Practicing Restraint

A grim exhibition might be made of inventions that are hailed as humanitarian, only to become symbols of inhumanity. Just as the guillotine was considered a great improvement on the axe, its contemporary, the straitjacket, had an early reputation for kindness as it replaced the manacles. When French physician Philippe Pinel and his assistant Jean-Baptiste Pussin freed the inmates of Paris’s Bicêtre and Salpêtrière asylums from their chains in 1795, he imposed the straitjacket instead. This he considered only the slightest curtailment of their freedom. “Forty wretched patients who groaned under the weight of the irons for varying numbers of years were set free in spite of all the apprehensions registered by the Central Bureau, and they were allowed to wander about freely in the courtyards simply with the movements of their arms restricted by a strait-jacket,” Pinel wrote in 1809.^[1] Free, but in straitjackets.

But where had the liberating straitjacket, or camisole de force, come from? Michel Foucault and others credit it to an upholsterer named Guilleret employed at Bicêtre and date it to 1790. More recent historians of Bicêtre date it to 1770.^[2] Certainly, numerous references to it can be found from years earlier than 1790. The earliest known description of the device is from the Irish doctor David Macbride, writing in 1772:

No small share of the management of mad people consists in hindering them to hurt themselves, or do mischief to other persons. It has sometimes been usual to chain and beat them, but this is both cruel and absurd; since the contrivance called the Strait Waistcoat answers every purpose of restraining the patients, without hurting them.

These waistcoats are made of ticken, or some such strong stuff; are open at the back, and laced on like a pair of stays; the sleeves are made tight, and so long as to cover the ends of the fingers, and are there drawn close with a string, like a purse, by which contrivance the patient has no power of using his fingers; and, when he is laid flat on his back in bed, and the arms brought across the chest, and fastened in that position, by tying the sleeve-strings fast around the waist, he has no power of his hands.^[3]

More than a description, this is a glowing recommendation. And physician William Cullen, writing in Edinburgh in 1784, gives the straitjacket similar praise, and adds that it is a helpful therapeutic tool:

Restraining the anger and violence of madmen is always necessary for preventing their hurting themselves or others: But this restraint is also to be considered as a remedy. Angry passions are always rendered more violent by the indulgence of the impetuous motions they produce; and even in madmen the feeling of restraint will sometimes prevent the efforts which their passion would otherwise occasion. Restraint, therefore, is useful, and ought to be complete; but it should be executed in the easiest manner possible for the patient, and the strait waistcoat answers every purpose better than any other that has yet been thought of.^[4]