Atlas›Domain XVI · Historical, discredited & harmful›Guide 024
Guide XVI-024

Rush's tranquillizing chair

Benjamin Rush1810Philadelphia
A 32 · L 56 · M 1218 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

This guide is listed for history and safety. The chair was a restraint device of the early asylum; it is not a treatment and is not recommended. It is described here as the National Library of Medicine's image and historians show it. The guide covers the psychotherapist's own work: historical literacy, recognising the legacy of mechanical restraint, assessment, safeguarding, reporting, and work with clients and families affected by coercive psychiatric care.

1. Introduction

Version followed: the chair as documented in Benjamin Rush's letter to Thomas Jefferson of 2 January 1811 (Founders Online), the U.S. National Library of Medicine's "Diseases of the Mind" pages, and Nicholas Tromans, "The Psychiatric Sublime", Tate Papers no. 13 (Spring 2010). Rush's 1812 textbook, Medical Inquiries and Observations upon the Diseases of the Mind (Philadelphia: Kimber & Richardson; public-domain digitisation on archive.org), is cited as a work; its passages on the chair are [uncertain: not verified].

Benjamin Rush (1745/6-1813), a Philadelphia physician on the staff of Pennsylvania Hospital from 1783, was by 1787 in charge of patients with mental illness and addiction, who were held in the hospital's locked basement [source: Penn Libraries, Rush's Life]. Around 1810 he devised what he called the "tranquillizer", a chair the Penn Libraries guide calls his most famous, and to some infamous, invention [source: Penn Libraries]. In January 1811 he sent Jefferson a drawing of "a Chair I have lately introduced into the Pennsylvania hospital to aid in the Cure of Madness" [source: Founders Online, Rush to Jefferson, 2 January 1811].

Core idea of change, as Rush and historians state it: Rush "believed that mental diseases were caused by irritation of the blood vessels in the brain" [source: NLM, Diseases of the Mind: Benjamin Rush]; his remedies (bleeding, purging, hot and cold baths, mercury, a "gyrator" and the chair) aimed to act on that supposed vascular cause [source: NLM]. Tromans writes that the chair was designed "to overwhelm every motion and sense of the raving patient", and places it among period treatments that used shock and awe to restore a patient's sense of proportion [source: Tromans 2010]. Today the theory is obsolete, and the chair stands for the long history of mechanical restraint in psychiatry. For the psychotherapist the main value of the topic is recognising that legacy and working with people harmed by coercive care [synthesis].

Rush is often called the "Father of American Psychiatry", and his 1812 book was the main American textbook on mental disease for almost 50 years [source: NLM]. His legacy is contested. He wrote against slavery and helped revive the Pennsylvania Abolition Society [source: Penn Libraries]. He also held that Black skin came from a mild form of leprosy he called "negritude", and the American Psychiatric Association used his image in its logo until 2015 [source: New York Times, 30 April 2021, as republished by History News Network]. On 18 January 2021 the APA issued an apology for its support of structural racism; the apology and its historical addendum do not name Rush [source: APA apology; APA historical addendum].

2. Framework

The chair has no phases of its own to teach. This section gives the historical setting in outline, then the phases of the psychotherapist's own work.

Historical setting (outline).

  • Pennsylvania Hospital, 1780s-1810s. Patients with mental illness were held in a locked basement [source: Penn Libraries]. In a letter of 24 September 1810 to the hospital's managers, Rush called for more humane treatment of patients "deprived of their reason": separate buildings, "labor, exercise, and amusements", and an end to showing patients "as a spectacle" to idle visitors [source: Founders Online editorial note]. The editors suggest the chair drawing he sent Jefferson "probably drew on" that letter [source: Founders Online]. Reform and restraint therefore sat side by side in the same physician's work [synthesis].
  • Transatlantic context. Early-asylum medicine used rotating and swinging machines, sudden drenching, and restraining chairs. A restraining chair was made for George III, and a chair like Rush's was considered for the King in 1811 but not adopted [source: Tromans 2010].
  • Afterlife. Rush's textbook stayed in use for decades [source: NLM]. Mechanical restraint and seclusion stayed in psychiatric practice in many forms. Current guidance puts the focus on de-escalation, and on planning with patients for any restrictive intervention [source: NICE QS154, statement 2, based on NICE NG10 (2015)].

Phases of the psychotherapist's work [synthesis; session number and length follow the client's needs and the setting]:

  1. Recognition and assessment. Notice when a client's history includes restraint, seclusion or other coercive care, or when a client, family or student is interested in this history. Assess the trauma, the current risk, and what the client wants from the work. Move on when the client's priorities are clear and immediate risk is managed.
  2. Safety and safeguarding. Make a safety plan; act on any current restraint of a child or adult at risk; give crisis resources. Move on when no one is in current danger and reporting duties are met.
  3. Processing and meaning-making. Trauma-focused work, historical context, family history, and mistrust of psychiatry. Move on when the client can approach the material without being flooded and can make choices about future care.
  4. Repair, advocacy and follow-up. Advance statements, complaints and records, service-level advocacy, re-engagement with needed care. The work ends or continues by the client's choice.

3. Guiding principles

  • History is told accurately and attributed. Practical meaning: say what sources say (Rush's own letter, NLM, Tromans), mark the rest uncertain, and never describe how the device worked [source: as section 1; synthesis].
  • No replication, ever. Practical meaning: the therapist never describes, demonstrates, endorses or supplies any restraint method, device or "calming" immobilisation, including for families or schools [synthesis].
  • The therapist never provides, supervises or refers to a harmful practice. Practical meaning: if a colleague or institution uses inappropriate restraint, the therapist's role is to raise concerns, safeguard and report, not to take part [synthesis].
  • Coercive care can be traumatic. Practical meaning: ask about restraint and seclusion in any trauma history, and treat the answers as possible trauma memories [synthesis].
  • The client sets the pace and keeps control. Practical meaning: the client decides what to discuss, can stop at any time, and is offered choices throughout; this reverses the loss of control that restraint imposes [synthesis].
  • Physical stillness and touch need care. Practical meaning: do not use exercises that immobilise the body or restrict the senses. Any touch (rarely appropriate) needs consent before and during, a right to stop, and is never sexual. Holding and restraint are never taught [synthesis].
  • Prevention comes before restriction. Practical meaning: support de-escalation plans and advance statements about restrictive interventions, as NICE describes [source: NICE QS154].
  • The legacy of reformers is complicated. Practical meaning: present Rush's reforms, his restraint devices and his racial theories together, attributed, without either praise or moralising [source: Founders Online; NLM; NYT/HNN; synthesis].
  • Mistrust of psychiatry can be rational. Practical meaning: name the historical and racial reasons for mistrust (the APA's own 2021 apology) while keeping open the client's access to needed care [source: APA apology; synthesis].
  • No medication advice. Practical meaning: never advise starting, stopping or changing a medicine; send such questions to the prescriber [synthesis].
  • Children and adults at risk come first. Practical meaning: restraint or seclusion of a child or adult at risk at home, school or in care triggers local safeguarding and mandatory-reporting routes [synthesis].
  • Dual roles are handled openly. Practical meaning: a therapist who works in the same service that restrained the client keeps to APA Ethics Code Standard 3.05 (Multiple Relationships) and considers referring the client on [source: APA Ethics Code].

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Historical literacy: placing the chair accurately

  • Purpose / when: When a client, student, supervisee or family member raises Rush, the chair or asylum history, or the therapist prepares teaching on the history of psychiatry.
  • Steps: (1) Learn the documented core: Rush's January 1811 letter, the NLM account of his vascular theory and remedies, and Tromans on period devices [source: Founders Online; NLM; Tromans 2010]. (2) Present it in three strands: theory (vascular irritation), practice (depletion and restraint), reform (the 1810 letter on humane care). (3) Name what is uncertain, such as the exact date of the NLM-held engraving: its caption says 1881, while the letter dates the chair to about 1810-1811 [uncertain]. (4) Leave out construction detail. (5) Connect to today: restraint and seclusion still happen, and guidance now centres de-escalation [source: NICE QS154]. [synthesis]
  • Example language (illustrative): "Rush believed madness came from irritated blood vessels in the brain, so his treatments tried to act on the body. The chair was one of them. He also wrote, in 1810, that patients shouldn't be put on show to visitors. Both things are true of him."
  • Watch for: Sensationalising ("torture chair") or excusing ("it was the times"). It is working when listeners can hold the theory, the harm and the reform together and link them to present-day restraint.

4.2 Working with a client's interest in asylum history

  • Purpose / when: A client is drawn to asylum history, museum displays, heritage tours or images of restraint devices, perhaps after their own admission or a relative's.
  • Steps: (1) Ask what draws them and what they feel when they look. (2) Separate curiosity from re-exposure: is the interest bringing meaning or flashbacks? (3) If it is distressing, agree limits together (what to view, with whom, a plan for afterwards). (4) Link the history to their own story only if they want that. (5) Offer accurate sources (NLM, Founders Online) instead of sensational online content. [synthesis]
  • Example language (illustrative): "You've been looking at a lot of pictures of the old asylum chairs since your discharge. What happens in you when you see them?"
  • Watch for: Compulsive viewing, sleep disturbance, identification with images of restrained patients. It is working when the interest turns into understanding and the distress settles.

4.3 Screening intake for restraint and seclusion history

  • Purpose / when: All intakes with a history of psychiatric admission, emergency care, police custody, youth residential care, special schooling or disability services.
  • Steps: (1) Ask a plain, permission-based question about whether they have ever been physically held, tied, strapped, secluded or forcibly treated. (2) Accept a yes or no without asking for detail at first. (3) Note setting, age and current impact. (4) Ask whether any current care still involves restriction. (5) Record carefully and share only with consent, except where safeguarding requires it. [synthesis]
  • Example language (illustrative): "Some people who've been in hospital or care were restrained or kept in a room on their own. Has anything like that happened to you? You don't need to tell me details now."
  • Watch for: Minimising ("it was for my own good"), dissociation as the question is asked, shame. It is working when the client can name the experience and say how much they want to explore it.

4.4 Trauma-informed assessment of coercive-care experiences

  • Purpose / when: After a positive screen, to understand trauma symptoms, triggers and how the experience affects help-seeking.
  • Steps: (1) Assess intrusive memories, avoidance, hyperarousal, dissociation and body-based triggers (being held, small rooms, certain smells or sounds, uniforms). (2) Map how the experience shapes fear of services and willingness to seek care in a crisis. (3) Ask about other trauma, especially events that led to admission. (4) Use validated measures under their licences, without changing items. (5) Make a shared formulation that includes the coercive event as a possible trauma. [synthesis]
  • Example language (illustrative): "When you think about being restrained, what do you notice in your body right now? We can stop at any point."
  • Watch for: Flooding; a client who appears calm while dissociated; the therapist's chair placement or door position acting as a trigger. It is working when triggers are mapped and the client feels the assessment was done with them, not to them.

4.5 Psychoeducation: restraint, fear and the body

  • Purpose / when: A client blames themselves for their reactions to past restraint, or does not know why ordinary situations trigger panic.
  • Steps: (1) Explain in plain terms that being immobilised against one's will can be experienced as a threat to life, and that trauma reactions can follow. (2) Describe common triggers and responses. (3) If useful, add the history: early-asylum medicine sometimes used fear on purpose, for example William Battie's suggestion that "fear substituted in the room of anger" could help [source: Tromans 2010]. (4) Check what the client takes from it. [synthesis]
  • Example language (illustrative): "Your body learned that being held down meant danger. When someone stands too close, it remembers. That isn't weakness; it's what bodies do after that kind of experience."
  • Watch for: Psychoeducation used to avoid feeling, or the history making the client feel like a museum exhibit. It is working when self-blame drops and the client can predict and plan for triggers.

4.6 Stabilisation and grounding that preserve choice

  • Purpose / when: Early in work with someone whose restraint memories cause panic or dissociation.
  • Steps: (1) Offer grounding through movement and choice (standing, changing seats, opening a door, orienting to the room). Do not use exercises that ask the client to stay still, close their eyes for long, or restrict movement or senses. (2) Let the client control the seating, the distance and the exits. (3) Use no touch. (4) Practise a stop signal and honour it every time. (5) Build a short list of what helps between sessions. [synthesis]
  • Example language (illustrative): "Would you like to sit nearer the door, or stand for a bit? You decide, and you can change your mind."
  • Watch for: Grounding techniques that accidentally copy restraint (body scans that require stillness, weighted objects pressed on the client). It is working when the client can come back from distress within the session using their own choices.

4.7 Suicide and self-harm risk assessment and safety planning

  • Purpose / when: Coercive care, trauma and fear of future admission can raise suicide risk and stop people seeking help in a crisis.
  • Steps: (1) Ask directly about suicidal thoughts, intent and plans, following standard risk-assessment practice. (2) Ask whether fear of being restrained again would stop them seeking help. (3) Write a collaborative safety plan: warning signs, coping steps, people to contact, and professional and crisis contacts they find acceptable. (4) Discuss safe storage or removal of means, without method detail. (5) Give crisis resources: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). (6) Review at each session while risk is present. [synthesis]
  • Example language (illustrative): "Sometimes people who were restrained in hospital say they would rather not call anyone in a crisis than risk going back. Is that true for you? Let's find options you could actually use."
  • Watch for: Hidden risk behind refusing services; the therapist's own urge to arrange admission without discussion. It is working when the client has a plan they believe in, with at least one contact they trust.

4.8 Advance statements and crisis planning

  • Purpose / when: A client with past restraint who may need crisis care again.
  • Steps: (1) Explain that NICE quality standards support people to identify de-escalation techniques that have worked, and to make advance statements about restrictive interventions [source: NICE QS154]. (2) Help the client record early signs of agitation, what calms them, what makes things worse, and their preferences if restriction is ever considered. (3) Suggest sharing it with their care team, with consent. (4) Review after any crisis. [source: NICE QS154; steps synthesis]
  • Example language (illustrative): "If things got bad again, what would you want staff to know first? What has helped before when you were starting to feel overwhelmed?"
  • Watch for: The client feeling that planning means accepting restraint. Make clear the aim is to reduce the chance of it. It is working when the client owns the document and feels some control over future care.

4.9 Supporting complaints, records and independent advocacy

  • Purpose / when: A client wants to understand, challenge or put on record a restraint they experienced.
  • Steps: (1) Explore what they want: understanding, acknowledgement, apology, change, or legal remedy. (2) Explain in general terms that records can usually be requested and that services have complaints routes, without giving legal advice. (3) Signpost to independent advocacy, patient advocates, ombudsman services or a lawyer as locally available. (4) Prepare for what the records may say, including distressing language. (5) Support them through the response, whatever it is. [synthesis]
  • Example language (illustrative): "Reading your notes could answer some questions, and it could also be painful. Shall we plan how you'll read them and what you'll do afterwards?"
  • Watch for: The process becoming re-traumatising; the therapist pushing for action the client does not want. It is working when the client feels the choice to act or not was theirs.

4.10 Safeguarding and reporting current inappropriate restraint

  • Purpose / when: A client, colleague or family member describes current restraint, seclusion or immobilisation that seems unsafe, punitive, unplanned or not in line with guidance.
  • Steps: (1) Establish the facts calmly: who, where, when, any injury. (2) If a child or adult at risk is involved, follow local safeguarding and mandatory-reporting routes at once. (3) If a colleague or institution is involved, raise it through the service's governance or speak-up route, and through regulators or licensing boards as they publish them. (4) Record what was said and done. (5) Tell the client what you will do and why, unless that would put someone at risk. (6) Never take part in, supervise or refer to the practice. [synthesis]
  • Example language (illustrative): "What you're describing worries me for your son's safety. I need to share this with the child-protection team. I'll tell you exactly what I'm going to say."
  • Watch for: Pressure to keep quiet; downplaying because the practice is routine in that setting. It is working when the concern is logged, the person at risk is protected, and the client's trust is kept as far as possible.

4.11 Recognising restraint of children at home, school or in care

  • Purpose / when: A parent, carer or teacher describes tying, strapping, confining or holding a child to "calm" them, or a child or young person describes it.
  • Steps: (1) Listen without judgement and get the facts. (2) Treat it as a safeguarding matter and follow child-protection and mandatory-reporting routes. (3) Do not suggest any alternative holding or restraint method. (4) Once the child is safe, refer to services that support behaviour and emotional regulation (child and adolescent mental health, paediatric or developmental services). (5) Involve the young person with age-appropriate assent and explain the steps. [synthesis]
  • Example language (illustrative): "It sounds like you've been really stretched trying to keep him safe. Strapping him down isn't safe, though, and I have to make sure he and you get proper help."
  • Watch for: Parents presenting restraint as a recommended "therapy"; disability-related situations where restraint is normalised. It is working when the child is protected and the family is connected to support.

4.12 Working with families and descendants of institutionalised relatives

  • Purpose / when: A client has found asylum records, photographs or family stories of a relative who was confined or restrained, or carries family silence about mental illness.
  • Steps: (1) Explore what they found and what it means to them. (2) Place the relative's treatment in its historical context without excusing it. (3) Work with shame, fear of inheriting illness, and grief for someone they never knew. (4) Support memorial or commemorative acts if the client wants them. (5) Help with disclosure to other family members if wanted. [synthesis]
  • Example language (illustrative): "Reading that your great-grandmother was kept restrained on a ward must be hard. What do you most want to understand about her?"
  • Watch for: Fatalistic beliefs about heredity; over-identification. It is working when the relative becomes a person with a story, not only a patient record.

4.13 Working with racial history and mistrust of psychiatry

  • Purpose / when: A Black, Indigenous or other racialised client raises psychiatry's history, Rush's racial theories, or mistrust of services.
  • Steps: (1) Acknowledge the history accurately: the New York Times reported Rush's "negritude" theory and his image in the APA logo until 2015, and the APA apologised in January 2021 for its support of structural racism [source: NYT/HNN; APA apology]. (2) Invite the client's own experiences of racism in care. (3) Do not defend the profession or claim the problem is fixed. (4) Explore how mistrust affects their choices, and keep access to needed care open. (5) Consider whether the client would prefer a therapist with shared background, and support that choice. [synthesis]
  • Example language (illustrative): "You have good reasons to be wary. Psychiatry's own professional body has apologised for its part in racism. What would you need from me to make this feel safer?"
  • Watch for: The therapist's defensiveness or guilt taking up the space. It is working when the client can name concerns openly and trust grows through consistent behaviour.

4.14 Supporting re-engagement with needed care

  • Purpose / when: A client avoids all psychiatric or medical care because of past coercion, while having needs those services meet.
  • Steps: (1) Validate the fear. (2) Separate the past service from present options. (3) Help prepare questions for providers about restraint policies and de-escalation. (4) Offer to help coordinate care with consent. (5) Never advise starting, stopping or changing a medicine; send medication questions to the prescriber. [synthesis]
  • Example language (illustrative): "You're allowed to ask a new clinic how they handle a crisis before you agree to anything. Shall we write down your questions?"
  • Watch for: The therapist sliding into persuasion or becoming the client's only source of care. It is working when the client makes informed choices about services.

4.15 Repairing ruptures where therapy itself felt coercive

  • Purpose / when: A client experienced a safeguarding report, a crisis referral or an involuntary assessment arranged by the therapist as a repeat of past coercion.
  • Steps: (1) Raise the rupture directly. (2) Explain the reasons for what you did, without defensiveness. (3) Acknowledge the client's experience of loss of control. (4) Agree what you will do differently, and what you cannot promise (safeguarding duties stay). (5) Review the relationship over the following sessions. [synthesis]
  • Example language (illustrative): "When I called the crisis team, it may have felt like hospital all over again. I'd like to hear what that was like for you."
  • Watch for: Polite compliance hiding anger; dropout. It is working when the client can disagree openly and keeps coming.

4.16 Working with staff who used or saw restraint

  • Purpose / when: A client is a nurse, support worker, officer or other staff member who took part in or saw restraint and now has guilt, intrusive memories or moral injury.
  • Steps: (1) Assess trauma and moral-injury symptoms. (2) Explore what happened and what they believe it says about them. (3) Separate personal responsibility from organisational practice. (4) If they disclose current unsafe practice, follow 4.10. (5) Support them to use speak-up routes if they choose. (6) If you work in the same organisation, consider APA Ethics Code Standard 3.05 (Multiple Relationships) and refer on if needed [source: APA Ethics Code]. [synthesis]
  • Example language (illustrative): "You followed the procedure, and part of you still feels you did something wrong. Let's look at both."
  • Watch for: Rushing to reassure; collusion with unsafe practice. It is working when guilt becomes something the client can think about and act on.

4.17 Service-level advocacy for restraint reduction

  • Purpose / when: The therapist works in or consults to services that still use restraint or seclusion.
  • Steps: (1) Learn the service's policy and the relevant guidance (NICE NG10 and quality standard QS154 in England) [source: NICE QS154]. (2) Advocate for de-escalation at the first signs of agitation, and for advance statements, as the quality standard describes [source: NICE QS154]. (3) Support post-incident review and support for patients and staff [synthesis]. (4) Bring patients' and survivors' perspectives into service design [synthesis].
  • Example language (illustrative, team meeting): "Could we add a section to admission plans asking what has calmed each person in the past?"
  • Watch for: Token consultation; blaming individual staff. It is working when incidents of restriction fall and patients report being asked about their preferences.

4.18 Teaching and supervision: the chair as an ethics case

  • Purpose / when: Training, supervision or reflective practice on how well-meant treatments can harm.
  • Steps: (1) Present the documented facts (section 1). (2) Ask learners to find the theory, the intent and the effect. (3) Compare with modern pressures to subdue distress quickly. (4) Discuss which present-day practices future clinicians might judge harshly. (5) Leave out device detail and images of restrained patients unless needed and handled with care. [synthesis]
  • Example language (illustrative): "Rush wanted to cure his patients and also designed a chair meant to overwhelm their senses. Where might our good intentions blind us?"
  • Watch for: Present-day superiority ("we'd never do that"). It is working when learners link the history to their own practice.

5. Handling problems

The problems below are the psychotherapist's own synthesis [synthesis]; a source tag marks any point drawn from a cited source.

  • Stuck client (circling the same restraint memory without change). Move from the event to its meanings ("what did it teach you about yourself, about help?"). Check whether ongoing threats, such as a current care plan that allows restraint, keep the memory live, and address them through advance statements (4.8).
  • Resistance or refusal to discuss coercive care. Respect it. Name that the subject is available whenever the client wants it, and work on current goals. Pressing for detail repeats the loss of control.
  • Overwhelm, panic or dissociation in session. Stop the narrative and use choice-based grounding (4.6): movement, orientation, control of the door and distance. Never hold or touch the client to settle them. Reassess risk before the client leaves (4.7).
  • Non-adherence to needed care because of fear of restraint. Do not argue. Explore the fear, help the client prepare questions for providers, and support a crisis plan that sets out their preferences (4.8, 4.14). Medication questions go to the prescriber.
  • Ruptures after safeguarding or crisis action. Use 4.15. Keep explaining your reasoning and your limits; do not promise that you will never act on risk again.
  • Client wants the therapist to confirm that "psychiatry is torture". Validate the experience and the documented history (including the APA's 2021 apology) without making sweeping claims. Keep open the client's access to care that may help.
  • Client romanticises or collects restraint imagery. Explore the function: mastery, identification, or self-punishment? Agree limits if it is causing distress or risk (4.2).
  • Family or school asking how to restrain safely at home. Do not advise any restraint or holding method. Follow safeguarding routes if a child or adult at risk is being restrained (4.11), and refer to specialist behaviour and developmental services.
  • Colleague or institution using restraint inappropriately. Do not take part or supervise. Raise concerns through governance, speak-up and safeguarding routes and regulators as they publish them, and record your actions (4.10).
  • Therapist's own reactions (anger at services, guilt about the profession, defensiveness). Take them to supervision. Watch for over-identifying with the client against all services, or for minimising.
  • Suicidal crisis. Follow 4.7. Give 988 (US) or Samaritans 116 123 (UK and Ireland), and use agreed emergency routes, explaining each step to the client.

Harm account

What was actually done

At Pennsylvania Hospital, Philadelphia, around 1810-1811, the physician Benjamin Rush introduced a restraining chair that he called the "tranquillizer" and described to Thomas Jefferson as a chair "to aid in the Cure of Madness" [source: Founders Online; Penn Libraries]. Tromans describes it as designed "to overwhelm every motion and sense of the raving patient" [source: Tromans 2010]. It was part of a regime based on Rush's belief that madness came from irritated blood vessels in the brain, alongside bleeding, purging, hot and cold baths, mercury and a rotating "gyrator" [source: NLM]. Patients at the hospital were then held in a locked basement [source: Penn Libraries]. The chair belonged to a wider transatlantic set of early-asylum devices: rotating and swinging machines, sudden drenching, and restraining chairs, including one made for George III; a chair like Rush's was considered for the King in 1811 but not adopted [source: Tromans 2010]. An engraving of the chair, captioned "Observations on the Tranquillizer", appears in the Philadelphia Medical Museum; NLM dates it 1881, which conflicts with the 1810-1811 dating of the chair [uncertain]. The NLM's image of the chair shows a seated patient held immobile by straps around the body and limbs, with a box-like device enclosing the head and a bucket hanging beneath the seat [source: NLM, tranquilizer chair image page]: the patient could neither move nor look around, which matches Tromans's phrase about overwhelming "every motion and sense" [source: Tromans 2010].

How it caused harm

  • The chair imposed prolonged immobilisation and sensory restriction on distressed, unconsenting patients. In Tromans's account, devices of this period were meant to shock or overawe patients [source: Tromans 2010]; fear itself was proposed as a remedy in the era's medicine [source: Tromans 2010, quoting Battie].
  • It rested on an obsolete theory of madness and was used together with depleting remedies (bleeding, purging, mercury) [source: NLM]. See this domain's bloodletting and depletion guide (013).
  • Injuries or deaths caused by the chair itself are not documented [uncertain].
  • The long-term harm is that it shaped professional practice: Rush's textbook was the main American text on mental disease for almost 50 years [source: NLM], and mechanical restraint kept a place in psychiatric care.
  • Today restrictive interventions are still recognised as a source of potential harm and discomfort, which is why NICE supports de-escalation and advance statements [source: NICE QS154].

Recognising it today

  • Client accounts of being strapped, tied or confined to a chair or bed, or secluded, in psychiatric, emergency, custodial, residential, school or home settings [synthesis].
  • Trauma reactions to being held, to small rooms or to staff uniforms; avoidance of all services after coercive care [synthesis].
  • "Calming" devices or practices offered to families or schools that immobilise a child or adult [synthesis].
  • Distress or fascination triggered by museum displays, images or heritage tours of asylum devices (4.2) [synthesis].
  • Mistrust of psychiatry rooted in its history, including its racial history, as the APA's 2021 apology acknowledges [source: APA apology].

What to do instead and how to help those harmed

  • Supported care: prevention and de-escalation from the first signs of agitation; continued de-escalation if restriction is considered; advance statements about preferences for any restrictive intervention [source: NICE QS154, based on NICE NG10]. Within Rush's own lifetime his 1810 letter to the hospital managers called for separate buildings, "labor, exercise, and amusements" and an end to showing patients as spectacles [source: Founders Online]; see this domain's moral-treatment and non-restraint guides for the reform tradition.
  • Survivors: trauma-informed assessment and therapy that preserves choice (4.3-4.6), safety planning with 988 (US) or Samaritans 116 123 (UK and Ireland) (4.7), support with records, complaints and independent advocacy (4.9) [synthesis]. Survivor-led and peer-support organisations can be offered as they describe themselves; check them yourself before referring [synthesis].
  • Families: family-history work and support for relatives of people who were restrained (4.12) [synthesis].
  • Reporting and legal routes: safeguarding and mandatory reporting for children and adults at risk; service governance, regulators and licensing boards for clinicians and institutions; independent legal advice for possible claims (4.10) [synthesis].
  • Profession: honest teaching of this history, including Rush's racial theories and the APA's 2021 apology (4.13, 4.18) [source: NYT/HNN; APA apology].

Sources

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