(TW: Descriptions of depression, suicidality, and ECT.)
The first thing to know is that I left my Ph.D. program. By last December, I’d been hospitalized for depression and suicidality three times. I was on a medical leave of absence, but I wasn’t getting better. It wasn’t clear whether or when I would improve enough to go back, but it was pretty clear that grad school made my symptoms worse. So I left. It was a devastating decision, though I think it was the right one.
In January I was hospitalized for a fourth time, for the by-now usual reason—I couldn’t be trusted not to try to kill myself. This brings me to the main thing I want to talk about right now: on the recommendation of my treatment team, I underwent a course of electroconvulsive therapy, or ECT. Much of the forthcoming description is based on conversations with my husband, therapist, and friends.The doctors who talked to me about the treatment and the informative booklet they gave me told me that “short-term memory loss” was the most common side effect. In other words, it would be more difficult for me to make new memories while I was doing ECT. More severe memory loss was, the booklet told me, infrequent. (Try this or this for a description of modern ECT. It’s pretty different from the days of Sylvia Plath.)
I have a few memories of the ECT itself. I remember the nurse, the anesthesiologist, and the ECT psychiatrist standing in a small room, mostly taken up by the wheeled bed I lay on. The anesthesiologist—a heavy-set middle-aged woman with dark curly hair—would say, I think, “You’re going to go to sleep now,” and the nurse, standing on the other side of the bed, would tell me, “I’ll see you when you wake up.” I remember the experience of succumbing to the anesthesia: the pull of exhaustion (when I would dutifully tell the nurse, “I’m getting sleepy”), an infinitesimal moment of panic where my brain would yell, stay awake! Don’t lose control!, and then the delicious sensation of relaxing into the darkness: It’s over now. I don’t have to worry any more. Sometimes I would dream. Then struggling up into the world again, being reminded where I was, drinking juice or tea or ginger ale in a waiting room with the other recovering patients for a monitoring period. If I was an inpatient, an MHS (Mental Health Specialist) from the Short-Term Unit would come down with a wheelchair to bring me back up to my room. Otherwise, eventually they’d call my name, and my husband would come take me home.
That’s about it. I remember hardly anything of the six-week period during which I was having ECT. I know Carmen came to visit me because my husband has told me that she did, but even when he describes the visit (it snowed a lot; we had coffee with a friend from our master’s program), it doesn’t evoke any internal recognition. I don’t remember the books I read or the things I did. I stopped writing in my journal. I had nothing to say.
They tell me that I was pretty happy during much of this period. I didn’t seem to want to kill myself any more. I didn’t seem to want anything any more. My doctors were pleased with my progress. They sent me home from the hospital, serene; and six days later I was bad enough to be readmitted. I seemed to be doing fine in the hospital, but I didn’t stay fine at home. The ECT seemed to be working, but it wasn’t working well enough (In retrospect, I think the inpatient environment was helping more than the treatments.). The ECT team decided to up the dose a bit, from “unilateral ultrabrief pulse” to “unilateral brief pulse,” in the hope that a higher voltage, a larger or longer seizure, would solidify the effects. They were optimistic and reassuring.
Allie Brosh of Hyperbole and a Half recently published an account of her own depression. It’s funnier than I can possibly describe, and hits hard and truly. Her description of her symptoms is different than mine: she describes an overwhelming, vacuous apathy, the inability to feel anything or care about anything, a calm deadness that cut her off from everyone she knew. What struck me was that that’s pretty close to how I felt, not during the depression, but during the ECT—or, more accurately, how I didn’t feel. Everything was muffled. I would go to therapy and just sit, saying nothing, for ten minutes at a time. It wasn’t that I was keeping quiet; my head was simply empty. I had to be reminded to eat. My daily planner—usually full of scrawled and crossed-out appointment times and things to do—is virtually blank for these six weeks.
The worst, according to my husband, was the week when I had three treatments, on Tuesday, Thursday, and Friday. When the weekend rolled around, I was unable to carry on a conversation—by the time I came to the end of my sentence I would have forgotten what we were talking about. This didn’t seem to frustrate me. I would start to reply to a question, stop to think, and then trail off into silence and resume my usual activity of sitting quietly in an armchair. I could neither describe the book I was reading nor remember the main characters’ names, let alone summon up an opinion on it. My husband tried to engage me in making scones, but I couldn’t figure out how to follow the recipe. Though I could still read, I couldn’t remember what I read for long enough to carry out the recipe’s directions. As my husband put it, “You weren’t even a zombie. At least zombies want to eat something.”
Throughout all this, I was pliable, compliant. The ECT doctors and nurses were kind to me, and they didn’t seem concerned about the disappearance of my personality. They said I was doing just fine. All my usual suspicion of expert opinion, my native trust in my own experience, my natural cussedness, was gone or muffled or hidden away somewhere. As I was reminded at every turn, I was at the best psychiatric hospital in the country, maybe the best in the world. I was extraordinarily lucky to be here. They knew what they were doing. Nonetheless, gradually, through the fog, I began to listen to the voices—both internal and from the people who knew me—telling me that something was not right, that this was not what I signed up for. I was coming to the end of the course of treatments anyway—usually patients undergo around 12 treatments, and I was up to 15 or 17—and so, eventually, I stopped. I left a phone message saying that I thought the ECT was hurting more than it was helping and that I wouldn’t be making my upcoming appointment, and that was that. That was the end.
It wasn’t the end, of course. From where I stand now, it was only the beginning. I don’t remember those six weeks of being vacant and withdrawn, but I do remember coming back to myself and discovering that large chunks of me were missing. The discovery was gradual—who can remember what she doesn’t remember, after all? First there was the reawakening, the week or two during which every day I felt more alive, more myself. It was like coming home after a long trip and turning the lights on in one familiar room after another. I started applying for jobs again, and answering my phone and email. As I came back, I began to notice gaps. Someone would refer to a visit made or a joke told or a dinner eaten, and I would say, “I don’t remember that.” The things that had been lost expanded in scope: the visits with family last Christmas, books read over the last several years, a friend’s pregnancy. I didn’t remember working at Starbucks for two months in the fall, my husband’s best friends from his graduate program (who have become dear friends to me, as well), the crisis plans and other strategies we’d come up with to fight the depression. I couldn’t recall how many times I’d been hospitalized because I was suicidal, or when, or where. I didn’t remember reading and becoming annoyingly obsessed with Infinite Jest over a period of several weeks. I didn’t remember the therapist I had seen for over a year through my school. I didn’t remember taking an Inquirer’s Class at my church. I didn’t remember this blog.
Some of these things more or less returned to me once I was reminded of them. Some of them didn’t.
Eventually, quite recently, I realized that most of the time I spent in my Ph.D. program is just…gone. I’m sure that if I went back through my notes I’d get back some inkling of the classes I took, the papers I wrote, the people I knew, the part-time jobs I took on. I might even remember the steps that led to my withdrawal from the program. Given how fiercely I’ve loved this career, how much of myself I’ve put into being a scholar, and how many sacrifices I made for it in the past (hello, long-distance marriage! Hello, crushing student loans!), I suppose my reasons were good. I expect that, like many of my choices in the last two years, it boiled down to “I have to leave school because otherwise I might die, and people don’t seem to be okay with that.” But to be honest, I don’t remember.
I’ve always been forgetful. It took me years to make checking for phone, wallet, and keys part of my routine before I left the house. I forget people’s birthdays, holidays, library due dates. Somehow I thought “short-term memory loss” would just be more of the same. It wasn’t, in ways that I was totally unprepared for. In losing my memory, I lost myself. Who I was—who I am—feels discontinuous, sketchy, tentative. I rely on other people to remind me. Many days, I feel like a ghost.
Perhaps the most unsettling part was forgetting where my belongings came from. I hadn’t even noticed the constant internal narrative of recognition until it was gone. Maybe I should wear that red wrap dress that my sister got me that looks really good on me; it would work with the brown boots from Target. I’ll make a pot of tea in the blue teapot Carmen gave me. These are napkins I sewed from cloth that I bought on sale at Gather Here. The sweaters, the can opener and cheese grater, the knicknacks, the earrings, the mugs, the scissors—they looked familiar, but there was no history to them. They, like myself, had apparently materialized from thin air. I wondered if I was even the same person who had bought these jeans, made these napkins, picked out these earrings. It felt more like I was a vaguely unsuitable replacement. I drank Earl Grey from the same hand-thrown blue pottery mug and wore the same size 10 turquoise flats, but they didn’t belong to me in the same way as they did to that other Mary, that Mary who used to know where they came from and how they came to be in her hands.
I’ve taken to asking my husband endless questions to fill in gaps and verify what I think I remember. Where did we get this red dutch oven? What about the silverware? Do you remember when I got these jeans? What did we do when Penelope visited? Did we visit Brian and Lori in New York? Sometimes his answers prod open unnoticed doors, and I remember what Brian and Lori’s house looked like, or the name of their dog. Sometimes, particularly for events from the period of the ECT itself, there is nothing. I learn his answers like I’m in a history class, imagine what it must have been like to live the life he’s telling me of. So gradually, between the things that are coming back and the things I have to let go of, I’m reconstructing my life. I’m rebuilding.
Ernest Hemingway had ECT, I found out recently. He wrote to his biographer, “It was a brilliant cure, but we lost the patient.” When I tried to describe to my psychiatrist what ECT had done to me, she said, “Well, it sounds as though you found something worse than being suicidal.” Which sounds about right.
Am I angry? Some days I am so filled with rage about all this that I can barely contain it. Today I’m less angry. On the one hand, the treatment that was supposed to help me ended up hurting me profoundly instead. (Incidentally, the main symptom ECT was supposed to deal with—the suicidality—came right back after I stopped.) On the other hand, the psychiatrists and nurses were very clearly trying to help, and they very clearly believed that ECT was something that helped people. I met a lot of people at McLean who were doing ECT, and (so far as I remember) they were uniformly enthusiastic and positive about it. They thought it was helping them. The fact that they also tended to be docile, placid, without discernible will, might have warned me; but I was desperate. Anyone who didn’t seem to be under the impression that she was being tortured, relentlessly and without mercy, was doing better than I was. I knew ECT posed a risk. But I wish someone had told me that I was risking myself.