like torture.” In what sense can a lobotomized and heavily medicated female captive agree to consensual sex or effectively resist rape? Or, afterward, be believed as a credible witness?

Ellie X is mentally retarded. She also suffered from post-traumatic stress disorder due to a childhood history of sexual and physical violence. After she reported being raped for the first time, she recalls that staff members “tackled me to the floor, put me in a straitjacket. I would scream. They would mock me, which made me angry. Every time while I was straitjacketed that I tried to talk about my feelings they’d just ignore me.” “The staff didn’t try to help me at all. If they would have just listened to me instead of ridiculing me it would have calmed me down. No one had any sympathy for me. They treated me like an animal, a crazy lady.”

When Ellie reported a second rape, she says that the staff “didn’t do anything about it, they didn’t do any paperwork, they just let it go. I asked to be examined. They said no. I think the head nurse blamed me for it. She said I consented but I didn’t consent. She said I was lying and restricted me to the unit.”

After being raped repeatedly, Martha X finally “tried to run away from that place. When they found me, they didn’t ask what problems I was having or anything. They just put me in a straitjacket.”

Patti X describes the attacks as feeling like “just another situation with my dad. In the sixth grade I told a counselor that my dad was abusing me and my mother blamed me for lying.” This woman continues to have nightmares about her father and has had similar nightmares about the men who raped her while she was psychiatrically incarcerated. As a child, Dana X had been horrendously abused by her mother, her father, and other male and female relatives, both sexually and physically. While institutionalized, she was raped and gang-raped by male psychiatric inmates. Unable to find anyone who would believe her reports, she became depressed and tried to cut herself with a pen-knife. She recalls being “tackled by staff members and put in restraints,” which made her feel utterly “defeated.”

She explained that being tied in leather restraints by staff “reminded her of when her mom held her down for her dad to assault.” Placed in restraints, straitjacketed, isolated after reporting her rape, Dana had flashbacks, over and over again, of a repeated childhood occurrence in which she was locked in a “very hot room with no food and no water” for days at a time.

Such staff responses to inmate allegations of rape are extremely retraumatizing. As numerous studies have indicated, a large proportion of women in psychiatric and other institutions have harrowing histories of incest and childhood sexual abuse. It is probably why they are there in the first place.

Female (and male) patients are raped precisely because they are helpless; routinely, their very vulnerability is also used to minimize or justify the crime: she didn’t know what was happening anyway, she seemed to like it, she didn’t die, she didn’t fight, so why complain? Being diagnosed as mentally ill — because you have been savagely abused and never treated — also renders the female mental patient “non-credible.”

Imagine if you had to continue living in the same small, controlled space as your rapist, in constant fear of future assaults. What if this had already happened to you before, perhaps in your own family? What if this had driven you over the edge in the first place, and you’d landed in the nearest state institution to regain some peace of mind, presumably safe from such lawlessness?

What if the same thing happened — and kept happening — to you in this so-called place of refuge?

Ah, friends, there is little “asylum” in America. Women who have been repeatedly raped in childhood — often by authority figures in their own families — are traumatized human beings; as such, they are often diagnosed as borderline personalities, or as suffering from substance abuse or post-traumatic stress disorder. If they are institutionalized, they are rarely treated as the torture victims they truly are. Instead of being trained to understand this, most institutional staff — psychiatrists, psychologists, nurses, and attendants alike — do not believe the rape victims, nor do they think of rape as a “big deal.”

For more than 20 years, courtesy of feminist activism and feminist academic and clinical studies, data has been available in psychiatric, psychological, nursing, and social work journals that describes rape trauma syndrome, confirms how serious it is, and outlines treatment protocols. There is no excuse for psychiatric staff who fail to diagnose and compassionately treat such victims of violence.

The coarsening, deadening effects of institutional structures are too hard for individual staff to overcome, especially if they’re overworked and forced to conform to authority. Most staff — from psychiatrists to orderlies — tend to reflect society’s prevailing prejudices. In addition, they have the power to brutally enforce traditional misogynist views. Thus, such staff will usually disbelieve and punish the female (or male) sexual victim in their midst. Staff, both male and female staffers may themselves have a vested interest in punishing those women who “tell.”

Thus, when women or men are raped in American institutions — whether they be psychiatric wards, jails, prisons, or facilities for the mentally retarded and multiply disabled — the absent physicians and the overworked and poorly trained employees usually deny that anything criminal or traumatic has occurred. Institutional staff tend to look the other way (”give them some privacy”), deny that a staff member has raped an inmate, or maintain that sex between inmates is simply “consensual.”

Compassionate staff say that “mental patients are also entitled to love.” But in my view, rape is not love. Perhaps people still confuse the two. Both criminal and non-criminal inmates are entitled to conjugal visits and on-ward sex — when, and only when it is truly consensual.

Society has an obligation to keep criminals in jail, not to release them into the “therapeutic” culture. What we need are longer sentences upfront, not institutionalization afterward — especially since the mandatory treatment of sex offenders rarely works. Legislators have long fancied themselves gynecologists in the matter of abortion; now, judges have deemed themselves psychiatrists. Sex offenders are no longer merely criminals. By judicial diagnosis, they are “mentally abnormal,” have “personality disorders,” and/or are likely to engage in future acts of a sexually predatory nature. On June 23, 1997, in Kansas v. Leroy Hendricks, the Supreme Court upheld the 1994 Kansas Sexually Violent Predator Act that allows the state to commit a sex offender to a mental asylum — perhaps indefinitely — until he can show that he is no longer “dangerous” or subject to “irresistible impulses.”

The defendant, 62-year-old Leroy Hendricks, admits that when he gets “stressed out,” he “can’t control the urge” to molest. Ironically, Justice Clarence Thomas upheld the involuntary, civil commitment of sexual predators. His decision stresses that such civil commitment is meant to provide treatment rather than punishment, and that “the conditions surrounding confinement do not suggest a punitive purpose…such restraint of the dangerously mentally ill has been historically regarded as a legitimate non-punitive objective.”

Thirty-eight states have urged courts to allow sex offenders to be detained beyond their served sentences as “mentally abnormal.” Similar civil commitment acts targeting sexual predators have been passed in the states of Arizona, California, Minnesota, New Jersey, Washington and Wisconsin — often after a child had been murdered as well as raped. Some of us have had enough. We say: Pedophiles and rapists are epidemic, they inflict lifelong harm, serve short (if any) sentences, and return to rape again. And again. Others of us, especially civil libertarian and anti-institutional psychiatry organizations, are afraid that the state will exercise its new psychiatric powers in biased, political ways. We say: It always has.

Don’t get me wrong. I’m still in favor of locking up pedophiles and rapists of adults for a good long time — maybe forever — but I’m afraid of something else. If the courts hold that sex offenders are too dangerous to roam society’s streets, what do they believe such men might do to other inmates in state custody? Especially to male or female inmates who are childlike in height, weight, or mental abilities, and may in addition be sedated, straitjacketed, physically disabled, deaf, blind, wheelchair-bound, or lobotomized?

Absent treatment (and, liberal wishful thinking aside, there is none), sex offenders will do what they do best, and what we allow them to get away with.

The institutional structures have to change — which cannot happen unless we, the people, allocate more money for appropriate staff training, skilled therapy, and rehabilitation programs. There is no excuse for subjecting late-twentieth-century institutional inmates to the same awful conditions that existed in the nineteenth century. Then, people did not understand incest or rape or domestic battery, nor what their effects were. Today, we understand these abuses fully. We even have some effective methods of dealing with them.

I hope the Supreme Court’s decision is used to lock all serial rapists and pedophiles away — but only with each other. And sure, go ahead and try to treat ‘em — feel free to use my tax dollars — but only if you treat their victims first. We owe it to our most vulnerable patients to do just that.