Electroconvulsive Therapy, Part 2

Wishful-DrinkingThough she has been to a galaxy far, far away, Carrie Fisher knows the benefit of Electroconvulsive Therapy. “Over time, this f@#king thing [ECT] punched the dark lights out of my depression,” she wrote. “It was like a mute button muffling the noise of my shrieking feelings.”(1)

“The Edge… There is no honest way to explain it because the only people who really know where it is are the ones who have gone over.”(2) Even now, I don’t consider myself an expert on the edge. Like many of the lines I’ve crossed in my life, the edge was a blur. It had all the definition of the interstate when viewed from the rear passenger-side window of a car with your head stuck out the window and looking down. There are no edges, nothing discernible, as dashes and lines become two continuous yellow stripes connected by acceleration. The edge is always a blur just as depression is a blur of the gradual and the sudden.(3) No one is an expert on the edge unless it’s posthumously. I was near the edge in my first inpatient stay when wrestling with both homicidal and suicidal ideation. I was near that edge while being babysat by the day hospital being incrementally medicated after enduring a less-than-intimate daily group therapy session with 40 fellow patients. Even then, I was near the edge, even if I was holding on to it dangling over a Nietzschean abyss. I was still holding on to something during my second hospitalization because I remember choosing to starve myself. Not eating was me exercising what little agency I was allowed on the unit. By my third stay, second in one calendar year, I had made three suicide attempts. The third attempt was with a rockstar cocktail of prescription medications. It was my most lethal attempt to date. With the third stay any further discussion of edges was pointless as I was in free fall. Medication alone had not slowed my descent. Faster and faster, yellow lines and dashes became two endless stripes that signaled I would not be able to change lanes. There is no talk therapy for those in free fall as it is hard to talk while metaphorically, and often literally, screaming. Even still, I managed to argue my way through each day starting with the huddle of attending physicians each morning, then my clergy friends before lunch, ending my day with family visits each evening. Morning, noon, and night, I protested, “No ECT for me!” I argued for over a month which in behavioral health unit time feels like an eternity at the DMV. Five weeks in and Summer’s, my wife, gentle nudge became a bulldog. “Chris, we need ECT!” To be fair, she was, as usual, right. She was exhausted: caring for our daughter, Sophie; our home and whether we’d continue to have a home; our finances and my mounting medical bills; her work; my disability and leave of absence from the church. Summer, understandably, could not perform another daily “Daddy Check.” This is where she came home to make sure I’m not dead before getting Sophie from after-school. It was time. The fact that Summer had a euphemism for “suicide watch” was evidence enough that my health had deteriorated beyond the reaches of medication, therapy, and a leave of absence. Ultimately, my love for the two women in my life persuaded me to give ECT a chance. I borrowed from their will to see me well again.

What I wasn’t aware of at that time was how many hurdles I would have to leap over just to begin treatment. While leaping, I made the mistake of talking to other patients. I have to confess that though the unit encouraged such conversation I failed to see how we, the sick, could purchase some group-rate therapeutic benefit from our shared experience of illness. A bit of the blind leading the blind or the slightly less blind leading the more blind, either scenario I was certain at some point would involve a ditch and an unpleasant experience of gravity. My decision to undergo ECT was not helped by talking to other patients. They passed on such helpful things like, “You ever been really hungover?” “Of course,” I said, “I went to the 19th grade.” “Well, it is like being really hungover, but no epic story about how you got wasted.” Another volunteered, “You’ll feel like shit for a day or so which is exactly the time between one dose of shittiness-inducing ECT and the next.” Hangovers and shittiness aside, the worst thing I heard from other patients was, “You know, it doesn’t work.” In my depressed state I believed them; their words evidenced by my seeing then current ECT patients leaving our unit nervous only to return drawn-up, aching, confused, exhausted, and nauseous. My view was skewed. This is not surprising considering the population I surveyed. Think about it, those who benefit from ECT are not in behavioral health units. When I was suicidal I often told myself, “I don’t want to die. I just don’t want to feel like this anymore.” Suicidal reasoning actually proved helpful as I likewise reasoned, “I don’t really want ECT, but I, and every living person connected to me, don’t want to live like this anymore.” (No one likes ECT. I don’t want to imagine the existence of some fringe fetish of elective electroconvulsive fans.) The cautionary complaints of fellow patients ignored, I approached my regular day-shift nurse about starting ECT. Far from Kesey’s Nurse Ratched, he was a man in his late 40s whose royal blue scrubs suggested he was a familiar with fitness, but no stranger to take-out. A short-sheared male-patterned baldness-induced tonsure haircut with a  meticulously groomed mustache and goatee all the color of confectioner’s sugar. His short sleeve scrubs left no doubt that he enjoyed the outdoors likely shunning those given to tanning beds in NC in late autumn. I asked to speak with him in as private a setting as a behavioral health unit can offer. We met in my room, where I stood in my oversized slippers, baggy long sleeve navy blue t-shirt, and matching plaid drawstring-free-thus-suicide-proof pajama bottoms with a steady flow of tears like dew in the lawn of my month’s worth of five-o’clock shadow. Struggling to stand and speak, I managed, “ECT” between sobs. He said, “OK.” “Does it work?” I asked wanting a no that would excuse me from the treatment. My nurse looked at me and said gently and honestly, “I’ve seen folks in such bad shape they had to be wheeled in. And, I have seen those same folks walk out of here a few weeks later.” It may not sound like much of an endorsement, but I appreciated his not adding the phrase “worse off than you” and reporting only what he saw. His endorsement was echoed by my nurse that night, a kindly woman who reminded me of a young Angela Lansbury, think “Bedknobs and Broomsticks” Angela, not “Murder She Wrote.” One nurse’s witness and his evening replacement’s echo grew my courage such that during the next morning’s rounds I gave my attending, an accomplished and confident Vietnamese-American woman, much to her approval, my consent for treatment.

1.) Carrie Fisher, Shockaholic, 2011.

2.) Hunter S. Thompson, Hell’s Angels: A Strange and Terrible Saga.

3.) “How did you go bankrupt?” Bill asked. “Two ways.,” Mike said. “Gradually, then suddenly.” Ernest Hemingway, The Sun Also Rises.

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