ECT and Me
by Evelyn Sachs
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“Seriously? You’re undergoing shock treatment like in “One Flew over the Cuckoo’s Nest”?!!? I didn’t know they still did that! Doesn’t it ?” This is the reply I receive nearly every time I relate to someone that I undergo electroconvulsive therapy (ECT). “It’s so barbaric! What kind of a reputable place still offers that as a treatment?” The so-called “disreputable place” I receive my treatments is UCLA’s world-renowned Resnick Neuropsychiatric Hospital. Overall, the treatment has been greatly refined since its introduction in 1938 and most film depictions are not realistic.
I’m bipolar. The illness initially reared its ugly head when I was in high school although I wasn’t diagnosed until a few years after I graduated from law school. In retrospect, I’m not sure how I managed to get through high school, college and law school, pass two different state Bar Exams and enter the workforce. Somehow I powered through but everything and everyday was an intense struggle.
I have bipolar 2 which, in part, means the mania is not as extreme. For me, it was not a 50/50 split between mania and depression. It was closer to 95% depression. I also have a nifty case of OCD that manifests in hoarding behavior and obsessions about certain activities. I was crazy about competitive swimming, couldn’t miss a practice. If my mom wasn’t around to take me to swim practice at 7:00 pm I’d walk the ten miles—Midwest winter or not. I had to be at the library in law school every day at the time it opened, or else. In law school I had a carrel in the library that I called my crying desk. I would go there and bawl my eyes out and then I’d go to my regular area and study. Many days I would just lie in bed and cry.
I would go through phases where I wouldn’t speak at all. In college, I spent the summers working as a lifeguard. I sat through a lengthy staff meeting where I said nothing to anyone, even when prompted. After the meeting one of my fellow lifeguards told me that, if he came to work the next day and found out that I’d killed myself, he wouldn’t be surprised. At other times I spoke non-stop but my thoughts were so disjointed because I couldn’t focus on one thing for very long.
The people in my life knew that I had struggled with things but no one came close to a diagnosis. People assumed that I was just moody or on my period or something like that. My parents would send me to my room until I could act like a mensch. At a college reunion I recall telling a friend about my diagnosis. She replied, “Well, that explains a lot!” I was really clingy. I would have one friend and focus all my attention on that person. I would pour out my problems to the point of overwhelming them. When I did start talking to a psychologist about specific plans to hurt myself, he sent me to a psychiatrist and that psychiatrist was the one who finally diagnosed me.
After my diagnosis and concurrent talk therapy, my psychiatrist and I began the search for the medication, or combinations thereof, that might help me feel better, stop the rapid cycling and the panic attacks, curtail the manias, and eliminate the massive depression. After several years of trial and error, it became clear that the depression part of my bipolar disorder was treatment resistant. Although some meds worked better than others, ultimately, I experienced little relief.
During that time, I had a lot of trouble with interpersonal relationships which made friendships and job security dicey propositions at best. I was so depressed that I didn’t have the energy to do a lot of things—cleaning and bathing among them. I periodically would come to work a couple of hours late and more than once I was sent home to shower and change clothes because I smelled. I regularly engaged in serious acts of self-harm. I frequently abused my psychotropic meds with the same goal as the self-harm; I just wanted some relief from the overwhelming pain. Although suicide wasn’t my ultimate goal, I didn’t give a crap if my actions resulted in my death. I believed that my life was horrible; I was a complete loser and, therefore, things couldn’t and wouldn’t ever improve. The self-harm was a way for me to release the toxic feelings and have some relief from the psychic pain, at least for a little while.
On multiple occasions, my psychiatrist recommended both long-term inpatient treatment and/or ECT. I steadfastly refused to do either. ECT freaked me out and, as for the hospital, I was afraid that, if I went, no one would ever let me out. Also, my one and only friend was my cat, Frank. I did not want to be separated from him. I told my psychiatrist that if he tried to put me in the hospital, I would run away with Frank and no one would ever see me again. Fear and stigma certainly played the biggest roles in my life-changing decision. The turning point was the death of my mother. I sunk into such a severe depression that I finally agreed to go inpatient at UCLA. After spending a few months at UCLA’s psych ward, speaking to other patients who were undergoing ECT and ultimately feeling that I had nothing to lose, I finally consented to the procedure.
Because of the severity of my depression and the frequency of my treatments at that point, a good portion of my hospitalization remains a blur. I remember when I got to the psych ward they took away my shoelaces and my favorite part were the daily art projects. I also liked their lemon ices. Although my psychiatrist was not my attending physician, he still came to see me everyday. My sister visited a lot and I read a lot of books. I did not like having to wait my turn for ECT where they fit you in between the outpatient’s appointments. That meant you might not get treated until early afternoon which meant no eating or drinking until then. I remember one time I got caught chewing gum and had two more hours tacked onto my waiting time which was really frustrating.
ECT is frequently considered a treatment of last resort for depression although, perhaps surprisingly, it’s one of the most effective. And yet, it still carries one of the greatest stigmas. (After reading a draft of this essay, my psychiatrist stated that it’s his opinion that most psychiatrists want the treatment much earlier than last resort because of its efficacy.) But, for me, it has been the only thing that has really helped my debilitating, treatment resistant depression.
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People imagine that ECT is some sort of horrible torture that is physically painful and turns one into a zombie. That has not been my experience. My attorney dad was worried that I’d forget everything that I’d learned in law school and he gave me a post-treatment quiz which I passed with flying colors. Currently, I undergo maintenance ECT every six weeks as an outpatient. On ECT days, I typically have a 7:00 am psychiatrist appointment immediately prior to my treatment. Upon the conclusion of our session, my doctor walks me over to the ECT treatment/recovery area. The ECT treatment area consists of four beds separated by curtains, a bathroom, a storage area, a nurses’ station, and the actual treatment room. The atmosphere is warm and welcoming. There is little turnover and thus I’ve become friendly with the staff over the nearly two years I’ve been undergoing maintenance treatment.
My doc sticks his head in and asks “Are you ready for Evelyn?” This morning, Lupe greets me. “We sure are. Hey, Evelyn.” She points to a specific bed and says, “Here’s your gown, put your clothes in the bag… You know the drill.” I remove all my clothes from the waist up. I always wear leggings or sweats on ECT day. I then hop onto the gurney and snuggle under the blankets. There’s nothing like a warmed blanket.
Once I’m settled, various people step into my area. A psychiatrist with whom I’m not familiar opens the curtain and, after greeting me, asks “Do you know why you’re here?” This independent psychiatrist is there to determine whether I have the capacity to provide informed consent to undergo ECT (CA requirement every 30 days). By now I simply say, “Let me help you. I’m here because I’m batshit crazy. I have treatment-resistant depression and medicine does not help me. ECT does work but there are side effects such as loss of memory. I understand this and accept the risk.”
The master of the IV, RN Julio, is next. “C’mon Evelyn, let’s find your juicy vein.” With that, my IV is in place. Another nurse pops in. “Hey, Evelyn, how’s the writing going? Okay, move your arm over here.” And with that a blood pressure cuff is on and measurement has begun. Lupe comes back again. “Do you have a ride home? Is your sister coming to pick you up? We’ll call her about 30 minutes ahead. Oh wait, your sister’s always late. Let’s give her 45 minutes. Are you still living at the same place?”
Soon enough it’s my turn to be wheeled into the treatment room. My gurney is pulled in and the door is shut. That sounds kind of ominous but really it’s not. The room is relatively small and kind of non-descript with a landscape painting that hangs opposite the bed as a nice homey touch. Typically, there are four people in the room in addition to the patient: the psychiatrist, an RN, and the anesthesiologist who typically is accompanied by a resident. Several psychiatrists rotate ECT duty but at this point I know all of them. Today’s psychiatrist is Dr. E. “Good morning Evelyn. How have you been doing? What are you doing to keep busy? So things are going well? That’s good to hear.”
While the psychiatrist speaks to me, the anesthesiologist attaches what’s needed for an EKG and the nurse attaches what’s needed for an EEG as well as the ECT electrodes. The mood in the room is upbeat and the conversations are lighthearted. Once everything is ready the anesthesiologist injects the requisite meds and off to sleep I go. It’s all exceptionally peaceful.
By the time I’m awakening from the deep sleep of anesthesia, I’m back in the curtained area and nearly completely dressed. The nurses help me to finish the job and then move to a wheelchair. A member of the ECT staff takes me down to valet parking and hands me off to whomever drives me home. Once home, I’m still groggy and typically sleep for a few hours and take it easy the rest of the day. I certainly feel the effects of the anesthesia and probably the ECT as well. I get the “uh, it’s on the tip of my tongue, if only I could remember” feeling for a few hours but by the next morning I’m fine. Fine and in a fairly good mood.
Yes, ECT affects memory. Yes, ECT has affected my short-term memory although, thankfully, not to a great extent. That said, for me it works while nothing else has and, without it, I’d probably be dead. I wish that I agreed to do it earlier. My aim is not to shill for ECT, people have to work with their doctors to determine whether it’s an appropriate treatment for them and whether they want to accept the risks. Instead, I hope to erase the stigma that dogs this effective treatment so that this important conversation between patient and provider can take place.
After my stint at the psych ward I spent another 9 months at a residential treatment facility and continued my ECT treatments at UCLA. From there I moved to transitional housing where I still live. At that point I began the UCLA’s Partial Hospitalization program which is an intensive outpatient program. Its purpose is to help patients work on skills to reintegrate into life. It was a very positive experience and I’m still in contact with some of the people I met there. Once I completed that program I returned to weekly therapy and kept up with ECT although by this time it was being spread out more and more.
At this juncture I see my therapist once a week and my psychiatrist every 3 weeks. At some point, and as my mood improved, I realized that a good portion of my remaining issues related to my OCD. I looked into and was accepted into UCLA’s OCD intensive treatment program. That program was exceptionally helpful as well. There was and is a lot of therapy involved in creating a new life. I didn’t just get zapped and things turned around on a dime. I still have a lot of issues but I’m now able to actually get out of bed and address them instead of lying in the dark and wishing I were dead.
My mood is stable. This is the longest I’ve been stable in decades, if ever. Recently I called up my psychiatrist and told him I was worried that I was hypomanic. He had me describe my symptoms and determined I was not. He said, you’re euthymic (normal, stable mood) and it’s been so long you just don’t recognize it. COVID has slowed things down a bit but I Zoom, text, and email my therapist and psychiatrist on a very regular basis. I’ve had one ECT treatment since the quarantine began and that was close to what I described above but everyone was dressed like the hazmat team.
One of my inspirations in life is Elyn Saks who wrote a phenomenal memoir called “The Center Cannot Hold.” Professor Saks is a law professor who has schizophrenia. Instead of having a Wall Street legal career she had to determine what she could successfully do within the limitations of her illness. That’s where I am now. While I have not forgotten what I learned in law school, practicing law is not appropriate for me right now. What I do instead is write. I am at work on a novel as well as articles about mental illness. My psychiatrist likes to say that Kitty Dukakis and I are the ambassadors for ECT, and as the treatment has given me my life back I am happy to do so.