Most of the attention this has gotten on the internet stops right there, with the headline. The impression is justifiably chilling, horrible. But if you read on you find that the boy was “wielding a piece of glass and threatening to hurt himself, officials said Thursday.” As a physician, I am not familiar with the potential lethality of this ‘sub-lethal’ weapon when used on a child of 6. A quick medline search has nothing to say. And I am sure that the policemen wielding the weapon had no idea how ‘sub-lethal’ it might be in a 6-year old, never anticipated using it on a child that small. Insofar as the electric shock did not stop the child’s heart, did they ‘dodge a bullet’?

But assuming for a moment that it was not merely sheer luck that the shock did not kill him, he was efficiently disabled at a time he was potentially quite lethal to himself, having already cut himself on the face, hands and leg. The article takes pains to note that, while one officer shocked him, another grabbed him to prevent a violent fall to the ground. Perhaps this was, thus, lifesaving heroism in a desperate situation. I cannot underestimate the value of a minimally injurious way of disabling someone who might be on the verge of, for example, opening up an artery and bleeding out. It is pretty likely that a six-year old cannot appreciate the finality of death and the concept of the potential lethality a chosen behavior; some thinkers deny that there can be true suicidality in someone so young. Regardless of whether you believe that certain adults can make a rational decision to end their lives and that preventing them from having the discretion to do so is immoral, the same cannot be said in children; I believe that all self-destructiveness in children requires and justifies preventive action.

But unlike the usual authoritative posts on psychiatric topics to which FmH readers are accustomed, in which I lead with my confidence and opinionation in my chosen field, here I remain bewildered and befuddled. This turns out to be a deceptively complex and difficult situation for me to make sense of as a psychiatrist, someone who treats deliberately and inadvertently self-destructive people day in and day out. I cannot actually metabolize that this was a 6-year old who was so disturbed. Both as a psychiatrist who cares for adults and has seen most of the things adult psychopathology can throw at me (and has no training or experience in child psychiatry) and as a father, whenever I hear about such derangement in a 4-, a 6-, a 7-year old, I can only reel with incredulity. My hospital has a child unit, but I stare at the daily census in blank incomprehension when I read the ages of the kids hospitalized there. Does such a young child even have the capacity to be so disturbed on their own, or is it only in the eyes of the (adult) beholder? And, once conceived of as so disordered, does it have a self-fulfilling prophetic influence on their behavior? What must some adult have done to them for them to present in such a deranged fashion? And what would it take to ever conclude that your child’s care, no matter how out of control in acute crisis, needs to be abandoned to the hospital instead of your dropping everything to care for him at home (with professional assistance in the community)? Despite utterly believing in the premises of the psychiatric hospitalization of adults, something in me balks at extending those rationales to child psychiatric admissions, especially realizing that they are subject to the same managed care pressures and bastardization of psychiatric training that mitigate for cost-cutting measures, an inability to deliver nurturance and individual attention, and an obscene rush to overmedicate. (No, medication practices with children are not likely to change appreciably even with the new ‘black box warning’ of enhanced suicide risk associated with SSRI antidepressants…)

Grappling with this has me wondering, what if there were no such thing as a child psychiatry ward? Where would these children be? The opportunity exists to look at that issue since, with such a severe shortage of child psychiatry beds throughout the country, many kids in crisis are turned away from being hospitalized if any other setting will do.