Zap
By Abbey Porter
I climb into the big beige chair and reach for the bowl of earplugs on the table next to me. After ripping open the plastic package and stuffing a spongy blue earplug into each ear, I lay my head back and push on the arms of the chair to make it recline. Amanda’s fingertips are light and gentle as she parts my hair, looking for the mark.
“Here we go,” she murmurs, and the flat, hard electromagnetic coil presses against the right side of my head, toward the top, where the frontal lobe of the brain is located.
“How’s that?” Amanda asks. “Too much pressure?” I can’t see her; she stands behind me.
“No, that’s fine, thanks.”
I hear a series of beeps. Then the rhythmic zaps start, coming perhaps a second apart: not-quite-painful little kicks delivered neatly to my scalp.
“You OK?” Amanda inquires kindly.
“Yes, thank you.”
She rustles into the inner office, where I can see her through a pane of glass.
Each zap produces a pulse that blooms briefly inside my skull. The sound reminds me of the tot-tot-tot of a woodpecker, the spark of two live electrical wires touching, the tap of a message sent in Morse code. I wondered what such a message would say.
"[Medicine is] entering an era when new methods will be available for the modification of brain circuitry and function of normal or disordered types by means of painless extracranial techniques that seem to be without obvious detriment to neuronal populations."
-R. G. Bickford, 1987
By the time I was 13, I’d noticed I felt very different on some days compared to other days. Sometimes I enjoyed doing work and accomplishing tasks; other times, I didn’t seem to have the energy. I wondered if I was lazy. Though I knew I had episodes of feeling bad, I lacked perspective on how often they occurred, or how long they lasted. On the bad days, even my eyes felt strange, as if the lids were too heavy. Sitting at a desk in my high school classroom, I knew the other kids could tell something was wrong.
I stayed home from school a lot—not sick, really, but not wanting to go. I lay on the nubby brown tweed couch in the family room, ate snacks I’d snuck from their storage place in the basement, and watched sit-coms and game shows—“Three’s Company and “Family Ties,” “Wheel of Fortune” and “The Price Is Right.”
One day, the daytime talk show “Donahue” did an episode on depression. A therapist described a phenomenon in which people experience periods of low energy and sadness that are beyond their control. With a shock, I realized: It was me. There was comfort in the notion that an external, definable force could explain what was happening.
The deadening bleakness has come and gone like the weather since those teen years—not always, or entirely, divorced from reason, yet powered by its own mysterious force. The decades have filled with a string of therapists and an ever-growing list of medications—Zoloft, Welbutrin, Effexor, Prozac, Paxil, Pamelor, Celexa, Seroquel, Cymbalta, Vibryd, Abilify, Fetzima—one after another started with hope, then stopped in disappointment at its ineffectiveness or intolerable side effects. One produced a panic attack; others silently stole my sexual pleasure.
At 40, I had the feeling that the deep grey cloud was part of me, its wisps entwined with my being as inextricably as my tendons and blood vessels.
One evening, at my regular monthly appointment, my therapist told me about transcranial magnetic stimulation, or TMS, an experimental treatment that was proving effective for depression. Unlike electroconvulsive therapy, it produced few side effects. In sessions conducted in a doctor’s office, magnetic pulses are used to stimulate the brain. The patient can get up and drive home afterward. My therapist recommended Dr. John O’Reardon, a pioneer in TMS who practiced at the University of Medicine and Dentistry of New Jersey, about an hour from my home near Philadelphia.
At my first appointment, I followed Dr. O’Reardon’s tall, slightly stooped form down a hall to his office. Sitting at his polished mahogany desk, Dr. O’Reardon tallied the score on a test I’d filled out to gauge my mood and pronounced, “Severely depressed.” He eyed me from under grey eyebrows and said in a soft Irish brogue, “When you’ve been depressed for so long, it can start to seem like it’s part of you. But it’s not. That’s just the depression talking.” My eyes filled. He understood. I glimpsed a future I’d seldom imagined, free from depression’s heavy cloak.
TMS treatment would entail 30 sessions—one daily, five days a week, over a six-week period—and would cost $7,000. It was not covered by insurance. I would need to make the hour drive each morning before work. It was time and money I didn’t think I had. But there seemed to be little choice.
The room in which the TMS sessions were conducted was decorated in neutral, soothing colors. Behind the chair on which I sat, a black box with control knobs rested on a cart. A small lamp sat on a stand against the wall opposite the chair; it cast a soft downward cone of light. Its stem of gracefully twisted metal looked like women with their arms raised over their heads, as if in triumph.
At the start of my first session, Dr. O’Reardon had me lay my left hand on the arm of the chair with my thumb extended upward in an imitation of the “thumbs up” sign. He said he needed to locate my motor threshold to determine the level of stimulation to use. He laid his hands in my hair, as if in affection. Then he pressed something flat and hard against my head and … zap. At first, nothing happened, but he moved the apparatus around and adjusted the level to an accompanying “beep-beep-beep,” and eventually the zapping produced an involuntary twitch in my thumb. He marked the spot on my scalp. After the initial appointment, the treatments were delivered by Amanda, a slim young woman with long brown hair.
Some days, I almost fell asleep during the 15-minute sessions. Often, I meditated and envisioned the zaps awakening the “good cells,” which I pictured as round, cartoonish blue figures who clambered out of their beds and danced about, embracing. Likewise, I pictured the pulses putting to sleep the cells’ mud-colored, shriveled counterparts, the conveyors of my dark moods.
Sometimes I closed my eyes and opened them to realize Amanda was behind me. I heard high-pitched beeps as she adjusted the level on the machine.
“Doing OK?” Amanda was brisk; she moved quickly.
“Yep.”
In my memory, everything is grey and grainy, like a poor television picture.
I was 14. It was Christmas Eve, early in the day. I had taken refuge in the second-floor bathroom of my childhood home, where I must have thought no one would bother me. I was sitting on the lid of the toilet, staring out the window at the neighbors’ blue stucco house. Things had slowed down the way they did when I was depressed: It was as if the seconds and minutes were distilled, and I became keenly aware of each movement and the effort it required.
A crisis loomed: My mother was going to take away my dog. Minka had belonged to a friend who was moving, and I’d offered to take her and find her a home. She had been with me for months, I had gotten attached, and the notion of “placing” her
had faded. My dogs were a rare source of reliable comfort. My mother had decided it was time for Minka to go—to a new home or to the dog pound. There was a deadline. There was nothing I could do.
My mother entered the bathroom. In a tight, carefully controlled voice, with spaces between the words, she said, “I hope you will help to make this a good day.” I was not trying to act normal. She wanted me to act like I was supposed to. Like everything was fine. Her words traveled from across a gray ocean.
That evening, in the same bathroom: I fumbled with pill bottles in the tall, narrow cabinet. I remember only a desire to stop the pain and the thought that I would take any pills I found. The cabinet yielded Vivarin and aspirin. I shook a handful of the yellow and white tablets into my palm, threw them into my mouth, and swallowed. Did I know it wouldn’t be enough to kill me?
Later, I had a headache and felt dizzy and light. I opened presents with my family and tried to be nice.
Once, as I talked to Amanda about scheduling my next TMS appointment, she commented, “I have one woman who just comes four days a week; she goes down the shore on Fridays.” In New Jersey and Philadelphia, “going down the shore” was a common phrase for visiting the Jersey Shore.
I wondered about this unseen sister sufferer and imagined a middle-aged woman wearing a floppy beach hat, looking trim and composed, strained but still able to go on about her life and routine, go to the shore. Maybe she had a family.
I wondered, too, about the other people I’d see sitting in the chairs that lined the waiting room. One day, a black boy, perhaps 8 years old, was seated at the round, kid-sized table, his close-cropped head bent over a drawing. After eyeing him for a moment, I asked, “What’s that?” He held up a paper on which was scrawled a green, squarish form topped by two horned protrusions. “A demon,” he said in a hushed, husky voice. I nodded.
I’ve learned that depression can skew my perspective so that otherwise manageable tasks, from housework to paying bills, seem overwhelming. It’s disconcerting to know I can’t trust my own perceptions. The truth as it appears when I’m depressed seems as real as the one I perceive when I feel good, if not more so.
Over the years, I also have learned the ingredients to ward off depression’s quicksand grip, like exercising and talking to friends. “People are oxygen for you,” my therapist said once. But on bad days, when I slump with relief after closing the door of my house behind me, the notion of contacting anyone seems too difficult and frightening.
On bad days, I let myself recede into it, observing the downward slide as if from outside myself. I lie on the futon in the living room for entire weekends while one true-crime TV show blends into the next, occupying my mind and filling the minutes. Now and then, terror and a ravenous sadness break through. Letting myself do nothing carries a seductive pleasure; it feels like relaxation. Pulling the blanket up to my chin and closing my eyes brings delicious, guilty relief. But by the end of the day, I’ve sunk farther.
Sometimes, walking next to the giant steel wheels of a commuter train, a fleeting impulse strikes me. I think about Poe’s Imp of the Perverse, which I read years ago as an undergraduate:
the “paradoxical something” that, “shuddering upon the edge of a precipice, thus meditates a plunge.”
My mind splits. The objective part recites what I’ve learned: Depression distorts your thinking. It’s temporary; it only seems like you’ll always feel this way. But another, perhaps deeper part insists that how I see things in these moments is the truth, that anything else is an illusion. The truth when I’m depressed is that I have never been successful, never belonged in the world. Life offers no pleasure. If the future is only this pain, I don’t think I want it. But if I follow such thoughts any distance, I come up against a barrier: the impact my loss would have on my parents, on the other people who love me. I turn back.
***
Perceptions tilt.
In this vacuous landscape, each small effort blooms dark and distinct as a beating heart.
The energy it takes to push open the car door, push your body from the seat. To do these things when you lack their reason.
How everything crowds in at once. The impossibility of choosing when all options seem equal.
Don’t look at the whole. Look only at your feet: one in front of the other. (Yes; rely on the cliché.)
It’s a matter of getting through the moments, stringing them together.
“Keep moving past the open windows.” You read it somewhere, years ago, written by someone who must have known.
Moving. Keep moving.
A wiser part knows you should stay still, knows what you should do. It’s so much easier to sit, to lie down, to let the stillness fall over you.
Everything becomes something to be gotten through.
Get through this just get through.
The impossibility of going out, seeing people, being seen. What people will think; what they will know.
Step. One step.
The dumb gratitude when it passes. You don’t care why; you don’t question.
How your eyes always feel it, always show it. How they give you away.
It will get better. (A hollow theory.) One must have faith. Even if that faith is very, very thin. Even if you can see right through it.
END
Author BIo: Abbey J. Porter has been writing for years, but only recently began to submit her work. Abbey holds an MFA in creative nonfiction from Queens University of Charlotte, an MA in liberal studies from Villanova University, and a BA in English from Gettysburg College. She is a freelance writer and editor based outside of Philadelphia.