ow does it work, Dr. Benson?”
“That’s the thing, Trent—we don’t know how it works,” I said.
“You’re kidding. You don’t know how it works?”
“Then how do you know it even does?”
Trent sat on the couch across from me, next to his wife, with his arms folded across his chest. He pushed his jaw out and stared at me.
“Trent, I’m not here to force this on you,” I said. “It’s just an option. Nothing else has worked, and it is something to consider.”
“I thought they didn’t do this anymore,” he said. “I thought they stopped doing this a long time ago. I mean, come on! You’re talking about running electricity through my brain, and you don’t even know how it works. Do you think I’m crazy? I’m not crazy!”
I had heard this reaction from many patients over the years, as I discussed electroconvulsive therapy with them. The topic brought up fear and revulsion, images of Jack Nicholson strapped down and held by muscular men as the doctor in One Flew over the Cuckoo’s Nest bent forward with the two electrodes to touch his skull and cause the violent, grimacing, arm-and-leg flopping seizure as his brain slowly melted in the grip of the electricity.
This is the image most people have when they think of Electroconvulsive Therapy. Shock treatments. They so often see the treatment as a violent assault on the brain, and at some subconscious level, it is perceived as a punishment.
A punishment—yet it is the most effective treatment we have for those so severely depressed that nothing else has helped alleviate their suffering. And even I had mixed feelings about this treatment. I tried to communicate to my patients, those who came to talk to me about it, that it was now a safe and humane treatment, free of pain. But it was also a frustrating treatment, a procedure whose mechanism we did not understand. There were theories, of course. Many of them. But it remained a puzzle. More than seventy years after its discovery, we did not know how it worked.
Perhaps this was what lay at the heart of my frustration. I could talk to my patients about all the details related to the treatments, but I had to admit to them that there was a huge gap in our understanding of this most dramatic of all psychiatric treatments. I believed in the treatment. I had seen it work with my patients, many times leading to dramatic, miraculous changes in their lives. I had seen people devastated by depression—those curled up on a bed with no hope at all for anything beyond an existence framed by the four walls of a darkened room—rise up and leave those rooms.
But how did it work? My patients, for the most part, seemed satisfied with answers like it increases the neurotransmitters, the chemical messengers between the nerve cells in the brain; the effect seems to be related to this change. But there remained the mystery of the effect. It was almost like a voodoo cure, with no rational western scientific explanation.
I looked over at Trent’s wife, Carla. She smiled weakly at me and shook her head back and forth.
“Come on, Trent,” she said. “Just listen to what he’s saying. What do you have to lose? Nothing else has worked. Nothing at all. The doctor has tried every medicine there is, and you still just mope around the house. You can’t sleep. You can’t eat. You tell me life isn’t worth it and you just want to die. For God’s sake, what could be worse?”
She finished speaking and leaned back on the couch. Trent looked over at her and frowned.
“Sure,” he said. “Sure. It’s all easy for you to say. You don’t have to live with this shit like I do.”
I smiled at Trent. I tried to make it a reassuring smile, but I wasn’t sure that I succeeded. Trent was a new patient for me, referred to me by his outpatient psychiatrist, Don House, who specialized in treating severely depressed patients, patients resistant to treatment with medications and therapy.
Trent’s wife switched her focus to me now. She looked away from her husband, but she kept on talking as if to him, and I could see tears beginning to form in her eyes.
“Damn it, Trent,” she said. “Who the hell do you think you are? I cringe when you wake up in the morning. I cringe when you come in through the door. Our daughter, our beautiful four-year-old daughter, she asks me all the time, ‘What’s wrong with Daddy?’ Did you know that, Trent? Huh? I don’t know what to tell her anymore, it’s been going on so long!”
Carla covered her eyes with her hands and lowered her head slowly into her lap. I looked at her, then over at Trent. He looked at his wife sadly. Seconds passed, then minutes, as he stared at her. Finally he spoke.
“I’m sorry, baby,” he said. “I’m so sorry. This goddamn depression eats me up; it eats at me like an animal tearing at my insides until I can’t think of anything else at all.”
He reached inside his breast pocket and pulled out a cigarette. As he put it between his lips, I leaned forward—I was about to tell him that he couldn’t smoke in my office—and then I stopped. Something about Trent, something about his desperation, stopped me. I let him light the cigarette. The smoke rose from the tip of the cigarette, and the smell of tobacco spread through the room. Trent leaned back in his chair and inhaled deeply. The smoke came out through his nose and mouth, spreading out and covering everything between us.
“OK. OK. Tell me about this procedure, doctor. Tell me about these shock treatments.”
“What would you like to know?”
“Does it hurt?”
“No. No, it doesn’t hurt. An anesthesiologist puts you to sleep, and then we give you the treatment. We cause you to have a controlled seizure while you’re asleep. You don’t feel anything, and you won’t remember anything either. It all just takes maybe ten minutes or so, and then you wake up. That’s all there is to it.”
“If it’s so easy, how come more people don’t have it done?” Trent asked.
“Because they’re scared,” I said. “They’re afraid, and some of them just can’t get beyond that fear.”
Trent leaned his head back and inhaled deeply on his cigarette. He looked over at his wife and tried to smile. She had raised her head now, and she smiled back at her husband. The mascara had mixed with the tears under her eyes, and it formed dark circles in the shape of half moons.
“I’m glad you’re listening to him, baby,” she said.
“I don’t know what to do, Carla. What if this—this treatment fries my brain? What if it erases my memory, so I don’t know who you are, or who our little girl is?”
I have performed these shock treatments for going on twenty years, and I have seen so many patients in consultation tell me that they had no hope of ever getting better. And so I reviewed the treatment with Trent, concluding with what I always told my patients.
“There’s no evidence that it will cause permanent brain damage, or any long-term memory loss. It’s true, we don’t know how it works. But we do know that it works. It can pull people up out of depression when nothing else will.”
I thought again of the puzzles in medicine. There are many treatments that we do not fully understand. For all the common medications that we use, for pain and diabetes and all manner of things, the mechanism of action of these medications is not understood. But we tell our patients that we can help them with these agents. And it seems that the more we surround our explanations with scans and machines and tests, the more convincing we become.
Trent looked at his wife and nodded. He wiped the back of his hand across his face.
“There’s nowhere else to go, Carla. I’m gonna die if I don’t do something.”
Now it was Trent’s turn to cry. The tears came suddenly, springing up into his eyes and coming out over his cheeks. He raised his right hand to try to stop them, but it was too late. His sobs racked his chest and burst out into the room.
We started the treatments early on a Monday morning. Two nurses wheeled Trent into the room, and he looked up at me from his stretcher as he rolled into view. He tried to smile at me, but the muscles in his face were tight, and his eyes moved back and forth as he looked around the room.
“I hope you’re ready, doctor,” he called out. “I hope you got lots of sleep last night.”
Trent smiled, and then he tried to laugh at his own joke. But the laughter caught in his throat. It rattled around and emerged in a short, choking sound that barely cleared his lips.
“I’m all set,” I said. “Just try to relax, and this will be over before you even know we started.”
And it was. The anesthesiologist injected his medicine. Trent’s eyes rolled back in his head, and he was out within a minute. That’s the thing about ECT treatments. The whole procedure takes only about twenty minutes. First, the patient gets a short-acting anesthetic. Once he loses consciousness, within a minute or two, he gets a muscle-paralyzing medicine to stop him from having violent contractions when I cause him to have the seizure. Then the anesthesiologist places a soft rubber mouth protector in his mouth, to protect his teeth and gums.
I bent down and applied a circular black paddle to each side of Trent’s head, and I adjusted the placement of the paddles to make sure that I had good contact with his skin. Then I pressed the orange button on the end of one of the paddles and watched Trent’s face.
Trent grimaced, and the muscles in his face tightened and snapped into a frozen mask as the rest of his body came up slightly off the stretcher. He stiffened for an instant, and then his arms and legs began to flutter in tiny trembling movements that grew and grew until his entire body was shaking. I watched his face as his teeth tightened down on the rubber mouth protector and the muscles flared out across his cheeks. His expression looked almost sexual as the corners of his mouth spread out and his arms and legs bounced up and down softly off of the stretcher.
The seizure lasted about forty-five seconds, and then it stopped, as quickly as it had come. Trent’s body relaxed, and his head fell back onto the pillow.
“Good seizure,” I said to the anesthesiologist.
“Great.” He nodded to the nurse and smiled. “That’s it, then.”
Trent awoke slowly over the next ten minutes, and as he came fully awake he asked what many of my patients ask after a shock treatment.
“What? Is it over? Did I have the treatment already?”
Trent had a series of nine treatments over the next three weeks. After each one, he awoke as puzzled as he was after the first. He would look around, blink a couple of times, and then slowly reconnect with his surroundings. He tolerated the treatments well, with only mild headaches and some difficulty concentrating, which made it hard for him to read.
These were common side effects, these headaches. Some patients had upset stomachs, even nausea, which could be treated easily enough. More difficult, when it happened, as it did to many people, was the short-term memory loss. There was no real way to treat this, but it would clear up once the course of treatment was finished.
But the best thing, the best thing of all, was that Trent began to feel better. This was true for 70 percent or more of patients who went through a course of six to twelve treatments. Trent started to feel his depression lift after the fourth treatment. This was when he began to smile. He didn’t even notice it at first, but his wife did.
Carla sat in front of me in one of the recovery rooms at the hospital. She was leaning back on a metal chair next to her husband, who sat in a large, padded chair.
“He’s smiling again, doctor,” Carla said. “He’s playing with our daughter. I can’t believe it. He hasn’t played with our daughter in so long I can’t even remember.”
Carla wiped the back of her hand across her face. Then she expressed the fear I knew was there.
“This won’t stop, will it? I mean, he won’t suddenly go back to how he was, will he?”
I had been asked this question so many times over the years, always with fear.
“Nothing should happen ‘suddenly,’” I said. “Depression doesn’t come on fast, and it doesn’t go away quickly either. If Trent starts to become depressed again, we should be able to catch it before it goes too far.”
“God, I just pray he’ll keep getting better. I want it more than anything. I want it for all of us.”
Trent did feel better and better, until he felt “great,” and his life began to turn around—until he was up and doing things and playing with his daughter and going to work and making love to his wife. And at that point, I stopped the course of electroconvulsive therapy and referred him back to his outpatient psychiatrist.
“Thank you, doctor,” he said. “Thank you. Thank you. You’ve given me my life back.”
I always felt a sense of sadness once I completed a course of this treatment. I worked as a consultant; these were not my regular patients. I tried to keep track of them, through their outpatient psychiatrists, but sometimes it was impossible to keep up with them.
I was happy for Trent. I felt good about my role in his treatment. But he wasn’t really my patient anymore.
It was several weeks later, around Christmas, that my pager vibrated while I was sitting alone in my office.
Christmas. It was a hard time of year, for me and my patients. All of the pressure to be happy, to smile, to buy gifts and hug the family. God, it could be awful. It all crashed together, and I wanted to be somewhere else.
I looked down at the number on the pager, hoping it was my wife, Leah, calling to chat. She did this every day around this time, eleven in the morning. It was our ritual. But this time, it wasn’t Leah. It was someone else. The number looked familiar, but I couldn’t place it. When I dialed the number, a man’s voice on the other end picked up almost immediately.
“I can walk on water!” he shouted. “I can walk on water! I can fly! I can turn water into wine!”
The exclamations stopped only for an instant—long enough for me to get out a few words. “Pardon me?” I asked. “Do I know you?”
“Do I know you?” He repeated the question. “Does it matter? I know everyone. I know everything. Do you know who you’re talking to, my friend? Do you have any idea who you’re talking to?”
The questions came at me, one after another.
“Excuse me,” I said. “I don’t know who you are, sir. I have no idea. Please slow down.”
The voice was high-pitched, almost squeaky, like a nail scratching over steel. But there was something about it, something …
And then I knew, and the knowledge slapped at me. It was Trent.
“I sit at the right hand of God,” he said. “That’s who I am. That’s where I sit. Now do you know who you’re talking to? That’s right. You are talking to Jesus Christ himself, right here on the telephone. In fact, you have my phone number now.”
He started to laugh, and the sound rolled out through the phone and into my ear like thunder. The laughter went on for a long time, until it slowly subsided into squeaky peals and giggles.
“You have got the personal, direct phone number of Jesus Christ himself. Put it in your Rolodex now, and don’t you lose it. And don’t be calling me collect, either. Heaven is loooong distance, and the charges add up real fast.”
The laughter burst through the line again. Then I heard voices arguing, a struggle ensuing in the background.
“Give me that phone!” someone said.
“No,” came the reply. “No. Get away from me. Give me that back.”
Then a woman’s voice came on.
“Doctor? This is Carla Mathis,” she said. “Trent is out of control. My God, he thinks he is God, and I don’t know what to do. He thinks he can fly. He thinks he can walk on water. What am I gonna do?”
“Try to calm down, Carla,” I said. “Take a deep breath and try to slow down a little.”
There was a long pause on the other end of the line, and I waited until I thought she was ready to answer my questions.
“Now tell me, has he done anything dangerous?”
“I don’t think so,” she said. “He keeps walking around the apartment looking at the windows, but I don’t think he’s going to do anything.”
“OK,” I said. “OK. I think he’s moved into a manic phase of his illness. It happens sometimes. The most important thing is to be calm, and to try to reassure him that we’re going to take care of him, and nothing bad will happen.”
“Doctor, he’s not worried about anything bad happening. He’s not worried at all. The only thing that he’s worried about is the world and how he can take care of that.”
“What do you mean?” I asked.
“I mean, he thinks he’s the Son of God, sent down here to save all of us from sin!”
“What’s he doing now?”
I could hear vague words on the other end of the line, two voices arguing. Then Trent’s voice came through the receiver again.
“We need to talk,” he said. “I need to tell you a few things.”
The phone clicked off before I could reply.
Fifteen minutes later, Carla and Trent walked into my office. My office. Not his outpatient psychiatrist’s office. My office.
Carla trailed behind her husband, walking slowly with her head bent forward, as if being pulled on a leash. Trent was dressed oddly, in a bathrobe cinched tight around the waist with a terrycloth belt. He was unshaven, and his eyes gleamed brightly as he marched into the room.
“Good to see you again,” he shouted. “Damn good to see you.”
His fingers encompassed my hand, and the strength of his grip folded down around my own fingers until I felt a sharp pain run through my hand and up my arm. He kept a tight grip on my hand as he spoke.
“I want to tell you something,” he said. “I have to tell you something.”
“What’s that, Trent?” I asked.
I tried to back away from him, to put some distance between us. He was frightening in the small space of the room. I had treated other patients who had switched from depression into mania—these were people who had an underlying bipolar disorder, a manic-depression—but I had never encountered someone who had flipped into such an extreme manic, psychotic phase before.
“It’s simple,” he said. “Simple, but not easy. But if you can do it, you will have everlasting life eternal. A life beyond life. Something you never dreamed possible.”
He paused and stared at me.
“Accept me as God,” he said. “Accept me in your life as God here on earth, and everything will fall into place, and you will stand on the edge of eternity.”
“The edge of eternity?” I asked.
Trent smiled, and he stretched both of his arms out wide.
“Yes, eternity!” he shouted. “Life everlasting, in a place of peace and love.” He stretched his arms out wider and thrust his head back.
“I gave up my life for you, on the cross in the burning sun and the cold night air, hanging there between two thieves with the Roman guard beneath me and my mother sweet Mary crying at my feet. Hanging there as the life slowly ran out of me until it was gone and nothing was left but pale skin and bones stretched out on the cross.”
As he spoke, Trent’s eyes shone brighter and brighter, and he looked at me in a way that frightened me even more. I tried to interrupt him.
“Trent, I don’t know what—”
Bam! Trent’s hand slammed down on the desk between us.
“Call me Jesus,” he shouted. “I am Jesus Christ, come again to be in the world. Jesus, the Son of God, the one who sits at his right hand in the halls of glory. I am love for all of time, your savior, only if you ask it of me. And I wait for you to ask it of me. I pray and hope that you will ask it of me.”
Trent spoke faster and faster, and his words flew out into the room and raced around and through it, blurring into one another until I could hardly make out what he was saying. I turned toward his wife and spoke the first words that came into my mind.
“I guess his depression has lifted,” I said.
Carla looked at me with a quizzical expression on her face. I don’t think either one of us knew what to say. Trent stood before us in my small office and spoke on and on and on. At one point, he stopped and smiled, and for an instant I thought he was going to laugh, but he didn’t. Instead he reached out and rested his hand on my forehead.
“Stop,” he said. “Stop, and listen to what I have to tell you. For even though you are not worthy, what I have to tell you holds the key to your destiny.”
Trent reached up, and his fingers pressed against my forehead as he looked down at me and smiled. He traced the sign of the cross over my forehead with his right thumb.
“Love,” he said. “Love is the key.”
Then Trent turned and walked—no, ran—out of my office.
I didn’t hear from Trent or Carla for a long time after that day. No phone calls. No visits. Nothing.
I called their apartment, but no one ever answered the phone, and they didn’t return my calls. I called Trent’s outpatient psychiatrist, Don House. He had not heard from Trent or Carla for several weeks. He too had left messages, but Trent never returned them.
“He was looking great when you finished his course of ECT,” Don told me. “I just thought that things were still going well.”
I scanned the newspapers and watched the news, afraid I would see something about a madman caught in a confrontation with the police, something horrible like that. But nothing appeared.
Nothing until one day in June, many weeks after I last saw Trent and Carla. My phone rang, and when I picked it up, it was Carla. I could barely make out her words.
“Please talk to him, doctor,” she pleaded. “Can I put him on? Will you please talk to him?”
I started to ask her what had happened, and then I thought better of it. Carla’s voice shook, and she sounded desperate for me to talk to Trent right away.
“Go ahead, Carla,” I said. “Put him on the phone. Let me talk to him.”
There was a rustling sound on the other end of the line, and then a jarring noise as the phone fell to the ground and bounced once, twice—and then I heard Trent’s voice.
“You have betrayed me,” he said. “You have betrayed me for such a small amount of money. You are no healer. You have betrayed me for money.”
“What do you mean, Trent?” I asked. “Tell me what you mean.”
There was a screeching sound, and then Carla’s voice came back on the line.
“The mania is gone,” she said. “It’s gone. He thinks that you took away his powers. He thinks the shock treatments robbed him of his powers. He says he’s no longer a god, that he’s no longer Jesus, and it’s all your fault.”
Then the line went dead.
That was the last time I heard from Trent or Carla. I called their house again, but there was no answer. The phone had been disconnected. I contacted the police, to see if they could do a welfare check, to go to Trent’s house and make sure that he was safe. And they did. They called me later to tell me there were cars in the driveway, and they could hear sounds in the house. But no one would answer the door.
The police had no search warrant, no reason to force their way into Trent and Carla’s home. There was no way they could go beyond what they had done. And I was left with my questions.
Was Trent all right? It appeared that he had cycled back into a severe, psychotic depression. He did not return to see me, to seek my help.
I think about him often. I failed to help him, and I am left to hope he will recover from his deadly spiraling disorder of moods that distorted his views of life like a funhouse mirror in the circus of his existence.
Patrick Mathiasen is a Psychiatrist, who practices in Seattle Washington. He deals primarily with patients who are struggling with episodes of mental illness, and need to be hospitalized, including patients with severe depression which has not responded to medication and psychotherapy treatment. These patients are frequently referred to him for consideration of Electroconvulsive Therapy (ie; Shock Treatments). Much of Patrick’s fiction arises from his clinical work with patients. He has authored and published one non-fiction book related to Alzheimer’s Disease; ‘An Ocean of Time; Tales of Hope and Forgetting’ (Scribners; 1997), and he has co-authored the book ‘Late Life Depression’ (Dell; 1998). Patrick lives in Seattle with his wife and rescue cat Bentley, whom no one thought would survive.