This is madness - Quaker perspectives on mental health?
I'd really appreciate if some of my Quaker blog readers would comment on this one - just give a perspective even if you're not an expert :)
I've just been reading Rob's recent post about the use of restraint in mental health settings. Seeing that I ultimately want to work in mental health, this is something that I'm very interested in.
Sometimes people who work in mental health are put in a position where they have to decide to physically restrain a person for their own safety and/or the safety of those around them. I've only ever had to restrain very small children (under 5) - which is not something I like doing, but on occasion I've had to. However, I think this is much easier to do than restraining adults. Firstly, as a woman I can restrain a very small child single handedly and I can do so very gently without the need for actual restraints and I never raise my voice when I'm doing it - I talk in nice motherly soothing tones and usually the kid will calm down, cry, say sorry and its all forgotten about, aside from the bruises I suffer as a result! :( Hmmmm - maybe I'm getting the raw deal here.
Restraining adults seems a different kettle of fish to me. Firstly, it may take more than one person, there may be strapping big men using their physical strength to intimidate a patient, it may involve the use of physical restraints and sadly, I've had to listen to people who work in the field recount their experiences in such ways that are dehumanising to the patient. I'm uncomfortable with the use of restraint, but reluctantly I have to admit that I can see situations in which it may be necessary in order to protect the safety of a person and those around them.
I wondered what Quakers thought about this - given our commitment to non-violence. I had a look in Faith and Practice but found absolutely nothing about mental health treatment. (Friends - maybe we should write more!)
I know from the early days Friends have been concerned about the treatment of the mentally ill. George Fox (our founder) wrote, "frends doe seeke some place convenient…wherein they may put any person that may be distracted or troubled in minde." .
Friends hospital in Philadelphia have an interesting account of their early days where they seemed to have cottoned on to some wonderful principles that are only now being recognised in mainstream mental health practice. (As ever, the Quakers were well beyond their time - I feel really quite proud!)
Believing that all people have that of God within them, Friends working in mental health have put an emphasis on the humanity and worth of patients, no matter how erratic and unreasonable their behaviour may be. Friends asylum staff were encouraged to, "cherish every ray of returning reason" and above all to treat patients as "brethren and men". It seems they did use restraint as necessary, but with compassion and aiming to respect the dignity of the individual rather than to over power and subdue them.
"We placed the hand straps on her just on going to bed, and removed them this morning, but finding the buckles had marked the skin, we proposed substituting the sleeves and have chosen the softest pair for the purpose." (Bonsall)
"The clanking of chains, and the noise of the whip are no longer heard in their cells. They now taste of the blessings of air, and light, and motion in pleasant and shaded walks in summer, and in spacious entrees warmed by stoves in winter… protected from the eye of visitors. In consequence of these advantages, they have recovered the human figure, and with it their long forgotten relationship to their friends and the public." - (Benjamin Rush)
The old mental health institutions were cruel places - where the mentally ill were written off and often treated as prisoners. Thank God, times have moved on - but mental health staff have a tough job to do, and the temptation to dehumanise is always there. In our frustrations and stress, we must always remember the humanity of those we treat and offer love, kindness and compassion to them - aiming to respect their privacy, their humanity and their freedom.
Where we use restraint, I think we need to find ways of doing so calmly, without intimidation and with compassion and even gentleness.
Any more perspectives - Quakerly or otherwise?
posted by Ruthie @ 4:00 PM
5 comments
5 Comments:
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A few years ago I heard a talk by a Friend named Asa Watkins, who was a conscientious objector in World War II and was assigned to work in a mental hospital. He and some of the other CO's objected stenously to some of the methods then in use to restrain patients and - if I remember correctly - succeeded in forcing some changes in the hospital's practices. Asa has now died, but there may be other Friends from that era who know something of the impact CO's had on treatment of mentally ill people. Whether anyone has written about it, I don't know.
Generally speaking, I think Friends (and decent people in general) should look for the kindest and gentlest available ways to respond to violent behavior. One element of kindness is creating safety for the the patient and for others in the vicinity. If that does require restraint, then I don't think Quakerism offers any reason to shrink from using it. The trick, of course, is for the care-giver who may be understandably frightened, frustrated or angry to know the difference between using restraint as a necessary step in creating kindness and using restraint as an outlet for those angry feelings without regard for the welfare of the patient.
"Violence" in the sense of strenuous and forceful behavior is not a concept directly addressed by the Peace Testimony, at least as I see it. Jesus' driving the moneychangers out of the temple by flourishing his whip of cords may have been "violent" in our terms, but it doesn't appear to me that He was trying to harm or kill anyone. His concern was for the holiness of the temple and perhaps for those whose piety was being exploited by profit-seekers. I can't imagine that Friends ever thought this demonstration was a violation of the peace testimony.
In the twentieth century some Roman Catholic pacifists - notably Dan and Phil Berrigan - forced their way into draft boards, seized documents, and either poured blood on them or burned them as a protest against the War in Vietnam. This, too, is within the bounds of peaceable behavior as I understand it, and not an act that would be contrary to the Peace Testimony. (Whether it was a good idea is another question).
Friend Newton Garver, a professor at SUNY Buffalo and prominent member of New York Yearly Meeting, has written some interesting things about what violence is. His definition of real violence is both broader and narrower than the usual ones. In his thinking, violence would include things like forcing people to live in poverty by cutting off their opportunities even if no physical force were involved. On the other hand, it might not include things like symbolic destruction of property. The defining characteristic of violence in Newton's thought,as I understand it, is that violence is a violation of someone's personhood. He wrote about this concept in the days urban riots against racism in the U.S. and was seen by some (incorrectly, I think) as defending the riots. He wrote somewhere of hearing that a philosophy class who studied his article assumed he was a black militant (He is actually a white guy and might be called a pacifist militant, but has never to my knowledge been seen in a dashiki; I recommend looking him up on google or in a library).
So my basic point is that bearing witness to the power that takes away the occasion of war is our peace testimony. Always being gentle and nice and non-confrontational is something else.
5:29 PM
Rich in Brooklyn says it better than I could have and I agree with him. Restraint is necessary at times, in fact, without it someone may do harm to themselves, harm they would most likely regret after their episode passed.
Friends have had a long history of treating patients and prisioners in humane and novel ways. Sometimes they failed miserably, but because of their willingness to find a different way, institutions changed.
Care is a dual thing - you cannot really have compassion for others if you don't also have some regard for yourself too. It's a distorted selflessness that doesn't take account of your own wellbeing as well as those you care for. I think this needs to be bourne in mind, in case a sense of nobility makes you consider it unloving to prevent someone from harming you.
My younger brother Nathan probably has mild ADHD. Sometimes he plays with me in such a violently physical way that I have to physically stop him from unthinkingly hurting me. I try not to de-humanise him along the way, but have no scruples about holding him against his will. I suppose I'd be careful about too strong a dilineation between childhood and adulthood in these ethics, in physical and mental senses, given the variety of people you come across...
thanks for your thoughts ruthie. for those of you who don't know me, it was my post from 14/2/5 that was referred to.
a good example is perhaps from my oncall last night - i was asked to see a guy with brain damage after a recent head injury who had no concept at all that his intellect was not what it was a week ago. it may well settle, but right now he has major defecits in his ability to keep himself safe. i would have been justified in detaining him, however this would probably have involved the use of restraint. instead he went home and i am arrangeing someone to see him today.
i was able to do this because i am only concerned about him on a day to day basis not an hour to hour or minute to minute one. had he been more immediately at risk, i think i would have had to put his safety above his (impaired) decision making - this has to be my decision on the spot and it's not one i like making, but i liked what rich said about "decent people in general" looking for the kindest solution and trusting their judgement if this involves restraint.
Rob
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