(Please note – this post contains vivid descriptions of severe clinical and catatonic depression)
Let’s play a quick game of word associations: If I say Electroconvulsive Therapy or Electroshock Therapy, you think…What?
‘They still do that?’ is a common response. A half jokey reference to ‘One Flew Over The Cuckoo’s Nest’ is another. If you thought there was stigma surrounding psychiatric medications (and there is), ECT takes the stigma, myths, misinformation, and at times insults to a new level.
ECT is a big topic, so I’ve decided to split it into two consecutive posts.
I have had two courses of Electroconvulsive therapy. The first in 2006 for a total of 12 treatments. The second in 2015 for a total of 15 treatments. Both were given at a frequency of three times a week while I was a voluntary inpatient in a private psychiatric hospital.
The stigma surrounding ECT is so strong it even divides patients into those who have and those who haven’t had it. During my most recent hospitalisation I was talking to another patient. At some point in the conversation I mentioned I’d had ECT in the past. Her response:
‘Yes, I’ve had that recommended as an option. But I need my brain for my work. I’m a scientist.’
I was amused by her assumption that ECT would automatically result in brain damage. So, I diplomatically pointed out that even after a long course of ECT, I had been able to successfully return to the scientific aspects of my own work, such as doing surgery and medical work ups. She seemed unsure how to process the fact that having a course of ECT and retaining sufficient intelligence to return to an intellectually stimulating career were not mutually exclusive.
Along with the antiquated depiction of ECT in ‘One Flew Over The Cuckoo’s Nest’ one of the reasons this treatment carries such stigma, is that its exact scientific mechanism of action is unknown. And it’s easy to demonise something we don’t understand. For someone with scientific and medical training, not knowing the ‘why?’ has been frustrating. In time I have had to learn to sit with that discomfort. Uncertainty is the nature of this field of medicine. As a patient you either learn to accept this, or you can give yourself an anxiety disorder on top of your original diagnosis by trying to work out the exact reasons for everything.
I believe the success or otherwise of a patient’s ECT treatment relies heavily on case selection. So, before going into a description of what ECT entails and how I experienced it, I’d like to try and show you how sick I got before my psychiatrist and a second opinion psychiatrist recommended this treatment for me:
Both times I had deteriorated into catatonic depression. Catatonic depression means little to most people. Even just depression is hard to imagine for anyone who hasn’t experienced it. I’ll try and take you into it for a moment.
Let’s start with the following analogy for depression:
When the snow starts to fall silently, making my world a little fuzzy around the edges, I don’t guess it could turn so deadly. I’m trapped in a little car with the windshield wipers flicking madly to prevent this silent obscuring of vision, eyes, clinging desperately to the dark snake of the road in front of me. Terrifyingly quickly I lose my bearings. All sense of direction is obliterated. No matter how much I try and how much I want to, I can’t see where I am anymore, and I can’t see where I need to go to get out. Something much bigger than me has taken over.
Thicker and thicker it comes. The windshield wipers are choking under the white weight. A heavy layer has settled, pressing down on the roof of the car, rubbing out its colour and shape. Soon no one will be able to tell it’s a car. Soon no one will be able to tell there’s a person in there, a person and their rising panic trapped in white, screams muffled.
After a while the panic gives way to hopelessness and an all-encompassing despair. It makes pulling the icy air into my lungs seem like too much of an effort. There is a sense of inevitability about everything. I relinquish myself to the snow. I long for death to turn the endless white into an endless black, while somewhere out there, I’m told, the sun shines. They say some day the sun will melt all the snow, and life and feeling will return, but I am deaf to words of hope. My white cocoon of terror grows dense like glass.
And now – let’s go worse. Let’s enter catatonic depression:
It spreads, aggressively as the most malignant cancer. My limbs fill with concrete. The electrical connections between brain and muscle fail often. My body rejects food. The physical motion of eating is overwhelmingly difficult. My taste buds interpret everything I put in my mouth as saw dust. My digestive system shuts down. Constant nausea is not responsive to anti-emetics. Weight drops away. The muscles in my face don’t work, so I have no expression. And then there’s breathing. The respiratory centre in my brain still works. Just. It’s primitive function battles with the rest of my brain, because drawing breath feels like breathing the same concrete that fills my limbs.
My brain shuts down every function except suffering. The sort of suffering I imagine is like waking up on the operating table in the middle of open heart surgery, chest cracked open, and unable to tell anyone I’m awake because I am paralysed. To look at me, no one could imagine who I am, because I am a shell. I can barely move or talk. I am approaching a vegetative state but I am in acute mental pain. To say I have no quality of life implies I had some once and I know that’s not true, because I have been like this forever and I will be like this forever…
A fellow inpatient’s relative once told them: ‘Don’t have ECT. It steals your soul.’
Even if this uneducated rubbish were true, once catatonic depression kicks in – there is no soul left to steal.
The next post: ECT: Blowing up some myths – Part 2 will drop tommorrow. I promise it ends on a more hopeful note than this one. So, stay tuned.
As for the photo accompanying this post:
20 years ago. My first Caesarean Section. These babies emerge dusky blue as the sky moments before dawn. Deciding whether to enter our world. A tiny gasp for ‘yes’. And then the sun rises under their skin, floods them with pink. And just like that – they are here.