Sept. 18, 2006 — -- After a lifetime of depression, battles with drug and alcohol addiction, and 25 years on antidepressants, Kitty Dukakis finally found a solution to the mental illness that plagued her: electroconvulsive therapy.
For many people, shock therapy brings to mind scenes from "One Flew Over the Cuckoo's Nest."
But as Dukakis explains, ECT today is very different from a few generations ago.
Her new book, "Shock," co-authored by journalist Larry Tye, talks about Dukakis' personal battle with depression, and describes the evolution of shock therapy and how it has hurt and helped people over the years.
The wife of former Massachusetts Gov. Michael Dukakis calls ECT a "last resort" treatment, but one that she says saved her life.
Read an excerpt from the book, "Shock," below:
It is June 20, 2001, Michael's and my 38th wedding anniversary. It also is the end of my fourth month of depression, my crisis period. I'm normally a person with enormous enthusiasm for and interest in the world. All that is just missing now. Fun or enjoyment are things I cannot even imagine. I don't speak to my kids on the phone, or to my sister. I do keep up with Dad, but he calls me more than I do him. The last two people I want worrying about me are my father, who is too old and dear, and my husband, who has had to worry for far too long. I have run out of options and I don't want to drink.
These are the times when I am most vulnerable. Having a drink is the only way of bringing me away from the horrendous feelings I am having about myself. It starts out as a glass or two of wine. It generally ends up with vodka. The alcohol is like an amnesiac, it is able to take me away from the darkness. Last night I was so afraid I was going to drink that I had them check me in here at Massachusetts General Hospital.
Today I am going to try the only thing left: electro-convulsive therapy.
Michael and I have reason to be anxious. His older brother, Stelian Panos Dukakis, had ECT back in 1951, in what I think of as the treatment's Dark Ages. Stelian had had a mental breakdown. One day he tossed a pile of sleeping pills in his mouth. They gave him ECT along with insulin coma treatments, which was a combination they often used at the time. Stelian never really was the same person. He had a zombielike look that melted the heart of everyone who knew and loved him.
Neither Michael nor I knew they still were doing electroconvulsive therapy before my doctors showed us a video on it three years ago and explained how the treatment had been transformed. We knew that if the time came again when we were desperate for a solution - some kind of positive action -- we would try it. That time is now. Yesterday they admitted me to the hospital under the name Jane Dee, a pseudonym they use as a courtesy to protect my privacy after my 12 years as first lady of Massachusetts and Michael's long campaign for president in 1988. Today, as I lie here waiting for my treatment, the image of "One Flew Over the Cuckoo's Nest" flashes through my mind. Getting ECT will make me a full-fledged member of the mental health family. What am I doing?
I am the first patient of the morning. No one else is around. They clip to my finger a device that measures the oxygen in my blood. They stick a bunch of electrical leads on my legs, arms, and over my heart. The anesthesiologist comes over and says, "I'm going to give you a shot of sodium pentothal. You'll be asleep within seconds." I am lying down. He says to think of something bright and cheerful. I think about Michael and our anniversary.
It was the medical madness of an earlier era, a remedy forever equated with thrashing limbs and obliterated memories.
Now, at the same Harvard teaching hospital that Kitty Dukakis gets her treatment, 20 patients a week volunteer for shock therapy. All are tormented by depression too deep to defy or another disabling disease of the mind, and all, like Kitty, are counting on 20 volts of electricity to jolt their brains back into equilibrium. Muscle relaxant ensures that the only signal of their seizure will be a twitch of the toe; anesthesia guarantees they will not remember that paralysis or anything else leading to the convulsion. Scores more line up for similar sessions at two dozen other hospitals across the state. Even at nearby McLean, one of America's most exalted citadels of psychiatry, 50 patients a week are transfused with enough current to kindle a 60-watt bulb and, if the procedure is true to its well-established form, vanquish the demons of the moment.
In Massachusetts as in the rest of the nation the evidence is unmistakable: ECT is back.
A procedure pioneered in the 1930s that seemed on the edge of extinction just a generation ago is being performed today at medical centers large and small, on patients staying in the hospital and on a growing number who simply show up an hour before treatment and leave an hour after. More than 100,000 Americans a year get ECT for ailments ranging from mania to catatonia, with 10 to 20 times that many worldwide. Electroconvulsive therapy is now as ordinary as hysterectomy and twice as common as knee replacement surgery. And it all is happening just enough out of sight that it has taken many medical professionals by surprise. Madness no more, electric shock is quietly being resurrected as a restorative wonder that someday could rank right up there with penicillin and Prozac.
How one of the most reviled psychiatric procedures is fast becoming one of its mainstays is an astounding yet untold chapter of American medical history. It is a narrative that begins with an epidemic of mental illness that has stubbornly resisted a cure, and a handful of doctors who have equally stubbornly refused to give up on a remedy that most had banished as barbaric. Researchers still have not filled in the puzzle of how or why ECT provides relief, although the proof is compelling that it does, faster and more surely than drugs or talk therapy. Questions also remain about the price that shock patients pay in memories lost, in rare cases permanently, and whether such risks can be minimized or eliminated entirely. The rise, fall, and rise again of ECT thus remains an epic without an ending, as practitioners and potential patients alike wait to see if hopes for success are sustained and it can come back all the way.
Barbara Collins-Layton could not wait. Like millions of Americans, the retired banker suffers serious depression, and has since childhood. Her bathroom vanity was beginning to look like pharmacy, stocked with Risperdal, Zyprexa, Lamictal, and other psychotropic drugs that once worked but did no longer. Her desk was cluttered with crumpled bills from therapists. It had gotten to where she would wake in the morning and make a beeline for the living room and her rocking chair. Forward and back. All day long for six long weeks. While she rocked, her 3-year-old adopted son whispered: "Did I make mommy sick?" Collins-Layton finally went to her psychiatrist and pleaded, "I can't do this any longer. I can't live in this state of mind." He suggested ECT.
Looking back six years later, Collins-Layton, now 56, realizes how radical a treatment ECT is. Was I afraid to get electricity to my brain?" she asks. "Hell, yes!" She knows there are questions still unanswered, like whether her lost memories will return. "But it made me function again," Collins-Layton explains from her home in Portage, Indiana. "You don't function sitting in a rocking chair. I didn't shower. I couldn't cook. couldn't take care of my family. It takes a while with ECT. I had like six treatments. But when I came home from the hospital I was functioning again. ECT gave me my life back."
Next thing I know I am waking up. I am back on an upper floor of Mass. General, in the unit where I slept last night. I feel lightheaded, groggy, the way you do when anesthesia is wearing off . I vaguely recall the anesthesiologist having had me count to 10, but I never got beyond three or four. I remember Dr. Charlie Welch and his ECT team but am not sure whether not I got the treatment. One clue is a slight headache. Another is the goo on my hair, where they must have attached the electrodes.
There is one more sign that I did in fact have my first session of seizure therapy: I feel good -- I feel alive.
Michael is standing there as I struggle to keep my eyes open, and I give him a big grin. That surprises him right away. After a bit more dozing I am awake for good, and get dressed. Michael takes me to the car. I have been warned not to expect too much from any single ECT treatment, especially my first. But I already can detect difference. Feeling this good is truly amazing given where I am coming from, which is a very dark place that has lasted a very long time. As we head home to Brookline, I remember that it is our anniversary. I turn Michael and say, "Let's go out for dinner tonight!" asks, "What?" I say, "I'm serious. Let's do it!"
Michael and I did eat out at a restaurant that night, remaking an anniversary I wanted to forget into one I will remember always. I was back at the hospital on an outpatient basis the next two weeks for four more treatments. After the second one I went to the hairdresser, then a dinner party, and watched the Red Sox on TV.
Love it or hate it. That is the way things have been with ECT since the 1960s. There are two camps, at war. One labels the treatment the best in psychiatry and says it is vastly underused. The other brands it brain-damaging and insists it be banned. Both argue their positions with a righteousness and pertinacity reminiscent of third rail issues like abortion and evolution. Both say it is their way or no way.
Now comes Anne Donahue and her middle way. The Republican lawmaker from Vermont entered the world of ECT a decade ago, when she came home for a breather from overseeing programs for runaway kids in New York and Los Angeles. She started teaching, and playing a game during her commutes on the interstate: "I dared myself how long I could close my eyes before panicking and opening them. It was not a direct attempt at suicide, but I wanted to have a terrible car accident so I would be taken care of. People would realize how desperately I needed help."
She confided in a friend, who convinced her to go to the hospital. That led to a series of hospitalizations and medication trials to treat the depression she had been suffering since the mid-1980s. When they failed, her doctors convinced her to try ECT. She got 33 treatments in all in 1995 and 1996.
Her ECT was a triumph and a miscarriage. The treatment was able "to break the stranglehold of a seemingly intractable and severe depression." It saved her mental health and her very life. But it sliced into the life she had lived starting a full six years before her ECT. Memories from the year before treatment have not come back at all, those from two to four years before are hit-and-miss. Donahue is philosophical about the trade-off, comparing herself to a "cancer victim who must choose the horrible side effects of chemotherapy over certain death to the disease."
Most ex-patients would stop there, focusing on their personal recoveries. Holding things in is not Donahue's way. So she pressed hospitals and state regulators in Vermont to agree to one of America's strictest informed-consent requirements for ECT. She filed a malpractice suit against the teaching hospital in New Hampshire where she got her treatment, agreeing to a settlement under which it adopted Vermont's consent form and created a more candid video for prospective patients. She ended up as a reviewer of the American Psychiatric Association's latest book on ECT, and in 2002 was elected to the Vermont House of Representatives.
In the process, she has become a pariah. ECT critics cannot stomach the good things she says about the therapy, including that she would have it again. Boosters are at least as disdainful, suggesting that because her memory loss is worse than most, she must be imagining it. The truth is that the Vermont legislator represents a substantial minority of ECT patients who applaud what the treatment did for them but bemoan what it did to them. Even those who cheerlead for ECT generally have some complications to report, just as many who are bitterly opposed acknowledge that ECT did some good for them or someone they know.
It is not just patients who are eager to find middle ground in the ECT debate, but a growing number of psychiatrists. They know that ECT is one of their profession's most effective remedies but also know that too many patients suffer side effects. They are adjusting techniques in ways that demonstrably minimize those losses, in the process doing battle with fellow doctors who insist that attempts to lessen its impact on memory will lessen its impact on disease.
Donahue is working with those patients and doctors to carve out a compromise, one that reforms the treatment rather than sees the status quo as immutable or seeks to ban it. "I was being told from all the research that my experience of loss doesn't exist. Yet I know without question what happened to me," she explains. "I also was discovering this opposite view that said, 'This deliberate and knowing fraud on innocent psychiatric patients who are having their brains destroyed by the evil kingdom.' I am not the kind of person who can believe that, either. I don't believe in massive conspiracies."
It is not an exaggeration to say that electroconvulsive therapy has opened a new reality for me. I used to deny when a depressive episode was coming on. knew how much it would hurt, how long the darkness would last. Now I know there is something that will work and work quickly. It takes away the anticipation and the fear. I also used to be unable to shake the dread even when I was feeling good, because I knew the bad feelings would return. ECT has wiped away that foreboding. It has given me a sense of control, of hope.
That does not mean I look forward to the treatments. Who would? But when I lie down, I know that within seconds I'll be asleep - and that this process going to make me better. I also know that like many patients today, I can go home after each treatment rather than stay overnight in the hospital.
I have had seven more sets of ECT since the first in 2001. All my treatments have been unilateral, which means the electrodes go on just one side of my head in positions aimed at minimizing memory loss. The same concern led them to gradually lower the intensity of the stimulus they give me, to a level the doctors say one-10th of what Stelian Dukakis probably got in the 1950s. I generally need treatment every seven or eight months, my timeline for depression returning.
A nun who contacted me after a story on my ECT appeared in the newspaper described how afraid she had been to have ECT. She said, "This is the way would feel going in for a root canal." As for me, I hate fillings, and don't like to go to the dentist, period. I happened to have had a root canal not long before my first electroconvulsive therapy. In some ways ECT is less traumatic for me than going to the dentist, and certainly less frightening than the root canal. Lots of doctors say I am crazy for thinking something like that, but I don't think negatively about the treatment.
Excerpted from Shock: The Healing Power of Electroconvulsive Therapy, published this month by Penguin. Copyright 2006 by Kitty Dukakis and Larry Tye.