Yesterday I described some of the information in the Government Accountability Office testimony before the House of Representatives, involving deaths and injuries of schoolchildren physically restrained by school staff (you can read this testimony at http://alt.coxnewsweb.com/palmbeachpost/pdf/gaoreport.pdf ). Today, I want to start discussing some of the history and belief systems behind the potentially lethal use of restraint methods with children.
Much of the motivation for restraining children probably has to do with staff members' lack of training or reflectiveness about disciplinary methods. Some staff members may be frustrated by their inability to cope with children's serious problems, and others---one hopes not many--- may find pleasure in intimidating and hurting weaker people. But these issues cannot be the whole answer to the problem, because we would expect school administrators to supervise staff behavior, and we would expect a grand jury to indict a teacher who had caused a child's death in the manner described in the GAO report. Yet administrators seem to have ignored these situations, and at least one grand jury has apparently found a child's death acceptable. Why might this be?
A clue giving a partial explanation of all these adult actions may be found in the term "therapeutic holding". A small number of articles in professional journals have used this term. They use the expression "therapeutic holding" in claiming that children receive psychotherapeutic benefits from being physically restrained when agitated and having the restraint continue for a period of time afterward. However, there is no research supporting this claim. In articles where authors have cited empirical research as supporting the idea of therapeutic holding, many of the articles cited have actually been about "holding therapy", a different, though equally disturbing, technique which I will discuss in a later blog. It is possible that some school administrators or staff have come across references to therapeutic holding, have failed to understand the lack of evidence for its usefulness, and have employed their limited knowledge in making decisions about teachers' restraint practices.
But why would anyone at any time have thought of physical restraint as a form of treatment for emotional disturbance and "misbehavior"? Of course, restraint and various forms of asphyxiation have long been favored by torturers, as they create enormous pain and terror in the victim but are reversible (if the asphyxia is not allowed to go too far). I need not comment on our present national discussion of this matter. I should also note that restraints in the form of strait jackets and "wet packs" (immobilization by wrapping in wet sheets) were very much part of psychiatric treatment before the development of tranquilizing drugs. These methods were not simply a matter of maintaining physical control of patients, but were thought to calm agitation.
Looking at psychological publications in the early 1960s, we see the first specific recommendations about restraint as a means of changing children's mood and behavior.
The well-known hypnotherapist Milton Erickson (not the same as Erik Erikson) described a case in which he recommended that a mother restrain her disobedient young son by sitting on him for hours. Erickson also suggested that the mother limit her son's diet to cold oatmeal, while she and her daughter continued to eat appetizing foods in front of him. After some weeks of this routine, Erickson commented---apparently to his own satisfaction--- that the boy trembled when his mother spoke to him. He regarded this as a successful outcome to the case, and this case study provided a paradigm for others' thinking about restraint of children. In combination with other beliefs and assumptions, this kind of restraint use helped give rise to the treatment known as "holding therapy", in which a calm child is first restrained and then enraged by physical and mental torment, on the unfounded assumption that a "corrective emotional experience" will resolve psychological disturbance.
Even in the 1990s, injuries and lawsuits connected with holding therapy already raised questions about its use. But authors such as the psychiatrist Howard Bath suggested that restraint used for safety purposes could become therapeutic when prolonged. The concept of therapeutic holding began, and with it came perceived support for the restraint of children in a variety of settings--- although there was no systematic evidence to show that the practice was worthwhile.
Next time: some authors who have suggested to the public that forms of restraint are beneficial to children.