Coming Out of Electroshock Therapy

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

Janalynne Rogers shares her experience with electroconvulsive therapy (ECT), often called “shock treatment”—but it’s far less crude and risky than you might think:

Note: The kind editors at The Atlantic gave me the option of posting this anonymously. I’ve decided to use my full name because there is absolutely nothing to be ashamed of when it comes to having a mental illness and seeking whatever treatment works for you.

With the tragic death of Carrie Fisher propelling mental illness back into the mainstream media spotlight, I’ve been fielding more questions than ever about living with bipolar disorder. As someone with bipolar I [characterized by at least one manic episode, compared to the lesser bipolar II], I experience manic episodes wherein I feel invincible. I also have episodes of crippling depression. The most dangerous episodes are mixed, presenting with unbearable sadness combined with intense anger, self-loathing, and frenetic energy. Not only do I desperately want to die, I have the motivation to make that happen.

It’s terrifying.

One of the things people are most curious about is ECT (electroconvulsive therapy). Carrie Fisher was candid about her experiences with it, yet for many people ECT remains a mysterious, frightening concept. But ECT saved my life.

In 2012, an overwhelming mixed episode had me fighting for my mind and my life, and I begged my psychiatrist for help. He admitted me to the psych ward. After I settled in, we discussed changing my medication. We’d been conducting this chemistry experiment for 15 years, but it wasn’t enough. I had run out of options. He recommended ECT. It was my best shot at taking back control of my bipolar brain.

Also terrifying.

Before I agreed, I did some research. I learned that ECT was still the recommended second line of treatment in the standard medical guide to mental illness (the first being the drugs that had failed me). I considered the list of side effects, including memory loss, impaired thinking, and headaches. When the other option was waiting until I finally snapped and took my own life, these seemed like minor inconveniences.

So, I signed up for voluntary brain electrocution. For those unfamiliar with ECT, it goes something like this:

You are given general anesthesia and taken into the treatment room. You are given a drug that paralyzes your body. The doctor then sends electricity into your brain to disrupt its signals. In simple terms, you experience a seizure-like interruption of the electrical current inside your head and, over the course of treatment, the mind over which you’d lost control is supposed to return to its old self. The procedure itself is thankfully quite brief, and you wake up in recovery with no memory of what happened.

Despite the memory loss that followed my first treatment, that day stands out with startling clarity. The hospital had already been scheduled for demolition, and the interior was aged and neglected. As I rode the rickety elevator to the fourth floor, I struggled to squelch my growing terror. My mind is my primary marketable feature—the sudden reality of what I was about to do turned my stomach when I realized that my choice of treatment might leave me with permanent impairment. And might not work at all.

There were eight of us scheduled for ECT that morning. The nurses lined up our stretchers in the pink tile-lined hallway and systematically administered our sedatives. It was an assembly line of last resort. The fluorescent lights came in and out of focus as I slipped into the drug-induced slumber. My next memory is of being thrust back to awareness by the force with which I vomited on the recovery-room nurse.

I had felt nothing during the procedure and was shipped back to the main hospital while I was still numb. The memories from before, during, and after the treatments are either completely blurred or simply missing. Trying to recall specifics from the rest of my hospital stay is like searching in vain for a simple word that rests on the tip of your tongue but refuses to be said. I don’t remember that Christmas with my family or spending time with my parents in Florida. The photos I took while I was there look foreign and staged.

I did three sessions a week for six weeks. On treatment days, I was ferried to the regional mental health centre in a taxi before sunrise. Nothing quite cements the idea that you’re crazy like daydreaming of Nurse Ratched.

I still whole-heartedly recommend ECT. Obviously, I’m still alive. Electroconvulsive therapy was more effective than any combination of drugs I’d ever taken, and in less time. It did, however, take over a year before I felt I had complete control of my mind. Those around me saw the difference long before I did.

Since bipolar disorder is a life-long battle, the odds are good that my medications will once again fail. If my doctor recommends another round of ECT, I’ll most likely volunteer. When staring into a suicidal abyss, grasping for lightning doesn’t seem so bad.

What also doesn’t seem so bad is this video of ECT from 2013, especially when compared to the Hollywood version embedded above, which was filmed in 1975 and based on the 1962 novel One Flew Over the Cuckoo’s Nest—both of which negatively shaped the popular conception of ECT more than anything else. The main difference between that movie scene and the real-life version is the use of anesthetic in the latter, leaving the patient unconscious and not in need of physical restraints. The patient still convulses for about 30 seconds (starting at the 3:30 mark), which is a bit unsettling to watch. But as the narrator explains, there’s very little to worry about:

Serious physical complications from ECT are rare. Mortality rates of ECT are low—1 in 50,000. This is comparable to risks of general anesthetic for minor surgery.

In contrast to Cuckoo’s Nest, the two people most responsible for normalizing ECT in the public consciousness are Kitty and Michael Dukakis. This recent NYT profile of the married couple calls them “the nation’s most prominent evangelists for electroconvulsive therapy.” Following Michael’s defeat in the 1988 presidential election, Kitty spiraled into a deep depression and several years of rehab for alcoholism. But then she tried ECT—and it was a godsend:

Mrs. Dukakis, 80, still receives maintenance treatment every seven or eight weeks. She said that she had minor memory lapses but that the treatment had banished her demons and that she no longer drank, smoked or took antidepressants. She went public with her use of electroshock in 2006 in her book, “Shock: The Healing Power of Electroconvulsive Therapy,” which she wrote with the journalist Larry Tye.

Here’s another story of ECT, this time from a reader:

I sort of had my heart in my throat when I read you were soliciting stories about time spent in the psych ward, since I was hospitalized three times in the past year or so after experiencing the most harrowing episode of post-partum anxiety and depression. Even though I didn’t really want to re-live it, I knew I had to write you.

So here goes.

The first stay in the psych ward was for a month. I remember thinking at a certain point that they were never going to let me out, because I was never going to get better, and that I was going to have to either 1) make a break for it, or 2) kill myself on the unit. I remember actually planning it.

Every day they would ask me if I have any intent of harming myself on the unit, and I would lie—even though I told them in the emergency room it was my intent to kill myself, so that at least my partner would feel he did everything he could. I remember feeling awful about that, as the nurses were (in hindsight) generally kind and well-intentioned people. But I remember feeling like they were my captors, and not really feeling like my well-being was their concern so much as my safety in the most basic physical sense.

One of the early nights I was there, another patient howled through most of the night. I mean, really scream. My roommate had PTSD, so she would sort of start howling too. Another woman I met told me she really believed that she was being watched by the government. She knew how it sounded. Another had actually tried to kill herself; she’d jumped in front of a train. They’d had to amputate a leg and arm, and she was in a wheelchair. She is the hardest person to think about.  

They threw the book at me in terms of medications: Klonopin, Effexor, Remeron, Zoloft, Lithium, Seroquel, and Zyprexa—serious drugs with awful side effects. After one dose of Seroquel, my tongue started making weird circles in my mouth and I start smacking my lips—it’s called tardive dyskinesia, or TD—and one of the doctors told me it was possibly permanent. I remember that I didn’t even care. At that point I had so thoroughly lost my mind—myself—that if this drug could bring that back, it would be a small price to pay.

***

Eventually, the psychiatrist recommended ECT. ECT! It was something that would have struck terror in my heart in my former life: the general anesthesia, the possibility of memory loss, the tinkering with your brain. And all I remember thinking was “Well, maybe I’ll just die on the table.”

Believe it or not, I am actually well now. The ECT helped, eventually. (20 rounds! I kid you not.) I can no longer really access that person I was; her thoughts, her feelings, are hermetically sealed, and mercifully alien to me. It’s almost as if it happened to someone else. I guess that form of magical thinking is part of mental health.

But the psych ward kept me safe so I could outlive my worst thoughts, and for that I am grateful. Like anyone who survives suicidal depression, I hope that maybe someone else out there somewhere will read this and think “Hey, if she could get through that, maybe I can get through this, too.” Because the adage really is true: This, too, shall pass.

***

Update from a reader:

Hello, and thank you for publishing the poignant stories regarding stays in psychiatric wards. There is one thing I believe needs to be addressed—this line in the first reader story: “As someone with bipolar I [characterized by at least one manic episode, compared to the lesser bipolar II], I experience manic episodes wherein I feel invincible.”

It’s important, particularly because so many contributors (and readers, I’m sure) of this series struggle with bipolar disorder, to clarify that bipolar II is not the lesser of the two bipolar disorders. The differences are far more nuanced and complex.

True, the mania associated with bipolar II is less destabilizing than the mania experienced in bipolar I. However, bipolar II patients are often dogged by longer periods of deep depression.

Additionally, the absence of psychosis in manic episodes present challenges in both diagnosing bipolar II and convincing individuals to accept that diagnosis. It took my very astute clinician four years to get me to accept my bipolar II diagnosis. It’s also important to note that bipolar II hypomanic episodes can become more acute with the passage of time.

I often hear bipolar II referred to as the “mild” bipolar, and each time it gets me in the gut. Every day is struggle. For me, it’s prolonged, paralyzing depression.

Anyway, given how often bipolar is in the news these days, especially with the passing of Carrie Fisher, I think an exploration of both bipolar I and II is in order. (Catherine Zeta-Jones suffers from bipolar II.) Best wishes, and thanks again for providing a platform for stigma-free mental health awareness.