Bender’s goal wasn’t to make life simpler on the ward by taming unruly children. Nor did she view ECT as a permanent “cure.” Her belief, after seeing the results of electric shock on adults, was that it would allow her most disturbed patients to respond more effectively to other treatments—psychotherapy, counseling, music, puppetry, and dance. Bender helped establish a public school at Bellevue to teach remedial reading and language classes. And at a time when many psychiatrists, led by her former colleague Fredric Wertham, were blaming comic books for causing “juvenile delinquency” and “sexual perversion”—Wertham insisted that Batman and Robin were secret lovers—Bender encouraged her older patients to read them as a form of “mental catharsis.” Her personal favorite was Wonder Woman, who, she believed, taught girls that they, too, could be heroic, powerful, and just.
In pushing shock therapy, Bender may also have been reacting to the views of several prominent neurologists at Bellevue, who argued that “severely defective” children were beyond saving. Indeed, the department chair, Foster Kennedy, had recently lectured the prestigious American Psychiatric Association on the subject. “We have too many feeble-minded among us,” he said, adding: “I am in favor of euthanasia for those hopeless ones who should never have been born—Nature’s mistakes.” Bender was appalled.
Each of her subjects received an “extensive neurological examination” before and after ECT. The procedure mimicked the one for adults: twenty shocks in all, one per day, with 95 to 130 volts “until a grand mal convulsion was produced.” In a follow-up study, published in 1947, Bender claimed that while “the essential schizophrenic process [did] not appear to be modified by the treatments,” the subjects seemed “less disturbed” and thus “better able to accept teaching or psychotherapy.”
There was some anxiety, Bender noted, especially among children “near puberty.” The girls “clearly related the [shocks] to sexual intercourse and fantasy,” while the boys feared “it was punishment or that they might not recover consciousness.” Overall, however, the complications were “minimal.” If anything, Bender concluded, “children can tolerate electric shock better than adults.”
The first real criticism of Bender’s experiments came in 1954. Two independent researchers using a national sample of ECT cases, the majority from Bellevue, concluded that the positive effects “were temporary and resulted in no sustained improvement in the patterning of behavior.” Much of the evidence was anecdotal—provided by parents who believed that ECT had made things worse for their children. One boy had come home and tried to strangle his sister; a girl had beaten her infant brother; several had turned violent following minor disturbances.
The researchers didn’t entirely rule out electric shock for children. It might be “justified,” they wrote, when “all other measures have failed.” But their study implied that Bender had ignored the potentially catastrophic risks. “It appears to [us] that one should be fearful of giving electric shock therapy to…those four or five years old,” they concluded, “for we have no good understanding of [its] later effect…on the personality that is only in the developmental stage.”
Though the parents in this study remained anonymous, they may have included the novelist Jacqueline Susann and her publicist husband, Irving Mansfield. In 1946—two decades before writing Valley of the Dolls—Susann gave birth to a son with severe developmental problems. His early words became shrieks and he seemed indifferent to affection. Alarmed, Susann took the boy to a specialist who suspected autism and recommended Dr. Bender, an obvious choice.
Bender didn’t believe that autism resulted from a lack of maternal warmth, as did other leading child psychiatrists of that era, including Bruno Bettelheim and Leo Kanner. She suspected that it most likely was inherited. “I have never seen one single instance,” she noted, “in which I thought the mother’s behavior produced autism in the child.” Bender met with Susann and Mansfield and proposed electric shock. The couple reluctantly agreed.
The treatments didn’t work. “I think they destroyed him,” Mansfield recalled. “He came home with no expression, almost lifeless.” Whether electric shock worsened the boy’s condition is impossible to say. He was sent to a private mental facility, where he remained for the rest of his life.
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The most disturbing parts of the critical 1954 study were the interviews with the children who had received ECT. Many displayed emotions that Bender hadn’t commented upon: anger, humiliation, and pain. One child wanted to “kill” the doctor who shocked him. Another had tried to hang himself in order to stop further treatments, saying he was “afraid of dying and wanted to get it over with fast.” A third was so furious at his mother for consenting to ECT that he assaulted her and then tried to leap from an apartment window. Numerous children recalled the throbbing headaches that followed each session. And few claimed to be better off. “I don’t think they did me much good,” an eleven-year-old told the investigators in a typical comment. “I couldn’t do any school work so good any more.”
The most detailed recollections of ECT at Bellevue would come decades later from an attorney named Ted Chabasinski. Born to an unwed mother with a history of schizophrenia, Chabasinski was living in foster care when a social worker, noting signs of mental illness (which Chabasinski disputes), had him committed to Bellevue for observation. The year was 1944—the height of Bender’s ongoing ECT experiments—and the six-year-old Chabasinski became a subject. “On the mornings when I was going to get the shock treatment, I didn’t get breakfast, so I knew what was going to happen,” he recalled. Three attendants would drag him, kicking and biting, to the treatment room, where a rag was stuffed into his mouth and the electrodes fastened to his head. “And that was the last thing I would remember, until I woke up in a dark room somewhere….I had learned to try to memorize my name…so I would remember it after the shock….I would cry and realize how dizzy I was.”
Chabasinski described the children’s ward as an unspeakable place where the attendants abused and raped him. He also recalled Dr. Bender as an austere presence, cold as ice. “Sometimes she would pass very close to me, looking at me but not acknowledging me, as if I didn’t exist.”
Following the requisite twenty sessions, Chabasinski was returned to foster care but removed shortly thereafter and sent to a state mental facility, where he spent the next ten years of his life. “The little boy who had been taken [to Bellevue] to be tortured didn’t exist anymore,” he wrote. “All that was left of him [were] a few scraps of memory and a broken spirit.”
Chabasinski’s narrative is as complicated as it is painful. Written more than sixty years after the experience, it had a larger purpose in mind: to abolish what Chabasinski and his supporters see as the barbaric practice of electric shock. But the people who worked alongside Bender in these years hold very different memories. The children’s ward they describe was hectic and overloaded, on the one hand, but caring and professional, on the other—staffed by an army of skilled psychiatrists, nurses, social workers, teachers, and volunteers.
Their perceptions of Dr. Bender border on the reverential: a brilliant woman, a devoted mother, a fearless pioneer. “She brought her children to the unit so often that this became an unremarkable event,” wrote the renowned psychiatrist Stella Chess. “Clearly, the warnings I had been given that choosing a professional career ruled out marriage and motherhood need have no reality….Lauretta Bender’s greatest legacy was the group of leaders whom she bequeathed to the field of child psychiatry and who, in turn, trained others.”
Bender left Bellevue in 1956 to become research director of the children’s unit at Creedmoor State Hospital, a sprawling psychiatric facility in Queens Village, New York. If anything, her methods became even more controversial. At Creedmoor, she moved beyond electric shock to something with almost no experimental history in the medical world—LSD.
Bender was hardly a cultural rebel. She seemed driven, as before, by the so-called logic of default. If nothing presently ex
ists to effectively reach those with “severe schizophrenia” (her definition of autism), the search must go on. Bender had seen a handful of adult studies on the liberating effects of LSD. She theorized that the drug, by arousing the “sensory stimuli” of autistic children, might breach their impenetrable defenses.
Bender began her LSD experiments in 1961 with few guideposts. (Even guru Timothy Leary had yet to be heard from.) She claimed to understand the dangers, recalling that “we were extremely cautious when first using the drug, even obtaining parents’ consent”—a hint, perhaps, that she hadn’t always bothered to consult them in the past. Eighty-nine autistic Creedmoor children, ranging in age from five to eleven, were given LSD between 1961 and 1965. Extreme caution soon disappeared; seeing “no serious side effects, no evidence of severe disturbances, or of toxicity,” Bender tripled the dosage and accelerated the schedule from twice a week to once a day. Most of the children “became gay, happy, laughing frequently, especially early in the treatment program,” she wrote in her preliminary report. “Nearly all of them were more alert, aware, and interested in watching other persons….With some…there was a decrease in regressive behavior such as tearing clothes, smearing food and feces, and rocking and banging.”
Hopes were raised. The American Druggist, a top industry publication, lauded the “beneficial results” of Bender’s experiment, noting that Sandoz, LSD’s sole manufacturer, was seeking “more studies” before committing to its “large-scale use in schizophrenic children.” The problem, however, was that the few researchers who tried to replicate Bender’s results were unable to do so. Their autistic subjects didn’t improve on LSD, and the side effects were pronounced. The end came in 1965 when Sandoz, fearing the drug’s potential for “recreational misuse,” discontinued production.
Bender retired shortly thereafter, her reputation firmly intact. A survey of mental health professionals in 1982 described her as “the preeminent woman psychiatrist of the second half of the twentieth century,” adding: “There is some justification for naming her the preeminent living psychiatrist in the world, period.”
Bellevue, meanwhile, abandoned electric shock for children following Bender’s move to Creedmoor, and then for all patients by the 1970s. It did so not because its psychiatrists believed it to be dangerous or ineffective—most felt just the opposite—but because of an intense anti-ECT campaign led by “medical rights” activists and fueled by the horrific portrayals of electric shock in movies like One Flew Over the Cuckoo’s Nest. “Their violent attacks and even lawsuits intimidated [us],” a Bellevue psychiatrist admitted. The repeated claims of “barbarism” and “permanent brain damage” won the day.
Electric shock has made a dramatic comeback in recent years, with strong support from the pillars of mainstream medicine: the American Psychiatric Association and the National Institutes of Health. And the Bellevue legacy of Lauretta Bender has played a key role in this ongoing debate. Opponents of ECT often cite her as an example of the slippery slope of medical research, where a questionable treatment rides roughshod over ethical concerns. (Some anti-shock activists have gone a step further, describing Bender as a “child torturer” and the American twin of Dr. Josef Mengele.) More surprising, perhaps, are the growing number of child psychiatrists who insist that she was on to something important, and that her work, while deeply flawed by current standards, deserves a second look. “With appropriate checks and safeguards,” five of them wrote recently, “modern researchers could do worse than follow the example of pioneers like Lauretta Bender.”
Bellevue resumed electric shock on a limited basis in 2015. “We consider it the treatment of last resort, when medication and psychotherapy simply aren’t enough,” said Dr. Dennis Popeo, who came from Mount Sinai to restart the program. “Some of the hospitals in the area are using it on adolescents, with all the built in precautions, but the youngest patient at Bellevue so far has been twenty-two. We’re not interested in controversy. We’re taking it slowly. But the program thus far has been extremely effective.”
16
SURVIVAL
In 1956, a Nobel Prize in Medicine came to Bellevue. The recipients, André Frederic Cournand and Dickinson Richards, were honored for their groundbreaking work in cardiac catheterization, a partnership that stretched back to the 1930s when the French-born Cournand was chief resident on Bellevue’s famed Chest Service, and the American-born Richards ran a small laboratory there. Though the Nobel Committee had occasionally made a lackluster or head-scratching selection—such as the 1949 award to Portugal’s António Egas Moniz, the father of lobotomy—the choice in 1956 was warmly received, and remains so to this day. “Just about everything modern medicine knows about the heart and lungs,” wrote a breathless admirer, “was made possible by the work of [André] Cournand and Dickinson Richards.”
The men were part of Columbia’s First Division at Bellevue, which ran the Chest Service, the hospital’s second-largest unit (behind psychiatry), with close to four hundred beds. Columbia had long viewed the Chest Service as a blessing and a burden—strong on public service, yet expensive to run. “Might I ask that [we] be consulted before any further assignments be made?” Columbia’s perplexed medical school dean wrote the Bellevue trustees in 1916. “There seems to be an unwritten tradition that Tuberculosis should belong to the First Division…and it is not considered by Columbia an equitable assignment.”
That tradition, however, would pay big dividends over time. Begun by James Alexander Miller in the early 1900s, the Chest Service quickly became Columbia’s prized possession at Bellevue—a model for teaching and research. “At least six clinical studies will be published this year by various members of the visiting staff,” the director reported in 1933. “[We] are engaged in very important anatomical and pathological studies [and] our chief resident is studying functional pathology by modern methods.”
That chief resident was André Cournand. A graduate of the Sorbonne and the University of Paris, Cournand had served as a battlefield surgeon during World War I, earning medals for courage under fire. Reaching out to Dr. Miller, Cournand was offered an internship at Bellevue and told to look up Dick Richards about a position in his lab. “If you succeed, maybe we’ll make something of it,” Miller promised. “Are you willing to take a chance?”
Cournand and Richards bonded immediately. Both men were thirty-seven years old, decorated veterans of World War I, and devotees of the fine arts. Both agreed, moreover, that the future of their specialty lay in viewing the lungs, the heart, and the circulatory system as integral parts of a single unit. “Richards introduced me to all the techniques he had mastered in his early investigations,” Cournand recalled. “He was a humanist; he was a scientist; he was a superb clinician and he was an outstanding gentleman.” Together, they created the finest cardiopulmonary laboratory in the world.
There was no precise method at the time for measuring the heart’s pumping power. The best tools were the trusty stethoscope and the electrocardiogram, developed in the early 1900s by Holland’s Willem Einthoven, which won him a Nobel Prize. On a trip back to Paris in 1935, however, Cournand learned of an obscure journal article by a German researcher named Werner Forssmann, whose eccentricities had overshadowed his revolutionary ideas.
A few years earlier, Forssmann had performed the first human cardiac catheterization—on himself. Assisted by a nurse and some painkillers, he made an incision at his elbow and carefully threaded a thirty-inch rubber catheter—the kind used to drain urine from the kidneys—through a large vein in his arm. Upon reaching the shoulder blade, Forssmann walked down a flight of stairs to the hospital’s X-ray room, the tubing still inside him, and got the technician on duty to record the moment when the outer point of the catheter touched the right chamber of his heart. Forssmann had not only done the medically unthinkable, he’d filmed it for posterity.
The first question, of course, was why? What good, if any, could come of it? Those who learned of Forssmann’s experiment—and there wer
en’t many—thought it a bad publicity stunt or, worse, a masked suicide attempt. Forssmann himself appeared vaguely interested in the possibility of delivering vital drugs quickly to the heart. Asked years later why he’d chosen to be the subject of his own procedure, Forssmann replied, as did many researchers of his era, that he had no choice: “I was convinced that when the problems in an experiment are not very clear, you should do it on yourself and not on another person.”
In 1940, following numerous tests on dogs and a chimpanzee, Cournand got permission to catheterize a terminal cancer patient; the procedure failed, he noted, because the man had “extensive metastases to the lymph nodes of the [armpit], and Dick Richards [couldn’t] get the catheter past them and into the right atrium.” Still, a bridge had been crossed. Cardiac catheterization had been shown to be safe in animals—thus, human testing could proceed. Cournand never considered the path taken by Werner Forssmann—self-experimentation—and later regretted it. What bothered him most, Cournand admitted, was the judgment: “Well, he did it on other people, but not on himself.”
Finding human subjects was a relatively simple matter at Bellevue, which had a long tradition of in-house research. And the timing couldn’t have been better for Cournand and Richards, given America’s entry into World War II. Desperate for information about battlefield shock, the government’s Office of Research and Development funneled large grants their way for studies regarding cardiopulmonary blood flow. Early on, Cournand and Richards got their “clinical material” from the dozens of car crash survivors rushed to Bellevue’s emergency room, but as wartime gas rationing cut down on automobile traffic, they turned to the victims of violent crimes, explosions, and fires. “We had…a surgical resident on call twenty-four hours a day,” Cournand recalled. “I had my technicians in contact with me by phone and as soon as…a case [arrived] I would go to the hospital.”
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