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ON THE USE OF RESTRAINTS
By Pamela Spiro Wagner
Imagine this scene: A patient on a psychiatric unit is screaming, bellowing threats, swearing at invisible persecutors, throwing things. Finally a hurled shoe hits a staff member, who becomes understandably upset, perhaps understandably enraged. The “goon squad,” consisting of several burly men in scrubs or security officers’ uniforms, is summoned to subdue the offender. They toss her onto a bed and strap her down in locked leather cuffs, pinioning her wrists and ankles and leaving her, immobilized, for hours at a time. Leaving her there, in truth, until the staff is less angry and eager to punish, less eager for revenge.
This is very often the scenario, or one like it. But it is not the best or, more important, not the most helpful way to use restraints. I should know, having been a victim of them too many times.
I say “victim” and yet I am not particularly opposed to their use, only to the all too common fact that they are used to appease the fury of a staff member, not to help a distressed patient or ensure his or her safety. Certainly not to provide the reassurance of knowing one can harm neither oneself nor others.
No one likes to be wrestled to the floor and treated like a rabid beast, especially not a disturbed frightened hallucinating schizophrenic, and then to be ignored for long hours by staff impervious to and unaffected by the fact that the crisis has long since passed. Revenge and punishment have even justified their use for days, simply because the nursing staff wanted to have what it considered a troublemaker taken off its hands.
But had I been able to request restraints, on time, before I got out of control, as a short-term way to deal with serious agitation, they might have been helpful. Of course, I wasn’t. And if asked about it or if they had been recommended to me before being implemented through force, I would have screamed, “NO! I don’t need them!” Yet they have in fact provided relief. A friend suggests that if the process works, it must be not unlike socking it to a punching bag. Perhaps that is a good analogy. Restraints, at least occasionally, have been more effective in calming schizophrenic frenzy than the massive doses of Thorazine or Haldol – with their intolerable side effects -- to which I used to be subjected, supposedly as a more humane alternative.
My sister is a psychiatrist who for years ran an in-patient unit at a psychiatric hospital. She witnessed first hand, in fact oversaw, the voluntary use of restraints, restraints requested by patients aware that they were getting past the point of reasoning, reaching a point where they were unable to control themselves, when the safety of all would be in jeopardy. She knows that patients may ask for something that helps them, especially if it does not involve humiliation or punitive measures. Requesting restraints on her unit was possible, even admired. It meant patients knew when they were escalating and were asking for help. At the same time it meant they preferred not to be drugged into oblivion for what in the end was a problem of that particular moment.
Psychiatric units can justify many measures during a crisis, but why must one wait for a crisis? Patients may be aware that they are getting out of control but be unable to stop it. That doesn’t mean they don’t want to. It doesn’t mean they want to threaten others, don’t want *both* to be protected and to protect others from harm. If restraints can be preferable to the chemical straitjacket now used instead, why not make them available by request before they are required?
Posted by pamwag at August 8, 2004 05:17 AM | TrackBack