Hindsight is 20/20
New Year’s Eve of 2003 started my second incapacitating episode of bipolar disorder that lasted a whole calendar year. I was lucky to find a psychiatrist at an outpatient hospital clinic in New York who took the lousy HMO insurance I had at the time. My dear brother, a mathematician, was my psychotherapist. We held our emergency sessions through long distance phone calls on my cell. Thank goodness for siblings and cell phones.
In 2007 I experienced another incapacitating bipolar episode, this time for a year and a half. Second time around I had an experienced psychotherapist from Manhattan’s Upper West Side. He recommended me a knowledgeable psychiatrist, his colleague from an even more upscale Upper East Side neighborhood.
Both times I ended up having electroshock treatments for the same reason — simply because I begged my medical team to administer them. People close to me couldn’t bear to see me suffer immensely, and so they supported me in my decision.
When I was hospitalized for shock treatments in 2003, I only spoke with my brother a couple of times from a payphone in the hospital hallway. While I was hospitalized in 2007, my psychotherapist came and conducted a couple of private therapy sessions in the psych unit, a practice unheard of even in New York City.
So I obviously had moved up as a mental health consumer, and my therapist was quite qualified even in his league. And yet he later felt remorse and even shame that he had let me be treated with electroshocks.
When half a year prior to my treatments we spoke about me being terrified with my episode spiraling down into depression too fast, my therapist asked me, in our shared native Russian:
“What are you so scared of, what’s this terrified look on your face all about?”
“I’m afraid it’s gonna get to shocks again” was my immediate response.
“C’mon, it’s not gonna get to that, trust me” he smiled confidently.
***
Electroconvulsive Therapy (ECT) or electroshock treatment is prescribed for clinically depressed or bipolar patients suffering from severe depressive symptoms.
And yes, it’s exactly what it’s called: it’s a series of shocks to your brain. And if it sounds scary it’s because this treatment is, indeed, very invasive and risky.
It can cause major memory problems, both retrograde and — most importantly — going forward. It has been shown and proven to adversely affect retention ability for reading, as well as cause major impairment of other cognitive functions.
ECT is only prescribed to those who don’t show any response to various psychotropic medications, and is claimed to be effective for about eighty percent of suicidal depression patients, although the validity of this seemingly impressive statistic is widely disputed since often the urges return shortly thereafter.
Effective, first of all, means that the person stops feeling suicidal — which is why it’s referred to as an “emergency treatment” or sometimes “last resort treatment.” It’s not that the doctors are unaware of its horrendous possible side effects; it’s just that everyone gets very nervous when the term “suicidal” is tossed around, and this symptom makes people see the world in black and white terms.
When people get nervous they like to feel in control, to act. Especially if they are used to being in control, like doctors are (or believe they are).
Psychotherapists are different than MDs, and different than psychiatrists, at least in theory. At their best, they’re supposed to be non-invasive and non-judgmental and not impose their personality and their decisions on a patient. In reality, when push comes to shove psychotherapists are also doctors.
At the same time, psychotherapists have a close relationship with their patients, and they feel empathy for them, just like family and friends do… So if the patient is desperate they are liable to lose perspective as well, unfortunately, just like family.
In the classic cases of depression, ECT is not only about saving the person by taking away the suicidal urges. ECT is also designed to “take the edge off” depression, to make the person functional. In other words, the person can finally get out of bed and take a shower, stops crying all the time, speaks in complete sentences, etc.
But in my case, a case of atypical bipolar disorder, it meant more than that, since I wasn’t completely lifeless, I was actually restless and agitated. What “taking the edge off” meant was that the enormous mental anguish that was tormenting me was supposed to stop.
That anguished feeling is the key to understanding the story of my ECTs. It explains why my caring and experienced therapist felt he had no choice but to support me in my insistence on ECT. My therapist’s support, in turn, was at fault in my loving husband being unable to stop me from that invasive procedure. As much as my husband wanted to, as much as he was scared of side effects he was overpowered by my treatment team and especially the authority of the therapist.
That anguished state of mind and body is hard to compare to anything, it’s like trying to jump out of your own skin and not being able to, feeling extremely restless inside, unable to focus on anything — and wishing to die that very second, and not being able to tolerate this urge to die… It’s an intense, desperate state of mind; conducive to suicide attempts. Except that during both episodes I was too scattered and not consistently energetic enough to try anything, to actually attempt.
Trying anything that could make the mental anguish go away seemed plausible and sort of the only way to find an exit from that desperation… I was lucky psychiatry didn’t yet invent other treatment options, even more invasive and with more detrimental side effects, that I could try.
***
For me, ECT did nothing. I didn’t stop being suicidal and the mental anguish didn’t stop. I ended up being in the twenty percent during both 2003 and 2007 episodes, two times in a row.
During my 2003 episode I received a series of ten shocks and at first they seemed to “magically” cure me. However, it took only a month for me to go back to feeling depressed and suicidal — again. Even though those shock treatments didn’t seem to do any cognitive damage to my brain they simply proved not to be the magical solution everyone was looking for.
In 2007 I had again a series of shocks over a two-week period — only to discover that I felt more energetic yet still as anguished and suicidal as before the shocks. Meaning my risk of acting on intense suicidal feelings didn’t diminish, but actually increased — I had more energy to carry them out.
They also had the effect of a failure of the “last resort” treatment on me. Therefore the desperation to end the suffering became even more compelling…
I later discovered a diary, among my papers, of my 2007 hospitalization for shock treatments. I found it quite peculiar, never having been in the habit of keeping diaries, that here I was, writing my thoughts down on that psych ward, of all times and places.
My thoughts, before my first shock treatment, revolved around two topics. I didn’t talk about how terrified I was, it was likely way too painful to describe or even name…
I was writing about what sins I had committed in my life that God was now punishing me for, and how could I possibly atone for them, and that there was no way I could, not that coming Yom Kippur nor ever.
I was admitted during High Holiday season so the diary was talking about how my family was miserable celebrating the holidays without me.
And they were indeed miserable. My then almost seven-year-old twins learned that something must be majorly wrong with mommy if she has to go into the hospital a few days before Rosh Hashanah, Jewish New Year’s, and then went for some incapacitating procedure on the Eve of Yom Kippur, the holiest day of the Jewish year.
Not that they never suspected anything beforehand; after all, I had been in the throes of a bipolar episode for some eight months by then. It was hard all along but that ECT episode made it officially tragic, both for them and somehow even for my husband. It wasn’t just an unplanned hospitalization; it was an emergency hospitalization that nobody ever explained to them — not then and not afterwards.
It was too scary, too confusing even for my husband back then. No wonder he couldn’t explain it to our kids. Scary since he knew of possible lasting side effects. Confusing since he knew it had not been helpful the first time around, and therefore he felt it was unjustified that second time.
The main reason I got the shocks, that highly risky and invasive treatment procedure, the second time around, was my insistence on it. And my insistence on deliverance from suffering was amplified by the empathy my doctors felt for my mental anguish.
Since I was having an episode of bipolar disorder, and not just depression, it meant that in my type of disease the suicidal mood was coupled with a sporadically agitated, high-energy state. And given how anguished I was, I channeled my boost of energy towards begging my medical team, my psychiatrist and my therapist, to try that powerful treatment.
I’ve always been good at convincing people, a definite strength of mine, and bipolar agitation was helpful in that particular situation. I was telling medical professionals who believed in being able to relieve people’s suffering that they had a powerful weapon at their disposal and thus they could beat all odds.
***
Given that there is no physical pain from ECT, there is only the pain of emotional awakening, the coming back to my senses — only to realize I had just survived the shocks. In 2007, the second time around, I already knew how invasive the shock treatment was, so I was honestly dead scared of what was to come, what would become of my exhausted brain.
Over the next few weeks, as I was recovering from the shocks of 2007 I was feeling disoriented in time, hardly had any memory of the happenings during the past few months, was uncoordinated and unable to drive. I would never recover the retrograde memories of the few months around the series of shock treatments.
But unlike many ECT patients I have no grossly incapacitating memory problems going forward, thank God; my brain functions relatively well.
I even fully regained my coordination and ability to drive after a few long months.
However, it eventually became apparent that my ability to retain and recall information clearly suffered since that second series of shocks in 2007 — an irreparable damage I have to live with for the rest of my life.
Three years later I would suffer from exactly the same feeling of mental anguish during my bipolar episode in 2010. By then the mighty science of psychiatry would invent another experimental treatment, injections of the chemical Ketamine. Luckily Ketamine wouldn’t be famous for possibly invasive side effects, although for a while its main anti-depressive properties would be proclaimed to be as powerful as that of ECT, a short-lived fad.
***
We were sitting in the office of my new psychiatrist, a faculty member from an Ivy League medical school. As we started talking about the total ineffectiveness of my Ketamine injections (akin to my ECTs) my new doctor grinned and pronounced about my previous episode:
“You had a psychiatrist from the Upper East Side, a therapist from the Upper West Side, and you ended up with going through ECT, unbelievable!”
I was very depressed at the time and thus had no energy to defend anyone or to argue with her, I just smiled politely.
Back then I was and I still am feeling grateful that I can read, remember, and write.
I don’t remember or write as well as I used to. But I do.
Unlike thousands of patients who were administered shock treatments while suffering from mental anguish, with all odds stuck against them… Years later they can hardly recall who they are, can’t follow the storyline of survivors’ testimonies, and never dream of writing their own.