Shades of "The Snake Pit": The Wet Pack is Back

I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19^th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18^th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19^th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20^th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19^th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.

  

 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19^th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18^th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19^th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20^th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19^th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.

  

 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19^th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18^th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19^th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20^th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19^th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.

  

 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19^th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18^th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19^th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20^th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19^th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.

  

 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19^th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18^th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19^th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20^th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19^th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.

  

 I thank my colleague Linda Rosa for bringing this to my attention: http://autismum.com/2012/01/18/le-packing-pack-it-in. The piece describes the use of “packing”, or wrapping naked children in cold wet sheets, as a “treatment” for autism. It quotes the opposition of Michael Rutter and Simon Baron-Cohen--  leading British researchers on causes and treatment of childhood mental illness--- and their signatures on a 2009 statement rejecting this practice. The “Autismum” author also points out that “packing” has been used in Europe for over thirty years.

I want to point out that in fact this practice goes back much farther than that, is based on ideas such as the hydropathic (“water-cure”) beliefs of the 19^th century, and has never been supported by any empirical evidence. It has, however, been fostered during the last thirty years by related suggestions and treatments, some of them put forward by occupational therapists.

The use of “wet packs”  for the mentally ill probably originated in their use (appropriate for the time) in treating fevers. With minimal pharmaceutical knowledge or resources, physicians of the 18^th century and before used “packing” as a treatment for the high and dangerous fevers associated with typhoid and other serious infections. The agitation and  restless activity that may be associated with fever were easily confused with the agitation and activity that may characterize manic episodes, autism, or other mental disturbances. Just as John Hughlings Jackson later took the regression of function resulting from brain damage and supplied it as a metaphor for cognitive or emotional dysfunctions, physicians treating the mentally ill thought of physical illness as a model for their treatment. Dr. Willis, George III’s physician and “mad doctor”, used hydrotherapy in the form of both warm and cold packs, a cold pack on the chest being expected to calm the action of the heart. According to Joseph Whorton’s book Nature Cures, a “wet-sheet” technique was thought  by 19^th-century hydropaths to draw off impurities that disturbed both physical and mental functioning.

The use of “packing” in mental hospitals continued well into the 20^th century. Mary Jane Ward’s semi-autobiographical novel The Snake Pit, in the 1940s, depicted its heroine’s experiences of wrapping in wet sheets, the “wet pack” treatment. (Incidentally, when this novel was issued in paperback in the 1960s, it was supplementary reading in many a psychology class; I have to wonder how many students of that time came to accept “packing” as a legitimate treatment. Just goes to show, you have to watch what reading you assign--- someone might actually do it!) Tubs full of hot water were also used by some practitioners, leading to the scalding death caused under the supervision of the egregious Jacqui Schiff of Transactional Analysis fame.

An issue related to the use of “packing” was the employment of restraints for calming purposes. George III was restrained in a special chair when agitated. The idea of restraint as a treatment in addition to a safety measure has remained with us, and it’s only recently that the use of restraint and seclusion has been considered to need careful regulation. Restraint in the form of physical pressure was advocated by chiropractors and similar practitioners from the 19^th century on (by the way, there were chiropractic mental hospitals up until about 1960).

In the 1960s, the occupational therapist A. Jean Ayres posited individual variations in sensitivity to sensory stimulation, including both light and deep pressure, and argued that developmental problems of children could be treated by a program of carefully balanced sensory stimulation—a “sensory diet” that might include regulation of light and sound, deep and light massage, and vestibular stimulation. (These ideas were also associated with programs designed for handicapped children by French educators like Itard and Seguin.) A connection between physical pressure and autism was suggested by the high-functioning autistic Temple Grandin, who described how as a child she longed for the pressure of the “squeezer” that held her grandmother’s calves for medical treatment; in her most recent book, Animals Make Us Human, Grandin refers to placing an animal in a box and filling the box with grain to provide all-over pressure and calm the creature. All of these claims lent support to the idea that physical pressure is calming and beneficial.

There are common practices that use pressure to have a soothing effect. For example, swaddling young babies is a world-wide method, and in Russia and some other places used to be continued until the child was a year old. The babies were so carefully wrapped that it was said you could pick one up by the legs and wave it around like a package without its body bending at all (I doubt that this was advised, however!). But although swaddling of young babies is still recommended as a calming method, not all uses of restraint and pressure are so harmless. For example, at www.sptimes.com/2006/12/15/Tampabay/letter_explains_schoo.shtml, there is a description of the use of stretchy bags called  “Body Sox” as a substitute for “timeout” for preschoolers. The practice of the complimentary and alternative psychotherapy called Holding Therapy or Attachment Therapy also involves physical restraint of a child in the form of an extended embrace by a parent or therapist, sometimes in spite of the child’s struggles to get away. Neither Body Sox nor Holding Therapy is based on evidence of efficacy, and the latter has well-demonstrated dangers in the form of injuries and deaths resulting from restraint and from related practices.

Physical restraint of the kind exemplified by “packing” is a practice left over from previous centuries--  what we might call the “trailing edge” of an idea. Historically, a variety of related beliefs have melded with the original treatments for fever and agitation to extend the lifespan of restraint intended as therapy. However, it is more than time for these practices to come to an end. They are without therapeutic merit, and they are potentially dangerous both mentally and physically. It’s time for us to follow the recommendations of Michael Rutter and Simon Baron-Cohen, about “packing”, and to question carefully all other practices based on similar ideas.