I’ve seen straitjackets used a couple of times but probably not in more than thirty years. I actually tried one on. All of us in our residency program did. This was to convince us that immobilizing people like that could only worsen their fear, anxiety and feelings of helplessness.
The intention of a straitjacket was to prevent the wearer from hurting self or others. The arms were immobilized, usually next to the chest, although they might also be fastened with the wearer's arms behind them. The wearer could still walk around and didn’t have to be restrained to a bed or wall this way. Of course, they could still run head first into a wall or person. Plus, circulation to the hands and arms could be so limited that the wearer experienced pain and swelling. Sometimes the damage resulted in losing the limb completely.
MEDICATION WASHOUT It was while in residency that I met David. He wore a straitjacket day after day and was also tied to a chair. The chair in turn was bolted to the floor and backed up to a tall wooden column that stretched to the high ceiling. This is where David watched the world, rocking the bolts loose from the floor, roaring unintelligible things and throwing himself against his restraints.
When David wasn't restrained he would tear through the ward knocking over fellow residents, attacking staff and destroying everything in his path. We did have medications that could slow down some of the worst behaviors, but his family had signed him up to try out a new treatment. When I met him, David was in a "washout" period. This meant that he received no new medications until any old drugs he had been given had "washed out" of his his system. Therefore he sat, tied down for weeks, helpless and agitated.
INFORMED CONSENT IN THE TREATMENT OF HUMAN SUBJECTS
In this day and age it's unlikely that David would be restrained in a straitjacket and literally tied to a chair for months at a time just to get him to a point where we could try an experimental drug on him. At the time, though, this could be done. The National Research Act of 1974 was the first law that laid down the rules for ethical treatment of human subjects. Today before someone agrees to a procedure, takes a medication or participates in a study regarding medication or procedures, he signs an “informed consent” form that outlines what he’s being treated for, alternatives to that treatment and potential side effects. All this is as a result of increased concern for human subjects. The law was in its infancy then, however. It had not yet become part of medicine’s conscience when I saw how David was treated. And getting studies on humans approved was still pretty easy.
ASSAULTING A PATIENT
One night I was there later than usual, sitting in the shadows. I could still see everything that was going on, but someone coming in would have had a hard time seeing me As I watched, an attendant in white, a thin, wiry man, sauntered toward David. Upon seeing him David began to bellow. He rocked so fast I was sure he'd pull the bolts from the floor and launch himself across the room.
Wiry Guy moved to where David couldn't see him. The bellowing became a roar. David strained against the leather straps. His face was purple. He threw himself back and forth with incredible force.
Then Wiry Guy leaned out from behind the column and gave the berserk David a long, sloppy kiss. A second later he licked David on his other cheek.
Others came running but by the time they arrived, Wiry Guy was talking soothingly to David. For his part, David continued to lunge against his restraints, bellowing and frothing at the mouth. “There’s something about this time of day that just don’t agree with ol' David. Maybe we should ask the docs to give him something so this don’t happen again. Poor guy."
NOT BELIEVING MY EYES
I didn't understand what I was seeing at first. It was as though my brain and my eyes were disconnected. Then it sank in. David was being emotionally tortured by a hospital employee.
I stood up and came out of the shadows toward the staff. “Hey doc,” the nurse asked. “Did you see what happened with David before he exploded like this?”
I nodded. “Yeah, I’ve been here for quite a while. I did see what was going on.”
There was an inquiry the next day, but no one ever saw Wiry Guy again. And when it was time for me to move on, David was still there, tied down, rocking and bellowing, just like he was when I got there.
Image of informed consent by: © Can Stock Photo Inc. /artursfot
Image of straitjacket by: © Can Stock Photo Inc. /nito