When ECT Doesn’t Work: My Experience With Electroconvulsive Therapy
Dealing With the Lifelong Repercussions of a Last-Resort Treatment
Trigger Warning: Mention of self-harm, suicide ideation
Having been diagnosed with Major Depressive Disorder, chronic Anxiety, C-PTSD (Complex Post-Traumatic Stress Disorder), and Anorexia, one might think that something horrible must have happened to me as a child- I must have been raised in a nightmarish environment, surrounded by monstrous adults and violent circumstances. The truth is, my experience (like that of many others) was varied and confusing; there is no one way to experience trauma, and similar events can have wildly different effects on different people.
The combination of my genetic predispositions to certain mental health conditions and a wide array of difficult life experiences resulted in my reaching young-adulthood with little semblance of mental health and an iron-fisted grip on a myriad of extremely unhealthy coping mechanisms. I entered college barely eating, regularly self-harming, and hoping to dream my death into existence. I leaned heavily into a cycle of partying, abusing drugs and alcohol, refusing food for days, and exploring unhealthy sexual activities, all while insisting I was in full control of my life.
Self-esteem through the floor, I was somehow still able to excel in school, as the same clinical perfectionism that compelled me to keep my body at a certain size also dictated extreme academic productivity. Only at my lowest point, when my grades actually started slipping, did I reach out to a school counseling service, that then put me in touch with an off-campus therapist.
Reaching Out
My first therapist was not, in my opinion, prepared to deep dive with someone like me into unpacking the deeply ingrained self-hatred that had accumulated in my core. She tried her best, but in all honesty, the point at which I finally chose to ask for help was actually the point at which I was most in need of extreme intervention, and a weekly 45-minute therapy session did little to slow my steep decline.
Telling my family that I was going to be inpatient came with a wide array of issues, as my parents had always turned a blind eye towards my struggle. It must have been painful for my parents, a hard-working immigrant couple with strict views on the morality of those struggling with mental health, to see that their child was now officially “less than perfect,” and potentially — in part — due to their choices and actions regarding how they consistently chose to treat me. Admittance to an intensive mental health treatment program was the unforgiving nail in the coffin that they had been unaware I was lowering myself into.
When I entered the psychiatric hospital near my home, I was stripped of everything the facility supervisors deemed to be potentially dangerous, given a small utilitarian room, and walked through my daily treatment schedule. Over the next few weeks, I was put on Zoloft, Wellbutrin, Prozac, as well as Ativan for panic attacks. I was given an eating program intended to help me gain weight, and prevented from taking part in any form of exercise or strenuous physical movement.
What I naively thought would be a simple two-week stay turned into a four-month excursion from school, family, relationships, and normality.
I began intensive therapy sessions three to four times a week or so, including art therapy, family therapy, and group sessions designed for those with a history of substance abuse. While I made some progress with my weight and finally acknowledged a few of the roots of my problems, I struggled to internalize the coping behaviors I was being taught. A month or so of treatment found me self-harming and engaging in suicidal behavior once more, much to the alarm of my family and care team. Therapy, medications, and weight gain were not working, and I was finally asked to consider Electroconvulsive Therapy.
ECT is not what you see on TV. It is now a mostly painless, simple procedure that is said to have up to an 80% efficacy rate in those with certain mood disorders. It is most often used in cases like mine, where medications have not worked, therapy is not having the desired effects, and the patient is an immediate suicide risk. It is given only with the informed consent of the patient or their guardian, and only after a physical exam and psychological assessment.
I agreed to receive this treatment, though admittedly when it was presented to me I was extremely frightened. My mind brought up images of me being strapped to a gurney, wheeled down a damp underground tunnel by faceless nurses as they held me down with gnarled hands which fell into relief under the dim, flickering fluorescent lights. I would be violently electrocuted by some monstrous machine while wide awake and screaming.
The reality is much like arriving for a routine doctor’s appointment, the waiting room much like a dentist’s office.
I would be led into the bright white treatment room, lined with beds and clean machinery, and asked to lay on a freshly made single bed on wheels. Sticky electrode pads would be applied to my chest by a few kindly medical staff, and they would make sure I was comfortable. The worst and best part was the large needle they would insert into the nook of my right arm, which would fill my veins with something that would have me asleep in less than ten seconds. I would wake up after about thirty minutes, begin recovering from the procedure, eat a little, and then sleep most of the day.
This treatment happened three times a week for a month or so before my treatment team called it quits. Not only did it not seem to have much of a positive effect on my mood, but it was in fact resulting in some alarming side effects. I experienced severe memory loss, dissociation, and I eventually went into a sort of psychosis. Memory loss is par for the course; both long and short term memory are expected to return after a few months. In my case, I lost about 2–4 years of my long term memory- most of college, to be precise — and my short term memory was severely affected to the point where I could not remember what had just happened the hour before. I was unsure of how I got to places, what I had done or eaten, and who I had met. I began to disassociate from reality- I was often unable to tell if I was awake or asleep, and thus began the slippery slope into psychosis. I was unable to cope with my waking life in which I was prodded and poked, kept confined, forced to confront my worst fears and experiences.
So I regressed once again.
Beginning Again
I became convinced that I was absolutely not awake, and that everything I was experiencing was a disturbing dream. Nothing I did had real-life consequences in my mind, so I stopped being concerned about how my actions and words might affect others. I am sure that to those around me, I was intolerable during this time. My only true recollection of this is the fact that I kept a detailed journal during my entire hospitalization, which I have since read with astonishment, with no memory of writing or experiencing almost any of it.
Unfortunately, my suicidal ideation during this time skyrocketed. I was convinced that to wake up from this living nightmare I had to die. I was extremely angry that everyone around me; real, concerned people who I simply thought were my dream companions. They were trying and succeeding at keeping me alive and confined. It went on like this for weeks, possibly a month; me trying to “free” myself, and my care team trying to keep me in treatment. I eventually left against medical advice.
Despite being furious and embarrassed by what I was putting them through, my family came through at this time and was the main reason I was able to move forward. They helped me find and move into a new apartment (having been kicked out of my old one during my hospitalization) and continued to attend family therapy with me. My relationship with them was still fraught, but I was able to observe them as they, for the first time, acknowledged that I was in pain and committed to doing the work set forth for us with our family therapist.
New Challenges
Though I found a personal therapist who specialized in the care I needed and was starting to learn how to complete daily tasks, I had still left the hospital with almost no grasp on the coping mechanisms I needed. My dual sense of reality meant that, as I was developing a relationship with my parents, I also had overwhelming moments where I did not believe they were real people. I would sometimes lose days of memory, and occasionally be unable to speak properly, thinking that my thoughts were being beamed into the mind of whoever I was talking to.
The one thing I did learn from the hospital was the way in which I was encouraged to question immediate thoughts and reactions — to observe them as they were, and then try to view them with a different perspective; Essentially, to be critical of my own mind, and to be curious about the possibility of alternative outcomes. Even while perceiving a different state of reality, this was the main way in which I was able to rationalize living a little longer, despite how convinced I was at times that I was dreaming.
Under new guidance, I tried Zoloft again, this time taking it slower and over a longer period of time. In addition to therapy and a healthier living environment, the medication began to do its job, and I started my healing process. I relapsed into disordered eating and self-harm a few times after my hospitalization, each time observing the precursor to be a feeling of low social/familial support in addition to some major stressor in my life.
Analyzing why relapses happened for me encouraged me to speak up about my needs and boundaries, both to those around me and to myself. I was able to finally understand that, to bolster my ability to cope, I had to question my assumptions about what I needed, and what I could reasonably expect from myself.
Five Years Later
It has been almost five years since my hospitalization. I see my therapist every other week; I am off medication and I am in a healthy relationship with both my partner and my family. I use gentle nutrition and have a strong, healthy body. I recently began reading books again, as my memory problems once made absorbing new material almost impossible. I disassociate every so often and experience visual hallucinations in times of stress. I have little to no working memory of my late teens and early adulthood, and I have lost friendships and relationships. I struggle with extremely low self-image and self-worth.
The good comes with the bad, but I am glad to have found a sense of balance.
My personal experience opened my eyes to a few important takeaways. Despite being a valid medical issue, there is a reason why treatment for mental illness is so haphazard and ill-defined- the stigma surrounding it is blinding. ECT is a helpful treatment for many people; In my case, however, the treatment I needed might have been better introduced at an earlier point in my life. My symptoms were clear and yet no one, including myself, recognized them for what they were, and so I suffered in silence, convinced that I just wasn’t strong enough to cope. I was driven to wallowing in shame for being sad, to feel deserving of my unhappiness, guilty for not being a perfect child. I put these judgments on myself as well- this is not only to call-out others but also ourselves.
We as a society cannot meet the needs of our people if we continue to perpetuate harmful stereotypes, moral judgments, and criticisms of character towards those who need the most help. All people deserve support, and to feel heard. We must proactively learn what we can about treatment options, build stronger social support systems, and grow together with a higher understanding of how to help those with mental illness live full, enriched lives.
Richa Saran is a Boston MA- based musician, visual artist, and writer- primarily of fiction and short stories. Their other works can be found at www.richasaran.com.
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