Nineteenth- and Early Twentieth-Century History

Abstract

Calls and successful practice to eliminate restraint can be documented as far back as the eighteenth and nineteenth centuries. Individuals who attempted to reduce or eliminate restraint included Chiarugi, Pinel, Tuke, Hill, Prichard, and, most notably, John Connolly. Moral treatment was a broad system of management that in part sought to reduce or eliminate restraint through programs of active treatment, careful staff selection and training, and optimism concerning treatment of mental illness. Connolly’s report of elimination of restraint in psychiatric institutions was carefully documented. It included a broad system to measure and track restraint use, take actions to eliminate its use, and provide motivation to continue to do so by public documentation of restraint use. Connolly’s work was publicized and highly cited over many years and provided a model for many others who modeled their own efforts at restraint elimination after Connolly’s work. His work, however, met with mixed reactions from professional colleagues. Others documented extensive restraint use in community services in the nineteenth century which provided motivation to set up humane institutions. The late nineteenth and early twentieth centuries saw a decline in interest in restraint reduction reflecting the increase in the size of services, the changing function of institutions from habilitation to containment, and growing pessimism regarding habilitation.