Angela to continue bilateral ECT...

After meeting with her psychiatrist yesterday, Angela has decided to continue her bilateral electroconvulsive therapy treatments for intractable drug resistant depression and suicidal ideation. 

She told me that she had considered going back to unilateral ECT, which is gentler, but generally less effective. 

However, after consulting with her psychiatrist, she has chosen to solider on with bilateral ECT, which has proven considerably more beneficial in her case, despite developing problems with her memory. 

"The side effects are not permanent, so I will continue with the bilateral treatments," she said of her increasingly "annoying" memory issues. "And I have only three weeks left."

Angela is planning to go back to school in June and her psychiatrist assured her that she should be fine by then. 

Prior to having her fifth bilateral ECT treatment at 7:15 a.m. this morning, she had 12 unilateral ECT treatments. 

Marking Madness and Angela's memory...

This is a dreadful time for college teachers. Assignments are piling up, students are anxious for their marks, final examinations must be set and as the end of term approaches, stress levels are on the rise everywhere.

AN UNNERVING EXPERIENCE

Plus... yesterday, I gave a speech about my mental health history and my life since my 1971 graduation from Seneca to a class of students, not my own, as part of the brand new Seneca Alumni Speakers Series. I was the second Alumna to speak. This was a first and not unnerving. (More about that later.)

Angela is chugging along. Her memory, after four bilateral electroconvulsive therapy treatments is becoming troublesome. "I have to write everything I have to remember to do on Post It notes," she told me last night. She sounded a little groggy after taking some of her nighttime meds. 

The problem with that system, she explained, is that she can't always remember where she puts the Post Its. I suggested she keep a journal and write everything in one place, but then I thought. What happens if she can't find that journal?

"I can't remember how much I owe on the new motorcycle I just bought and I had to call the dealer and ask," she said. 

ANGELA'S MEMORY

On the plus side, her mood is good. So today, when she sees her psychiatrist, she plans to discuss whether she should continue with the bilateral treatments for another three and a half weeks or go back to unilateral ECT.

"I'd like to continue with bilateral, but the memory loss is annoying. I have things I have to do that demand memory," she said. "Right now, I'm not erasing any emails because once they're gone, they're gone."

So we'll see. You'll be the first to know. Promise.

TIME OFF TO MARK

Meanwhile, I'm taking the today off and Friday, too – to mark, mark, mark. I simply have to get all my marking finished or my students will murder me. 

You don't want that to happen, do you? On second thought, don't answer that. :)

So, I trust you'll understand. And incidentally, that's why I haven't been responding with my usual regularity to your comments. The end is in sight, though. After April 28, I'll be a free woman. For a while. Maybe. Who knows?

Speak soon. We're living in historically exciting times. 

Have a healthy meantime.

Angela's news and "Words on the Wall"...

"I'm confused," Angela said at the outset of our conversation last evening at 7:56 p.m. "Really confused."

She sounded groggy and sluggish. I hadn't heard quite this sound before. Her affect wasn't flat. She did not sound in the least depressed, but she didn't have the bounce in her voice I have come to expect lately. 

Angela had her third bilateral electroconvulsive therapy treatment 12 hours earlier – her 15th over the last eight weeks. Her first 12 were unilateral. This coming Monday, she will begin the final stretch of her 12-week treatment course.

"I COULDN'T REMEMBER WHY I WAS HAVING ECT"

"I came out of the anesthesia this morning and I couldn't remember why I was having ECT and I'm still foggy," she said. "I had to do some stuff on the computer and I couldn't remember how. Eventually it came back though..."

"I bought a motorcycle today," she announced, voice sounding a little more cheery. She had been looking at one for over a week. Last summer, her motorcycle was stolen and she's wanted to replace it ever since, but she hasn't been able to move on that decision until now.

She informed me that she did not have her customary afternoon post-ECT nap yesterday, either. 

Instead, she spent the whole day "doing things I had to accomplish," which included spending $16,000 on this new 2009 motorcycle.

"I spent money I don't entirely have," she said. "My mother is lending me $5,000, but when I talked to her about it earlier today, I couldn't really have a conversation with her, I was so confused. This evening, we talked again and I was feeling a little better."

I cut our conversation short. Clearly, she needed sleep. I sensed it and we discussed it. She admitted she was tired and going to bed right after she hung up the phone.

THIS MORNING SHE SOUNDED REFRESHED

At 10:42 a.m. this morning, she sounded like a different person when she answered the phone – refreshed, alert and bright as the day. It's sunny and will reach 18 degrees Celsius. 

"I'm much less confused, though some things are not back yet," she admitted. "I've only been up for about an hour and a half."

We talked about how she learned an important lesson, yesterday, about her need for a nap after her ECT that seems to "scramble my brain." Sleeps seems to unscramble it. 

SLEEP UNSCRAMBLES HER BRAIN AFTER ECT

Sleep heals. We chatted about it and she admitted that having a nap when she can fall asleep on the afternoons after her ECT treatments "may be an answer." 

She was giggling and laughing a lot during our talk. She reported that she was feeling "not too bad" – generally "normal" about her mood and life in general, with "not a lot of plans for the day." 

Usually, Angela sees her psychiatrist on Friday mornings, but today, her psychiatrist is attending a conference.

"I'm not nearly as confused as I was last night, not by a long shot," she said. "I'm feeling much better and my memories are coming back. It just takes a little time, which can be frustrating."

*   *   *   *   *

HONOURING THE MEMORIES OF PSYCHIATRIC PATIENTS PAST

About four weeks ago, Geoffrey Reaume sent me a note about an upcoming, intriguing and creative-sounding artistic initiative called "Words on the Wall" ~ a fundraiser for plaques for the 19th Century Patient-Built Wall.

Geoff and I go back quite a few years. I've interviewed him several times on a variety of topics related to the history of psychiatric treatment of "inmates" at the former Provincial Lunatic Asylum, now the site of the Centre for Addiction and Mental Health (CAMH) at 1001 Queen Street West. 

He is not only a "psychiatric consumer survivor" himself – and flourishing in his recovery, I might add – but also he is the author of Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940. 

This is fascinating and at times alarming history. Geoff is a dedicated and passionate advocate of honouring the memories of the patients who built this wall. He is the driving force of The Psychiatric Survivor Archives who freely and quite regularly shares his expertise and the stories behind the bricks for for people who wish to tour the wall with him.

And finally, Geoff is a York University assistant professor who teaches and researches in the area of disability studies and one of his courses is called Mad People's History. 

BUILD A BRICK WORK OF ART AND HELP PUT "WORDS ON THE WALL"

Now that I've given you Geoffrey's history, here's why he contacted me. 

On April 21 at the Gladstone Hotel, this special "Words on the Wall" event will be held in conjunction with This is Not a Reading Series.

You can take part. The Psychiatric Survivor Archives of Toronto is giving out bricks to serve as the basis for a work of art – possibly yours. Artists and groups, anyone, really, can use a medium of their choice to decorate or create an original brick-based work of art that will be sold by silent auction that night. The evening will raise funds for historic plaques to commemorate the history of the patient-built wall.

That evening, Geoff will also lead one of his engaging tours of "the wall," followed by a relaunch of the 2nd edition of his book, Remembrance of Patients Past. This evening will wind up with the silent auction.

The deadline for submissions is Wednesday, April 7 and to request a brick or for more information, email psychsurvivorarchives@gmail.com or phone 416-661-9975 or 416-809-1013.

WE MUST KEEP CHALLENGING DISCRIMINATION THOUGH EDUCATION

This is a universally significant event, I think, because we must never forget where we've come from, how important and vital our history is and how much work needs to be done to publicly educate everyone, young and old, about psychiatric issues past and present.

Without emotional health and well-being, we have nothing. 

We must challenge and keep challenging discrimination – through education.

We are the best experts. We all can raise our voices. We need to be heard. 

My lunch with Angela...

Angela and I had lunch last Friday and here's what's transpired since.

When she picked me up (on Fridays I'm carless as Marty teaches and needs our trusty 1999 Honda Accord) I couldn't believe how thin she looked.

Over the last few months, she's lost weight and claims she wants to lose more. Though she's often said she tends to forget to eat, lately she's been working out – and it shows. 

Also, last Friday was a dreary, windy, bone-chilling day. Raining hard. Miserable. Depressing. An old back injury of hers was acting up and she was in pain. She's so drug resistant, only morphine helps, she claims. She didn't have any handy, so she was trying to ignore the aching in her lower back, but I could see it in her face, and in her eyes.

Plus, she drives a sporty Jeep that prides itself, she informed me, in providing bouncy, bumpy, jerky, jarring rides. Ouch.

LAST FRIDAY'S FIRST BILATERAL ECT WAS NOT FULL-THROTTLE

We drove over to a local Middle Eastern restaurant about five minutes from here called Shoom Shoom, which means "Garlic, Garlic" in Hebrew. Angela likes the chicken Shawarma there and I like the fig and walnut salad. 

En route, she mentioned that her first bilateral electroconvulsive therapy treatment the previous morning (her 13th thus far in her 12-week course of 24 in all) "only brought me to a threshold because they wanted to see how I'd handle it," she said. "I'm going to get the full treatment on Monday."

Her psychiatrist had just told her that about 90 minutes earlier during one of their regular bi-weekly sessions.

She seemed more subdued than celebratory. The spunk and spirit I thought I had heard in her voice on the phone the night before had drained away. 

Over lunch, our conversation flipped around. We caught up, mostly. Small talk. Her sister was coming in for the weekend and we talked about her upcoming wedding. We discussed her mother's health. She chatted about the complications of her life. We shared stories about her therapy, and mine. 

She showed me pictures on her iPhone of her latest sculptures and the abstract paintings she has started. "I tore that one up," she kept saying, despite my pleading with her to never destroy her art.

HER MEMORY SEEMED FINE

I was mindful of the tempo of the conversation and there didn't seem to be much difference. Her memory didn't seem to be slowing her down. She wasn't searching for answers to my questions.

However, this week, since her Monday "full-throttle" ECT treatment, that tempo and her tone has changed.

On Monday afternoon, about six hours after her treatment, she seemed more volatile than I remember her. Frustrated. Anxious. Angry. She was feeling "ripped off" – but definitely spirited. There was an edge in her voice that I didn't recognize. I had some thoughts about what was happening, about the relationship between anger and depression. Was the ECT doing this? I'm no expert. 

AFTER HER STRONGER MONDAY ECT TREATMENT, SHE SOUNDED ANGRY

Rather than speculate, I consulted my resident expert, Dr. Ron Pies, Editor-in-Chief of Psychiatric Times, professor of psychiatry and lecturer on bioethics and humanities at SUNY Upstate Medical University in Syracuse and clinical professor of Psychiatry at Tufts in Boston. He is, with S. Jacobson and I. Katz, author of Clinical Manual of Geriatric Psychopharmacology, and a number of psychiatric texbooks. His most recent book is Everything Has Two Handles: The Stoic's Guide to the Art of Living his upcoming book, "Becoming a Mensch", is to be published late this year by Hamilton Books.

I've never been depressed. I tend to voice my frustrations. Loudly. But, I'm not Angela, and I've have many more years of psychotherapy than she has. I'm also a lot older, though not necessarily wiser, than she – 24 years older.

Ron responded quickly, as always to my question about whether "depression is anger turned inwards." 

IS DEPRESSION ANGER TURNED INWARDS?

Here is a section of his answer. It's general. I never ask him specific questions about Angela as that would be betraying a confidence and unethical:

"The notion that depression is ''anger turned inward' has a long pedigree — it goes back at least as far as Freud and his theory of 'melancholia'; he held, in effect, that after the death of a loved one, the melancholic’s unconscious anger with the deceased becomes directed at the self, which has 'incorporated the lost person through introjection''. If it sounds complicated and dubious, it is!," Ron wrote.

"To my knowledge, there are few empirical studies that have supported the 'anger turned inward' model of depression. I also think there is very little empirical evidence that 'getting mad' as such is of any real help to people with serious depression. I think this is mostly part of the 'let it all hang out' philosophy that dominated the late 60s, and I think most mood disorder experts don’t put much stock in it. 

"There is some truth to the idea that if you constantly walk around feeling that you have been “short-changed in life”, “ripped off”, “victimized”, “screwed over”, etc., you will undoubtedly feel angry, and probably depressed as well—or at least demoralized and impotent," Ron continued.

"The idea, then, is to examine your presuppositions about what the world 'owes' you—as in, 'Who said the world is fair? Who said that the world owes you what you think it owes you?' etc."

This really resonated with me because Dr. Bob has often said, "Who said life is fair?" when I bemoan the fact that I'm now chronically ill because a former psychiatrist of mine neglected to monitor my Lithium levels properly and I lost my kidney function and had to have a kidney transplant after two years of dialysis. The drugs I take to prevent rejection have dire side-effects, like chronic anemia.

Or because I was raped at the age of 14 in a psychiatric ward by an orderly when I was there for observation and that assault precipitated my psychotic episodes and has left me with permanent emotional scars. 

However, the difference between me and Angela is that I don't blame anyone for anything. What's the point? 

Blame is a waste of time and solves nothing. Just like guilt and worry. They're not part of my emotional make up anymore, but I work hard at this. I guess that's what more than 49 years of psychotherapy has taught me. You don't get that kind of insight out of a pill bottle and all the time and work in psychotherapy makes for a much more peaceful psychic existence. 

IS BILATERAL ECT FINALLY HELPING HER DEAL WITH HER REAL FEELINGS?

I kept wondering if the ECT was freeing Angela's mind and helping her to get closer to her real feelings.

Ron continued...

"Here is where REBT (Rational Emotive Behavioural Therapy), CBT (Cognitive Behavioural Therapy), and other cognitive-behavioral therapies come in — as well as the stoic philosophers discussed in my "Handles" book. Another approach is to teach the chronically angry and depressed person to be more assertive, in a constructive way — not throwing tantrums or screaming, but taking assertive, appropriate action to bring about desired change. (It is a misunderstanding of stoicism to think of it as saying, 'Just accept things the way they are' or 'Suck it up!'. Rather, stoicism is more like the now well-worn maxim usually attributed to Reinhold Niebuhr:

God, grant me the serenity

To accept the things I cannot change;

The courage to change the things that I can;

And the wisdom to know the difference.

"All that said, the relationship between anger and depression is probably very complicated, with a question as to which is the 'chicken' and which, 'the egg.' A full answer to your question would probably take a book, Sandy, but the bottom line for me is that when people are chronically angry, it probably has an 'erosive' effect on their mood."

"DIFFICULTY RETRIEVING INFORMATION FROM MY BRAIN, BUT IT COMES BACK IN A MINUTE"

Yesterday, when we spoke on the phone, 36 hours after her second bilateral ECT treatment on Monday, Angela sounded less frustrated and angry, much calmer. We talked about The Serenity Prayer, which she'd heard of and then I asked her about her memory.

"It's interesting," she said, sounding perfectly fine, intrigued by the way her mind and memory were reacting to this new-for-her ECT modality – she's switched from unilateral ECT. "The things I'm forgetting now are the things I know, but it takes me extra time to find them. It takes more concentration. Like if I'm driving somewhere and I know that I know the route, I have to concentrate on where I'm going, whereas before, I didn't have to think about it. It was automatic," she said.

"I'm have difficulty retrieving information from my brain, though in a minute or two, it comes back. I wouldn't call it memory loss because the information is there and I know it. I just need a little more time. I have to put extra cognitive thought into strategically focussing on finding it. But it's there and it always comes back."

Meanwhile, she's getting things done. She's out and about, working on getting her life back in order with more energy and determination than she's shown in months.

Tomorrow morning, she'll be having her third bilateral ECT treatment. I'll keep you posted.

Angela goes bilateral...

Wednesday, March 10 at 4:45 p.m. The phone rings.

"What do you think of the idea of me trying bilateral?" Angela asked.

Her psychiatrist in charge of her current course of Electroconvulsive Therapy had raised the issue in a telephone conversation earlier that day. 

WE DISCUSSED MAKING THE SWITCH

For about 15 minutes we discussed her concerns about making the switch, much in the way we had when she called and asked me, "What do you think of ECT?" back in early January. 

Angela explained that her doctor had made the suggestion because was she might progress more quickly with bilateral versus unilateral ECT. She has had 12 unilateral ECT treatments over the last six and a half weeks. 

"I'm definitely going for the extra four weeks," she said, referring to the option she was given when she first discussed her treatment course and the study on memory loss in which she's involved. "But I'm worried about changing things mid-stream." 

Ultimately, I suggested she speak to her outpatient psychiatrist, who knows more about her psychiatric history and about the differences between unilateral and bilateral ECT than I do. 

She agreed and signed off.

In the meantime, I started nosing around the Internet for a good, reliable distinction between the two variations on ECT administration, without much luck. Most sources were dated in the last century and not very reliable, as far as I could tell.

Within 10 minutes, Angela called again.

"I'm having my first bilateral ECT treatment tomorrow," she said. "I'm going to try it. I discussed it with my psychiatrist and she thinks is a good idea. If I find it's too hard on me, I can always go back to unilateral."

UNILATERAL VERSUS BILATERAL ECT

Wednesday, March 10, 5:41 p.m. 

I fired off a note to my mentor and friend, fellow blogger and sage, Tufts University clinical professor of psychiatry Ronald Pies, MD. 

"I have a question for you. Angela has decided on her doctors' recommendations to try bilateral ECT. She's not progressing fast enough, I guess. She's going to have her first bilateral treatment tomorrow. I want to post about it on Friday. Although, I see an impressive improvement. It's not enough. She's in week seven and has decided to go for 12 weeks. 

"If I could quote you and link to a good article that describes the pros and cons of bilateral versus unilateral ECT, something recent, in this century, that would be perfect. I've looked and I cannot find anything. Am I missing something? Is there something in the archives of Psychiatric Times that I cannot see? I'd rather quote you and link to an article on this ultra controversial subject, but I'm a little stumped." 

At 8:07, Ron's email arrived:

"Given that these are very technical matters, I thought the comments from the Royal College of Psychiatrists, 2008, would be more helpful than a journal paper," he wrote. "I think this really summarizes the situation, as I understand it, quite well. It comes down to a trade-off between very high efficacy, significant cognitive side effects [bilateral ECT] and high efficacy, mild-to-moderate cognitive side effects [unilateral, non-dominant ECT]. There really is no “right” or “wrong” decision."

NO "RIGHT" OR "WRONG" DECISION 

"In bilateral ECT, the electrical current is passed across the whole brain; in unilateral ECT, it is just passed across one side. Both of them cause a seizure in the whole of the brain. Although there is a lot of research being done, it's still not clear which type of ECT is 'best'. 

"Bilateral ECT seems to work more quickly and effectively and it's probably the most widely used in Britain; however bilateral ECT seems to cause more side effects. Unilateral ECT has fewer side effects, but may not be as effective; unilateral ECT is also more difficult to do properly. 

"Sometimes ECT clinics will start a course of treatment with bilateral ECT and switch to unilateral if the patient experiences side effects. Alternatively they may start with unilateral and switch to bilateral if recovery isn't happening. The choice of bilateral or unilateral ECT will depend on the needs and wishes of the patient, the opinion of their doctor and the skills of the ECT team." 

(The boldface is Ron's – not mine.)

Thursday, March 11 at 4:05 p.m.

When I get home from Seneca, I pick up a voicemail message Angela left on my home phone at 1:13 p.m. 

"Hi. It's me. Just checking in. Call me."

HER VOICE SOUNDED COMPLETELY DIFFERENT...  NEW

It doesn't sound like her. At all. I barely recognize her voice, but from the log on my telephone screen, I know it is.

Instantly, I call her back. 

"How are you?" I ask.

There's a liveliness in her voice I've never heard before. Ever. We met in 2006, on the phone. She called me when I was still working at The Toronto Sun. I knew nothing, then, of her psychiatric history or her depression.

"I feel good, but confused," she says.

I can't get over her tone. It's sharper. Stronger.

"Can you describe your confusion?" 

"It's a little bit of confusion, like I can't remember everything I'm supposed to remember," she says.

"What do you mean?"

"Well... it like my thoughts are dull," she says. "I guess I'd call it mild confusion, but it's more pronounced than before."

She said she slept most of the afternoon, following her first bilateral ECT treatment at 7:15 a.m. that morning.

"I just got up," she said. 

I couldn't believe the way she sounded. 

"Maybe I'm spunky. The bilateral treatment was great!" she said. "There were three medical students with the psychiatrist and so she explained everything she was doing very carefully to them, and to me. She told them that I had been having unilateral and that now I'm having bilateral. And so far, I think I can handle it, so I'm going to continue with it." 

Then she started chatting about how much money she had spent that day on new brakes and tires for her car.

"It needed to be done, so we finally got our act together and did it," she said.

TODAY, SHE'S COMING UP HERE AND WE'RE CELEBRATING!

This was the most proactive thing she had done in months. Two weeks ago, she couldn't get it together to get out of her apartment and go for a walk on a sunny day. 

"Oh, and you know what? I had a good time with my anaesthesiologist today," she said. "When he gave me my drugs, he said, 'Have a good sleep.' And you know what I said to him?"

"No, Angela. Tell me."

"I said, 'Night, night!'" 

She was laughing. Really laughing. 

So, today we're celebrating. Right after she sees her psychiatrist this morning at 10 a.m. she's driving up here and we're going out for lunch. 

And I can't wait to see her!

 

Angela's progress ...

Hi there.

I'm back! How are you?

You have no idea how much I've missed you. So much has happened over the last week – my Reading Week. There were times I ached to sit down here at my trusty iMac and write to you – what a relief it would have been to interrupt the monotony of "marking midterms," but I needed a break.

I've continued speaking with Angela daily over the last 13 days even though I've not been posting about her progress. I take notes. I have an Angela journal.

She's had a few little ups and downs but nothing dramatic – with one exception – and this would definitely qualify as an "up"... she's sleeping well. Better than she's slept in years. 

Angela is athletic. She loves to snowboard. Watching hockey is one of her passions. You know where she is every Saturday night and could safely bet money on it. It's a good thing she doesn't have her Electroconvulsive Therapy treatments on Saturdays.

On a few occasions, over the last week and during the Olympic Hockey matches, she slept through the games. 

And she wasn't upset about it.

Once, she said she went to sleep "to escape my mind," a curious phrase. When I asked her why, she mentioned some long running personal concerns, matters of everyday living that no ECT treatment can or ever has been able to resolve. The stuff that can turn a good day sour for anyone. The stresses that wear you down emotionally.

ECT IS GRADUALLY TRANSFORMING HER OUTLOOK ON LIFE

These issues are not the cause of her drug-resistant clinical depression. They could be filed in a drawer called "Life Sucks" and we all have those drawers. Sometimes, I think unhappiness is confused with depression. Both can be exhausting and stressful, but for Angela, her ECT is gradually transforming her outlook on life. Brightening it. Refreshing her mind. Buoying her on so she can better handle the real consequential issues in her life.

Not just those "Life Sucks" issues, but even tougher stuff. 

SLEEP HEALS

Sleep, as I've often said, heals. So it is, often, for Angela. She's an early riser and not only on the two days a week when she must awaken at 6 a.m. to be at the University Health Network at 7 a.m., hopefully to be the first in line to receive her ECT treatment, which she prefers.

Since she began her eight or possibly 12 weeks of bi-weekly ECT treatments on Monday, January 25, she's has changed dramatically, although it's a slow and steady transformation and she's not entirely aware of it. These posts have become a mirror for her.

It's blatantly obvious to me that she's joking and laughing more these days than I've ever known her to do – and we've known each other for years. When I called last night, she was watching the Toronto-Boston Hockey Game and not sleeping.

"It's tied right now," she said, sounding anxious to get off the phone. I let her go back to her passion. Three months ago, Angela felt no passion for anything. She complained constantly of feeling "flat" or "feeling nothing" or "being blah." She was immobilized by her severe depression.

Last night, her gusto for the game she loves seemed a significant benchmark in the headway she's making.

SUICIDAL THOUGHTS SEEM LIKE A THING OF THE PAST – FOR NOW

After 12 treatments, her suicidal thoughts seem a thing of the past. She hasn't mentioned them in several weeks. This doesn't mean she is perfectly recovered. ECT doesn't purport to solve all your problems and cannot. She knows this. She sees her psychiatrist twice a week. She takes all her medications.

She also knows that she may need follow-up weekly or semi-monthly treatments when this current treatment course finishes because ECT is not permanent. Depression can be cyclical. So she may need ECT on an ongoing basis or every three or four or more months. But it should keep her suicidal thoughts at bay and help her function better than she has in years.

ECT IS NO ONE SHOT DEAL

No responsible, knowledgeable and experienced psychiatrist who routinely administers ECT would ever suggest that ECT is a one-time only treatment course. For some people, not all, it's not. 

Like medication, it may have to be part of an ongoing treatment protocol for mood stability. (Like the Tegretol that I take twice a day for my mania. I've been taking it for 22 years. It's one of my major recovery tools.) Any follow-up ECT regime, its schedule, differs depending on each individual ~ as does everything in life, it seems. 

Since her first course of ECT treatments in 2001, Kitty Dukakis has follow-up "sets of ECT treatments," on average, every seven or eight months, when her depression returns. The wife of Michael Dukakis, former Massachusetts governor and 1988 Democratic Presidential candidate, bravely and with brutal, visceral honesty writes about her ECT experiences in Shock – The Healing Power of Electroconvulsive Therapy. It ended her lifelong struggle not only with severe drug-resistant depression, but with her alcohol and amphetamine addictions that masked it for years.

HER MEMORY HAS STAYED PERFECTLY INTACT

Angela is now in Week Seven of her treatment course. It may end next week or continue for four more weeks. She doesn't know. So far, her memory has stayed perfectly intact. Sometimes, like this past Monday morning, 90 minutes after treatment, when I called her from Seneca, she sounded groggy.

It was 10:30 a.m. "What day is it?" she asked.

She had been sleeping and my call woke her.

"It's Monday and I'll call you later."

Let's be honest. Don't you find that sometimes, it you take a nap in the late afternoon and wake up at 9 p.m. you feel a little disoriented. "Did I sleep through the night?" you ask yourself. You search for a clock wondering, "What time is it?"

By Monday night the disorientation Angela felt earlier in the day had disappeared. It always does within a few hours of her ECT treatments, always with healing sleep. To the best of her knowledge, she is experiencing no permanent or even temporary memory loss whatsoever, thus far.

Time will tell. And I'll tell you.

Now, then. Let me know how you're faring. Comment. Comment. Comment. 

I've missed your voices. Your ideas. Even your criticisms. You inspire and stimulate me.

It's great to be back.

Speak soon!