What It's Really Like To Receive ECT (Electro-Convulsive Therapy)

The first time a doctor asked me to try ECT, I thought he had lost his mind. 

I had just been released from a long-term state facility and my transition back into the community wasn't going very well. I was sitting in a small room with an older male psychiatrist as we looked at the options on my fragile, falling plate. The day before, we had gone over a list of possible medications that could remedy my dysphoria. The problem? I had already tried and unsuccessfully taken every. single. one. 

So, this psychiatrist looked at me, and he said: "Ms. Smith... have you ever considered ECT?"

I remember giving him a double take, staring with my jaw dropping, half infuriated, half confused.
Did this man really say what I think he just said?
Is he sure he has a proper, present-day, authorized MD?

But I did hear him right, because he just smiled and repeated himself calmly as a million nightmarish images ran through my head. Images of bright electrical shocks, of metal contraptions, of people strapped to beds, shaking, in pain; images that I know a most people in the community today still think of when they hear the words "ECT". 

The psychiatrist sat with me and explained to me for what felt like half an hour what ECT, or Electro-Convulsive Therapy, now was. It's true, I was told, that it used to be barbaric -- hospitals used to use what was called "shock therapy" in ways that, decades later, would become unethical and illegal. Just as all other forms of medicine through the span of time and increased human knowledge, I was told, the practice of "shock therapy" evolved into a much more safe, and humane, procedure. Now, he said, electro-convulsive (not shock -- they hate the word "shock") therapy had become a common practice in modern psychiatric medicine -- used in a much different way -- to treat severe mental health symptoms. 

He proceeded to explain to me exactly how it was done; and then he, once again, asked me if I would be willing to give it a try. 

I said yes... but the reason was a bit more tricky than a clear cookie-cut black and white scenario. I said yes because I was given two choices: Either give electro-convulsive therapy a chance, or go back to the state psychiatric ward. 

I did ECT once (in 2014, a total of 9 treatments) and then I did ECT a second time (in 2015, a total of 6). It wasn't as terrible as I thought it would be, and below I've described what my experience was like.

How the media portrays it:

American Horror Story, The Snake Pit, Requiem for a Dream, Frances, Shines, Shock Corridor, One Flew Over the Cuckoos Nest; all of these, plus more, have scenes where ECT is portrayed. And in any Hollywood movie or TV show you encounter that depicts ECT, you will see generally the same thing: people thrown into a chair, or a onto a bed, and strapped down with metal cuffs or restraints while doctors pull out nodes, wires and machines; people screaming or biting onto a rag as they shake uncontrollably, having a terrifying seizure, their eyes rolling in the back of their heads. 

How it used to be done:

High doses of electricity were sent via electrodes to patient's scalps, to induce a seizure, with zero anesthesia administered; patients were often restrained to beds or held down by nursing staff to prevent them from flailing or falling off. 

How it's done now:

Patients are given anesthesia so they are unconscious for the procedure. Two electrodes are attached to the head, as small amounts of electricity are administered to the cranium to induce a small seizure. Patients are heavily monitored in a medical setting and are given medications to control symptoms of nausea and pain. 

How it was for me:

For this portion of my blog, I'm actually going to include a chapter from my book, "Ward Two West".

The last thing I see before losing consciousness during ECT:

"You have to go through a bunch of tests to be approved.

They give you a chest x-ray and an EKG to check your heart, and they do a urinalysis and draw a bunch of labs to check your blood. If you have any heart abnormalities, or if your blood comes back raising any red flags, they’ll tell you no, that you can’t do it. 

You cannot take many kinds of medications. In my case, almost all of the meds I was prescribed were incompatible and/or dangerous combined with the therapy – I had to come off of my Lithium, Klonopin and several other drugs in order to proceed with the treatment.

Once approved by a doctor, they stick you with an IV. (That is, assuming you’re approved immediately before the first day of your round – treatments take place on Mondays, Wednesdays and Fridays, so if you’re approved on a weekend, they may wait until Sunday night to do the stick.) You keep the IV in your arm at all times, even on days that you’re not having treatment. You’re not attached to a machine or any wires or anything – just the tip is left embedded in your skin and covered with a clear plastic wrap to keep it from being knocked out of place at night and during the day. It can get annoying, and it can make your arm sore at the embedded spot. And, you don’t have to keep it in if it becomes unbearable – a patient can choose to have a nurse take it out; or the nurse may remove it if it becomes dislodged or swollen; however, if you take it out, you have to deal with being stuck all over again the next day when they need to put a new one in. 

Every night before treatments, they ask you to take off your regular clothes and wear a blue hospital gown to bed. They check to make sure you’re not wearing anything with metal; no bracelets, earrings, or even an underwired bra. You sleep overnight in the gowns and, at 4:00 or 5:00 in the morning, they wake you up and wheel you down to the Post-Anesthesia Care Unit – PACU.

The procedure takes place in PACU; the same area where other people go to recover from their surgeries. You’re situated in a bed and wrapped up in blankets as a bedside nurse tends to your needs. Usually, it’s cold, so an extra blanket is asked for. And, since it’s so early, before sunrise, you’re usually sleepy and groggy and barely aware of what’s going on around you. I remember things seemed to be dark and unfocused around me, and even before receiving the anesthesia the hospital around me blurred in a murky haze.

The nurse rubs your forehead down with an alcohol-scented substance. She puts one small black electrode on the middle of your forehead, and another small black electrode on one of the sides of your head. It was explained to me that, in the past, they stuck nodes on both sides of the head – but that caused severe damage to the patient’s brains. Somehow, they told me, putting a node on only one side  and placing the other at the front of the scalp decreased the risks of any actual damage. 

In the background, you can hear machines whizzing and making sounds. “Looping” sounds – that’s the best way I can explain it. I would soon learn that the sound indicated brain wave activity, and that when a patient, asleep under anesthesia, was induced into a seizure, the sound would get faster and ring out in volumes to indicate that the person’s brain was seizing and that the electrical pulse to their head had done its job. I would hear that happen sometimes, if other people were ahead of me, and sometimes hearing that loopy seizure-indicating sound scared me. 

As you’re laying under your blankets and the nurse is tending to you, pretty soon a huge swarm of people surrounds your bed. People in black and blue scrubs, people in white coats. They stand around in a circle and talk to each other, talk to you. 

“Hi, I’m Dr. Peters,”

“Hey, I’m Dr. Carmichael,”

“Hello, I’m Dr. York.”

Medical students shadow and observe your procedure so that they can understand what it entails. Sometimes, nursing students do the same thing. They crowd around and smile and stare. Sometimes as many as eight or ten people are standing next to you, waiting for you to have ECT.

The lead doctor; the doctor who actually performs the ECT; arrives and greets you. He talks briefly with all of his assistants and confirms medication doses with the anesthesiologists, and the anesthesiologists inject strong doses of drugs to alleviate and/or prevent potential future side effects from what they’re about to do. “Here’s 25 of Zofran,” they’ll say, before injecting the nausea medication into you IV. “And here’s 50 of Toradol,” they’ll say, as they do the same with a drug for pain.  You can feel the sting as the drugs go directly into your veins. 

Dr. Liles, the lead doctor, will stand over you and ask you for your basic information.

“Can you please tell me your full name?” He’d ask.

“Bethany Smith,” I’d tell him.

"And can you tell me your date of birth?"

"June 4th, 1990."

“Bethany, do you consent to ECT today?”

The first time, I only nodded, and I was told that I had to verbally state my consent. Without actually hearing my voice, they would not proceed. 

“Yes,” I’d tell him.

This process had to be repeated every single time.

Then the doctor repeats your basic information to the students and assistants around him, while the anesthesiologists put a clear breathing mask over your face. 

“Count down from 10,” they tell you. 

The smell of the air coming through the mask is sterile and cold as it pushes its way through your nose and the whooshing can be heard throughout your ears.

“10…”

“9…”

“8…”

“7…”

“6-“

I usually didn’t make it past seven, and very rarely past six, before my vision faded and the noises around me muffled and the ceiling and faces grew distant and smaller as my body calmed and my eyes closed into a deep, heavy, unconscious sleep."

---

Usually I would wake up with a headache. The medications administered into my IV - the Toradol and Zofran - did their best job at preventing serious pain and discomfort; unlike my first time, when I had a soul-splitting migraine and full-body aches, and was puking my guts up excruciating agony; the times thereafter just consisted of minor neuralgia and fatigue. 

But I was always confused. I always woke up very hazy after having the actual procedure - though, that could be attributed to the anesthesia. I would wake in PACU - the Post-Anesthesia Care Unit - not knowing who I was or where I was or what was going on. One time I woke up in a full-on hysteria and, even though I barely remember it, I allegedly started clawing at my face. I would usually feel confused and disoriented until hours after I had returned to the main ward. I think sometimes I went straight to bed and slept until lunch, but other times I think I may have just wandered around the unit aimlessly. If I did, I can't remember - that's one of the biggest ways that ECT has affected me physically. It does have its negative side-effects... one of the hardest and most significant side effects to electro-convulsive is memory loss. 

There are many things I don't remember from during the time that I received ECT. It's like a blank, an empty void... I know, just from instinct and personal common sense, that that span of time was extremely hard for me, and I know I struggled in many serious and devastating ways. I know that my mental health was in horrible condition and I was suffering through one of the darkest moments of my life. Unfortunately, I don't know or remember much of anything beyond that one fact. 

Not only are the hospital stays where I received ECT blurry, but almost an entire year of my life has disappeared from my memory; 2014, starting from my long-term discharge on April, no longer lives within the realms of my mind. At times I have tried to think back and pick up on details from mid-2014 to early 2015, but it hurts - because there is nothing there to grasp. That time of my life barely exists in my memory. 

Would I get ECT again?

Probably not.

While I would never talk bad about ECT, and while it definitely has notable healing aspects to it medically, it is also simply that - a medical procedure, and an intensive one. It's a very intensive medical procedure that requires time and likely (although not required - some people can do it outpatient) hospital admission for proper medical monitoring and care. And right now, I have to devote too much of my time and energy to things like travelling, essays and exams.

Which is where I will end off saying that I do not regret getting ECT. Because, it has helped - when I got it done the second time, in September 2015, I not only started excelling and rising up higher in my life, but I managed to stay out of the hospital for over an entire year. It wasn't until 14 months later, in December 2016, that I was admitted to a psych ward again.
That was breaking a lifetime record for me. 

In the end, I also just want people to understand that the procedure I went through is nowhere near anything like it used to be. I don't often tell people that I've had electro-convulsive therapy -- granted, the topic doesn't come up very often -- but when I do inform others that electro-convulsive therapy is a part of my history, they are often confused, worried or surprised. Sometimes they look concerned or give me a sorry look of pity; other times they seem nervous, or afraid, and awkwardly change the conversation. 

Most times, I get asked, "How is that possible?" "I didn't think that was legal anymore." "How are you still alive?", which is the reason I created this specific topic specifically for this blog. Because, no, I was not shocked while I was wide awake. I was not held down while I screamed and writhed in seizing pain. I did not have metal object pressed to my body, and I did not have large volts of electricity shot into my head for the sole purpose of torture or barbaric treatment.

I've had ECT, but it was done in a PACU, in the local hospital, here in my city, and I don't remember what the shocks felt like because I was not awake. 

And no, there is nothing wrong with me - at least, not because of the ECT. I will always admit that I have my faults, and yes, I have issues, and for that reason I still seek active help. It's part of my illness - I have a disability, and I'm not afraid to admit that. But the simple (or, actually, complicated - whichever term you'd use to define it) fact that I received a complex medical procedure that sent electric volts into my brain to try to alleviate that problem does not make me any more flawed than I already was. It also doesn't make me a freak, or any less of the person that you are, or the person I am today.