Historical aspects of the use of physical restraint: from antiquity to the era of moral treatment

Abstract

The implementation of harsh methods of restriction has been seen since ancient times as an acceptable solution to the problems caused by mental illness. This practice was hardly questioned and only a few professionals struggled to improve the hard living conditions of the patients. Amongst these can be mentioned some physicians of ancient Greece and Rome: such as, Caelius Aurelianus, Asclepiades or Soranus of Ephesus, who objected to this procedure. During the Middle Ages, Arabic culture also helped to humanize care in the first hospitals for the insane, Avicenna being one of the most important figures. By contrast, in Medieval Europe madness was seen as a form of sin, and punishment was the way to treat it. Already by the fifteenth century asylums in Valencia and Zaragoza were pioneering the removal of chains and more humane treatment. Although, undoubtedly the most notable advances in the care of mental patients occurred during the eighteenth century through moral treatment, Philippe Pinel being its most well-known practioner. Also at this time, the benevolent efforts of the Quakers stood out. As an alternative to shackles, they introduced occupational programmes to stimulate patients; in fact, this type of therapy had already been applied centuries before. To put this phenomenon in perspective, it can be said that discussions about physical restraint have been taking place since ancient times, causing debate amongst professionals for many centuries, when considering its advisability.