|A note about physical restraint
|At times it becomes necessary to restraint an individual because he has posed a danger either to
others or self. There are negative aspects involved with physical restraint or lack thereof. Increased
chance of physical injury to both caregiver(s) and the individual and lawsuits are negative aspects of
physical restraint. Likewise, there are some negative aspects of not providing restraint. If an
organization or an individual facility advocates a "hands-off" policy no matter what, it is advisable
that such entity carefully screen the population it serves and admit only individuals who have had no
history of physical aggression in the past. If the organization knowingly admit a physically aggressive
individual to a "hands off" facility, an injury or death to another person could result in civil and
There are many certified methods of restraint available that one can be trained-in to deal with
physical aggression in the least pervasive way. However, realistically, the chances of two 140
pounds 5'7" individuals safely and successfully restraining a 250 pounds 6'2'' person is pretty slim.
At the same time, I have witnessed a 4'5" female requiring three police officers to restrain her after
she knocked one of them to the ground.
All these dynamics considered, weighted emphasis and training in verbal intervention techniques
combined with certification in a physical restraint method will produce a balanced and safe
What restraint communicates?
As mentioned before, every form of aggression, be it physical or verbal is a form of communication.
While the context of a verbal aggression may imply that the person neither like the food nor the
attitude of the caregivers; a focus on the person's feeling (that of frustration) may result in a more
successful intervention than a focus on the words (I don't like the food and I hate you people).
Physical aggression is an attempt to communicate something. Commonly, a low
functioning/non-verbal individual may be expressing physical pain, hunger, precipitating causes,
medication side-effects, mental illness and neglect. Likewise, it is common for a high functioning
person to express some of the above as well as emotional pain, stress and frustration and etc,. in a
form of aggression. Recognizing that some people engage in physical aggression for sexual and
emotional needs can help caregivers not provide positive reinforcement for such actions. I once
worked with a highly intelligent young man who liked to inflict pain on his partner during sex. He
favored sharp objects for this purpose and had had bitten two of his girlfriends prior to entering our
program; his favorite song was Bryan Adams', "cuts like a knife". While in our custody, he resorted
to finding female staff alone before acting out. He would stuff toilet paper in his pants and while he
was being restraint by them, he would struggle as hard as he could before having an orgasm. Here
again, it took some data collection and correlations of events as well as observation to figure this
out. The problem was resolved by making sure there was a male staff available in his unit at all
Another scenario was a 47 years old albino man whom had never left the farm he lived-in until his
parents died. As one can imagine, he had no social skills; was partially deaf, no teeth and at times
aggressive. He would corner the female staff when they were alone and begin to threaten and at
times punch or kick them. Upon one staff observation who was assigned to restraining him, he would
immediately "melt" in his arms when staff bear hugged him from behind. It was determined that this
individual was suffering from lack of touch. A program was put in place for staff to reinforce his
positive behaviors with light touches such as pats on the back or placing hand on his shoulder. He
was also placed on a program to earn points when he controlled his physical aggression which he
could exchange for hugs.
Both scenarios presented above illustrates how an act of physical aggression can be rewarding to a
person and why.