After Alcoholism I fell into a deep depression and for me ECT(Shock Treatment) was the only way out. The following story was originally published in the South African YOU magazine. What do you think?
At the End of the Road
After hospitalisation for Alcoholism in March 2000 ( See June issue of Men’s Health ) I returned home to face yet another test of my strength and spirit. I gradually slipped into the very dark world of depression, anxiety and phobias. As the months passed the hope of a return to a normal life was shattered as a black cloud once again hovered above my head. Without the crutch of the drink I turned to the twilight world of prescription and non-prescription pills. My loved ones had to stand by yet again and see me reduced to a babbling shell of a man. Weakened by my fight to control my drinking I crumbled in the face of this new enemy. It stripped me of my dignity, respect and hope for a return to the land of the living. By Xmas 2000 I was in every way, dead man walking. Every day seemed an endless hell on earth and as with all depressants I retreated into my own private world of psychotic hallucinations, voices and fantasies. Suicide started to be a very real option, the last classic act of desperation. Visits to a number of psychiatrists and psychologists had not helped. Anti-depressants, sleeping pills, sedatives and tranquilizers had only bought me some time, but I was now ready to crack wide open. On a sunny summer’s day in March 2001 in my home town of Margate, Natal I somehow found the strength to sit in front of my G.P. I cried like a baby as I poured out my heart to him. He stood up and came around to me and put his hand on my shoulder. "Alan, I think it is time for you to try Shock Treatment." My head dropped onto my knees as I tried to take this in. I really had reached the end of the road.
This is my account of my experience of the fear inspiring treatment of E.C.T. ( Electric Convulsive Therapy ), commonly known as Shock Treatment.
It was almost a perfect summers day in Margate but my time of reckoning was here. It would soon be time to set off on the journey to Entabeni Hospital in Durban . As I ran my Estate Agency from home I plonked myself at my desk in the office, closed my eyes and listened to the sound of my own heart beating rapidly. My ‘better half’, Mary and my parents were talking in the background and getting ready to drive me through. I took a guess that it was about mid-morning and in normal circumstances the thought of the 120 kms. expedition would be no big deal. But today was far from normal circumstances. I was trying to come to terms with the horrifying position that I now faced. Having started to pop the pills since the early hours I drifted in and out of reality but there was no mistaking the awful anxiety that I was feeling. A journey to a mental institution and Shock Treatment awaited me today. No amount of pills could get me away from that fact. I raised my head to see Mary standing in front of me. She said it was time to go. As she turned away I closed my eyes again and prayed. I would need his help today.
So we began our mission. I had a pocketful of pills and a desperate hope that maybe today could end my pain. My father manouvered the car into the traffic and with me in the front passenger seat we were off. Part of me was in that car and another part of me was in a very secret and dark place that nobody could enter. Familiar landmarks passed us by I was only vaguely aware of Mary’s hand on my shoulder. I sensed the despair around me and yet I could feel the hope in the air. But I had no room for any more emotions now. Only a smell of fear and dread. I fumbled in my pocket and gulped down another palmful of pills. There was not enough strength in me to go through this alone. The months of despair, confusion and gut-wrenching fear all seemed to come in to focus now. I had never felt so lonely and isolated in my whole life. I slumped forward in the seat and reveled in the grateful thanks that the pills were kicking in big time. The trip to Durban was normally only about one and a half hours but for me time was distorted. Maybe I had passed out but in no time at all I was aware of my father asking me to get out of the car. We were in the middle of a large carpark and I was only vaguely aware of the sights and sounds all around me. As I got out of my seat and stood up my legs seemed to be on their own mission and my father put his arms around my waist and we started to walk. I felt as though I was walking in slow motion and I could not make out the words coming out of Mary’s mouth. I was only aware of the pain in her eyes. The reception area was busy and I leaned against a counter as I presumed that I was being processed into the hospital. Depression had also introduced me to the world of paranoia and everybody was staring at me. I had made a supreme effort to clean myself up for this ordeal but it had obviously not worked. The relentless attention of everybody forced me to bow my head and I walked with my eyes focused on the ground. There seemed to be endless steps to negotiate and I knew that I was weakening fast. We finally reached the so-called Annexe at Entabeni Hospital. A polite version of saying the ‘madhouse’. It was quiet and very bright. More like a large surburban home than a mental institution. But there was no mistaking the atmosphere. My stomach knotted in fear and horror as I realised that this where THEY would do it to me. I had finally reached the end of the road.
Much like the last year or so of my life nothing was simple. My room was not ready yet so off we returned to the main section of the hospital. Finally my mind started to close down and it retreated to the very special and private places that I had created for myself. I awoke in a private ward with a small balcony overlooking Durban city. There was a T.V. on the wall opposite my bed and a bathroom to my right. Mary and my parents were gone and I could feel that the pills were starting to wear off. It felt good to be in a clean bed and I noticed that I was wearing the new T shirt and shorts that I had bought. In a strange way my mood was O.K. and I could feel that I needed to sleep and I did just that. It was dark outside when I was awakened by a young nurse asking me if I was feeling better and that it was time to eat. She wheeled in a bed trolley with my food and I sat up to take the pills that she handed to me. " They’ll help you to relax." She wrote something on the chart at the end of my bed and then turned and closed the door behind her. With some difficulty I ate some of the food on the tray and as I finished there was a knock on the door and a tall well-dressed man, probably in his forties entered the room. He immediately introduced himself as my Anethetist for tomorrow. He went about his business of checking me out but his very presence had sent my mind into overdrive. So it begins and I was overwhelmed by a terrible dread of what was going to happen to me tomorrow. My Psychiatrist had taken a great deal of trouble to explain to me how the whole procedure worked but I could not remember his words. My classic panic attack kicked into action and I pulled my arm away from the Doctor. My brain was revolting at the new turn of events. I felt physically sick at the thought of what was happening to me. He must have sensed my uncertainty and unable to help myself the tears streamed down my face. I blurted out my thoughts to him uncontrollably. " Doc, is it going to hurt tomorrow?" He was a kind and compassionate man and he placed his hand on my shoulder. " Alan, don’t worry, I’ll be there with you and I promise you will not feel a thing." As I had done many times over the last year I now felt humiliated by my outburst and I put my head back on the pillow and closed my eyes. His voice echoed in the background. " I’ll see you in the morning. Try and get some sleep. You’ll be O.K." With that he was gone and I was alone again. He had switched the light off and I lay in the darkness of my room. The pills that I had taken were beginning to work and as I drifted off to my version of sleep I realised that after all the medical advice and help as well as the love and caring of Mary and my family it all was up to me. I would have to find the inner strength and courage to face my own demons. Nothing had helped so far so what had I to lose. Depression had stolen my very soul from me. It had forced me to the very point of suicide. What worse could a couple of electric shocks do to my miserable life. Thankfully my twisted thoughts were interrupted by the luxury of sleep and I managed a short prayer before the darkness overcame me.
Whatever they had given me had worked like a charm and I was awoken by a different nurse telling me that it was time to get ready. She handed two of those green hospital gowns and said that she would be back in 5 minutes. I sat up on the side of the bed and gathered my thoughts. It was now time for the real deal. I would be fine. I had led a colourful life with many dramatic ups and downs so this should be a walk in the park. But my deepest instincts told me otherwise. I was frightened. I could my heart beating rapidly. They were going to pass electric shocks through my brain and try and bring me back to the real world. It was bizarre but true. A lot of people had suffered terribly due to my illness and I owed it to them to go through with this. But they were not here at this very minute. Fortunately my thoughts were once again stopped by the return of the nurse. She asked me to follow her to the Annexe. We walked slowly as my legs once again felt heavy and unco-operative. I could feel her watching my every move. Was she expecting me to make a run for it and if so, why? It was before 7 o’clock but the corridors were full of people and staff going about their business. Each step was bringing me closer to my fate and I could feel my resolve weakening. Was I out of my mind? The Annexe was right at the rear of the Hospital grounds and we had to walk out in the open to reach it. It was a lovely summers day in Durban with a clear blue sky. I almost felt like one of those men in the American movies who is taking his last walk to the execution chamber. As we reached the entrance to the Annexe she opened the door for me and took me through to a sort of waiting lounge, then she disappeared. I was alone again. I sat with my head on my knees and started to pray out loud. I needed his help now more than ever. To my left was one of those flipcharts that you see at seminars. Some other demented soul had obviously tried to pour out his own demons. The words were the ramblings of another broken and sad person and only reinforced my own misgivings of this place at the end of the road. This time I was snapped out of my spiral downwards by the sound of another nurse at the lounge entrance. "We’re ready for you Mr. Butterworth." I forced myself to stand up and walked towards her. She too seemed to be watching my every move and as I reached her she took my hand and said softly, "You’ll be fine." Tears flowed down my cheeks as I took a few steps right behind her as she walked down the corridor and stopped at an open door entrance. For a moment I peered into her eyes and wondered what she thought of me. Maybe sorrow. Maybe just another sick and warped mind to be fixed. I froze in the doorway. I had to say something. I needed to hear my own voice. I stammered out the only thing that I could think of. " Lethal injection time." She smiled and moved aside to let me pass and enter the room.
The so-called ‘chamber’ was smaller and darker than I expected. No bigger than a small family home bedroom. My mind was speeding as I tried to take in the sight before me. It absolutely resembled the death chamber that we’ve all seen in the movies. Right in the middle was a long chair, similar to what you see in a dentists surgery. The type that you can recline the backrest. I was sure that there was straps hanging down. Around the walls were small medical type machines on trolleys. There seemed to be at least 6 people standing around, both male and female. Out of the corner of my eye I recognised the Anesthetist who had seen me the previous night. I was only a couple of steps away from the chair but I could not move. I could sense the occupants of the room waiting for my next move. Even I was uncertain about that. Here was my last chance to give this whole fucking scene a total miss. What right had these people to put me through this agony. I wanted to scream at the top of my voice that I was a person, just like they were. I had feelings , hopes and dreams. I was scared. More scared than I had ever been in my life. I was not suffering from depression. They were all wrong. I was just confused and needed to rest. If only they would give me a chance to explain. This was all a huge misunderstanding. My hesitation was obviously the cue for the "Shock Team" to swing into action. The nurse gently took my hand and led me to the chair. I had put the gowns on to cover my front and back and as I started to lie down they were twisting around my body. She helped me to straighten them. The chair was in the upright position and I leaned slightly back and made contact with the backrest. The nurse was adjusting my legs and I was aware of the Anethetist to my left taking my arm gently. It was nearly time and I was paralyzed and overwhelmed by a numbing sensation of hopelessness and fear. From my raised position I could make out what seemed to be at least three other persons, all staring intently at me. I could feel their eyes boring into me. What was passing through their minds at this moment? Somewhere deep inside of my tortured soul I pleaded for their understanding. Could they not see that I was a good man at heart, someone who had just gone wrong, someone who could not help it. A broken lifespirit crying out for help. To my left I heard the soft voice of the man getting ready to let me have some rest from this hell. " Relax Alan, it won’t be long now." The nurse appeared at my side again and smeared a strong smelling liquid on my left and right temple. It must have started to run into my eyes and instinctively my hand moved to wipe it. She beat me to it and pulled my hand away and wiped my eyes clean. "How's that?" Unable to speak I nodded and she took this as a yes and stepped back. Moments later she reappeared holding two leads with what appeared to be stickers attached to the end. These were gently pressed onto my temples and then she stepped back again. Time was now in double slow motion and through my haze of confusion I noticed all the bright flickering lights of the machines around the room. My mouth was so dry that the shock of the salty taste of my own tears brought a new wave of panic. I wanted to scream out for someone in this torture chamber to hold me and say that everything would be all right. I suddenly tried to sit upright and at that very moment my own Psychiatrist was standing at the bottom of the chair. At last somebody who knew and understood me. He stood with his arms folded behind his back. " And how are you this morning Alan?" He pronounced my name with a kind of French accent and as I paused to consider this strange action I leaned back on the chair. I closed my eyes and the only thought that I could muster was who was going to throw the switch? I opened them again and a stillness had settled over the chamber. Peering into the eyes of my Psychiatrist and the nurse I could sense that it was time to rock n’ roll. How I wish that my Mary was standing beside me now. A terrible weight descended on me and I now knew that I was ready. The months of desperation and pain compressed into a single second and I was tired, so very tired. I sensed a movement to my right and before I could respond the blackness overcame me.
And so began my journey back from the suicidal hell of chronic depression and hopelessness. The "Shock" was so powerful that I awoke about 45 minutes later to find myself standing at the reception desk, with my escort nurse at my side and in the middle of a conversation. I felt no pain and only a kind of dreamlike reality surrounded me. I managed to walk slowly back to my ward and thus began my experience of the ‘last resort treatment" of ECT. The trip to the Annexe was to be repeated four more times, every morning at about 6.45am. Once back in my bed I would be given breakfast and I would spend the rest of the day watching T.V. and reading. I could sense that something had happened to me but I could just not put my finger on my feelings. After the months of torment, tears and despair I was sure that somehow or other the lifespirit was returning to my broken soul. I was calm and yet at the same time not quite sure what my feelings were before this latest chapter on my journey. The nurses were continually in and out of my room with my meals, snacks and pills and I slowly started to realise that I was alive and well. I wasn’t perfect but all things considered the glimmer of hope was returning. At night I slept like a baby and every meal was a treat for me. My Psychiatrist regularly came to visit me and said that everything was going well. After the first "Shock" the whole mission of getting down to the Annexe and walking into the "Shock Chamber" did not seem as horrific and I even found myself admiring the lovely Durban morning. It had became a time to savour the rest and peace. To savour the thrill of the splashing water under the shower and the clean bedding. To recognise my favourite T.V. show and to hold a conversation with one of the nurses without tears and raised voices. To stand on the balcony and marvel at the sight of the Port of Durban. To come to terms with the fact that I was maybe going to make it after all the drama that I had put myself and my loved ones through. By day five I was almost feeling human again. Physically I still felt as though I was not back to 100% and generally I seemed to exist in a slight blur but with no pain. My Doctor came in to say goodbye and give me the drugs that I would need in the weeks ahead. I liked him. He was a quiet and compassionate man and wished me well. He also asked to come and see him in a couple of months time. I dressed and waited for Mary and my parents to arrive. I had my back to the door when they walked in. I turned and almost ran into Mary’s arms. She held me tightly and I murmured quietly in her ear. "I’m back."
And so ended my personal experience with Electro Convulsive Therapy (ECT). That it had been life-saving in my case was beyond doubt. I walked out of hospital with most of my reason and personality returned to me. I had walked in a babbling and confused man, probably close to taking my own life. Chronic and long-term depression had reduced me to a shell of my former self. Self-hate had brought me to the brink of self-anihilation, the last desperate act of depression. The late American President, Abraham Lincoln, himself a sufferer had described it perfectly, "To remain as I am is impossible. I must die, or be better." After months of counselling and numerable drugs my home Doctor confided in me that it was time to try ECT. He later told me that I was one of the worst cases of mania and depression that he had encountered. Even in my confusion and mental pain this advice took me by surprise. As with most laymen my visions of ‘Shock Treatment’ were not inspiring. Movies such as ‘One Flew over the Cukoo’s Nest’ had not helped. I had images in my mind of been dragged into an institution, strapped down on a bed and forced to endure a form of legalised torture which would result in a scene of spine-twisting, tongue-shrieking and bone-breaking torment. However I found myself in such a cold and isolated place, with no immediate hope for a recovery that I was ready to try anything that would relieve me of my misery. I made the right choice.
Fortunately for me the advances in modern Psychiatry have resulted in a well-used but controversial form of treatment. The controversy appears to be based mainly on an emotional level rather than medical science. In 1934 Ladislas Meduna, a Hungarian neuropsychiatrist noticed that sufferers of Schizophrenia who developed epilepsy showed a remarkable improvement. He went on to intentionally induce seizures by injecting chemicals. By 1938 Italian psychiatrists took this one step on and induced the seizures by means of electrical shocks to the brain. The idea of ECT had been born and until 1954 and the introduction of alternative drugs, such as Thorazine to replace electrical induced seizures, ECT was an important tool in the fight against Schizophrenia, mania and chronic depression. However by 1970 the new drugs were proving to be not entirely effective and the modern treatment of ECT evolved. It was in this period up to the 1970’s that ‘ShockTreatment’ achieved it’s dubious reputation. Without the help of anesthetics and muscle relaxants stories were rife of the ‘legalised torture’ inflicted on the mentally ill. There were also claims that the procedure was used to calm many forms of uncontrolable behaviour. The fact is that nearly 100,000 shocks are administrated every year in the U.S. South African figures are harder to come by as the central Department of Health does keep those records but it is widely used in both the public and private sector and unoffical numbers run at around 12,000 annually.
The modern procedure is remarkable safe and according to numerous studies carries no more risk than any minor operation carried out under anesthesia. I returned to my Doctor and asked him to fill in the blanks for me. My initial impression of going to the ‘execution chamber’ is the impression of a very confused and sick man. In reality you are met by a well-oiled and drilled team of professionals well aware of the fear and trepidation that you are feeling at that moment. Ideally they would like you to walk in on your own steam but as is the case with many people you can be sedated beforehand. Once you are on the ‘shockbed’ it is only a matter of minutes until you are under the anesthetic. A rubber bite bloc is inserted in your mouth and straps are positioned on your legs, chest and waist. After getting the go ahead from the Anesthetist and Nurse that your vital signs are O.K. the Psychiatrist administers the electrical shock. This is delivered to your brain via the two electrodes attached to your temples and lasts between 30 and 180 seconds. According to my Doctor there is contortion in your face and legs but nothing like is imagined. After about 30 minutes you are awoken in the recovery room and ready to walk to your ward. In fact in many instances the procedure can be undertaken as an out-patient. In effect the machine-induced brain seizure sends impulses which directly affect the various hormones and master glands which in turn control our moods. It is estimated that 95% of the medical knowledge concerning the human mind has been discovered in the last 10 years so it is comforting to know that people such as Dr. Harold Sackeim of Columbia University U.S.A. considered to be the modern pioneer of ECT, continue their work to improve this very useful tool in the psychiatric fight against mental illness.
There are of course opponents against the continued use of ECT. Their opposition usually stems from some of the side-effects arising from the procedure. Headaches, nausea and memory loss are the most common. In my case I had to completely relearn how to use my computer and on occasions I could not help Mary with her crossword but on the plus side I rediscovered my long lost sex drive! Looking back now it is clear that for about two months I was not the full sixpence! My brother Neil and his wife Irene from Cape Town, whom I had not seen for 5 years came up to see me and Mary and myself went out for lunch with them. To this day I have no recollection of that event. The World Health Organisation estimate that by the year 2005 depression will be the most serious disease on earth. We live in a fast moving world and stress appears to be part and parcel of modern life. In the April edition of ‘Psychiatric Services’ which is published by the American Psychiatric Association, Curtis E. Hartmann an attorney and writer records his lifelong fight against depression in the most moving way. He has received over 100 shocks over a period of 30 years and it is the only treatment that offers him a chance to live a normal life. His analogy of depression is both accurate and moving at the same time. He akins it to watching your own execution and then been forced to look at the corpse. Like him I use the description of the monster calling on you at any time, without warning. It strips you of your self-worth. It leaves you questioning your very existence. Most importantly over a period of time it strips you of your resolve to fight back. Depression is a fatal disease. It must be treated as soon as possible and this is where family and loved ones come into the picture. The very people whose life you no doubt made a hell during the worst of your illness are the very ones that can be there when you need it most. As Hartmann says, it is life by strangulation. The great author, Ernest Hemingway booked into the renowned Mayo Clinic for a series of ECT and on coming out wrote, "It was a brilliant cure but the patient is dead." He committed suicide one month later. He had lost his hope.
For me ECT was an astounding success. It has been a year or so since my experience and it has not been an easy road. On occasions I have yearned for peace of mind. The monster comes and goes without warning. This time however I am aware of the great uncharted oceans of the human mind. ECT is now considered to be a ‘continuing’ treatment and for many sufferers regular trips to the ‘chamber’ remain a necessity in an effort to counter the unwelcome visitor that chronic depression can become. Electro Convulsive Therapy gave me back my hope and for that I am eternally grateful. One year ago I had reached the end of the road and through the miracle of ECT I regained the lifespirit within me.