In Canada and elsewhere, both children and adults with significant disabilities experience higher rates of violence than do other individuals. Three distinct but interrelated pathways connect violence and disability. First, violence is a major cause of disability. Second, the presence of a disability increases risk of victimization, partly due to impaired defenses and partly due to social responses to disability that increase risk. Finally, other events and conditions appear to increase risk for both violence and disability. The strong association between violence and disability was manifest in, although did not originate with, the eugenics movement.

History
Violence against individuals with disabilities appears to have been a fact of life throughout history although it was rarely specifically discussed until the 19th century. Many individuals with mental health or developmental disabilities were grouped with paupers or criminals kept in jails or poorhouses, so efforts to address abuse and neglect in these facilities also affected people with disabilities. In the 1840s, Dorothea Dix became an outspoken advocate for people with psychiatric and intellectual disabilities who were often neglected or physically and sexually abused in American family homes, jails, and poorhouses. Her advocacy played an important role in the development of asylums, where they were expected to receive more humane treatment. Sadly, almost immediately, these asylums also were cited for extreme abuse and neglect.

While much of the original drive to build asylums was well motivated, the rapidly evolving eugenics movement fueled the drive for increasingly large institutions to warehouse people with intellectual or mental health impairments. The primary concern was simply to remove these individuals from society with little concern for what happened to them once isolated in residential institutions.

Elizabeth Packard’s (1873) personal account of her institutionalization gave a glimpse into the abuse in psychiatric facilities. In 1887, 23-year-old reporter Nelly Bly had herself committed to New York’s Blackwell’s Island asylum in order to investigate the living conditions of patients residing in the city’s first municipal mental hospital. She published a series of articles under the title Ten Days in a Madhouse describing abuse and neglect in New York World.

Numerous other accounts of institutional abuse and neglect of people with disabilities followed over the next century. Albert Deutsch’s (1937) The Mentally Ill in America painted a grim picture of institutional violence. Reports of institutional abuse intensified around the time of World War II when many conscientious objectors were sent to work in institutions and reacted to inhumane conditions. Robert Kennedy’s report on New York’s Willowbrook State School and Geraldo Rivera’s subsequent televised report on the same institution brought institutional abuse of people with developmental disabilities into the public limelight in 1972.

While concern up until that time had focused largely on institutional abuse, The middle 20th century also saw the beginnings of the science of victimology and increased interest in the abuse of children. German Criminologist Hans von Hentig is frequently considered the father of victimology; in The Criminal and his Victim (1948), he identified disability as a factor that led offenders to select vulnerable victims.

The 1960s also brought about a renewed interest in child abuse and child maltreatment. From the beginning, of what has been termed the second wave in child protection, it was noted that there was association between developmental disabilities and child abuse. For example Elmer and Gregg (1967) in a follow-up study of physically abused children found that 50% had intellectual disabilities, but the study could not determine if the disability preceded or resulted from the abuse. Numerous small-scale studies reported strong associations between violence and disability, but large well-controlled studies were not available until the beginning of the 21st Century.

The association between violence and disability
Current research clearly and consistently shows a strong relationship between violence and disability for both children and adults. In 2012, Jones and colleagues published a meta-analysis of the studies on child maltreatment and disability that met strict standards for valid research design. Their overall conclusion was that children with identified disabilities were 3.68 times as likely to be reported as maltreated as children without disabilities were. Children with “mental or intellectual” disabilities were at even greater risk. They were 4.28 times as likely to experience some form of maltreatment, 3.08 times as likely to experience physical violence, 4.62 as likely to be sexually abused, and 4.31 times as likely to be emotionally abused. Other researchers have reached similar conclusions.

Hughes and colleagues (2012) conducted a similar meta-analysis of studies of violence against adults with disabilities. They found that adults with disabilities were 1.50 times as likely to be victims of violence. The odds ratio increased to 1.60 times for adults with intellectual disabilities and to 3.86 for adults with mental or psychiatric disabilities.

Statistics Canada found that Canadians with disabilities were more likely to be victims of violent crimes than other Canadians and individuals with disabilities who experienced violence were more likely to experience multiple episodes of violence than their counterparts without disabilities (Perrault, 2009). Brownridge and colleagues (2008) found that Canadian women with disabilities were 1.4 times as likely to experience intimate partner violence than other Canadian women. Women with disabilities were twice as likely to experience more severe forms of violence from their partners and three times as likely to be assaulted by them.

Erika Harrell (2014), reporting for the Department of Justice Statistics, tallied 1,346,900 nonfatal violent crimes against individuals with disabilities in the United States for the year 2012. These included more than 830,000 simple assaults, 195,000 aggravated assaults, and 80,000 rapes or sexual assaults. The age adjusted rate for violent victimization of individuals was 2.72 the rate for Americans without disabilities, and for the most serious categories of violent crime, individuals with disabilities experienced a victimization rate more than three times higher than their peers without disabilities. In every year from 2009 to 2012, individuals with cognitive disabilities experienced the highest rate of violent crime in comparison to other (i.e., hearing, vision, ambulatory, self-care, independent living) categories. Disturbingly, while the age adjusted rate of violent victimization decreased from 22.4 to 22.3 per 1,000 between 2009 and 2012 for Americans without disabilities, the rate rose substantially for persons with disabilities from 50.1 to 60.4 per 1,000.

Violence is a cause of disability
Violence often results in physical or mental harm that causes disability. For example, 10-15% of brain injuries and 15-20% of spinal cord injuries result from violence. In addition, abuse, neglect, and violence, even in the absence of gross physical injuries, contribute to cognitive and emotional disabilities. Since violence and abuse that take place in families or caregiving relationships is most frequently chronic, and it is difficult to identify an exact beginning of disabilities that may emerge or be identified over a period of years, it is often difficult to determine if maltreatment may have been a causal factor in an individual’s disability

Disability is a risk factor for victimization: direct and socially determined effects
Disabilities increase vulnerability to violence in two ways. First, disabilities that limit motor skills, movement, communication, and other critical areas limit a person’s ability to avoid or escape from maltreatment. Second, social responses of others to the existence of a person’s disability result in differential attitudes and treatment that increase risk for maltreatment.

An individual with limited movement will have more difficulty defending him or herself. Limited mobility makes escape more difficult. Limited communication makes it more difficult to tell someone and recruit help. Dependency on caregivers (which is often partially the direct result of impairment and partially socially determined) increases vulnerability to caregiver abuse.

Attitudes toward and beliefs about disability play an important role in disinhibiting violence toward people with disabilities. Bioethicists such as Joseph Fletcher and Peter Singer have argued that individuals with severe or profound cognitive disabilities are nonhumans or nonpersons, and as such lack moral status and human rights. Therefore, offenses committed against them should not be viewed as crimes against other members of society. Many offenders who commit emotional, physical, or sexual assaults against people with severe disabilities have made very similar arguments. Some have argued that people with disabilities lack the capacity to experience pain or suffering and therefore it doesn’t matter if they are abused, while others argue that people with disabilities already suffer so much that more abuse is of little consequence. In addition, some have viewed people with disabilities as a threat to society and therefore deserving of maltreatment. The eugenics movement brought this view to an extreme, portraying people with disabilities as a threat to the human race that had to be eliminated through sexually segregated institutionalization, involuntary sterilization, or euthanasia. The discredited dependency-stress hypothesis, which posits that children with disabilities provoke violence from parents and caregivers with excessive demands, continues to be used to excuse abusive caregivers and blame their victims.

Social practices go beyond mere attitudes and beliefs. For example, people with intellectual disabilities have often been denied the right to testify in court about the abuse they experience, even when they have been quite capable of communicating what happened to them. Institutions housing people with psychiatric or developmental disabilities commonly kept telephones locked away from residents and censored all incoming and outgoing mail, further isolating residents from potential help. Special education programs have overwhelmingly focused on teaching compliance and have done little to teach people with disabilities to be assertive or stand up for their rights. As a result of these and many other practices, people with disabilities have been systematically disempowered.

-Dick Sobsey

• Brownridge, D. A., Ristock, J., & Hiebert-Murphy, D. (2008). The high risk of IPV against Canadian women with disabilities. Medical Science Monitor, 14(5), PH27-32.

• Deans, K. J., Minneci, P. C., Lowell, W., & Groner, J. I. (2013). Increased morbidity and mortality of traumatic brain injury in victims of nonaccidental trauma. Journal of Trauma and Acute Care Surgery, 75(1), 157-160.

• Deutsch, A. (1937) The Mentally Ill in America: A History of their Care and Treatment from Colonial Times. Garden City, NY: Doubleday.

• Elmer, E., & Gregg, G. S. (1967). Developmental characteristics of abused children. Pediatrics, 40(4, Part I.), 596-602.

• Harrell, E. (2014, February). Crime Against Persons with Disabilities, 2009–2012 - Statistical Tables. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics [NCJ 244525].

• Jackson, A. B., Dijkers, M., Devivo, M. J., & Poczatek, R. B. (2004). A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Archives of Physical Medicine and Rehabilitation, 85(11), 1740-1748.

• Hughes, K., Bellis, M. A., Jones, L., Wood, S., Bates, G., Eckley, L., et al. (2012). Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. Lancet, 379(9826), 1621-1629.

• Jones, L., Bellis, M. A., Wood, S., Hughes, K., McCoy, E., Eckley, L., et al. (2012). Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies. Lancet, 380(9845), 899-907.

• Perrault, S. (2009). Criminal Victimization and Health: A Profile of Victimization Among Persons with Activity Limitations or Other Health Problems. Ottawa: Canadian Centre for Justice Statistics. [Catalogue no. 85F0033M — No. 21]

• von Hentig, H. (1948/1967) The criminal and his victim. Hamden, CT: Archon Books.