by Naomi Judd
That night, in the hotel room, I was certain I would be able to sleep calmly since I was free of the noise of the psychiatric ward at UCLA, but that wasn’t to be. I had a powerful anxiety attack that made me jump to my feet.
Our hotel room had a bathroom with two doors, one leading to a small sitting area and the other into the bedroom. There was also a door between the sitting area and the bedroom. I could walk a full circle, from the sitting area through the bedroom, through the bathroom, and back to the sitting area. As I paced this circle, my mind ran rampant, my heart beating wildly. I was consumed with worry about heading into yet another program or treatment. My body felt like such a dumping ground for too many medications that had not helped me. I could only guess at what Dr. Rosenbaum would try. Could I survive yet another round of trial-and-error? I didn’t want to merely be tranquilized as a way out of pain, but I was losing hope that anything would help.
As it turned out, Dr. Rosenbaum’s first suggestion was not for another medication. It was for me to stay in the Boston area for the next three weeks and start treatment rounds of electroconvulsive therapy there at Mass General. The words made me gasp. Having a convulsion because of electricity coursing through my brain seemed like such an extreme measure.
Dr. Rosenbaum assured me that it wasn’t like the horrific treatments that actress Frances Farmer went through in the 1940s, or the ECT depicted in the film One Flew Over the Cuckoo’s Nest. There had been decades of study and modernization of the technique since then and ECT treatment was now relatively low risk and shown to be successful for depression like mine that wasn’t responding to regular medications. Still, my legs bounced up and down with nervousness and my palms broke out in sweat with the thought of having a seizure induced by electricity.
I could see that Dr. Rosenbaum was studying my every movement as I sat across from him in his office. He took the time to explain to me all of the long-range side effects of the huge amounts of benzos I had ingested in the past year and why continuing on them was not advisable. He also voiced his concern about my having been on so many antidepressants, none of which had helped me. Dr. Rosenbaum felt that my severe treatment-resistant depression was affecting my overall health and he was greatly concerned about my having suicidal ideations for over two years.
ECT has a strong and immediate effect on the neurotransmitters in the brain. It’s the minute-long seizure that changes the neural networks, the biological abnormalities, which are associated with depression. The modified seizure would make changes in the brain centers that control moods, appetite, and sleep. Typically, patients need six or more treatments to see a noticeable improvement.
The main side effect of the treatments was a possible loss of short-term memory for a while; usually patients can’t remember what happened in the time right before the treatment. The stack of release papers and informed consent forms that I had to sign prior to having an ECT treatment was intimidating, especially when I had to struggle just to keep our hotel room number in my memory. Wading through the “what could go wrong” pages on these forms was more than I could absorb. I signed everything, only reading some of it. In the darkness of depression, you give up caring what they do to you. You are willing to try anything to get out of the constant pain.
I was sent back to the hotel with instructions to have no food or liquids after midnight. I couldn’t take any medication at all, but benzodiapenes especially were not permitted because of how they might interact with the general anesthesia. I had been counting on being able to take a Klonopin to help minimize my apprehension and anxiety about the first treatment early the next morning. All night long I paced the oval track from the bathroom to the sitting area to the bedroom, around and around.
The next morning, a nurse had me change into a hospital gown, took my blood pressure, checked my heart rate with a monitor, and inserted the IV needle. It was an assembly line atmosphere, with a patient before me, and another after me. I waited my turn, wary of how casual the technicians were. What if they make a mistake? What if I lose all my memory and become what I fear most, a woman who can’t take care of herself?
Soon I was wheeled into a room of the outpatient psych unit of Mass General, where a doctor, nurse, and anesthesiologist were waiting. The nurse placed thick padded straps across my upper chest and on my legs above my knees, which secured my body to the bed as the doctor explained the procedure one more time and how quickly it goes. Two electrode pads were placed on my head, one on each temple. The doctor said about sixty seconds of electrical current would pass through the lobes of my brain, causing a controlled seizure.
He kindly rested his hand on my shoulder and looked in my eyes as he talked. The nurse put in a mouthguard to keep me from biting down hard on my teeth or my tongue during the seizure. Then the anesthesiologist added the “knockout” drugs to my IV. I was told to count backward from one hundred, but I don’t remember doing that. I was out.
When I came to, it took a few minutes to understand where I was and what had taken place. A nurse was asking me my full name and if I knew what day of the week it was, to make sure that my memory was intact.
The first physical sensation I felt was that the bed below me was wet and I was uncomfortably damp from the waist down. It took me another minute to realize that I was lying in my own urine. I couldn’t believe that had happened. No one had told me to make certain that my bladder was completely empty before changing into a hospital gown. I was humiliated to the core.
I was tired and spacey and only wanted to wash up, get dressed, and go back to the hotel. The muscles in my legs felt as shaky as if I had hiked a steep hill. My arms also shook, as if from muscle fatigue.
My short-term memory proved to be fine, so I was released for the day and told to come back in three days. This was to be my life for the next eighteen days: have a treatment, recover from it, and then return for another. I had short appointments with Dr. Rosenbaum so he could see how I was progressing. I didn’t notice much change after the first three treatments. He told me that people with profoundly severe depression, like mine, might not feel the remission of symptoms for at least six to twelve treatments, maybe more.
After the fourth ECT treatment, Larry took me back to the hotel room to rest. I was starving. I hadn’t had a bite to eat since an early dinner the night before. I ordered a stack of pancakes with a side of eggs from room service and looked forward to having a big breakfast.
We set up the room service table near the window to get the full effect of the little bit of Boston winter sunlight that had found its way to our side of the building. I buttered the pancakes and poured syrup over the top. When I took my first bite, I almost choked on the putrid taste. I had to spit it out on the plate. The pancake tasted the way raw sewage smells. I pushed it all away from me. I told Larry that someone in the room service kitchen had played a disgusting prank on me, somehow making the pancakes look normal while adding some type of rancid and nauseating ingredients that would make me violently ill. The room service manager apologized profusely, saying that he was astounded that something like that had happened, and said he would send up another breakfast right away.
The second serving of pancakes tasted as bad as the first batch.
Larry decided to try the pancakes himself. It was obvious that he didn’t share my experience of the taste at all. He said they were delicious and ate the whole stack.
I tried a bite of the eggs and had to spit those out as well. A wave of panic set in.
What had happened to my sense of taste? I definitely couldn’t eat anything on the plate. All I could do was hope that it was a temporary side effect of the ECT treatment and that it would go away. I had been warned about the risk of memory loss, but not about having my sense of taste go haywire.
The next morning Dr. Rosenbaum responded that in all of his years at the hospital he had never known a patient to have their taste buds altered through ECT treatments. Dr. Mona Lisa had never heard of it, either, but said she would look into it.
We sent emails to all the doctors and scientists we could think of, who in turn forwarded them on to every professional they knew. No one had ever heard of taste buds being so adversely affected.
I did notice some subtle improvement in my state of mind. I wasn’t sure if it was the ECT treatments, or having my freedom back after being locked up in UCLA’s psychiatric ward. I started to look forward to bundling up and taking a walk with Larry around the Beacon Hill area. I found myself seeing and appreciating pleasant things: kids playing, dogs wagging their tails, and boats docked in the harbor. Most noticeably, I found that my suicidal thoughts had been pushed out of the daily lineup of thoughts I had to fight against. The ECT treatments did seem to increase my willingness to participate in life once again.
The major disappointment was being in a great food city like Boston and unable to eat anything that didn’t taste putrid. I had to resort to drinking smoothies mixed with protein powder, because I could just swallow them and not have to taste them. Every morning I had a hopeful anticipation that my sense of taste would return, but each day brought repeated disappointment. I became frightened that this would now be my new “normal.”
The gradual lifting of the fog around my depression was a relief by day, but the anxiety at night was still relentless. I would be able to doze off for an hour and then wake up suddenly with a crushing feeling of fear. It was nearly impossible for Larry to sleep with my constant pacing in a circle. I would feel trapped in the hotel room, but going outside on the frozen streets at 1 a.m. was not an option.
Following my sixth ECT treatment, Dr. Rosenbaum did an assessment of my progress. He recommended that I continue with an ECT treatment program through an outpatient psych unit connected to Vanderbilt University Medical Center so that I could go home. I gladly agreed to the plan. I wanted to sleep in my own bed, surround myself with my four dogs, and see my friends again, which was taken as a positive sign by everyone.
I was missing Ashley and hoping for the chance to reconnect with Wy. Elijah, my grandson, was sending me texts to hurry home. He wrote that he was missing my cooking him pork chops, mashed potatoes and gravy, and corn on the cob. Time used to pass quickly and joyfully when I was out on a tour, but the past three months had seemed more like three decades.
Before I left Boston, we had a meeting with Dr. Rosenbaum about my panic at night and sleep issues. Sleep is paramount to helping the brain deal with depression. Without it, the amygdala, the area of the brain that controls the “fight or flight” survival instinct, goes into overdrive. You use less of the prefrontal cortex, which helps you apply reason and logic to whatever you’re experiencing and keeps you calm.
Dr. Rosenbaum went over a list of suggestions that he calls “sleep hygiene,” which he felt would lead to better rest for me:
1. Go to bed at the same time every night.
2. Rise at the same time every morning, even if you didn’t sleep well during the night.
3. Choose some type of regular exercise and stick with it. Daily regular exercise improves the quality of sleep.
4. Keep the temperature in the bedroom cool, if possible.
5. Don’t watch TV, especially late night news, or look at a computer screen in bed. The light stimulates activity in your mind.
6. Turn out all the lights and keep the bedroom quiet to facilitate good sleep.
7. Don’t review problems in your head. Use a relaxation exercise or think about a recent pleasant experience.
8. Try a warm bath and listen to calming music before bed.
9. No napping during the day. (This one was problematic for me since I rarely slept during the night. Along with the list, he gave me a prescription for a light sleeping pill.)
The man who I credit with the fact that I’m still alive and have a bright future, Dr. Jerrold Rosenbaum, chief of psychiatry at Massachusetts General Hospital in Boston.
“Will these nighttime panic attacks ever end?” I asked Dr. Rosenbaum. “They make me feel like I’m suffering a psychotic break.”
Dr. Rosenbaum nodded in sympathy. “It’s not a realistic fear. You’re generating your own fear of fear. You will learn to float through it, and you’ll start sleeping. Do deep breathing. Eventually you’ll fall asleep. Most importantly, stay in the bed, so you can let your mind realize that the panic won’t harm you. You won’t die. You’ll get through this.”
He made it sound so simple. And it used to be. I would get in bed, read a few pages of a book, and I’d be out for seven or eight hours. Now my deep sadness and traumatic past were erupting like Old Faithful every single night.
As Larry and I went through the security at Logan International Airport, a woman on the other side of the line caught my eye. She reminded me of one of my mother’s very few friends, Martha Compton. Her daughter, Hattie Lou, had been my brother Brian’s age and had died of the exact same type of lymphoma six months before he did.
A few years later, Mother met Martha Compton when she started working at the town’s small gift shop, the Aladdin, following her divorce from Daddy. They formed a special bond, both being mothers who had lost a teenage child to the same kind of cancer. Martha was certain that Brian and Hattie Lou had died from the effects of toxins in the air and water from the chemical plants in Ashland.
After Mother became friends with Martha, she shared these words with me, only once, when I was on a visit home to Ashland. “Naomi, always be nice to everyone, because you never know what they are going through personally.” I knew she was talking about herself and her misery after my father moved out, but those words came back to me at Logan as I watched this woman who looked so much like Martha Compton walk away while other travelers started to approach me for autographs and photos.
As I smiled and posed for pictures with people who asked on the way to our gate, I thought about my mother’s advice in terms of what I was going through and what others expected me to be. I’m certain each of these dear fans would find it hard to believe that I had just received six electroconvulsive treatments for severe depression, or that I had been hospitalized three times in psychiatric wards. Could they imagine the number of times I had pondered if today would be the day I jumped from a bridge? Would they ever guess that I was grasping for a miracle to save my own life? No, they wouldn’t. I tried hard not to show any of it. I wanted their experience of me to be positive. I wanted to be Superstar Naomi Judd again and not this frightened woman, cowering under the attack of so much unresolved trauma in my life.
As Larry and I settled into our seats, rays of sun spilled through the window and onto my lap. I wanted to lie down and sleep in this warmth and forget about everything I had gone through. It’s odd what the mind chooses to retain, years and years later, even if it has only experienced it once. From a long-ago memory file, I remembered the inscription on the sympathy card Martha Compton sent to Mother on the day after Brian died, but years before she and my mother met.
“Somewhere, upon some bright new dawn, the beautiful soul of him is bursting with eager joy.”
Would there be a “bright new dawn” in my life? Could I feel an “eager joy” again? Did I dare to hope the ECT treatments would work to unscramble my worn and battered brain?
Chapter 17
Radical Acceptance
I am putting my brain in their hands! The thought of it made me anxious every single time I had electroconvulsive therapy at the outpatient psych unit at Vanderbilt hospital in Nashville. The records show that things go wrong in hospitals all the time. What if I lose my memory?
Every three days, Larry would wake me up at 7 a.m. and drive me into Nashville for another treatment. We always went first thing in the morning before I had any breakfast or even a cup of coffee, which I really didn’t miss since none of it tasted good to me.
I would see the same group of psych patients, awaiting their own ECT treatments, when I arrived for my appointments. The group ranged in age from the late seventies to a teenage girl. I knew they each had a story of what brought them to this
point, the same way I did. But depression is a solo disease. As we all waited our turn for treatment, a sad silence hung over the room.
I had the same IV anesthesiologist, who delivered the knockout drug, at each appointment. He would rest his hand gently on my shoulder and solemnly assure me, “We’re going to take really good care of you. Don’t worry.”
I would say to him, “Now, make sure you tell me before you put me to sleep. I want to be in control of this one thing.” I would try to count and see how far I got before the powerful drug would put me under. There was a relief in those few seconds before becoming unconscious. My body had no choice but to relax, and for that brief pause in time I was free of my depression and anxiety.
Later, as we were driving back to our farm, I thought about Michael Jackson’s death and how he reportedly begged his doctor to administer propofol, a surgical anesthetic, so he could be unconscious for a while. As extreme as that request seemed to most people, in my current state of mind I could comprehend why he wanted the medication. Trying to prepare for his massive final world tour must have been a terrible pressure. Tickets had sold out around the world and expectations were sky-high. Could the fifty-year-old Michael still wow an audience like the twenty-five-year-old Michael? Every decision was his to make. As his family described it, he was having an impossible time turning off his anxious mind and sleeping.
More performers than you would suspect suffer debilitating effects from anxiety, stage fright, insomnia, or depression. Long before I had my own issues, ironically, I would sometimes be called upon to console other artists who were being held back by fears.
My friend the singer-songwriter Carly Simon has been public about her panic attacks since the mid-1980s. When she first started to tour again, she would call me from backstage right before her concert. Because of my nursing career and my own personal suffering, I had developed ways of helping others through anxiety. When you get nervous, your shoulders rise up and your stomach caves in, which is the worst thing for a singer who needs all of her breath support. I would always call it “earrings” when Wy and I were backstage before a show. It was a signal that our shoulders were creeping up by our ears and not relaxed.