Varga Benedek szerk.: Orvostörténeti közlemények 145-146. (Budapest, 1994)
TANULMÁNYOK - ESSAYS - Pisztora, Ferenc: A „No-restraint” és az „Open-door” irányelveinek megvalósítási kísérletei és értékelése a hazai pszichiátriában
(3) There are characteristically a number of preliminary conditions for introducing a basically norestraint strategy. The most important are as follows: (a) adequate number of, and appropriately educated nursing staff (as G. Oláh stressed), (b) a comfortable, convenient and satisfactory institute, (c) and the separation of mental patients with a criminal record (L. Epstein's points). (4) It is also important to remember that the application of no-restraint does not essentially mean the ultimate abandonment of any restrictive, or coercive method. The mere hospitalization of a patient —which is often reasoned by the self-defence of society against publicly dangerous insane —is itself coercive. Equally, during the period of 1867-1914 some so called "modern measures" were introduced in order to replace restraint, methods which consisted hydrothérapie procedures (like coercive baths in a covered tube), artificial nutrition, and even the chemical restraint of our days is though a milder but obviously restraint method. The possible realization of the application of no-restraint systems always depended on the contemporary level of development of psychiatric pharmaco and labour therapy. (5) We must also take into account abuses of chemical restraint as a main danger of contemporary psychiatry. Two motivations could be separated here (a) to replace or strengthen mechanical restraint (as G. Veruhek pointed out), (b) or in contrast to override it with chemical means and consequently to enforce to maintain no-restraint system. G. Oláh emphasized that this was one of the main misunderstanding of his forerunners i.e. they had simply replaced mechanical no-restraint by the chemical one. (6) The outstanding psychiatrist of Hungarian medical history (E. E. Moravcsik, G. Oláh, J. Salgó, Gy. Nyíró') already realized that the liberal therapies of no-restraint which could produce improvement at high proportion of mentally ill, could not be adopted with the same results for many kind of deviant illnesses (e.g. in the case of criminal imbeciles, in whom criminal and pathological liabilities interfere with each other, or socipaths, psychopaths, hysterics, and alcohol and drug addicts, especially again those with criminal record, etc). To sum up, we can conclude that the introduction of no-restraint systems was beneficial in the history of Hungarian psychiatry for the mentally insane, but only in those cases, when the cardinal principles of this method were adequately understood, and when it had been realized that for whom, when, and in what extent it could be applied. In other words, when the barriers of no-restraint were recognized.
