Maternally Challenged

And Why Should You Escape?

So today we are sending out the last of the Christmas cards, some of them with a letter enclosed, and it occurred to me that all four or five of my readers out there might be interested in our Yearly Recap, too. Hell, it took  me a WHOLE DAY to write:

At this house, our motto for Christmas letters is “All the news that fits, we print,” but we still pledge to keep it relatively short. For 2007, this will be no problem because, frankly, there are a few stretches of 2007 you wouldn’t want to hear a lot about. 

The bad news first. Tracy underwent some ECT treatments last winter for a severe depressive episode and we’ll spare you the details because, actually, we don’t remember them. ECT is known for doing a number on one’s memory of recent events, so it’s been a year of surprises: outfits we don’t remember buying, e-mail correspondents we don’t remember having met… On the plus side, it also wiped out the memory of several really bad Disney movies, and it helped Tracy recover. ECT is very effective that way—but then, amputation is effective on gangrene, too, and there are good reasons why neither treatment has ever really caught on. Still, while humans can’t sprout grow new limbs, they can and do grow new brain cells. It was a long haul, but we are pleased to report that things are now back to what passes for normal around here. Work-wise, Tracy has several projects going: you’ll see her in the Civil War Times soon, she’s working on something for the NYU Law Journal which will involve traveling to The Hague to interview an eminent judge who sits on the World Court, the paperback edition of her book came out this summer, and there may be another book idea out there somewhere. Life goes on.

In extraterrestrial news, David’s working on a NASA project that would, if funded by the Powers that Be, map the universe’s distribution of Dark Energy. What is Dark Energy? you ask, to which the brightest minds at NASA would answer: We dunno. All scientists know is that it is a mysterious force which accounts for about 25 percent of the energy in the universe, and it is, like, totally awesome, dude: it sends stars careening around galaxies, it can bend space and time, and it keeps that donkey kid in back of you kicking your seat for the entire duration of a trans-Atlantic flight. The official name for the project is ADEPT (Advanced Dark Energy Physics Telescope), but around here we just call it The Map of Where Is, Is. 

On the kid front: Rebecca is now 11, making her officially a ‘Tween, and so we have been introduced to the Great Big Honkin’ Attitude years. Not that Rebecca has ever lacked an Attitude, but up to now she had not brought it to bear on clothing. All that changed when she and Tracy went shopping for back-to-school clothes this year, and Tracy’s idea of fashion (subdued things with interchangeable components) fell victim to Rebecca’s fashion vision (spangles, sparkles, sequins and drapey things cut on the bias, all in hues unknown to nature).  Compared to this kid, Porter Waggoner would have looked like a funeral director. Well, okay, maybe that’s exaggerating a bit, but still: you see the potential for conflict. Rebecca is also deeply into the Cat Warriors books, and can diagram all the cat clans and interconnections thereof for anybody who displays the faintest interest, as well as for lots of people who don’t. (Our advice: don’t.) She has also caught the Horse Virus from her Aunt Nonny, and as any parent knows, “adolescent girl” + “horse” = “second mortgage,” so thanks a lot, sis. Rebecca takes riding lessons once a week at a nearby stable, where, besides learning how to ride, she is also learning to work with an implement known as a “pitchfork.” Our hope is that not only will she learn some horsemanship but that her expertise may someday transfer to using implements known as a “yard rake,” a “mop” and a “broom.”

Suzanne started first grade this year and has already won two professions of love from little boys in her class, which puts her one up on mommy at the same age. But then, Suzanne has these adorable freckles, which gives her an unfair advantage. She is a bundle of spontaneous bursts of enthusiasm (told for the fourth time to get out of the bathtub one night, she replied, “Okay, Mommy, but first I have to DO THE WET NAKED DANCE YEAH! YEAH! YEAH! BABY!!”—and there went another 10 minutes) and non-stop creative energy. At home, this means piles of paper, markers, paint, clay and other art projects in various stages of completion all over the place. At school, this recently resulted in a phone call from the vice principal informing Tracy that Suzanne and an unnamed male co-conspirator had been thwarted in their plan to tie each other up during recess. Suzanne has been banned from even touching a jump rope until after the first of the year; fortunately, the school supply list does not include "whips" or "chains." Otherwise, she keeps us busy with Inscrutable Questions (“Who invented broccoli?” and “How dark is pink?”are a sample) and creative manglings of common expressions (notably, “Fruit of the Loo,” which Tracy is thinking of marketing in the U.K. as a new brand of toilet paper).

No exotic vacations this year; we spent ours this summer a whole 100 miles from the house, at a mountain cabin in the Shenandoah Valley, where we went to a county fair (lots of fun, and who knew pigs could be so squeaky clean?), spent the day at a water park, did a bit of hiking (which prompted another Inscrutable Question, this from Rebecca: “Why is the Appalachian Trail so steep?”), and learned that a tiny little mountain chalet is way too small for three high-maintenance females and one outnumbered husband/father about two millimeters from the end of his rope. The kids had a blast; Tracy and David survived.

So that’s the year. And now that we think about it, it hasn’t been dull at all. Really: how many people get to map the universe? Or get paid for putting words on paper, for pete’s sake? So, as usual, once we look at the big picture we realize the good vastly outweighs the bad, and that goes triple since the recent pathology report came back marked "benign." (See previous posts.) Compared to 99 percent of the world, we are filthy rich; by any measure, we are incredibly blessed. We hope this finds all of you similarly situated. Merry Christmas.

The Moms' Disease

It's called Postpartum Depression, or PPD for those of us (too much) in the know. I've done a fair amount of research on this subject, both in the professional sense and in the Reality Bites sense. PPD is a subtype of depression which is not to be confused with the "baby blues," which virtually every new mother has for a few days or so. PPD is to the "baby blues" what a tsunami is to an ocean breaker. It makes you want to die, and this in spite of the fact that you have a new life to nurture and cherish. That's one of the worst things about it, in fact--that it happens at a time in your life when there is so much cause for joy. And that is also why so many women suffer it in silence, white-knuckle their way through the first year or so of motherhood: they are ashamed to be feeling so shitty when everyone expects them to be happy. Shame on top of depression is a lethal mix.

Here are just a few quotes from some of the women I interviewed for my book, The Ghost in the House (HarperCollins, 2006), who talked about this subject:

“I was afraid of her and ashamed of myself. I used to watch [my baby] sleeping and wonder with pride at how beautiful and perfect she looked. Then I would cry because I felt so sorry for her for her having such a screwup for a mother.”

“I lost me. I never knew me. And if I had a gun in the house, there wouldn’t be a me.”

Depression is a disease of recurrence; once those toxic neural pathways in the brain are ignited, they catch fire much easier the next time, and the time after that. That means any woman suffering from PPD is at risk of being on her way to a lifetime struggle with a disease that is the leading cause of disability in the world, according to the World Health Organization. And PPD, like maternal depression in general, is a disease that has a unique ability to spread the damage to the next generation. Research by Sherryl Goodman of Emory University, who co-authored the survey on which much of my book was based, has found that women who suffer from depression, especially women who suffer from depression during pregnancy, are more likely to have babies who are fussy, hard to soothe, colicky. The result, when the baby is born, is a vicious spiral: an unhappy baby who unknowingly creates more anguish for an unhappy mom, who then has trouble caring for this unhappy baby, who...That's what happened to this mom:

“My daughter cried for 8 weeks constantly. Finally, I was crying too. She barely slept. I barely slept…Finally, I stopped my life. I spent the entire morning deciding if I should give her up for adoption. It was that bad.”

Older cultures were a lot smarter about PPD than we are, and some still are. Some cultures routinely seclude a new mother for 40 days following delivery, a time in which she has nothing to do but rest, recuperate and care for her baby. Even in Elizabethan times, this was the case. Today, our "enlightened culture" ships new moms out of the hospital in 48 hours or less (even those who had C-sections); mothers who work for small employers (50 employees or fewer) are entitled to zero maternity leave. Zero. Is it surprising that doctors in this country aren't particularly attuned to this problem, and miss the diagnosis even when it's staring them in the face?

Here's a quote from a mother who is a physician, who suffered from PPD after the birth of her own daughter:

"The mother has to be pretty bad before someone picks it (PPD) up. In my experience, the physicians weren’t asking—the pediatrician, the obstetrician, the specialist. I didn’t see my internist, but I doubt she would have asked either—it’s not something we are trained to ask about.”

Today is Blog Day for the MOTHERS Act (S. 1375 ), otherwise known as The Moms Opportunity to Access Help, Education, Research and Support for Postpartum Depression Act, or MOTHERS Act. This proposed legislation, sponsored by Senators Menendez and Durbin, would ensure that new mothers and their families are educated about postpartum depression, screened for symptoms and provided with essential services. In addition, it would authorize money to be awarded as federal grants to researchers who are exploring the causes, diagnoses and treatments for PPD.

I end with one last quote--this one from an older mother who raised all her kids while struggling with depression, at immense cost to her and them.

"Depression is the parent with the most power."

Think about that for a minute. And then, when you're done, call or e-mail your senator. 

Nobody, Nowhere

Just when I think we are making progress in erasing some of the stigma attached to mental illness...

“Jesus loved crucifying me,” Cho Seung Hui, the Virginia Tech mass murderer, said in a video he made before he killed himself last week. “He loved inducing cancer in my head, terrorizing my heart, and ripping my soul all this time.” I am quoting from the Washington Post; I did not see the video. I don't want to. I already know more than I want to about mental illness from firsthand experience. 

And here we reach the point at which I might be expected to distance myself—to note that depression is very different from psychosis, or schizophrenia, or whatever it was Cho had; you can’t equate them. And in many ways you can’t. Psychiatry, inexact discipline that it is, makes a sharp distinction between mood disorders, which depression is, and thought disorders like schizophrenia. But they both fall under the broad rubric of “mental illness” and so as long as I identify myself as a person with a mental illness, I am associated with Cho, however distantly and unwillingly. And it is this association—or, more precisely, the fear of this association—that keeps so many people from ever mentioning their own mental pain or seeking help. In his rampage, Cho has not only struck down scores of promising young lives; he also fortified that barbed wire fence which has existed for so long between anyone who suffers any form of mental agony and the possibility of surcease and help.

Mental illness is often associated with evil acts, especially when it hits the front page. It's an aberration of the natural order; its association with evil is no accident. Usually, however, the evil it fosters is primarily turned inward—like the decision made by a person in the depths of depression to harm him or herself. On the other hand, mental illness has no corner on evil: plenty of perfectly sane people do evil things every day. But when the cynical movie producer makes slasher films, or the drug-addicted doctor steals morphine from his patients, or the priest abuses little boys, we see these as discrete events. It’s only when an evil act is committed by someone insane that his entire “nation”—i.e., the mentally ill—get tarred with the same brush. And so it will be now. I can already hear the phrases. “Nut case.” “Fruitcake,” “Shoulda been locked up in the loony bin.” All the terms people will use in speaking of Cho are terms people will live in fear of being applied to themselves. Mental illness will be equated with violence, and violence will foster fear, and fear will foster prejudice.

But Cho doesn’t represent my “nation,” any more than he represents, say, Koreans. And instead of viewing him as somehow representative of a special group, suppose we see him as a tormented young man who deliberately chose a path of destruction. Because, insane as he obviously was, he still had a clear choice; he referred to this explicitly. “I didn’t have to do it,” he said on the video. “I could have left. I could have fled."

If we can remember that he did not represent anything except himself, we can at least stop compounding the damage he caused. It's not much, in the face of so much devastation, but it would be something.

 

Balm

I have anxiety. Sometimes it's the worst part of this deal, this ongoing battle with depression. It's like a fire, smoldering in the brain, something wrong with the wiring that doesn't shut down the apparatus--oh no, it keeps working, if anything it speeds up--but impedes its function, gives it more to do than can possibly be done. And it feels, if this makes any sense, like a mental burn. You can't forget it for a second; it's with you always, like acid on exposed nerve endings. After awhile, all you think about is relief. This is why people drink; it's why they do drugs.

So this morning I woke up and I felt it descend again, this constant companion of mine, and I was getting ready to go to the gym. I thought swimming would help; sometimes physical activity does help, sometimes exercise to the point of exhaustion is the only thing that will help. I was going to take my oldest daughter with me. We had the gym bag packed; she was downstairs, ready to go, and I was tidying up obsessively--making the bed, folding blankets, plumping pillows--because that is one of the things I do when I have this affliction; I feel the need to try to control every element of my environment, which of course I cannot do, but the more I fail the more I feel compelled to try, and no, don't ask me to color with you, or listen to this knock-knock joke, don't you see the linens must be folded?? But this time, for some reason, it was different. This time, something just snapped. I fell across the bed.

I cannot do this anymore, I thought. 

That was it; for a moment, no other thought occurred. I rolled over on my side. My mind, which had stopped in the middle of its frantic busy-ness, began to pick up speed again, but slower. Fortunately, my husband and I had been watching the James Bond movie, "Casino Royale," on DVD the night before, and that intricate plot became my next obsession, taking my mind off myself for a moment. I began to worry it, working out nuances, making connections, turning it over and over and gnawing on it like a dog with an old pork chop. After awhile I became aware of the fact that I was getting cold, and I grabbed a blanket from the foot of the bed, covered myself, and lay down again. My mind slowed more. Outside I could hear the rain. I heard birds--at least three different kind of bird calls. I listened to the birds. I listened to the rain.

I said to the cosmos: Help.

All the time, I was expecting my daughter to come bursting in, or my husband to trek upstairs to ask what in the world had happened to me, but nobody came. The house was quiet. I lay there some more, and slowly the mental burn subsided, and my mind's white-hot activity slowed some more. The birds were talking to the sky, to each other, and I lay there and listened. After awhile, the rain picked up, and the drops fell faster and faster, and then, after some indeterminate period, I fell asleep.

And when I woke up, I felt--not healed, that was too much to expect, only fairy tales work that way--but more whole. Calm. I went downstairs, and my family was there, and my husband said, "I thought you needed to sleep." My oldest daughter said, "Mom! I made finger sandwiches!" and my six-year-old came up to me and put her arms around my waist and said, "Mommy, snuggle." And I said to the cosmos, Thank you.

If I Only Had a Brain

ECT will definitely alleviate depression, I'm here to tell you. It works. Unfortunately, as with just about anything medical, it has side effects.

It's Saturday morning, and my husband and I are lounging on the bed reviewing the week. He says, "Yesterday, Emma called me at work--I guess you weren't home--and said that Sophie had logged off the computer and that Aunt Nonny needed the password. I don't know where you were."

"Yeah," I said, wondering the same thing. "Sophie turned off the computer by mistake. Emma told me about it when I got home." And all the time, I'm thinking: where was I? where was I?

"I was pretty sure I had already told Nonny what the password was once already," David said. "But I told her again. No big deal. I guess you were at the grocery store."

"That's it!" I cried. "I was lying here trying to figure it out."

Imagine you have this killer headache and there's a cure for it, but the price is you lose little pieces of your vision. So you take the cure and the headache goes away, but from now on when you look out your front window there are big blank spots in your field of vision. Which is worse? Yesterday I was invited to a book party at the Chevy Chase Club for Manic Depressive Illness, a re-issue of the definitive text by Fred Goodwin and Kay Redfield Jamison. (Hey, I only go to the most fun parties.) I got downtown early and spent a profitable hour and a half at Filene's Basement on Wisconsin, and then took Military Road over to Connecticut, and as I'm driving through northwest Washington I am passing roads that I am pretty sure I used to be intimately familiar with--but honey, they are gone now. Pfffft! 41st Street. Reno Road. 39th Street. Didn't I once live on 39th Street? I may never know.

It seems the deal, as I told my husband, is that I can have a sick brain, a brain that is oozing dysfunction, but which fundamentally holds information--or I can feel happy, at home in my skin, and not have a clue about things like the name of the eye doctor I've been seeing for the past 18 years, or what I was doing this time yesterday. It doesn't seem like a fair bargain, but that's the way it is. My kids are happy with the new me--they've stopped imploring me to not have the treatments, and they seem to like the fact that I'm happier, more energetic, not wanting to sleep all the time; I'm interesting in playing tennis with them, building pillow forts in the living room, I'm generally a hell of a lot more fun to be around......but. But. BUT. My husband keeps trying to reassure me. "It'll come back," he says, and in the meantime he finds my lapses funny. And so do I, I guess. I mean, you gotta laugh or cry, right?

Okay. What was I talking about again?

Flying Blind

That's what I'm doing. I find myself thinking, You must be insane, to let people attach electrodes to your head and run electrical current through your brain--and then I catch myself: of COURSE you're insane, dimwit, that's why you're doing it. You can see how a certain tendency toward circular thinking is built into this process. The truth is, ECT (Electroconvulsive Therapy--a better name for it would be Seizure Therapy) is a step nobody takes unless they're desperate, so coming up with a reasoned, well-thought-out list of pros and cons is not usually a prominent feature of the whole decision-making thing. And so you wind up where I am: wondering if, having lost your mind, you're now preparing to flush it down the toilet.

In this, as in almost every other medical procedure I have undergone in my life, I turn out to be Medically Unusual. Supposedly, people receiving ECT have some slight "retrograde amnesia," meaning they wake up after the anesthesia not being able to recall the last few moments just before they went under. Not me: I can recall every single moment, which is why the other day I recall that the doctor--an elderly gentleman, I get the impression he doesn't do much of anything else at this particular institution--put an electrode on my right temple, as usual, and then put one on my left temple, which was not usual.

"Are we doing bilateral or unilateral?" I asked, and I heard him say, "Oh!" and he removed the electrode on my left temple. For those of you who don't know, and I'm assuming this would be most people since up to about two months ago I didn't know anything about this either, bilateral ECT is associated with much more memory loss than unilateral ECT (the kind with the electrodes attached to only one side of the head, usually the right). It was too late to leap off the table at that point, but when I woke up I thought a lot about this, and I decided that it scared me shitless--a point of view seconded by my husband when I told him about it. Don't get me wrong: I know doctors are human, I understand mistakes get made in medicine all the time; there was a nurse standing right there who would have, I believe, caught this error even if I had not said anything, and it's possible the doctor himself would have caught his own error. But still.

So now, in addition to my usual baggage load of doubts and fears, I have this added feature: an all-too-vivid demonstration of how things can go wrong, and do. This happened, mind you, at a highly regarded institution of mental healing, not some suburban community hospital.

So tomorrow my job is to get on the phone and have a heart-to-heart discussion with the psychiatrist I initially consulted at this place, to ask about the mechanisms they have in place to prevent such errors from happening. Maybe he can convince me it never would have happened. Maybe I'll wind up asking him for the name of somebody in another city who can take on my case. Maybe I'll just decide to say, once and for all, to hell with it. I just don't know. All I know for sure is that I needed this additional wrinkle about as much as I needed--well, I started to write "a hole in my head," but given the way things are going, I may HAVE a hole in my head before the week is out. With scorch marks around it.

Once More, Dear Friends, Into the Breach

So five sessions of ECT is not enough.

This is a discovery I have made the hard way: by getting five sessions of ECT, feeling much better, and deciding that this was all I needed. The effects lasted about two weeks--two weeks in which my energy level went up, I began wearing make-up again, I re-started my exercise program, I began cooking meals for my family again....everything seemed different. And yet the anxiety was gradually building. It was as if I was waiting for the other shoe to drop--and finally, late last week, it did.

There's no way to put down on paper the thoughts inspired by severe depression without sounding melodramatic, or fake. That's because depression inherently distorts thinking; any faithful rendering of what depressive thinking looks like would come out cartoonish. My thoughts ran along the lines of what a miserable mother I was, how toxic my presence was to my house, how much better off my husband and children would be without me if only they knew it, how much I would prefer to be dead if only there was a means of getting that way without inflicting enormous pain on innocent people. And the shame: my God, the shame. What business did I have feeling terrible? Why was I inflicting this on my family? Why couldn't I just get off my ass and enjoy the good things life had given me? And so on. Not to mention that I was an economic liability--unemployable, unable to write, unable to do anything more demanding than maybe a job in retail...providing I could stand up all day, which I probably couldn't.

My husband came home from work to find me sitting on the floor of my office, sobbing. From time to time one of the kids would come knock on the door. "Mommy, are you okay?" they would ask. No, I'm not okay. But I'll be out soon. It's okay. You're okay. It's just...Mommy feels bad. But don't worry. As if that would help.

Saturday passed in a haze; Sunday passed pretty much the same way. Last night I downloaded a program from The Infinite Mind and listened to it on my Ipod while taking my walk through the neighborhood. The program is one I trust; it was begun by Dr. Fred Goodwin, who is the former head of the National Institute of Mental Health, and one of my sources from my reporting days. I know the people involved with the production company that produces it, Lichtenstein Creative Media, some of whom have their own mental health issues. I know that the sources the program uses are not perfect, in the sense that medicine is not perfect, but that they are the best sources to be had on any particular topic. This program was about ECT; it was one I probably should have listened to before I went for my first treatment. Yes, the program said, there are problems with memory loss. On the other hand, ECT is the most effective and rapid treatment for severe depression that medicine knows about...and there are ways to minimize the memory loss. I listened to this, and I thought: What point is there having a brain if life is not worth living? What good are intact memories if you cannot enjoy a simple afternoon with your own children?

This morning I got on the phone and talked to my shrink, and we realized that we had miscommunicated; he is not opposed to ECT, just not up to date on it; as for his remark about "shock jocks"--well, it was just slang. "Sometimes they call themselves that, but I shouldn't have used that language around you." Once I responded to the initial treatments, he asked, "Why didn't you talk to me about stopping?" "Because," I said, "I thought I was on my own." And he apologized for that; it was a position I should never have felt myself to be in, he said. At this point, he thinks I should go back.

So I hung up from talking to him, and and then I picked up the phone again and made the call. The only thing worse than making that call was not making it.

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.

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.