Coercive measures in psychiatry (Abstract only)


Giulia Feldhoff (Ruhr-Universität Bochum)

Coercive measures are still a crucial component of psychiatry, be it medical restraints or involuntary hospitalization. Even if they are no longer considered therapeutic, in psychiatric praxis they are now considered a safety measure – for the protection of both patients and professionals. However, due to its unethical, violent and potentially traumatizing nature, psychiatry today aims to decrease – perhaps abolish – coercive measures altogether. It is a historical effort indeed: starting in the nineteenth century with attempts to introduce the so-called non-restraint principle and still ongoing in current debates, findings and jurisdictions (Gonther, 2018; Löhr et al., 2019; Steinert and Hirsch, 2019) – an effort that therefore may demonstrate a historical continuity (Steinert, 2011). Although coercive measures vary in history – one certainly cannot compare today’s medical restraints to those of i.e. ‘Cox Swing’ – the question of its permanence and consistency still arise.

This paper aims to consider the persistence of medical restraints through praxeological analysis. Practices are embodied and materially interwoven routines of behaviour that depend on shared and implicit understandings (Reckwitz, 2003, p.289; Schatzki, 2005, p.12). They are held together by routine body movements and artefacts in use – “material instances” (Reckwitz, 2003, p.290, transl. GF) that are particularly important as objects of investigation. Using a methodical approach of description and observation I try to detect those routines that may motivate medical restraints until this day. An analysis of various psychiatric documents, like patient files, may demonstrate the assumption of coercive measures as a persistent practice of violence. As Alkemeyer (2019, p.293) criticizes a praxeological disregard for ambiguities of social order, interruptions of practices are also considered. This may also point to historical developments in coercive measures. In order to prove possibilities of resistance or dissent, those who experienced medical restraints also should share their perspectives. A one-sided perspective, in which the patient is once again the subject of psychiatry (Dörner, 1984, p.10), should be avoided as much as possible. However, the period of the historical investigation remains undetermined – this depends on the available data and the documented coercive measures. Perhaps the practice of documentation may be the most significant challenge here.


Bibliography

Alkemeyer, T., 2019. Bedingte Un/Verfügbarkeit. Zur Kritik des praxeologischen Körpers. Österreichische Zeitschrift für Soziologie, 44(3), pp.289-312.

Dörner, K., 1984. Bürger und Irre. Zur Sozialgeschichte und Wissenschaftssoziologie der Psychiatrie. Frankfurt am Main: Europäische Verlagsanstalt.

Gonther, U., 2018. Zu den verfassungsrechtlichen Anforderungen an die Fixierung von Patienten in der öffentlich-rechtlichen Unterbringung. Was bedeutet das Urteil des Bundesverfassungsgerichtes für die psychiatrische Theorie und Praxis? In: Soziale Psychiatrie, 42(4), pp.35-6.

Löhr, M., Schulz, M. and Nienaber, A., 2019. Safewards. Sicherheit durch Beziehung und Milieu. Köln: Psychiatrie-Verlag.

Reckwitz, A., 2003. Grundelemente einer Theorie sozialer Praktiken. Eine sozialtheoretische Perspektive. In: Zeitschrift für Soziologie, 32(4), pp.282-301.

Schatzki, T. R., 2005. Introduction: practice theory. In: T. R. Schatzki, K. Knorr Cetina and E. v. Savigny, eds. The Practice Turn in Contemporary Theory. London, New York: Routledge, pp.10-23.

Steinert, T. and Hirsch, S., 2019. S3-Leitlinie Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen. In: Der Nervenarzt, pp.1-6.

Steinert, T., 2011. Nach 200 Jahren Psychiatrie: Sind Fixierungen in Deutschland unvermeidlich? In: Psychiatrische Praxis (38), pp.348-51.


Tags: