To Zap or Not to Zap: Fragmented Memories of Electroconvulsive Therapy (ECT), etc.
Electroconvulsive therapy, also known as ECT, is a medical procedure used in psychiatry when other treatments are unsuccessful. ECT can be used for patients with certain mental health conditions including dementia, severe and/or treatment-resistant depression, and severe bipolar mania. The patient is put under anesthesia, and subsequently, a brief seizure is induced by passing small electrical impulses through electrodes and into the brain. ECT is believed to alleviate symptoms by causing changes in brain chemistry, but it remains unknown to medical professionals exactly how it works.
“Are you sure this is the best possible option?” Mom asked through a strained voice, the audible version of a computer screen error message. Simultaneously, she scribbled away on her notepad as if she was the prescribing physician.
We sat tentatively in the kitchen, the first room on the right after entering the adolescent section of Cloudycreek Hospital’s psychiatric inpatient unit. It was closed off for our meeting. A locked door within a locked door. Dad made consistent eye contact with Dr. W. He was looking for any subtle hints in the psychiatrist’s body language giving away that the suggestion of ECT was a bad idea – negligent practice, a poorly thought out treatment plan, an experimental exercise for a resident, or even a practical joke.
Mom was the nurse, Dad was the “numbers guy.” Both were concerned parents and interrogated the doctor by frantically alternating between unrelated yet equally panicked questions.
“What kind of care is involved before and after the treatments?”
“Out of the patients that need ECT, what percent of them also have bipolar I disorder and are experiencing a severe manic episode like her?”
“Which medical risks should we be most aware of?”
“How many sessions does a patient need, on average?”
“Where is the anesthetic delivered into the body – intravenously or through inhalation?” “What is the typical length of time before full recovery from side effects?”
“Who will be the doctors performing her ECT, and how much experience do they have?”
Dr. W. fields these inquiries expertly like a professional tennis player, serving back answers and trying to cover the entire court single-handedly in a doubles’ match. But he cannot answer the main question that induced their insomnia and reduced their belief in Adonai.
“Why is mental illness ruining our daughter’s life and tearing apart our family?”
I sit and stare off into the shiny hallway through the glass-paned window of the kitchen door. My drunk ears danced with the words around me but didn’t remember anything about them in the cab ride home. The cafeteria trays rattle in their temperature-regulated storage cabinets, making mechanical noises that fill the room with ambient clamour. All patients had to fill out daily menus the previous morning at breakfast. That day was a Wednesday, and I ordered a grilled cheese – one of the best menu items out of our limited selection of unpalatable foods. My stomach grumbled impatiently, tired of the conversation.
“What time is lunch?”
There is a stigma regarding the use of ECT as a medical treatment. Historically, it was performed without anesthesia, and high doses of electricity were applied. As a result, patients faced serious side effects, including fractured bones acquired during the seizure. Although ECT is much safer today, and the use of muscle relaxant is now standard practice to prevent such injuries, the controversy continues.
“Wait, what? They tortured you? Is that even allowed nowadays? I can’t believe they still do that!”
If I could mass wipe out every memory of One Flew Over the Cuckoo’s Nest from society’s collective mind, I would. My treatment resembled nothing of medieval punishments performed without consent, nor covert laboratory experiments depicted in Frankenstein fairy tales.
If my choice to undergo this course of treatment makes me a monster, let me be a werewolf. Delinquent and unpredictable, I cycled through states of being with no control over the transition. Even the moon herself ignored my pleas for a mood calendar.
“You’re not going to be awake during the procedure,” the nurse told me. “After the anesthetic, the doctor will administer a muscle relaxant which will prevent you from moving during the seizure and reduce the number of aches and pains afterwards.”
“So, no spasms, then?” I felt lucky and guilty, as if this whole circumstance were a test of my courage and I cheated on a multiple-choice section. She sensed my wariness and instantly reassured me.
“No. We will place a blood pressure cuff around your ankles. This will prevent the muscle relaxant from entering your feet. During the seizure, the feet will move back and forth in small rhythmic motions and this way, the doctor will be able to monitor the seizure activity.”
She demonstrates the movement innocuously with a flat hand by flicking her wrist back and forth like car windshield wiper. I smile at its simplicity.
“Keep in mind, you won’t feel any pain during the procedure. You will be asleep the entire time, relaxed and unaware of the treatment while it is occurring. Your feet will be the only body parts that move, and that motion will be the only outward indication of the seizure.”
My blood simmered like marinara sauce in a cooking pan (I couldn’t have made pasta even if I wanted to – psychiatric patients aren’t allowed to use the stove without supervision). With all the time I wasted on conquering my anxieties about having ECT, I could have made lasagna for the entire fucking psych ward!
The ultimate deception. The misrepresentation of ECT for film, for entertainment, for money. The ultimate consequence. Patients dissuaded from ECT due to fear, shame, and poor portrayals.
One Flew Over the Cuckoo’s Nest is a film based on the 1962 novel of the same name by Ken Kesey. The infamous scene from the movie involving electroconvulsive therapy was a principal moment in the establishment of the (negative) understanding of ECT in popular culture. However, the brutal portrayal of this treatment was inaccurate. By the film’s release in 1975, the procedure was hardly ever administered without anesthetic. The film was outdated before it was created.
I vent to my journal regularly about these misunderstandings and frustrations, because conversations I have about ECT get taken up by other people’s ignorant questions. I spend extensive mental energy defending the life-saving decision I made to have this procedure. I spent expansive mental energy during the two-month manic episode that necessitated my treatment.
In my grade nine science class, we learned about astronomy. Like the celestial bodies we studied, my brain was burning out. But stars have millions of years left on their lifespan. I had tried ten medications, several rounds of therapy, and put my existence on hold for intense mental healthcare. Left untreated, mania can escalate to psychosis and its repercussions can permanently ruin or end a patient’s life.
I was running out of time.
Although many dangers associated with ECT in the past have been drastically reduced, in present-day it still poses certain risks and side effects to the patient’s health. These possibilities include confusion, physical side effects, and medical complications. Typically, the most pervasive side effect resulting from ECT is memory loss.
The treatment happened during December in the middle of the winter holiday break. ECT was my surprise present that year. My parents moved it to the top of my wish list for me (since I didn’t have access to a computer on the unit) and ordered it directly through the doctor (sorry, Amazon) with free shipping, complimentary gurney, gown, and all.
I think they realized I needed it when they figured out I was the Jewish Grinch who stole Christmas. A psychotic little gremlin with tattered hair. Enough fuel for eight candles, and then some. Selfishly took up time and cheer during a special time of year. I essentially unplugged the Christmas tree and rammed my own manic fingers into the outlet – sucking up the energy and unaware of the danger I posed to myself. If you’re wondering, the return policy was shit but I couldn’t re-gift it so I lugged around side effects for six months.
I’m just kidding. My real present was a teal pen and a tattered purple scrapbook of the highlights of 2016, with heaps of photographs haphazardly ripped out. That’s how the memory loss felt. Like missing pictures from a photo album. On the last page was a clear, glossy plastic pocket with a brainwave graph tucked into it. I had asked for an electroencephalogram from the procedure to keep as a souvenir. The doctor drew arrows on the chart paper in black ink to indicate the different stages of my brain during the treatment. My first seizure lasted 57 seconds.
I carefully removed the folded chart paper from its nestled spot in the scrapbook. With delicate hands, I unfolded it gently and cradled it in my palms. I felt like a mother holding a sonogram of her unborn baby, a grainy black and white image, her smile glowing from the inside out at the reminder that something beautiful was growing within her.
Even if I couldn’t remember the past, a new beginning was on the way.
It is important to remember that ECT is not effective in all cases, and that even for those who benefit from it, relapse is common. For many mental health conditions treated by this procedure, the emphasis is placed on ongoing symptom management through medications and/or psychotherapy rather than a cure. Certain patients may need to undergo ECT again in the future. But, predicting who among them would require it and the surrounding circumstances of their relapse is an enigma.
ABOUT MIRA SARINA
Mira Sarina (she/they) is a bubbly lemur lover who sees the world in purple and teal. They are an undergraduate student at Ryerson University whose creative work can be found across spoken word stages in Toronto, among various online media and on scrap paper in a recycling bin near you. She is very energetic and runs on lithium just like the Energizer Bunny. Equal parts adventurous spirit and couch potato, they are also the full-time human companion to beloved pets Panda the Pretty Pup and Lizzie the Lizard. Mira lives in a melted ice cream sundae of queerness and mental illness topped with sprinkles of happiness.