Tuesday, April 12, 2011

Shock Therapy

Here is an article on Kitty Dukakis and Electroschock Therapy, originally published in the December 2007 issue of Brookline Magazine. I was skeptical of her "cure," and she was unhappy with the tone of the article. We were threatened with libel, but since I took good notes from our interview, I kept my job for another year (when the magazine went bankrupt.)


A shocking story?

A Controversial Treatment for Kitty Dukakis

By Jared Manley

1,849 words

Sometime in the early 1930s, an Italian neurologist by the name of Ugo Cerlitti happened to observe what was then a standard procedure of Roman slaughterhouses: butcher zaps pig with a jolt of electricity, pig falls into a seizure and loses all sense of pain, butcher kills pig. Cerlitti–a stern-faced man with a strong resemblance to Vincent Price–was inspired and began testing what the effects of electricity-induced seizures would have on other animals, eventually figuring out what voltages would not cause any visible harm to his subjects. At this time, convulsions caused by insulin and metrazol were thought to temporarily curb psychotic episodes in the mentally ill, leading Cerlitti to reason that a controlled seizure from electricity would have a similar effect. In April of 1938 he tested this theory on his first human subject, a schizophrenic that police had found lurking around a train station in Milan, muttering incoherently about telepathic voices in his head.

Ten sessions of one-hundred-volt blasts to the brain later, the patient stopped hearing the invisible voices and actually forgot that he ever had. He was reunited with his wife and was judged well enough to hold a steady job, thanks to Cerlitti’s inexpensive, simple treatment. Cerlitti made his procedure public, and it became a fashionable panacea for mental ailments such as schizophrenia, depression, alcoholism and even homosexuality. Though Cerlitti dubbed this mysterious procedure “electroshock therapy,” he later regretted that it became popularly known as the more frightening term of “shock treatment.” It was eventually agreed that Electroconvulsive therapy (abbreviated as ECT) is the more politically correct version of the two.

But with or without the more edgy name of “shock treatment,” ECT gradually fell out of favor and became notorious for its undesirable side effects, including temporary and permanent memory loss. The media became distrustful. Its portrayal as a torture device in the Ken Kesey novel One Flew Over the Cuckoo’s Nest (1962) and successful Hollywood movie (1975) frightened a whole generation away from ECT. When pharmaceutical drugs such as Prozac first appeared on the market, suddenly blasting electricity into your head instead of popping a pill seemed barbaric—about as obsolete as leeches.

By the mid-1980s ECT had become reserved only for the most extreme of cases. But about a dozen years ago, ECT–quietly but with no shortage of controversy–started to gain more credibility among doctors and patients. Glowing testimonies from contemporary patients have clarified some of the mystery and fear over ECT. Its most outspoken supporter would probably be Brookline resident Kitty Dukakis, who began receiving ECT therapy in 2001 for clinical depression. Within the past year, Dukakis has made radio and television appearances to tout the benefits of ECT, though the most compelling praise for ECT can be found in her new book Shock: The Healing Power of Electroconvulsive Therapy. Co-written by medical journalist Larry Tye, Shock presents a revised opinion on an old therapy: ECT can be safe and effective.

Because most doctors do not want to be caught in the act of raving about ECT, Shock has the potential of being one of the more surprising and controversial non-fiction books of the year. However, the end result is far from being completely convincing, though it is a good place to start if you want to hear the good, the bad and the bizarre stories of ECT. Co-author Larry Tye has done a compelling amount of research on the benefits of ECT and still does an admirable job at not sounding too in love with the notorious therapy. In between these more objective chapters of the book, Kitty Dukakis recounts her story with ECT, her life before and after the treatment that she claims dramatically changed her life for the better. This dichotomy between reporting and storytelling elevates the book’s readability above the level of robotic medical literature. However, readers should know that if they are already wary of ECT, the book will probably not change his or her mind, though the scope of Tye’s research and Kitty’s enthusiasm is impressive nonetheless.

As chronicled in Shock and her 1991 memoir Now You Know, for most of her life Kitty has suffered from crippling bouts of depression and drug abuse. She was hooked on diet pills for twenty-six years, alcohol for even longer. “During the long hours between campaign stops, I would anticipate that sweet cocktail when the day’s politicking was done,” writes Dukakis in Shock. Kitty’s desire to drink would come on so strong that she resorted to taking shots of rubbing alcohol when there was no other liquor in the house, a blunder that almost killed her, though it ultimately convinced her to sober up.

However, Kitty still felt helpless against the clinical depression that persisted even after she sobered up in 1989. Anti-depressants would work for a few months before their effectiveness would inevitably falter, leaving Kitty without peace of mind and uncomfortable side effects. “Fun and enjoyment are things I cannot even imagine,” wrote Dukakis in the book’s introduction. “I couldn’t cry. I would become anorexic, losing as much as fifteen pounds. I would fall apart and start to drink.”

On June 19 2001–the eve of her thirty-eighth wedding anniversary–Kitty fell into a depression so merciless that she decided to check herself into Massachusetts General Hospital. Knowing the history and persistence of her depression, Kitty’s doctor suggested ECT. It had been brought up to Kitty several years before, though she was terrified at the notion of it and refused. But on this night, Kitty felt that she had tried everything else and scheduled her first ECT session for the following morning as “a last resort.”

After the procedure, Kitty woke up with a slight headache and found in her hair goo left over from the electrodes. After shaking off the dizzying cloud left over from anesthesia, Kitty noticed a change in her mood immediately, which was unexpected considering the severity of her case. The near-suicidal depression of the previous night had completely dissolved. There was no desire to drink. She even felt cheerful enough to go out to dinner with her husband later that night for their anniversary. “Feeling this good is truly amazing given where I am coming from, which is a very dark place that has lasted a very long time,” wrote Dukakis. She found that her emotions and social graces returned. She once more enjoyed shopping. And she finally felt able to cry over the death of her father, a mourning that had been stalled by the numbing effect of the medication she was taking. “It is not an exaggeration to say that electroconvulsive therapy has opened a new reality for me,” wrote Dukakis towards the book’s conclusion. “It has given me a sense of control, of hope.”

However, these results are not guaranteed. Most patients do not feel the positive effects of ECT until they have received at least five to twelve sessions, though others have also reported feeling better immediately after the initial treatment. Unlike most pharmaceuticals, the results of ECT usually do not weaken over time, though some – including author William Styron – have found their first ECT to be effective and subsequent treatments to be useless. Typically, ECT produces its desired effect after five to twelve sessions and additional treatments can be trusted to bring about the same results when the peace of mind wears off. Since 2001 Kitty has had seven rounds of ECT with intervals averaging at eight months, now calling herself “completely calm” over what she refers to as a “comfortable procedure.” True, modern ECT is much more comfortable than in Cerlitti’s time. Broken jawbones and cracked teeth are a thing of the past. Muscle relaxants have reduced the once violent convulsions to the mere twitching of the big toe, and anesthesia ensures that the patient sleeps peacefully through the procedure.

Despite its success stories, paranoia over ECT did not spring up unfounded. Stelian Dukakis, Michael’s brother, received ECT treatment in the 1950s for depression that stemmed from getting dumped by a girl. “Stelian was never really the same person,” Dukakis recalled. “He had a zombie-like look, which melted the heart of everyone who knew and loved him.” Cases like this–though extremely rare–are responsible for ECT’s reputation as being slightly more benevolent than a lobotomy. In the early 70s, folk musician Townes Van Zandt underwent ECT for alcoholism. It didn’t do much to calm his drinking; ECT also erased all his childhood memories. No matter how many photographs he looked at, the introspective songwriter never could remember anything before the age of fourteen. Though cases such as this are unheard of with modern ECT treatment, the risk of temporary – though occasionally permanent -- memory loss is an side effect too common to be ignored.

To her credit, Kitty devoted an entire chapter (appropriately titled “I Forgot”) to her ECT-related memory loss. This includes small goofs–forgotten doctor’s appointments–as well as more upsetting losses. For example, Kitty has forgotten every single moment of a weeklong vacation to Paris that she took several months before her first treatment in 2001. Her daily ritual of picking her husband up from his teaching job at Northeastern University is occasionally hampered when she cannot remember what street to turn down. When interviewed over the telephone about the writing process of her new book, Kitty was unable to recall certain details and seemed frustrated. Simple questions were--for the most part--left unanswered.

“It is a price I was told I might have to pay,” wrote Dukakis. “I would do it again. The choice is simple: Would I rather be depressed or forgetful?” Does this mean that Kitty would recommend ECT to just anyone with depression? Not quite. The final words of the book read like a disclaimer to the curious, and a shoulder shrug to anyone that would rush to condemn her. “I fully expect to be attacked,” wrote Dukakis. “I feel like I am putting a target on my back for ECT’s critics. So let me be clear. I am saying that ECT worked for me, not that it will work for everybody. There is too much need for open discussion to continue the vitriol and finger-pointing that have characterized the last half century of debate about ECT.”

If nothing else, Shock’s controversial angle will come as a relief to some ECT patients. Its candid, unapologetic account on depression and substance abuse is a testament of her dedication to promoting a better understanding of ECT. “Shock was actually a very personal story,” said Dukakis. “It flowed very easily because ECT has become a huge part of my life. I felt I had an obligation to help others and to de-stigmatize the public’s perception of ECT.” For years, Kitty was too embarrassed to admit to her friends and family that she had received shock therapy and continued to do so at least once a year. To stop this from happening to others, Kitty is planning to form a support group of ECT patients who have had both positive and negative experiences. For better or for worse, Kitty’s unabashed rhetoric might win some new converts to ECT. “I want to help open the door for people who are too afraid to try ECT treatment,” said Dukakis. “It’s been a very gratifying experience.” So far, the public’s reactions have been gentler than the attacks that Kitty’s conclusion to Shock first anticipated.

Perhaps the most convincing testimony found in Shock (not to mention the most damning to the dental industry): Dukakis considers shock therapy to be far “less traumatic” than a visit to the dentist. “Lots of doctors think I am crazy for thinking something like that,” she wrote.