Seclusion use with children and adolescents: an Australian experience

Objective: To summarize the current state of knowledge on the use of seclusion and restraint with children and adolescents and to report the findings of an exploratory study to identify factors that place a child or adolescent at increased risk of seclusion during their admission. Method: Literature searches were undertaken on MEDLINE, CINAHL and PsycINFO databases. Articles were identified that focused specifically on seclusion and restraint use with children and adolescents or contained material significant to this population. The study reports findings from a retrospective review of patient charts, seclusion registers and staffing from an Australian acute inpatient facility. Results: The data available in regard to seclusion use in this population is limited and flawed. Further research is needed on the use and outcomes of seclusion and restraint and on alternative measures in the containment of dangerousness. Both the literature and this study find that patients with certain factors are at increased risk of being secluded during an inpatient stay. These factors include being male, diagnoses of disruptive behaviour disorder and a previous history of physical abuse. Staffing factors did not show a relationship to the use of seclusion. Conclusions: There are patient factors that predict increased risk of seclusion; these factors and their interrelationships require further elucidation. Further research is also needed on the outcomes, both positive and negative, of seclusion use and of alternatives to seclusion.

The state of history and the empire of metaphysics [Review]

One of the curious things about this challenging book is that its ostensible subject— the Saxon medical and political scientist Hermann Conring (1606–1681)— is not mentioned in the title. Constantin Fasolt argues that we cannot know what Conring really thought or meant in his writings, which means that his topic cannot be Conring as such and must instead be that which occludes our knowledge of him, the titular limits of history. Given that we do in fact learn a good deal about Conring from Fasolt’s book, we can only hope that the decapitation of its subject will be rectified in a subsequent edition, or perhaps by the restorative work of librarians putting together subject headings. And yet Fasolt’s decision is understandable, for Conring is indeed a stalking-horse for a much bigger quarry: historiography and the historical consciousness. By “history��� Fasolt understands a way of imposing intelligibility on the world, which is founded on the twin assumptions that the past is gone and unchangeable, and that the meaning of texts can be determined by placing them in their historical contexts (ix). In challenging this mode of intelligibility, Fasolt is not attempting to improve professiona history���it’s already as good as it can be—but to displace it. He regards his work as a declaration of “independence from historical consciousness” (32). At the same time, Fasolt insists that he is not simply jumping from historiography to philosophy, or attempting to preempt history with ontology (37-39). That has been tried by Nietzsche and Heidegger, who have been tainted by Nazism (Fasolt thinks unfairly). It has also been attempted by modern philosophers from Gadamer to Foucault and Charles Taylor who, in failing to address the “violence” that its mode of intelligibility does to the world, have not succeeded in outflanking history. Perhaps, Fasolt wonders, it is only the personal experience of those who have been subject to this violence—the experience of those who have been subject to historical examination—that can break the spell of history. Fasolt’s disclaimer notwithstanding, in the course of these remarks I shall argue that he is indeed jumping from history to philosophy, or attempting to outflank history by subjecting it to a particular metaphysical understanding. I shall do so in part by sketching the recent intellectual history of this move—a historical examination that I hope inflicts as little violence as possible on Fasolt’s argument.