Women, ECT, and Memory

As signaled in the title above, this article is about women, ECT, and memory. Despite the fact that the memory loss caused by ECT is greatly minimized by psychiatry to the point of downright denial, it is fairly common knowledge at this point, at least among people who have looked beyond the official ECT line, that one of the main and most devastating effects of ECT is the destruction of memory (for an example of a standard denial thereof, see, Abrams, 2002).  Innumerable shock survivors have testified to it (e.g., see https://coalitionagainstpsychiatricassault.wordpress.com/articles/); and it is conclusively established by credible research (see Sackeim et al., 2007 and Breggin, 1991). That noted, many of those who take in the reality of ECT-created memory loss are aware of it largely in an abstract manner.  As a statistic. As a fact supported by research. If our memory is relatively in tact, we can forget how very integral memory is to most every aspect of our daily lives. In this regard, I  am grateful to the many ECT survivors who have given testimony over the decades and whose words have made this destruction of memory real in the way that statistics never could. Note, in this regard, this sensitizing statement by survivor and author Linda Andre:

Imagine you wake up tomorrow with your past missing….You may not be able to recognize your home or know where your banks accounts are….You can’t remember your wedding or your college education. Eventually you realize that years of your life have been erased, never to return. Worse, you find that your daily memory and mental abilities aren’t what they were before. (Andre, 2009, p. 1)

Now generally the memory loss that besets ECT recipients is spoken of with little or no explicit reference made to gender. In this article as in certain of the literature (e.g., Burstow, 2006), on the other hand, gender is highlighted.  My intent in this article is to hone on gender per se, more specifically to shed light on how ECT, memory loss, and women’s lives come together.

That noted, I am aware that some folk may be wondering: But why are you writing about women specifically?  Is not ECT, comparatively speaking, a gender-neutral issue? To address that quickly, while both men and women are unconscionable harmed by this procedure—and I in no way wish to minimize what happens to men—as shown in Burstow (2015a and 2006), ECT and the lived reality of it is not even close to gender- neutral. Throughout the history of ECT, two to three times as many women as men have received electroshock. And as research has established, they have generally received it because of a man signing for it, often for behaviour seen as “inappropriate” for a woman, and this despite the fact that the women themselves do not want it—hence feminists such as myself theorizing it as a form of violence against women (Burstow, 2006). What is up and above this, there is a gender-specific differential impact that needs to be factored in.

The point is, yes, women are men both suffer devastating memory impairment because of ECT—but not equally. A short story to introduce you to this topic: When I was part of an organization that held public hearings into shock in the 1980s, the fact that such a difference existed was painfully apparent albeit no one commented on it. The point is, while men survivors too were often horrendously affected, overwhelmingly, it was women survivors who made reference to chunks of their lives as big as 5 to 20 years being totally wiped out. By the same token, it was overwhelmingly women who would make statements like, “That was fifteen years ago, and I still have to take notes all day long just to get through the day.”  Which led me at the time to conjecture a gender-specific impact differential. Decades later, the difference was confirmed by Sackeim et al. (2007)—the largest study in ECT history. This study established at a level of statistical significance that women’s memory is more impacted than men’s—a reality possibly related to women’s lower seizure threshold. A particularly perverse statistic, I would add, when you consider that it is the precisely the sex that is most adversely affected by the procedure that is being singled out for it!

That noted, the difference with respect to memory does not end here. The point is that we are all of us social beings, that both men and women lead gendered lives. And so to understand the real meaning of the destruction of people’s memory, whether the survivor be male or female, we need to understand it in the context of those gendered lives. By way of example—and this is just one among many different identities that could be drawn on, for women are also lesbians, teachers, seniors in nursing homes—with women commonly being in the role of wife and mother, to understand the meaning of that destruction of memory, one very helpful lens through which to view ECT is precisely the role of housewife and mother. Questions that we might ask in this regard include: What happens between a mother and child when the mother cannot recall a good part of the early years of her own child’s life?  When she is impaired in her ability to figure out how to be a mother? What happens to a woman expected to be a housewife when she cannot remember any of the everyday operations which allow her to navigate the very particular world in which she finds herself? 

With the intent of making this dimension more “real” for people, what follows is an excerpt from a novel of mine in-progress (currently under active consideration by a publisher) which delves into some of these issues, takes up a number of these questions, fleshes out a character whose post-ECT existence is deeply embedded in the social world of housewife and mother.  A few words by way of introduction: The novel is called “The Other Mrs. Smith” and it is the culmination of decades of research. The narrator is Naomi Smith (a totally fictional character). Once upon a time, Naomi was a budding young filmmaker but having fall prey to psychiatry shortly after giving birth, such avocations are no longer on her horizon. It is now late August of 1973—approximately five months since her last shock treatment. She is living with a husband named Earl (whom she has no memory of ever marrying him, nor any appreciable pre-ECT memory of) and a baby daughter named Ruth (of whom she has no pre-shock memory whatever). This is one and half years after the birth of her daughter.  For several years now, she has been estranged from her family of origin, though she has no idea why because she has no memory of the breakup. Her family of origin consists of her mother, her father, and her twin sister Rose. Naomi is now living in Toronto, has been ever since marrying, albeit she has no memory of ever having moved here and no pre-shock memory of Toronto. She is a Jew originally from Winnipeg (a city in Western Canada). Her husband Earl is an atheist Christian, originally from Newfoundland (one of Canada’s Atlantic provinces). St. Pukes, referred to in this excerpt, is the name the “patients” give to St. Patrick-St. Andrew’s Mental Health Center (the fictional psychiatric institution where Naomi received ECT). And Dominions is a local supermarket.

Excerpt From Novel “The Other Mrs. Smith”

Fear—that was the common thread that wove its way through my days, making them what they were.  I feared the growing frustration in Earl’s voice.  I feared that I would not be able to find my way into Ruthie’s heart.  I feared that my brain, my memory, my life were lying in tatters somewhere in a St. Puke’s garbage bin.  I feared that I would never again be in the loving arms of the sister and parents that I so adored.  I feared that all those years of hope and study had come to naught, for no celluloid world would ever issue forth from my shattered ship-wreck of a mind.  I feared the faces that I met—the ones that looked away embarrassed, the ones that snickered, the ones that whispered to their children as I walked by.  I feared myself for I knew not who I was nor what terrible thing I had done to deserve such a punishment.  But most of all, I feared existence itself—my very being in the world—for the unvarnished truth is, I did not have the wherewithal to be, to cope, to muddle through. 

Poor Earl expected a wife and mother, the family, indeed, needed a wife and mother; and me, I simply could not function.  At night, I would tuck in my child and see her cringe and turn away, holding onto her doll for dear life.  Now if her daddy was not right there, she would scream blue murder.  And there I would stand—useless—knowing full well that a mother with her faculties in tact would have found a way in.  How come I am just fine with most vulnerable people on the ward and absolutely clueless when it comes to my baby daughter?, I would ask.  And Ruthie, if you are reading this, be assured that not a day went by when I did not ask, when I did not long to be the mother that you deserved.  Then, my heart heavy, I would crawl into bed with this stranger, even have sex with him, though neither of us were under any illusion about my feeling what he so desperately wanted me to feel.  The Mrs. Smith that I used to be, I would wonder, did she hunger for this man?  Was she able to lift the pain from his heart?

#

It was a weekday morning, not unlike the ones that came before, not unlike the ones to follow. 

“Brnng…brnng,” went the alarm.

“Time to get up,” urged Earl, reaching over and turning it off.

I rose, quickly closed the child’s gate, praying that Earl had not noticed.  I rustled up breakfast, saw Earl hovering over me. Gotenyu!  Had I left a burner on?

“Darling, don’t forget to mail the letters,” he called out minutes later.  Then with a hurried peck on my cheek, he rushed out the front door. 

Dreading the inevitable, I put off the chore a good half hour.  Then I gritted my teeth, lifted up Ruthie, started scouring the streets in search of the mail box.  Where could it have gone?  It was here yesterday.  At long last, I passed a little green house, a white picket fence at front. Shortly thereafter, I happened upon a rectangular box.  I dropped the letters into what appeared to be a slot.  Fine and good.  But how does one get home?  I whirled about, intent on retracing my steps.  Here was the little green house with the white picket fence on my right.  I passed it, scrupulously turned whenever the street turned—but back I find myself in front of the little green house. 

“Sir,” I call out to an older man in Bermuda shorts ambling by, “could you give me directions to 532?”

“No 532 here.  You must be looking for Palmerston Avenue.  This’s Palmerston Square.”

“So there’s two Palmerstons?”

“Three,” he corrects, chuckling.  Then a curious look comes over him. “Excuse me, but aren’t you the young woman who asked me this yesterday?” he queries, eyeing me ever more keenly.  “If this is a joke, young lady, it isn’t funny.” 

I apologize, back away mortified, eventually find my way home.  With Ruthie hollering that she is hungry again, and the word “vacuum” mysteriously coming to mind, I pull out what appears to be a Hoover.  Then suddenly, suddenly, I remember.  Groceries—God help me—I’m supposed to buy groceries.  Also, my daughter is hungry. 

I instantly stash the vacuum in the hall closet, hoping that’s where it came from, then feed Ruthie.  Then once again the two of us set out into the wilderness that is Toronto.  And once again, I search and search.  I pass a Victorian house.  Vaguely familiar.  I come to a corner.  A tall burly man in a police uniform is positioned in the middle of the street directing traffic.  Now somehow, his hand signals—if that’s what they are—do not compute, but this time, I know better than to draw attention to myself.  I stand at the very edge of the sidewalk, doing absolutely nothing as the policeman gazes my way.  Who could get in trouble just by doing nothing?  Suddenly, a horn begins honking.  Then another, and another.  The policeman stares right at me, while waving his hands progressively quicker.  And now he approaches, his expression very like Earl’s. 

“Lady, just whatchya expecting me to do?” he asks.  “Turn green?”

Eventually, I catch sight of the local Dominions, usher Ruthie safely through the door.  And while I cannot make head or tail of my grocery list, I recall that we are out of peas.  As luck will have it, I spot the right row, the right section of the right row.  With trepidation, I position myself smack in the middle of the peas section.  I reach out my hand.  Then I stand in front of those hundreds of tins of peas utterly stymied.  So many sizes, so many kinds—Libby’s, Aylmer’s—how is a person to choose?  Beads of perspiration forming on my brow, I take a deep breath, grab a tin at random, then hightail out of there as quickly as my legs will carry me.

Now I am half way out the door when it dawns on me that I have not paid.  Also, that there is one other item that I simply have to pick up.  Hoping that security is not on the way, I reenter, make my way to the meat counter—and brace myself. 

You see, pig, that turned out to be a staple in the Smith household, and it utterly flummoxed me.  Pork chops, ham, sausages, bacon, Newfoundland steak—hell, being Jewish and electroshocked to boot—they all seemed the same to me.  Now Earl would answer all my questions, would keep rattling off the different types, but try to hold onto to them though I did, every name, every description would come leaking out of my brain. 

“So lady, what’s it today?” asks the man in white behind the counter.

“A few pounds…a few pounds…a few pounds of…of…that,” I stammer, pointing at something reddish.

Meat in hand, I head over to the cashier, give the woman every ounce of lucre in my possession.  Her eyebrow raised, she hands me back most of my bills and several coins, together with what must be an itemized receipt.  I glance at it.  Another blur.  Then I pick up my daughter because she is clearly tiring, and scurry home.

“This’s just fine,” says Earl, hours later, gobbling up a poor imitation of a dinner.  But I can tell from his eyes that all of the meshugas is wearing him down. 

8:30 p.m., I tuck in Ruthie, hear her scream for her father.  Then Earl and I sit and sit and sit in that living room.  He tells me about his day, and I pretend to be following.  I tell him about mine, and he pretends to be listening.  “Missus, it’s about that time again,” he eventually announces.  I breathe a sigh of relief, take the pills, observe him watching me. 

At long last, the moment that I have been waiting for arrives—I get to crawl into bed—that nice, warm, comfortable bed—and call it a day.  I bury myself in the safety of the blankets, eager to fade into nothingness, eager to forget.  But now Earl, he’s crawling on top of me.  I instantly spread my legs.  Oh let him come quickly!, I pray.

Finally, finally, I close my eyes.  I drift off, glimpse a better place, a better time.  It is our fourth birthday, and attired in our new black tunics, Rose and I are blowing out the candles.  Now all four candles are out and the two of us are smiling at each other, nestling into the recesses of each other’s souls as only we can.  “Mazel tov,” chimes in my mother’s voice.  “Never mind with the mazel tov; Ida, give the girls cake,” pipes up dad.  Even as I savour the first tantalizing mouthful, a shrill sound shatters the stillness, and I awake with a start.  Frantic, I cast my eyes about.  I spot an alarm clock.  I see a bump in the covers next to me.  No!  No!  It can’t be!  Not here again! 

And so the days went.  How can we possibly keep this up?, I wondered.

(from novel-in-progress, Burstow, 2015b)

This particular passage, as you can see, focuses in on the abject terror of living in what is now an alien world. In the process, it probes Naomi’s inability to perform the everyday tasks integral to her life as housewife and mother, also the profound injury to Naomi’s relationship with her child and husband. 

I will comment no further on the passage—for better the reader make their own discoveries. However, I cannot leave the topic of the novel per se without commenting on the experience of writing it: As author, putting myself in the head of an electroshocked narrator struggling to tell a story, so much of which she simply cannot remember was one of the most frustrating and humbling tasks that I have ever taken on. Many a time I vowed to abandon the project once and for all because the journey ahead felt just too daunting. Whenever I was on the brink of “throwing in the towel,” however, I remembered that I always had the luxury to put aside the double binds and frustrations related to ECT and return to a life where memory is in tact—while shock survivors have no such option.

Then I would take a deep breath, pick up my pen, and resume writing.

Closing Remarks

I hope that this article has helped the reader gain a deeper sense of the reality of ECT as lived. More particularly, I hope people walk away better able to appreciate how the memory loss shatters lives and how that shattering invariably, indeed, inevitably transpires on a gendered level. In ending, let me express an even more ardently held wish—that some day soon we will be able to rid the world of this atrocity. That said, as long as ECT is being unleashed on people and as long as women and men survivors continue to have to navigate a world which has in essence been stolen from them, I would invite readers to factor gender into their understanding—for however poignant and sophisticated it may be, our grasp of the ECT phenomenon is lacking otherwise. 

References

Abrams, R. (2002). Electroconvulsive therapy (4th. ed.). New York: Oxford University Press.

Andre, L. (2009). Doctors of deception: What they don’t want you to know about shock treatment. New Brunswick, New Jersey: Rutgers University Press.

Breggin, P. (1991). Electroshock: Scientific, ethical, and political issues. International Journal of Risk and Safety in Medicine, 11, 5-40.

Burstow, B. (2006). Electroshock as a form of violence against women. Violence Against Women, 12 (4), 372-392.

Burstow, B. (2015a). Psychiatry and the business of madness: An ethical and epistemological accounting. New York: Palgrave.

Burstow, B. (2015b). The Other Mrs. Smith (a novel in progress).

Sackeim, H., Prudic, J., Fuller, R., Kielp, J., Lavori, P., & Olfson, M. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244-255.