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ON THE SEA OF MEMORY
How I Lost My Memory
Something must have happened on May 4, 1998, because from that day forward my entire life changed. Since I don't remember what occurred, a Spanish friend of mine, Isa, who was visiting from Madrid and staying at my apartment in New York City, recalled the following:
"You came to Madrid in February 1998 and went several times to see a psychic who guided you in a kind of seance and put you in touch with your mother [who had died three years previously] in order to break the imprisoning bonds between you and her. I came with you each time to translate for you; and you cried and said good-bye to your mother, and you seemed much happier after this.
"Three months later I visited you in New York, and one morning you woke up and said, 'Why are you here? Why are you here?' I didn't understand, because you had always been a very good friend to me. And then you started shaking uncontrollably. So I went out and bought you some Bach Flowers, but you didn't want to take them, and finally you called a doctor who told you to go to the hospital.
"I went to visit you every day. They were giving you electroshock treatments--I didn't even know they still gave shock treatments--which I was against, and I spoke to the doctors. But they said you needed the treatments. One day when I came to the hospital I noticed that almost overnight your hair had turned gray. Everything was very strange. But you looked as if you had so much light in you. It was as if your soul was very spiritual but it was your ego that wasn't. Your ego was depressed and maniacal, but your soul was full of light. Maybe the psychic in Madrid opened up something that was too much for you to take."
Between 1998 and 1999 I was a patient in four New York City hospitals, suffering from major depression and suicidal thoughts. At the first two of these hospitals I underwent a course of thirty-six treatments of electroconvulsive therapy. ECT, or electroshock, entails sending an electrical current of about 200 volts--though sometimes less or more than that--for a fraction of a second by means of electrodes connected to a machine resembling a stereo receiver through the frontal lobes of the brain of a patient who has received general anesthesia and a muscle relaxant to prevent broken bones, cracked vertebrae, and physical spasms (the only perceivable movement during the treatment is usually the slight, involuntary twitching of the patient's toes); a face and nose mask to provide oxygen to the brain; and a rubber block to prevent biting off his or her tongue. The result is the creation of a grand mal epileptic seizure that lasts up to one minute. (Remarkably, it is still not known how or why ECT works or what the convulsion actually does to the brain.)
In the popular imagination, the prototypical electroshock patient brings to mind Randle P. McMurphy (who thought of ECT as "a device that might be said to do the work of the sleeping pill, the electric chair, and the torture rack"), the antihero of Ken Kesey's 1962 novel, One Flew over the Cuckoo's Nest, a book drawing on his experiences working in a psychiatric ward in an Oregon state mental hospital in the 1950s. Like McMurphy, ECT recipients at that time, as Sandra G. Boodman observes in The Washington Post, tended to be under forty, male, and impoverished--patients confined to state mental hospitals, often against their will. But women, of course, were also sufferers of this then often misused procedure. In the late 1940s and early 1950s, the internationally renowned writer Janet Frame, misdiagnosed without formal interviews or tests as a schizophrenic, underwent more than two hundred electroshock (including a few insulin shock) treatments over eight years, without an anesthetic, in two New Zealand hospitals where patients lived in rooms covered in human feces and ate meals off the floor. The treatments triggered extreme memory loss, comas, convulsions, and nightmares ("I dreamed waking and sleeping dreams more terrible than any I [had] dreamed before. . . . Everything tortured me and was on fire"). The doctors benightedly deduced that these symptoms indicated the need for further ECT. In The Bell Jar, published in 1963, Sylvia Plath describes her harrowing experiences with electroshock, also administered without an anesthetic, in the 1950s: "Then something beat down and took hold of me," she writes, "and shook me like the end of the world. Whee-ee-ee it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant. I wondered what terrible thing it was that I had done."
Incredibly and often ludicrously, ECT was once also used as a sedative to control disruptive patients as well as to treat ul- cers, hysteria, colitis, backaches, psoriasis, phobias, anorexia nervosa, mental retardation, marital discord, and abhorrently, homosexuality--electroshock was supposed to "release" sexual impulses! The most notorious and egregiously baleful misuse of ECT occurred in the late 1950s and early 1960s, when Dr. Ewen Cameron, at one time the president of both the Canadian and American Psychiatric Associations, performed ghoulish experiments at McGill University's Allan Memorial Institute (since closed) in Montreal. In these Cold War experiments--part of the infamous "MK ULTRA" program subsidized by the CIA--which were meant to explore the processes and possibilities of brainwashing, Cameron, like the nefarious scientist in The Manchurian Candidate, maimed and brutalized patients with drugs (including LSD), lobotomies, and especially ECT (he would shock his patients six times in rapid succession two or three times a day for thirty days) in an attempt to discover ways of "depatterning" and then using "dynamic implants" (via tapes placed under the patients' pillows) to reprogram the human mind. His experiments were disastrous, resulting in individuals in vegetative states, with wiped out memories and the ability merely to repeat the sentence "I am at ease with myself." (Canadian survivors of this torture obtained and shared a $750,000 settlement from the U.S. government in 1988.)
Today electroshock is no longer applied for such barbaric purposes. ECT treatments are now given annually to an estimated 100,000 Americans (mostly women)--nearly triple the number in 1980--to alleviate mental illnesses such as major depression (women are often treated for postnatal or menopausal depression), mania, catatonia, and some forms of schizophrenia, primarily as a last resort, when other treatments, such as psychotherapy, psychoactive drugs, and hospitalization, have failed. The cost per treatment of ECT ranges from $300 to $1,000; and as the Tampa psychiatrist Dr. Walter E. Afield, a former consultant to Johns Hopkins Hospital and a supporter of ECT, comments somewhat grimly, "Insurers no longer will pay psychiatrists to do psychotherapy, but they will pay for shock or for medical tests. . . . Finances are dictating the treatment. . . . We're being pushed as a specialty to do what's going to pay."
Using electricity to heal people goes back at least two thousand years. In the first century a.d., Roman healers applied electric eels to the heads of both mentally disturbed persons and those whom today we would say were suffering from migraine. Physicians in the eighteenth and nineteenth centuries used electrical generators whose charge was built up by electroluminescence (resulting from rubbing a rotating ball of sulfur) on their patients, claiming efficacious results in the treatment of various mental disorders. But the modern use of ECT began in Rome in 1938, when Dr. Ugo Cerletti, chief of the Clinic for Nervous and Mental Diseases at the University of Rome, in collaboration with Dr. Lucio Bini, adapted a pair of tongs used to stun hogs before slaughter and applied them to the temples of a delirious and delusional thirty-nine-year-old homeless man who was found wandering in a train station spouting gibberish. As the psychiatrist David Impasto, who administered the first electroshock treatment in the United States in 1940, wrote: "After the electric spasm, the patient burst into song. Cerletti suggested that another treatment with a higher voltage be given. The patient suddenly sat up and pontifically proclaimed, no longer in jargon but in clear Italian, 'Not again! It will kill me!' This made the professor think and swallow, but his courage was not lost . . . and the first electroconvulsion in man ensued."
In 2001 the New York State Assembly Committee on Mental Health, chaired by Martin A. Luster, scheduled two public hearings--in New York City on May 18 and in Albany on July 18--to determine the efficacy, benefits, and risks of ECT. According to the committee's report, "It was clear from the testimony received that there was a wide variation of opinion related to the use of ECT. Proponents claimed that ECT is a safe, effective procedure with no permanent adverse side effects, and cited a figure of 1 in 10,000 deaths related to ECT to document its safety. [The American Psychiatric Association Committee on ECT in a 2001 report claims one death occurs for every 80,000 treatments.] In contrast, opponents maintained that ECT causes brain damage, can result in permanent memory loss, and asserted that the death rate related to ECT was closer to 1 in 200. Opponents expressed additional concerns about the utilization of ECT on children, the elderly, other vulnerable populations, and of its possible use as a behavior-modifying, non-therapeutic intervention for mentally retarded individuals." The committee report also mentions that although the Food and Drug Administration has recognized the risk of illness or injury from ECT and has designated and classified ECT machines as Class III medical devices--a designation used for premarket approval for equipment that shows an unreasonable risk of illness or injury--the FDA has never completed testing ECT devices to determine their safety or the effects of ECT on the brain, and there is currently no regulation of ECT by the federal government.
Even taking into account that some memory loss can result from stress, depression, and aging, what I know for certain is that after thirty-six electroshock treatments, innumerable memories have been literally and permanently erased, with only occasional freeze-framed flashbacks. Neuroscientists have confirmed that strong emotions, which release adrenaline, which activates the brain, make for emotionally charged memories, often called "flashbulb memories." One such memory for me is of the night in December 1994 when I found myself lost in the Sahara Desert in Niger and had to spend fourteen hours alone until I was found by my party's Tuareg guides.
I have discovered that I have totally forgotten persons I used to know well: a friend told me that after my ECT treatments, I telephoned her, mentioned that I had come across her name in my address book, and asked, "Who are you?" And I have also found my explicit, short-term memory debilitated, my IQ quantifiably diminished (attested to by extensive neuropsychological assessments), my abstract reasoning and learning facility (such as trying for an ungodly number of hours to figure out how to work a new phone-fax machine or how to accomplish simple computer tasks) seriously impaired, my ability to find the words I want and need reduced (such that I struggle to write more than four or five sentences at a time and have to compensate for the loss of words I mean with simpler and less precise ones), and my cognitive capabilities weakened to the extent that I immediately forget what I've just read, even losing track of the meanings of the words.
The singer-poet Lou Reed, who underwent electroshock treatments to "cure" his homosexuality at a New York state mental hospital in 1961, when he was seventeen, shares my reading plight in the first stanza of his song "Kill Your Sons": "All your two- bit psychiatrists / Are giving you electroshock / They said they'd let you live at home with mom and dad / Instead of mental hospitals / But every time you tried to read a book / You couldn't / Get to page seventeen / 'Cause you forgot where you were / So you couldn't even read." And a few hours or a day after I watch a movie, I find myself unable to recollect most of what I've seen. First I realize that I have forgotten the film's ending, then its middle, and finally its beginning, like a kind of retrograde process of film erosion. (Even as I type these pages, I often lose track of what I've just written, and I search for words I no longer remember. Sometimes an unbeckoned word or phrase will come suddenly to my mind--for example, "the exactitude of pain," which popped into my head a few minutes before writing this sentence. Sometimes I am overjoyed to catch a needed word like a fisherman with his net in a sea of forgetfulness. Someone once said that memory is like the ocean because from memory flow all thoughts and words. I am truly at a loss for words.)
While I clearly remember the smallest details of my early childhood--sitting under the piano at the age of four or five listening to my mother play Chopin's Prelude in A Major, for example, or sitting next to a blond-haired narcoleptic, eight-year-old girl named Betty, who continually used to fall asleep, head on her desk, when we were in the third grade--many of my later years have been almost totally expunged. In a significant study undertaken in 1974, the psychiatrist and neuroscientist Dr. Larry R. Squire tested psychiatric patients before and after ECT treatments on their memory of television shows. Before ECT, these patients exhibited a good memory for programs from the late sixties and early seventies, though not for shows before those years; after ECT, however, they had trouble remembering programs aired a year or two before ECT but almost no problems remembering shows from more remote time periods. In neurological terms, as Joseph LeDoux writes in Synaptic Self, "damage to the hippocampus [the horseshoe-shaped part of the brain where memory is initially encoded] affects recent memories, but not old ones that have already been consolidated in the cortex. Old memories are the result of accumulations of synaptic changes in the cortex as a result of multiple reinstatements of the memory.&
Excerpted from On the Sea of Memory by Jonathan Cott Excerpted by permission.
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