restraint and seclusion: torture, not “treatment”



opening doors 1

 

We ran a series of posts the last few days on the effects of isolating people , and depriving them of sensory stimulation.

We propose that anyone – without exception would be tested by being forcibly kept in a cell alone.  It is not the case that it could never happen to you – but simply a question of how long would you last?

If you choose to believe its all down to brain chemicals, then by all means maintain that delusion, but you may want to check your meds.


If it looks like a duck…

Services call it “treatment” but it looks like torture.

The same methods sometimes used to “de-escalate” patients are also used as torture – when captors think they can get away with it. As security services well know, torture has a low efficacy when it comes to garnering intelligence but can a very be powerful way to exert power and induce compliance or cooperation in captives: it is about exerting power to gain control. Yet even security services do not call their methods “treatment” the way that hospitals do.

In some countries laws and hospital policies offer the same protection to those who would torture psychiatric patients as is provided by rogue states [and non-states like Guantanamo]  to those who would torture their targets. 

What’s the difference? Whereas one happens in far flung places beyond the reach of parliamentary democracy – the other is happening, and very likely right now and in your city, in the name of “treatment” and  “healthcare”.

And, yes, before you say its not the same thing: it may not be exactly the same,  but the effect is and, we’d argue, intentionally so. The biggest difference may be that one is more honest than the other.

Seclusion – forcible isolation and confinement – is not treatment.
Restraint – forcibly, violently strapping a person down so that all they can do is scream, is never treatment.

Both courses of action reliably give rise to the very “symptoms” they claim to control. 
We don’t do it to other mammals – we even have laws to prevent it – why do we do it to humans?

Even if we do think its justifiable on occasion, when we do it why do we insist on calling it ‘treatment’? Rationalising torture in the name of healthcare can never  justify torture – it simply diminishes both the “heath” and the “care” in “healthcare”.

Even the UN’s Special Rapporteur has declared that such practices are  “torture” and a breach of human rights.

Torture_in_Healthcare_Publication – UN Special Rapporteur

 

The Right to be safe at work is not the right to torture patients

People who work in services have a right to be safe, and there are cases to be made for using force some times but would it not be better to focus on equiping those workers with skills to deal with situations in different ways so that force is never needed? surely better for everyone involved.

“They need the drugs so I can feel safe [at work]” – hospital worker.

This quote is from a worker, who like many found themselves in difficult situations and likely is not alone in thinking what’s expressed. It is a difficult place to be. It is also  a reasonable question to ask: in such situations,  who exactly needs the drugs?

Like in any other field of employment, if people don’t have the skills necessary to work they can reasonably expect, demand, to be offered opportunities to learn those skills – and, if  they remain unable to perform,  encouraged to leave. 

If the only way I can feel safe at work is by forcing “treatment” on others then I really need to find alternative employment.

And to Unions – where are YOU? why are you silent and complicit too? Grow a pair eh?

Torturing the most vulnerable people in our society
Research shows the majority of people diagnosed with sever mental illnesses have lived a life of oppression and violence and the some of the worst forms of abuse by others. It is time every worker in our health services took a stand to stop dishing out yet more violence and abuse to some of the most vulnerable people in our society.

Opening Doors 

But what to do?

Here’s a start…  a video from a project in Aotearoa/NZ – an educational programme for workers hoping to offer understanding of the impact of violent ways of controlling patients – and some skills that enable people to work in different ways.

Its 29mins long. We suggest that secluding yourself to watch it, and  better yet watching it with colleagues, might just be the most productive 29 mins of your week.

 

Opening Doors is a training resource developed by Awareness: Canterbury Action on Mental Health and Addictions to help people working in the mental health sector understand the impact of seclusion on all those involved. The intention is to encourage the use of alternatives, so that mental health inpatient seclusion — leaving a distressed or agitated person locked in a bare room, alone — can become a thing of the past.

more
http://www.mentalhealth.org.nz/page/1309-opening-doors

 

Related

 

Brian Keenan – Music https://recoverynetworktoronto.wordpress.com/2014/05/22/brian-keenan-music/

Total Isolation                   https://recoverynetworktoronto.wordpress.com/2014/05/21/total-isolation/

How Isolation Warps The Mind https://recoverynetworktoronto.wordpress.com/2014/05/16/how-isolation-warps-the-mind/

If it’s forced it’s not “treatment” https://recoverynetworktoronto.wordpress.com/2014/02/11/if-its-forced-its-not-treatment/

 

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We believe people can and do recover from "mental illness" - because we are living it. We believe in the power of supporting each other: learning from and with each other. You are welcome to join us..
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9 Responses to restraint and seclusion: torture, not “treatment”

  1. Egan Bidois says:

    Kia ora Kevin,

    Great to see you spreading the message far and wide.

    Seclusion is an admission that the system has run out of options. If anything it is an admission of failure.

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  2. Hi Loreen, that’s not what I said, certainly not what it meant.
    you have your view and every right to it, others who have been in similar situations [and on both sides as it were of such treatment] have theirs and think it is possible and have shown it to be so.

    As I have said to you I believe the sickness or deficit is not with individuals but in society – and our collective inability to support people in distress.

    Regardless of how long it takes I refuse to believe that giving up is a worthwhile goal.

    and, meanwhile, like the article says – even it is ocassionally deemed necessary -like in circumstances you illustrate- to call it “treatment” will remain a veritable pox on all our houses.

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    • Loreen Lee says:

      True, especially is that is the crux of the matter, it is indeed a euphemism, and thus hides the reality of the situation. But what is the ‘reality’. I don’t think that those involved in presenting their situation did so within a perspective, which would ‘see’ the effect of their actions on others within their immediate environment. For instance, the chap who was putting into practice a religious method for overcoming his psychological state, described what was happening, (to my interpretation) as expressing perhaps difficult emotions, and within a ‘loud’ expression. Perhaps he was unaware of the effect he might be having on others. Perhaps in his ‘illness’, this therapy he had chosen was in effect an acting out or something. We are only given the situation from the perspective of those who were victimized by the ‘treatment’. I could outline other alternative interpretations regarding the other examples in the video as well.
      From hopefully a neutral perspective, I could understand that the staff would feel it necessary to put a stop to any ‘violent’ outburst, religious or not. My description of the behavior of the Buddhist aspirant for instance certainly revealed a propensity and attempt at self-harm. I have witnessed many other such outbursts, and have seen how they effect others patients. It is such ‘disturbances’ that generally precede the ‘treatment’ of the person considered, usually because of a ‘perceived’ need to ‘isolate’ the disturbance, and remove the source of possible imitation by the others. Please understand that I have witnessed mental health incidents that are not usually seen within the context of social engagement. The situations I have witnessed I would consider as lacking in stability, with the possibility of many the lack of control getting out of hand, so to speak. They have to be dealt with, I maintain, with hopefully quiet efficiency. However, I certainly do not ‘like the way’ these people are ‘treated’ but I can’t suggest another word to replace the euphemism. This inability suggests to me that a solution is not immediately forthcoming, as it demonstrates little understanding as to ‘what’ is ‘really’ happening.

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    • Loreen Lee says:

      P.S. I have also never seen examples of the ‘torture’ inflicted on ‘inmates’ as portrayed in several of the videos you showed. Isolation generally lasts for several hours, that is, or until the person ‘quiets down’. There are always reading facilities available, and the holding rooms, could not be described as ‘unbearably’ uncomfortable. When in solitary confinement, I was also taken for regular outdoor breaks on the roof of the building, and I had access to shower, etc. Just my experience. I’m glad we live in Canada.

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    • Indeed.

      Yet also, I know people who have, whilst in hospital for treatment, been forcibly held in seclusion for days, weeks, even months and not treated as you describe… and yes in Canada too.

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  3. Loreen Lee says:

    I will say it again. I spent about three months or more in what was called ‘solitary confinement’ – not ‘seclusion’, and I felt at the time that it was the best alternative available to me. I was actually quite fearful of what was happening ‘on the range’, (it’s called) and was surprised when the guards finally returned me to my ‘cell’, that I was welcomed back and that the inmate who had been ‘put in charge’ was friendly with me.
    The stories I heard expressed in the video I watched did not surprise me at all. This is the same argument against seclusion and restraints that was being argued twenty-twenty-five years ago. Indeed, I felt that my own personal experience would be just as ‘valuable’ and as it was ‘my own’ real life experience, felt that my experience would have as much cognancy as I expected others would find within those who told of their own experience in the video. But it seems that my experience is not being accepted as ‘valid’. I have long ago ‘outgrown’ my ‘victimization’ mentality that is very often a significant aspect of those of us who have been/are designated to be ‘mentally ill’. I found that victim mentality evident in some cases among those telling their stories in the video. We have to outgrow this, if we are to become well..
    I have merely made the point that there ARE EXTREME SITUATIONS, comparable to such experiences outside of institutions where people find they need to ‘call the cops’. The actions of many persons that I met when incarcerated were, I repeat, very frightening, indeed far more frightening than I found my own placement ‘in seclusion’ to be. Indeed the time I was put ‘in seclusion’ before the murderers decided to adopt me and give me their protection, was justifiably very disturbing to me, for reasons which I am sure you understand now. My ‘anger’ at being placed in seclusion, was thus related to once again being considered the cause of the disturbance, and thus putting on me the ‘blame’, for the ‘low life’ who was ‘disturbing me’ was not placed in any confinement, nor given any punishment.

    This brings up the major contradiction with this article, a point only merely brought up, and referred to obliquely, within the video. That is: the lack of communication that is real in the context of any therapy given to the mentally ill. That is part of the environment that is not placed within the purview of those watching this video. If there was more dialogue generally, and more knowledge about the specific issues of each individual, this might indeed reduce the need for ‘seclusion’ in the case of emergencies. The difficulty however, is that I suspect that most ‘mental health patients’, might be like I was: that is unable to identify the ‘real’ root of the problem. That was, as we discussed in the cafe, the journey of mental illness itself. And in some cases, having the silence to attempt to come to grips with one’s ‘inner dynamic’, might actually be a beneficial aspect of seclusion. I’m not attempting to distract from the ‘truth’ of what is said by people who are pushing for general change, but merely to point out that this is but one factor among many that need to be addressed. And as long as the bigger issues are not met, I believe there will remain a ‘need’ (particularly in ’emergencies’) for seclusion.

    If you don’t want to grant that ‘my story’ has ‘some’ validity. That’s fine. I really don’t need your support or the support of any one else. I feel quite confident that I have a very ‘realistic’ perspective regarding my own experience, and that of others ‘incarcerated’. I also believe I have an excellent philosophy with respect to my situation ‘within the world’. Thank you.

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  4. Loreen Lee says:

    Although I agree that there can be many cases in which such ‘treatment’ is not necessary, I have also seen behaviors in which I would suggest some form of restraint is necessary. I shall give a few examples: a gentleman who was so ‘upset’ that he was throwing (literally) furniture around the common areas, broke a few chairs, and had attacked a couple of patients viscerally; a gentleman who was so ‘upset’ and immersed in his interpretation of Buddhist principles, that his incoherence was justified by the Buddhist monk accompanying him, as not being related to Buddhism per se. He was, I believe, in danger of self-harm. These are merely two of many situations that I have witnessed.
    I was also detained in Psychiatric seclusion when I became upset, however, and perhaps because it was happening to me, I could see no justification for such ‘treatment’. I endured the isolation cell for a couple of hours, until it was decided that I had recovered sufficiently to be released. As this happened in the facility that housed people under forensic examination, I was fortunate enough that this situation drew the attention of a couple of murderers to my side of the fence, and I was invited to eat with them, and spend time with them. This was indeed the preferable community to belong to within the detention center. The murderers it turned out were the most hospital persons I could have encountered. I was glad to become a member of their club. It prevented further upsets by ‘low-life’s’ on minor charges who were sexually ‘provocative’. In the company of the murderers I no longer had any reason to get upset and nothing to ‘fear’..
    Another story. While in the West Detention Center for the longer sentence, I ran across some competition over which inmates would be the ruling authority on the range. (Indeed, the rule of law is generally from within, and the guards acknowledge this reality, and conform to the law as being laid down by the persons in charge.) To avoid what was happening, when I found myself again in seclusion for another upset, I decided that I was much better off in solitary, and indeed they had to finally force me to leave. I regretted having to give up my reading time. I was right in the middle of a book about a person being detained as a pow in the Korean war. I was learning much from the comparison.
    Further to our conversation this morning, Although my experience reflects the ‘state of the union’ as it was about twenty- twenty-five years ago, I reiterate that progress is made with minor changes both for the better and the worse. The sexual harrassment issue would be treated differently today. The diagnosis of PTS would be considered more frequently. Indeed, as the situation I was involved in was due to the ‘triggering mechanism’ of the ‘Perceived’ sexual harassment of professors, (I say perceived as to this date I have no ‘proof’) I was indeed one of the ignorant regarding what were the causes, etc. of what I was experiencing. Indeed, as I mentioned to you, even within a situation in which I could have confronted a certain ‘professor’ with things that he said, I was not able to do so. Not only did I feel when it came right down to it, that I would not be believed, but I was also fearful that it would be just another example given to the courts and the psychiatric ‘industry’ of the extent of my paranoia. I just did not have the ability to ‘defend’ myself and act as my own lawyer. I did not have the courage to ‘speak up’ at a critical time even when that was my intention in defending myself., –but I sure made a lot of phone calls registering my disatisfation with the whole situation (grin grin!!!!) Enough on me. Merely to say that I do not see that there will be an ending to all cases of seclusion or restraint.

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    • Hi Loreen.
      There are those who have been in the kind of situations you describe who think and have demonstrated that there are always other ways – see the video.
      it will take time – until then calling it “treatment” will remain a pox on all of humanity and on healthcare especially.
      time this patient [ie services] gained insight into its own deficits and its own violent nature.

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