Chapters in the History of the Insane in the British IslesTuke, Daniel Hack
History
Chapters in the History of the Insane in the British Isles
Tuke, Daniel Hack
Mental health laws -- Great Britain; Mental illness -- Great Britain; Mentally ill -- Care; Psychiatric hospitals -- Great Britain
5. That mechanical restraint, if used at all, is liable to great abuse
from keepers and nurses, who will often resort to it for the sake of
avoiding trouble to themselves; and who, even when well disposed towards
the patient, are not competent to judge of the extent to which it ought
to be applied.
6. The patient may be controlled as effectually without mechanical
restraint, as with it; and that the only requisites for enabling the
superintendents of asylums to dispense with the use of mechanical
restraint, are a greater number of attendants, and a better system of
classification amongst the patients; and that the additional expense
thereby incurred ought not to form a consideration where the comfort of
the patients is concerned.
On the other hand, the medical and other superintendents of lunatic
asylums who adopted a system of non-restraint as a general rule, but
made exceptions in certain extreme cases, urged the following reasons
for occasionally using some slight coercion:--
1. That it is necessary to possess, and to acquire as soon as possible,
a certain degree of authority or influence over the patient, in order to
enforce obedience to such salutary regulations as may be laid down for
his benefit.
2. That, although this authority or influence is obtained in a majority
of cases by kindness and persuasion, there are frequent instances where
these means entirely fail. That it then becomes necessary to have
recourse to other measures, and, at all events, to show the patient
that, in default of his compliance, it is in the _power_ of the
superintendent to employ coercion.
3. That a judicious employment of authority mixed with kindness (and
sometimes with indulgence) has been found to succeed better than any
other method.
4. That the occasional use of slight mechanical restraint has, in many
instances, been found to promote tranquillity by day and rest by night.
5. That it prevents, more surely than any supervision can effect, the
patient from injuring himself or the other patients.
6. That, particularly in large establishments, the supervision must be
trusted mainly to the attendants, who are not always to be depended on,
and whose patience, in cases of protracted violence, is frequently worn
out. That in such cases mild restraint insures more completely the
safety of the attendants, and contributes much to the tranquillity and
comfort of the surrounding patients.
7. That in many cases mild mechanical restraint tends less to irritate,
and generally less to exhaust the patient, than the act of detaining him
by manual strength, or forcing him into a place of seclusion, and
leaving him at liberty to throw himself violently about for hours
together.
8. That the expense of a number of attendants--not, indeed, more than
sufficient to restrain a patient during a violent paroxysm, but
nevertheless far beyond the ordinary exigencies of the establishment--is
impracticable in asylums where only a small number of paupers are
received.
Public-domain text, read in full here on John Shaqi.
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