Date of Award
Medical Doctor (MD)
The Evolution of Restraint in American Psychiatry
Author: Danilo Rojas-Velasquez
In psychiatry, restraint generally refers to direct methods such as mechanical restraints or the use of drugs. Despite psychiatrists’ best efforts to utilize restraint judiciously, many patients still view it as the field’s defining feature, especially on inpatient units with involuntary commitment, medications against will, and locked doors. This essay is an attempt to understand the pervasiveness of restraint in psychiatry. It uses changes in the practices of restraint to examine the growth of the field over time. To accomplish this, the paper identifies three distinct regimes of restraint: the moral treatment of the 1800s, associated with the asylum; the somatic treatment of the early 1900s, associated with psychosurgery; and the pharmaceutical treatment of the later 1900s, associated with pills. The essay analyzes primary sources drawn from the scientific and psychiatric literature of each period, in addition to marketing materials. It also examines the work of prominent figures associated with each regime, including Samuel Tuke, Clifford Beers, and Walter Freeman. The paper engages the work of a range of historians of psychiatry, including David Rothman, Michel Foucalt, Andrew Scull, and David Herzberg. Two major conclusions are drawn. First, restraint evolved from the physical form seen in madhouses to self-restraint first seen in the early asylum. The role of the psychiatrist followed this evolution, as the psychiatrist increasingly became the figure to help patients achieve self-restraint. Secondly, because psychiatrists became the judges of how much self-restraint is acceptable, they have come into conflict with society during periods of change, which contributes to the stigma and backlash against psychiatric practice.
Rojas-Velasquez, Danilo Alejandro, "The Evolution Of Restraint In American Psychiatry" (2017). Yale Medicine Thesis Digital Library. 2167.