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Deadly restraint: Reform or abolish?

By Patricia Deegan, Ph.D.

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Restraint and neglect are synonymous. They are substitute for the thousand attentions needed by a disturbed patient. -John Conolly, 1856

Unfortunately most of the discussion following The Courant's investigative report has been about reforming the use of restraints as opposed to abolishing them. This refusal to consider the abolishment of mechanical restraints has a long history in America but not in Europe.

As early as 1838, Robert Gardner Hill successfully banned the use of mechanical restraints at the Lincoln Asylum in Great Britain. Soon after, John Conolly successfully repeated the experiment in non-restraint at the Lunatic Asylum in Hanwell, England. In 1857 he published his results and method in a book titled, Treatment of the Insane Without Mechanical Restraints. Despite such dramatic successes most American asylum doctors had grown insensitive to the physical and psychological damage done by restraints because of this country's long history of slavery (Gamwell and Tomes, 1995, Madness in America, Cornell University Press).

The pro-restraint stance of American psychiatry continues today with studies demonstrating that the use of restraint remains higher here than in many other countries. In Kenya and New Zealand, for example, mechanical restraints are not used in psychiatric hospitals. These examples help us understand that we do not have to settle for mere reform. Mechanical restraints kill and should be abolished.