by Daniel Smith
Those who oppose the procedure have seen it ruin lives, often their own. They argue that electroshock can have calamitous effects on cognition, personality, and especially memory, and that it is no more legitimate a medical treatment than knocking someone over the head with a cinderblock. In Doctors of Deception: What They Don’t Want You to Know About Shock Treatment, Linda Andre, a writer and activist who underwent a course of electroshock in the early 1980s—and the plaintiff in the complaint against me1—writes:
The memory “loss” that happens with shock treatment is really memory erasure. A period of time is wiped out as if it never happened. Unlike memory loss associated with other conditions such as Alzheimer’s, which come on gradually and allow patients and families to anticipate and prepare for the loss to some extent, the amnesia associated with electroconvulsive therapy . . . is sudden, violent, and unexpected. Your life is essentially unlived.
Electroshock therapy is the sort of topic that makes the salivary glands of your typical magazine editor work double-time. In addition to the built-in conflict, it has a colorful history (the procedure was developed, in Italy in the 1930s, by applying electrodes to the anuses, mouths, and heads of stray dogs), a counterintuitive slant (what sounds brutal and primitive may in fact be therapeutic and empirically validated), madness, science, even a whiff of celebrity: Ernest Hemingway, Judy Garland, and Lou Reed all underwent shock therapy. (Reed had shock therapy when he was a teenager; his parents were trying to rid him of homosexual urges.) It is a topic rich with all kinds of complexities—medical, statistical, ethical, legal, narrative—and so one ideally covered by a journalist who knows what he’s doing.
I was not that journalist. I was not a journalist at all. I had never reported before, not even for my high school paper. I had never physically held, let alone read the articles in, a psychiatric journal. The only person I had ever interviewed was an electrician (coincidentally), and that was for a report I wrote in the third grade. At the time I proposed the article the only qualification I could claim was my work as a checker. Checking had at least introduced me to the skills a good journalist needs: the ability to navigate the byways of databases and archives, to mine expertise for resonant generalizations, to sniff down elusive details and sources. But a journalist needs to know how to do so much more than that. He needs to be able to accumulate and digest innumerable discrete bits of information, many of them contradictory, and weave the most pertinent and telling bits into a text of a preordained length that honors both the letter and the spirit of the subject, satisfies the biases and pet curiosities of the editors on whose good dispositions the publication of the article depends, and holds the attention of thousands of anonymous readers with very little time or brain space to waste on something that isn’t super-interesting or -essential.
I had none of these skills. But I had watched the powers-that-be at The Atlantic hold the clammy hands of enough neophytes and incompetents—had watched with amazement as, time and again, they took an inferior piece of writing and alchemized it into something resembling literature—not to be paralyzed by the task ahead of me. “Not to be paralyzed” is indeed an understatement. I was downright soothed. If in the case of my mother I resented my anxious tendency to negate my will in favor of someone else’s, in the case of The Atlantic I invited it. It felt comforting to place myself in the hands of someone else’s competence, to feel that there was something authoritative and institutional backing me up, nudging me in the right direction, promising to save me. Giving over your will, I was learning, could be a balm as well as an acid.
William James knew this well and said it best. In The Varieties of Religious Experience, he describes the many ways that the “sick soul” can be redeemed: “[The] new birth may be away from religion into incredulity; or it may be from moral scrupulosity into freedom and license; or it may be produced by the irruption into the individual’s life of some stimulus or passion, such as love, ambition, cupidity, revenge, or patriotic devotion.”
As it happened, love was irrupting into my life at just this time, too. On a trip to New York to attend a party thrown by my brother Scott and his new wife, I met a girl, and the immediate and mutual attraction between us went a long way toward quieting my mind. It redirected my attention from myself to someone else, from my hatred of my nature to my affection for someone else’s, from despair and demoralization to excitement and anticipation. Of course, feeling soothed by love turned out to be as temporary and full of folly as feeling soothed by authority turned out to be. You can’t be converted out of anxiety any more than you can be shocked out of being gay. No one can do the work but yourself. But both were nice while they lasted.
• • •
In a way it was like being an anti-checker, those long months of nights, weekends, vacations, and lunch hours I spent reporting and writing the article. During my salaried hours: stonewalling authors, uncited claims, unreturned calls, slogs through soporific government reports and hernia-inducing tomes on subjects in which I had no interest. During my catch-as-catch-can hours: information gathered steadily and by choice, no fear of error because there was no imminent deadline and because there were safety nets in place—and because error was no longer the point. Knowledge was. For once I wasn’t inspecting; I was building.
But there was a blind spot to my work: I was afraid of madness. I was terrified by the very thought of it. I was terrified of being contaminated by it. This isn’t unusual. Physical disease and mental illness are the two most common fears known to humankind. For the anxious, in whom the fears are naturally pronounced, it seems to be a matter of disposition which will be dominant. The best litmus test is a panic attack, during which some will be convinced they are dying and others that they are going insane. I thought I’d go insane. When I wasn’t in a panic, I simply felt a revulsion to anything that smacked of madness.
Over the years, therapists have tried to disavow me of my fear of insanity in much the way that another web site devoted to anxiety tries to disavow its readers of the fear. “No one with panic attacks and anxiety has ever gone ‘crazy,’ ” the site claims. “In fact, because you realize that you have panic attacks, this is just another indication that you are not going crazy. People that ‘go crazy’ lose contact with reality. Anxious people are too much in contact with reality. Thus, people with panic and anxiety problems NEVER ‘go crazy.’ It simply cannot happen.”
Counsel like this has never worked on me; you can’t reassure someone out of an atavistic fear. No, the only thing that has helped, perversely, is devoting a decade of my life to writing about mental illness—exposing myself to insanity until the urge to recoil is brought to bay. I have watched a man so tormented by compulsions that he actually applied to have two lesions surgically burned into his brain in a last-ditch effort for relief. I have sat in the back of a sweltering auditorium as dozens of people discussed the disembodied voices they walk around listening to. I have interviewed the schizophrenic, the schizoaffective, the depressive, and the manic-depressive, and I have pored over accounts of mental disintegration from Nebuchadnezzar to Zelda Fitzgerald.
I have done all this, in large part, because I suspect my fear of madness improperly influenced my electroshock article, and I have wanted to correct for the error. In reporting, I looked at both sides of the issue. I used The Atlantic’s clout to schedule interviews with everyone who seemed important in the debate about the politics and science of electroshock. I got in touch with Linda Andre, director of the Committee for Truth in Psychiatry, an organization made up of several hundred former electroshock patients, and interviewed her at an Italian restaurant on the Upper West Side. She brought her son, who quietly did his homework while Andre outlined the deceptions and venality of the psychiatric establishment. In a sun-drenched dining room in an exquisite Long Island house I interviewed Max Fink, a voluminous, aging psychiatrist who has studied and promoted electroshock for more than fifty years. I interviewed a representative of the Citizens Commission on Human Rights,
a lobbying organization affiliated with the Church of Scientology that has been active in trying to get electroshock restricted in several states. I interviewed clinicians who presented electroshock as an invaluable treatment with an unfortunate history of abuse and a range of possible side effects. I interviewed Roland Kohloff, the principal timpanist for the New York Philharmonic, who credited electroshock with saving his life. And, on a cool fall day in 2000, I drove out to McLean Hospital, the legendary facility where Lowell, Plath, and Anne Sexton had all been treated, and I watched as doctors administered electroshock to a desperate-looking middle-aged man in tennis shoes and a purple shirt. They fastened a blood-pressure cuff around his ankle and injected him with a muscle relaxant. During the procedure, only his foot twitched.
Given the entrenchment of the opposing sides—the activists disdainful of the integrity of the psychiatrists, the psychiatrists resentful of the severe rhetoric of the activists—the article I wrote over the next few months was bound to elicit criticism. The article gave ample space to electroshock’s detractors, delineating their backgrounds and presenting their complaints at great length—but it failed to treat those complaints with seriousness or compassion. It lent credence to the view that electroshock can sometimes cause profound memory loss—but it made no real effort to explore the medical science behind that side effect, to describe its emotional costs, or (most egregious from the point of view of electroshock’s critics) to investigate the claim that in many cases patients are still administered electroshock without informed consent. The article couldn’t do any of those things—I couldn’t do any of those things—because to do them would have meant inserting myself into the experiences of people whose lives were defined, rightly or wrongly, by madness. It would have meant having to empathize with some truly horrifying feelings of anger, betrayal, and trauma, and I simply couldn’t do that. My anxiety wouldn’t even let me get close to that fire, for fear of falling in. And so I came down, ultimately, on the side of order—of a refined medical treatment meted out cautiously, meticulously, undramatically, and usually successfully, with the comforting sanction of esteemed professional organizations. I came down in favor of electroshock.
When the article was published it was lauded by almost every one of the mental health professionals who chose to comment. Almost. Fink wrote me an e-mail that seemed to suggest that by giving voice to electroshock’s detractors my article would dissuade seriously ill patients from seeking out or assenting to the treatment and would thereby result in the deaths by suicide of thousands. I had blood on my young hands. The other side of the line was more crowded with dissent. On the Atlantic’s online comments page, I was pilloried for incompetence. In the lawsuit Andre eventually filed, she counted that the comments were 70–2 against the article, and offered some choice denunciations:
‘This article feels like marketing; it saddens me to see Atlantic’s reporting so biased.’ (Comment #4) ‘Journalistic standards that would apply to high school newspapers are thrown out the window when it comes to electroshock.’ (Comment #10) ‘DANIEL SMITH IS NO JOURNALIST.’ (Comment #12) ‘In Journalism 101, we were taught the basics, and I’m afraid that Mr. Smith has ignored what he should have learned in college . . . Daniel, you should have CHECKED your piece.’ (Comment #15)
One commenter went through the article line by line, pointing out all the inaccuracies in a document that ran for many single-spaced pages. He fact-checked my article! I got several calls from Andre, demanding answers. The editors heard from Andre, demanding answers. The journalist Liz Spikol, later a prominent blogger on mental health issues, responded with a column titled “Shocked and Appalled.” The last line of her piece was, “I’m thinking maybe it’s time for Daniel Smith, the author of ‘Shock and Disbelief,’ to have his head examined.”
My sentiments exactly. By then I was well on my way to a mindset that made my response to losing my virginity seem like a pleasant afternoon nap. I still had to work. I still had to sift through other people’s articles for errors. I still had to monitor my underarms for moisture. And now I had to contend as well with the mounting indictments of my own potential errors and the consequences I was being told they would have—not on me, which was self-evident, but on other people, and on the world.
Consequences. It is not a favored concept for the anxious. During those times when I am berating myself for all that I’ve done wrong, all the mistakes I believe I’ve made, I call Scott and he reminds me that the only choices that have permanent consequences are creating life and ending it. I hadn’t killed anyone or knocked anyone up. I hadn’t even acted maliciously. I had worked hard and tried my best and hoped to do well, to do good. But the thought I could not shake was that there was no way to know what effect those 500,000 or so copies of the magazine floating out there in the world were going to have, whether they would coax some unlucky person in distress to have electroshock and thereby have his memory erased, or whether they would coax someone in distress not to have electroshock and thereby to sink further into distress and self-destruction. The deed was done, and the result could be anything.
And for what? Toward what end? A byline? For that I’d opened myself up to scorn, demands for a retraction, legal threats? I wasn’t Christopher Hitchens. I took no pleasure in controversy. I was a junior editor twenty months out of college. All I’d wanted was to write and be published. A little light literary glory, that was all. Instead I’d called up a storm. A great tidal swell of panic overtook me and refused to recede. No permanence save life or death? Tell that to my brain, big brother. It didn’t hear the news. It was too busy counting bodies. Every day at work the postmortem continued, and every day I was reassured by my superiors that all was well—this was journalism, this was how it sometimes went—and every day I became less able to hear a positive or logical word anyone said. The sensation was like when your ears fill with fluid and you can’t get them to drain: a cocoon of the self. I stumbled viscously through. I began to dream of being mad and institutionalized, face up on a gurney, electrodes at my slick temples. Nooses. Pill bottles. Pistols. Bridges. Knives. The absence of choice. The absence of consequence. If this was life, what was the point?
13.
anxious love
Dear Dan,
You are sitting now in the Duomo—a Tintoretto here, a Pisano there, Jesus everywhere—and you are feeling down. What it is is something you’ve felt before when it seems as if life has placed you in a position in which you do not want to be. No, let’s clarify: You have put yourself in a position in which you do not want to be. You are feeling (we’re going to have to use that tapioca word quite a bit, I’m afraid) what you have learned to call “anxious,” a term it’s a little hard to define but that can include a number of psychopathological elements: fear, dread, self-loathing, homesickness, a desire to retreat into some place where the self-reflection can be total and you can luxuriate in self-abasement for hours (bed, e.g.), a tendency toward questioning your decisions both on the micro and macro scales (this one maybe should be moved to the top of the list) . . . let’s see, what else? Ah yes: physical symptoms. These may include loss of appetite (in Tuscany! Sweet Moses!), nausea, a lump in the throat, lack of short-/long-term memory, lethargy, the icicle of course. No decreased libido. After all, you’re twenty-three yrs. old.
There’s got to be more . . . did I mention self-loathing? Yes? Did I really put enough emphasis on taking every big and little decision and scrutinizing it as if it were literally a matter of life or death? I did? Well, then, how about the insatiable (because who would do it?) urge to call your mother and cry?
Now, if all this is a disease, as I’ve been told, what is the cure? Is there a cure? No, probably there isn’t. But there is a course of action. On the tortured decisions and catastrophizing and dwelling, always remember the following: IT IS MORE THAN LIKELY THAT THIS WILL NOT KILL YOU. Also: DANIEL, YOU MUST GIVE YOURSELF A BREAK. THIS IS NOT EASY. IT IS NOT FUN. BUT IT CAN BE IF YOU REPEAT AFTER ME: IT’S JUST LIFE. IT IS NOT
PERFECT. THERE ARE NO ASSURANCES. NOT EVERYONE WILL LIKE YOU. NOT EVERYTHING YOU HAVE TO DO WILL BE ENJOYABLE.
Larger now:
YOU ARE HUMAN!
YOU ARE FALLIBLE!
YOU WILL ENJOY LIFE MUCH MORE IF YOU ACCEPT—NO, EMBRACE—THE FACT THAT THERE IS NO SUCH THING AS A GOOD DECISION AND A BAD DECISION.
THERE ARE ONLY DECISIONS.
MAKE THEM, FUCK UP, ENJOY, REPEAT.
This passage was written in the central cathedral in Lucca, in northern Tuscany—the Cattedrale di San Martino, named after Martin of Tours, the first saint to have the dubious honor of having to endure his biblically allotted threescore and ten rather than being burned, beheaded, stoned, crucified, or tortured to death in his prime. In the marble composition notebook in which it appears the passage bears the title, “Painfully Obvious Letter to Myself.” It isn’t dated, but I know it was written in April 2001, in the middle of a two-week trip to Rome, Florence, Lucca, Siena, and Venice I took with my then live-in girlfriend, Joanna. That, it rattles the mind now to realize, is the undesirable “position” to which the passage refers, the event of which it moans, “IT IS NOT FUN”: a luxurious Italian tour with a lovely young woman, filled with food, wine, art, and lovemaking.
The trip took place two months after the publication of my electroshock article and twenty months after Joanna and I met, and was expected to further cement the relationship we had both believed was progressing steadily toward marriage. Instead it harnessed and distilled the years of mounting anxiety that preceded it and showed Joanna that the young man she’d fallen for was far too caught up in himself, too nervous, confused, and deluded—too selfish—to love anyone, and therefore to be loved in return. By the end of the year, she’d broken up with me. It would be years before I would win her back. In the interim I would have to learn how to wall my anxiety off from others, to seal it up inside myself so securely that its indiscriminate uncertainty would no longer be able to influence or infect the people I loved—which is to say, my feelings for the people I loved. I would have to learn how to protect love itself from anxiety.