Restraint
"Wherever restraint may become necessary, owing to the imperfect adaptation of the building, or to a want of sufficient attendants, the most simple means should be selected." -Robert Gardiner Hill, 1839 |
In the moral asylum the use of mechanical restraints had to be limited. As devices that physically bound the body and hindered movement, mechanical restraints were reminiscent of eighteenth century treatment of the mentally ill and therefore unacceptable in the implementation of moral therapy. Moral therapists believed so fully in this principle that many embraced a system of non-restraint which relied solely on the powers of the well-built asylum to maintain order. Reality, however, proved that a measure of humane force was necessary to control violent or self-destructive patients.
The use of mechanical restraints, even minimally, presented the most blatant attack on the moral utopia for the mind. It illuminated the shortcomings of environmental determinism and reminded patients and physicians of the cruelties present in the eighteenth century. Moral therapists had to try to reconcile restraints with moral therapy in order to maintain their world of healing.
The use of mechanical restraints, even minimally, presented the most blatant attack on the moral utopia for the mind. It illuminated the shortcomings of environmental determinism and reminded patients and physicians of the cruelties present in the eighteenth century. Moral therapists had to try to reconcile restraints with moral therapy in order to maintain their world of healing.
When moral therapy first began in the United States there was a flurry of inventions meant to both treat an insane patient and make them comfortable. In the first decade of the nineteenth century Benjamin Rush invented a chair which he called the tranquillizer. The purpose of this chair was to regulate blood flow to the brain, lessen muscular action, and ease the condition of insanity. Looking at the engraving of the chair, twenty-first century standards would declare it a cruel restraint but there are no iron chains on the chair, the seat is padded, and all of the straps around the patient’s body are made of leather. Compared to the naked, raving lunatic of the eighteenth century the tranquillizer was viewed as progressive and humane. It did fall out of favor with moral therapists who, as the century progressed, viewed it as too restrictive.
As the era of moral therapy continued into the 1850s and 1860s, American physicians continued to accept the measured use of chains, straitjackets, and other forms of restraint. To make such devices more humane they added leather padding to chains to prevent them from abrading a patient’s skin and insisted that no mechanical restraint was to be used unless first approved of by the asylum superintendent.
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Moral therapists in England challenged this system of minimal restraint by arguing that nothing short of non-restraint fulfilled the principles of moral therapy. Theoretically they were correct. As the British physician Robert Hill wrote:
in plain and distinct terms, that in a properly constructed building with a sufficient number of suitable attendants, restraint is never necessary, never justifiable, and always injurious, in all cases of Lunacy whatever. I assert the possibility of the total banishment of instruments of restraint, and all other cruelties whatsoever.
For those who practiced the system of non-restraint, the only excuse to use manacles stemmed from imperfections in the realization of the asylum utopia.
in plain and distinct terms, that in a properly constructed building with a sufficient number of suitable attendants, restraint is never necessary, never justifiable, and always injurious, in all cases of Lunacy whatever. I assert the possibility of the total banishment of instruments of restraint, and all other cruelties whatsoever.
For those who practiced the system of non-restraint, the only excuse to use manacles stemmed from imperfections in the realization of the asylum utopia.
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One mechanical restraint in particular exemplifies the contradictions and attempted humanity of control in the moral asylum: the Crib Bedstead.
The most quintessential crib bedstead was the Utica Crib, built in 1846 by Amariah Brigham, superintendent of the New York State Hospital in Utica. Brigham believed that a crib bedstead held the potential to bridge the gap between barbaric and humane restraint. Initially the Utica crib was a wooden box frame covered in lattice work with a lid that could be shut like a trunk. Brigham later removed the lattice work and replaced it with rungs similar to stair bannisters.
Largely because of Brigham’s influence, American moral therapists were quick to adopt the use of the bed. They argued that the necessity of such a device stemmed from the behavior of the asylum patients. Despite the attempts of moral therapy to treat patients with minimal to no restraint, physicians recorded cases of patients who refused to sleep, who would walk around at all hours of the day and night, and others who would smear feces on the walls at night when unsupervised. Still other patients would squat in the middle of the floor and refuse to move which could cause blood clots or extreme stiffening of the legs. The most violent patients would throw themselves against the walls of their rooms in an attempt to commit suicide. The Utica crib controlled this behavior while still providing patients with some freedom of motion. It was not a mechanical restraint in the sense that it physically bound a person, but it still restricted movement.
Not all physicians supported the use of the Utica crib. British superintendents condemned American asylums for using these beds. John Conolly, the father of the non-restraint system said that the Utica crib was:
an apparatus not only inhuman, but one which no person possessing a competent knowledge of the physiology of the brain and the pathology of insanity would venture to introduce into the wards of a lunatic asylum. |
Patients themselves gave mixed responses to their confinement in the beds. For Francis Delilez the crib represented different things at different times. Some nights it was simply a place to sleep. Other times he showed ownership of the crib by referring to it as “my crib.” When his insanity was particularly bad he believed that demons were after him and he viewed his crib-bed as a safe haven in which he could lock himself where no one could hurt him. And yet at other times the crib-bed represented a form of punishment. One evening he started singing, and believing that the Christ reincarnate (in another patient) encouraged his action, he continued singing even after attendants asked him to stop. When Francis would not stop singing the attendants threw him on the floor and “cruelly strangled him.” When they let go of his throat they set him in his crib-bed with the express purpose of using it as a punishment.
When the moral therapy movement began, physicians were reacting against centuries of abuse and neglect as they applied to the insane. It was therefore essential that their methods of curing insanity not resemble the dark, dirty cells of the eighteenth century. Confinement was incongruous with moral treatment. And yet, throughout the nineteenth century, the Utica crib was one of the most conspicuous and contentious items in a moral asylum. They represented the ambiguity surrounding the use of mechanical restraints. The reality of treating insanity pushed against the ideological notions of moral therapy to reveal that benevolent treatment was not always easy or possible.