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Caring Through Restraint: Violence, Intimacy and Identity in Mental Health Practice


In this article, I discuss the meanings of “restraints,” or physical intervention strategies that are used at a total institution for mentally ill adolescents in the United States. This paper argues that this particularly complex form of mental health treatment is simultaneously a violent and an intimate way in which men relate to one another and also takes on complex meanings about trust and identity in mental health recovery. Using data from 18 months of ethnographic fieldwork at one residential treatment center, this article examines what restraints reveal and embody about intimate interpersonal staff/client relationships, how Black men relate to one another in this setting and how staff members use physical interventions to link institutional mental health treatment with street violence in the outside world. I conclude that understanding these meanings of restraints provides a valuable way of understanding local knowledge in mental health practice, treatment and recovery.

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  1. Therapeutic Crisis Intervention is a formal treatment philosophy at Havenwood focusing on manual restraint practice.

  2. Residents often recovered in confinement rooms following restraints. Confinement rooms are small, white concrete rooms with a small windowed door. The door can only be locked if it is closed and a red button is pressed and held.

  3. If residents were sent to Havenwood by the juvenile courts, their first month was funded by “probation.” The remaining months of treatment were usually funded by their public school districts.

  4. The other shifts were 11 p.m. to 7 a.m., or overnight; then the school hours, 7:30 a.m. to 3:30 p.m., were worked by Teaching Assistants who worked in the cottage from 7:30 to 9 a.m. and from 3 to 3:30 p.m. The Teaching Assistants were assigned to different classrooms during the school day.


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Correspondence to Katie Hejtmanek.

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Hejtmanek, K. Caring Through Restraint: Violence, Intimacy and Identity in Mental Health Practice. Cult Med Psychiatry 34, 668–674 (2010).

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  • Violence
  • Intimacy
  • Identity
  • Mental health practice