Maternally Challenged

How to Add Suspense to Your Life

I am sitting at my computer wearing a beautiful blue silk blouse. It's lovely, really. I found it in my closet this morning when I opened the door so I imagine I bought it and put it there but I'll be damned if I can remember anything associated with this. My six-year-old went off to school today without her coat because I put it in the washing machine last night and forgot to put it in the dryer in time for her to wear it today. Also, I got up at 5:45 a.m. today feeling like I wanted to puke. I assumed I had some kind of stomach bug until my husband said, "Did you remember to take your pills?"--and I realized that I had forgotten that, too.

This is life post-ECT. The literature says "some memory problems" may "be associated" with undergoing ECT, and I'm sure these things vary from one person to the next, but around here the "few memory problems" are creating a kind of daily suspense I haven't known since high school. Back then, the biggest questions had to do with whether my hair was going to frizz or whether the guy I had a crush on would sit next to me at lunch--things, in short, I could mentally steel myself for a bad outcome on. There's no way to prepare for this kind of suspense: you can't steel yourself for the consequences of some action you have completely forgotten taking. When the boxes start showing up at the front door I may find out that I went on a catalogue shopping spree, too.

The ECT doc says (according to my husband; I don't remember this conversation) that the main problem he sees with people who decide to try ECT is that they stop too soon. If this is a sample of what you can expect, I can understand why. I do not like this constant state of bewilderment, temporary though it is supposed to be; more to the point, if I still worked for the Washington Post, my career simply could not afford it. And yet, despite all, I'm not sorry I tried it. It's a measure of the psychic pain induced by depression that a person would even consider attaching electrodes to his head and inducing a seizure. I do feel better. I have more energy; I enjoy my kids more; I'm back to my exercise program, which I had lost energy for; I get up in the morning with a sense of purpose.
I am grateful for the surcease. It means a lot.

Would I do it again? My most fervent hope is that this is a question I will never have to answer.

The Month I Love to Hate

It has come to my attention that tomorrow is February 28, which in my book ought to be a national holiday: the last day of the shortest, bleakest month of the whole calendar. So long, Feb. Don't let the door hit you in the ass on the way out.

I don't know what Nobel Laureate ever came up with the idea of February, but if it came to a referendum I would vote in favor of abolition tomorrow. Lengthen January by two weeks and March by two weeks. What does February have to recommend it? Valentine's Day? Get real. Either you have a true love, in which case you don't need an excuse to go do something nice for them, or you don't, and Valentine's Day is just a poignant reminder that in the Love Department, you are Unclaimed Freight. I am in the former category now but I spent way too many years in the latter category, and I wouldn't go back there for any amount of money. Although I will say that there is one thing worse than spending Valentine's Day as a single person, and that is spending Valentine's Day as a single person in the psych ward. I did that too, once, a long time ago.

Weather wise, February is unpredictable. It's either unseasonably warm or the weather gods dump two feet of snow on you with about 20 minutes notice. I live in the Washington, D.C. area, and it gets dangerous here. In Atlanta, where I spend the first half of my life, people at least knew they had no business being behind the wheel of a car, and if the results were sometimes infuriating they at least happened in slow motion. But Washington, as John Kennedy remarked once, is a city of Northern charm and Southern efficiency, and up here people think a thin glaze of black ice on the road is a signal to drive faster.  God help you if you impede them in this endeavor.

So far this week, the daffodils have emerged, and we have had a) one ice storm, followed by a b) 36-hour power outage, followed by c) six inches of snow. But the maple trees, bless them, are beginning to show the faintest trace of red, and the gardening catalogues are showing up in the mail. March has been known to bring blizzards, so we're not out of the woods yet, but I for one am ecstatic that tomorrow is the last day of the lousiest  month of the year. Good bye and good riddance. I am a pretty tolerant, open-minded person, but there are some things there are just no excuse for. Paris Hilton is one; February is another.

Chemotherapy for the Mind

That's what ECT (electroconvulsive therapy) reminds me of. Strictly speaking, taking antidepressants better fits that description, since there are chemicals involved in that and none in ECT (except the ones they use to put you to sleep, and powerful chemicals they are), but somehow the image of chemotherapy seems better suited to a procedure in which it is a mighty close call which is worse, the cure or the illness. I don't wish to scare anybody away from ECT--it's clear to me that it can be a lifesaving procedure in certain circumstances--but let us be clear here: whatever it is that causes ECT to lift depression also comes perilously close to messing around with the essence of what makes us human.

I knew going in that ECT was apt to have an effect on some of my short-term memories. I wasn't prepared for the fact that last weekend I took my daughter to see "The Bridge to Terebithia" and that I do not recall a single frame of the picture. I even went to the website, hoping that some stills from the movie would jog my memory--but no. It's as if it never happened.

That's a disappointment I can live with; after all, I can always go see a movie again. But it did raise the issue of what other memories I might lose if I kept this up. And I have to admit to some serious disappointment with is the way the psychiatric profession has handled this whole issue. On one hand, there's my doctor, who hasn't kept up with the news on what is a valuable therapeutic procedure, and who dismissively refers to doctors who use ECT as "shock jocks." My doctor is a good guy, and I expected more open-mindedness from him; it's disappointing to see bias creep into his professional judgment. But that, in the end, paled in comparison with the disappointment I felt at the hard sell I got from Sheppard Pratt. When you think about it, it's clear that ECT is an extremely cheap therapy--a few cents worth of electricity, a few minutes of an anesthesiologist's time, somebody who can interpret an EKG and monitor vital signs. This is the medical equivalent of restaurant iced tea--something you can create for pennies and sell for dollars, and did they ever sell it. I heard stories about people who kept coming back for 20, 30, 40 treatments, about people who loved it so much they had to be turned away. I heard about the benefits of "maintenance ECT." I heard marvelous stories about the wondrous curative effects of ECT. What I didn't hear was any serious discussion about a) its specific applicability to me and b) the particular concerns about memory loss posed when you make your living from observing and recording what you see. There's no doubt in my mind that I could have signed up for twice-a-week treatments for the indefinite future and the only thing that might have thrown a monkey wrench into things would be if Blue Cross began to raise some objection, thus interrupting the money flow.

In the end, I walked away with two lessons here. One is that yes, ECT can be helpful in some circumstances. It is by no means the blunt instrument of mind control that its opponents have made it out to be. If anything, its peril lies in the fact that it is so cheap and easy to administer--and, oftentimes, so fast and effective. Why? Because it's not something anybody should undertake casually. The potential for misuse calls to mind the old United Negro College Fund motto: "A mind is a terrible thing to waste." Or another, from Roman times: "Caveat emptor"--buyer beware. And that's sad: you'd think that if ever there was an endeavor that should be insulated from the brute forces of the marketplace, it should be the so-called healing professions. Yet if anything, here is where they seem to be magnified.

ECT Part 2

The next time you hear about the Psychiatric Establishment and their supposed abuse of electroconvulsive therapy, bear this in mind: nobody in his right mind would do this casually. Of course, not being in your right mind is the reason a person would even consider it, but the point I am making here is that ECT is not fun. Really not fun.

Having noted that, I must also note that I think it's helping me.

I wasn't sure I was a candidate for it. I wasn't positive I had exhausted all my phamacological options. I wasn't sure my depression was severe enough (though if feeling like shit for the past four or five months counts in terms of duration, I would certainly qualify). My own psychiatrist was not enthusiastic. The people who were enthusiastic were a) people who had suffered from mental illness much more serious than mine, who had found it helpful, and b) the doctors my own shrink refers to as "shock jocks," who are true believers anyway. My first two experiences were not the type that would sell it as a relaxation therapy, by any means: there was the head-banging headache I woke up with, the short-term confusion and memory loss (extremely disconcerting, especially for a writer for whom memory is my stock in trade) and just the godawful feeling of the anesthesia--that sense of being slammed underwater. It didn't help that in my second round I was under-anesthetized, with a faint muscle memory of the whole procedure, and also woke up with the mother of all anxiety attacks. (I have always required higher doses of anesthesia and painkillers than is considered "normal" for someone of my height and build--just another way in which I am Medically Unusual). In short, to go back for Round Three, which I did today, required considerable psyching up. I almost didn't go.

But the doctors and nurses listened to me when I told them about being under-anesthetized; they increased my dose, and also gave me some anti-anxiety meds in the recovery room, and, on the whole, it wasn't nearly so bad. What's more important, though, is that I find myself enjoying things again. Not big things--just simple things, like sitting by the fire reading with my husband, like putting my six-year-old to bed, like the sight of a brilliant red sunset, the glitter of ice on the branches after the storm this week. My God, I had almost forgotten what pleasure there was to be had in such things.

Don't get me wrong: ECT is not to be casually undertaken. I don't intend to keep it up one minute past the time I think I've gotten the maximum benefit. My brain is important to me--it's my only marketable skill--and messing around with it scares me to death. But then, so does the living death that is depression--a state of affairs I had become so used to that I had begun to forget what feeling good felt like. I am starting to remember. And for that, I got down on my knees tonight and thanked God.

And thanks, also, to the many people who have been in touch by e-mail and phone over the past week or so. Your support means more than you can possibly imagine.

The Nuclear Option

For about four months now I have been slogging through a prolonged period of depression. It's actually not the worst I've ever had, in the sense that I have not been actively trying to destroy myself and I've been capable of doing routine work, but it's been bad. The phone rings, and I don't answer. In the mornings I count the hours until I get to go to bed again. I am detached and flat with my kids. My libido is--pffft! Worst of all, I cannot think of a reason why I should continue to be here, what possible interest there could be for me on this planet for another five years, let alone another 25. I have started and put down a dozen books; my concentration doesn't last past chapter two. And if reading is impossible, writing is even more so, which is why there haven't been many blog entries lately. My career as a writer seems over; every day, I feel a little bit deader.

A lot of things have led to this, none of them anybody's fault; it's just the way life is sometimes. My mother died just over a year ago, and I miss her acutely. I published a book I had poured the last three or four years of my life into, and--unlike my first book--the interest from the mainstream media was nonexistent. (Which is not to say that I regard it as a failure or not worth doing; whoever is reading this has probably run across my book; the fact that the mainstream media didn't pick up on it has nothing to do with the importance of the topic; and I know it's helped some people.) But still: the book was written against long odds, and I guess I had hopes that it would spark more of a public conversation than it did about the topic of depression and motherhood, so there's disappointment, to say the least. This year has also been a year of health issues, probably not coincidentally: surgery on my knee, an unusual number of colds and stomach bugs and fevers, arthritis in my neck and lower back. This was the year we established a health club membership and I was going to finally lose those 20 pounds (again). Didn't happen.

But mainly, it's just the fact that it's winter--February, to be exact--and this has always been my worst month. It comes every year without fail. This year it came early. And every day for the past three or four months, I have felt a little bit deader, a little bit less like ever coming back to life. I upped my meds, and that didn't help. I started in on the benzodiazepines again, even though they are addictive, for the same reason that you reach for morphine when you're having surgery: it blocks the pain of constant anxiety...even though there will be hell to pay later on.

Depression takes a toll, and not just on you. Repeated episodes of depression have been associated with decreased volume in the hippocampus, the area of the brain where emotion and memory are integrated. For people who think antidepressants are a crutch, here's some news: a lifetime of untreated depression can literally leave you brain damaged. And that's saying nothing of the damage to your family: the husband who gets a hologram for a wife, the children who beg, " Mommy, can you spend some time with me?" only to hear, "No, I can't, I'm sick." They get fooled, because the person they know as mommy is still making dinner and picking them up at school--she's not on life support in a hospital anywhere--but she's not really mommy. She's the person who is inhabiting mommy's body, and, increasingly, that person is a ghost. (Which is why I chose the title I did for my book,The Ghost in the House.)

All of which comes as background for my reason to take a step which may sound extreme: electroconvulsive therapy, or ECT. Yeah, I've seen One Flies Over the Cuckoo's Nest, and I know that what people think when they think of ECT is of a drooling Jack Nicholson at the hands of a punitive medical establishment, a shell of his former self. ECT began a bit that way, but even in the 1960s it was nowhere near as barbaric as Ken Kesey described. Today it's often done on an outpatient basis, and among its more famous consumers is Kitty Dukakis, wife of former Democratic Presidential candidate Michael Dukakis, who has written her own book (with co-author Larry Tye) entitled Shock: The Healing Power of Electroconvulsive Therapy. Mrs. Dukakis' experience is extremely atypical, in some ways: she gets "maintenance" ECT about once a year, since her experience with depression follows an extremely predictable pattern (which, come to think of it, mine does too). I also have two friends who have gone through ECT, one of them twice and one of those times back in the bad old days before they sedated patients or gave them muscle relaxants to mitigate the physical effects of the artificially induced seizure, and before techniques were developed the minimize the (usually temporary) memory loss associated with ECT. Even so, both of these people said it helped them.

How does it work? Doctors don't know. But then, they don't know much about how antidepressants work, either, just that they usually do. The brain is still very much a mystery to science, even though we know more about it than we ever used to, and it may well be, as a scientist at Eli Lilly once told me, "If the brain were simple enough for us to understand, we would be too simple to understand it." About all we know is that a low-voltage electrical current, when passed through a portion of the temporal lobe, will induce a temporary seizure, and that this in turn changes the levels of neurotransmitters in the brain (which is what antidepressants do, by a different mechanism). Still, it remains extremely controversial. My own psychiatrist was not thrilled with my idea; he calls the ECT doctors "shock jocks." But one of the things you learn when you have a chronic illness is that, in the end, it's not your doctor who will be living with the results of what you do or what you don't do. It's you....and your family. In the end, my psychiatrist wrote the referral, and said he could understand my decision even if he didn't agree with it.

I had my first treatment yesterday. It was like getting hit by a truck (and I can say that with some authority, having survived being hit by a car as a teenager while getting off a school bus). Today, I have some muscle aches. It also gave me the mother of all migraines, and for an hour or so I was extremely disoriented. But then things slipped back into place, and now I can even remember the anesthesiologist saying, "You're going to sleep now" as he pressed the syringe into my IV. I also know that last night I looked at the sunset with real appreciation, and that after I went to bed I cried for a long, long time. They were healing tears. I felt much better after I was through.

Am I doing the right thing? God only knows; I don't. All I know is I have two little girls that I love, and a husband I love, and things I want to do. And when I die, whenever that day comes, I don't want anybody to be able to say it was for lack of wanting to live.