The Center Cannot Hold: My Journey Through Madness

by Elyn R. Saks

One afternoon on the unit, one of the patients, Henry—suddenly and without apparent provocation—jumped full-body on another patient, screaming wildly as he did so. Staff and some other patients pulled him off and away, taking him to a different part of the unit, where he sat and calmed himself. An hour or so later, a doctor came in and sat with Henry, quietly telling him that what he’d done wasn’t appropriate and couldn’t happen again. There was no punishment for Henry’s infraction, no beefy orderlies standing ready to mete out some kind of response, and no physical restraints. No straitjacket, no leather straps to hold Henry in his bed or on a chair. In fact (and in sharp contrast to most American hospitals, even now), British hospitals rarely use any kind of mechanical restraint, and have not for over two hundred years. Save for a small percentage of extreme cases, there was rarely anything dramatic that happened after the kind of scene Henry had just created other than a simple, humane, and clear response, with the basic message addressing the inappropriateness of the behavior, instead of the damaged mental capacity of the patient.