[The consideration and execution of the principles of no restraint and open door strategies in Hungarian psychiatry].

In order to understand the problems and dilemmas of Hungarian psychiatry regarding no-restraint, and open-door strategy, it is indispensable to comprehend the 18th century beginnings, the original principles and objectives of this healing approach. The first representatives of this method appeared between the second half of the 18th century, (V. Chiaruggi, Ph. Pinel, W. Tuke), and the first half of the 19th century (E.D. Esquirol, B.A. Morel, V. Magnan, J. Conolly), during the times when the main principles of keeping the mentally ill in asylums were those of security, guarding and separation. There were four reasons which led to the elaboration of restraint itself: (a) overcrowded institutes; (b) high proportion of restless and agitated patients among the sick-population; (c) outnumbered and undereducated medical staff; (d) and that the typical method of contemporary psychiatry preferred to apply sudden, unexpected and drastic effects assuming their healing power. As a result mechanical restraint was developed with a wide variety of means, regarding always as a principal objective to keep the patient isolated from the rest of society, and to obstruct him or her to make any harm either to himself or herself, or to the others. Thus restraint consisted of all forms of coercive and restrictive measures, such as mere physical limitation of motion, meals, relaxation, sleep, intellectual activities, and any other forms of personal liberty there might be. Consequently, the program of no-restraint intended to get rid of all of these measures and to guarantee the greatest possible level of liberty for the patients. This guiding principle of no-restraint appeared in the methods of psychiatric therapy, the objectives for the reorganization of psychiatric institutes, and in the legal actions taken to secure the civil rights of the mentally ill through parliamentary enactment. The realization of open door strategy belongs to the development of no-restraint in a wider sense. Just like in other countries the elaboration of this method--with more or less success--has been started in Hungary at the end of the last century as well, and is still in progress. The cardinal principle of this method is not to keep the doors of mental hospitals or wards by all means open, but to create a social milieu, an atmosphere in which any further harm for the patients that may occur as a result of their residence, are likely to be avoided. The open door strategy stands not for an unlimited but the greatest possible level of liberty for the mentally ill ... 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.