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Should children and teenagers be given electroshock treatment?
Ever since electroconvulsive therapy (ECT) was first introduced in the 1930s, psychiatrists have advocated its use for treating a wide variety of psychiatric illnesses, including depression and schizophrenia. Despite the controversy surrounding ECT and reports of neurological damage, including memory loss, many hospitals around the world continue to administer ECT for treating depression in patients who cannot be helped with conventional medication. During the 1950s and 1960s, ECT remained the treatment of choice for schizophrenics until better treatment methods became available and opposition by human rights groups protesting its use led to it being largely phased out. Adverse publicity surrounding ECT stemming from human rights campaigns, not to mention movies such as One Flew Over The Cuckoo's Nest, has ensured that ECT use remains notorious even today.
Despite this controversy, ECT continues to be used in treating children and teenagers with psychiatric problems even though available evidence for its effectiveness remains spotty at best. In a fifty-year review of ECT use in underage patients, Steve Baldwin and Melissa Oxlad argue that there are numerous problems in how child patients can be diagnosed as suffering from psychiatric problems requiring ECT. In many cases, doctors have advocated using ECT to treat symptoms that have no clear diagnosis in the hope that children showing these symptoms may be helped. For Balwin and Oxlad, not to mention numerous other critics of current mental health practices, this borders on professional negligence.
Even though there are no clear guidelines for using ECT in children, many psychiatrists continue to defend its use for treating adolescents presenting with a wide range of psychiatric problems, including depression and schizophrenia . Despite some research evidence suggesting that it can be used effectively in younger patients, the stigma surrounding ECT has led to it being formally banned in many jurisdictions. Much of the controversy over the use of ECT in children and adolescents stems from reports of how it was first misused and the persisting legacy of this misuse even today. All of which brings us to the case of Dr. Lauretta Bender.
One of the early pioneers in child neuropsychiatry, Dr. Bender is primarily remembered today as the inventor of the Bender Visual Motor Gestalt Test (more commonly known as the Bender-Gestalt), a popular drawing test for measuring "visual-motor maturity". Born in Butte, Montana in 1897, she went on to graduate as an M.D. from the State University of Iowa before becoming a resident psychiatrist at the Boston Psychopathic Hospital and later becoming a staff psychiatrist at Bellevue Hospital in New York City in 1930.
As the Senior Psychiatrist in charge of the Children's Service at Bellevue, Dr. Bender became interested in treating cases of "childhood schizophrenia", a diagnosis that included children who would be diagnosed as suffering from autism today. Described in a variety of ways, including showing "atypical and withdrawn behaviour," "general unevenness, gross immaturity and inadequacy in development," or "failure to develop identity separate from the mother's," psychiatrists dealing with these children often disagreed on the proper diagnosis as well as how best to treat these young patients.
It was during her tenure at Bellevue that Dr. Bender became actively involved in using electroshock to treat her patients. It is a matter of public record that she received a great deal of funding from the U.S. government to subsidize her use of shock treatment on several hundred child patients. Much of this research, which she described as "pioneering" was published in clinical journals during the 1940s though she would later change her mind about the effectiveness of electroshock in children.
Along with child patients who were clearly suffering from psychiatric problems, many of the children who received electroshock under Dr. Bender's supervision were otherwise normal children who had been institutionalized because they had nowhere else to live. One of these children was Ted Chabasinski who was committed to Bellevue at the age of six and diagnosed with childhood schizophrenia.
His mother had been hospitalized for schizophrenia and a social workers had suggested that his own withdrawn nature suggested that he was schizophrenic as well (belief in hereditary madness was still strong at the time). That his mother was unmarried added to the stigma and made his diagnosis all the more plausible. It was after his arrival at Bellevue that he became one of Dr. Bender's patients. She was the one who formally diagnosed Chabasinski with schizophrenia and he was one of the first child patients to receive ECT in her experimental program.
Although the exact nature of the funding she received from the U.S. government, and which department was actually involved, is still unclear, the purpose of her experimental work involved using ECT in the crude form that was available at the time. This meant that the children in her program were subjected to electric shocks without anesthetic, muscle relaxants, or any of the other standard safeguards that were meant to protect patients. Not only were there no accepted guidelines for safe use of ECT in children then, but Dr. Bender subjected her patients to levels of shock that were significantly greater than what adult patients were typically receiving.
As for Ted Chabasinski, he would receive twenty sessions of ECT over a three-week period to see how well he responded to the therapy. As Chabasinski himself described what happened to him, the horror of his experience and how it remained with him for all the years since then is plain enough.
"It took three attendants to hold me. At first Doctor Bender herself threw the switch, but later when I was no longer an interesting case, my tormenter was different each time. I wanted to die but I really didn't know what death was. I knew that it was something terrible. Maybe I'll be so tired after the next shock treatment I won't get up, I won't ever get up, and I'll be dead. But I always got up. Something in me beyond my wishes made me put myself together again. I memorized my name, I taught myself to say my name. Teddy, Teddy, I'm Teddy...I'm here, I'm here, in this room, in this hospital. And my mommy's gone...I would cry and realize how dizzy I was. The world was spinning around and coming back to it hurt too much. I want to go down, I want to go where the shock treatment is sending me, I want to stop fighting and die...and something made me live, and to go on living I had to remember never to let anyone near me again."
Along with Ted Chabasinski, Dr. Bender would subject hundreds of children to ECT over the course of the 1940s and 1950s. Most of her publications describing her research spoke "glowingly" about how beneficial this treatment was. Other psychiatrists drew on this research and began using ECT with their own child patients, often without even the basic safeguards that were supposed to be in place. Even though Lauretta Bender herself gave up on the use of ECT during the 1950s, her early research papers continue to be cited even today to justify the use of ECT with children.
Despite this misplaced confidence that many psychiatrists placed in Lauretta Bender's findings, the reality was very different.
To be continued
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