ma, such as the shooting at the Inland Regional Center, affects the intellectually and developmentally disabled in predictable and unpredictable ways. For those under behavior management and psychiatric care--which is true of a significant proportion of individuals with developmental disabilities--disruption of routine occasioned by the traumatic event can be terrifying. For instance, one of the victims, Daniel Kaufman, employed developmentally disabled clients in the coffee shop he ran at the Inland Regional Center. The disappearance of a beloved employee/staff member can cause chaotic responses in a mentally disabled individual. The news of the shootings will complicate their difficult understanding of the world.
I had observed this anxiety and panic in my own clients in response to disruption of routine as the residential manager for a group home for the developmentally disabled. The disruptive event that affected my clients was the catastrophic flooding of the Red River that runs through North Dakota, Minnesota and Manitoba, Canada. Following a brutal winter, the Red River crested at 54 feet, flooding large sections of North Dakota under water, including Grand Forks, where I worked and lived.
I worked for Development Homes, Inc. (DHI), that provided services for disabled clients with the dual diagnosis of mental illness and mental retardation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has since updated the nomenclature previously known as mental retardation to "intellectual and developmental disabilities." The approximately 125 clients were a mix of new and deinstitutionalized residents of the old-order state "institutions," where, during the 40s, 50s and 60s, those with cognitive and personality disorders were consigned to live out the rest of their lives, often to the detriment of their personal growth, discovery and dignity. In the 1980s, when states deinstitutionalized the mentally incapacitated, they partnered with community-based disabilities services providers such as DHI to implement the new paradigm of assisted residential rehabilitation programs.
My four clients --SM, VM, GS and SD--were on the low end of intellectual and adaptive functioning and diagnosed with both mental illness and intellectual and developmental disabilities. They were in their mid-forties and had come into the residential care of DHI after years of being institutionalized. They suffered from limited receptive and expressive language use, bipolar disorder, schizophrenia, depression, anxiety and panic attacks, poor impulse control, eating disorders, epileptic seizures, and impaired sensory and motor skills. DHI provided them with the full spectrum of holistic bio-psycho-social and developmental treatment through supported residential services, behavior management through Behavior Intervention Plans, Life Plans geared towards specific outcomes, job training and skills training. The North East Human Service Center, a social service agency with the ND Department of Human Services, provided them with psychological counseling and psychopharmacological care for psychiatric disorders.
The winter of 1997 in North Dakota had been a brutal one with countless blizzards and record amount of snow on the ground. The news of the impending flooding of the Red River entered my clients' lives through the air, radio, television, and newspapers. They were terrified. In the weeks leading up to the flood, their day-to-day lives and routines were disrupted. My staff and I talked to them, explaining what was happening in the town; why they could not go to work or the movies or for walks or to Burger King; why we might have to pack up and leave; why the city was in a panic. Panic in others panicked my clients to unimaginable lows from which it was hard for them to climb out. So we talked to them about safety plans for their home, for themselves.
Talking helped. When the mayor ordered mandatory evacuation of the entire city on April 18th, we helped our clients pack up their essential belongings. We took the medically fragile clients to the Grafton State Center, and the more able-bodied individuals went to Jamestown State hospital.
My clients could not believe what they were seeing through the window of the van on the day we left the flooded city: long traffic jams, convoys of cars leaving the city, fire fighters in gear, FEMA, North Dakota Air Guard, National Guard, helicopters whirling ahead, things floating by in the river, pretty much everything destroyed. At each sight, the staff and I explained to our clients what we saw; the efforts that the community was undertaking to protect the city from the flood. Talking and explaining the flood helped orient our clients to the reality of the flood.
Our clients returned to Grand Forks in a month and a half to a city they could not recognize. An uncontrollable fire had started in downtown Grand Forks after the breaching of the dike, which destroyed eleven buildings and sixty apartment blocks. The charred downtown skyline rising from the debris-strewn floodwater rendered the chaotic city in an apocalyptic light. We described the fire and recovery efforts to our clients. This reassurance was important to their tenuous grasp of confidence in us, in the world. We were what they knew of stability, of a reality they knew and trusted.
The mass murder at San Bernardino and the way the world brute-forced its way into a space of stability, support and trust will be a life-changing event for both the staff and the clients at Inland Regional Center. There will be stress. There will be normal and abnormal grieving. There will be breakdowns. The staff and clients at Inland Regional Center have a long and challenging road ahead of them in rebuilding their shattered lives. The disabled clients might or might not ask us why their safe space was violently attacked, or why certain people are no longer to be seen around. Explaining an act of nature, such as a flood, was hard. But explaining this act of total violence with its human signature to a population that suffers from very complex anxieties and impairments will be harder.