Mystique in the Mirror - Restraint in Psychiatry
Hi! It’s been a while since my last essay, but I finally have some time again and I really wanted to write about Mystique in the Mirror, a BL that addresses a very important issue: mental health and its institutions.
First of all, if you aren’t familiar with this blog, my name is Nico, I’m in the sixth year of Medical school in Brazil and I really enjoy watching (and talking about) BL shows (especially if it is Medicine related!). In this essay, I’m going to discuss something that happens at the very beginning of Mystique in the Mirror: restraint in Psychiatry.
When Alan is at the Psychiatry Hospital, the nurses suddenly grab him by the arms and literally drag him away until the doctor injects a medication that makes him sleep. I believe that, regarding the concept of restraint in Psychiatry, this type of scene usually comes to our imagination since it is very present in the media. However, that is not how it typically happens in real life.
According to the Cambridge dictionary, “restraint” can be defined as “something that limits the freedom of someone or something”. This term has a lot of definitions in Psychiatry, but, in summary, it is the practice of restricting a patient’s behaviour or freedom of movement by using verbal, chemical and/or physical techniques.
Considering this, we have a very important question: which patient should be restrained? Each situation should be addressed on its own, but most scenarios involve a state of "psychomotor agitation”, defined as an abnormal physic and motor activation, restlessness and increased reactivity towards external stimuli, with a possibility of escalation to aggression or violence. Hence, medical intervention is important to prevent a patient from causing risk to themself or others.
Psychomotor agitation can be caused by a variety of factors, such as stress, physical trauma, anxiety crisis, psychosis, alcohol intoxication and the list goes on. Usually, an individual in this state is visibly tense, hypervigilant (very alert), annoyed, physically or verbally unrestless and can be very demanding.
Taking this into account: was our protagonist, Alan, agitated? Well, he had just immobilized another patient, was repeatedly talking about “finding the truth” and hypervigilant about an old man he sees in mirrors. Regardless of the reasons behind it, he was obviously agitated. Therefore, some kind of restraint was necessary.
The health team should always start with verbal restraint. Preferably, the staff with a closer bond to the patient should be the one to approach them and talk to them. It is very important to actively listen and try to understand what is happening, aiming towards a mutual agreement, without judgements or lies. Many times, this is enough to calm the patient down, but there are situations in which chemical restraint is needed.
Of course, no one is going to force medication down a patient’s throat. The professional should offer the medication by paying attention to their demands: “Oh, are you annoyed? This pill is going to ease that, do you wanna try?” or “Perhaps you can’t sleep? This medication will help.” A calm and comforting speech helps a lot. Essentially, all patients are human beings and should be treated with dignity.
But what if the patient doesn’t accept medication? Or what if they are too aggressive and communication is impossible? Well, then, unfortunately, physical restraint is needed. Even in this situation, the health team should explain to the patient what they are about to do and why. There are techniques to do this and nobody should drag a patient around, like the nurses did to Alan. By the end of it, the responsible doctor is going to inject medication in a muscle or vein (another type of chemical restrain). Physical restraint should last as minimum as possible.
So, now that we learned the correct approach to psychomotor agitation, let’s analyze how restraint happened to our boy, Alan.
He was in the office, very alert, and suddenly, two nurses yelled “Catch him!”. Definitely not a calm and comforting speech. None of them tried to talk to him and understand his behaviour. They jumped verbal and chemical restraint and went straight to the physical one.
Notwithstanding, they not only restrict Alan’s movement, but instead of injecting medication there and saving him from more aggression, they dragged him towards the hallway to another room. (I honestly didn’t understand why, because they could’ve done it in the office!!!)
Alan became more and more agitated until, finally, the doctor administered some intramuscular medication.
So many mistakes, guys! That is not treating a patient with dignity at all! Despite the drama needed for the scene - it is a BL series after all -, I think it is important to discuss that mistakes can also happen in real life. As an example, one day I was in the infectious diseases ward and there was a patient with a psychiatric condition in one of the rooms. In the hospital of my school, the psychiatric ward has just a few beds, so their patients can stay in other wards waiting for a spot. Well, this particular patient was wandering around the ward, unrestless, making other patients - and even the nurses and the infectologist on duty - scared. The nurses would raise their voices at him, saying “Go to your bed!”. Everyone was really tense waiting for the psychiatrist on duty to come and I, as a student, despite knowing the theory, didn’t know if I was able to control the situation alone. Things could’ve gone really bad, but thankfully, the psychiatrist came and approached the patient, calmly. “Can you give me a hug?”, the patient asked the doctor. And they hugged each other. The doctor offered a pill and the patient agreed to go back to bed.
Of course, this situation wasn’t as dramatic as Alan’s, but is a nice example of how there are many health professionals who don’t know how to deal with these scenarios. When the staff is unprepared, they are filled with fear and disasters can happen. Patients and professionals can suffer emotional and physical damage, such as Alan did.
In conclusion, to wrap this essay up: restraint is a necessary intervention when patients are agitated, but it should be done in a way that preserves their dignity and prevents damage towards them and the hospital staff. There are also verbal and chemical restraints, which should be tried first. Physical restraints are the last resource and should last as minimum as possible.
Well, to all of you who got to the end of this text, I thank you very much and hope you enjoyed it! Feel free to ask me anything if you have any doubts! Also, if you want to know more about this theme, I suggest reading this article from the European Journal of Psychiatry, which is very good.
See you next time! =)
