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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 wholly by accident but he 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 with locked leather cuffs, pinioning her wrists and ankles, only to leave her there, immobilized and now completely subject to the whims of staff. Leave 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 staff members, not to help a distressed patient or ensure his or her safety. As utilized in hospital units today, restraining someone is rarely a measure meant to provide a source of calming reassurance, even less to emphasize the security of knowing that you cannot harm either yourself or anyone else. Why? Because we care enough not to let you.
No one likes to be wrestled to the floor or pinned down to a bed like a pithed frog, especially not when you’re a disturbed, frightened, hallucinating, young person with schizophrenia. To then be ignored for long hours by staff, impervious to and unaffected by the fact that the crisis has long since passed, is unconscionable. Revenge and punishment even justified once keeping me restrained for days, simply because the nursing staff wanted to have what it considered a troublemaker taken off its hands. I was never a troublemaker; just an extremely scared young woman who didn’t know that what she experienced wasn’t actually happening.
But had I been able to request restraints, on time, before I got out of control, had hospital policy and culture encouraged it as a short-term way to deal with serious agitation, I suspect they could have been helpful. Of course, knowing the prevailing attitude towards restraints, I wasn’t able to. What I already knew made it too scary, too dangerous and degrading. And if restraints had been recommended to me before being implemented through force, I would have screamed, “NO! I don’t need them!”
So I admit that the changes I propose might not work with me, not yet. I have simply had too many terrible experiences being restrained. Perhaps because of a hospital culture that makes going into restraints a procedure ultimately fraught with degradation, indignity, and humiliation, many aspects of the experience would have to change radically before I could see myself agreeing to it.
Yet even forcible restraints have provided relief. A friend suggests that the process may work because it is not unlike socking it to a punching bag. Restraints, and the subsequent struggle against them, have at least occasionally been more effective in calming me in the midst of a 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.
At least, with restraints, when voices shrieked in my ear that the doctor wanted to kill me, that I must run, escape, do something--there was a physical barrier to struggle against, to expend all that extra energy on, without the fear of doing real harm. Just to wear youreslf out fighting against the bonds that hold you down can relieve a great deal of pent-up terror and anxiety, thereby reducing the frightening emotional valence of the symptoms. And thirty minutes later you’re calm, and ready to be released (if you’re lucky to have a doctor who understands.) Otherwise those leather straps and other paraphernalia might hold you down for many hours more than necessary.
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 would be 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 employed instead, why not make them available by request before they are required?
Posted by pamwag at August 8, 2004 08:12 AM | TrackBack