Jim Howell

Marie Howell says her 78-year-old husband Jim had always been a worrier, but it wasn’t until six years ago that Marie realized just how serious the worrying had become.

In the spring of 2010, Marie said Jim started to let a lot of little things get to him.  He became more and more concerned about the house repairs, garden work and other jobs around the family home.

Also during this time, Marie and Jim contacted a house inspector to check out their home.  A small crack in the foundation was found.  They hired a repair contractor who came to do the repair without first contacting the gas company.  The job was completed without any damage to the gas line.

Soon after this, Jim began to worry excessively that he had not contacted the gas company.  He was convinced his neighbours were going to sue him for failing to notify them in advance about the risk the repairs could have on the gas line.  Marie said the worrying persisted even after the crack was successfully fixed.

Because this fear so overwhelmed him, one evening in early August he took several tylenol and could not get up in the morning.

That was how Jim first ended up in the psychiatry ward of The Ottawa Hospital, where he stayed for the next six weeks.

“I remember walking into his hospital room with my son and Jim pulled us over and said ‘they’re coming for me; they’re coming for us’.”

At first, the doctors thought Jim’s condition might be a result of a stroke, but with further testing, it quickly became clear that the problem was mental, not physical.  Jim was completely out of touch with reality and was having a psychotic episode.

At first, Marie said Jim was treated with medication.  But after a week and a half with no sign of improvement, the psychiatrist, Dr. Kiran Rabheru, mentioned Electroconvulsive Therapy.  Marie was skeptical at first.

For Jim, it wasn’t until the latter few days in the hospital that he really began to understand what was happening to him.

“I began to think, ‘What the hell are they doing here?’”

Jim said he worried about what would happen if they didn’t give him just the right amount of anesthetic.  He worried that the doctors would start the ECT before he was completely asleep.  The thought of more treatments terrified him.

During his first ECT treatment as an outpatient in September, his blood pressure was extremely high.  He had to stay in recovery until late in the afternoon.  Because of this, instead of following his psychiatrist’s advice and getting on a maintenance regime in which he would receive ECT every couple of weeks as a preventative measure, Jim refused all treatment.  Four months later, he relapsed.

Marie said that while Jim’s relapses are often triggered by excessive worrying, they eventually end up turning into episodes of major depression.

Jim describes his relapses as a complete withdrawal from everyday life.

Once he recovered from that first relapse, Jim said he finally accepted that regular ECT treatments needed to become part of his routine.  Today he receives his treatments on an outpatient basis — in by 7 a.m., out by nine, every month.

For Marie, Jim’s sole caregiver, his mental illness affects her almost as much as it does him.

“I would say the first word that really comes to me is isolation.  You feel very isolated and very lonely, because even though our friends are concerned, they don’t phone very often,” Marie said.

Because Jim’s episodes are so severe, he prefers it when she stays home to care for him.  She finds it lonely to not be able to go out for coffee with friends, or to a movie, or to have guests over to the house.

Over the years, though, Marie says she’s become better able to cope.  She finds it therapeutic to spend her time reading and knitting.  She also belongs to a grandmothers-to-grandmothers group and is able to garner support in the hard times from a couple of friends she met there.

For Marie, the biggest thing that helps her get through the darkest of times is the knowledge that with ECT, Jim will eventually get better.

“It’s not like someone having terminal cancer,” she said.  “You know that there’s a light at the end of the tunnel, so that helps you to cope.”

Marie said that for she and Jim, ECT is their silver bullet.  While she acknowledges that it does come with its side effects such as short-term memory loss, she says it is the only thing that brings Jim back to her.  Without the treatments, she said she doesn’t know if Jim would have survived his first episode back in 2010.

Having started this experience not knowing anything about ECT, Jim says his biggest piece of advice to those contemplating treatment is to realize that there is no reason to feel ashamed.  Jim says that people with mental illness should be recognized as having just another treatable health condition.

Jim also said that it’s important for patients with mental illness to seek help from a psychiatrist with whom they feel comfortable enough to forge a meaningful relationship.  Jim says that Dr. Rabheru’s advice and understanding have meant everything to him and Marie.

In terms of ECT treatment, Jim says that it’s important to be patient, since the ECTs don’t always work right away.

“For me, ECT made the difference between spending my life in sort of a fog or being back to my normal self again,” he said.  “That’s everything.”

A group of psychiatrists in Canada are hopeful that impending guidelines for ECT will lead to more success stories like Jim’s.

The Canadian ECT standards document, which will be released in the next few months, will help centres across the country deliver ECT at the highest possible level, consistent with the latest research and developments in the field.  The document, which is ten years in the making, is the result of a national survey of ECT in Canada that was carried out between 2006 and 2007.  The survey revealed that there are large variations in how ECT is delivered across the country.

The group leading the charge believes that a higher quality ECT treatment, performed consistently across Canada, will make for a safer, more effective therapy.  The standards will provide a new benchmark for ECT and the group hopes that it will encourage centers to deliver a high-quality ECT, in line with the standards.

Five years and three relapses later, Jim says that while he doesn’t look forward to going in for ECT, he’s now able to cope with the treatments without getting too upset.

While he’s currently on a maintenance regimen of one ECT a month, his hope for the future is that he will eventually be able to space out his treatments to three or four a year.

“That would be great,” he said.  “I would feel really pleased with that.  It would be a way for me to mark progress.”