Historical Use of Restraints at Eastern State Hospital
According to records from Eastern State Hospital, Lexington, Kentucky, there were several types of mechanical and environmental restraints used on patients. Some of these include camisoles, tying up patients, strong dresses, straitjackets, and the use of seclusion. The following data sample represents the years of 1937 and 1938. They will show the number of patients that were restrained, their gender, types of restraint used, and the number of hours.
Restraints Used at Eastern State Hospital for the Years 1937 and 1938
|Restraint Method||Female Patients|
| Male Patients|
|Tied in Bed||2||6||325|
|Total Combined Hours:||83,387.4|
Historical Types of Restraint Devices
The use of mechanical restraints on human beings has been practiced since before the medieval period. They are most notably recognized in restraining prisoners or those that have broken some law(s). In American society, the use of mechanical restraints precedes the official union of the United States as a country. In the 19th century the burgeoning field of psychiatric hospitals, known then as asylums for the insane, readily welcomed the use of mechanical and physical restraints on their patients. During the 19th and 20th centuries, insanity was often a matter for the American legal system to determine. In Kentucky, “the insane are committed by the inquest of a jury and by order of a court, their presence in open court being required, unless, upon the affidavit of two reputable physicians, it is shown that it would be dangerous to bring the supposed lunatic into court.” As such, asylum patients in the Commonwealth were referred to as “inmates.” Physicians knew extraordinarily little about psychiatric disorders and matters of the brain which only added to unnecessary treatments and restraining of patients. As time progressed, however, the scientific mind realized that the use of restraints was not only dangerous but antithetical to [then] emerging treatment theories and modalities.
If we take a quick trip back in time, we can quickly look at asylums and “madhouses” that erupted throughout Europe. This is likely where most of us get perceived notions about restraining psychiatric patients; these asylums warehoused psychiatric patients, many of them in shackles, chains, straitjackets, and cells. At the time it was believed that madness was incurable; as such, the typical regimen was to admit an individual in an asylum and their treatment modalities often included physical and mechanical restraints. Just remember that, historically, using the word “treatment” is parallel to a very unsteady vernacular. What we consider “treatment” in the 21st century is much different compared to what was generally accepted in the 19th century. With little understanding of insanity in the 19th century, the complete loss of one’s faculties essentially stripped them of their humanity, and they were no longer seen as any other functioning human being. Lower animals were (and still are) often caged away; seeing a human as a lower animal was not uncharacteristic of the time, unfortunately. An accepted belief was that one of the most primitive emotions we all share, even the insane, is that of fear. If fear could be instilled inculcated into the insane then, perhaps, they could overcome their madness, even if that came at a price of pain and suffering.
The Commonwealth of Kentucky, like most other states in the Union, was no stranger to employing mechanical restraints on psychiatric patients. In 1957, the superintendent of Eastern State Hospital, Dr. Logan Gragg opened the hospital doors to invite people in for tours and as a means to put on display some of the old equipment that was used to treat and restrain patients. One restraint was a metal ball-and-chain shackle that was used to restrain patients (or inmates) to always keep them on hospital grounds. Additionally, the use of leather restraints and various metal shackles and chains were used at all of Kentucky’s institutions, including straitjackets. By the middle of the 20th century, however, the use of mechanical restraints in Kentucky’s institutions slipped from quid pro quo to an outright violation of human rights. Somatic treatments, such as the use of medication and non-physical and mechanical restraining were utilized. Physical and mechanical restraints are strictly limited in psychiatric hospitals in Kentucky today.
Mechanical restraint can be defined as the use of a mechanical device, material, or equipment attached or adjacent to a patient’s body that the patient cannot easily remove but also restricts their range of movement thus limiting their freedom of movement and normal access to their body.
In 1950, Dr. Alfred Paul Bay, superintendent of the Manteno State Hospital in Illinois made a presentation to the Kentucky Welfare Association on the use of mechanical restraints for mental patients. Dr. Bay said, “The abuse of mechanical restraint is a symptom either apathy or ignorance on the one hand or of actual callousness with regard to the essential dignity of man on the other.” By this time the state of Illinois had banned the use of mechanical restraints on mental patients for about three decades, representing a growing change in the medical community nationwide. According to Dr. Bay, mechanical restraint is “rationally unsound, there is an instinctive resistance against any attempt to limit a person’s bodily movements. It does not prevent the overactivity of a patient; it merely postpones it.”
The Tranquilizing Chair
Developed by Dr. Benjamin Rush, the spinning tranquilizing chair required patients to be strapped in and with their eyes covered while the chair spun around in a circle. Based, in part, on the rotational theory, it was believed that spinning the patient in a controlled environment would help to reduce or eliminate congestion within the brain and, thus, curing mental illness.
Restraint Jacket/Waistcoat aka Straightjacket
The straitjacket was described in the 18th century by David Macbridge. Straitjackets were used to restrain patients but also as a treatment modality. The use of the straitjacket would grow out of favor in the United States for more moral approaches.
Made of canvas, this straitjacket buttoned up the front and had sleeveless side straps that allowed arms to be tied at the level of the waist. These were used on “unruly or violent” children.
A strong dress was worn by female patients and made of heavy cotton and materials that could not be easily ripped in order to protect patients from any self-injurious behaviors or from habitually removing their clothing.
Ball and Chain Restraint
The ball and chain restraint is most notably remembered for its use in prisons. However, psychiatric patients could be restrained on wards or when helping out on the grounds of the hospital property. Many hospitals had their own farms and patients would work them. The ‘ball’ portion typically weighed around 50 pounds and was used at Eastern State Hospital in Lexington, Kentucky.
Leather Restraint Harness
Leather restraint harnesses were popular in early insane asylums. The goal of the garment was to restrict the movements of the more violent or aggressive patients.
Coercion chairs or restraint chairs with basic leather waist restraints were used to keep “unruly” patients in a single location. It kept patients from wandering around.
Leather Belt and Manacle Restraint
These types of restraints allowed patients to be mobile but severely limited the range of motion of their hands. The goal of the garment was to restrict the movements of the more violent or aggressive patients.
Restraint collars were a bit different than other restraints in that they were to protect aggressive patients from biting or harming themselves or others. If used with manacles, it was reported that it essentially prevented self-injurious behaviors and aggressiveness towards others.
Restraining patients in a bed (referred to above as being “tied in bed”) using a standard bed sheet was applied to elderly patients and acutely agitated patients to keep them from self-injurious behaviors or those that were fall risks.
These blankets were both large and made of heavy, thick material. These were sometimes used on violent or suicidal patients. It also represented a shift to less cruel methods of restraining patients.
Physical and mechanical restraints are often used interchangeably. For purposes here, physical restraints have been differentiated from mechanical restraints. The latter involving devices, such as belts, vests, metal shackles, etc. Whereas physical restraint involves one person physically restraining another person, usually a psychiatric patient that is acutely agitated. The use of physically restraining a patient was, and still is, a controversial method. In the hospital setting, physically restraining an actively agitated patient poses danger to the hospital employee, patient, and potential patients or employees nearby.
Pictured below is an employee at Central State Hospital in Louisville, Kentucky attempting to physically restrain a female patient that attacked staff.
Sedative Drug Therapy
The middle of the 20th century meant that the collective scientific mind had all but done away with mechanical restraints (save for very few emergency instances) and turned almost exclusively toward chemical restraints. Essentially, actively agitated patients could be injected with a sedative drug, resulting in near-instant “calming” of the patient. This gave time for the patient to calm down as well as staff to collect themselves. Like with physical and mechanical restraints, some have argued that the use of chemical restraints goes back to quid pro quo in exchanging one bad vice for another. However, the use of chemical restraints was and still is closely monitored.
Pictured below, Donna Jackson, a Central State Hospital nurse, demonstrates the dispensing of tranquilizers for patients in 1962.
Other Restraint Methods
True to its name, seclusion can be defined as the confinement of a patient who is alone in a room or a specially designated area where the patient is physically prevented from leaving. In the early to mid-20th century, the use of seclusion rooms was common, and some patients could be confined to seclusion for days or longer. Though seclusion rooms are still used today, they are limited to emergency situations and only on the order of a physician along with regular checks on patients. There are also time limits in which a patient can remain in seclusion, usually no longer than a few hours.
It was believed that hydrotherapy could calm down the most acutely agitated patients or even lull insomniacs to sleep. Patients were placed in a bathtub with a continuous flow of warm water running over them. In some cases, the room was dark and there were often multiple tubs (with patients) in the same room. To provide a patient with some level of “privacy,” a fitted cover would go on top of the tub.
Contributed by Phil Tkacz & Shawn Logan | firstname.lastname@example.org
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