Medicine is an inexact science. It is constantly evolving making truths of today fallacies of tomorrow. The same is true with how medical science has approached theoretically and in practice mental illness.

Throughout the centuries it has employed exorcism to asylums, bloodletting to lobotomy, from tonics to talk therapy with limited success. In the latter part of the past century, medical breakthroughs were discovered.

Foremost of which is chlorpromazine which was prescribed to at least two million people within eight months of official release in 1954 and is still prescribed today. The same pattern of success was seen recently with the release of Prozac. It has achieved success even in pop culture with frequent reference to it in music and films.

Some form of treatment appear strange and harrowing in the context of modernity's ease and convenience. Such is the case with lobotomy which consists of cutting the connections to and from, or simply destroying, the prefrontal cortex (the primary area where movement and memory are conceived and processed).

Until the early 1990s, lobotomy was still performed in specialized psychosurgery centers in the United Kingdom for limited indications.(BMJ, 1996) These procedures often result in major personality changes and possible mental retardation.

However, the most depraved form of "treatment" that has survived until now is the straightjacket. It is a garment shaped like a jacket with overlong sleeves. The ends of these can be tied to the back of the wearer, so that their arms are kept close to their chest with possibility of only little movement. It is used to restrain people who may otherwise cause harm to themselves and others.

Restraints are also indicated for non-psychiatric use such as in orthopedic, geriatric, pediatric and post-operative care. For example, when a patient has a long-leg fracture, a restriction of movement may occur with the traction applied on the distal leg.

The negative connotation of restraints dates back to the Victorian era wherein such method was employed as a form of torture. Straightjackets were considered before as more "humane" than other forms of bondage such as ropes or bolts and chains. Historically, the use of restraints has to do with the ignorance of the family of the patient and the people in the facilities that provide "care" to them. These patients are often left in poorhouses alongside criminals. They were thus bolted into prison cells.

Surprisingly, such practices can still be seen in the Philippines and more visibly in Negros Occidental. When a family can no longer "control" a family member with a mental illness from his or her fits, they would usually get the assistance of the police.

For the others who appear knowledgeable, they would call the emergency medical services. However, these medical service provider would call the police in stead fearing legal retribution and fearful of facing their own ignorance. If ever the patient gets restrained they would be left to the "care" of the police until formal medical care can be given--which means on the usual office hours or when the price is right.

Unfortunately, there is no facility in the province that is specialized for such care. The lone facility that has semblance of it is provided by the Bacolod City government that gives fluctuating support. In that facility, psychiatric patients are also incarcerated while others are heavily sedated. The traditional straightjacket may not be visible (probably owing to lack of funds to purchase materials for it). In lieu of the jacket would be straps, cords and ropes that are tied on the patient's wrists and ankles.

At the back of the Corazon Locsin Montelibano Memorial Regional Hospital a building was built around ten years ago but has never been used for such purpose.

This might be due to lack of personnel (such as nurses) to work there. The psychiatric patients are in stead placed in the regular medical ward. Consequentially, they receive the same level of treatment and the same level of inattention as the other patients. The room delegated for such purpose is actually dangerous for the patient, hospital personnel and the public. The patients can climb the wall and break the glass window pane and use the sliver as weapon.

The apparent danger they pose is meted with crude attention by the nurses and allowed by the doctors through restraints. Restraints can pose danger to the patients as well. Wearing an institutional straitjacket for long periods of time can be quite painful. Blood tends to pool in the elbows, where swelling may then occur.

The hands may become numb from lack of proper circulation, and due to bone and muscle stiffness the upper arms and shoulders may experience excruciating pain. Thrashing around while in a straitjacket is a common, but mostly ineffective, method of attempting to move and stretch the arms.

Other complications may be expected. Severe sensory deprivation can cause hallucinations and delusions. (Kenna, ; Hebb, et al, ) Apparently the same symptoms experienced by these patients are the same as those experienced by prisoners in solitary confinement, lone sailors and Arctic explorers.

The Citizen's Commission of Human Rights (CCHR) have investigated and documented since 1969 deaths that occur with patient's under the psychiatrists' "care". It has documented 100 unexplained deaths in California's Camarillo and Metropolitan State Hospital. Along with that CCHR has exposed to the public that up to 150 restraint deaths occur every year in America alone. (Milken, 1998) Local data is not available.

The CCHR argued that patients are provoked in order for restraints to be justified thereby giving the facility at least $1000/day from insurances. Unfortunately (or fortunately), the Philippine Health Insurance Corporation and most health insurances do not reimburse for psychiatric cases.The CCHR also noted that some patients on restraints get so exhausted while under sedative medications that they succumb to respiratory and cardiac arrests.

Explicit policies and clear guidelines were usually deficient in psychiatric facilities. It is evident, however, that restriction of freedom is the only certain way of ensuring the safety of the patient and other persons in the vicinity, when that patient is violent and alternative methods of management have failed or have been rejected by the patient. Patients who are terrified by the feeling of loss of self-control, and patients who deteriorate in the over-stimulating atmosphere of the ward, may even request seclusion.

Alternative methods to restraint can be the following:

1. Orders that the patient may not leave the ward without a chaperone and requiring the patient to remain in sleeping attire, thus limiting mobility.
2. Use of quiet rooms: Disturbed patients who are rapidly losing control may be requested to remain in a quiet room until their self-control improves.
3. Chemical restraints: Modern psychotropic drugs have been used for patients who need help in controlling their aggressive behaviour. It is often sufficient and possible to persuade the patient to ingest medication or take an injection voluntarily.

As Jan Eastgate of CCHR puts it: It may be stating the obvious that psychiatric "care" is not supposed to kill patients, and certainly no one expects patients to die in psychiatric hospitals. yet this is what happens under the watchful eye of psychiatrists around the world. Psychiatric restraint procedures are "assault and battery", in every respect, except one; they are lawful. And because of this thousands of individuals die each year.

It should be recognized by every hospital employees that psychiatric patients are entitled to the same rights and responsibilities as patients in any other medical setting. The facility should provide ample support to the patient and provide privileges that reflect concern for the patient's safety, well-being and increasing ability to be self-reliant and self-controlled.

The institution should also formulate a written policy regarding the use of methods of limiting patients' freedom. This policy should be made known to all members of the hospital staff.

The members and staff should then be aware and mindful of their responsibilities. Orders and records should be periodically reviewed in order to ensure that policies are followed. Chemical restraints should be given more preference over physical restraints owing to the latter's deep psychological impact and stigma.

Understandably straightjackets are not products of the psychiatric patient's minds but borne out of the constricted, not-so straight minds of the public and medical "professionals".