Seclusion: the inside story.

The objective of this study was to gain a better understanding of the seclusion room experiences of chronic psychiatric patients, the way in which they cope with their seclusion room experience, and the effect of seclusion on subsequent relations with care providers. A qualitative research design was used, in line with the procedure of Grounded Theory. Semi-structured interviews were held with seven chronic psychiatric outpatients whose seclusion took place at a certain remove in time. The transcriptions were analyzed with the aid of Winmax. The following results were found. Most seclusion experiences by far are negative. However, patients whose experience took place a considerable time ago also mention positive experiences. It is hard to come to terms with the seclusion experience; this is a matter of learning to live with it (adaptation) rather than assimilating it (adjustment, or active coping and controlling). Factors conducive to the coping process are: understanding the reason why it took place, time, distraction, possibilities to discuss it with others, and quick recovery of control. Factors prohibitive to the coping process are: the danger of recurrence, iniquitous treatment by care providers during seclusion, confrontation with others being secluded, and lack of opportunity to talk about it. Seclusion does not affect subsequent relation with care providers, with two exceptions. When patients feel they have been treated iniquitously during seclusion, or when seclusion continues to be a daily threat, this has a negative effect on relations with care providers. The central themes of this study are autonomy, trust, and loneliness.