Walter De Maria, 1977
“Sanity is found at the centre of convulsion, where madness is scorched from the bisected soul.” – Sarah Kane
As we work towards opening 4.48 Psychosis, my assumptions regarding mental illness continue to be challenged in the best way possible. One thing that’s been discussed in rehearsal and around the office this past week is Electroconvulsive Therapy (ECT), the ubiquitous treatment that is divisive as it is mysterious.
ECT has been around in some form since the late 1930s, and but it remains unclear exactly how it modifies the brain the way it does. Fundamentally, ECT is an induced seizure, electricity delivered to the brain through brief-pulse currents. The muscles are depolarized with a relaxant to limit the convulsions. What is known is that ECT produces a variety of temporary and long-term affects within the human brain, changing thought, feeling, and behavior.
Naturally, ECT has a contentious reputation. Our brains are the safe and source of our identities—our sense of self. When historically the treatment was used to control so-called misfits and deviants, how are we to see it as a potentially beneficial form of treatment for chronic depression? The truth is that ECT is
n’t good or bad in and of itself. It is a powerful tool that can be used and misused by anyone with access to it.
Is ECT a “brute force assault on the brain,” as it was described in this Toronto Star cover story from mid-December? There is no denying that people who’ve undergone ECT have experienced adverse cognitive effects. But the more I learn about it, the more I have to entertain the idea that it is more (and less) than crude or brutal or damaging.
In a recent conversation, my friend Emily mentioned the possibility that one day we might look back at chemotherapy with as much skepticism as we now observe ECT. Chemotherapy has been derided as poison, but it continues to be used to treat cancer because of one undeniable factor—it works.
The upshot of Emily’s analogy is clear: we will never get rid of a treatment that, even as it damages one thing, palliates another. As soon as something better, faster, or cheaper comes along, the paradigm will shift, and we are free to condemn something as arcane and inhuman.
I can neither endorse nor refute ECT as a form of treatment. My limited experience with it is that my grandmother, who suffered from (what was then called) manic depression, underwent multiple rounds of (what was then called) Electroshock therapy. In my mind, my grandmother was fun and creative and energetic, sometimes frighteningly so. Periodically, she would electively check herself into a treatment facility, and upon return, would appear glassy-eyed and distant. Not herself. But in time, she’d come back. It was a relief, and I often wished that she wouldn’t go for those treatments, which I imagined involved an electric chair, upholstered in floral chintz like the furniture in my grandmother’s living room.
Now I am older, and I see that ECT not a magic bullet, nor is it a form of torture. It has helped some, and not others. Some treatment facilities and administrators apply it judiciously, and some don’t. How do we think about it? Is it a political, ethical, moral, or medical issue? Is it all of these things?
I’m curious to know.