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Lauretta Bender (August 9, 1897 – January 4, 1987) was an American child Neuropsychiatry known for developing the Bender-Gestalt Test, a psychological test designed to evaluate visual-motor Maturationism in children. First published by Bender in 1938, the test became widely used for assessing children's Neurology function and screening for developmental disorders. She performed research in the areas of autism spectrum disorders in children, suicide and violence. She was one of the first researchers to suggest that mental disorders in children might have a neurological basis, rather than attributing them to the child's bad behavior or poor upbringing.
At the time, Bender was considered an expert in the psychology of African-American children because most of the children at Bellevue were African American. Although she documented race when conducting her research, she often divided the differences in race into two categories: functional (significant differences that influence behavior) and non-functional (differences have no significant impact on behavior). In short, she believed that there were differences in the races, and some made a difference while others did not. Bender used the word "primitive" to describe natives and used the term "civilized" to refer to African Americans. Describing African Americans as "civilized" was not the norm at the time. Bender explained that "primitive" did not mean intellectually different, and that to her it described those who were not exposed to the same education and culture as those she considered "civilized".Doyle, D. (2010). 'Racial differences have to be considered': Lauretta Bender, Bellevue hospital, and the African American psyche, 1936–52. History Of Psychiatry, 21(2), 206–223. doi:10.1177/0957154X10365193 Though not a Gestaltist, Bender believed that all people are made up of a sum of their parts, and that race was only one factor in what made a person who they are.
During the 1930s and the 1950s, when Bender was working at Bellevue Hospital, there was little knowledge in the realm of mental disorders. Many childhood psychiatric disorders were attributed to bad behavior or unsatisfactory upbringing.Walter, G., Robertson, M., Rey, J. M., Soh, N., & Malhi, G. S. (2010). Electroconvulsive therapy in young people and the pioneering spirit of Lauretta Bender. Acta Neuropsychiatrica, 22(5), 253–254. doi:10.1111/j.1601-5215.2010.00487.x Bender was one of the first to propose that there was something neurologically impaired with these children. Bender diagnosed many children with "childhood schizophrenia", and sought to treat these patients. It is important to note that with more knowledge, clinicians today would most likely diagnose these children with developmental or behavioral disorders.
In an attempt to treat those patients diagnosed with childhood schizophrenia, Bender employed electroconvulsive therapy (ECT) after finding that the practice was successful in other applications. ECT was used in an experiment in Paris on children and adolescents in 1940 and showed positive results. In 1947 Bender conducted ECT on 98 children diagnosed with childhood schizophrenia under the age of twelve years. Although only a few of the patients were considered to be in remission of schizophrenia, Bender considered the treatment overall beneficial to all but two or three of the other patients.
Bender considered art as an effective way to diagnose childhood disorders. She used this technique to better understand the psyche of the child. A child's art work was a medium in which a child could express their anxieties and aggression, and allowed the clinician to gain insight into the child's mind.Bender, L. (1952). The therapy of a child. In, Child Psychiatric Techniques: Diagnostic and therapeutic approach to normal and abnormal development through patterned, expressive, and group behavior (pp. 287–302). Springfield, IL, US: Charles C Thomas Publisher. doi:10.1037/14530-018 This belief was supported by several case studies, one of which was a study on a six-year-old African American female who was abandoned by her parents, and later sent to Bellevue Hospital in 1943. The child expressed many feelings and past experiences in her artwork. Later it was revealed through her art that she had been Sexual abuse before she was abandoned. After extensive art, talk, and dream interpretation sessions the child was placed into a foster home and was considered to make an impressive recovery.
In another study, The Body Image of Schizophrenic Children Following Electroshock Therapy, Bender incorporated ECT and a child's self-image. This study used fifteen children with schizophrenia over the age of six. The children were asked to draw portraits of themselves before ECT, immediately after ECT, and fifteen minutes after ECT. The children were exposed to ECT every day, for a mean total of twenty treatments. After each treatment the patients completed the visual motor Gestalt performance test. Patients were followed up with after the treatments had ended.Bender, L., & Keller, W. R. (1952). The body image of schizophrenic children following electroshock therapy. American Journal of Orthopsychiatry, 22(2), 335-355. doi:10.1111/j.1939-0025.1952.tb01960.x It was observed that the children became more anxious after the treatments had ended, and this was reflected in their drawing; which became more primitive after each ECT treatment. Verbal body image distortions also occurred well after the ECT treatment for that day.
In an attempt to alleviate the symptoms in children, Bender also used LSD (LSD 25). Many psychiatrists at this time were experimenting with LSD as a way to treat schizophrenia, as there were no psychotropic medications invented at this time. An example of another controversial treatment for schizophrenia during this time was called insulin shock therapy and metrazol treatments. Patient were given large amounts of insulin to induce insulin shock, then given metrazol to induce Epilepsy convulsions.Shipley, W. C., & Kant, F. (1940). The insulin-shock and metrazol treatments of schizophrenia, with emphasis on psychological aspects. Psychological Bulletin, 37(5), 259–284. doi:10.1037/h0061037 The use of ECT in psychiatric treatment lessened after the invention of psychotropic medications.
(1) Vortical movement, biologically determined in the optic field, gives rise to the most primitive visually perceived forms, such as circles and loops. (2) Movement, always present, is directional—"clockwise or counterclockwise—"or on a horizontal plane—"dextrad or sinistrad.(3) By controlling or inhibiting this action-pattern, globes, circles, and arcs are constructed.
(4) This organizes the visual field into foreground and background.
(5) Boundaries between objects are delineated.
(6) Verticalization arises concurrent with body-image maturation as the postural model shifts in the infant from the prone to the upright position.
(7) Crossed lines, diagonal or slanting relations, and angle formations are a later level of maturation, usually occurring at about 6 to 8 years of age.
Bender believed that the lower aged or more primitive abilities were signs of childhood schizophrenia, brain damage, or learning disabilities.
Bender also conducted extensive research on autism. She believed that autism is a type of schizophrenia, and was often one of the first signs. The lack of ability to communicate one's experience of being autistic (due to age) would cause them to be quiet and withdraw, and this was one of the signs of early schizophrenia. Bender was one of the first to extensively observe and document the behaviors of autism, some of which we attribute to those with autism even today.Faretra, G. (1979). Lauretta Bender on autism: A review. Child Psychiatry And Human Development, 10(2), 118–129. doi:10.1007/BF01433504 Steve Silberman, the author of Neurotribes, is sharply critical of Bender's therapeutic approach to children with autism. In the 1950s and 1960s, he told an interviewer from The Sun magazine,
"autistic kids were often subjected to seclusion, restraint, and physical punishment by clinicians who did not understand their condition. The head of children's psychiatry at Bellevue Hospital in New York City, Lauretta Bender, administered electroconvulsive therapy to autistic patients and also insulin-shock therapy — administering overdoses of insulin to put them into a short-term coma. She gave them antipsychotic drugs like Chlorpromazine. She also tried giving autistic kids LSD every day for nine months or more, but decided they were becoming "more anxious."
Lauretta Bender also opposed Freudian views of childhood disorders. According to Freud and others, childhood anxiety stemmed from early hostility and aggression. Bender observed that childhood anxiety, aggression, and hostility was often caused by frustration or developmental issues, either physically or environmentally.Bender, L. (1950). Anxiety in disturbed children. In P. H. Hoch, J. Zubin, P. H. Hoch, J. Zubin (Eds.), Anxiety (pp. 119–139). New York City, NY, US: Grune & Stratton. doi:10.1037/11273-007
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