RICHARD SKINNER

Shock treatment (extract from a novel)

At ten o‘clock Geoff and I left the ward and walked along the corridors. Geoff, who was twenty-eight, had been a patient on the ward for several years. He regularly smashed windows. A few weeks previously he had thrust his head through one of the dormitory windows, and when the night staff had pulled him free, he had been jabbing his neck down repeatedly onto the jagged edge and shouting, ’I must! I must!’ Yet again he had been prescribed a course of electroconvulsive therapy.

ECT had come into use decades ago, following on from an alleged observation that people suffering from epilepsy did not suffer from depression. Thus, it was argued, if someone could be induced to have epileptic-type fits, that would banish their depression; and so a brief burst of electricity is sent through their brains to trigger off convulsions. The fact that the originating observation concerning the mutual exclusivity of epilepsy and depression was now in disrepute had not led to the discontinuation of ECT. It was still part of the psychiatric armoury.

Geoff was smartly dressed as though attending a job interview. He marched along the corridor with a determined look on his face. The side-piece of his spectacles was broken; the Elastoplast holding it on had darkened to a shade approximating that of the rest of the black frame.

‘Do you think ECT does you any good?’ I asked him. ‘I suppose it must do,’ said Geoff in his rather gormless voice, ’otherwise the

doctor wouldn’t have said that I had to have it, would he?’ ‘You’ve had a lot in your time.‘ ’Yeah, I suppose I have.’ ’You don’t mind it?‘ ’It‘s something to do, innit? I’m on a course of ten this time. This one’s me

‘Has it helped?’ ’I ain’t broken any windows recently, have I?’ I t struck me that shoving electricity through someone’s brain was a strange

’Does it stop you feeling depressed?’ I asked. ’The best part of it is afterwards when, you know, you can’t remember

anything. It makes everything go cloudy for a bit and stops you thinking. Gives you a break. I suppose if I have enough of it, I’ll get better, won’t I?’

‘If you hit a window hard enough it’ll turn into strawberry jam,’ I said,

seventh.‘

way to go about safeguarding windows.

68 Critical Quarterly, vol. 29, no. 4

remembering a philosophical discussion on the use of the word ’enough’. ’Yeah,’ said Geoff. We reached the ECT ward and I handed Geoff‘s medical notes to the sister

in charge. Several patients from other wards had already arrived, accompanied by nurses. One frail old lady was clutching the arm of a student nurse and repeatedly asking her to look after her teeth.

’But you haven’t got any false teeth,‘ the nurse said patiently, ’you’ve done very well. You’ve really looked after your teeth well. They’re all your own, aren’t they? I hope I’ve still got all my teeth when I’m your age.’

’But they’re always telling me to take them out,’ the old lady said querulously. ’Only if they’re false teeth. Yours aren’t, are they?’ The nurse caught my eye

and gave me a conspiratorial wink. I responded by briefly rolling my eyes. Leaving Geoff sitting with the other patients in the little room outside the

main part of the ward, I went in to where the beds were. It was clean and unfussy, and lit by several large windows with yellow curtains. There were eight beds, four jutting out into the centre of the ward from both of the two long walls. The sister, a diminutive Chinese woman, was bustling about, preparing the trolley and equipment in time for the arrival of the doctor who would administer the shocks. On the trolley was a black metallic box with several switches and dials, and which was plugged into a wall-socket. From the box emerged two coils of flex, each terminating in a short black rod with a disc an inch or so in diameter attached to the end. Each disc was covered with white fabric. These were the electrodes through which the electric current would be transmitted to the temples of the patients.

Along with two or three other nurses I was told to prepare the beds. An incontinence sheet was laid on each bed, a blanket put on top of the sheet, and another blanket placed in readiness at the head of the bed. A pillow was placed on each bed at its foot. The patients would be lying on the beds the wrong way round, with their heads towards the gangway between the two rows of beds, so that the trolley could easily be trundled along and the shocks administered efficiently. There was something about i t that strongly resembled a production line.

‘Get them in please,’ said the sister when the beds were prepared. ‘Make sure they remove spectacles, false teeth, jewellery and things like that. Make sure they haven’t got anything in their pockets like combs or keys which could injure them when they fit .’

The patients trooped in. Geoff, an old hand, sat on the bed assigned to him and made himself ready without any prompting from me. He was far more familiar with the routine than I was. He removed his shoes, took off his jacket and tie, loosened the belt on his trousers, then swung himself up on to the bed and lay down. I partly covered him with the second blanket.

Shock treatment (extract from a novel) 69

‘I’ll keep me specs on a bit longer,’ he said, ‘until the doc gets here. And all

’Nothing in your pockets?’ ’Nope. I need a thing for me wrist though. You know, with me name on it .’ ’Oh yeah. Thanks for reminding me.’ I wrote his name on a small slip of paper and inserted it in a plastic bracelet

which he fastened around his left wrist. ’In case you forget who I am,‘ he joked. The patients were all on their beds, blankets covering them. The sister fiddled

with the machine, then flicked through Geoff‘s notes. She looked at her watch, walked smartly from the room, and returned almost immediately with the doctor. He spent several minutes looking at the patients’ notes. A nurse was checking the hypodermic needles and the drugs which would be used.

Geoff wiggled his toes and said he wished the doctor would get a move on. The frail old lady was still moaning about her teeth.

’All right,’ said the doctor at last, ’we‘d better get going. You’re the first, are you? Geoff Stove, isn’t it?‘

’It‘s Stone,’ said Geoff. ‘Geoff Stone.’ ’So i t is. Dreadful writing some doctors have. Looks like Stove, doesn‘t it

sister? This is your eighth one, isn’t it?’ ’Seventh,’ said Geoff. ’This is me seventh. Three more to go after this one.’ ’I think you’ll find it’s your eighth.’ ‘No, seventh. You have a look.‘ ’Could I have the notes again please, sister. One . . . two . . . three . . . four

. . . mmm, yes, this is your seventh. Quite right Geoff. You keep us on the straight and narrow. Okay. Glasses off. Feel all right?’

‘Yes, thank you, doctor’, said Geoff politely, handing me his spectacles. ’Good, that’s the spirit. All right, could someone find me a vein, please?’ The injection Geoff received consisted of a short-term general anaesthetic and

a muscle relaxant. The latter was to diminish, and preferably eradicate, the violent muscular spasms which would occur in its absence. Since the relaxant also affected the person‘s breathing, air had to be administered by a face-mask attached to a large rubber bladder pumped by hand. To keep the air passage open, and to prevent the tongue getting bitten during the convulsions, a stubby plastic tube, curved and with fat lips, was inserted into the mouth, pinning down the tongue.

The anaesthetic took quick effect. When Geoff was unconscious, three of us on each side held down the blanket covering him, a further restraint to prevent any injury arising from the convulsions.

The doctor looked at Geoff‘s notes again, then took the electrodes handed to him by the sister. The cloth-covered discs had been moistened in a special

me teeth are me own!‘

70 Critical Quarterly, vol. 29, no. 4

electrolyte to enhance electrical contact with the skin. He held them briefly in the air, one in each hand, like someone holding aloft a carving knife and fork just before plunging them into the Sunday joint. He rocked slightly on his heels, then slowly bent forward and placed one electrode on each of Geoff’s temples. There was a complete, reverential silence. Even the old lady had temporarily ceased her dental lamentations.

He pressed the button at the end of one of the electrodes, and there was a brief buzz like a distant electric doorbell.

Geoff began convulsing. The doctor handed the electrodes back to the sister and watched dispassionately as Geoff‘s face twitched and his legs gave repeated little kicks. We kept a tight hold on the blanket.

‘Must have been hell in the old days before they used relaxants,‘ observed one of the student nurses on blanket restraint duty. ’When they did straight ECT, I read that patients would sometimes bang about so much when they were convulsing that they‘d break an arm or a leg.’

’That doesn‘t happen these days,’ said the doctor briskly. ‘We‘re civilised now.’ Geoff continued convulsing for several seconds, then, after a series of

’That’s satisfactory’, said the doctor. The sister stepped forward and put the mask over Geoff‘s mouth, and began

to squeeze the bladder. When she was satisfied that he was breathing normally, she stepped back and told us to continue. We had to turn him on to his side. We pushed our arms beneath his bulk, and with one nurse supporting his head we heaved him over and arranged his legs in a way that would prevent his rolling on to his back again. I gave the mouthpiece an experimental tug, but i t was still clenched between his teeth.

‘There was that thing a few years ago,’ said the same student nurse, ’when a hospital did ECT for two years with a new machine before discovering that it didn’t work. It hadn’t broken; it just couldn’t have worked from the start; it wasn’t wired up properly. And nobody had noticed for two years. They went on giving shocks that weren’t shocks at all. A study then showed that just as many patients got better having these non-shocks as had been getting better when they were getting proper shocks.’

shudders, became still.

‘How many was that, then?’ asked one of the others. ‘I don‘t know. It didn’t say.’ ‘I don’t believe it . You can‘t tell me that no-one noticed the patients weren‘t

’Maybe they thought they were using exactly the right amount of relaxant.’ ’Or maybe the patients heard the buzz and went into a f i t because of it. You

‘We haven’t got all day,’ said the doctor. ’There’s six more to do.’

convulsing.’

know, conditioned response.’

Shock treatment (extract from a novel) 71

We moved on to the next patient, another man a few years older than Geoff. He had a pale face with tufts of hair sprouting from the skin just below his eyes. He was lying rigidly on the bed, arms stiff by his sides, legs stretched to their limit, feet together and pointing vertically.

’Frederick Peterson,’ said the doctor reading the name on the case notes handed to him. ’How are you, Mr Peterson?‘

Mr Peterson gave a long groan. The doctor nodded his head wisely, a trained interpreter of cryptogrammic

groans. ‘We’ll soon have you to rights,‘ he assured Mr Peterson, who responded with another long groan.

’You’ll be all right, Freddie,’ said one of the female nurses. The procedure for Mr Peterson was the same as for Geoff; then it was repeated

for the other five patients. Injections. Electrodes. Buzz. Twitch and jerk. Stillness. Face-mask. Roll on to side. One, two, three, four, five, six, seven. And all the time keeping an eye on those who had received the treatment to ensure that they were still breathing.

By the time the seventh patient had been rolled over on to her side, Geoff was beginning to stir. I removed the plastic tube from his mouth and dropped it into a bowl on the trolley.

’How are you feeling?‘ He looked at me groggily, then closed his eyes again. A few minutes later

’You’ve had i t . It’s all over. Done.’ ‘I don’t remember.’ ‘It’s all done.’ ‘Was it all right? Did I jerk a lot?’ ‘A bit. Keep lying down for the time being. Don’t get up in a hurry. Tea and

biscuits as usual when you’re ready.’ ‘Yeah.‘ A few minutes later, Geoff threw aside the blanket covering him and sat up.

He pulled on his shoes then stood up, supporting himself on the bed rail. ’All right?‘ I asked. ‘Yeah, I think so. Funny innit? I don’t remember it.’ While Geoff and the others were having their cups of tea and biscuits, the

ward had to be returned to its former state. The oxygen cylinders, which had been standing by in readiness’ in case anyone’s breathing went haywire, were trundled back into a side room, unused. The extra blankets were removed from the beds, the incontinence sheets thrown away, the mouthpieces left to soak in a sterilising solution, and the trolley with its electrical paraphernalia was pushed into a back room. I washed my hands in a little basin, and dried them

he re-opened them. ‘When‘s he going to start?’ he asked sleepily.

’Got me specs? Thanks. Give us me shoes, could you?‘

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on the rough, green paper towels which had been treated with a water repellent. 'I'm ready now', said Geoff. 'Have you got your jacket?' 'Where is i t? ' 'Over that chair.' 'Mustn't forget that, must I?' I collected Geoff's notes from the sister's office, and we walked slowly back

the way we had come. Turning into one corridor, Geoff stopped. 'This ain't the way,' he said, looking round in confusion.

'Maybe it's not the quickest way,' I said. 'I'm never sure which is the shortest route.'

'But ECT's that way.' He pointed back down the corridor the way we had come.

'You've already been,' I reminded him. 'We're on our way back to the ward.' 'Oh yeah. It does funny things to you, don't it?' I t was pigs, I remembered. Some fellow, possibly in the last century, had

got the idea about inducing fits with electricity by watching pigs being stunned with electric currents in a slaughterhouse. Of course, it didn't matter what happened to the pigs' brains as a result; they weren't going to be having much further use for them.

'Hilarious,' I said to Geoff. He looked at me strangely.