Helen Simmons, Electroconvulsive Therapy, and the Damage Done

As a child, I spent most of my summer breaks with my grandparents in Daisy, Arkansas. They owned and tended to a large farm there. I can remember seeing them both work so hard but enjoying every minute of the modest and fulfilling life they had created in the southwest corner of rural Arkansas.

My grandfather, always busy bailing hay, feeding the cattle, or plowing fields, still took us fishing or swimming every day at the river. My grandmother was equally loving and attentive. She taught me how to sew and cook. I can still remember sitting at her sewing table watching her quilt and learning how to thread a needle. My days there were filled with visiting, exploring their farm, and immeasurable love. Their house will always feel like a second home to me.

Despite those picturesque summer memories, I can also remember the warnings. For example, we were warned not to bring up certain people or events that would upset my grandmother, and not to act too disruptive, as this could make her nervous. I was also warned at an early age that my grandmother could lose her temper at a moment’s notice. I remember thinking, “How can my grandmother, who has always been so loving, instill so much fear in those who love her?”

In time, I gained a clearer understanding of the situation. When my mother was four years old, my grandmother suffered a nervous breakdown caused by the stresses of tending to her dying mother, managing a twenty-acre farm, and raising four small children. Her doctor diagnosed her with manic depression, now commonly known as “bipolar disorder,” and prescribed electroconvulsive therapy as her only treatment option. Upon her return from the hospital, my grandmother was in such disarray that she didn’t even recognize the smiling faces of her four children who stood at the door, eagerly awaiting her return. The invasive and under-researched shock therapy had reduced her to a shell of her former self. Over time, her memory gradually returned, but from that moment on, her children strove to keep her calm in an effort to avoid another breakdown.

The history of electroconvulsive therapy, commonly known as “electroshock therapy” or “ECT,” started in 1938 at the Clinic for Nervous and Mental Disorders in Rome, Italy. Two doctors, Ugo Cerletti and Lucio Bini, invented the procedure. Their goal was to use electricity to induce convulsions in psychiatric patients considered too mentally ill for psychoanalysis to prove effective. The only other treatment options at the time for those with severe depression or other psychiatric illnesses like schizophrenia were problematic: Insulin Coma Therapy, a therapy that included coma-inducing levels of insulin; Metrazol Convulsive Therapy, which involved injections of the drug pentylenetetrazol, a stimulate, which given in large amounts will cause seizures; or surgically lobotomizing the patients. All of these therapies have since been replaced with ECT since it has proven less damaging and barbaric. ECT actually mimics Metrazol Convulsive Therapy, but instead of large or possibly lethal amounts of drugs, electrical currents provoke the seizures.

A man receiving early ECT treatment

A man receiving early ECT treatment

Initial experiments of ECT began when Cerletti and Bini started preforming tests on canines. Unfortunately, about half of the dogs experimented on died of cardiac arrest due to an incorrect placement of the electrodes used. However, Bini soon discovered that when the two electrodes were placed on each side of the dog’s craniums, epileptic fits were consistently induced, and the dogs survived.  Once the procedure was tested on animals, the first human testing of ECT took place in April of 1938. Today, ECT is used to treat patients with clinical depression and severe bipolar disorder who have failed to respond to medication. However, most medications now commonly used to treat bipolar disorder, such as Lithium, were not available at the time of my grandmother’s diagnosis. Unfortunately, we will never know whether or not she would have responded well to medication.

The side effects and benefits of ECT were still being debated in 1965, the year my grandmother received her treatment for bipolar disorder. In fact, today, psychiatrists and doctors are still torn over how patients will be affected on a long-term basis after receiving ECT. One of the major and lasting effects is memory loss. This explains why my grandmother didn’t recognize her own children when she first arrived back from the hospital. Other side effects include confusion, headaches, muscle spasms combined with stiffness, and disorientation, all heightened by the amount of electricity used and the number of treatments. During the timeframe my grandmother received her treatment, ECT was stronger and more frequently used than it is today.

Reports from patients who have received ECT vary. Andy Behrman, author of the autobiographical book Electroboy, equates the experience to drinking “a frozen margarita too quickly,” and notes that afterwards, he felt “elated.” On the other hand, registered nurse Barbara Cody, who claims to have lost fifteen to twenty years of memories due to ECT, calls the treatment “a rape of the soul.” Ernest Hemingway, who committed suicide shortly after receiving ECT in 1961, summed up his opinion on the treatment by saying, “It was a brilliant cure, but we lost the patient. . . .”

Early on, patients were awake for the entire ECT process, unlike the current patients who are anesthetized. Improvements have been made towards making ECT less traumatic for the patients, but controversy still surrounds this therapy and it’s actual benefits. I agree that for severe cases of depression and mental diseases, ECT can be effective, but I do not agree with administering ECT to an overworked housewife, at least not until other treatments such as psychological therapies or anti-depressants have been tried. Electroconvulsive therapy should only be used as a last-resort treatment plan.

My grandmother’s erratic behavior and ECT treatment had an immense effect on my mother, aunt, and uncles. My mom tells me stories about how my grandmother would throw tantrums in stores and completely overreact over the slightest mistake or misunderstanding. I remember one story in particular. My mother had been talking innocently and excitedly about her upcoming birthday party. She had mentioned to my grandmother that she just knew she was going to get the Barbie doll she had been eying. My mother didn’t get her Barbie or her party. My grandmother was convinced that my mom had been sneaking around collecting information from her classmates about her party and presents. My grandmother cancelled my mother’s party and returned her gifts. Mom still cries when she tells me about that day.

My Aunt, the oldest of the kids, still has a very strained relationship with my grandmother. I can only imagine the memories she has of growing up older than the other children and therefore more aware of the chaos and depression. I think she bore most of the brunt of the yelling and punishments. She ended up marrying and moving out of the house before she was sixteen. She has suffered with addiction and depression most of her life and has yet to forgive my grandmother. It breaks my heart to see my aunt still meek and skittish around her own mother. As far as my uncles, they rarely talk about what happened, and they, too, moved away at early ages, even moving to different states. They were both responsible for helping with the farm, which probably came as a welcomed distraction. They were both close to my grandfather, and I believe the relationship they had with their father relieved some of the sadness and frustration they had with their mother.

grandmother

When my grandmother returned home from her ECT treatment, no additional support was offered to her or my family. There was never a case manager provided for her to check on her progress and to monitor how she adjusted back into her day-to-day life as a wife and mother. My overworked grandfather, essentially a single parent struggling to care for his family, provided her only source of support. But he did it, and he never treated her like a burden. During the 1960s, a stigma surrounded mental illness. My grandmother was unable to share her experience with her friends and relatives in fear of what they would think or say. However, she was fortunate enough to have a husband who, in his own words, “towed the line” for his family. Without his unconditional love, support and never-ending friendship, my grandmother could have felt isolated and might have had more than just the one nervous breakdown. She might have even been institutionalized like hundreds of other less fortunate and abandoned patients. There’s a message here for researchers, medical institutions, and caregivers everywhere.