At 9:30 on the morning after the Fourth of July, I sat on my bed wearing only a hospital gown and a pair of ankle socks thinking independence was about to have new meaning for me. I was going to become free from psychotropic medications, manic episodes, recurrent hospital stays, severe depression and the recurring, passionate desire to end my own life.
All these horrors had waged war on me since age 18, when I was a senior in boarding school. Now 21 and a junior at New York University, I was going to find inner peace with the help of electricity.
"Ms. Patton, we're ready for you," a short nurse with a sharp Irish accent said as she stood in the doorway wearing a white jacket that hung just below mid-thigh.
She smiled and I nodded. I didn't want her to see I was afraid. I took deep breaths and clenched my fists to keep my hands from trembling. I had already used the bathroom but suddenly felt as if I had to go again. As we walked slowly down the hallway bustling with nurses, doctors and anxious, sad and disturbed patients, I couldn't help but remember actor Jack Nicholson's distorted face as he was shocked in the 1975 film "One Flew Over the Cuckoo's Nest."
In a small treatment room, I took my position on the gurney surrounded by a heart monitor, blood pressure cuff, oxygen apparatus, electrodes and a phalanx of white-coated doctors and nurse technicians. They had performed hundreds of these treatments, which are administered every Monday, Wednesday and Friday morning on the locked psychiatric ward at St. Vincent's Hospital in New York City.
The night before my treatment, a male nurse walked into my room at midnight holding a large pair of red pliers.
"What are you doing with those?" I asked.
"I have to turn off all the water," he said. "No food or drink after midnight."
I told him that he didn't have to turn the water off. All he had to do was tell me not to drink.
Not good enough, he reminded me: This was a psychiatric ward. He did his job, then left me alone to wrestle with the images racing through my brain, images that would soon be blasted by a jolt of power in a procedure that holds a special rank of fear in the popular imagination.
Despite a resurgence in its use--100,000 Americans a year undergo electroconvulsive therapy (known by the initials ECT), up from 40,000 a decade ago--shock treatment remains the most controversial procedure in psychiatry. The echoes of a gruesome form of execution, the history of horrifying abuse, unfavorable media presentations and conflicting testimony of patients all contribute to the forbiding aura: convulsing patients foaming at the mouth, breaking bones, fracturing spines and suffering from skin burns. Statistics from the American Psychiatric Association say that one in every 10,000 persons treated with ECT dies, usually from cardiac arrest after the procedure.
The doctors at St. Vincent's emphasized the sophistication of modern treatments, and the fact that all available treatments had risks associated with them. They said ECT patients suffer varying degrees of unpleasant side effects immediately following the treatments, from mild to severe, and that I could lose my memory for a short term. They also warned there was no certainty that this treatment would work.
So why was I lying on my back in this locked ward waiting for them to hook me up and jolt my brain?
Inside the Pain
Last December, in the midst of a manic episode, I sat in a tattoo parlor on Sixth Avenue in Greenwich Village. I watched the tip of the artist's tongue rest between his thin lips as he concentrated on the design--a red heart with a scroll of my mother's name inscribed in the middle--the mother I never knew.
At first, the quick needle stung. My blood dribbled onto his protective gloves. "Hold still," he said as I gave an occasional twitch. Fifteen minutes passed and the pain worsened. Looking at my blood and eyeing my grimacing face in a mirror, I remember thinking that no one lives and dies without seeing his own blood and knowing pain. It was unavoidable. So I began to concentrate on my pain, to stop resisting it. Incredibly, it worked. Soon the sensation felt almost normal. My face must have relaxed.
"No pain, huh?" the tattoo artist smiled. "I told you it wouldn't be so bad."
My ability to normalize pain struck me as a revelation. I began to wish I could do the same thing with my internal pain. I just had to figure out if the source of it was in my heart, or my head. If in my heart, then all I had to do was try to examine and understand the trauma of my past.
I don't know how old I was. My eyes stretched to make sense of the darkness surrounding me. When they couldn't, I cried. Footsteps climbed the staircase. The doorknob turned and a large hand flicked on the lights. An adult form stood silently in the doorway. I could see the eyes watching me, assessing me. When they saw that I was not injured or in great danger, the door clicked as it fit neatly against its frame, and darkness prevailed again.
That was life in a foster home. No matter how loud or long I cried it was to no avail. The doorknob was not going to turn again. The lights would not chase away the darkness. So I loosened my grip on the bars of the crib, let the blanket dry my eyes and rocked myself to sleep, as I occasionally still do now as an adult.
A week after my fifth birthday, the state-paid caretaker I had called Mommy told me that I was getting new parents. At the time, saddened and confused, I thought that when everyone turned 5 they got new parents.
The couple who adopted me had always wanted children. But two miscarriages and a hysterectomy ended that dream. I was supposed to fill the void in their lives. Every Christmas I sat between my adoptive parents on a cushioned seat made for two. We watched the movie "Annie."
"See, Stacey, you're just like Little Orphan Annie," my adoptive mother said. "Someone was nice enough to take you in, clean you up and give you a nice home."
They bought me the Annie doll on my first Christmas with them. I hated that doll. I spit in her face and used her as a punching bag, because that's exactly how I was being used, and my doll was the only one I could hit back.
Every day I held back the tears, the anger and rage that built up each time my adoptive mother struck me with a cord, belt, hanger, shoe, broomstick, hand or anything else she could pick up and throw at me. For eight years I lived in the thick of a war. My adoptive parents' home was the battlefield and my adoptive mother was my enemy. She had better weapons than I did. And her strength and control overwhelmed me.
"You're not wrapped too tight," she would say. "You'll wind up like your crazy mom." Then she'd refuse to tell me anything more.
The adults in my life--teachers, aunts, uncles, neighbors and my adoptive father, a Pentecostal minister--did nothing to become my allies. They all lived in oblivion, ignoring the scars, bruises, broken bones and emergency room visits. All I could do was try to stay alive.
Unconsciously, I had trained myself not to feel the pain. I couldn't feel it, or I wouldn't survive, and I needed to survive to fulfill my dream--to one day be reunited with my biological family. Finding them would heal the wounds and erase the past, I thought. If I was left alone in the house, I would desperately search for any clue to my origin. Desperately and unsuccessfully.
When I could no longer stand the beatings, I ran. I wound up in a youth shelter in a bad part of town where I was locked in my room and watched like a criminal. It was fine with me. At least I was protected.
And now that I was no longer living with my adoptive parents, I didn't need their permission to pursue my biological ones. I could give the adoption registry in Trenton, N.J., precious little to go on. I didn't even know my birth name.
From the shelter I was placed in a group home. The director laid out my future: finish high school, go to community college. When I told her I wanted to go to the $23,000-a-year Lawrenceville Prep, a boarding school in Princeton, she called the school and told them they weren't equipped to handle someone like me. That just motivated me to take the tests, do the interviews, write the applications and solicit enough recommendations to counteract the negative comment.
The envelope from Lawrenceville came in March, 1993. It was so small, I was sure it was a rejection. I sat staring at it in my room for two hours before I could bring myself to open it. The first words were, "It gives me great pleasure to inform you that you have been accepted . . ." I never read the rest.
Ten months later, at the end of my sophomore year at Lawrenceville, the school psychologist called me to his office.
"I've talked to your Aunt Donna," he said.
"I don't have an Aunt Donna," I replied.
"Yes, you do," he insisted. "Your biological aunt."
My heart dropped to the pit of my stomach. I couldn't breathe. Then he gave me the rest of the news. The registry had located my great-grandmother, two aunts, two half brothers and a half sister. By then, I had already guessed what he was leading up to: My mother was dead.
"How?" I asked.
"Suicide," he said.
My longing ended, and another nightmare began.
Doomed to Darkness?
Early that afternoon two very tall white women with green eyes and salt-and-pepper hair walked into my dorm's common area.
"Would you like me to go upstairs and get someone?" I asked, sure they were here for one of my white dorm-mates.
"I'm your aunt," one of the women said.
"There must be a mistake," I said. "My mother wasn't white."
That was only the first thing I didn't know about my family. My aunts and my mother were of mixed race, part Bahamian, part Italian, they told me. Each of my siblings had a different father. And my father?
"Unknown," they said.
"We're a dysfunctional family," my elder aunt said before she even told me her name.
That same day we drove to Montclair, N.J., and pulled up in front of a one-story house where my mother and her sisters lived after my grandfather, a gangster, was murdered and found floating in the Hudson River. It was the house they lived in when my step-grandfather shot and killed my grandmother in front of her children. It was the house where they found my mother hanging from bedsheets she had tied to a hook in the ceiling. She died four years after I was born, and three years after she had given me up to the state. She was 25.
My mother, her name was Robin, made frequent trips to mental hospitals throughout much of her life, according to my great-grandmother. "She was sick in the head," my great-grandmother said. "We didn't call it bipolar disease then."
I learned that Robin played four instruments--piano, violin, flute and guitar. Everyone who knew her said she was an extremely intelligent and troubled person. She was fastidious, sad and always sat in front of a window with the blinds shut, often staring at who-knew-what on the ceiling.
This wasn't how I pictured it. I was guilty of foolish hope. I had always imagined that I would find my biological family and be enfolded in love. The past would be forgotten.
Instead, I was left with questions and anxieties. Was I doomed to follow my mother into darkness?
I comforted myself by counting the ways that I had already diverted from her path. Robin had two children by the time she was 18, and by 21 gave birth to two more. I was child-free. I survived the war at my adoptive parents' house by running away, escaped foster homes and youth shelters for two more years, won a scholarship to a prestigious prep school and received another scholarship to attend college and play basketball. I had fulfilled my ultimate dream of finding my family.
With all my success I still could not escape the darkness. Though I maintained an often uncomfortable relationship with my biological relatives, by the spring semester of my senior year, I had realized that my family and I did not share the same dream. For them, I was part of a past too painful to dwell on, not part of an optimistic future.
One morning that spring, with prep school graduation two weeks away, at a moment when all the people around me expressed how proud they were of me for making it against steep odds and being on the brink of a bright future, I woke up to the same sunlight I'd seen on every other recent morning. But for some reason, on this one it seemed far too bright, painfully bright. I could barely drag myself from bed long enough to pull down the shade. All I knew was that suddenly, there were too many colors in my room and too much life that I didn't understand or want to be part of.
Tears poured from my eyes and I didn't know why. Yes, I had been sad because of all I had learned of my mother, and because I never got to know her and never would. Yes, I was haunted by her eyes in the photo by my bed, my eyes. And I still hated the scars on my face and the chipped tooth in my mouth--the handiwork of my adoptive mother.
But these tears came from somewhere else, a part of me that had been waiting to come alive and make me recognize it. A part of me that doctors would later tell me had been sown into my genes, and would have ambushed me at some point no matter how idyllic my life might have been.
Now that it had emerged, my bed became the only place I wanted to be. The dark world underneath my cotton sheets gave me the only solace I could find. I daydreamed that it was the bottom of the ocean, deep in outer space, buried in a casket and a grave. Although my bed became none of those things, it understood me and was my bathroom and last resort for three days before the school psychiatrist helped me out of it and placed me in a room with no windows for almost two weeks.
"If you don't eat, we're going to send you to the psychiatric hospital. They don't beg you to eat, they'll put an IV in your arm," one of the nurses threatened. But I still refused to eat or drink, not out of defiance, but simply because I wasn't hungry or thirsty. All I needed was solitude and sleep. In the process, I hoped to close my eyes and die.
Many days passed and the psychiatrist diagnosed me with bipolar disorder, the same disease that had caused my mother to take her own life. She put me on Elavil and Paxil, both antidepressants. Gradually I came out of what I came to think of as a "rough spot." I told the doctor that I didn't have a mental disorder and refused therapy and medication.
Life seemed to return to normal. I graduated, played basketball and seemed my usual jovial and resilient self. I looked forward to my freshman year in college and putting my past behind me.
But it didn't happen that way. In November 1996, I woke to the same nameless despair that had felled me before.
The doctors said I had to learn how to manage my illness and that medication was the way to do it. But sometimes the medications made me feel even worse, causing dry mouth, skin rashes, nausea, tremors, weight loss, sleeplessness, confusion, headaches and anxiety. With school and sports as my focus, I was too busy and preoccupied to remember to pop open a pillbox two or three times a day. Going to the pharmacy for refills and the hospital every six weeks for liver function tests was exhausting, embarrassing and a financial drain.
There was always someone who said all I needed was God and prayer. Some people reminded me how blessed I was to be in a good school, to be smart, athletic and attractive. But when I looked in the mirror all I saw was a troubled person on the verge of breakdown.
When I was drug- and therapy-free I dealt with manic episodes and depression alone. When I was depressed I lost interest in things I enjoyed doing. My blinds were always shut and the lights turned off. I watched sad movies and played morose music. I went days without eating, or being seen or heard from.
At first, I enjoyed the manic episodes, which came mostly in winter. The infinite energy, racing thoughts, ability to go without sleep for days and unshakable conceit made me feel like a demigod. I skipped classes, emptied my bank account and thought every little thing I had to say was important and everyone else should shut up and listen.
And then I crashed. Two manic episodes ended in failed suicide attempts. Intellectually I knew suicide was an illogical solution to a temporary problem. But when I found myself trapped in the vortex of the problems, suicide made perfect sense. An end to pain.
No day passed when I didn't think of taking my life. I constantly fought impulses to jump in front of cars, leap off buildings, slit my wrists or put a bullet in my head. Last March I swallowed more than 100 pills--a concoction of Eskolith, Depakote and Tylenol. As I waited an hour to die, I only got sick and spent the night in the emergency room getting my stomach pumped and feeling liquid charcoal drip down the back of my throat through a tube in my nose. My hands and ankles were strapped to the bed until I was moved to the psychiatric ward among patients who talked to themselves, paced the hallways or threw fits.
Being in the locked ward made me feel like a prisoner. There was nothing to do all day except watch the madness surrounding me. At times I felt I was being driven out of my mind. When the floor chief reneged on a promise to discharge me, desperation broke over me in a wave. I lost control and threw a wooden chair. Of course, the doctors saw it as confirmation that I was too unstable to go home. I heard a loud buzzing and a code number echoed over the loud speaker. Four large men and a nurse ran down the hallway and wrestled me to the floor. They dragged me, still fighting and yelling, down the hall to the "quiet room," which was the size of a prison cell and empty except for a plastic mat. Before they locked the door, the nurses stripped off all my clothes and put a gown on me. Then I felt a needle being pushed into my backside. In less than 30 seconds I was asleep. When I awoke hours later, still lying on the plastic mat, I gazed up at the white ceiling wondering if my life was just a dream.
But reality soon crushed back in, a reality that was worsening as I got older. I had been hospitalized eight times in 2 1/2 years. Medications failed. I saw nothing but misery and longed for peace.
As a last resort, I put my faith in electricity.
I watched the anesthesiologist insert the IV into my right hand. I turned my head to tune out the needle's sharp pinch and the stinging fluid of the fast-acting anesthetic and muscle relaxant rushing through my vein. I listened to the blip of my heartbeat and watched the jagged eruption of green light with each pulse on a small video monitor as the blood pressure cuff squeezed my arm.
"Okay, Ms. Patton, you're gonna take a little nap," the anesthesiologist cooed.
As he uttered those words, the doctor who administers the treatments appeared. He was a stiff, large man who walked with thudding footsteps and rarely showed any emotion. I thought of him as Dr. Frankenstein. I watched that emotionless face as the room began to spin, then darken into a dream with no colorful images. I saw nothing. Heard nothing. Felt nothing.
I can only assume what happened based on what I was told about the procedure: Dr. Frankenstein pushed a button and sent enough electricity through my brain to light a 50-watt light bulb. For less than one minute I had a predictable induced seizure.
The Shock of the New
ECT was the brainstorm of Ugo Cerletti, an Italian psychiatrist who was zapped with inspiration in the mid-1930s after watching slaughterhouse workers use electric shock to cause seizures in pigs. The shocks and resulting fits had a calming effect on the animals, and eased the job of slitting the pigs' throats.
In those days, patients who had natural seizures were frequently confined to mental institutions. Cerletti returned from the slaughterhouse and began to observe those patients. Sure enough, he noticed drastic changes in their mood--calmer, more engaged--after epileptic seizures. He speculated that there was a relationship between mood and seizures.
In Genoa, and later in Rome, he used an electroshock apparatus to provoke seizures in dogs and other animals. Although many animals died, their ultimate sacrifice made it possible for Cerletti to refine the technique enough to use on a human.
In April 1938, a diagnosed schizophrenic with delusions and hallucinations received a series of electroshocks and, according to Cerletti, returned to a calm and untroubled state of mind.
Although shock therapy has been performed for decades since Cerletti's discovery, no one could tell me precisely how it would combat my depression. There are theories. One suggests that shock treatment acts like antidepressant medication by changing the way brain receptors receive important mood-related chemicals such as serotonin, dopamine and norepinephrine. Another notion is that shock-induced seizures dampen abnormally active brain circuits, thus stabilizing one's mood, and yet another ascribes the changes to reactions in the hypothalamus, the part of the brain that regulates water balance and body temperature. After an induced seizure, the hypothalamus releases chemicals that cause changes throughout the body, and possibly alter mood.
The most disturbing theory suggests that the "improvement" is actually a byproduct of impairment, brain damage caused by the treatment, which results in memory loss and disorientation and creates a temporary illusion that the patient's problems are gone.
In my case, even the illusion of improvement was something to look forward to.
Awaiting the Light
When I opened my eyes many hours after my first treatment, I didn't know where I was. The locked window next to my bed reminded me that I was in the hospital. I had a throbbing headache and severe nausea. My afternoon was spent hunched over the toilet bowl vomiting and massaging my inflamed temples.
Over the next 11 days, I had five more treatments. After each one, I felt horribly sick and confused. The pain was intense enough that I began to question why I had let myself in for this. I understood what poet Sylvia Plath had meant in her autobiographical novel "The Bell Jar" when she said of her shock therapy experiences, "I wondered what terrible thing it was that I had done" to deserve the pain. I tried to force myself to believe that it would pass, and I would feel happy again.
As my release from the hospital neared, the symptoms eased. Each treatment was a little easier to weather. When I left St. Vincent's, I had a smile on my face; I felt relaxed and renewed.
I woke up the next day, the first day of the rest of my life, looked at a very close friend and said, "Who are you?"
She laughed, until she saw the tears in my eyes. I wasn't joking.
I felt empty, like a prop onstage where everything else around me had life, meaning and a purpose. I was in the middle of some big theatrical performance and I didn't know my lines, or even which character I was supposed to be.
The days passed in an agonizing void. I studied myself in the bathroom mirror. As I looked at the color of my skin, the thick braids dangling from my head, the sleepy eyes and taut muscles, I wondered how I had gotten this way. I traced the tattoos on my arms and I asked myself what could have possibly possessed me to scar myself like that. I touched every scar on my body, and then the scars on my face. Flashes of an extension cord whipped across my memory. But I couldn't feel the pain associated with those violent moments of my childhood.
My left hand stroked my left knee. I couldn't figure out why it ached, why it was swollen and why there were three incisions across my kneecap.
"You had surgery in April," my friend told me. "It was the third time."
I shook my head and wondered how I could play a sport that took such a toll on my body.
Questions I had about myself played tug of war in my head. Why was I such a tomboy even at age 21? Why did I have so many pairs of brown shoes?
I had been so busy trying to escape the pain of my past, I had never realized how important memory could be. Now ECT had erased both the pain and the past.
After four days of total confusion and fear that I had lost not only my mind but my self, a fear so intense I sometimes wondered if it was worth living, the memory loss began to wear off like a heavy dose of Novocain at the dentist.
Now it has been eight weeks since my last treatment. My memory has, for the most part, returned. The pain has stayed away. I know it is too early to celebrate, but I no longer feel depressed or suicidal.
Statistically, I have encouraging, but sobering, odds. Harold Sackeim, professor of psychiatry and radiology at Columbia University and chief of the department of biological psychiatry at the New York State Psychiatric Institute in Manhattan, says that 80 percent of those who undergo ECT report significant improvement immediately after treatment is completed and at least half of those continue to benefit for one year or more. Still, that means that many relapse.
There can be some long-term side effects of memory and function loss, but I know of at least one unexpected side benefit: Electroconvulsive therapy made me want to be a better person. For years I took my mind and my reasoning skills for granted. I did well without serious effort. After losing my memory for those four days, I promised I'd never take my mind, life, friends, happiness or simple things for granted again.
Some people close to me say I've changed. They say I'm more serious and less emotionally needy. On the other hand, I smile and laugh more. I even can laugh about the shock treatments: as my new e-mail name I've chosen "Electrogirl." Bad memories don't haunt me now.
But the true test is ahead with the coming of winter. Every day the sun goes down precious minutes earlier. I can feel night slipping toward me, and an onrushing chill in the air. When it rains, I feel like crying. When it's cold, I feel my loneliness urging me to seek that dark world under my sheets.
But what is electricity for if not to light the darkness and chase away the cold? Perhaps it has done that for me.
I can only wait, and hope.
Stacey Patton is a junior at New York University and a member of the women's basketball team. She is working on a memoir titled "Somebody's Child."