Posts Tagged 'restraint'

held: Restraint Symposium at the Institute of Psychiatry

This week, as part of Jane Fradgley’s held exhibition at the MRC SGDP Centre at the Institute of Psychiatry, a public symposium focused on the difficult topic of restraint in mental health care. This was inspired, in part, by a focus group held last year at the Bethlem Gallery, in which service users, artists and doctors discussed the different ways in which restraint might be understood and experienced. Indeed, as one participant in the earlier discussion reflected, the very visible historical garments offered a useful focus to reach into less tangible modern encounters: rapid tranquilisation or physical holding, for example. A sedated person is less obviously restrained to those around them than someone in a canvas dress, although the person constrained might well not see this distinction.

Speakers ranged across the spectrum, looking at clinical practices, historical debates and personal experiences to reflect on the topic, questioning the very use of restraint, as well as the way it is managed. Particularly striking was the suggestion of one psychiatrist that, prior to being invited to speak, restraint had not been something he had really reflected on, although aware that it occurred in the unit in which he practiced. The way in which restraint was reported and understood was noted to be a shaky area: often being seen as a response to an event, rather than an episode that, in itself, requires to be understood, in particular allowing patients an opportunity to respond and explain their feelings. Acknowledging that restraint – even where it seems to be the only course of action – may nonetheless have important consequences for vulnerable people was agreed to be an important step forward. Guidelines, in particular, were shown to be inadequate: something highlighted in the recent Mind campaign on physical restraint in crisis care.

Today, The Lancet published an online editorial reflecting on some of the issues raised by the panel, who had a variety of different perspectives and experiences of mental health care. Some felt that restraint was entirely avoidable, and the ‘No Force First’ movement in North America was raised as a possible model for removing restraint from mental health care. Others insisted that restraint was inevitable in a system in which confinement occurs, and that other aspects of psychiatry might be more unpleasant for patients than physical restraint. All agreed, however, that it was an important discussion to have, and that the views and suggestions of patients on their experiences of constraint and how it might be avoided as well as best regulated – the impetus for the exhibition and symposium in the first place – was vital.


held: Jane Fradgley’s photographic exhibition returns to London

Selected images from Jane Fradgley’s held return to London in an exhibition opening today at the Institute of Psychiatry. The opening runs from 5 – 7pm this evening (Wednesday 10 July), and all Bethlem Blog readers are welcome!

The exhibition showcases some of the artist’s photographic series of historical restraining garments and strong clothing from the Bethlem Archives and Museum. These haunting photographs offer a unique perspective; a poetic documentation for contemplation with the added intention of contributing to a dialogue and debate around protection, restraint and chemical intervention in mental health care today. The research, development and production of held was funded by Guy’s & St Thomas’ Charity.

The exhibition continues from 10 July to 27 September, and is open Monday – Friday, 9.30am – 4.30pm. Accompanying the exhibition, there will be a public symposium on the evening of 31 July, inviting clinicians, support workers, service users, historians and artists to respond to the topics raised in the exhibition. The event is now fully booked, but we will be reporting the full details on this blog afterwards, and hope that it is only the start of debate on this important topic.

What’s more, with funding from Maudsley Charity and support from Plymouth Arts Centre, the artist will be launching a book about the project later this year. Watch this space for details…

Exhibition runs: 10 July – 27 September

Times: 9.30am – 4.30pm

Location: MRC SGDP Centre, Institute of Psychiatry, Memory Lane, De Crespigny Park, London SE5 8AF (link to map).

Station: Denmark Hill

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(Image © Jane Fradgley)

Confronting the Collections: Challenging Objects

The history of the Bethlem Royal Hospital spans hundreds of years, bringing us right up to the present day. As such it can give an account of the history of the understanding of mental health issues and their treatment over the same period. Some of the collections may be controversial or challenging, raising issues such as consent or restraint. As part of our ongoing discussion, Confronting the Collections, we’d like to ask for your opinions on which of these objects we should or should not display, and how they should be interpreted in the museum.

Some of these items are representative of treatments or physical interventions that may provoke strong emotional responses, but nonetheless form an aspect of mental health care, past or present. ECT machines, like that pictured below, feature heavily in our collections, as do mechanical restraints including manacles, strait-jackets and other forms of ‘strong clothing’. How would you feel about viewing objects like this? What would it be important to understand if these artefacts were displayed? And how do we deal with the issues they raise today? The link below leads to a short questionnaire, that should take no more than ten minutes to complete. Your thoughts and ideas will be fed back to the designers to form an important part of the design of the new museum.

Click here to take survey

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held by Jane Fradgley: A Symposium on Restraint

On the evening of 31 July, the MRC SGDP Centre at the Institute of Psychiatry and the Damaging the Body seminar series will co-host a public symposium on the topic of restraint and strong clothing in mental health care. This event accompanies artist Jane Fradgley’s held exhibition, on display in the foyer from 10th July to 27th September. This series of striking photographs of garments from the Bethlem collection was funded by Guy’s and St Thomas’ Charity and, as previously noted on this blog, the artist has captured these late nineteenth and early twentieth-century garments in a very different manner from the usual methods of displaying such objects (previously explored in Curatorial Conversations IV).

The exhibition is currently on display at Plymouth Arts Centre (until 16 June). However, Jane’s photographs have already opened up debate around the topic in London. Last year, the Bethlem Gallery hosted a focus group on “strong clothing”, bringing together a variety of people within the mental health field: service users, clinical and curatorial staff, therapists and art practitioners. The garments and their history were exhibited, and a lively debate explored the various forms of coercion adopted within contemporary health care and the relation of the historical garments (and their display) to this context.

The term “strong clothing” was used by late nineteenth-century psychiatrists to refer to garments used in English asylums to restrict movement. These doctors wished to distinguish the clothing they used from the “revolting instruments of mechanical coercion” rejected by the “non-restraint” movement of the 1840s and ‘50s. While English asylum superintendents at this time claimed to have abandoned all methods of mechanical restraint, physicians of the 1880s and 1890s re-introduced restraining garments by claiming them to be something else entirely. Strait-jackets (generally known as strait-waistcoats) and handcuffs were replaced with “strong dresses” and “padded gloves”, placed on a relatively small number of patients to prevent self-inflicted injury or the destruction of clothing and other items. By the turn of the twentieth century, however, strait-jackets appear to have returned to some institutions.

Today, it is often assumed that the exhibition of restraining garments will be distressing to viewers: a stark reminder of past cruelties. Participants in the focus group, however, exposed a much more nuanced view of these items. The forthcoming symposium will invite a wider audience – including clinicians, historians, artists and service users – to explore what restraint is, and how (and if) we can ever draw a line between care, cure and control. Following short presentations from a variety of practitioners, the debate will be opened up to the audience.

Tickets are free, but places are limited and must be booked in advance at:

Doors will open at 5pm, with a reception and chance to view the exhibition. The symposium will begin at 6pm, ending by 8pm. The artist will be releasing a book associated with the exhibition later in 2013, funded by the Maudsley Charity.

Location: MRC SGDP Centre, Institute of Psychiatry, King’s College London, 16 De Crespigny Park, Denmark Hill, SE5 8AF (within the Maudsley Hospital site).

held exhibition photograph

held: Guy’s Hospital Exhibition by Jane Fradgley

This week, a special exhibition by artist Jane Fradgley opens at Guy’s Hospital. held is funded by the Guy’s and St Thomas’s Charity, and is informed by the historical collection of restraining garments housed at the Bethlem Royal Hospital Archive & Museum, and investigates a largely unexplored area of mental health history.

During the “non-restraint movement” of the 1840s, the vast majority of asylums in England and Wales abandoned all forms of mechanical restraint. “Strong clothing” was a term used in the late 1800s to describe certain forms of protection or restraint which were reintroduced to asylums, and claimed not to be “strait-waistcoats, handcuffs, or what may be called true instruments of restraint”. The terms, descriptions and types of garment used were fraught with meaning for contemporaries, many of whom saw themselves as enlightened humanitarians.

With a background as a fashion designer, and a passionate interest in functional and tailored garments, Fradgley was inspired to delve into the archive after seeing Victorian portrait photographs of patients at Bethlem wearing unusual quilted dresses. By exploring this powerful and poignant subject, the artist’s intention is to open new dialogue and debate around restraint and protection, by setting a historical perspective alongside today’s treatments of chemical intervention and sedation.

She recalls:

“I was fascinated by the seemingly comforting strong dresses, and related this form of protective care to my own experiences in hospital and encounters with modern day psychiatric care.

“For me, the purpose of the strong clothing was not to invoke or exacerbate fear or anxiety in the patient; rather, the attention to detail in creating such well-constructed garments was to bring some dignity, serenity, peace and tranquillity to the wearer as an antidote to their anguish.”

It is easy for us to assume that such garments are relics of a brutal past, but in making such judgments we may miss many concerns that remain very relevant today. As Fradgley’s haunting images indicate, the line between freedom and constraint, care and control, safety and coercion remain hard to draw.

held runs until 8 March 2012, in Atrium 2, Guy’s Hospital, Great Maze Pond, London SE1 9RT.

Readers who are interested in discussing the topic of strong clothing and restraint further are invited to respond to this blog in the comments section.

Bedlam in the Old Vic Tunnels

Two artists associated with the Archives and Museum are currently exhibiting in a new show at the Old Vic Tunnels. Bedlam is described as the third and final meeting of minds between Lazarides Gallery and the Old Vic Tunnels, creatively exploring the history of the institution. Like Nell Leyshon’s play at the Globe Theatre two years ago (and as we blogged at that time), the event seeks to explore the parallels between the hospital itself and a “world gone mad”, using the institution’s history as part of a more general critique of society, art, madness and genius.

Much of the work included reflects the interests of Lazarides Ltd, who pride themselves on their popularisation of urban and non-traditional art. The dark, cavernous space of the Old Vic Tunnels suits the material well, lending a haunting quality to the spray-painted canvases and muted video installations. From the near-total darkness of the entry-way, the artworks slowly emerge from the space, the lighting and context lending an uneasy fragility to some of the material, such as Tessa Farmer’s glass and taxidermy sculptures or the ominous presence of Doug Foster and Nachev’s Lidless – a huge weather balloon on which footage of an eye, staring and blinking, is projected.

We were particularly excited, however, by the opportunity to see work by Jane Fradgley and War Boutique. Jane’s striking photographs of the museum’s collection of strong clothing will soon be on display at Guy’s Hospital. Here, however, the large-scale projections emerge with slow beauty on the dark brick walls: ghostly, exquisite and unsettling all at once. These haunting images of late nineteenth and early twentieth century garments of restraint offer a much more complex perspective on mental health care and experiences past and present than the usual stereotypes that fall under the “Bedlam” tag. Jane’s own exhibition, Held, will open in Atrium 2, Guy’s Hospital, on 9 November.

War Boutique’s practice examines forms of conflict – whether physical, psychological or emotional. For Bedlam, he has produced The Noosphere (literally meaning “sphere of the mind”). The sculpture combines Victorian crinoline construction with modern military fabrics, and is based on ideas of rotational therapy for mental illness, which date back to Erasmus Darwin’s Zoonomia of 1801. The Archives and Museum collection contains a model centrifuge, seemingly made in Bethlem’s workshop at a later date and for unknown reasons. The Noosphere even offers visitors a chance to experience the spinning chair, perhaps providing a new visual perspective on the world beyond it.

Bedlam runs until 21 October at the Old Vic Tunnels, Station Approach Road, London SE1 8SW. Book your free tickets online here.

Curatorial Conversations VIII

( continued from a previous post )

Instances of exhibits that function in the way described by Wright and Flis are given not only by them – we will return to their commentary in a future post in this series of conversations – but also by other contributors to the Exhibiting Madness volume. Bronwyn Labrum highlights two antipodean examples of displays that seem to fit Wright and Flis’ description of the “ubiquitous asylum museum”.  In Labrum’s account, these displays are centred on late nineteenth-century ‘seclusion rooms’ and are interpreted by museum labels written from the point of view of the staff who used them to manage patient (mis)behaviour.

“Visitors arrive at the dramatic isolation cell with its peephole, after proceeding through several rooms…It creates an aura of secrecy and dread, and reinforces the stereotypes about lunatics and confinement…The detailed description of the seclusion room continues to resonate… Seclusion Room – used right up until the late 1960’s [sic]. A shutter was placed over the window to prevent violent people from harming themselves. The mattress on the bed and blanket are made of heavy canvas to prevent them from being torn up..” 1

It seems to us that the common failing of these kind of displays – whether inculcating a “psychiatric establishment” perspective on the history of mental health treatment (as in Labrum’s examples), or an “anti-psychiatric survivor” perspective (which, as we will see when we come to the examples offered by Wright and Flis, is equally vulnerable to the temptation of voyeurism) – lies precisely in their tendency to inculcate. We conceive of the Archives & Museum here at Bethlem as being something other than the “ubiquitous asylum museum”, and to assist in the discharge of the task we have assumed of “recording the lives and experience, and celebrating the achievements of people with mental health problems”, we want our new displays (still only in the planning stage at the moment) to inform, engage, provoke and question…but certainly not to inculcate.

1 B. Labrum, ‘Always Distinguishable From Outsiders: Materialising Cultures of Clothing from Psychiatric Institutions’, in Catherine Coleborne and Dolly MacKinnon, Exhibiting Madness in Museums: Remembering Psychiatry through Collections and Display (Routledge, 2011), pages 71 and 73.