Physical restraint and the nonpsychotic patient: clinical and legal perspectives

Recent legal challenges to the use of therapeutic seclusion in the treatment of the mentally ill have forced psychiatrists to defend this practice in court. The clinical characteristics of 10 nonpsychotic inpatients who required restraint are reviewed. These patients are characterized by intense labile affect, impulsive, manipulative behavior and transient micropsychotic episodes in the context of immature personality patterns suggestive of the borderline syndrome. Restraint was precipitated by transient micropsychotic episodes or impulsive behavior during sustained regression. Physical control in these cases is required to defend the social milieu more often than to prevent injury to self or others. The legal implications of these clinical findings are discussed.