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Psychiatric Restraints: Physical and FigurativeMichael W. Adamowicz, LICSW Updated: Sep 25th 2009Some years ago, I was running errands in Providence and North Providence. Much like today, it was an unusually hot, humid Fall day. Eventually, I got hungry and thirsty. I remembered an Italian bakery in the area. It was in a rundown neighborhood but had great calzones. I drove to it.
Once inside, I took my place in line at the counter. There were around twenty people in the bakery. Some, like me were in line; others ate at small tables.
 Out of the corner of my eye, I saw a neatly dressed, cute, young black girl walking toward me. She was maybe 8 or 9 years old. I didn't recognize her and wondered why she was looking at me.
She walked right up to me. In a clear, matter-of-fact voice, she said "You're the man who grabbed me and held me on the floor at the hospital!"
It felt like everything stopped in the bakery and all eyes turned on me.
The girl was right, of course. I remembered her as soon as she said that I had restrained her. Her statement was a fair representation of what had happened.
That didn't help my situation much. A pretty, young girl, with no malice, had just introduced me to the patrons and staff of the bakery as the man who grabbed her and held her down on the floor.
My hair is long and runs 3/4 of the way down my back. That morning, I was in a rush. I hadn't taken the time to make it into a ponytail. I was in the process of renovating my house and was dressed in torn sweat pants and a grungy t-shirt. I was unshaven and sweating in the heat of the day. In short, I looked pretty much like a mess. That day I was more interested in running errands and working on the house than in making good first impressions.
Given what the girl said to me and my appearance, I couldn't really blame anybody in the bakery if they thought I was a dangerous creep.
I squatted down a bit to get more towards eye-level with the girl. I asked her how she was since the last time we met. She told me that she felt a little happier. I asked if the hospital had helped her and she said not really. I said that I was glad to see her and hoped that things got better for her. We spoke for a few more moments.
By then it was my turn to order. I got a coke and a calzone. I got it to go instead of eating at one of their tables.
Let me offer a little bit of history. I worked in a psychiatric hospital for about 15 years and much of that was spent in the emergency room, or patient assessment service as it is now called. This girl was brought in for an evaluation. I did the initial assessment of her. At the end, she asked me if I thought she needed to be there. I said that I thought the hospital could help her. She did not like that response and tried to elope from the evaluation room. The room that we were in had doors that opened to a hallway and to the ambulance entrance. To stop her, I restrained her until other staff came and helped.
The girl was quickly admitted to the hospital and I did not see her again until maybe a year later in the bakery.
As part of my duties at that hospital and in various other of my jobs, I have been in more restraints than I can now count. While not commonplace, restraints happened with regularity. Usually, I did not think much about them afterward. To my knowledge, none of people I restrained was ever physically injured. I got hurt only twice. Except for those two instances, I didn't see much point in thinking about the restraints after they were over. Although I will admit that for years, I watched my rearview mirror on the drive home, sat facing the entrance in restaurants, and took similar precautions. A fair number of people that I restrained or was involved in involuntarily hospitalizing made threats about what they planned to do once they left the hospital.
Clearly, this girl had a different attitude about the restraint. She was frightened, in a strange place against her will. The hospital was filled with strangers and she only wanted to go home. I physically stopped her from that. I can't say for sure, but I believe it was the first time any professional had ever restrained her. So, for her, the event was unique, novel and wholly unwanted.
And that's how she remembered me. I was the guy who grabbed her and held her on the floor in the hospital. She wasn't angry with me. I don't think she held a grudge because we chatted fairly easily for a few moments in the bakery. Yet it seems fair to say that she didn't think I was a nice person.
She did not remember me as the clinician who spent an hour gently talking with her about her life. For her, I was not the man who suggested that the hospital could keep her safe and help her to feel better. Her memory of me was not one of jointly finding her strengths and trying to build her sense of self-confidence and optimism. All that is, however, what I remember of the time we spent together in the hospital's ER.
In the bakery, I was in a strange place filled with strangers. She seemed quite at ease there. Maybe she lived in the neighborhood. I guessed so at the time because she was not accompanied by an adult. When she said that I had grabbed her, I felt ashamed, embarrassed and afraid. I did not know how the other people in the bakery would react. I feared a scene or worse. In addition, I felt badly because she seemed not to understand my situation in the bakery or at the hospital. I greatly wanted to turn and run out of there.
All in all, this was a very neat reversal of positions, courtesy of fate.
A number of years ago, the hospital made a policy that all restraints are reviewed with the patients once they become safe. But that could be done by staff that were on a different shift and had only second hand information about the restraint. I never reviewed that restraint with the young girl. She was sent to the children's unit and I assume staff went over the event with her some time later. However, only she and I knew firsthand what happened in the room. Just the two of us knew the emotional bond that formed during the hour-long evaluation and was ruptured by the restraint.
Her memory of me remained as the guy who grabbed her and put her on the floor.
As I say, I left the hospital several years ago. I have no knowledge of their current policies on helping patients process being restrained. Perhaps they have included at least one of the staff actually in the restraint into the review with the patient. That would be a good thing, I think.
Why does this memory surface again now? There is no chance that I am aware of that I'll be in a restraint any time soon. I don't think it's because it's a similarly hot and humid day in early Fall. I do know that I am about to use a different type of coercion with a current patient. That's something that I don't like to do at all. However, I can't come up with another option to keep him safe. Perhaps this memory has come to try to help me see my plan from his perspective. Alternatively, maybe I've been in a position of power with somebody else recently and pushed it too quickly out of awareness. Whatever event that was, the memory could be prompting me to pay more attention to it. I'm not sure at the moment.
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Michael W. Adamowicz, LICSW provides evidence-based psychotherapy to teens, adults, and couples in the Rhode Island and southern Massachusetts areas. Call him at 401-264-0004 to schedule an appointment. View his website here, or read his blog here