This post is part 4 of a 4-piece series about ECT.
Here are links to the other three parts:
Shocking 1: Waking Up,
Shocking 2: Into the Void,
Shocking 3: On Wheels.
Some eight or nine years ago, my father died. I cannot recall what illness – apart from old age – caused his death. I believe he was in hospital for a while, but I have no idea when or where or how I last saw him. People tell me I made a fine speech at his funeral service (and how in spite of being a non-believer I managed to touchingly recite a traditional psalm). But I myself do not remember anything of that funeral. Not a thing, not a place, not a face, not a word, not a feeling. I just don’t remember. Nor for that matter do I recall anything of how and where my wife and I first met, or of our wedding day. I don’t really remember the events of the day our daughter was born, or how I used to care for her when she was a child. I had to be told my wife once had a miscarriage: I didn’t remember.
My past is broken, and with it I miss not just an important (defining and guiding) part of my own identity. Because much of the common past I am supposed to share with others is broken, important relationships are damaged as well. A past that needs to be reconstructed from what someone tells you or shows you, is never the same as a shared, remembered past. In daily life this effect is often very unsettling both for myself and for others: it can make people you ought to know well into relative strangers.
Over the years I kept most of my skills, such as riding a bike or speaking some German and French. Probably (and maybe just because I no longer have my university job) I lost some of my academic experience and knowledge, some elements of my former professional background. But most of all I did lose the actual recollection of many specific events in my life, small and big, happy and sad, trivial or important. From writing books to family vacation trips: I have my own books on a shelf, I have old travel photos to stare at, but I don’t really remember doing all that. Since the time when psychiatrists treated me with ECT (electroshocks, see here and here and here) much of my life between age 25-55 is a blank.
In an experiment in 1950, when electroshock therapy was still new, a researcher (Irving Janis) asked patients a series of biographical questions both before their ECT treatment, and some weeks and months later. He found that nearly all patients had forgotten parts of their personal history. Whether this memory loss was just a temporary effect or a more permanent problem, remained unclear. Later research (especially since the 1980s) confirmed that many ECT patients did experience memory loss, but such studies often show very contradictory results on the matter of the problem’s scope and permanency. For example, while in the 1990s the American Psychiatric Association claimed that only 0.5% of ECT patients suffered memory loss, official (state-required) statistics for California at the same time showed that 20% of all ECT patients were affected.
Speaking just for myself, I can only say that my own memory loss is substantial and real. This memory problem became apparent to me four years ago, when I stopped having frequent ECT treatments. At that time, I awoke from a long-term kind of daze induced by the combination of ECT treatments and strong medication cocktails. Regaining some clarity of mind meant I also became more acutely aware of my memory loss. Over the last four years this has remained a serious problem – my memory seems like a harddisk where some of the folders have simply been wiped. Viewing an old photo and still not being able to remember or recognize its context: a File Not Found effect.
Just blaming ECT for this (as radical electroshock opposers usually do) may be a little bit too simple. Many other factors should at least be taken into consideration. To name an important one: it is an established fact that an extended period of severe depression may also cause memory loss by itself. As ECT treatment is usually reserved for patients with severe depression, maybe relatively many ECT patients might have developed memory problems anyway? Another factor to consider is of course that when you are getting older, your memory may also degrade just by aging. Are younger ECT patients less affected by memory loss effects than older ECT patients? I have no idea. Yet another question is about the possible results of the ongoing refinement of ECT methods and devices: over the last few decades, did recent patients experience less memory problems than earlier patients? Existing research about all such memory-related factors appears to be fragmentary, contradictory and therefore inconclusive.
I can only conclude that within existing formal psychiatry, the problem of memory loss as a potential side effect of electroshock treatment never really got the attention it deserves. Somehow the involved psychiatrists tend to regard this problem too easily as a passing, minor effect. Apparently the main question of the effectiveness of ECT as a depression cure – a question that is still provoking heated discussion – is still overshadowing all other questions. I myself once observed an evaluation gathering where former patients met with ECT professionals. Several patients reported serious memory problems, but this did not appear a main issue here: the personal and social consequences of such memory loss were not really meant to be part of an overall evaluation.
I feel it is very important that this problem finally gets researched in a more systematic and coordinated way. Equally important, it also should get more attention both in the daily context of regular after-ECT-care, and as a factor in the personal decision whether or not to try ECT in the first place. I myself do remember my last ECT treatments reasonably well, but the period of my first ones – some years before, when I was in very bad shape – is just a haze. So I cannot even remember how people have helped me to make a decision about accepting or refusing ECT treatment. I don’t recall anymore if (and how) I was warned about possible memory effects.
I do not belong to the group of ECT opponents who simply reject ECT under all circumstances. I am willing to accept the possibility that perhaps it may work as a kind of last-resort therapy, in suicidal depression cases where all other therapies failed. But I would certainly like to see better, more thorough research. In the meantime, for myself I am not in a position to judge whether all those electroshocks have really saved me. Maybe they did – or maybe refusing ECT would in the end have made little or no difference. Who knows? Who can tell? Not me. For some specific kinds of medication I can estimate how the price to pay (such as loss of concentration) relates to the result. But I still do not know if the price I may have paid for my ECT treatments (this long-lasting, serious, sometimes crippling loss of personal memories) was in fact worth the result.
I want to end here with one interesting idea that came up a few times when talking with some of my fellow ECT patients. Are we sure that memory loss is just a side effect of ECT? What if it actually is the main effect, the thing that makes ECT work for some people? The thought behind this is that in a severe depression, looking back to one’s own past may often be a very traumatic experience: the depression makes one’s entire life history into something that feels somber, gloomy, futile and pointless. Both sad and happy recollections then merge into a kind of traumatic component of the depression itself, keeping you endlessly mulling over the past, again and again, in a very negative and counterproductive way. Maybe, according to this theory, ECT sometimes works because by simply eradicating memories, the shocks also erase some of the memory-associated traumatic feelings generated by depression. In that case, some kind of daily forget-everything pill might work just as well…
• tip: In my own experience, when you are afflicted by memory loss, having to reconstruct your own past will often become more painful than helpful. When I see old holiday photos and my lack of memory makes me feel miserable, I stop looking at them. Sometimes I even intentionally avoid places or people that may confront me with my memory loss.
For what it’s worth, here is my general advice. Do not keep trying forever to reconstruct your lost past: try constructing some present and future instead.
June 18, 1924 –
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