Mental Health by Howard Burton

Author:Howard Burton
Language: eng
Format: epub
Tags: Psychiatry, law, psychology
Publisher: Open Agenda Publishing
Published: 2021-04-25T00:00:00+00:00

Questions for Discussion:

What does Elyn mean, exactly, when she says, “It was Pinel who loosened the chains”? Who was Philippe Pinel and what did he do, exactly?

To what extent do you think that American legal and medical practices involving restraints for psychological patients are a product of broader societal attitudes towards mental illness and the mentally ill?

IV. Empathy

The missing link

HB: Let me get back to exploring some details that I think I may have glossed over a little bit, specifically with respect to restraints, because I think it’s important for people to get a clear sense of what the law is, what your efforts were, how things have changed in different places, and so forth.

To me, a key issue that I’d certainly like to return to is this idea of autonomy, this idea of capacity, this idea of when someone is in a position to be able to make a judgment himself or herself, as opposed to having a judgment made for them. Can you maybe, very specifically, talk about restraints, the work that you did, what the law was previously, and compare and contrast that in different places?

ES: Four- and six-point restraints—tying someone spread-eagled to a bed—have been around for a long time. In England, they went away around the end of the 19th century with people like John Conolly, and moral treatment—treat people with dignity and respect and they will act in a dignified and respectful way. That seems to be the case.

HB: Is it actually against the law to do that now, or is it just policy that people treat people with dignity and respect in so far as they don’t physically restrain them in the United Kingdom, but if they were to physically restrain them, would it be against the law?

ES: I don’t think it would be against the law, no. I just think the practice is not to do it. I’m not aware of any law in England about that. In America, places vary in their use of restraints. I remember, when I was in the hospital, reading my records after the fact and it said, “Use restraints liberally.” So they thought of it as a form of treatment. They thought that that would help me, but I didn’t experience it that way at all. As I said before, there have been efforts to reduce the use of restraints that have been highly successful, like in Massachusetts and Pennsylvania, but in other places they are still used quite a bit.

The robust finding in the literature is that whether you get restrained has less to do with your characteristics as a patient, the staff-patient ratio, or anything like that; what it has to do with is the ethos that comes from the top. So, if management, if the head people say, “Use restraints liberally,” they will, whereas if they say, “Do everything you can to de-escalate situations so you don’t have to use restraints,” then that’s what will happen.

Restraints are potentially dangerous, as I’ve said. People die in them.

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