Posted by: MC | April 30, 2013

Women Claiming Life with ECT

mosaic art, walnut creek, CA Feb 2013   mmc

Today a journalist contacted me.  She’s writing a story on women and Electroconvulsive Therapy (ECT) and wanted to know two things — what I know of the history of mental health care for women over the past 40 years, and what I know about ECT.

The truth is I cannot claim any expertise with regard to ECT.  But I have listened to women in recent years who have considered or experienced the therapy.

In response to her more general question, I did find some thoughts about women and mental health.   It seems to me that the most recent waves of feminism and the increasingly public presence of women (in particular in mental health professions) have had some positive effect on women’s mental health overall.  For example, outside formal systems of mental health service, the informal ways women have of supporting one another have changed over the years.  We’ve gained skill and nuance around self help and peer support from movements like the consciousness raising of the 70’s when women would gather in small groups to support each other.  In these groups, women were talking with each other about the personal and political aspects of being women, about who each of them were and what they wanted with and in their lives.  Of course, the women who had time and motivation for these talks were those of relative privilege — women with access to money, education, time.  And while, certainly, we are not done when it comes to addressing gender or socio-economic injustice, consciousness raising and its more formal representation in Women’s Studies, in the research and scholarship of women on women in the years since and in the impact of all of this on mental health practice has improved women’s mental health (and related activism) globally.

Yet even as counsciousness raising and its offspring have had positive influence on women, the past 40 years have also presented new challenges — challenges as varied as

  • The masculinization necessary (still!) for participating in most professions — with women often becoming too busy for woman-to-woman or any other kind of support,
  • Continued pay differentials which stand as tangible evidence that women and the feminine are still less valued by the dominant system, and
  • The generally weak support of mothers (really parents) and children leaving low income and poor women too often  isolated from one another and from any other support (e.g., sequestration is doing this RIGHT NOW).

In this social context women who have depression or bipolar disorder continue living the shadow lives still too common for people with conditions compromising their mental health.  Of all marginalized groups, people with mental illness may be colored most invisible.  So frightening is mental illness to people who consider themselves free of it, that the whole world would rather not speak of it — except, of course, to exaggerate it in the way of absolution when incidents like Aurora, CO or Sandy Hook, CT leave innocents brutally murdered by men wielding automatic weaponry legally available to them.  The absolution — “Whew, we can rest assured none of ‘us’ would do that since we’re not mentally ill.”  The point can be a bit subtle but it is no less damaging when the only way dominant sensibility addresses mental illness is as needed for a locus of blame with the corollary, “and I’m so not mentally ill.”

Add to that the historic, and often accurate, horror stories of electroshock therapy and the journalist’s question about ECT and women becomes even more edgy.  So, once again stating that I’m no authority, this is what I know.  ECT continues a therapeutic option, but generally only for women who have access to insurance.  My sense, however,  is that it’s making a come back — and not in an oppressive way, but as a viable treatment alternative when therapy and meds don’t work or the latter become toxic.  I understand from women who have depression or bipolar disorder, for example, that ECT can be a welcome alternative when all else is failing.

One woman relayed the story of how ECT saved her life.  After years throughout her late childhood of medication, hospitalization, residential treatment and therapy the day came when the only option for this then teen-aged woman was ECT.  A last resort, but a vital one, the treatments bought enough space from her depression for the young woman to begin benefiting from less intrusive therapies.  Now in her early 20’s she has been symptom free for over a year.  Yes, perhaps remission, but also a profound success that provides precedence for when/if her disorder reactivates.

Another woman described that, just as heart attacks are the symptom that can kill people with heart disease the symptom that kills people with depression is suicide.  The compellingly acute aspect of this truth is that suicide so appeals to people living with this disease.  In that sense suicide can appear elected where heart attacks arguably are not.  But I’m convinced that when all else is failing, suicide is the only ‘treatment’ that many brilliant and capable people with this disease have.  In that sense alone (a very difficulty one to communicate)  and if for no other reason, compassionate, intelligent, wise, empathic … provision of ECT seems vital.

I must also say I am new to this position in the past 7 years or so having dismissed ECT as arcane prior.  And this is what comes of listening — of refusing to participate in coloring people with mental illness invisible — women in particular.  I’ve said it before and I’ll say it again, it’s a radical act that shouldn’t be radical at all — please join me in the listening.

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Responses

  1. I am not sure. Yes this therapy may provide temporary relief from the symptoms but doe not address the cause. And i wonder how many treatments women receive and in the end take their own life anyway. Thinking of sylvia plath and others like her, who, because of systemic opression feel like they have no other option. Band aid solutions vs systemic change. It has to be women helping, teaching and reaching out to other women regardless of class, race or other barriers. Working on this in my world. Thanks for the provocative writing.

    • Thanks for this comment. Yes, receiving ECT is not an experience most people would ever wish to have — neither is chemotherapy or having depression in the first place. And YES to women supporting women. I guess I’m persuaded that, as women get stronger in supporting ourselves and each other, these two external interventions stand as possible ways for opening space for lives to be saved. However, I only have indirect experience here, based in listening to women in these circumstances. I want to hear more. As women, and as all of humanity, I want us to claim and practice listening well to the people who know from direct experience. To me, listening and being listened to are major antidotes to mental illness.

  2. Today, a friend forwarded these comments:
    As you know, I don’t have an academic background in ECT; rather, my perspective is utterly personal. Given that, your description of ECT and its history sound correct. I would have compared the treatment of cancer, rather than that of cardiac disease, to using ECT to treat mental illness. I’ve not heard anyone question a patient’s election of chemotherapy, which can be very expensive and has the potential for killing, while it is not unusual to disparage a person’s informed decision to trial ECT. I would encourage the journalist to consider the possibility that ECT may be more benign than many types of chemotherapy. Additionally, there are circumstances in which ECT may be used to treat a condition with higher morbidity and mortality than some forms of cancer.

    It may be worthwhile to compare the side effects of lithium and those of ECT in the treatment of my own bipolar disorder. It’s possible that the ECT administered in the 90’s caused some word-finding difficulties. If it did, the changes were so subtle that they were not quantifiable in a neuropsych eval. By contrast, lithium has permanently altered the function of my cerebellum, teeth, thyroid gland, parathyroid gland, kidneys, and endometrium. Given that, I feel fortunate to have access to the drug. As my psychiatrist said, discontinuing the lithium in order to preserve my renal function would likely result in my death by bipolar and a corpse with very health kidneys.


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