Will I ever be the same again?
I cannot help but be a little resentful. Everyday it seems I discover yet another part of my life that is irretrievably lost to the deep recesses of my mind. Last month, I had electroconvulsive therapy (ECT)—twelve treatments total—hoping that it would save my mental health. Like a cancer patient who chooses the side effects of chemotherapy over the deadliness of the disease, I chose the side effects of ECT over a life of psychological anguish and possible suicide. Depression is one of the most horrific, degrading, painful experiences there is and I was in a deep hole, a hole that I could not get out of despite courses of numerous medications and talk therapy. I was at the point where the controversial treatment seemed like my only hope. Now that I have completed therapy, I remain unclear if it alleviated my depression. What I do know is that I am now suffering from a significant cognitive deficit in the form of memory loss.
ECT is the psychiatric use of an electric current to stimulate a seizure. It is a medical procedure done under general anesthesia. It is thought that the seizure affects the chemical imbalance that leads to depression, setting things right. It is often the only treatment that works for individuals suffering severe depression where medications and psychotherapy have failed. A course of ECT normally ranges from six to twelve treatments. There are primarily two types of electrode placement used for the delivery of ECT: right unilateral and bilateral. To generate a seizure using the right unilateral technique, one electrode is placed on the crown of the head and one is placed on the right temple. Those receiving right unilateral treatment may respond more slowly, but generally have less side effects. Those who do not seem to be responding with right unilateral treatment are often switched to bilateral treatment which involves placing electrodes on both temples and inducing a seizure in both hemispheres in the brain. Bilateral ECT is often indicated for severe mental illnesses including psychosis associated with depression. My ECT adventure began when I was admitted to the psychiatric department at Mayo Clinic in Rochester, Minnesota. I had five treatments right unilaterally after which I was switched over to bilateral where I had seven treatments. Before the procedure, I took Tylenol to prevent any jaw pain and headache that may occur after the treatment. I was then brought to a prep room where I was placed on a gurney and given a warm blanket. ECG electrodes were placed on my chest to monitor my heart activity, a blood pressure cuff was put on my arm, and I was given an IV. When the medical staff were ready for me, I was wheeled into the well-lit treatment room which looked like a small operating room but less intimidating. It was attended by a nurse, a psychiatrist, and an anesthesiologist. I was given pure oxygen to breathe while an anesthesiologist gave me medication to put me to sleep as well as a muscle relaxant. After the procedure was completed I woke up in a recovery room and shortly thereafter a nurse escorted me back to my room. I was unconscious during the procedure itself and did not experience any pain. In fact, ECT was less painful than a visit to the dentist.
Public stigma over mental illness has reduced somewhat in recent years, but ECT remains in a class of its own. It is the stuff of innumerable myths and misunderstandings. The treatment has a notorious past thanks in part to its depiction in Sylvia Plath’s The Bell Jar and in the 1975 classic film, One Flew Over the Cuckoo’s Nest. Probably as a result of such portrayals, much of the general public continues to hold negative attitudes toward ECT. There are also a few dissenting psychiatrists, a handful of former ECT patients, and various activist groups who have called for the complete elimination of ECT, painting it to be archaic and destructive. Dr. Peter Breggin, psychiatrist and director of the International Center for the Study of Psychiatry and Psychology in Bethesda, Maryland, is a well-known anti-ECT spokesman. He views the therapy as purposeful assault on the brain and argues that it creates in patients profound feelings of apathy and docility to the point where they are willing to praise the treatment even when they feel it has done them harm. Breggin argues that doctors delude themselves into believing that they are helping a patient. Breggin is a former student of Thomas Szasz, author of the book The Myth of Mental Illness and one of the frontrunners of the anti-psychiatry movement. Along with individuals such as Erving Goffman and R.D. Laing, Szasz promoted the view that mental illness is a social construct. Like Szasz, Breggin does not view mental illness as biomedical in the sense that it is the result of a chemical imbalance. He believes that love and care will cure a psychotically depressed patient, not medical intervention. And despite all evidence to the contrary, many people listen to him. As a result, a common perception of ECT is that it is an antiquated and torturous treatment, associated with cinematic images of a mental patient writhing in a straight jacket as menacing doctors and nurses flood the patient’s body with electricity. ECT frightens people because they assume it is barbaric and untested. This is not true. ECT today is modernized and used in mainstream medical treatments for schizophrenia, catatonia, and severe depression. ECT has side effects, but when weighing the risks and the benefits of ECT it is important to realize that people who are treated with ECT are suffering from an illness that could kill them. When ECT helps people break the stranglehold of intractable and potentially lethal depression then the price of some retrograde amnesia is one that probably should be paid.
Memory loss is one of the greatest concerns for people who receive ECT. Most patients emerge from the procedure temporarily confused and disoriented. However, more seriously, some patients experience retrograde amnesia afterward. They no longer remember many events that occurred a few weeks to months before the treatment. In rare cases, the loss of memory is much more severe, with patients losing access to years of their past. My memory deficits far exceed anything I was advised about or anticipated. I cannot remember seemingly insignificant things such as whether I responded to an email and then slightly more important things such as the location of my therapist’s office. Furthermore, I have lost access to important life events. Of course, everyone forgets things: we’ve all had the experience of walking into room and then losing track of why we came or stumbling to come up with the name of someone we have met dozens of times. But this memory loss is different. It feels like the complete erasure of linear time. Each moment is new without history. The truth is I do not know how much memory I have lost. After all, you cannot be aware of something that is missing. It is through the gradual process of hearing others talk about the miscellany of life that one rebuilds the knowledge, though not necessarily the memory, of past events. I am told that this will go away, but I have also read accounts that suggest it might not. And I am wondering what happens in the case that I do not recover from my retrograde amnesia. Human memory seems to be one of the most precious aspects of our personality, since our memories are so critical to how we see ourselves and others. The memories of our past give us an understanding of where we fit in the world. If our very notions of self are based on the experiences we have had and on the memories we have collected, then wouldn’t deleting our memories lead to destroying a part of ourselves? Perhaps this is not such a bad thing considering much of my self has been a depressed one. That self hasn’t been working out so well for me.
I want to stress that my experience is my own. What occurred with me should not be assumed to be the standard practice or result of ECT. In sharing my experience I hope to assuage my own sense of damage and disappointment that it appears as though the treatment did not work for me. Interesting, even though I do not feel much benefit from ECT, others around me have said that my affect and mood have appeared to change for the better. Perhaps it is the case that my decades long struggle with depression has become so ingrained in my personality that I am having trouble breaking the practice of identifying myself as a depressed person. I can only hope that is the case.