I can’t remember the first time Electroconvulsive Therapy (ECT, aka “shock treatment”) was brought up to me as a potential remedy for my “mental illness.” I just know that after a certain point I would have done anything to make the pain go away, to make life on this planet livable again.
I had no idea at the time that the most likely culprit for this despair was my own psychiatric med cocktail (at that point Lamictal, Geodon, and Wellbutrin), which was drowning my brain in a pool of alien chemicals day after day with no break, no respite, no chance of resuscitation.
I don’t really recall ever fighting the suggestion of ECT. But I do know I was scared. I was worried that the shocks would erase all my good memories. That the few meaningful moments of my life, the ones that I held so dear and clung to so tightly, would vanish forever. Watching my grandfather, listening to his deep, gentle voice as he narrated his woodworking projects to me, letting me practice carefully with some scrap on the band saw; the twilight moments contemplating the universe with my best friend, pumping our legs back and forth on the swing set in our neighborhood park, belting out the silliest words of our favorite songs; the sweet innocence of my first teenage love teaching me what it felt like to be truly and completely seen and cared for. Could I afford to risk losing those moments?
I know what my answer would be now. And I can only imagine how horrible things must have been back then for me to have responded with anything but a resounding “NO” to that question. But luckily that past anguish is only a fleeting memory, bobbing up and down in my sea of emotional flashbacks, spotted only occasionally, until I dare call it to shore. I guess I can thank the ECT for some things after all.
It was the summer of 2018. After more than 20 psychiatric med trials over almost 10 years, I had come to the end of my rope. The suggestion of ECT seemed almost merciful. I knew of ECT’s sordid past, understood the severity of the procedures (though I was assured that the field had made great strides in the technology and the humaneness of the procedure — the “One Flew Over the Cuckoo’s Nest” trope was a thing of the past). I thought, surely, if they’re recommending this treatment, that must mean they see how severe my pain is, they must understand I’ll not be able to go on like this much longer. Looking back, I was far more grateful for that than I should have been, really.
Strange thing was, I was NOT what I would call “suicidal.” I don’t believe I ever have been. I wanted so desperately to live. Not even a happy life, just one with a modicum of peace. A moment of each day where I could find relief from that foreign, chemical pull that insisted that everything was empty and meaningless. Was that so much to ask? I perplexed psych professionals because I seemed rational, I could explain what it was about the feelings that was wrong and yet I still could not get rid of them. I wasn’t sick enough to warrant immediate emergency help, I wasn’t bleeding out (at least not anywhere other than the soul), and I could send my supports away with complete honesty when I said, “don’t worry, I won’t be killing myself tonight.” I had never had any self-injurious behavior either. None of it added up. It seems like very few professionals understand what it’s like to feel intense psychic pain without an actual overt desire to kill oneself.
Of course, it makes complete sense now — these feelings didn’t come out of nowhere. One glance at the side effects of most antidepressants and the first thing you’ll see is “increased thoughts of suicide.” Why is it that we so willfully ignore these black box warnings? I understood none of that at the time, however, and I remained trapped in that agonizing limbo with no escape, one way or the other. With no other place to turn, I made the decision to go forward.
I did my research and found a hospital in the area that performed ECT and admitted myself to get an evaluation of my fitness for the treatment. This wasn’t my first inpatient stay. The original, five years earlier, had traumatized me more than the “mental illness” itself (ask anyone who’s been locked in a psych ward and you’re likely to hear the exact same sentiment, even in the “best,” not obviously abusive settings). I achieved my ECT referral with ease. I mean, who voluntarily admits themselves to a psych ward? That person must have a screw loose. Couple shocks couldn’t hurt, right?
The hospital I was staying in only performed the procedure inpatient, meaning that you had to stay on the ward in between shocks. This was unthinkable to me. I didn’t have much of a support network, but the idea of being away from my husband, my dog, and the comfort of on-demand internet browsing was too much to bear (phones are confiscated on the wards, only to be used with special supervised permission for emergency correspondence — can’t have any outside interference mucking up one’s “recovery”).
But I was in luck! Our local county hospital offered ECT on an outpatient basis. What a relief. I could come in in the morning, get my zaps (as I liked to call them in those days), and be home in time for lunch. How novel! Perfect in this era of convenience, shock treatment at your fingertips, available like never before!
I had an appointment with one of the doctors who would be administering treatment and received my start date. Frequency would be high initially, three times a week, and unilateral shocks (to only one side of the brain) would be tried first with continued adjustment based on effectiveness. My anxiety began to swell alongside the anticipation. I had had surgery once in the past (gallbladder removal) and the what-ifs of being put under anesthetic sedation terrified me. What if I was put to sleep and never woke up? Well, would it really matter at this point? So, I trudged along on the journey, figuring whatever was meant to happen, would happen. I had little problem holding that deep fear in my heart, because what other options did I have? Certainly no one was offering any.
All in all, it was 17 shocks over a period of about two months.
The whole process was not unlike those first days of school. Waking up at the crack of dawn, dragging myself out of bed. “Here I am, one shock, please.” Just tell me where I’m supposed to be and what I’m supposed to do. No need to worry though — soon enough, just like school, the whole process would become routine.
The ECT department occupied a couple of rooms on the second floor. On one side of the hall there was a little waiting room — the place where my husband gathered with a handful of other loved ones waiting to provide rides home (though most of the patients took medicabs, likely due to their socioeconomic status and/or lack of a support system). I’ll never be able to thank my (now ex) husband enough for the support that he gave to me during this time, driving me back and forth, arranging for work flexibility. For that love and patience, I am forever grateful.
The patient area was a bit different. About 20 or so uncomfortable vinyl upholstered chairs lined the walls of the long, narrow room. Each morning I would arrive and search the rows of chairs for my name, scrawled on a post-it by one of the (likely underpaid) techs, an indication that would be my spot for the day.
We were to get ourselves “ready” and changed into the distinctive rust orange psych scrubs, if we so desired (the color being another lovely dehumanizing feature, to be sure that mental patients were easily discernible from the “healthy” folk), though we were allowed to keep our street clothes on if we chose to. My first day I was shocked (pun intended) to hear that there was a not-so-insignificant chance that I would lose control of my bladder during the seizure and changing into the scrubs was the only way to ensure I’d have clean clothes for the car ride home. I changed into the orange pants for all 17 shocks, each time cursing the fact that I had to be there worrying about whether or not I was going to suffer the degrading experience of pissing myself that day. Yet, as fate had it, or perhaps just lucky biology, it never once happened, and I was spared the humiliation of seizure-induced incontinence.
Once we were all ready, we began the trek down to the pre-op area on the first floor, the same place where the public would go to receive their regular, run-of-the-mill outpatient surgeries (the knee replacements, tonsillectomies, etc). We were herded down in groups of four or five, following our tech, navigating the public hospital hallways in our trademark orange scrubs, not unlike the way kindergarteners follow their teacher on a field trip to the park, or ducklings scurry after their mother. Even though we all seemed to be surviving in our isolated bubbles, there was something significant there in that moment that connected us all. We didn’t need a rope to grab our little hands onto, we had the crushing weight of chronic, lifelong depression to tie us all together.
At the age of 31, I was consistently one of the youngest patients there. Most were older folks, 50s and 60s probably. Many seemed to be suffering from the stereotypical Parkinsonian side effects of the antipsychotics wreaking havoc on their dopamine. It’s a strange sight to see, that paradoxical dance of rigid immobility occupying the same body right alongside frightening involuntary movements and tremors. Take a walk in any psych ward and it’ll be easy to spot. I would often wonder if, in 20 to 30 years, I would end up like these people, a mere shell of my former self. If I had believed in god, I would have been desperately praying that I would be able to find the courage to take my life before that ever happened. Nobody ever said much at treatment. Not sure if that was the 6am roll call or just the desire to get on with the discomfort of it all. No need to make friends, there would be no reminiscing about these moments.
Once in the pre-op area, we would be directed to a gurney to lay on while we waited for one of the nurses to come set up the IVs that would allow the anesthetic to be administered. Waiting for the IV was my favorite time of the morning. It was a quiet 15-20 minutes where my incessant pondering of what had gotten me into this mess could be punctuated with observations of the staff drama and hospital goings-on. My own personal Grey’s Anatomy or ER unfolding in front of me. From my perch on the back wall, I got to watch the pre-op providers rush around and prepare for the day. It was as though us psych patients were invisible, or maybe they just never saw us as human enough to care about how we could see and hear everything they were doing.
It often seemed as though us headcases were just a task to be completed before the “real” work of the day began and the actual surgery commenced. There were definitely some providers that treated us like a chore — I’d imagine many of those most likely had only a single lecture’s worth of “How to Deal with a Crazy Person” during their time at school. Sure, there were some kindhearted nurses and doctors, but most of them were on a power trip or trying to get through as many of us as possible as quickly as possible. Not nearly the “heroes” they’re typically made out to be, at least in my experience.
One side of the pre-op area consisted of four little rooms, with curtains and glass doors that allowed what was going on inside to be hidden from view. We would be wheeled to these rooms when it was our turn, and the doctor would come to us one by one, often accompanied by a group of fresh-faced young students eager to observe. It was hard to maintain any sense of dignity when feeling so much like an animal in a zoo (and to this day, I refuse to let students sit in on my health appointments). These procedures were lightning fast. The doctors couldn’t have been in the room for more than 10 minutes at a time before it was on to the next, a sort of round-robin choreographed spectacle. By the time the doctor was done with the patient in room 4, room 1 would be all set again with the next subject, prepped and ready for their zap. Another name and face to be forgotten before the postictal state has a chance to subside.
Occasionally the providers would be careless and wouldn’t take the time or effort to make sure the curtains were closed all the way and I’d be allowed a peek into what happened to us patients after we closed our eyes. Wasn’t much, honestly. Seems unfair that such a seemingly boring, innocuous event can cause such devastating side effects and radical changes to one’s thoughts and feelings, one’s sense of personhood.
Now depending on who you ask, you’re likely to get very different answers regarding what effects ECT has on a person’s memory. Like much else in psychiatry, there doesn’t seem to be any real consensus. Either it’s “there’s been no evidence of any lasting effects on memory” or “well of course there are effects, but they must be weighed against the patient’s suffering.”
What to believe?
I don’t need to believe, I know. I live with the changes every day, even now, four years later. Not only has my once mildly impressive ability for rote memorization vanished completely, but my working memory is totally shot as well. I often explain to people who haven’t studied it, that we can think of working memory like a sort of “mental desk.” Some of us have mental desks that are clean and orderly, some messy but workable. Some big, with ample space to organize, and some pitifully small. We pick our tasks, thoughts or feelings up off these desks when necessary, engaging with them, moving them around, putting them back down as appropriate. Since the ECT, not only do I NO LONGER have any desk at all, but it often feels as though the shocks have rendered me one-handed, only ever capable of dealing with one thing at a time. It’s been incredibly frustrating and disabling, in a way I could have never imagined.
As an added insult, these struggles are “non-apparent,” and if you interact with me there’s little outward evidence of the mental effort I must put forth to stay afloat in our conversation. This is my real, personal, daily experience, my “anecdote.” But anecdotes have no place in psychiatry. I wonder what would happen if we actually listened to the real experiences of psychiatric survivors — if we valued the “subjective” instead of some imagined “objective” farce. I mean, the truth is that we’ll never really know what’s going on in someone else’s mind, will we? At least not in our lifetime.
But this had been my choice. Had I asked for this “trauma”? Only I could be to blame, right?
How is the mental healthcare system accountable? How had my trust been violated, and what responsibility do they have to answer for this?
In a physical sense, our brain’s lack of pain receptors means that we can’t feel what’s happening to it. This is how they can perform neurosurgery on people who are completely awake, skull cracked open, brain laid bare as the patient keeps on talking as if nothing out of the ordinary is going on. Psychotherapy and psychiatry seem to operate in much the same way, we often don’t feel the impact as it’s happening. Well-intentioned words from even the most caring and competent therapists can cut like scalpels on our minds, excising our thoughts willy-nilly. And if the provider has no awareness or no openness about the ways in which they can do harm, the destruction can be massive and unending. There’s rarely an understanding of how those thoughts and feelings have really shaped our identities. Cut those out and what are we left with? Zap those out and what do I become? Replace one emptiness with another, a more palatable version. One less demanding on the lives of others.
These therapies and treatments which we have made easy and accessible must not be mistaken as harmless. Us psychiatric survivors are whole people, not a malleable playdough to be molded, manipulated and tossed aside when it’s time to play with the next toy, the next client. We are certainly not subjects to be experimented on. The assumed inevitability of it all, the way in which psychiatry is happy to follow these casual routines, to tread the same well-worn paths with no regard for the damage that their inept, clumsy steps cause to our mental environments.
I’m so lucky to have somehow woken up, to have felt that suspicion and with my characteristic stubborn obstinance slogged forward through the muck of “mental healthcare” with a steadfast commitment to myself and my experiences only. To be able to tell myself and everyone else that THIS. IS. NOT. RIGHT. I desperately want the same for those still stuck in their nightmares.
Time to set the alarm.
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.