In a recent commentary, University of Toronto historian Edward Shorter laments the efforts of people like myself in states like Texas who have successfully put limits on shocking children in order to induce grand mal convulsions. His argument is that we who have fought against this are denying children a benevolent medical treatment. (1)
In order to understand why Shorter’s plea to use electroshock on children is so egregious, we need to know what it does to children’s brains, which means a look at the science. First, however, a brief look at the history of shocking children in the United States.
Electroshocking Children in the 20th Century
In 1947, psychiatrist Lauretta Bender, wrote about how she was now giving electroshock to children. She described the results in this way:
It is the opinion of all observers in the hospital, in the school rooms, of the parents and other guardians that the children were always somewhat improved by the [electric shock] treatment inasmuch as they were less disturbed, less excitable, less withdrawn, and less anxious. They were better controlled, seemed better integrated and more mature and were better able to meet social situations in a realistic fashion. They were more composed, happier, and were better able to accept teaching or psychotherapy in groups or individually. (2)
In 1955, she reported on how she had administered 20 shock treatments to a child under three years old, who was on the children’s ward at New York’s Bellevue Hospital.(3) Bender eventually administered this “treatment” to more than 500 children, and enjoyed a career as one of the most honored psychiatrists of her time.
One of the children she shocked was Ted Chabasinski, when he was a six-year-old foster child. His description of that experience stands in stark contrast to Bender’s:
I was six years old [in 1944]. My mother had been locked up in a mental hospital just before I was born, and I was a ward of the state. A psychiatrist at Bellevue Hospital in New York, Dr. Lauretta Bender, had just begun her infamous series of experiments with shock treatment on children, and she needed more subjects. So I was diagnosed as a “childhood schizophrenic,” torn away from my foster parents, and given 20 shock treatments….18 I was dragged down the hallway crying, a handkerchief stuffed in my mouth so I wouldn’t bite off my tongue. And I woke [after the shock treatment] not knowing where I was or who I was, but feeling as if I had undergone the experience of death. After four months of this. I was returned to my foster home. Shock treatment had changed me from a shy little boy who liked to sit in a corner and read to a terrified child who would only cling to his foster mother and cry. I couldn’t remember my teachers. I couldn’t remember the little boy I was told had been my best friend. I couldn’t even find my way around my own neighborhood. The social worker who visited every month told my foster parents that my memory loss was a symptom of my mental illness. A few months later, I was shipped to a state hospital to spend the next 10 years of my life.
Was this [referring to the electroshock] the work of some isolated sadist, some mad scientist practicing in a closet? No, the psychiatrist who did this to me and several hundred other children is still a leader in her field, with many articles published in prestigious psychiatric journals; she still draws a salary from the New York State Department of Mental Hygiene. And not one voice was ever raised within the entire psychiatric profession to protest what she had done. (4)
Even while Bender was publishing articles touting her success, a follow-up study of 32 children she had electroshocked was telling of the harm she had caused. Those doctors wrote:
[P]arents have told the writers that their children were definitely worse after EST [electroshock treatment]. In fact, many of these (electroshocked) children were regarded as so dangerous to themselves or others that hospitalization become imperative. Also, after a course of such treatment one 9-year-old boy made what was interpreted as an attempt at suicide.” (5)
When the 9-year-old boy was admitted to a state hospital, he said he had tried to hang himself because he was “afraid of dying and wanted to get it over with fast.” “Afraid of more terrifying shocks” is probably a more accurate description of the boy’s fear.
Electroshock is referred to by psychiatrists as electroconvulsive treatment or ECT because it involves the production of a grand mal convulsion, similar to an epileptic seizure, by passing up to 600 volts of electric current through the brain for one-half to four seconds. Before application, subjects are typically given anesthetics and drugs to paralyze the muscles, to suppress fear and pain, and to cut down on the number of broken bones — particularly in the spine, a common occurrence before drugs were used.
The ECT-induced convulsion usually lasts from 30 to 60 seconds and may produce life-threatening complications, such as apnea and cardiac arrest. The convulsion is followed by several minutes of unconsciousness. Electroshock is usually administered in hospitals equipped to handle emergency situations, including death, that may develop during or soon after the shock.
Medical doctors, as well as the building trades, do their best to prevent people from being injured by electrical shocks. People are given anticonvulsant drugs to prevent seizures because they are known to damage the brain.
The brain naturally operates in millivolts of electricity. ECT, however, jolts the brain with an average of 150 to 400 volts of electricity. ECT induces a grand mal seizure and it is obvious that ECT causes brain damage.
University of Pennsylvania neuroscience professor Peter Sterling put it this way in testimony at a 2001 hearing on ECT before the New York Assembly Standing Committee on Mental Health, Mental Retardation, and Developmental Disabilities:
ECS [ECT] unquestionably damages the brain. The damage is due to a variety of known mechanisms:
1) ECS is designed to evoke a grand mal epileptic seizure involving massive excitation of cortical neurons that also deliver excitation to lower brain structures. The seizure causes an acute rise in blood pressure well into the hypertensive range, and this frequently causes small hemorrhages in the brain. Wherever a hemorrhage occurs in the brain, nerve cells die — and nerve cells are not replaced.
2) ECS ruptures the ‘blood-brain barrier.’ This barrier normally prevents many substances in the blood from reaching the brain. This protects the brain, which is our most chemically sensitive organ, from a variety of potential insults [injuries]. Where this barrier is breached, nerve cells are exposed to insult and may also die. Rupture of this barrier also leads to brain ‘edema’ (swelling), which, since the brain is enclosed by the rigid skull, leads to local arrest of blood supply, anoxia [lack of oxygen], and neuron death.
3) ECS causes neurons to release large quantities of the neurotransmitter, glutamate. This chemical excites further neuronal activity which releases more glutamate, leading to ‘excito-toxicity’ — neurons literally die due to overactivity. Such excito-toxicity has been recognized relatively recently and is now a major topic of research. It is known to accompany seizures and over repeated episodes of ECS may be a significant contributor to accumulated brain damage.
The bottom line is that ECT “works” to the extent that it damages and disables the brain.
Doctors acknowledged the reality of ECT-caused brain damage soon after the procedure was introduced and statements to that effect are easily found. Leonard Roy Frank’s Electroshock Quotationary is the best single source for a review of the history of electroshock. Here is an example from 1941 from Walter Freeman, who introduced the lobotomy in the United States and was its most ardent practitioner and promoter: “All of the above-mentioned methods [i.e., various forms of shock and drug treatments] are damaging to the brain….” (6)
Memory loss is a key factor pointing to the existence of brain damage. It is highly significant, then, that the electroshock industry attempts to deny or minimize electroshock-induced memory loss.
In 2001, leading ECT researcher and advocate psychologist Harold Sackeim admitted in an editorial in The Journal of ECT that “virtually all patients experience some degree of persistent and, likely, permanent retrograde amnesia.” Even the most ardent electroshock “expert” proponents now admit memory loss.(7)
More recently, Sackeim and his colleagues published the results of an important study in the January 2007 issue of Neuropsychopharmacology. They acknowledged that ECT may cause permanent amnesia and permanent deficits in cognitive abilities, which affect ability to function: “This study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”(8)
The worst outcome of electroshock is death. Leonard Frank has provided one of the best summaries of the extant data on electroshock-induced death, showing that estimates vary widely(9); journalist Sandra Boodman provides a little perspective:
According to the 1990 APA [Task Force] report, one in 10,000 patients dies as a result of modern ECT. This figure is derived from a study of deaths within 24 hours of ECT reported to California officials between 1977 and 1983. But more recent statistics suggest that the death rate may be higher. Three years ago , Texas became the only state to require doctors to report deaths of patients that occur within 14 days of shock treatment and one of four states to require any reporting of ECT. Officials at the Texas Department of Mental Health and Mental Retardation report that between June 1, 1993 and September 1, 1996, they received reports of 21 deaths among an estimated 2,000 patients.(10)
That is a huge range. The Texas Department of Mental Health’s three-year
study found that one in 95 patients had died within 14 days of undergoing ECT; in contrast, the APA report estimated one death in 10,000 ECT patients.
The very highest death rate I have found is a study showing 1 in 4 among the very elderly. U.S. shock psychiatrists David Kroessler and Barry Fogel reported on the treatment of 65 depressed patients 80 years of age or older upon admission to the Rhode Island Hospital in Providence between the years 1974 and 1983.Thirty-seven were treated with ECT and 28 with antidepressant drugs. At one year following treatment, the authors found a 73.0% survival rate for the ECT group and a 96.4% survival rate for the non-ECT group. That is 10 deaths among the 37 ECT patients and 1 death among the 28 non-ECT patients.(11)
Besides the fact that electroshock directly violates the Hippocratic oath to first do no harm, it has not even been proven to provide a short-term benefit. Randomized, prospective, placebo-controlled trials comparing the administration of real ECT versus sham ECT under double-blind conditions have been done. In the sham ECT condition, the patients receive a general anesthetic, are hooked up to the ECT machine, the button is pushed, but no current is delivered. As psychiatrist Colin Ross reports in his review of the literature, sham-electroshock (anesthesia but no electroshock) has the same short-term outcomes as electroshock , and there is no evidence that it provides a lasting beneficial effect. Many studies failed to find a difference even during treatment.(12)
Let me reference Harold Sackeim one final time from another 2001 article he wrote with several colleagues on “prevention of relapse” after electroshock. The authors state in their conclusion, “Our study indicates that without active treatment, virtually all remitted patients relapse within 6 months of stopping ECT. (Italics mine)” (13)
PR vs. Science
As is quite clear from a review of the science, electroshock causes brain damage and memory loss, and does not appear to provide even a short-term benefit beyond “sham electroshock.” How is it, then, that we hear Shorter and others arguing for “making this treatment” available to more children?
One answer is that the psychiatric PR on electroshock has tended to overwhelm the science. Linda Andre’s Doctors of Deception: What They Don’t Want You To Know About Shock Treatment (14) is one of the best available books on electroshock. One thing she does particularly well is to lay out the clear difference between pubic relations and science, detailing the history of psychiatry’s strategic decision and actions to fight a public relations war for electroshock. I highly recommend her book.
Electroshocking Children in the 21st Century
It would be bad enough if electroshocking children simply constituted a footnote in psychiatry’s history, but psychiatrists’ willingness to inflict brain damage on children continued after Bender’s death in 1987. A USA Today article in 1995 noted, “at a seminar for shock therapy doctors . . . one-third of psychiatrists raised their hands when asked if they did shock on young people.” (15)
This is, in large part, due to the public relations war that Andre describes. Those who support this practice speak regularly of its “benefits”, regardless of the facts.
Psychiatrist Lothar Kalinowsky, for example, propounded this false statement in a chapter he wrote for a 1975 psychiatric textbook: “Children have been treated without harm as shown by the extensive experience of Bender.”(16)
As a result of such statements which are clearly false, children are still being shocked today. Given what we know about the resulting brain damage, I think this is a form of assault, and certainly constitutes a form of child abuse. No child is consenting to being “shocked.”
Advocates for this practice are now targeting autistic children as a group that could benefit. At least four electroshock psychiatrists have promoted the notion of using ECT to “treat” such children. Psychiatrists Dirk Dhossche and Sara Stanfill of the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center in Jackson recommended the pursuit of ECT research on autistic children in 2004,(17) and in 2009, psychiatrist Lee Wachtel of Baltimore’s Kennedy Krieger Institute reported on “the first documented case of a young autistic child who successfully improved self-injury behaviors after receiving ECT.” The experimental subject was an 8 year-old-boy “known as D.” (18)
Electroshock survivor, author and activist Leonard Frank said, “Dhossche and Stanfill have falsified and omitted certain key facts about ECT. Not only is electroshock unhelpful, it is also a memory-destroying, intelligence-lowering, brain-damaging, and life-threatening procedure that has worsened the lives of millions of people since its introduction almost 70 years ago.”(19)
Shocking children is not limited to the United States as demonstrated by one recent example from Australia. On January 25, 2009, the Herald Sun, reported, “Children younger than four who are considered mentally disturbed are being treated with controversial electric shock treatment.” In Australia, the use of electroconvulsive therapy (ECT) is increasing, and the Herald Sun’s report on “Child Shock Therapy” stated that last year “Medicare statistics record 203 ECT treatments on children younger than 14 — including 55 aged four and younger (italics mine).” (20)
The article also says that the Western Australian government was moving to ban electroshock for children under age 12.
It is impossible to know how many children are being shocked in the United States since very few states have reporting laws, and those that do have such laws, like California and Texas, are also the ones with prohibitions on shocking children. So while California, Colorado, Tennessee and Texas today ban electroshock on children and adolescents under certain ages, most states permit the brain-damaging practice if approved by two psychiatrists and a parent or guardian.
The truth about electroshock is clear. The short version, as stated on the website of our Coalition for the Abolition of Electroshock in Texas (CAEST) is clear:
- Electroshock damages the brain.
- Electroshock always causes memory loss.
- Electroshock sometimes kills.
- Electroshock is never necessary.
I offer the interested reader my own “9 minutes of truth about electroshock” here.
1. Edward Shorter, “Electroconvulsive Therapy in Children: The legislative over-reach concerning ECT in children leaves one open-mouthed“, Psychology Today online, Dec 1, 2013
2. Lauretta Bender, “One Hundred Cases of Childhood Schizophrenia Treated with Electric Shock,” Transactions of the American Neurological Association (72nd Annual Meeting), July 1947.
3. Lauretta Bender, “The Development of a Schizophrenic Child Treated with Electric Convulsions at Three Years of Age,” in Gerald Caplan, ed., Emotional Problems of Early Childhood, 1955.
4. Ted Chabasinski, “Electroshock: Medical Cure or Physical Torture?: Ex-patient Calls It ‘Destructive,’” Daily Californian, 26 October 1982. In Leonard Frank’s Electroshock Quotationary.
5. E.R. Clardy and Elizabeth M. Rumpf, “The Effect of Electric Shock Treatment on Children Having Schizophrenic Manifestations,” Psychiatric Quarterly, Volume 28, Number 4, 1954. Quoted in Leonard Frank’s Electroshock Quotationary.
6. Walter Freeman, “Editorial Comment: Brain-Damaging Therapeutics,” Diseases of the Nervous System, in Leonard Frank’s Electroshock Quotationary.
7. Harold Sackeim, “Memory Loss: From Polarization to Reconciliation,” Journal
8. Sackeim et al., “The Cognitive Effects of Electroconvulsive Therapy in Community Settings” Neuropsychopharmacology, Volume 32, Number 1, 2007.
10. Sandra Boodman, “Shock Therapy: It’s Back”, Washington Post, 24 September 1996.
11. David Kroessler & Barry Fogel, “Electroconvulsive Therapy for Major Depression in the Oldest Old,” American Journal of Geriatric Psychiatry, Winter 1993.
12. Colin Ross, 2006, “The sham ECT literature: Implications for consent to ECT,” Ethical Human Psychology and Psychiatry, vol. 8.
13. Harold Sackeim et al, 2001, “Continuation Pharmacotherapy in the Prevention of Relapse Following Electroconvulsive Therapy.” Journal of the American Medical Association, 285(10), (2001, March 14), 1299-1307. (Also see Peter Breggin, “Electroshock: scientific, ethical, and political issues,” International Journal of Risk & Safety in Medicine, 11, 1998, 5–40.)
14. Linda Andre, Doctors of Deception: What They Don’t Want You To Know About Shock Treatment , Rutgers University Press, 2009.
15. Dennis Cauchon, “More Children Undergo Shock Therapy,” USA Today, December 6, 1995
16. Lothar Kalinowsky, “Electric and other convulsive treatments,” published in Silvano Arieti, ed., American Handbook of Psychiatry, 2nd edition (New York: Basic Books, 1975).
17. Dossche, D. & Stanfill, S. “Could ECT Be Effective in Autism?“, Med Hypotheses, 2004;63(3):371-6.
18. Deanna Chieco, “Case study suggests new therapy for autism,” The Johns Hopkins News-Letter, 2/26/09.
19. Personal Communication.
20. Eleni Hale, “Child Shock Therapy,” The Herald & Weekly Times (Australia), January 25, 2009
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.