Leslie Kendall Dye | Longreads | May 2018 | 22 minutes (6,055 words)
It is a truth not nearly enough disseminated — despite all the discussion about depression and the recourses for those who suffer from it — that electroconvulsive therapy (ECT) can work. I had it six times in the basement of Lenox Hill Hospital in New York City in 2003 when I was 27 years old.
I'd awakened the morning before my first treatment in my mother's apartment on the East Side of Manhattan. I remember staring into the mirror, mute. My mother said: "You look haunted." What was my mother seeing? I remember seeing "it" too. My face was cradled in my hands, as though they held up its sagging contents. I looked captive, as though I were staring from behind prison bars.
For the previous six months, I had been unresponsive to a host of psychotropic drugs called in as a breakwater against a tidal wave of morbid depression. Who had I been? The details: I was a college graduate who had been a child actor. I was a chatty and expressive person, prone to melancholy moods but capable of romantic enthusiasm for life. I had been, simply, a human being, before illness descended and set off deterioration. Now, I was a clump of raw nerve endings.
It's an old story. Much like prostitution is the world's oldest profession, depression, I often think, is the world's oldest ailment. But old or not, it is my story too.
* * *
A few months before ECT, I had been living in Los Angeles. I had packed up and returned to my hometown after going to college, then theater school in New York City. I went where I could find an agent and start auditioning again after a long absence.
I found that I could not go home again. I slipped into a lonely dream state while sitting for hours in traffic. I couldn't feel a heartbeat in the place I'd grown up. I withdrew from the few things that once gave me pleasure — swing dancing at The Derby in Los Feliz, comedy shows at Largo in Hollywood, seeing movies. I withdrew from friends entirely. I barely left my apartment, except to audition or to work as a tutor for grade school children. And, as I later realized was crucial, I was too injured to take daily ballet class, having sprained my ankle after my pointe shoe slipped on the slick wooden floor of a dance studio. Depression is considered a progressive illness. One day, I slid from weary to limp. I was frantic but motionless. On this day, I walked out of my tutoring job. Words and notebooks and children shifting in their chairs began to swim before my eyes, and I couldn't figure out what any of it meant. I got up without an excuse and walked to my car, where I experienced a moment of escape-euphoria. Then I slumped over the dashboard.
* * *
It was not my first encounter with depression. I had suffered periods of melancholy throughout my life; I was briefly prescribed Prozac in my teenage years. But this depression was markedly more isolating and profound. I began to be unsure of whether I existed on the planet; I was unpersuaded by my own voice interacting with other people; my handwriting looked unfamiliar. I was astonished that I'd ever held opinions, deeply loved and been loved, enjoyed food, or achieved anything rational in a day. The word "depression" suggests a dip or valley, and indeed, many human functions are diminished by the illness, but the opposite is also true: the capacity to experience pain is augmented and fearful imaginings grow wild in the brain. Perceptions are outsize and distorted; depression is less a still valley than the peak of a mountain during a raging hurricane. I know the illness is digging in when my days are consumed by trying to describe it, as if I hoped to offer a map of my whereabouts to loved ones who might rescue me.
If I were to visualize depression, it would look like a house. When I wake up, I am in its darkest room, which is windowless and pitilessly silent. Strain for any sound and you will hear none. The house always changes in my sleep.
If I were to visualize depression, it would look like a house. When I wake up, I am in its darkest room, which is windowless and pitilessly silent. Strain for any sound and you will hear none. The house always changes in my sleep. The rooms are laid out differently, and nothing is where I left it. There are some places that are more comfortable than others, but there is no peace in any room. Also, this house is abandoned. I see that it is dusty, and the things scattered about are objects belonging to beloved people and places and events. There is one room that I can't get into. I'm sure there is sunshine in this room, and I might even faintly hear the chatter of people on the other side of its door. I can't make out what they are saying. I often can't even find the room. It moves up a floor or around the corner when I get close. As in horror movies, escape is out of reach, but only just.
If I seemed to be vanishing in the diffuse light of Southern California, the black and white crispness of New York City called to me. New York City became the room I hunted for. Fueled by the adrenal energy of desperation, I got myself back to New York City with the last of my savings.
* * *
I arrived in Manhattan midsummer. I moved in with my mother, who was living with her mother in the same apartment in which she'd had been raised in the 1940s.
My first night back, I walked down St. Mark's Place, admiring the tattoo parlors and comic book shops, the vegan cafés and greasy burger joints, and I remembered the lives I had already lived in New York City: as a ballet dancer at the Joffrey Ballet School, as a student at Columbia, as a theater student at the Neighborhood Playhouse. As I walked the streets briefly starry-eyed, I began to make plans.
But it was too late. I'd already spent months wasting away, unable to eat, unable to speak properly, unable to make change in a restaurant. The disease had advanced too far to simply retreat now. The biochemical march toward madness was in full swing, and a change of scenery only briefly derailed it. Within days of my return, I began to sit on the ledge atop our 17-story building, hoping for a strong wind to carry me off the roof.
I began to sit on the ledge atop our 17-story building, hoping for a strong wind to carry me off the roof.
One day, I was unable to answer basic questions during a job interview. I excused myself abruptly and made for the street, where I caught my reflection in a window. My etiolated cosmetics seemed a fitting mask for my internal decay. I shuffled into a church, not because I thought God might help but because I wanted a place to lie down immediately. Lulled by incense and the murmur of a few believers in nearby pews, I fell asleep. I woke up some time later, not so much worried for my safety, lying there asleep in a public space, but rather about how to get myself to the N/R train and then manage the transfer to get home.
* * *
"It's called end-stage depression," my father told my mother over the phone from Los Angeles. He'd consulted the head of psychiatry at Cedars-Sinai hospital, where he worked as an oncologist. "And the remedy is ECT. Go to Lenox Hill Hospital today." My illness had been unresponsive to medication; I'd been prescribed close to a half a dozen — Elavil, Remaron, Effexor, Prozac, and so on. Additionally, each drug weighed me down with side effects: arthritic pain, drowsiness, upset stomach. I seemed a hopeless case.
My mother was not a stranger to ECT. She had found my grandfather on his bedroom window ledge — in the same East Side apartment in which we were now discussing my fate — when she was just 17. My grandmother, who was recalcitrant about allowing mental anguish to disrupt her personal world, had been telling my grandfather to "just knock it off." My teenage mother, possessed of a sophistication born of necessity, had then told her mother to be quiet and got my grandfather to the hospital, where he was promptly zapped. It was relatively early days for ECT, the late 1950s, when they used more electricity for a longer period of time and routinely administered it as bilateral treatment, applying it to both sides of the head — overall a deeper drink of electricity. Still, my grandfather improved; he had escaped the torpor of irrational grief. He was prescribed tricyclic antidepressants, and while his life was not a happy one, he did not again slide into the agitation that had led him to the ledge. ECT had worked, and he came home his elegant, charming self, hiding his "normal" pain the way "ordinary," non-depressed people do.
* * *
My mother had barely hung up the phone with my father before we were off to Lenox Hill at 77th and Lexington.
For the second time in her life, she was dragging someone to the electrical pump.
* * *
I remember speaking to Dr. Bosworth in a consultation room off the ER. After she evaluated me, Dr. Bosworth announced that she was concerned for my safety and admitted me right away. I could scarcely believe what I was agreeing to, and even scarier than the electricity was being locked up. I was seized by claustrophobia, but I was so hopeless that turning back wasn't an option. Still, I didn't feel energized by the doctor's discussion of a "plan," as suggestive as the word was of hope and possibility. Instead, it felt like surrender.
For the second time in her life, she was dragging someone to the electrical pump.
ECT was carried out in the basement at 5 a.m. every other morning. We were not allowed to wear bras — something to do with underwires. I waited next to a pastry chef with an enviable marriage and professional life (how on Earth could she be depressed?), and I confessed that I had secretly worn my bra. She ran back to get her bra; this conspiracy cemented an understanding that we were now in this together, proving that ties form quickly in the most ad hoc communities.
Our doctor was a jolly, white-haired man in a bow tie. He talked to me about his grandchildren, and he asked me about Los Angeles. A nurse came at me with a mysterious appliance and he shooed her away. "Not yet," he said sternly. I later learned it was a mouth protector; without one, during the brief seizure the brain experiences during ECT, you can bite off a piece of your own tongue.
* * *
That night, my mother visited. She brought some lo mein but did not expect me to eat it; I hadn't eaten in months. I had had to explain relentlessly that I did not have an eating disorder, but that my eating — along with other basic functions, such as talking, walking, reading, and stopping for oncoming traffic — had become disordered. I had no interest in taking anything in — not food, not books, not music, not conversation. All stimulation felt like an assault.
I ate the lo mein my mother offered, finishing the bowl. Before my mother recovered from that surprise, I asked her for a newspaper.
"A newspaper?" she asked.
ECT had worked — and fast.
* * *
In an episode of the Netflix series Stranger Things, Matthew Modine, playing a sadistic doctor, administers ECT to silence a woman inside the lab where he holds people prisoner. We watch as Eleven, a young girl, witnesses the spectacle, powerless to help her mother as the doctor amps up the wattage in a tableau of cartoon villainy. This is ECT in the same theatrical context it has been relegated to since the films The Snake Pit and One Flew Over the Cuckoo's Nest — as shorthand for mind control. (In The Snake Pit, a patient stares up at the ECT practitioner. "You're going to electrocute me," she whispers. "Was my crime so great?") Fans of the show might well believe that the carnival act Stranger Things depicts is an accurate representation of ECT.
It is now 2018, and I am 42, a good distance from 2003 when I underwent what I recall as a benign experience. I rarely talk about it, because when I do, I'm met with wide eyes. People are, well, shocked. An honest description of ECT might be enough to frighten people, but I suspect the reaction has more to do with its theatrical depictions — all flailing limbs and the screams of its helpless victims writhing in pain.
Even people who are well-versed in depression — people who may have suffered from it profoundly themselves — are not immune to the popular conception of ECT as at best outdated and at worst depraved. In Daphne Merkin's account of her depression, This Close to Happy, she comments on ECT several times, despite having no personal experience with it. "The patients I saw returning from ECT acted dazed and dislocated, as if an essential piece of themselves had been misplaced," she writes. Merkin seems to confuse the effect of anesthesia with the effect of ECT itself, suggesting that ECT steals the soul in some ghastly, supra-medical way.
Well into her 40s, her depression as intractable as ever, Merkin is hospitalized for a fourth time, despite a regimen of medications. Her doctor asks her to consider ECT. "He pointed out that I lived with a level of depression that was unnecessary to endure and that my best shot for real relief was ECT," she writes. But she refuses, "haunted" by "the cartoonish image of my head being fried, tiny shocks and whiffs of smoke coming off it as the electric current went through."
Recent portrayals have renewed my interest in ECT, but it was a Facebook post from someone I didn't know that pushed me to investigate my own experience. She wrote that she needed advice from anyone who had had experience with shock therapy. I nearly scrolled by. It is easy to look away from suffering online; it can seem vaguely unreal. Then I began to wonder just how depressed the woman was.
Around that time, I watched a 2001 TED Talk by renowned surgeon and writer Sherwin Nuland in which he described his own savage depression, which he believed was rooted in childhood trauma and set off by a failed marriage. In the video, he speaks with charm, grace, and wit. His command of his own story — being hospitalized for months, unable to shower or shave or speak, losing a once thriving career in medicine, and finally being narrowly saved from lobotomy by a young resident who suggested ECT instead — speaks well for the procedure. He informs his audience, whom he assesses as hopeful and on the cusp of promising lives, that "anything can happen to you. Things change. Accidents happen. Something from childhood comes back to haunt you. You can be thrown off the track." He goes on to say that if he, "with the bleakness of spirit" he possessed in the 1970s, can find his way back from this, "anyone can find their way back from any adversity." If this is an overstatement, it is still an inspiring one.
His warning: Anything can happen.
His message: There is recovery. There is redemption.
Spurred by a sense of purpose, I reached out to the Facebook poster in need, assuring her that recovery from even the most dire depression was possible and that ECT was legitimate and safe.
if I could help deliver drowning people ashore by publicly rejecting the narrative that I had undergone something shameful, the stigma I had long feared might lose its power.
I then decided to probe my own case. What was the "anything" that had happened to me, that had sent me into a spiral? And how exactly had ECT saved me? Perhaps it was a story I was ready to share with more than just one Facebook friend. if I could help deliver drowning people ashore by publicly rejecting the narrative that I had undergone something shameful, the stigma I had long feared might lose its power.
* * *
I have been with my husband for almost 14 years; we have a darling 6-year-old. We absorb the regular pressures of middle-class life: a tight budget in an unaffordable city, anxieties about day jobs and artistic pursuits, the loneliness of a dense metropolis. But we are stable — and this solidity is the glue that holds my once-shattered psyche together. In my husband I have my true life partner. I am not, as I was in my 20s — alone. Motherhood also holds me steady; my central task as a parent is to provide stability. Someone as vulnerable as I am profits from nurturing someone more vulnerable — steadiness and routine, love and laughter are my central preoccupations, the perfect curriculum for a person who can swerve suddenly into depression.
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However, 13 months after giving birth, my hormones shifted — I know this because my menstrual cycle resumed — and the smooth surface of my early parental bliss became mottled by periodic melancholy. I briefly turned to an unusual regimen: I took a small dose of the antidepressant Zoloft (12 milligrams, considered by most psychiatrists to be "subclinical") for the second two weeks of my menstrual cycle.
When I first felt the gray waves rolling in, I took immediate action. Being a mother had, as is common, encouraged me to examine my own maternal role model. I remember my mother as emotionally frail, her life colored by a sense that all ships had sailed, that resistance to adversity was futile, that it was easier to hide from the world than to put up a fight. I think this model of capitulation had given me an extra shove down the path to helpless grief. So many things might contribute to depression — genetic predisposition, temperament, life circumstance, tragedy. My mother certainly did not cause my melancholy. In fact, I don't know if there is anything a parent can do to block the riptide of this peculiar illness. Still, I hoped that demonstrating a sanguine state of mind would tip the scales in my child's favor. I was lucky that the intervention of medication — this time — had worked.
I know that for many, a happy marriage, healthy offspring, job security, none of these things can prevent degenerative melancholy. I am not cured of depression, certainly. At present, I don't take medication, and I still suffer bouts of distress I consider dysfunctional. Luckily, these episodes resolve quickly. I am not among those who have needed maintenance ECT, but I'll never rule it out. I do not imagine myself stronger than the disease that once laid me so very low.
* * *
Slowly, public figures are revealing their own positive experiences with ECT. The late Carrie Fisher spoke about her ECT. Dick Cavett, when asked about his depression in a Psychology Today interview in 2016, replied that talk therapy failed him and that the right medication and ECT had worked. He does not specify how frequently he returned to the therapy or even if he did, but he does not shy away from mentioning ECT as a central part of his recovery from acute illness.
In Shock, journalist Larry Tye lays out the history of ECT, along with its pros and cons. Interwoven with the historical chronology of ECT are chapters written by Kitty Dukakis, the wife of former Democratic governor and presidential candidate Michael Dukakis. Her sections offer her reflections on her personal experience with the treatment. Prior to receiving shock treatment, Kitty lost 20 years to amphetamine and alcohol abuse, both substances used to control her agitated melancholy. She describes her illness thus: "I draw the shutters and retreat into myself. My energy is low ... contacts are difficult to sustain. ... Depression ... takes ahold of me in a very grasping way and lasts for months. Depression is a dark cloud that is always over me." And of ECT: "ECT breaks me out of my depressive cycle. It makes me feel like I am taking concrete, constructive action. ... I have been grasping for solutions, and this one is paying off."
In Shock, Tye confirms that Hollywood imagery, combined with the potent countercultural moment of the '60s and '70s, had brought the use of ECT to heel. Tye writes that in the '50s and '60s it had reached peak usage — about 300,000 patients a year underwent ECT. Mistakes were indeed made, largely because of the imprecision of the field from which ECT stemmed. Dr. Matthew Rudorfer says, "The field of psychiatry really lagged behind the rest of medicine in terms of standards. It was less evidence-based, there was a long reliance on theory rather than data." As a result, ECT was overused and often misused. ECT, he continues, "was used for everything under the sun. There were no other good options. In some ways, ECT never recovered because it was sometimes used quite inappropriately." Modern psychotropic drugs were invented, and given the increasingly sinister reputation of ECT — owing to some accurate accounts of misuse and inaccurate cinematic depictions — it fell out of favor.
Tye writes that excessive use of ECT, especially bilateral ECT, has historically resulted in patients losing memory, sometimes permanently. ECT had also been associated with the worst of mental asylums and as a kind of stand-in for the establishment's destruction of the individual. Tye writes that a ballot initiative cropped up in Berkeley in the '80s to outlaw it; patients who felt robbed of sections of their lives began to crusade against the procedure, and the national press took notice. "Imagine (and these are real-life cases, typifying conditions in certain states) having a relative in a public mental hospital and learning he had been subjected to electroshock treatment 800 times?" a New York Times editorial asked in 1977. "There are one million Americans in public institutions — jails and prisons and homes and hospitals for children. ... They are, in a way, the most vulnerable Americans. Why can they not be systematically protected against electrodes or cockroaches or rape?" Public hospitals were cowed into dropping ECT. This resulted in a sharp divide in access. "Policies at public hospitals are decided by lay boards of directors, who chased ECT out of the public domain. ... It means that poor people are denied wonderful care," says Dr. Jonathan Brodie, who was interim chairman of psychiatry at NYU at the time Tye interviewed him for Shock. As a result, ECT is now a kind of luxury service, available mostly to the white, well-educated, and well-insured.
And what of ECT's primary drawback — memory loss? I have always been happy to report that I barely forgot anything, that I actually recall not needing the pad on which I jotted down the names and numbers of close friends and family, as advised, prior to the procedure. I was not so much proud of myself as I was of ECT, which in my experience was not at all the barbaric practice it is portrayed to be.
Tye points out that depressed people can suffer substantial memory impairment, and it is difficult to determine exactly how much memory loss is attributable to ECT. When it does occur, memory loss related to ECT seems to be temporary and seems to affect only the memories proximate to the procedure. The noticeable memory loss I did have was classified as anterograde amnesia, which describes the failure of the brain to imprint memories of events directly following an event like ECT. I have no other recollection of memory loss and have corroborated this with friends who knew me at the time.
* * *
Recently, I dialed up Lenox Hill and asked how to obtain old medical records. They required an envelope, inside of which was a single paper on which I'd typed my name, my date of birth, and my date of treatment. Would the hospital record reflect my recollection — a rapid recovery with minimal if any memory loss?
May 7th, 2003
Charge: 240 mC
Energy: 68.6 J
Frequency: 60 Hz
Duration: 5 seconds
Current: 800 mA
Seizure: 31 seconds
It is not easy to see my records on the page. Seizure: 31 seconds. But grappling with the bare numbers is also a way to remind myself that science, not fantasy, should rule the day. Just as a pacemaker supplies electricity to a faulty heart, an ECT machine offers a brief jolt to induce a seizure that, for reasons that remain mysterious, induces a healing response in the brains of many agitated people. I might call it a pacemaker for the soul. Some theorize that the brain goes into a kind of healing overdrive in response to the seizure; according to Tye, Columbia researchers have found that ECT stimulates the growth of new neurons. My favorite metaphor for ECT is that of whacking an old-fashioned TV set whose reception has gone fuzzy. Anyone over a certain age knows that this often makes the picture clear again. While the brain is certainly not whacked by ECT, patients describe it as a kind of "reset." One thing is clear: It is the seizure, and more specifically the body's response to the seizure, that medicine is after; electricity is merely the means to that end.
Nurse's notes: Status post ECT: Patient initially very nauseated and reported feeling extremely anxious, tearful, was unable to respond to verbal contact. Received ½ tab Ativan. Alert and oriented in the evening, mood brighter and calmer. Able to verbalize feelings.
There it was — scrawled in the chicken scratch of medical professionals; I had not dreamt it. Mood brighter and calmer.
I had entered the hospital on May 5th and was thus described:
Patient is thin, dysphoric appearing, constantly tearful, expresses hopelessness and feelings of worthlessness. Neurovegetative symptoms. Insight good; judgment fair.
It's hard not to be amused by the dryness of clinical observations; a young actress uses the words 'jovial and scatterbrained' and hypomania is listed as a possibility.
I was also described as "suggestible" and it was of some question whether I might be considered hypomanic, given my description of myself as "at times jovial and scatterbrained." Tough crowd. Another doctor, who was covering for my regular doctor several days into my stay noted I was "guarded and had flat affect." (Was the possibility that I was guarded because the doctor was unfamiliar even considered? Not in the notes, anyway.) Nurses commented on my movements throughout the ward (standard practice, but creepy to read about), and I evidently went from passive and mute in my first group therapy session to "quite talkative, sometimes dominating group discussions." Ultimately, it seems, the possibility of hypomania, a less extreme form of bipolar disorder, was ruled out, due to a "lack of symptoms suggesting it." It's hard not to be amused by the dryness of clinical observations; a young actress uses the words "jovial and scatterbrained" and hypomania is listed as a possibility. Medical records need to be taken with a grain of salt; behavior along a wide spectrum of "normal" is easily pathologized. It is medical professionals' job to be on the lookout; it is our job (when we are well) to distinguish between our normal idiosyncrasies and the warning signs of mental turbulence.
* * *
ECT made its movie debut in 1948's The Snake Pit. Watching depictions of ECT on film is distressing because it is invariably the filmmakers' intent for it to be so: ECT is used to convey attempts at mind control, to convey that people who work in mental wards are malevolently consumed by a desire for power over the helpless. I think of my own avuncular doctor at Lenox Hill. I think of counting backward from 10 — the anesthesia worked by 8 — and waking up to ask, "When is it going to happen?"
"It's over! You're done!" the nurses told me, welcoming me back to consciousness.
The nurse's notes fill in pieces I have forgotten: I was "extremely agitated and nauseated" right afterward, "complaining of memory loss and confusion" and requiring Ativan. I was tearful and briefly inconsolable. But it's also clear that my memory has served me well: By the evening of my first session, I was of bright mood and clear eye.
After three sessions of ECT, according to hospital records, I had gone from "distractible, depressed, lethargic, anhedonic, unable to be future-oriented, anxious, dysphoric, labile, exhibiting symptoms of a neurovegetative state, unable to eat, hopeless, with passive suicidal ideation," to upon discharge "well dressed, groomed, smiling at times, articulate, with good judgment to match my insight" and, perhaps most interesting of all, "less forgetful." After discharge, I attended the remaining three sessions of ECT prescribed on an outpatient basis. I was placed on the medication Celexa, which I shortly discontinued. The symptoms of depression didn't return for some years, and never again did they come with the violence of the episode that brought me to Lenox Hill Hospital.
One cannot recount any memory without acknowledging that the moment an event occurs, it is colored by a dozen subjective inputs. Someone who has never had ECT may recall a moment from her life and when confronted with video evidence of that moment could well be astonished by how her memory has betrayed her. While precautions designed to minimize memory loss, such as the use of unilateral ECT and the use of as few sessions as necessary are important, memory loss is not especially fearsome for end-stage depressives when weighed against its alternative — an unproductive life tormented by constant psychic distress, or suicide. As Carrie Fisher put it in recounting her experience with ECT, "Some of my memories will never return. They are lost — along with the crippling feeling of defeat and hopelessness. Not a tremendous price to pay."
Upon reading my records, I am both relieved and disappointed at how unremarkable a case I was. On entering the hospital, the patient must fill out a form.
Why are you seeking admission? the form asks.
"I'm depressed," I wrote.
Indeed. I was depressed, and for all the colorful terms and descriptions we use to describe the brain in riot, it comes down to those two words: "I'm depressed." In Peter Kramer's most recent book on the subject, Ordinarily Well: The Case for Antidepressants, he describes depression as "a substantial psychological impairment with despondency at the core."
What else is there to say? Nothing, and so much more.
* * *
Reading my hospital records from 14 years ago, what unsettles me is not the ECT. What troubles me are the insights about my personality by doctors who barely knew me. They sensed a fragility, an indecisiveness, a lack of confidence surrounding commitment, whether it was to my vocation, a relationship, or my city of residence. Were these attributes symptoms of depression or traits more deeply connected to my character? Perhaps all these years later can the observations be of some use? Might this insight into my frailties help me to counter them? Or is it silly to trust the observations of doctors who observed me only briefly and at my most compromised? Were character traits at the root of my disturbance, so mysterious in its arrival, or had depression simply "happened" to me? "Things change. You can be thrown from the track," says Nuland. Was this all that had happened? Is there no grand explanation for my capitulation to madness that matches the largeness of the experience itself?
Finally, can I remember for myself what happened in the hospital, or must I leave it with the dry clinical record as taken down by others? There is a sense of reclamation in this exercise, a bid for ownership of the experience.
Was this all that had happened? Is there no grand explanation for my capitulation to madness that matches the largeness of the experience itself?
When you first walked onto the 7th floor ward at Lenox Hill, there was a couch, some chairs and benches behind it, a TV mounted in the corner. The nurses' station and dispensary were to the left, the eating area to the right. A corridor extended from the common area, off of which were the patients' rooms. My roommate was paranoid; she told me to keep an eye on the car parked across the street, as it held a bomb. There was group therapy and art therapy, which I remember only as a blur of blue paint. I'd love to see the historical relics of art therapy. I'm curious about what I drew while passing time in a mental facility, though I'm sure this would not offer the window onto that time that I now seek.
"Time hangs heavy in the hospital, and the best I can say for Group Therapy is that it was a way to occupy the hours," writes William Styron, in an account of his depression, Darkness Visible. This too is my memory, that there were "things to do" and that if they served no other purpose than to organize the day and reintroduce the recovering to social interaction, they were of value.
Maybe it's instructive that I have but a handful of recollections of the mental hospital. ECT was a restorative, and the hospital a benign way station; neither was cataclysmic or even particularly interesting. I went into the hospital virtually catatonic, and I left it a functioning, future-focused human being. That is all I remember with certainty — and all that matters.
I went into the hospital virtually catatonic, and I left it a functioning, future-focused human being. That is all I remember with certainty — and all that matters.
In his interview with Psychology Today, Dick Cavett says, "I don't really remember how many treatments I had. ... But I can tell you that I looked and felt better. I greeted people cheerily."
This is how I remember it too.
* * *
I stood in a pool of sunshine yesterday morning at a ballet barre. A woman stood next to me, warming up in pointe shoes. We marveled at the class turnout on this beautiful Sunday morning. Why weren't all these people out enjoying the park? We must all be crazy! "No," I said. "It's that we all want to stay sane." The woman smiled at me, then told me that she was a student of clinical psychology. She confessed that she danced to "clear the cobwebs" and "fight off the blues."
"Me too," I said.
Exercise and distraction are hardly reinventions of the wheel, nor are they sufficient in battling an acute depression. I have tried various medications and have not been able to stay on one without paying too steep a price in side effects. As Dr. Sackheim notes in Shock, he prefers ECT to medication because it limits the treatment to the affected region of the brain, rather than saturating it entirely. Drugs, he says, "are a pretty lousy manipulation, which is why you get all those side effects." Nonetheless, I do not at present need ECT, which is mostly indicated for depression that is nonresponsive or under-responsive to medication. It is not typically used in patients whose depressions are minor.
And so life is a juggling act. If I stay on track, fight my way through the bad spots, don't let any plates drop, make my pilgrimages to the dance studio, reject my existential anxiety, and tell myself that through the dust of hopelessness a clearer, brighter day is ahead, I do well. In fact, more often than not, I thrive, and the dimmest memory I have on most days is the sensation of freefall that accompanies melancholy.
Nuland speaks passionately about narratives of resurrection, and concludes his talk by summoning "the ancient story of the phoenix, who every five hundred years resurrects itself from its own ashes to go on to live a life that is even more beautiful than it was before." To anyone who has emerged from, to quote the late Styron, "depression's dark wood," after successful ECT, Nuland's comparison does not seem too dramatic. Daily survival, a commonplace act to the non-depressed, is to the depressed, heroic. And recovering from depression — awakening from a stupor to live life freely once more — is a uniquely cathartic experience. My experience with ECT has deepened my understanding of what the human soul can — with help — overcome.
If the day ever comes when I look in the mirror to see a person haunted, I hope someone will drag me back to the electrical pump, while reminding me of what I may have momentarily forgotten: ECT works — and fast.
Leslie Kendall Dye is an actress and freelance writer based in New York City.
* * *