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Personal Accounts: The Partnership
Kurt Sass
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.12.1541
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In February 1979, things were going pretty well for me. I was a business management major at Hunter College and had only one semester until graduation. I was living with my parents and working part-time. I had a steady girlfriend. My father had stopped drinking after many years, and we had started to become close.

Then, all of a sudden, one day I couldn't get out of bed. Then all of a sudden I wanted to kill myself. Then all of a sudden I had to go to Elmhurst General Hospital's psychiatric ward for two weeks. That would turn out to be the first of many, many episodes of what would later be diagnosed as major depressive disorder.

Since that first episode, more than 20 years ago, I've had (and lost) eight different jobs, been hospitalized on numerous occasions, gone through periods of cutting myself with a razor blade up to 70 times a day, tried more than 25 medications without any long-term success, and had 22 electroconvulsive therapy (ECT)— "shock"—treatments.

After everything else, including multiple medication trials, failed my psychiatrist mentioned ECT. I was dead set against it at first (I've seen One Flew Over The Cuckoo's Nest), but my wife got me to agree to at least research it, and we obtained 17 articles on the subject. Each article pointed out the safety of today's procedure; the only major problems involved patients who had been in extremely poor physical health and probably should not have been given the treatment. The statistic most mentioned was that the rate of deaths possibly related to the procedure was six out of 10,000, or 6 percent of 1 percent—less risky than crossing a street in New York City. The one major side effect was a small chance of partial memory loss. But my wife and I both concluded that the risks were worth taking.

The procedure was done at Gracie Square Hospital in New York City. I can honestly say that the worst part was the waiting before the procedure. The actual ECT was, if I can be so cavalier, a piece of cake. Once I was wheeled into the room, I was given an intravenous anesthetic and "fell asleep" within five seconds. When I woke up I felt a little groggy but was none the worse for wear. I was able to go home with my wife about 30 minutes later. I did lose some memories that day, but they had all returned by the next day.

The first treatment did not make me feel any less depressed, but I knew that it usually takes from three to five treatments before any substantial improvements might be felt. Sure enough, some time after the fourth treatment or so, my suicidal thoughts lessened considerably and I stopped cutting myself. I had a few more treatments after that and was close to feeling normal again. I was then scheduled to receive maintenance treatments once a month for the next six months.

At that point, in my infinite wisdom, I figured I didn't need any more treatments; I was starting to fear memory loss, even though I had not so far experienced any permanent loss. Big mistake. Within two weeks of stopping the treatments I was back in bed thinking of the best ways to kill myself and had started to cut myself again. When I realized the severity of the situation, I immediately resumed the treatments, and within a few weeks I was almost back to what is normal for me.

Although the ECT has lessened my suicidal thoughts, the thoughts have not disappeared. Even now, every single time I wake up I have thoughts of severe depression and suicide that can take up to an hour and a half to fade away. Before my ECT treatments, my daily suicidal thoughts were accompanied by an almost overpowering impulse to act on them. Now the impulse to act on them has virtually disappeared. Medications also help ensure that my thoughts remain thoughts and do not become actions.

Equally important is something I remember a psychiatrist telling me once, years ago. He told me that the statistics showed that only 3 percent of all suicide attempts are successful; more often than not, the person just ends up with physical injuries. I now realize that the psychiatrist might have told me this to scare me and that he might even have lied about the statistics. But it worked, and I still recall his words when I need to.

One other ally has been time. Although I still wake up with the same thoughts every day, as time goes by I tell myself that I have had these thoughts for X number of days or years without acting on them. And I now know that most of the time my suicidal thoughts will fade away within an hour to 90 minutes of my waking up and that the rest of the day will be just fine. I adjust my schedule so that these thoughts interfere as little as possible with my daily life.

And then there are the people: my therapist, who has stuck with me, and my psychiatrist, who opened the door to other treatment options after my previous doctors told me that nothing more could be done medically. These two have been my companions on this journey for years. Although my family, whose history of alcohol use, suicide attempts, and psychiatric symptoms might scare doctors and therapists, were once supportive, most are now deceased.

When it comes right down to it, the glue that holds it all together is my own management of my symptoms. But my self-management is built on my relationships with my partners—my psychiatrist and my therapist—who work together with me, using our tools. The tools are not sufficient if the partnership is flawed.

Mr. Sass lives in the Bronx, New York. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.




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