by Tom Hofmann
About six years had passed before I began to write about electroconvulsive therapy. I had thought about the procedure in the intervening years, but I hadn’t pulled the parts together. To do so would require acknowledging that it had occurred. It was real, despite my wishes to the contrary, and writing about it would require an in-depth investigation of its causes and effects. The task, I knew, demanded a substantial investment of time and energy. I also knew that I couldn’t move forward without such a confrontation. What follows is an excerpt from that examination.
Be good at something. Whatever it is that you are, be the best at it. That’s what I heard growing up, mostly from coaches and priests. Yes, priests, I think. If you’re going to dig ditches, goddamnit, be the best ditch-digger going.
I was the best sad person. I had always wanted to kill myself. As it turns out, that was something I wasn’t quite as good at. But the preoccupation with suicide festered in my brain and dripped pernicious thoughts into my consciousness that intensified as the years passed.
I was four years old when I climbed the stairs to the second-floor bathroom in our house. I locked the door behind me and took the screen out of the window.
“I’m going to jump,” I told my brother as he stood in the backyard.
“I’m going to kick your ass,” he responded. He could have, at the time.
We called it the blue bathroom, as opposed to the tan bathroom, the other one upstairs. A blue tub and a blue toilet sat opposite one another, and one-inch white and blue tiles covered the floor. Gold flecks resided on the white vanity, and a fluorescent-light tube hung above the mirror that spanned the double sinks. I stood and looked out that window at the backyard: Pine trees lined the far border, their limbs sagging with the weight of their needles; the redwood fence wilted; oxidation weakened the aluminum clothesline, whose weary arms extended outward; the basketball pole, with the splintered wooden backboard, overlooked rugged asphalt that had left my knees pock-marked; the grass burst with dandelions; the white statue of the Virgin Mary stood guard over it all, minding a house key under her base; and the three-foot slope slid from the upper level to the lower, near where I would bury my dog twenty-three years later in the midst of one of my life’s most painful episodes.
When I was small and the ground was snow-covered, I slid down that slope in a dimpled aluminum flying saucer. We called it a flying saucer; it was round, with a diameter of about three feet, and concave when sitting right-side up. If boyhood fantasies could have transformed themselves into reality and transported me to another galaxy via my flying saucer, they would have negated years of agony.
The Blessed Mother statue, with its white-trellis backdrop, was supposed to provide comfort, my mother always told me. She, the Virgin, never refused the prayers of children, my mother said. She damn well refused mine, though, and I asked only to feel alright. But I never was a child. I lay in bed each night and clung to my rosary beads in terror as I prayed to Mary for relief. She stood passively in white-on-white purity in the backyard.
My mother would tell the story differently about my having threatened to jump out the window. In her version, if she has chosen to have any recollection of it, which she likely has not, I probably just had to go to the bathroom and happened to look out the window. If I could have seen the world through her eyes, I would have been gazing out that window at suburban bliss. But it remains one of the more vivid memories of early childhood, and the nature of the incident has been the hallmark of the following 30 years.
When I related it to one of my psychologists, he immediately referred me to a psychiatrist for medication. Thus began an odyssey of trial and error with virtually every different category of antidepressant, all to no avail until fairly recently. Electroconvulsive therapy, with mixed results, appeared in the middle of that journey. I don’t remember why I didn’t relate that story to my psychotherapist until well along in our sessions, nor do I remember the details of why I wanted to jump from the upstairs bathroom. But I do know that it was more than a cry for attention; I was as serious then as I have been many times since, and a long stretch of my life has focused on a preoccupation with death. For so long I perceived it as the only remedy, the exclusive path to an elusive peace.
I’ve been married twice, divorced once. I’ve forsaken my Catholic upbringing, and I frequently find myself questioning religion and the existence of God. I’ve had a successful academic career, gone to college on an athletic scholarship and supported myself well through my working life. My father died at age 49 from cirrhosis of the liver, and one of my brothers is following him to the bottom of the bottle. I have two dogs and a beautiful wife and house, but I awaken each morning and gauge the struggle that lies before me. I have people that love me, but those same people frequently want to strangle me for what they say is my resistance to that love. They want to extract emotion, when for so long I’ve struggled to find an even keel. They say I’m not selfish with material possessions, but I’m selfish when it comes to what they want most: Permission to come in.
I’ve been necessarily self-centered; the energy required just to function, to stave off demons from within, sometimes has been so great that I can’t afford to allow anyone else passage. I’m frightened that they won’t want to stay, once they enter. I’m not sure if I’ve come across anybody willing to travel to the gates of hell and beyond. And I don’t want to be unnerved by what I might find if forced to accompany someone to the center of me.
And as I sit here and write, doubt plagues me about whether my story is worth relating. But I have chosen to make this trip on these pages, no longer a victim. The emotion associated with the task is mine, but I don’t do it alone. There are more than a handful of people who will be with me at various steps along the way. I have a story to tell, and I hope that, in the telling, a message resonates that it can be worthwhile to see what lies around the next bend.
“Why do you want to die?” a therapist with whom I’ve finally established a worthwhile rapport, asked recently.
I sat without answering.
I’m astounded I’m alive. Not in the holy-shit-ain’t-life-a-miracle kind of way, nor in the isn’t-it-wonderful-how-God-put-us-here sense. I don’t wake up thinking it’s a good day to be alive. I’m astounded because I should be dead. I’ve died a thousand times over in my head, and I’ve dedicated much of my life to thinking of ways to become dead. But I’ve been noncommittal, since, if I had put my mind to it, I would be dead.
At 17, I wrote a suicide note and sat on the floor of my dank bedroom pressing sharp, cold blades to my wrist and wondering whether to unleash a flow of warm blood. At other times, I have crumbled onto bathroom tile and considered swallowing bottles of pills. I rode my bicycle down a busy highway in the midnight darkness. I walked along a six-inch ledge and stared at death swimming in the current fifty feet below. I walked alone through the projects of New Orleans, and the unfamiliar buildings closed in on me. I’ve lain awake trembling, begging the angel of death to alight upon my shoulder. I’ve invited death, but He hasn’t been willing to kindly stop for me. I don’t perceive life in the same way that others seem to; it’s not a precious gift, it just is. What I experienced might at one time have been labeled a nervous breakdown. The term is inadequate. I wasn’t nervous, exactly. Guilt and anxiety, however, consumed me from as far back as I could remember. I bore them like a pall.
Electroconvulsive therapy was the electrical storm that was to have calmed the savage winds and incinerated the broken branches that danced in my head. ECT, as it is known by its acronym, became the culmination of years of bearing a burden I didn’t understand. I’ve never described the process in depth before. I didn’t want to remember. ECT is obliging in that respect, since it erases the memory for a while, but it doesn’t take away the feeling of having been subjected to possibly the most extreme remedy for serious depression, of having been violated. It was the electric chair for my demons, and I imagined the pyrotechnics in my head were like a lit cigarette careening off asphalt in the dead of night, orange flares ricocheting haphazardly.
Some people have the image of ECT as depicted in the movie One Flew Over the Cuckoo’s Nest, where Jack Nicholson’s character has his brains scrambled by a sadistic hospital staff. It wasn’t quite so. And maybe it’s a blessing that the process steals time, sears memories and sends them drifting away like fragile ashes from a campfire into the black night. But the job wasn’t comprehensive. I still have snapshots burned into my brain, and the occasional flashback temporarily paralyzes me. I understand how some people consider it archaic; the most enduring image we have, I think, of electricity associated with people is of death. I, however, was seeking life. And when you’re strapped to a table, and they’re about to turn on the juice, everything else becomes inconsequential; I don’t care anymore what you say, Mom, or the church, or anybody. I’m in the moment, finally, something my therapists have attempted to get me to do, but I don’t know if the moment will result in life or death.
I read a novel when I was in the hospital, and I had to re-read it. The institutional fruit-type drink there bubbled red and purple in plastic receptacles.
‘I come back for ECT every five years,’ an old woman told me. ‘It’s wonderful.’
Ping-pong broke up the monotony. Someone I knew made a delivery to the hospital, and I stared at him as if I hadn’t seen a human being before.
‘Tommy, it’s Scott,’ he said. I vaguely recollected that I knew him, but I stared without recognition. His eyes became a mirror, reflecting my perplexity and embarrassment.
I stood outside and smoked cigarettes. I waited for visitors. The doctor accused me of being on drugs because my septum was perforated. I wasn’t on drugs. I sat in therapy sessions with people who had been on drugs. Therapy sessions that I wouldn’t remember, except for that they had occurred and that I had to pay for them. I took my temperature nightly and recorded it in a log. I thought that if I had any dignity left, if I hadn’t already surrendered myself completely, I had done so after a doctor performing a physical examination probed my rectum. He inserted his finger, and I wouldn’t have been surprised if he had said there was nothing in there, nothing at all.
The details are also sketchy leading up to my admission. Apparently I cried all night the night before, with my head in my mother’s lap, but I don’t know. I can’t rely on her account, for she fashions occurrences into the way she wants to see them. She would have wanted to see me totally dependent upon her, while I shudder to think that I had nowhere to turn but to one of the people responsible for my condition.
Trees lined the road as we twisted our way through Princeton and I drove my mother’s car to the hospital. She sat in the passenger seat, and the scene still bothers me: I was admitting myself into a hospital for psychological treatment, but I drove. I couldn’t get back there today without directions. I don’t want to go back, but it’s frustrating because I usually retain such information easily. My doctor reminds me that I don’t want to return every time I adjust my medication.
‘The side effects don’t seem so bad, and you don’t want to have to go through ECT again,’ he says with a nervous smile. To a point, he’s right, but, then again, he doesn’t live with the side effects.
ECT: I lay in a gown on a gurney, strapped down; I swallowed a muscle relaxant so that the convulsions ( ECT treatments induce seizures) wouldn’t break my bones; the doctor strung wires to my head; the anesthesiologist injected my hand, I think. I counted backward from 100 and drifted into unconsciousness, wondering whether it would be the last time I would utter those words.
One hundred, will I ever say that again? Ninety-nine, is this the last time? I’m sorry to inform you, Mrs. Hofmann, that he never regained consciousness. His last words were: 100, 99, 98, nine’.
I wondered how, or if, I was going to emerge. If I was going to die, I wanted it to be on my terms. I imagined dying during a procedure that was supposed to stop me from thinking about how to die.
I awoke each morning with an idea that I was going to get electroshocked again, but my brain drew no connection between what I was doing there and what I hoped to achieve. I drifted through days, often wondering whether I ever would have a sense again of who I thought I was. In many ways, it was the most daunting sense of isolation I ever felt; in other ways, it wasn’t as bad as what I experienced before I went there.
The dislocation, though, is what haunts me. The thought process is so different from everyday life. For example, the weather became inconsequential. It rained, and I didn’t think about dressing appropriately. The cold didn’t register as I prepared to receive another treatment. Did I need to go to the food store? Didn’t matter. The small things that had helped sustain me were gone, the threads to which I had clung had dissolved. No sports scores, no television shows. Not even a radio. Just me, most of the time, on a gurney, staring at the ceiling, conscious of the anesthesia immobilizing me, counting down from one hundred.
Eventually I emerged from the fog, albeit hazily. According to my oldest brother, I received a call from him on the morning of my first treatment. I had expressed reservations the previous night, which I guess my mother had told him, and he was prepared to get me out.
‘Did they do it?’ he asked.
‘Do what?’ I responded.
Then he knew.
I cried when I was there. People came to see me, and I cried. They left, I cried. I wept for no apparent reason other than that my lifeline consisted of an electrical current coursing through my head every other day. Flip the switch, cut off the circuit, and I could be out of the picture for good. Then the electric jolts seemed to begin to evict my demons and liberate the nebulae that formed a galaxy in my head.
It was March 1994. My condition reflected well the time of the year, that transition month when the chilly gray dampness of New Jersey promises to depart but lingers. The cold winds reminded me that the barren winter wouldn’t accede to spring without a struggle.
The event that precipitated my admission into the hospital was a change in my work schedule, back to nights. I don’t know if it was the thought of returning to the schedule I was on when my wife left me a few years before or something else, but I didn’t want to be there. The solitude of the days and the upside-down world of working at night yet again staggered me. After a week or two, I got my schedule changed back to days, but by then I had passed the point of no return, and the hospital beckoned. The shift change represented the final straw, the culmination of slipping away into near-oblivion. The change nudged me over the edge of the precipice. If it hadn’t been that, it would have been something else.
My recollections are fragmented. The procedure wiped away memories from before, during and after. After more than a year, I recovered about 80% of my faculties. After another year or so, I was back to where I was before, capable of memorizing fifteen-page musical scores with little effort. But the vestiges of the ECT period, those snapshots that linger on the fringes of my consciousness, remind me that I’m never completely safe.
I see people: My roommate in the hospital curled up on his bed like a mound devoid of life. He made me look jovial, a feat I considered impossible. White-coated doctors. Friends. Drug-rehabilitation patients sitting around. But I view them all through a gray veil, their faces, their features, unattainable. The dim portrait of that time gnaws at me. Time that I have surrendered. Time that ECT burned. Since having been in the hospital, I have feared encountering somebody from there and not knowing who it was. I pass someone in a convenience store, catch a glimpse, our eyes meet. Who the hell is that? He looks at me knowingly. I have feared the nakedness I would feel if such a situation did occur, someone knowing something about me that I know but can’t piece together.
Perhaps it already has. I’ve gotten the feeling sometimes, a self-perpetuating discomfort, that some people know more about me than I wish they did. The skeletons dance out of my closet and stand next to me getting coffee at the 7-11. I have no doubt, however, that I risked surrendering much more if I hadn’t entered the hospital.
Consequently, I devote much of my energy to avoiding ECT, or, more generally, a relapse into a serious depression. This often puts me at odds with people with whom I have close, regular contact. Our frames of reference are so different that they perceive me as being cavalier. I have difficulty relating to what I consider more pedestrian concerns than I have confronted regularly. The water heater’s broken? I don’t care, I’m not on the verge of needing ECT again. You got a speeding ticket? I don’t care, no ECT. I got arrested for drunk driving? Ditto. There’s a disconnect between me and family, friends and co-workers. Their concerns are as real to them as mine are to me, but we’re on different planes. I try to be sensitive to their points of view, but more often it’s a struggle to lend weight to circumstances that aren’t life-threatening. I’m alone a lot, even in the company of others.
In one respect, this has freed me from many mundane worries that frazzle other people. It also has saddled me with an enormous burden – having to stave off depression. It’s restrictive. I can’t be self-indulgent when I’m not feeling right. For many, a bad day is a bad day, and they immerse themselves in it. I still have to be concerned with whether a bad day is the beginning of a relentless decline to emasculating depths. Standing on the edge of an abyss is a precarious affair. And when I have had enough of dealing with my situation, I’m all too ready to consider what I once thought was the most viable alternative: Suicide.