A Patient's Journey Through Catatonia and Electroconvulsive Therapy (ECT)
This blog post provides an inside look at my experience working with an individual who experienced catatonia and their journey toward recovery with electroconvulsive therapy (ECT).
My hope is that sharing this experience can provide education and help reduce some of the stigma surrounding catatonia, ECT, and inpatient psychiatric hospitalization.
***The individual discussed in this post reviewed my writing after discharge and gave me permission to share both their experience and my own, including details they shared with me throughout their journey. They are aware that this story is published on this website. I have taken care to protect their identity.***
My First Experience on an Inpatient Psychiatric Unit
Stepping onto my medical school's inpatient psychiatric unit for the first time during my psychiatry clerkship made me initially stop in my tracks.
It was clean and quiet, with beautiful paintings and photographs lining the cream-colored walls.
As I walked through the halls, I saw patients dressed in scrubs and sweatpants simply spending time together. Some were lounging while watching TV, others were drawing with huge Crayola markers, and a few were having an animated debate about their favorite singers.
It looked nothing like the psychiatric hospitals I had seen portrayed in movies and television.
During this clerkship, I had the incredible opportunity to speak with an individual who had recently undergone multiple ECT treatments and had finally "awoken" after spending approximately a month in a catatonic state.
What Is Catatonia?
Before continuing their story, I want to pause and talk about catatonia.
When many people hear the word "catatonia," they imagine someone completely frozen in space and time, almost like a statue.
That CAN occur, but catatonia can present in several different ways.
One possible feature is called "waxy flexibility," in which a person's limbs may remain in a position after someone moves them.
Other people experiencing catatonia may have profound decreases in movement, speech, interaction, or responsiveness.
Catatonia can become medically serious because an individual may have difficulty independently eating, drinking, moving, or meeting other basic physical needs.
See the table below from:
"Prototypes of Catatonia: Diagnostic and Therapeutic Challenges in the General Hospital"
Azzam PN, Gopalan P. Prototypes of catatonia: diagnostic and therapeutic challenges in the general hospital. Psychosomatics. 2013 Jan-Feb;54(1):88-93. doi: 10.1016/j.psym.2012.06.008. Epub 2012 Dec 4. PMID: 23218059.
Q: What Did Being in a Catatonic State Feel Like?
When I learned that this individual had recently emerged from a catatonic state, I desperately wanted to speak with them.
I wanted to understand their story.
What had they experienced while they appeared unresponsive?
What did they remember?
What had ECT felt like?
My heart ached as their voice quivered while they explained that they didn't "remember anything" from much of the previous several weeks.
They couldn't believe they had lost so much time.
I remember wondering:
How could they not remember?
Before meeting them, I had assumed that someone in a catatonic state might be fully aware of everything happening around them but simply unable to communicate.
Their experience was much more complicated.
They described a few vague memories of seeing their body surrounded by medical staff who were caring for them.
They also remembered feeling as though they were dreaming for much of the time.
One recurring memory involved being on a "large boat with tons of cabin rooms" while completing some sort of mission.
They remembered small pockets of time in which they thought they saw their mother or partner visiting them, although they weren't sure whether those experiences had actually happened or had been part of the dream.
Their memories of that month were fragmented and difficult to distinguish from one another.
Q: What Did They Remember About ECT?
When I asked whether they remembered receiving ECT, they described having a mask placed over their face, hearing the doctor ask them to count backward from ten, and then falling asleep.
They were actually very interested in understanding what had happened during the procedure.
At the time, it was only my second day on my psychiatry rotation, so I admitted that I didn't know very much about ECT myself.
I promised that I would learn more and come back to talk with them.
That conversation made me realize that many of my own ideas about ECT had not come from medicine.
They had come from movies and television.
My Own Bias About ECT
Later that night, I wondered what biases this individual might have had about ECT before receiving it.
Had they seen the same depictions I had seen in movies and television?
They didn't seem fearful.
Instead, they seemed intrigued.
Before this rotation, my own understanding of electroconvulsive therapy had largely been shaped by movies such as "One Flew Over the Cuckoo's Nest" and "The Silence of the Lambs," along with television shows such as "American Horror Story" and "Ratched."
These portrayals frequently showed a disheveled psychiatric hospital where patients were treated more like inmates.
There would be screaming, manic laughter, ominous hallways, and a terrified psychiatric patient strapped tightly to a metal bed.
The patient would then be shocked while their body convulsed violently.
Sometimes ECT was even portrayed as a punishment.
I remember watching those scenes with goosebumps covering my arms and my heart racing.
The storyline often suggested that ECT existed not to help the patient, but to control them, silence them, erase memories, or make them less burdensome to the psychiatric staff.
These images stayed with me.
But modern ECT looked NOTHING like what I had seen portrayed on television.
What Is Electroconvulsive Therapy (ECT)?
ECT is a medical treatment performed under anesthesia in which a carefully controlled electrical stimulus is used to produce a brief therapeutic seizure.
Modern ECT is performed with anesthesia, muscle relaxation, physiologic monitoring, and careful adjustment of the electrical stimulus.
ECT has been studied for decades and is used for several severe psychiatric conditions, including catatonia.
For severe catatonia, it can be particularly important when symptoms are persistent or when other treatments have not provided adequate improvement.
Here are two major articles discussing ECT:
1. Electroconvulsive Therapy Part I: A Perspective on the Evolution and Current Practice of ECT
Payne NA, Prudic J. Electroconvulsive therapy: Part I. A perspective on the evolution and current practice of ECT. J Psychiatr Pract. 2009 Sep;15(5):346-68. doi: 10.1097/01.pra.0000361277.65468.ef. PMID: 19820553; PMCID: PMC3042260.
2. Electroconvulsive Therapy Part II: A Biopsychosocial Perspective
Watching Catatonia Return
The following night, I returned to visit the individual.
I was devastated to see that they had quickly regressed toward the silent and distant state I had seen described in their chart.
They barely answered my questions, often responding with only one or two words.
When I asked how they were feeling, I could tell that putting their internal experience into words was incredibly difficult.
I pulled out the emotions wheel on my phone.
"I sometimes also have difficulty expressing what I am feeling, and I like to use this," I explained.
I zoomed into the center of the wheel and began with some of the broader emotions:
Sad.
Afraid.
Disgusted.
Angry.
Proud.
Joyful.
Intrigued.
Trusting.
Loving.
Peaceful.
Ashamed.
They stared intensely at the screen.
But I wasn't sure how much they were able to engage with me anymore.
In their hands, they repeatedly spun a small ball.
I tried another strategy.
"I heard earlier that you felt sad. Do you feel sad?"
Silence.
So I waited.
Sometimes, one of the most important things we can do in psychiatry is simply give someone time to respond.
They Were Still There
I tried several different approaches.
I asked what they were thinking about.
I brought up topics we had discussed the previous day.
Then, to my surprise, they remembered what college I had attended because they had once visited the town.
They could also follow simple requests, such as looking toward me when I spoke.
They were there.
Something was simply interfering with their ability to fully interact with the world around them.
After reminding them of a few memories and hobbies they had shared with me the day before, I decided it was best to let them rest.
I stood up from where I had been crouching beside them.
"It was good to see you," I said.
They looked at me and responded:
"It was good to see you too."
That small sentence meant so much to me.
Improvement After Another ECT Treatment
The next evening, they were noticeably more awake after undergoing another ECT treatment.
We talked for a while, and they told me they vaguely remembered our conversation about being on the boat.
This time, however, they also described experiencing increasing paranoia while in the hospital.
What fascinated me was that they could sometimes recognize that these thoughts were not based in reality while still experiencing them as frightening and intrusive.
At the end of our conversation, they asked whether I would return the following night.
I promised that I would.
Between our conversations, they continued receiving ECT as part of their treatment plan.
Their symptoms had been severe and had returned quickly between treatments, so the psychiatric team planned a longer acute treatment course.
"Today I Truly Woke Up"
After additional ECT treatments, I visited again.
This time, they were the most alert, vocal, and animated I had ever seen them.
They told me that today they felt like they had truly "woken up."
For the first time, they felt that they could think clearly.
They did not remember some of our earlier conversations about the boat or even initially meeting me.
But their fragmented memories seemed to be gradually coming together.
They began explaining more about the intense internal stress they had experienced before becoming catatonic.
People respond to overwhelming stress in many different ways.
They described an experience that reminded me of the phrase "deer in the headlights" — becoming frozen in the face of overwhelming fear.
They had become trapped in a cycle of panic, believing that their life was essentially over and that everything they had worked toward was disappearing.
Finding Connection Through Our Experiences
I related deeply to that fear.
I shared with them that I had experienced my own overwhelming stress response when I faced the possibility of having to leave medical school after failing my Step 1 examination twice and appearing before my school's academic board.
Obviously, our experiences were not identical.
But we both understood what it felt like to believe that one major event might suddenly erase years of work toward a dream.
We reflected together almost like old friends.
They described the frightening places their mind had gone while sitting in that hospital bed, largely unaware that more than a month had passed since they had first arrived by ambulance.
My Own Experience Assisting With ECT
One morning during my psychiatry rotation, I had the opportunity to put on surgical scrubs and observe and assist with ECT procedures.
We met the anesthesiology team in the recovery area and waited for the patients and attending psychiatrist to arrive.
The ECT machine was rolled into the treatment area, and the team began preparing the necessary equipment.
The first patient arrived and climbed onto the hospital bed.
While the team started an IV, we chatted.
They explained that they received maintenance ECT approximately once a month and that the treatment helped them continue functioning in their everyday life and career.
Medication was administered through the IV, and they calmly fell asleep under anesthesia.
The team placed appropriate monitoring equipment and safety restraints to prevent them from falling from the bed during the procedure.
The psychiatrist then prepared the electrodes and adjusted the ECT machine using treatment settings appropriate for that patient.
Within minutes, the stimulation had been delivered.
I remember being stunned.
The patient's body had barely moved.
Where was the dramatic convulsion I had seen in movies?
The answer was simple:
Modern ECT involves anesthesia and a neuromuscular blocking medication, which substantially limits the large muscle movements associated with the induced seizure.
The patient's brain was being carefully monitored throughout the treatment.
It was NOTHING like the frightening scenes I had grown up watching.
My First Close-Up Look at an ECT Procedure
We then moved to the next patient, an older woman who was quietly waiting for her treatment.
She told me she had been receiving ECT from the same psychiatrist for longer than I had been alive.
This time, I understood the basic routine.
I helped with preparation while the psychiatrist and anesthesia team performed the treatment.
Again, the entire procedure was remarkably controlled and calm.
There were no screams.
There were no giant restraints.
There was no punishment.
There was a patient under anesthesia receiving a carefully monitored medical treatment.
The contrast between reality and what I had seen portrayed in popular culture was extraordinary.
Q: Would the Patient Recommend ECT?
On the final day of the individual's inpatient psychiatric stay, I returned to talk with them about their experience.
By that point, they had received more than 10 inpatient ECT treatments and planned to continue outpatient ECT after discharge.
I asked whether they would recommend ECT to someone else experiencing something similar.
They said yes.
Why?
Because ECT helped them:
"feel more like me."
That sentence has stayed with me.
Destigmatizing Inpatient Psychiatry and ECT
My goal in writing this blog post is to acknowledge that mental health treatment can be scary.
Being admitted to an inpatient psychiatric hospital can be scary.
Receiving ECT can sound scary.
And not understanding what is happening to your mind or body can be terrifying.
But the images we see in movies and television often do not accurately reflect what modern psychiatric treatment looks like.
The purpose of an inpatient psychiatric unit is to provide safety, stabilization, treatment, and support for individuals who are temporarily unable to safely meet their needs outside of the hospital.
Sometimes that means caring for someone experiencing severe suicidal thoughts.
Sometimes it means treating severe psychosis or mania.
Sometimes it means caring for someone experiencing catatonia who cannot independently eat, drink, communicate, or care for themselves.
Needing that level of support is not a personal failure.
It Is OK to Take Time to Heal
It is OK to step away from work, academics, or everyday responsibilities when you need time to recover.
I learned this lesson not only as a medical student caring for patients, but also through my own experience as a patient who took a year away from medical school to focus on my health.
Taking time away was physically, emotionally, academically, and financially difficult.
But I would not be where I am today without it.
I came back with a better understanding of my health.
I learned how to better manage my pain.
I became more aware of my emotional responses to stress.
And I became better able to remain present when difficult academic and life challenges arose.
Healing does not mean that every future challenge becomes easy.
But getting appropriate treatment and support can give us more tools to face those challenges when they come.
More Resources About ECT
American Psychiatric Association
National Alliance on Mental Illness (NAMI)
National Mental Health Association
Additional patient and educational resources
References
Kerr RA, McGrath JJ, O'Kearney RT, et al. ECT: Misconceptions and attitudes. Aust N Z J Psychiatry. 1982;16:43–9. PubMed: 6956328.
Fink PJ, Tasman A. The stigma of electroconvulsive therapy: A workshop. In: Fink PJ, Tasman A, editors. Stigma and Mental Illness. Washington, DC: American Psychiatric Press; 1992. p. 189-201.
Reasoner J, Rondeau B. Anesthetic Considerations in Electroconvulsive Therapy. StatPearls. Updated May 17, 2022.
Lally J, Tully J, Robertson D, Stubbs B, Gaughran F, MacCabe JH. Augmentation of clozapine with electroconvulsive therapy in treatment-resistant schizophrenia: A systematic review and meta-analysis. Schizophr Res. 2016 Mar;171(1-3):215-24. doi: 10.1016/j.schres.2016.01.024.
Medical Disclaimer
***This blog post is for educational purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Nothing in this post establishes a doctor-patient relationship. All opinions are those of the writer and do not necessarily reflect the views of any institution or employer. Please speak with your healthcare provider or therapist if you have questions about your own treatment.***
I blog about living as both a patient and a medical doctor.
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