How I Lost My Memory

On the Sea of Memory
by Jonathan Cott

At the end of the 1990s, the esteemed writer Jonathan Cott lost fifteen years of his life. After receiving repeated rounds of electroshock treatments to combat his severe clinical depression, Cott couldn't remember anything he had experienced between 1985 and 2000. Not a shred remained of his intimate relationships, his travels, his writings, his joys and sorrows.

Though shattered by the loss, Cott summoned the will to try to understand exactly what had happened to him-and, beyond that, to probe the mysteries of human memory through neuroscience, psychology, spirituality, and literature. The result is this extraordinary meditation on the vital role of remembering and forgetting in every aspect of human life.

As Cott grapples with the personal and medical implications of his own case, he turns to experts in a range of fields for their unique insights on human memory. Neurologist James L. McGaugh discusses why the brain tends to remember one thing over another, and how science can help us forget trauma. Author David Shenk tells how researchers came to identify Alzheimer's disease and how treatments for dementia have changed dramatically in recent years. Harvard psychologist Richard J. McNally ponders why memory and imagination so often become confused, leading to difficulties in ascertaining the truth of recovered memories. Actress Ellen Burstyn reveals how actors summon emotional memories as they strive to fully inhabit a role. Spiritual thinker and writer Thomas Moore explores the deep connections between memory and the soul.

In the course of his journey, Cott comes to understand that though his loss was irrevocable, he has also gained a more profound understanding of how memory shapes and defines our lives, a new sympathy for those who struggle to remember or strive to forget, and a finer appreciation for the spiritual beauty of each transient moment. Though he began his journey in heartbreak, Cott ultimately finds inspiration in the power and delicacy of the human mind. Illuminating and original, On the Sea of Memory is a testament to a writer of extraordinary resolve and penetrating insight.

Something must have happened on May 4, 1998, because from that day forward my entire life changed. Since I don't remember what occurred, a Spanish friend of mine, Isa, who was visiting from Madrid and staying at my apartment in New York City, recalled the following:

"You came to Madrid in February 1998 and went several times to see a psychic who guided you in a kind of séance and put you in touch with your mother [who had died three years previously] in order to break the imprisoning bonds between you and her. I came with you each time to translate for you; and you cried and said good-bye to your mother, and you seemed much happier after this.

"Three months later I visited you in New York, and one morning you woke up and said, 'Why are you here? Why are you here?' I didn't understand, because you had always been a very good friend to me. And then you started shaking uncontrollably. So I went out and bought you some Bach Flowers, but you didn't want to take them, and finally you called a doctor who told you to go to the hospital.

"I went to visit you every day. They were giving you electroshock treatments-I didn't even know they still gave shock treatments-which I was against, and I spoke to the doctors. But they said you needed the treatments. One day when I came to the hospital I noticed that almost overnight your hair had turned gray. Everything was very strange. But you looked as if you had so much light in you. It was as if your soul was very spiritual but it was your ego that wasn't. Your ego was depressed and maniacal, but your soul was full of light. Maybe the psychic in Madrid opened up something that was too much for you to take."

Between 1998 and 1999 I was a patient in four New York City hospitals, suffering from major depression and suicidal thoughts. At the first two of these hospitals I underwent a course of thirty-six treatments of electroconvulsive therapy. ECT, or electroshock, entails sending an electrical current of about 200 volts-though sometimes less or more than that-for a fraction of a second by means of electrodes connected to a machine resembling a stereo receiver through the frontal lobes of the brain of a patient who has received general anesthesia and a muscle relaxant to prevent broken bones, cracked vertebrae, and physical spasms (the only perceivable movement during the treatment is usually the slight, involuntary twitching of the patient's toes); a face and nose mask to provide oxygen to the brain; and a rubber block to prevent biting off his or her tongue. The result is the creation of a grand mal epileptic seizure that lasts up to one minute. (Remarkably, it is still not known how or why ECT works or what the convulsion actually does to the brain.)

In the popular imagination, the prototypical electroshock patient brings to mind Randle P. McMurphy (who thought of ECT as "a device that might be said to do the work of the sleeping pill, the electric chair, and the torture rack"), the antihero of Ken Kesey's 1962 novel, One Flew over the Cuckoo's Nest, a book drawing on his experiences working in a psychiatric ward in an Oregon state mental hospital in the 1950s. Like McMurphy, ECT recipients at that time, as Sandra G. Boodman observes in The Washington Post, tended to be under forty, male, and impoverished-patients confined to state mental hospitals, often against their will. But women, of course, were also sufferers of this then often misused procedure. In the late 1940s and early 1950s, the internationally renowned writer Janet Frame, misdiagnosed without formal interviews or tests as a schizophrenic, underwent more than two hundred electroshock (including a few insulin shock) treatments over eight years, without an anesthetic, in two New Zealand hospitals where patients lived in rooms covered in human feces and ate meals off the floor. The treatments triggered extreme memory loss, comas, convulsions, and nightmares ("I dreamed waking and sleeping dreams more terrible than any I [had] dreamed before. . . . Everything tortured me and was on fire"). The doctors benightedly deduced that these symptoms indicated the need for further ECT. In The Bell Jar, published in 1963, Sylvia Plath describes her harrowing experiences with electroshock, also administered without an anesthetic, in the 1950s: "Then something beat down and took hold of me," she writes, "and shook me like the end of the world. Whee-ee-ee it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant. I wondered what terrible thing it was that I had done."

Incredibly and often ludicrously, ECT was once also used as a sedative to control disruptive patients as well as to treat ul- cers, hysteria, colitis, backaches, psoriasis, phobias, anorexia nervosa, mental retardation, marital discord, and abhorrently, homosexuality-electroshock was supposed to "release" sexual impulses! The most notorious and egregiously baleful misuse of ECT occurred in the late 1950s and early 1960s, when Dr. Ewen Cameron, at one time the president of both the Canadian and American Psychiatric Associations, performed ghoulish experiments at McGill University's Allan Memorial Institute (since closed) in Montreal. In these Cold War experiments-part of the infamous "MK ULTRA" program subsidized by the CIA-which were meant to explore the processes and possibilities of brainwashing, Cameron, like the nefarious scientist in The Manchurian Candidate, maimed and brutalized patients with drugs (including LSD), lobotomies, and especially ECT (he would shock his patients six times in rapid succession two or three times a day for thirty days) in an attempt to discover ways of "depatterning" and then using "dynamic implants" (via tapes placed under the patients' pillows) to reprogram the human mind. His experiments were disastrous, resulting in individuals in vegetative states, with wiped out memories and the ability merely to repeat the sentence "I am at ease with myself." (Canadian survivors of this torture obtained and shared a $750,000 settlement from the U.S. government in 1988.)

Today electroshock is no longer applied for such barbaric purposes. ECT treatments are now given annually to an estimated 100,000 Americans (mostly women)-nearly triple the number in 1980-to alleviate mental illnesses such as major depression (women are often treated for postnatal or menopausal depression), mania, catatonia, and some forms of schizophrenia, primarily as a last resort, when other treatments, such as psychotherapy, psychoactive drugs, and hospitalization, have failed. The cost per treatment of ECT ranges from $300 to $1,000; and as the Tampa psychiatrist Dr. Walter E. Afield, a former consultant to Johns Hopkins Hospital and a supporter of ECT, comments somewhat grimly, "Insurers no longer will pay psychiatrists to do psychotherapy, but they will pay for shock or for medical tests. . . . Finances are dictating the treatment. . . . We're being pushed as a specialty to do what's going to pay."

Using electricity to heal people goes back at least two thousand years. In the first century a.d., Roman healers applied electric eels to the heads of both mentally disturbed persons and those whom today we would say were suffering from migraine. Physicians in the eighteenth and nineteenth centuries used electrical generators whose charge was built up by electroluminescence (resulting from rubbing a rotating ball of sulfur) on their patients, claiming efficacious results in the treatment of various mental disorders. But the modern use of ECT began in Rome in 1938, when Dr. Ugo Cerletti, chief of the Clinic for Nervous and Mental Diseases at the University of Rome, in collaboration with Dr. Lucio Bini, adapted a pair of tongs used to stun hogs before slaughter and applied them to the temples of a delirious and delusional thirty-nine-year-old homeless man who was found wandering in a train station spouting gibberish. As the psychiatrist David Impasto, who administered the first electroshock treatment in the United States in 1940, wrote: "After the electric spasm, the patient burst into song. Cerletti suggested that another treatment with a higher voltage be given. The patient suddenly sat up and pontifically proclaimed, no longer in jargon but in clear Italian, 'Not again! It will kill me!' This made the professor think and swallow, but his courage was not lost . . . and the first electroconvulsion in man ensued."

In 2001 the New York State Assembly Committee on Mental Health, chaired by Martin A. Luster, scheduled two public hearings-in New York City on May 18 and in Albany on July 18-to determine the efficacy, benefits, and risks of ECT. According to the committee's report, "It was clear from the testimony received that there was a wide variation of opinion related to the use of ECT. Proponents claimed that ECT is a safe, effective procedure with no permanent adverse side effects, and cited a figure of 1 in 10,000 deaths related to ECT to document its safety. [The American Psychiatric Association Committee on ECT in a 2001 report claims one death occurs for every 80,000 treatments.] In contrast, opponents maintained that ECT causes brain damage, can result in permanent memory loss, and asserted that the death rate related to ECT was closer to 1 in 200. Opponents expressed additional concerns about the utilization of ECT on children, the elderly, other vulnerable populations, and of its possible use as a behavior-modifying, non-therapeutic intervention for mentally retarded individuals." The committee report also mentions that although the Food and Drug Administration has recognized the risk of illness or injury from ECT and has designated and classified ECT machines as Class III medical devices-a designation used for premarket approval for equipment that shows an unreasonable risk of illness or injury-the FDA has never completed testing ECT devices to determine their safety or the effects of ECT on the brain, and there is currently no regulation of ECT by the federal government.

Even taking into account that some memory loss can result from stress, depression, and aging, what I know for certain is that after thirty-six electroshock treatments, innumerable memories have been literally and permanently erased, with only occasional freeze-framed flashbacks. Neuroscientists have confirmed that strong emotions, which release adrenaline, which activates the brain, make for emotionally charged memories, often called "flashbulb memories." One such memory for me is of the night in December 1994 when I found myself lost in the Sahara Desert in Niger and had to spend fourteen hours alone until I was found by my party's Tuareg guides.

I have discovered that I have totally forgotten persons I used to know well: a friend told me that after my ECT treatments, I telephoned her, mentioned that I had come across her name in my address book, and asked, "Who are you?" And I have also found my explicit, short-term memory debilitated, my IQ quantifiably diminished (attested to by extensive neuropsychological assessments), my abstract reasoning and learning facility (such as trying for an ungodly number of hours to figure out how to work a new phone-fax machine or how to accomplish simple computer tasks) seriously impaired, my ability to find the words I want and need reduced (such that I struggle to write more than four or five sentences at a time and have to compensate for the loss of words I mean with simpler and less precise ones), and my cognitive capabilities weakened to the extent that I immediately forget what I've just read, even losing track of the meanings of the words.

The singer-poet Lou Reed, who underwent electroshock treatments to "cure" his homosexuality at a New York state mental hospital in 1961, when he was seventeen, shares my reading plight in the first stanza of his song "Kill Your Sons": "All your two- bit psychiatrists / Are giving you electroshock / They said they'd let you live at home with mom and dad / Instead of mental hospitals / But every time you tried to read a book / You couldn't / Get to page seventeen / 'Cause you forgot where you were / So you couldn't even read." And a few hours or a day after I watch a movie, I find myself unable to recollect most of what I've seen. First I realize that I have forgotten the film's ending, then its middle, and finally its beginning, like a kind of retrograde process of film erosion. (Even as I type these pages, I often lose track of what I've just written, and I search for words I no longer remember. Sometimes an unbeckoned word or phrase will come suddenly to my mind-for example, "the exactitude of pain," which popped into my head a few minutes before writing this sentence. Sometimes I am overjoyed to catch a needed word like a fisherman with his net in a sea of forgetfulness. Someone once said that memory is like the ocean because from memory flow all thoughts and words. I am truly at a loss for words.)

While I clearly remember the smallest details of my early childhood-sitting under the piano at the age of four or five listening to my mother play Chopin's Prelude in A Major, for example, or sitting next to a blond-haired narcoleptic, eight-year-old girl named Betty, who continually used to fall asleep, head on her desk, when we were in the third grade-many of my later years have been almost totally expunged. In a significant study undertaken in 1974, the psychiatrist and neuroscientist Dr. Larry R. Squire tested psychiatric patients before and after ECT treatments on their memory of television shows. Before ECT, these patients exhibited a good memory for programs from the late sixties and early seventies, though not for shows before those years; after ECT, however, they had trouble remembering programs aired a year or two before ECT but almost no problems remembering shows from more remote time periods. In neurological terms, as Joseph LeDoux writes in Synaptic Self, "damage to the hippocampus [the horseshoe-shaped part of the brain where memory is initially encoded] affects recent memories, but not old ones that have already been consolidated in the cortex. Old memories are the result of accumulations of synaptic changes in the cortex as a result of multiple reinstatements of the memory."

There have been notable attempts to forbid the use of ECT. In 1982 voters in Berkeley, California, passed a referendum banning the treatment, although the law was subsequently overturned by a suit brought by the American Psychiatric Association (an unequivocal and adamant advocate for ECT). And in 1991 the Board of Supervisors in San Francisco adopted a resolution opposing the use of electroshock. In 1997 a bill that would have made administering ECT a criminal act, punishable by a fine of up to $10,000 and/or up to six months in jail, was narrowly defeated in Texas.

In this regard, one has to mention the mission (more accurately, the crusade) undertaken by the controversial Citizens Commission on Human Rights to ban ECT everywhere in the world. Founded in 1969 by the Church of Scientology "to investigate and expose psychiatric violations of human rights," the commission is separately incorporated and has offices in forty states and chapters in thirty other countries. Along with its lobbying of state and foreign governments to ban ECT, the commission publishes pamphlets and information letters that read like manifestos but are often based on reliable facts about the dangers of ECT and the misrepresentations of some of its practitioners. I must note that it also attacks with paranoid abandon the entire psychiatric profession ("Psychiatry: A Human Rights Abuse and Global Failure," "Psychiatry Harming Lives: Betraying and Drugging Children," "Psychiatry Victimizing the Elderly," "Psychiatry's Creation of Racism") as well as the use of ECT ("Therapy or Torture?" "Shock from Birth to Grave," "Apartheid and ECT," "The Nazi Heritage-'Electroshock's development . . . traces back to a dark alliance between psychiatry and the Nazi concentration camps' ").

Impossible as it is to go along with this take-no-prisoners approach (the psychiatric profession is one that attempts to help and heal people, obviously does much good, and is hardly "a human rights abuse"), one has to acknowledge that the Citizens Commission on Human Rights has some positive accomplishments to its credit, such as pressuring the California legislature to prohibit ECT for patients under age twelve (some major teaching hospitals have begun to use the treatment on children as young as eight) and influencing the Texas legislature to make that state the most difficult in the nation in which to receive ECT treatment. In any case, it is generally acknowledged that the commission has called the widespread practice of ECT into question and put psychiatrists and ECT practitioners on the defensive.

The proponents of ECT, however, are still an extraordinarily powerful and influential group in the psychiatric community. One of the treatment's leading advocates, Max Fink, a professor of psychiatry at the State University of New York at Stonybrook, one of six ECT experts who served on the American Psychiatric Association's 1990 task force that drafted guidelines for the treatment, and the author of Electroshock: Restoring the Mind, has stated: "ECT is one of God's gifts to mankind. There is nothing like it, nothing to equal it in efficacy or safety in all of psychiatry. . . . ECT is the most effective antidepressant, antipsychotic, anti- catatonic we have today." (In a manner strangely reminiscent of Citizens Commission hyperbole, Fink likened the article "Electroshock: The Unkindest Therapy of All" by Fred Hapgood in the January 1980 issue of The Atlantic Monthly, which in spite of its provocative title is sober, reasoned, and thoroughly researched, to Mein Kampf!)

An editorial in the March 2001 issue of the Journal of the American Medical Association states: "The results of ECT in treating severe depression are among the most positive treatment effects in all of medicine. . . . For the sake of the many patients with major depression and their families, it is time to bring ECT out of the shadows." The psychiatrist T. George Bidder has written that ECT has "a therapeutic efficacy, in properly selected cases, comparable to some of the most potent and specific treatments available, such as penicillin in pneumococcal pneumonia." Richard Abrams, the cofounder and co-owner of Somatics, which The Washington Post reports manufactures at least half of the ECT machines sold worldwide at nearly $10,000 apiece, is at the same time the author of psychiatry's most comprehensive and standard textbook on electroshock, Electroconvulsive Therapy (now in its fourth edition). In it he writes: "There is simply no evidence-and virtually no chance-that ECT as presently administered is capable of producing brain damage."

Richard Weiner, professor of psychiatry at the Duke University Medical Center, who represented the American Psychiatric Association before the New York State Assembly Committee on Mental Health, stated:

Major psychiatric textbooks agree that, despite an ever increasing number of alternative treatments, ECT remains the most rapid and effective treatment of major depression, and also that it is efficacious in selected individuals with mania and schizophrenia. The effectiveness and speed of action of ECT are particularly valuable commodities, given the demonstrated high mortality and morbidity of these conditions, not only from the direct effects of the mental illness, e.g., suicide, anorexia, inanition, and general debilitation, but also from medical disorders of many types, including cardiovascular disease, which are significantly more likely and more severe in individuals suffering from these conditions. Serious mental disorders, particularly of the type and severity that typically leads to a referral for ECT, are bad for one's health and shorten one's lifespan.

One of the most influential proponents and practitioners of ECT is Harold Sackheim, a onetime consultant to MECTA Corporation (an ECT machine manufacturer), a member (like Fink) of the American Psychiatric Association's six-member ECT Task Force, and chief of biological psychiatry at the New York State Psychiatric Institute in New York City (where I received twenty-six of my ECT treatments as part of an ongoing multimillion- dollar research study funded by the National Institute of Mental Health). In his written testimony to the New York State Assembly Committee on Mental Health, Dr. Sackheim stated:

The efficacy of ECT in specific psychiatric conditions is amongst the most well established of any treatment in all of medicine. . . . During and following ECT, patients will show rapid forgetting of newly learned information. This is termed anterograde amnesia. All available information, from scores of studies, indicates that this deficit disappears within days to a few weeks following the receipt of the treatment. . . . All recent published surveys of patients who have received ECT have shown that the vast majority report that this form of memory loss is a small price to pay for the therapeutic effects of the treatment. As with all medical treatments, there are individual differences, and some very rare patients may manifest more extensive memory loss. There is no firm estimate on this incidence but my estimate would be on the order of 1 in 500 patients. Careful scientific study has shown that ECT does not cause brain damage (cellular death).

It is significant that Sackheim, who has always insisted that ECT memory dysfunction is "strongly associated" with "the severity of depressive symptoms," and has even suggested that subjective memory can "improve" following ECT, has recently acknowledged that memory and cognitive losses associated with ECT are real, admitting to The Atlantic Monthly in 2001 that "the field has been under attack for such a long period of time that a defensive posture was developed where limitations of the treatment were not acknowledged. So people complained of profound cognitive effects, and [those effects] were attributed to an ongoing psychopathology and essentially dismissed. I think that hurt the field of ECT."

On the other side of the ECT debate, the neurobiologist Steven Rose in The Conscious Brain states that "the neurological rationale [for ECT] is obscure, to say the least. Putting an electrical current through the head undoubtedly temporarily affects the electrical properties of most of the neurons; there are sharp biochemical changes in the level of glucose and its metabolites; oxygen consumption, protein syntheses, and many other parameters are affected as well. Some, presumably random, cell death must occur. The treatment is analogous to attempting to mend a faulty radio by kicking it, or a broken computer by cutting out a few of its circuits. Even accepting the therapeutic value of electroshock, it is difficult to believe that so massive and crude a treatment will ever be able to tell us much about the neurobiological bases for the disturbances it claims to cure."

In the September 1977 issue of The American Journal of Psychiatry, the neurologist John M. Friedberg concludes that ECT may result in brain damage, and writes this of the ECT-induced grand mal seizure and of its aftermath: "A tetanic muscular contraction, the 'electric spasm,' is followed after a latency of seconds by unconsciousness, a high voltage paroxysmal spike and sharp-wave discharge, and a clonic convulsion. Upon recovery of consciousness the subject is left with a transient acute brain syndrome, a high likelihood of permanent brain damage, and greater retrograde amnesia [in which people have difficulty remembering experiences that occurred before strokes and head injuries] than is seen in any other form of head injury."

And one of the most outspoken critics of ECT is Peter Sterling, a neuroscientist in the Department of Neuroscience at the University of Pennsylvania. In his testimony before the New York State Assembly Committee on Mental Health, he stated:

ECT unquestionably damages the brain, and there are a variety of mechanisms that lead to this damage. In the first place, the electroshock delivered to the skull is basically similar to what you would get out of an electrical wall outlet, except that there is a transformer in the ECT machine that steps up the voltage. When this is done two or three times a week for weeks, it's just completely obvious that this is going to eventually cause some kind of brain damage. Second, ECT causes grand mal epileptic seizures, and this causes an acute rise in blood pressure, well into the hypertensive range. And it frequently causes small hemorrhages in the brain. Wherever a hemorrhage occurs in the brain, nerve cells die, and they are not replaced. A third thing that ECT does is to rupture the blood brain barrier. This barrier normally protects the brain from potentially damaging substances in the blood. Breaching this barrier also leads to swelling of the brain, and swelling leads to local arrest of blood supply, to loss of oxygen, and to death of neurons. The fourth thing is that ECT causes neurons to release large quantities of glutamate. Glutamate excites further neuronal activity, and this becomes a vicious cycle. Neurons literally kill themselves from overactivity, and the key manifestation of this brain damage is retrograde memory loss. . . . Virtually all patients experience some degree of persistent and, likely, permanent retrograde amnesia.

There are many other witnesses to this kind of deleterious and permanent long-term, as well as short-term, memory loss. In his remarkable study of depression, The Noonday Demon, Andrew Solomon writes of a practicing lawyer who came out of ECT without any recollection of having attended law school. She was unable to remember anything she had studied, where she had studied, or whom she had known during her studies. The poet John Wieners, who spoke fluent French, was no longer able to speak or understand the language after receiving shock treatments. There have also been reports of persons who forgot they had children or, to give a less dramatic example, a woman who couldn't remember her own clothing and demanded to know who had put the unfamiliar dresses in her closet.

Most ironic and telling is the remark of one psychiatrist that psychotherapy was useless in patients undergoing ECT because they couldn't remember "either the analyst or the content of the analytic sessions from one day to the next." The New York City-based Committee for Truth in Psychiatry-a loose-knit national organization of ECT survivors-has collected hundreds of personal testimonies of similar devastating memory and cognitive loss, some of which were entered into the New York State Assembly Committee on Mental Health report. These are voices unacknowledged by most of the psychiatric profession. For example:

Nearly 20 years ago I underwent 30 shock treatments. As a result I lost two full years of memory. I have one child, a daughter, and the two years that were wiped out in my memory were the years when she was two and three years old; those memories are irreplaceable.

I had to retire from part-time work as a paraprofessional in a local high school and I doubt I will ever be able to work again. I have forgotten how to weave, could not concentrate on anything, felt very little pleasure in life and still feel suicidal. I often don't remember people who speak to me, much of my past life is gone from my memory, I have cognitive thinking problems, fear being in any social situation, cannot spell, cannot remember factual information and live a rather hermit-like existence.

Copyright © 2005 by Jonathan Cott. Excerpted by permission of Random House, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Jonathan Cott is the author of fifteen previous books, including Conversations with Glenn Gould, Wandering Ghost: The Odyssey of Lafcadio Hearn, and Pipers at the Gates of Dawn: The Wisdom of Children's Literature. A contributing editor at Rolling Stone since the magazine's inception, Cott has also written for The New York Times, Parabola, and The New Yorker. He lives in New York City.