Kathleen

Age at interview: 51

Brief Outline: Kathleen had a couple of episodes of depression when she was in the UK, which were treated with anti-depressants. She moved to Canada and then was admitted to hospital on several occasions. Kathleen had 2 courses of ECT as an inpatient (24 and 18 treatments) and one outpatient maintenance ECT treatment.

Background: Kathleen currently lives with her parents in the UK, has two children and is separated from her husband. She describes her ethnic background as White British.

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In 2003-4 Kathleen experienced a couple of episodes of depression which were treated with antidepressants, although she thinks she had experienced depression previously. 

Kathleen felt that her depression got worse because of the stress of her husband working in Nigeria for a time when she had two young children. Then the family moved out to Canada where she didn’t have many close friends. She felt isolated as she lived 11km up a road towards a ski hill and her husband was away at work again. Later she impulsively took an overdose. She had her first hospital admission in March 2007 and it was after that she had some time off to recover. She was admitted under the name “Jane Doe” as she was the local doctor and staff felt it was important to maintain her privacy. She also made the decision to separate from her husband during this time and moved out in February 2008 with her children. 

The next hospital admission she had was in 2009 where she was in hospital for another couple of months. She wasn’t offered ECT but tried different antidepressants. Although she felt better, she felt she didn’t return to ‘normal’. She found the continued stress of the separation and medical exams very difficult but had a supportive psychiatrist and saw him for outpatient appointments. She found that although she could cope on the surface, underneath she was struggling. Sometime later she was referred to a tertiary referral centre, then to a mood disorders clinic in Canada, initially for assessment, and went ‘down hill’ very quickly here. She made a serious attempt to kill herself whilst one the unit, had one to one nursing and was held under a section of the mental health act. In the end she was on the unit from November 2009 until February 2010. It was during this time she had her first course of ECT treatment, age 48. 

Kathleen doesn’t remember a lot about the ECT treatments she had, but she did keep a diary around this time. She remembers being shown a video about ECT and remembers little bits about the preparation before ECT. Her mother from the UK did speak to the doctor during her stay but wasn’t involved in the decision to have ECT. She had 24 treatments in total, which she now thinks is a lot of treatments. The first treatment left her with a very bad headache and jaw ache. Afterwards she found that she couldn’t remember the number of her bank card or password to her computer. Sometimes she forgot the directions to places even though she knew them well. However those memory problems all wore off. Kathleen felt she ‘definitely did respond’ as she can remember not feeling actively suicidal anymore. She was very upset she wasn’t allowed home for Christmas, even though she knew she wasn’t stable at the time. They arranged for her to have maintenance ECT when she went back to her home town. She says this was the worst ECT she has ever had thinks they ‘totally fried her brain’. She has no memory of an entire weekend and refused to have anymore ECT after that. She was left to walk home on her own, even though she had arranged a lift. But she said she ‘wasn’t at all with it’ when her daughter found her. 
After an extended period of absence she had lost her job although she had successfully passed her medical exams in Canada. Kathleen had another admission to hospital in 2010 for 2 months following a suicide attempt but didn’t have ECT this time, and changed medication.  

In April 2011 she had emergency ECT during an admission after a serious attempt on her life. She felt that it ‘definitely did work’ and her consultant was convinced there was a response. She hasn’t had ECT in the UK. She still has very negative thoughts but is seeing a psychologist and also a “lovely” psychiatrist who she sees every six weeks as well as attending weekly group therapy and seeing a community psychiatric nurse regularly. Kathleen is concerned about the side effects from medication and is particularly bothered about the weight gain as she has gained at least 50-60 pounds in weight.

Kathleen feels they handed over her care between countries very well on her return to the UK. She feels things are getting better and has only been in hospital once in the last year. 

When Kathleen became depressed she wasn’t sleeping and started drinking and self-harming, and took an overdose. She had marital problems and felt isolated from friends but she eventually got support.

My husband had gone away working again. It was not what I wanted him to do. But he felt he had to. So again I was on my own. The children were older, but I was on my own and living so far out, living 11km’s out of town working and running the B&B. I wasn’t looking after myself. I wasn’t eating properly, I wasn’t sleeping properly and I was, I’m ashamed to say this, I was using alcohol. But alcohol I find, if I’m depressed as well, of course it’s a depressant, it makes me impulsive as well, and I’ll do things which I didn’t really mean to do and I took an overdose of tablets actually. Some good came out of that because it meant that I got, it got me some help, it got me to see a psychiatrist, it got me friends, getting a break from work, and friends came round I got close to friends and I built up a network, a support network. 

Although Kathleen had a long history of self harm, she had never spoken to anyone about her depression. It was only in her 40s when she was working as a GP that she agreed to see someone.

In fact I think it makes it worse, because I thought ‘oh no, I can’t, I can’t get depressed’, you know, I just didn’t want to share how I felt with anybody, either with my GP or someone else. No I kept it to myself and it, I was yes, I wouldn’t say forced into, yes, I suppose I was forced into it really. It was kind of a peer review thing for revalidation and I had mine with a GP from another practice and she persuaded me that I ought to. She thought I was depressed and I ought to make an appointment to see my GP. Or she was going to phone him or something. It was like you’ve got to or else. So, so I did. That was the first time I ever saw anybody about depression and I’m sure I had depression, I certainly have a long history of self-harm as a teenager, as a medical student. Yes. A long, long time. That goes back a long way. And certainly other depressive episodes.

The first time Kathleen became unwell she didn’t confide in many friends, but later she built up a closer network of friends.

But it wasn’t anything as bad as the depression I had when I was, when I was over there. I think because again I suppose I hadn’t been for any treatment again and just thought I’d put up with it and hadn’t really got a, first episode anyway, I hadn’t really got a close group of friends that I felt comfortable to confide in. I didn’t feel comfortably confiding with close friends anyway. But that was something that I learnt during that first episode out there. Something I worked on was to trust people and allow myself to be vulnerable with people and be able to share with close friends and that. It wasn’t a weakness and no, I was depressed and yes, it was okay to be depressed.

I did learn a lot more and after that, during that, after, or during that episode, I did make a, build up a group of very close friends that I’d never had before. It sounds horrible doesn’t it. I had friends in this country but no one I felt, I never felt comfortable to talk about very personal things. I kept myself to myself really. But I did learn to, that it was okay to have friends and move on with them, and with the encouragement of my seeing my psychiatrist every week as well. He was very good. Sort of psychotherapy.

Kathleen, a GP, had worked in an ECT suit and knew it was safe. She said she knew enough not to be afraid of it.

I don’t remember feeling, that I didn’t want ECT that or being very anti or anything, because I knew about it. I knew about ECT and I knew it was safe. I’d actually given ECT during a six month job as an SHO in psychiatry. And in those days, with no training whatsoever we actually gave it to the inpatients that were having it. And, the only training was from the anaesthetist I think, it was really basic, it wouldn’t happen like that now, I don’t think. Yes, I’ve seen some dramatic effects on people improving with it. And I suppose I, don’t know whether I thought I would improve or not, but I certainly wasn’t against the idea at all. I knew enough about it at that time to not fear it particularly. I don’t know what I thought it was going to do to me, but I wasn’t afraid of it. Because I know it can kind of does conjure up fear in some people I think

When Kathleen had maintenance ECT as an outpatient she felt highly disoriented and had no recollection of leaving the hospital alone or of the two days following the treatment.

Well yes, I was discharged. I went home and about a week afterwards I went for an outpatient maintenance ECT treatment at my local hospital. And that is the worst ECT I have ever had and I didn’t have any more, maintenance ECT I refused to have any more after that. Maintenance ones anyway. I think they totally fried my brain, because I can remember going there. The preparation and everything. It was a Friday. And the next thing I remember is Monday. I have absolutely no memory for the rest of Friday, Saturday, Sunday. 

And yet apparently I walked home. I had someone fixed up to give me a ride home. But they couldn’t get hold of them and I asked if I could walk home apparently and they let me walk home which I think was a big mistake [laughs]. Because I was not at all with it. And I walked home, and my daughter when she saw what I was like. I must have been disorientated or something and she called various people. My psychiatrist and GP and whatnot and they admitted me, you know, to recover from this one ECT and the next thing I remember is on Monday. I don’t remember anything for about three days really. So that put me off a bit [laughs].

For Kathleen ECT had a more gradual effect. She found that she began to not have so many suicidal thoughts and that they were less intrusive.

What was the effect? Well it’s not like a light switch. It wasn’t a sudden thing I would say. I remember some of the things that I did on the ward, like sort of the occupational therapy type things. But for the length of time that I was there, there’s so much that I don’t remember. That’s why I don’t know whether it was unilateral or bilateral. It certainly must have been a lower dose and although you come round very quickly from it. You’re sort of sleepy. Sometimes I would sleep afterwards for a while, sometimes I would be wide awake and just be able to carry on. Other times I was totally disorientated and not, not know where I am or where my room is or whatever for a while. But from a mood point of view, well it just, things must have improved because I didn’t have the thoughts so much or I’d have the thoughts but they weren’t so intrusive. And I was able to do other things like these other activities that we did on the ward. 

It has taken a long time for Kathleen to feel comfortable talking about her mental health problems, even to close friends or health professionals. A sense of shame or failure means she won’t talk about some things.

I still find it difficult to talk about some things to do with my mental health with even people I am very close to, so it’s still attached to a sense of, for me, a sense of shame or something like that, failure or whatever.

And you were saying before that’s your sense of it, but people have reacted differently?

Yes. Yes. 

And has that always been the case or have you found who to talk to, and who not to talk to over the years, or how has it worked out?

It’s a relatively recent thing that I’ve talked to anybody so [small laugh] yes, I found, it’s, it’s taken me all my life probably to find, to feel comfortable, to find, to feel safe talking to close friends about things. And certainly no I wouldn’t want to just talk to anybody. Yes, there are those you can talk to and those you can’t talk to. Yes. I do feel that and of course any professionals in the field I used to find it difficult even to just go and see my GP about it, but I’ve come a long way from then, in a good way I think, because no one can help me if I don’t talk about it. But I still get anxious if I’m meeting somebody new and then afterwards I go over it in my mind. I think ‘did I ramble on too much or did I say the wrong thing?’ 

Kathleen describes her first experience of a psychiatric ward as horrible, even though she had a room to herself where she spent most of her time. She went in voluntarily, but was later sectioned.

I know a lot more about it now. At the time, I didn’t quite understand. They use a whole different language don’t they? Like you won’t know this but like clothes ‘privileges’. Like my psychiatrist arranging my admission over the phone and saying oh I could have clothes privileges. I thought what on earth are clothes privileges? It meant I could have my own instead of hospital clothes. And I had my own room actually which was nice, because most the rooms were not single rooms except the secure rooms. There were two seclusion rooms and a couple of rooms, which were single rooms with cameras in. 

My experience was, I can’t remember much about it. I was so, I was so distressed at the time, I spent my whole time in my room and I very rarely ventured out of my room. I was very ashamed, embarrassed. That was just me, and it just felt terrible. I hadn’t wanted to go in there, you know, it was just really terrible that I had to be an inpatient. But I had gone in voluntarily, but then I still wasn’t really given the option. It was said well if you don’t go in voluntarily then we’ll make you, you’ll have to go in. They said that every time. Every time to me. And then I’ve gone in voluntarily and then while I’ve been in there they’ve then sectioned me. I’ve been sectioned, virtually every time I think. I supposed they’re just worried for my safety.

And we had a named nurse each day. There’s a big sort of kitchen dining room area where we would have a community meeting each morning after breakfast. There was an activities leader and she would do relaxation and those that could go out of ward had a walk as well. But I still just, I found that, particularly that first admission, just horrible, because I’d never experienced anything like that before and I found that, yes, very hard, mainly because I felt so ashamed of everything. Ashamed of being ill, ashamed of what had been going on.

Kathleen described feeling anxious at first about speaking to her psychiatrist about things she’d never spoken to anyone about. She says they have since developed “a good therapeutic relationship”.

Because I just recently started this psychology treatment and after my first appointment with the psychologist and she’s a lovely lady, but I still worry about it afterwards and I did tell her. I did tell her, I said, “I did worry about it.” But like she said, you know, she has nothing to work on if, if I don’t talk or say anything and I’ve not had the kind of reaction that I’ve perhaps assumed, you know, I’ve had a, I’ve been talking to someone about it, it’s been different from my. Their reaction has been different from what I’ve assumed it would be, because I’m thinking one way so I just assume everyone else is thinking in that warped way.

So you mean in a negative sort of?

Yes.

And obviously I mean coming from you know, almost forced to talk to your GP initially to having relationships with several psychiatrists and so on…

Yes, I’ve come a long way.

Yes.

It doesn’t bother me now.

But how have they been for you. You’ve tended to talk about them in quite positive terms.

Yes. Yes. I miss my psychiatrist I’ve been seeing the longest, the one in [name of country], I probably been seeing him since 2007, almost every week. I had a regular appointment with him for an hour every week. We had a good relationship but even the first time I went to meet him, when I got home, I thought ‘oh no, he got me to tell him things which I’d never told anybody before. Oh why did I tell him about that?’ Things that I’d done to myself when I was young. Self-harm etc. I just felt, oh I can’t go and see him again, I can’t go and see him again after that, and I was just cross with myself for having told him these things. I very nearly didn’t go back to see him again, but I did, and I’m glad I did, because as I say, we did develop a good therapeutic relationship and over the years and he’s been a very positive influence and very helpful particularly in problem solving and sort of psycho therapeutic approach, and really not just medication.

Kathleen found ECT effective and says if a doctor is recommending it they must have a good reason. She would have it again.

Oh gosh. Well I would say if your doctor’s considering ECT and they are recommending it for you, then you know, they must have a good reason for it, and it is in the right circumstances a very effective treatment, a fast effective treatment. It works faster than medication I believe, and it’s very safe. It may be a bit scary, but they’ll tell you all about it. I think I on the whole had a good experience of it and positive experience of it. So yes, if they are recommending it, then go for it [laughs]. I would do it again, if I got really depressed again, if I was dangerous depressed again, I would do it again.