Shock to the System: Electroconvulsive Therapy
When I was eight, my Grandpa Albert went through several series of shock treatments in a Los Angles sanitarium. He was 70, diagnosed with depression. Before being zapped, Albert slept in his tool shed all day, and was fond of dunking his food -- including pie, potatoes, and chicken -- in coffee.Growing up, I thought electroconvulsive therapy (ECT) was Albert's punishment for lethargy and anti-social manners. It was difficult to understand why else the family would ship him 200 miles south to be jolted awake in a city he hated. Later I learned that his treatments consisted of about 160 volts of electrical current running through his brain for one second. Just enough juice to cause a grand mal seizure.The family claims it was Grandma who committed Albert, guided by a trusted doctor's orders. Doctors were still omnipotent in the late '60s. And my grandma, with her children in collusion, would probably have sprayed Albert with DDT if a doctor told her depression was caused by white fly infestation.High voltage didn't light Albert up; he continued to drown everything he ate in coffee, and sleep all day. Otherwise Albert just shuffled around, mumbling unintelligibly. There is only one phrase I remember him saying clearly: "I want to die."As a result of these memories of Albert, I grew up with an inordinate fear of being institutionalized, and a negative view of ECT. I assumed shock treatments had gone out of style permanently, like ice-pick lobotomies and blood letting.ECT was a popular psychiatric treatment up until the mid-'70s. But when the 1975 film One Flew Over the Cuckoo's Nest portrayed it as a brutal, sadistic punishment inflicted on helpless individuals, there was a public outcry. ECT eventually went underground, all the way through the '80s. But in the last few years, a "new and improved" ECT has been gradually gaining acceptance as a treatment for people suffering from severe depression, and those who are suicidal.According to a December, 1995 article in USA Today, 50,000 to 100,000 people per year currently undergo ECT treatment. Half of those people are over 65 years of age; 59 percent are women. Unlike in the old days, the majority of new patients freely choose shock treatment.In 1937, Ugo Cerletti-also famous for inventing a delayed -- action fuse for the Italian army -- hypothesized that electroconvulsion might treat schizophrenia. He first experimented on animals, applying electrodes to their anuses and mouths at the same time to create convulsions. After several animals died, Cerletti and his assistant changed the electrode positions to either side of the brain.In 1938 Cerletti attempted treatment on a human subject: an apparent transient talking gibberish in a Rome train station. The man sat up after his second shock and said, "Not another time. It will kill me." The experiment was reportedly a success, but it ironically established another precedent -- the first forced electroshock patient. Electroshock expanded from a treatment for schizophrenia to a cure for depression.ECT was a major form of treatment by the mid-'40s, continually increasing in popularity with the media and the public. Ernest Hemingway, Sylvia Plath, and Zelda Fitzgerald all survived early ECT sessions, but weren't able to weather the afterwaves and the weight of living. Some claim Hemingway committed suicide to avoid further ECT treatments. Seattle resident Morgan Ahern went through forced ECT during that time. It's hard to believe she's still alive. She says, "Politics saved me."Morgan's parents were Romaji gypsies; she became a ward of New York state, and later the token disadvantaged youth in a Catholic finishing school. One night she climbed a wall, crossed over a line, and kissed another girl in a working-class bar. It was her 16th birthday.Morgan and her friend were gang-raped by bikers in an alley after they left the bar. Morgan had her eye kicked out -- mainly muscles were damaged. The townspeople claimed the two girls had it coming. Back then, homosexuality was considered a mental illness. Morgan went to Bellevue, then Pilgrim State Hospital. The girlfriend hung herself."I had three series of ECT that first time, when I was 16," Morgan said. "Each series was 12 shocks, three times a week for four weeks. They wouldn't tell us what was happening the first time. We'd wait in the hallway. Someone would walk in, and get wheeled out on a gurney, unconscious and drooling. It was terrifying. Talk about feeling powerless. The medical people who weren't downright sadistic were patronizing and condescending."Morgan remembers the first jolt of electricity turning everything black before she lost consciousness. Then she'd go under, waking up with an excruciating headache that she compares to "a knife in the head." Morgan experienced many other side effects, including having her lungs collapse, having the electrical and chemical balance in her body change -- watches would stop on her wrist, jewelry turned green against her skin -- and developing recurring migraines.Her whole existence became focused on the ECT. "I used to keep myself going with this plan ,that I could shrink my brain down small enough to miss the shocks. I'd plan for hours. I left that hospital completely confused," she said. "The issue of the gang rape was never once mentioned by medical staff."Morgan was back in the line-up for ECT 10 years later because she attacked a guy in an alley who was working on his motorcycle. He made some comment to her; it could have been hello. It wouldn't have mattered. Morgan spent 18 months in the hospital, and underwent two more sessions of ECT. She got out of the hospital the second time by shaving her legs, putting on nylons and lipstick, and thanking the staff for her ECT treatments.Morgan ended up leaving New York to get away from the stigma of being an ex-mental patient. She hasn't made use of a mental hospital, medication, or a therapist since that time. She invested her rage and passion in several causes -- among them feminism (divorced from therapy), gypsy rights, and the fight against psychiatric abuses.There's about 10 years between when Morgan was forced into ECT and when Bambi chose it as a treatment, in 1984. A number of changes had occurred in the meantime, due in part to the public stir caused by One Flew Over the Cuckoo's Nest. Forced ECT as a treatment for everything from schizophrenia to homosexuality went out of fashion. Patients were required to review and sign an informed consent form which documented some of the risks of ECT. Other changes occurred in the actual procedure, with the advent of muscle blocks and paralyzers which prevent bodies from jerking around on the table, resulting in broken limbs and fractured spines.Bambi says, "People will believe what they want to," but she is certain that without doctors, meds, and ECT, she'd be dead right now. She suffered for years from a debilitating depression. She remembers long periods of everything being dark, "like being in a cesspool. Everything ached. My body ached," she said. The longest depression lasted six months. Bambi attempted suicide for the first time in high school, then several times after that, one attempt leading to a hellish stay in the Western State Psych Unit. Dr. Dunner and Dr. David Avery at Harborview suggested Bambi try ECT. Her mom, a nurse, was completely opposed to the idea, afraid of what could happen."But my mother supported me in my choice once she saw me start to get better, and she trusted Dr. Avery," Bambi said. For Bambi, part of getting better meant enrolling in college and completing a degree. Bambi can't say exactly how many ECT treatments she went through over a 10-year period. "Ask Dr. Avery," she says. Unlike Morgan, she doesn't remember any intense headaches.She does recall being afraid of not waking up from the general anesthetic; and she couldn't bring herself to watch the hospital's pre-ECT educational video. "It would have been like watching a horror film. I could still disassociate (from the treatment) if I just read about it."Memory loss was one side effect that both Bambi and Morgan talked about. Bambi doesn't consider her memory loss to be significant. But both women have a general chronological haziness about events leading up to and surrounding their ECT sessions.Heidi Grady, Director of Behavioral Health Services at Providence Hospital, gave me a tour of the ECT unit there, starting with the generic waiting room. The shock machine itself was about the size of a boombox; the electrodes resembled small earphones. There was a mask through which pure oxygen could be fed to a patient during a seizure. There were monitors for vital signs. An ECT treatment takes about five minutes from the initial shock to the disoriented awakening. It all seemed as simple, quick, and friendly as getting your teeth cleaned, until we came to the ominous white row of beds where patients recover after they're zapped.Grady showed me a room on the mental health ward where an inpatient receiving ECT would stay. There were no TVs, and no other distractions except for a tape deck used for listening to soothing New Age music tapes. Grady explained to me that ECT is not a quick cure, but a treatment alternative. Patients can quit the treatments at any time. Her theory, and the theory of two Providence nurses, was that ECT works because there's a chemical change in the brain. It's similar to the effect of an anti-depressant: the shift takes place at the micro-levels of the synapses -- the spaces between nerve cells.One mile to the west and one theory away, Harborview's Dr. David Avery believes that ECT sets the biological clock back to zero. People with severe depression often suffer from sleep and eating disturbances, which can be balanced again once the circadian clock is reset. Avery combines ECT with meds and light therapy: this is what he did in Bambi's case. Bambi now lives with a dawn simulator that starts at 4:00 a.m.: she rises at 6:00 a.m., starts the day with light therapy exercises, and never goes to bed later than 10:00 p.m.Opponents of ECT offer much different theories of why and how the treatment works. Dr. Peter Breggin, who wrote Electroshock: Its Brain Disabling Effects in 1979, is one of the foremost critics of ECT. In his book Breggin cites numerous studies which illustrate the ways an electric shock can damage the blood-brain barrier, which stands between the brain's smallest blood vessels and the brain tissue itself. Damage to this area can severely impair memory.ECT's induced convulsion produces an "electrical storm" in the body which can deplete energy stores in the brain, and may cause vasoconstriction, reducing the flow of oxygen and nutrients to the brain. Included in Breggin's book are early writings by a psychosurgery pioneer who claims that the point of ECT is to damage the brain and make the patient more docile.An argument similar to Breggin's can be found the literature of the Citizens' Commission on Human Rights (CCHR), which works under the auspices of the Church of Scientology. CCHR has been watchdogging psychiatry for the past 20 years. Other watchdog groups, like the Support Coalition and the Network Against Psychiatric Assault (made up of forced-ECT survivors like Morgan Ahern), are keeping an eye on psychiatric abuses in the U.S. and abroad. Dendron, a quarterly out of Eugene, Oregon, serves as an information network for these activist groups.THEORIES OF DEPRESSIONAccording to the National Institute for Mental Health, of the 17.5 million people in the U.S. who suffer from some form of depression, about 9.2 million have episodes of severe, recurrent depression. The latter type of depression, which supposedly has biochemical causes, is resistant to talk therapy and tends to be hereditary. Drugs like Prozac and Zoloft are usually prescribed to control these deeper depressions, which may lead to suicide. When drugs fail, or when they cannot be physically tolerated, often ECT is called upon to work its magic.Dr. Keith Hoeller, a Seattle professor, and editor of The Review of Existential Psychology, claims there's no evidence ECT prevents suicide. He questions the validity of the theory that depression is a recurring mental illness-whether depressed people have anything physically wrong with their brains, whether there is actually a disease process at work. Hoeller suggests depression may indicate that people need to make changes in their lifestyle or belief system, or even changes in diet, work habits, or environment.Whether you subscribe to the biological or the existential model of depression, there remain some disturbing facts and confusing statistics surrounding the current increase in ECT treatments, especially among the elderly.ECT AND THE ELDERLYA patient information pamphlet I picked up at Providence Hospital, published by Somatic, Inc., states that according to "a recent study in California one death occurs per 50,000 treatments." The study in question was conducted by Dr. Richard Abrahms, who is also one of the owners of Somatic, Inc. -- a company that, according to USA Today, manufactures shock machines. Perhaps Abrahms has a financial interest in downplaying ECT's dangers. The actual death stats, when it comes to the elderly, may be closer to the one-in-200 range. This figure is supported by a recent study of patients 80 and older who underwent shock treatments; also by 18 months of reported ECT-related deaths in Texas, where lobbyists pushed through legislation requiring doctors to report all deaths that occur within 14 days of an ECT treatment.The December 1995 USA Today article tells the story of Michael Charin, an anesthesiologist from Baytown, Texas who "participated in 3,000 shock sessions before he stopped two years ago, worried he was hurting elderly patients." Charin felt that older patients needed care for cardiovascular problems, chronic pain, and other medical issues, not shock treatment. He criticized the psychiatric profession for not being willing to admit harm "unless the patient gets electrocuted to death on the table while being videotaped and observed by a U.N. Task Force."ECT for the elderly may also be an issue of economics. Charin said it was difficult to quit his ECT specialty because it reduced his yearly income by $75,000.When I asked Seattle medical professionals about the cost of ECT, I got circular answers; so I went to other sources. Here's an approximate cost breakdown: Doctors get about $175 for each five- to 15-minute session; the anesthesiologist gets $300; the hospital ECT room gets $375. If you're an inpatient, you can add about another $600 a day for a room. Doctors who give three shocks a week can increase their incomes by over $25K per year.Given the current pro-ECT climate and the increasing incidence of ECT performed on elderly patients, Grandpa Albert might be facing the same electrical fate today he did 25 years ago.After researching this article, I realized that although a whole new language has evolved for talking about depression, mental illness, and how the brain functions, we're just as confused as ever about what exactly causes sadness, and what's inside our dark nights of the soul. My older sister didn't want to discuss what happened to Albert. "He had Alzheimer's or something," she said. "He was just a weird guy. I hope it's not genetic."These days, Grandma could no longer commit Albert, but a doctor might be able to steer him toward an ECT maintenance routine. The source of Albert's depression would still be locked away, though temporarily abated. And Albert could go on drowning his food in coffee, that brown, murky liquid that made everything taste the same.