Setting the record straight on electroconvulsive therapy
The procedure is painless and improves depression in 70–90 percent of patients. So why are we still stigmatizing it?
I spent this summer having 14 seizures. Tiny seizures. Brief. Controlled. Seizures scrawled in an appointment book. Induced by a doctor and a small electric current passing through my brain — a brain I’d nearly given up on.
I spent this summer undergoing 14 sessions of electroconvulsive therapy (ECT) to treat a severe episode of bipolar disorder. Though the process is not fully understood, ECT (in which a doctor uses small electrical currents to intentionally trigger a seizure while the patient is under general anesthesia) can quickly treat symptoms of certain mental illnesses. It can alleviate symptoms of major depressive disorder, schizophrenia, bipolar — often more quickly and more effectively than medication. I never would have guessed that electricity could give me relief.
Fourteen times, I was wheeled into the procedure room, jittery and anxious. Fourteen times, I closed my eyes as the psychiatrist and the anesthesiologist prepared me for the procedure. I imagined a gold flash, a current of glittering electricity dancing across my forehead. It calmed my nerves to think of the electricity as something visible, beautiful, hopeful. Fourteen times, I fell asleep with an IV in my arm and woke up with a slight headache and a plastic cup of apple juice. I’d had a quick seizure. And something changed in my brain. After seven sessions of ECT, the symptoms of my bipolar episode had subsided significantly. Those tiny seizures saved my life.
ECT was a last resort. Weeks earlier, I had been crumbling. My toes felt the limits of my self-efficacy, the emptiness beyond. I got bad news, I cut my foot on the ledge. I’d been hospitalized numerous times within months, and nothing was working — not medicine, not therapy, not outpatient programs, not dietician appointments, not groups.
When I was admitted to the hospital for the fourth time in a year, my doctors began discussing ECT. Some thought I was a good candidate. Some were skeptical. I was interested. I was also terrified. I had heard nothing but bad things about ECT. The stigma was strong. It looked horrifying on television. I was worried people would think I was irreparably damaged. I was worried I would be irreparably damaged. I was going to get shock therapy? I was going to be electrocuted? Would it hurt? Would I still be able to write? Would I lose cognitive function? “No,” they said. “No. It’s called electroconvulsive therapy, not shock therapy. It’s a controlled, brief seizure. You’ll be asleep. You won’t feel anything. You’ll be fine.”
They left me with the paperwork, the information, the decision to make. The facts were convincing; the treatment improves depression in 70 to 90 percent of patients. But because it’s usually a last resort, I had no one to ask about it. I know plenty of people who take medicine — people I could call with questions. I knew there had to be people in my circle of acquaintances who had experienced ECT or who knew someone who had. But I didn’t know who they were or if they were willing to talk. I heard silence. And I understood. Admitting to living with mental illness is hard enough; an experience with ECT can seem almost unspeakable. I wrestled with the choice. I looked down at my feet. Ultimately, my decision was based on exhaustion — I decided to try it because I saw no other way out.
It was among the best decisions I’ve ever made.
Before undergoing the first session of ECT, I had a full physical examination, including a meeting with a cardiologist. I had to review the risks of anesthesia and the procedure in general — which are similar to the risks of any minor surgery.
After the first session, I woke up to a nurse taking my blood pressure and a gel-like substance in my hair — from the electrode placement, they told me. I ran my fingers through it as I sipped my juice, fascinated and disgusted. When the nurses finished monitoring me, they wheeled me back to my room. Immediately, I wrote in my journal, “I’m not naive enough to think this is working yet. But despite the headache, despite the hair goo, I think this is what hope feels like.” It had been a long time.
Though plenty of people know about ECT and even more people are learning about it, the treatment still has a horrifying reputation and a strong stigma attached to it, largely because of movies that show patients receiving the procedure without general anesthesia. These portrayals were accurate at one point; in earlier days, ECT was administered without anesthesia, and doctors often used high doses of electricity that resulted in severe side effects.
ECT today still has side effects — my memory, especially around the time of the procedures, has been affected. I am constantly asking my husband to remind me of minor interactions and events that occurred over the summer. My mind feels slightly out of focus when I try to recall the last several months. It feels as though a fine mist has drifted over that dinner party, that walk in the park, the last time I saw my friend, visits in the hospital. But mist is far preferable to the thick smoke of crisis.
The procedure itself also still makes me quite anxious; being put under can be stressful, and waking up is disorienting. Admittedly, the thought of having to do maintenance ECT to maintain my stability is unappealing. But overall, ECT is safe and highly effective when other treatments have not been. We must debunk the myth that this treatment is dangerous or painful. We must do more to lift the stigma associated with ECT. We must ensure that those considering the procedure have the information they need and people with whom they can discuss it. We must help the people who have undergone ECT talk about their experience without shame. For me, that means admitting that I’ve been there and being open about my experience with the procedure — and mental illness in general.
Though it is typically highly effective, ECT doesn’t work for everyone. It is necessary to receive expert medical evaluation before deciding if ECT is the best course of treatment. There is a reason ECT is most often used when other treatments have failed or are not suitable. It’s more invasive. It’s more expensive. It disrupts your life. But for some people who are in crisis and are not responding to other therapies — people like me — it’s a life-saving procedure. I know the positive results of ECT won’t last forever. In the back of my mind, I know bipolar is a lifelong illness, and maintaining my stability involves taking my medications, going to therapy, and potentially undergoing maintenance ECT.
For now, though, I am happy to have regained my footing through this procedure, to have stepped back from the ledge, to have rediscovered my self-efficacy. I am happy to have my voice back, to be able break down the stigma surrounding ECT, to speak out as someone who has undergone the treatment and come out the other side. Someone who is in recovery. Someone who is here today thanks in part to fourteen hopeful seizures, fourteen quick jolts of lightning illuminating my brain, the space behind my eyes.