Treatment Failure: Seclusion and Restraints

The Observation Window

I quit that time and that place the moment I understood there was no possibility of freeing myself. The solution was a kind of disappearing. I collapsed time in on itself and hurried to a far off point where it was all, already, just a memory. I was simply remembering the room, the feel of the leather restraints around my wrists and ankles, the burn through my neck and shoulders.
While a number of psych techs held me down, another one laced the leather straps through the cuff around each ankle and wrist. He yanked down hard, fastening the tongue into the buckle’s silver teeth to force this tight, suffocating, unwarranted embrace.

We were all almost silent – just the sound of forced breath, a stray grunt, a “got her?” More than anything else we spoke in a language of physical exertion. There should have been a great deal of discussion about this event but there wasn’t any. I retaliated with my own silence, too. A final, furious tug forced my body to bow upward trying to gain leeway. They left.

How many times have I been here, now? How many more times before they will get it, that this act of restraining me dehumanizes them. I understand exactly why I am here again; I know what always leads to this moment. My rebellion is an act of absolute self-possession, a statement of total autonomy. I am certain of the story I am trying to tell over and over. I maintain all reason while those who leave me here, having bolted the door behind them on their way out, they must immediately begin to un-know everything about now. Each one of them trembles with the adrenaline rush. They shake their heads, examine their skin for evidence; they try to reassure each other and themselves that this act was necessary and reasonable. They split back into their separate selves striding down hallways, each back to his respective post in this hospital when the code fist called them to hurry, hurry. They carry a faint anxiety on their skin as they leave me; I can smell it. I, possessor of all reason, I understand that they have no reason, nothing to explain what rolls in and then recedes like thunder in their minds. They feel their hearts, place a hand there. There is nothing to do but hate me. It is a natural response to the incomprehensible dilemma of relationship. How important it is to balance cause with effect, to parcel out empathy to more deserving relatives than me.

In the dark I run my tongue over my bottom lip and feel the chap and sore of my dry mouth. I hear my throat contract as I try to swallow. Someone else bends down to suck at the arch of clean cold water from the water cooler in the hallway. Someone drinks long and hard, then rises to swipe a sleeve across their wet mouth. There are those of us for whom the image of someone drinking is enough. This is the biological basis for human empathy, the shared event of our physical selves. We build structures for the spiritual and emotional on that foundation. We understand others because of this.

In evolutionary terms the problem with putting people in restraints is that this is not a fight about territory, mating rights, food. It is about something abstract, intangible. It has something to do with meaning. How intolerably subjective the human experience! In the context of psychiatric hospitals there are only those who control and those who must be controlled. The dehumanizing element is that policy, liability, procedure have such great distance from anything meaningful. Isolated from meaning the event is simply violent.
Staff walk back to their units now carrying the burden of this violence, horrified that it must now be incorporated into who they thought they were. I, on the other hand, am pure.

At some point the night duty nurse comes on, stares at me through the observation window. She hauls the door open and my heart leaps. Maybe she has come to start pulling up anchor? First a wrist, then an ankle, and them the other wrist, and then the other ankle over a period of an hour to make sure I am calm, won’t fight, have settled down. “I ain’t messin’ with you tonight,” she spits. “You’re staying there,” she says.

I turn my head to the wall. Her face hates me with a passion she doesn’t have in its opposite: love. She does not know why. There are too many problems in her own life. She doesn’t get paid enough to deal with this shit.

She will come back, once every hour – or half hour? It’s not exact due to the demands of paperwork, other patients who won’t go to bed. She’ll stand over me in the half dark waiting for me to open my mouth so that she can pour down my throat a measured dose of liquid medication listed under “Allergies” in my chart. I will not clarify this point with her. It will lessen my chances of getting released before dawn. So I let her pour from her paper cup even as an almost immediate anxiety begins to rise in my chest, seethes, shoots outward along my limbs from my ribcage. Even before the heavy door closes again I am grinding my teeth, pulling at the belts, chafing the leather cuffs around my wrists.

Hour after hour I construct this future in which I am simply looking back on myself. There, that is my face framed in the tiny observation window floating in the dark above my toes. In the future, looking back on myself tied and restrained and bruised from the take-down and bruised some more by the struggle to get out of the restraints-- I never told this story. In that future I build while lying here in restraints in a dark, stinking room, I live alone—possessor of silences -- which are always more eloquent than words we come up with to try to tell our stories.

At some future point in the space between errands I imagine how I will remember this. I decide that I will remember it the way one remembers a landscape from a particular vantage point—, how what you see of the landscape surrounding you is entirely dependent on which window you are peering from in the act of cleaning your house—how your description of the landscape keeps changing like a child first learning to lie, how we get lost in the lies until -- with some sense of relief, we expose ourselves and the punishment is almost weightless, certainly lighter than the stories that we can’t keep straight.

I shift my body, bow upwards on my heels and the back of my head, rise off the mattress with the searing wounds of liquid metal and flames coaxing me to new heights of distance between “now” and “not anymore.” I turn to the angels slipping through the cracks on the wall. I begin to saw at my limbs until I am free. I walk out of my body to release it, and then I run, bodiless to some forest where the wind is blowing the white curtains in and I am struggling with the window until all is silent like the wide mouthed moon. The rain has a smell like turned earth and the blade of grass between my teeth is sweet and biting. I sound like birds, my cells dispersing like a flock of sparrows shuttering and dancing on the city streets. I lean into the wild and run, muscles ripping. The angels are all, like a red coal in my chest weeping and weeping. It is all, already, just a memory.

This is what I remember and all the restraint rooms and all that came with them, boredom, rage, the end of hope, the giving-in, the kiss-ass to just get out; pain, bitter compliance, pain --; the question: Is this what I meant? Is this what I meant? And I knew it would come to this – that someday it would just all come back to me while I was setting my own table one night, or lifting the fold of a clean sheet into its perfect triangle then sweeping the triangle under the foot of the mattress anchoring the top sheet into place on a Saturday morning. I would stand up puzzled by the expanse of white and suddenly there it would be: a blue plastic mattress – a yellow pillow; my body bowing upwards as if I am leaving instead of anchored. And my arms, their terrible lucidity - trying to tell the story even as I forget it.