Shock and Awe

The stunning comeback of electroshock and other harrowing treatments for the mentally ill

Despite these glowing testimonies, the hearing didn't go well for Neuronetics. The FDA advisers recommended against approval, citing worries that the device hadn't been proven significantly effective and wanting to see further study. So, for now, TMS remains an experimental treatment that can only be administered to patients in clinical trials. In the past year, the brain-stimulation lab has used TMS to treat about 30 people and continues to test it on patients with depression, depersonalization disorder, obsessive-compulsive disorder, and schizophrenia, and hopes to tweak it to be more effective for treating a whole range of psychiatric disorders. In the meantime, psychiatrists continue to send thousands of their clients for the more invasive but available treatment: ECT.


And that's what happened with Kelley after TMS eventually proved ineffective for her. At that point, "she had tried pretty much everything I or others could think of," said Dr. Suzanne Griffin, Kelley's psychopharmacologist of 15 years. From the start, Kelley was horrified at the thought of ECT. "She went into it kicking and screaming," recalled Deb.

No wonder, considering ECT's contro-versial history. It has been used to "treat" homosexuality, was given to punish uncooperative psychiatric patients, and was sometimes performed without anesthesia. But in 1999, the year that it was recommended for Kelley, ECT was in the middle of a comeback. The U.S. surgeon general had just released a controversial report promoting it as a highly effective treatment for the most severely depressed patients, and psychiatrists were touting the many improvements they had made to a once-barbaric treatment. ECT is now administered with anesthesia, oxygenation, respiratory support, and muscle relaxation. It uses lower currents, and scientists have tweaked the placement of the electrodes to minimize side effects. It has recently gained the vocal support of Kitty Dukakis, who co-authored a 2006 book detailing how ECT changed her life. Even as the shock treatment gained new followers—an estimated 100,000 Americans now receive ECT annually—many critics still call for it to be banned outright because of its devastating side effect: memory loss.

Kelley began getting three treatments a week. Her suicidal depression was replaced by a mindless stupor. After the first treatment, a nurse wheeled Kelley out looking disheveled and disoriented. She was sent to the cafeteria, where she sat "drooling milk out the sides of her mouth," Deb said. At home, Kelley couldn't empty the dishwasher because she couldn't remember where the dishes went. The only thing she was able to do was veg out on the couch watching football.

After 33 sessions, Kelley pulled the plug on the treatment when it was apparent that the side effects were lasting. She had lost 20 years of memory. Everything she knows about her life from the years 1979 to 1999 comes from photographs, medical records, and overheard conversations. After her mother died last year, friends and family tried to console her by saying that she would always have her memories, but she wasn't able to admit to them that she actually couldn't remember much about her mother. "I have a photograph of the two of us, but I can't emotionally connect," Kelley says. "I don't recognize my mother, and I don't recognize myself."

Nevertheless, she was alive and no longer suicidal. "When you get knocked senseless by a two-by-four, you're not thinking about how depressed you are," Kelley wrote. "At this level of depression, most doctors are elated that you are still alive after they treat you. They congratulate themselves on saving another [void-of-quality of] life" (her aside).

Kelley stopped the ECT in April 1999. By November of the same year, she was already searching for something else. What she found was even more shocking.


image
A sculpture made by Peter Bulow, a researcher at the Columbia brain-stimulation lab, with a device attachedcalled the transcranial direct current stimulator.
Peter Bulow
Perusing the online lists of experimental treatments available, Kelley discovered a new possibility: She would let surgeons at New York–Presbyterian Hospital cut open her neck and attach an electrode straight to a major nerve. The procedure, called vagus-nerve stimulation (or VNS), had been performed for years on patients with epilepsy and was now being tested as a treatment for depression. Electricity is meted out by a pacemaker-like device implanted in the chest and delivered via a wire connected to an electrode on the vagus nerve, a major nerve that reaches the brain stem. Once it's turned on, the stimulator sends electric pulses up the vagus nerve every five minutes.

Kelley applied for the brain-stimulation lab's VNS study in November 1999. Researchers called her on Christmas Eve and told her to be ready for surgery on January 10 at New York–Presbyterian Hospital. The news came at a crucial time: Her doctor described her as "chronically suicidal [and] severely despondent" when she entered the study. As before, she wasn't eating, sleeping, or bathing. The energy she did have was devoted to medical appointments.

Deb remembers thinking that "[Kelley] agreed to do it because her hope was that someone would mess up during the operation and she would die and then it wouldn't be suicide; it would be donating her body to science. I, on the other hand, was hoping beyond hope that it would work."

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