Restrained in Psychiatric Hospitals Hundreds of Times: Here’s What I Learned
My body has not been touched without my consent for two months. To some, this may seem like an odd statistic — who keeps track of something like that? But for me, those two months mean absolutely everything.
For the past five years, I have consistently experienced the right to control over my body being taken away in the name of my own safety — by which I mean, I have experienced hundreds of physical and chemical restraints in a psychiatric setting, and my psyche is completely changed for it.
I had my first restraint at 15. I was in an eating disorder inpatient program and had been refusing to accept a feeding tube, which was to be used to make up for the calories I was refusing to consume. I had grown up in an abusive home, and unexpected touch was something I was wary of. I can recall the incident well. Three female nurses, and one male counselor, dragged me out of the corner I was hiding in, lifted me into the air and dropped me on my bed. I immediately began to fight, scratching and kicking to the point that my sweatpants fell down. I had taken my hair and used it to cover my nose, aiming to not let them get the tube up it. Eventually, it became clear that it would take a lot more people and force to get me settled, and they elected to let me go. I lay there, in a full-fledged panic attack, as a nurse put a damp cloth on my forehead. I was crying, scared, confused. I blamed myself for putting my body in that situation and felt bad about the fact that I had possibly hurt the staff involved.
I experienced two more restraints that particular admission, both physical holds, though one involved an intramuscular injection (IM) which is otherwise known as chemical sedation — or, if you know your psych ward lingo, “booty juice.” But that would not be the end of it.
The next hospital in which I interacted with restraints added a new element: mechanicals. There are several types of mechanical restraints; most common are what are called “points,” which is a fancy term for straps that are tied around the wrists and ankles and secured to a bed, effectively immobilizing the patient. In this particular hospital, however, they used boards. A restraint board is a flat, plastic plank, with straps attached that staff tie the patient down with. I would be “on the board” many times at this hospital, but the first occasion was because I had attempted suicide. My plan was not well thought through, considering I was on a one-to-one (1:1) which is a counselor specifically assigned to be within arm’s length of me at all times. This particular 1:1 shouted for staff, and before I knew it, I was pinned down with a man narrating what he was doing to trainees. My body was a teaching tool. I felt absolutely dehumanized and irrelevant besides my apparent worth as an object to explain the unexplainable.
Over the years, I would accumulate restraints the way one would books. Each time held a story, and an immeasurable amount of pain, struggle and profound loss. As time passed, I began to accept that I did not have consent over what my body did. Self-injurious behaviors were so ingrained in my daily life that the idea of getting ambushed by six or more people as I screamed seemed … normal. I was utterly desensitized to what was considered legal, justifiable assault.
Things came to a head, however, when I turned 19. I was admitted back to the same hospital I had been in at the time of my first hold, and my health was in the worst state it had ever been in both physically and mentally. My anorexia nervosa had gotten to the point that I was medically compromised. My self-harm was at an all-time high, and before admission, I frequently had interactions with the police having to intervene to stop me from seriously injuring, or at times killing, myself. Things did not improve once I got to the hospital. I was dangerous to both myself and others, becoming assaultive when touched. Although I was easily able to accept my autonomy being out of my hands, that did not mean I wasn’t going to struggle every second of the way. I sent staff to urgent care, at one point breaking a nurse’s finger.
About four months into this stay, I stopped eating completely. I already was legally committed to that hospital under a section, meaning I could not sign out and had no consent over what medications I took. Because my health was rapidly declining, my team took this a step further: they petitioned the court to be able to force-feed me. They won.
Being force-fed in a psychiatric hospital is arguably the most traumatizing type of restraint out there. I was first secured on my bed — sometimes after being dragged down a hallway — pinned down by at least four staff members, with about seven in the room in total. I was then tied down and had one person on each limb in order to prevent me from thrashing and disrupting the process of inserting the feeding tube. At this point, I would shove my face into my shoulder and use all of my strength to keep it there. However, I was no match for a crowd of people trained to do exactly this task, and someone would grab my head and yank it out of my arm, then push it down into the mattress, giving unbarred access to my face. Once my entire body was immobile, a nurse would come towards me and push the tube down my nose and into my stomach. At times I would attempt to stop the tube from going down by refusing to swallow, and the nurse would jerk the tube up and down in my throat to force me to swallow.
Once the placement was checked, and the feed was flowing, I was left there. For hours. Someone sat in a chair at the edge of my bed, and a nurse took my vitals and checked the ties every 15 minutes. But I was largely left to lie there and listen to the sound of nutrients being pumped into my body — the last thing I wanted.
I have been restrained to have all of my clothes cut off. I have been forcibly dressed in a shower multiple times, only to be carried into my room and tied down from there. I have been dragged out of rooms in front of my peers, handcuffed by cops, carried down halls, frequently had a strap tied under my chest to prevent me from sitting up and harming myself or others, and have fought so hard I have become naked from the bottom down in front of several males with no one bothering to give me enough dignity and cover me up.
I do not blame the people who did this. I was extremely vicious in my self-injurious behaviors. The counselors and nurses that held me were doing so only because they believed I was putting myself in immediate danger, and that they couldn’t not intervene. I have spoken to mental health workers about what it is like to watch a patient doing the things I did. I understand that not intervening when someone is being so violent toward themselves is near impossible. But regardless, there needs to be conversation in the realm of psychology about the long-term effects of using force to keep someone from hurting others or themselves.
2019, when I was being restrained on a daily basis, versus 2020, restraint-free for two months.
From my perspective, I think restraints are necessary. Though I believe de-escalation tactics could be used more appropriately, I can only think of a few in the many times I have been held that were unjustified. I do not think the conversation is whether or not restraints should exist in hospitals, but what the process of prevention and aftercare should be. I found that I felt more alone and traumatized when no one bothered to talk to me while I was getting restrained, when tied down, and after being released. Something that made holds significantly less scary is when people would respond to my screaming. If I yelled, “stop touching me,” hearing a staff member say, “It’s OK. Calm down, you’re OK Katy,” gave me the sense that I was not invisible, that people were listening — and at times that allowed me to regulate quicker. I almost always close my eyes during crises, so someone telling me what specific people were doing was also helpful. The issue with this, however, is that staff are specifically trained to not do this because the rhetoric goes that patients will associate being restrained with comfort and positive attention. While I both see and at times agree with that logic, I don’t believe ignoring a patient crying out for someone to hear them is the right answer.
Psych wards are notoriously understaffed and underfunded, which often means most patients are not getting the time they need to work on their issues — there simply aren’t enough staff to go around. I have been very blessed to have had good experiences with staff, though this perhaps only came about because my issues were so severe and imminent. A viable solution to minimizing restraints is having patients feel comfortable talking to staff as they get agitated, and this will not happen if they don’t have a relationship with that nurse or counselor — which will never occur if hospitals are continuously understaffed. But restraint prevention comes in many other, more subtle ways. Having safe, quiet space clients can go is a must. Making rules and expectations clear can also affect the number of holds occurring.
To be quite honest, however, I don’t know how much could have been done to prevent my own restraints. I was determined to harm myself, and I would fight till the very end. That will to die is only overcome with intense therapy and time, and in the meantime, both I and the people around me had to be kept safe. The most successful holds I have been involved in had an element of choice. While this may seem backward, the concept is rather simple: while I did not have control over my body, I had control over my decisions. I had the option to calm down. I had the right to choose if I would take medication orally by choice or with force by IM. The time it took the restraints to come off was decided by my own behavior. A system I think is particularly effective, albeit annoying, is that of releasing one limb at a time. The patient gets to decide if they want an ankle or an arm released, and after a certain period of time, all restraints are removed. This allows both the patient the right to control which of their appendages they want free, and gives the nurse power to choose when each tie comes off.
I have also found it helpful when the incident was discussed with me following release. Sitting down with someone who was there, and expressing my feelings and thoughts, was a productive way to figure out what had triggered the event and what things both the staff and I could have done differently. It was almost always productive. Going over possible skills I could utilize in the future if feeling the same way would lead to me using those tools in upcoming situations — in fact, I still use them. This discussion also made me feel like I was considered a person, and that the restraint had not been an easy thing for the staff involved either.
I think an important marker for psych staff in terms of patient safety is how they react in these types of crises. No one should ever be jaded enough to be “used to” taking someone’s right to their body away from them. Every time a worker must restrain a patient, chemically or physically, there should always be a weighing of the pros and cons, and there should also be a sense of compassion for the person being held — even if they are cursing staff out and assaulting them. Anger is fear. I cannot speak for others, but when I was violent toward those keeping me safe, it was because I was scared. My brain had overflowed so quickly, and I didn’t quite know how I had gotten to that point. I was upset because I felt like I had the right to do what I wanted to myself. It was terrifying to have so many people touching me. No matter how much it happened, the pain was fresh each time. I also feel no staff should ever have a sense of power over a client. I have been in situations where I have been threatened with restraint as a punishment, in instances such as, “if you don’t eat in your room I’m going to force you to,” and, “if you don’t stop, we’re going to put you in restraints for the maximum amount of time, and we aren’t fooling around with that, we’ll leave you there.” If someone ever feels like they are controlling, and not helping the person, then that staff needs to reevaluate their motive for restraint.
In the past months, I have learned coping skills to deal with strong emotions and urges, thus making my restraint count minimize. This came after a lot of therapy, nutrition and self-work. I had to find it within myself to love my body enough to care about who touched it. Over the years, I lost respect for myself, thus not giving a damn about who had control over me. I was used to having to get physical and I was used to always failing.
This lack of choice in my teenage years has created such joy in simply being able to dictate who touches me, and on what terms. Even though I am hopefully out of that era of my life, there are long-term effects. Not having nightmares about holds is a rare occasion; I dream about them almost every night. I often feel like people are touching me, and will spontaneously kick or scratch the air. I cannot stand people bumping into me or approaching me from behind. I wake up crying, remembering particularly traumatizing incidents. Sometimes, I am going about my day and feel a deep sense of mourning for the girl I used to be, and all she suffered through.
At the same time, I have incredible amounts of compassion for people with behavioral challenges and I am planning to get my degree in emotional/behavioral disturbance special education, to work in schools with kids like me. I understand why people lash out, I understand why many become violent and I hope to use my experience to teach others to learn how to appropriately manage their emotions and to help those around them understand why they are doing the things they do. I am writing a YA fiction book loosely based on my experiences in psychiatric hospitals as a teen.
I have gone off the edge. I know what it is like to struggle, to be forced to do something over and over, against your will, for years. I know the loss of control, but I also know the freedom of getting it back. There is hope. The work to heal is worth it. I am living proof of that.
Image via contributor