All posts tagged brain

  • Rolling Stone story: ‘Building A Better Brain: Wired on Nootropics’, November 2012

    A 4,000 word feature story published in the November 2012 edition of Rolling Stone Australia; my first non-music feature for the magazine. Click the below image to view a PDF version, or scroll down to read the article text.

    Building A Better Brain: Wired on Nootropics
    By Andrew McMillen / Illustration by Amanda Upton

    A new generation of “smart drugs” that promise to enhance cognitive ability are now available, but are they the key to the human race’s next evolutionary leap or merely 21st century snake oil? Rolling Stone finds out…

    Before he swallowed the designer drug NZT, Bradley Cooper was having a shitty day. Scratch that; he was having a shitty life. Cooper was an unproductive, depressed writer with few prospects and fewer friends. His long-suffering girlfriend had recently left him. His unkempt appearance implied that his deep apathy extended to his body image. Here was a man broken by the accrued stress and malaise of living a seemingly pointless, joyless existence in modern day New York City.

    Moments after taking the transparent, odourless NZT pill, though, Cooper’s world changed dramatically. His visual and auditory perceptions sharpened significantly. His brain could instantly summon previously forgotten snatches of glanced-at facts and figures. His empathy and charm were suddenly amplified to the point where he was able to bed a woman who previously loathed him. A burst of inspiration saw him cleaning his apartment for the first time in years while forgoing both food and his usual addiction to nicotine. Within a few hours, Cooper produced a hundred pages of brilliant writing, which pleased his editor like never before.

    As his interior monologue put it, “I was blind; now I see. I wasn’t high, wasn’t wired; just clear. I knew what I needed to do, and how to do it.”

    This isn’t a scene from Bradley Cooper’s actual life, of course. It’s the life of a fictional character named Eddie Morra, which Cooper portrayed in the 2011 thriller Limitless. Right now, I’m psyching myself up for a Bradley Cooper moment of my own. My version of the make-believe NZT is a little, white, very real pill named Modalert. Produced by Indian manufacturer Sun Pharmaceuticals, the drug’s generic name is modafinil and it costs around $2 per 200mg dose. In Australia, it’s only prescribed to narcoleptics and shift workers who have difficulty staying awake. I’ve acquired some through an online retailer and at 5pm on a Monday, I take the drug for the first time.

    By 10pm I’m wide awake, and aware that my resting heart-rate is higher than normal. By midnight my mind is racing around like an agitated puppy: “Hey! Here I am! Play with me!” I occupy myself with the normally tedious task of transcribing interviews; when I next look at the clock, it’s 3.30am and I’m finished. I’m washing dishes to take a break from work, when I realise that my randomly chosen soundtrack has taken on an eerie parallel to real life. In the classic Nas track ‘N.Y. State of Mind’, he raps: “I never sleep / ‘Cuz sleep is the cousin of death.”

    For as long as I can remember, my answer to that age-old ‘just one wish’ hypothetical has been ‘to never fatigue’. To never need to sleep. To be able to learn, create and achieve more than any regular human being because I’m no longer confined by the boring necessity of a good night’s sleep.

    Thanks to modafinil, I’m closer to this long-held dream than ever before. And I feel incredible. Not high, not wired; just clear. The computer in my skull is crunching ones and zeroes while the rest of the world sleeps. I yawn occasionally, but my mind feels focused, at capacity, even as 5am approaches.

    It’s a kind of cognitive dissonance I’ve never experienced before; I know I should be feeling fatigued by now, but everything’s still working well. At 8.30am – roughly fifteen hours after taking the drug, which corresponds with its stated half-life – its effects wear off, and fatigue sets in. I take a three-hour nap, then pop another modafinil upon waking. I’m back on the merry-go-round of sleeplessness, and loving it.

    Giddy at the near-endless productivity possibilities that I’ve suddenly unlocked, I confess my off-label use of Modalert to a Sun Pharma spokesperson via email in a moment of clarity (or, perhaps, over-earnest honesty). The reply arrives in my inbox a short time later, and I’m briefly quietened by its ominous tone.

    “You’ve seen Limitless?” the Indian drug rep replies. “The cost is too much. Please evaluate what you are doing, even for test purposes. Neuronal circuitry is not to be messed with.”

    ++

    Modafinil is the brightest star in a galaxy of drugs and supplements called ‘nootropics’. The word was coined by a Romanian doctor in 1972; in Greek, its definition refers to ‘turning the mind’. More commonly known as ‘smart drugs’ or ‘cognitive enhancers’, nootropics work in one of three ways: by altering the availability of the brain’s supply of neurochemicals; by improving the brain’s oxygen supply; or by stimulating nerve growth.

    Smart drugs are not a new concept. Last century, both cocaine and amphetamine were considered to have enhancement potential. As researchers at the University of Queensland wrote in a 2012 paper, “…their use for this purpose was regarded in a wholly positive light. [Cocaine and amphetamine] were seen as safe and effective ‘wonder drugs’ that increased alertness and mental capabilities, thereby allowing users to cope better with the increasing demands of modern life.” These views became unpopular once both substances were found to be addictive: cocaine became a prohibited substance, though amphetamine is still widely prescribed as a treatment for attention deficit hyperactivity disorder (ADHD) under the brand name Adderall.

    The Therapeutic Goods Administration (TGA), Australian drug regulation authority, does not yet recognise nootropics as a class of drug, as “the information available on nootropic products provides a very broad definition.” A TGA spokesperson tells Rolling Stone that they are unable to comment on the matter, as “the issue here is that the definition of nootropics goes from nutritional supplements all the way through to prescription medicines, so depending on what the product is and its claims, it might be considered as listable, a registered complementary medicine, or a registered prescription medicine.”

    So regulation is a murky topic, then. But nootropics aren’t illegal, either. Admittedly, taking modafinil off-label is not a smart thing to do. I am not a narcoleptic. I sleep just fine, if begrudgingly. I am a healthy 24 year-old male who exercises regularly and eats well. My recreational drug use is occasional. I’ve never been addicted to anything, and I intend to keep that clean sheet. I would like to be able to concentrate for long periods during the work week, though. I’d like to be able to instantly summon previously forgotten snatches of glanced-at facts. In short, I’d like to be smarter. Who wouldn’t?

    In the fictional account of Limitless and its inspiration, a 2001 techno-thriller by Irish author Alan Glynn named The Dark Fields, the universally appealing idea of self-improvement through minimal effort is explored by a guy taking a designer drug to boost his brainpower to superhuman levels. In reality, nootropic enthusiasts claim significant cognitive benefits with few, if any, side effects from taking these supposedly non-addictive, non-toxic substances.

    Sounds too good to be true? You bet. With my bullshit detector cranked up to eleven, I’m wading into this contentious field with the goal of separating science from fiction. Are smart drugs the snake oil of the 21st century? Or am I about to become a better man just by taking a bunch of coloured pills?

    ++

    After Eddie Morra tires of writing while under the influence of NZT, he turns his attention to the far more lucrative stock market. When I tire of writing on modafinil, I waste away the night-time hours by shooting terrorists in Counter-Strike: Source online, trawling internet forums, and reading about nootropics.

    With a newfound surplus of time arises an interesting dilemma: how to spend it? I chose to alternately work, read, and play games. What if every night was like that, though? What if I had all that time? How soon would I become accustomed to operating on little, or zero, sleep? What would be the side-effects of this for my health, my relationships, my career? Would I become a kinder person? Would parts of my personality become amplified, or atrophy? Obvious productivity gains – or productivity opportunity gains – aside, would less sleep make me a better person?

    All Tuesday night, I’m keyed into a writing task with laser-like focus. By sunrise, I’ve produced an article which, at the time, feels like some of my best work yet. (When it’s published online, weeks later, I read it with fresh eyes and I’m pleasantly surprised to find that I still feel the same way.) On Wednesday, I choose to take a break from the drug, but I’m still up until 4am. My sleep cycle has been totally disrupted.

    Thursday just feels like a regular day. I’m yawning more than usual, probably due to the sleep debt I’ve incurred this week. But it does feel a little… boring to be operating at this level, rather than on modafinil, where I feel like I’m connecting all of the dots all of the time. I suddenly find myself weighing up the costs and benefits of taking a pill right now. I have nothing in particular that needs to be completed for the remainder of the week, but there’s an internal argument happening: “Being awake is so much more enjoyable than sleeping. Who needs sleep, honestly?”

    I dose another 200mg, and within the hour, I again find myself making connections in music that I’d never previously noticed. The Black Rebel Motorcycle Club song ‘Stop’ aligns with my current mindset: “We don’t know where to stop / I try and I try but I can’t get enough…

    I feel like an outlaw; as though I’m in on a secret to which everyone else is oblivious. I know how to subvert sleep; that knowledge is in the shape of a small white disc containing 200mg of modafinil. I feel as though taking this drug might be one of the best decisions I’ve ever made. I want everyone around me to take it, too, so that we can share our experiences and revel in the euphoria of the unclouded mind.

    That night, I drive to and from a rock show. I meet friends and strangers at the venue; as I talk, I feel as though I’m not making sense, and that those around me are acutely aware of this. I feel in control, but my mind is racing faster than my mouth can keep up. I buy one beer and feel a little drunk, but I don’t come close to crashing my car on the drive home. Around 2am, I note that I’ve got an impending feeling of doom going on. Like I’m riding this too far, and it’s about to start doing some serious damage. I turn in at 3.30am on Friday.

    My first nootropic odyssey whimpers to a close, after beginning with a giddy bang at 10am on Monday morning. I’ve taken three 200mg doses of modafinil during that time – 5pm Monday, 1pm Tuesday, 2.30pm Thursday – and napped for around 11 hours total. In all, I’ve been awake for 79 out of the last 90 hours.

    I arise at midday, refreshed, having effectively reset my debt with one normal sleep. I reflect on how my views toward modafinil have veered between utter devotion to, now, in the cold light of day, a realisation that it’s probably not a good idea to be taking that shit on consecutive days. I was feeling so fucking average the night before. I couldn’t bear the thought of continuing to stay awake. The body and the mind aren’t made for it.

    ++

    Next, I purchase some homemade nootropics from a vendor named Tryptamine on Silk Road (SR), an anonymous online market where illicit drugs are purchased with virtual currency and sent through the international postal system. Tryptamine’s vendor profile states, “I am a biologist who develops nutritional supplements to improve your health, sleep, and cognition. I use only natural or orthomolecular ingredients, and no adverse effects have been reported from my products.”

    Tryptamine makes and sells three nootropics. I order two 24-pill bottles of MindFood (“designed to optimize brain function, protect against stress- and drug-induced neurotoxicity, prevent/alleviate hangovers, and reverse brain aging,” among other alleged effects), and ChillPill (“designed to promote relaxation, attenuate stress, calm excess brain activity, enhance mood, and promote dreaming”). The seller kindly includes a bonus five-pill sampler of ThinkDeep (“designed to stimulate brain metabolism and glucose uptake, improve memory formation/recall, expand attention span, prevent mental fatigue and enhance blood flow”), too.

    The total cost is around AUD$100. As I pay this seemingly exorbitant amount, I’m reminded of that old aphorism about fools and their money. The package lands in my mailbox via the state of New York around two weeks later. The pills are brightly coloured and strong-smelling. I try all three nootropics in isolation, one or two at a time, on different days.

    After swallowing a ThinkDeep for the first time, I realise that I just took an anonymous black and red pill created by an anonymous internet seller who claims to be a biologist. They’ve got a 100% feedback record from over 400 transactions on SR, which counts as a sort of social proof, but still: bad things could happen to me after taking this pill, and the person responsible would never be caught out. (Tryptamine denied Rolling Stone’s request to verify his/her identity, or scientific credentials. “Whatever image you have in your mind’s eye from reading this, that’s how I look,” the seller wrote.)

    “Silk Road allows me to sell my products anonymously, and provides me with hundreds of thousands of potential customers who already take pills that aren’t made by pharmaceutical companies,” Tryptamine tells me. “On the other hand, it is a bit off-putting to see my products listed beside bags of heroin.”

    As it turns out, ThinkDeep doesn’t do much for me, even on another day when I double-dose. In fact, the only significant effect I notice from these three products is when one dose of MindFood eradicates a hangover much faster than my regular methods of paracetamol and/or ibuprofen. Perhaps ThinkDeep and ChillPill are so subtle that I don’t notice their effects; perhaps they don’t work at all. Potential hangover cure aside, it’s difficult to recommend these products for cognitive enhancement purposes.

    At the other end of the nootropic spectrum, far from secretive biologists and solo recipe-tweaking, is an Austin, Texas-based company named Onnit. Their flagship product is named Alpha Brain, which is slickly marketed as a “complete balanced nootropic”. Their biggest public advocate is the comedian, podcaster and former host of Fear Factor, Joe Rogan; they also have a few World Series of Poker players hyping the product on their website. I ordered a 30-pill bottle of Alpha Brain for around $40.

    Each green pill includes small amounts of eleven impressive-sounding substances, from vitamin B6 and vinpocetine, to L-theanine and oat straw. The serving size on the label suggests two pills at a time; as I discover, taking one does nothing. With two Alpha Brain pills circulating in my system, though, I feel an overall mood elevation and a heightened ability to concentrate on tasks at hand: reading, writing, researching. These effects last for between four to six hours.

    Alpha Brain worked for me, but it also feels like a triumph of marketing, too. As there are no clear estimates about the financial side of the nootropics industry, I ask Onnit CEO Aubrey Marcus whether it’s a lucrative field. “Absolutely,” he replies, though he won’t comment on Onnit’s annual turnover. “It’s something that everybody can benefit from. Whenever you tap into something [like that], there’s ample opportunity to make good money.” Marcus says that Alpha Brain has been purchased by around 45,000 customers across the world since launching last year. The company currently employs 13 full-time staff.

    He acknowledges that nutritional supplement manufacturers are met with their fair share of critics. “The pharmaceutical industry has done a good job of telling people that synthetic drugs are the only things that have an effect on the body. There are plenty who’ve never tried our products who’ll swear that they’re snake oil,” Marcus laughs. “We encounter that, and we just do our best to show as much research behind all the ingredients that we have.” He mentions that Onnit are intending to commission a double-blind clinical study on the effects of Alpha Brain, which he believes “will go a long way to silence the critics.”

    ++

    Perhaps nootropics aren’t a mainstream concept yet because the people most enthusiastic about their potential benefits are all scientists, marketers out to make a buck, ‘body hackers’, and other weirdoes. There are few ‘normals’ taking these drugs and supplements on a daily basis, so it all looks too strange and confronting for outsiders to try. As a society, we’re taught by our peers and the media that if something sounds too good to be true, it probably is.

    There’s also the possibility that nootropics will never become mainstream because their effectiveness is difficult to qualitatively measure, or alternatively, they don’t work at all. In this regard, Australian researchers are world-class sceptics of cognitive enhancement. When I visit the University Of Queensland’s Centre for Clinical Research (UQCCR) in Brisbane, I’m greeted by Professor Wayne Hall, who was first published on this topic in 2004. His essay, which appeared in a European biology journal, was entitled “Feeling ‘better than well’: Can our experiences with psychoactive drugs help us to meet the challenges of neuroenhancement methods?”

    Hall has studied addiction and drug use for over 20 years. “There’s been a fair amount of enthusiasm for cognitive enhancement [in scientific circles], but it hasn’t looked critically at the evidence on how common this behaviour is,” he says. The professor and his peers argue for “taking a step back, and not getting too excited or encourage unwittingly lots of people to experiment with stimulant drugs for the wrong sorts of reasons”.

    “If you look at the lab studies that have been done on whether these drugs [work], the effects – insofar as there are some – are fairly modest and short-lived,” Hall says. “To be jumping from that, to saying it’s good idea for people to be using these drugs regularly to enhance their cognitive performance, is a bit of a long bow.”

    Dr Bradley Partridge is another UQCCR academic who specialises in investigating “the use of pharmaceuticals by healthy people to enhance their cognition”. I bring along my bottles of Alpha Brain and Tryptamine’s homemade nootropics for him to cast a critical eye over. “I have never used any of these things,” Partridge says. He peers at the labels with bemusement. “And I’ve never heard of most of these ingredients.”

    He places the bottles back on the table. “The thing is, a lot of these supplements are touted as being ‘all natural’, and for some people, that implies that they’re perhaps safe. But it’s very hard to evaluate exactly what’s in it. Aside from safety, where’s the evidence that they actually work for their stated purpose?”

    “There’s no scientific literature on some of this stuff; for others, the results are very mixed. Also, there might be a really strong placebo effect.” He holds up the Alpha Brain bottle, which mentions ‘enhancing mental performance’ in its marketing copy. “You take this and you do an exam; maybe simply taking something makes you feel like you ought to be doing better, and maybe you convince yourself that you’re getting some effect.”

    Hall and Partridge co-authored a study which analysed media reports on “smart drugs”. They found that 95 per cent of media reports mentioned some benefit of taking a drug like Adderall, Ritalin or modafinil, while only 58 per cent mentioned side effects. “I tend to be very cautious about this stuff,” Partridge says. “I don’t like to see this getting portrayed as a widespread phenomenon, as a fantastic thing, that it works, that there are no side effects. That runs the risk of encouraging people who hadn’t thought about it to take it up, which could cause problems for people.”

    I offer to leave some of my nootropics with Dr Partridge for him to conduct his own research; he laughs, and politely declines.

    ++

    Underscoring this entire discussion is the threat of one-upmanship. If I’m taking these drugs and they markedly improve my performance, am I nothing but a filthy nootropic cheater? To address this question, I spoke with Dave Asprey, who has used modafinil constantly for eight years and describes himself on Twitter as a “New York Times-published Silicon Valley entrepreneur/executive/angel who hacked his own biology to gain an unfair advantage in business and life.”

    Asprey has a prescription for the drug, after a brain scan showed a lack of blood flow at the front of his brain – a common symptom of attention deficit disorder (ADD), he says. “Modafinil is actually used commonly as a treatment for ADD,” he tells me. “It’s an off-label use, but it’s accepted; it’s even reimbursable by some insurance companies.”

    Asprey takes modafinil most workdays, upon waking. “It’s not like it’s a great secret out there, it’s just that people don’t talk about it because there’s some feel as though it’s ‘cheating’,” he says. “My perspective is different: if you eat healthy food, then you’re also ‘cheating’, because that impacts brain function. Surprisingly, the only people who’ve ever given me shit about taking modafinil are like, ‘but how do you know it’s not hurting you?’ I’m a bio-hacker; I’ve done all sorts of strange things to my body and mind in the interests of anti-aging, health and performance. I look at my body as part of my support system.’”

    Asprey says that he considers modafinil to be on the healthier spectrum of drugs. He’s also a fan of aniracetam, a fat soluble version of piracetam, which itself was the first-ever nootropic discovered in 1964. “It’s longer lasting [than piracetam],” Asprey says. “I recommend it as a basic biohack. I’ve been using it for a very long time.”

    Though Asprey has never met anyone who bluntly considers nootropics to be bullshit, he hears another argument reasonably often – and he has a clever rebuttal ready. “People say, ‘[nootropics] are evil, because if you take them, then everyone else will have to take them!’ I don’t think that’s a very fair argument, because from that perspective, fire is evil. Back when there were two cavemen, and one had a fire, the other said, ‘you can’t use fire, that’s unfair!’ Well, we know who evolved.”

    ++

    Whether or not I’m qualitatively smarter after experimenting with nootropics for this story is difficult to measure. I feel slightly wiser, and more aware of the limitations of both mind and body after that week of bingeing on modafinil. I certainly appreciate the restorative value of sleep better than ever before, after staying awake for the best part of a full work-week. I found that Alpha Brain is useful for focusing for a few hours, but considering that a two-week supply costs $40, it seems a touch on the expensive side.

    I did order a few dozen additional pills of modafinil, but I intend to use these only when emergency deadlines necessitate long hours. (I’ve read it’s good for combating the effects of jet lag, though, so perhaps I’ll try it on my next international flight.) Ultimately, the nootropic I found most useful – and intend to continue using regularly – is aniracetam, which Dave Asprey told me about. Its mind-sharpening effects are subtler than Alpha Brain, but it’s much cheaper – around $40 for a month’s supply if purchased online – and its effects taper off much more pleasantly than Alpha Brain’s comparatively sudden drop-off in concentration and energy levels.

    Late one night while researching this story, modafinil coursing through my body, I watched Limitless for the second time. It’s not a brilliant film, but it’s entertaining and thought-provoking enough to make the viewer consider seeking out smart pills of their own. It’s easy to see why the nootropic industry’s shadier sellers have attempted to draw parallels between their products and the fictional substance of NZT. After viewing the film, I contacted Alan Glynn, the author behind the 2001 techno-thriller The Dark Fields, which Limitless was based on, via email.

    “The original idea of NZT – called MDT-48 in my book – came from the idea of human perfectibility, of ‘the three wishes’, of the chance to re-invent yourself, of the shortcut to health and happiness,” Glynn tells me. “This is why the diet and self-help industries are so huge. Hold out a promise like that and people will respond. The fact that most of these products and therapies don’t work, or are bogus, doesn’t seem to matter. The real magic here, the real dark art, is marketing. I think that if nootropics ever go mainstream, they’ll be fodder for the marketing industry.”

    I send Glynn a link to the Alpha Brain website and mention that I’ve been taking it while researching this story. “Look, I’m just as much of a sucker as anyone else and when I look at that website, I’m going like, ‘Woah, gimme some of THAT!’” he replies. “And I’m actually seriously considering ordering some. So, from a marketing point of view, I’d say it’s a total success. It’s shiny, professional-looking and stuffed full of ‘the science bit’.”

    “But it’s the massaging of the science bit that is the marketer’s real dark art. The truth is, I couldn’t argue with someone who can talk about ‘GPC choline’ and ‘neurotransmitter precursors’. My instinct is that it’s all bullshit… On the other hand. I don’t know. Have you taken Alpha Brain? Does it work?”

    I reply in the affirmative, and describe my findings in some detail. Alan Glynn, author of the book that inspired the movie that inspired me to write this story in the first place, writes me back immediately: “That’s interesting indeed. I’ve ordered some Alpha Brain, and I’ve just got an email to say it’s been dispatched. I’ll report back to you – in the interests of science, of course.”

    Note: At no point should any of the products mentioned in this article be ingested without first consulting a health professional. An earlier version of this story incorrectly identified Ritalin as an amphetamine; it belongs to the methylphenidate class of stimulants.

    To read more on nootropics, I recommend that you continue your research at Smarter Nootropics. Good luck!

  • GQ Australia story: ‘Shock To The System: Electroconvulsive therapy’, March 2012

    My first story for GQ Australia magazine: a 4,200 word feature about the psychiatric treatment electroconvulsive therapy, otherwise known as ECT or ‘electroshock’. This story appeared in the Feb-March 2012 issue of GQ.

    Click the below image to read the story in PDF form (link will open in a new window), or scroll down to read the article text underneath.

    Shock To The System

    Electroconvulsive therapy has long been the stuff of cinematic nightmares. But after nearly four decades since One Flew Over The Cuckoo’s Nest, many are arguing it does much more good than harm.

    Words: Andrew McMillen

    As the young man is led into the operating theatre, the smell of salt water and sterilisation fluid hangs in the air. The room is unremarkable; all greys, blues and whites, just like any other theatre in hospitals across the country, except for a couple of innocuous-looking machines stacked on a bench. Twenty-five-year-old John Vincent doesn’t know it yet, but those machines would soon change his life.

    Helped onto a gurney, Vincent lies flat on his back as a clamp is placed on his index finger to monitor his oxygen levels. He feels the cold wipe of saline solution on his collarbone, biceps and forehead, before a nurse applies several electroencephalography (EEG) electrodes to trace his brainwave activities. Moments later, a general anaesthetic makes its way up his arm, and he drifts out of consciousness.

    Having been sedated, he doesn’t remember what happened next, but it goes like this. A specialist affixes an electrode to the middle of his forehead, and another one above his left temple, then switches on the Thymatrons – those machines in the corner – sending a series of short electric shocks coursing through his brain, bringing on a grand mal seizure. Fifteen seconds later, it’s all over. The current is switched off, the electrodes removed, and Vincent is wheeled into an adjacent recovery room.

    It might sound like a scene from a ’70s movie, from the days of roguishly experimental medical procedures, but this was Boxing Day 2010, and Vincent had just received his first course of electroconvulsive therapy (ECT) at Toowong Private Hospital in Brisbane. A psychiatric treatment most commonly used on those with severe depression, ECT – better known by its outdated term, electroshock – is also called upon to treat patients suffering from acute mania or, in Vincent’s case, bipolar disorder. And despite the popular public perception of ECT as a barbaric, archaic practice, the treatment is administered on a daily basis at both public and private hospitals all over Australia.

    Growing up, Vincent was a happy kid. He had lots of friends, enjoyed playing soccer, and loved going fishing with his younger brother while on regular camping holidays with the family. Then, aged 17, in his final year of high school, Vincent was diagnosed with bipolar disorder.

    As he got older, his mental illness became harder to manage. “John was existing, but he wasn’t happy,” recalls his mother, Tina, a kind woman in her early fifties with a fair complexion and green eyes who runs a small business alongside her husband. “He wasn’t right, and at some stage he decided to go off his medication. Unfortunately, with his type of bipolar – type one – when he goes off medication, he goes into a state of catatonia. Everything shuts down; no communication, nothing happens.”

    Things worsened as the years passed, and by late 2010, Vincent was living a life of isolation in Townsville, north Queensland. He’d withdrawn from the people around him: friends, family, even the younger brother he lived with. “You know those wildlife documentaries on TV, where they record the animals’ every move, behaviours and moods, and all that?” he asks, his hazel eyes burning with intensity. “I felt like I was an animal; like I was being surveyed.”

    This was a dark time for Vincent, who says he spent a lot of time in his room “trying to hide away”. He constantly felt as though there was someone outside looking through the windows at him, recording his behaviour.

    One Friday in December, his parents went to Mackay for their first trip away together in a year. The next morning, Tina and her husband received a call from their youngest son. “He didn’t think John was all that well,” she says. “We jumped on the first plane and came home. We spent all Saturday with John. He continued to decline into a catatonic state; not eating, not talking. It was almost like he was in a coma.”

    By 5pm, Vincent’s movements had become “robot-like”, with his body barely responding to the signals sent by his brain, and the famil rushed him to the emergency ward at Townsville General Hospital, before he was transferred to the mental health hospital. “It’s pretty sad, because there just aren’t enough facilities,” says Tina, remembering how they how desperate they were for a solution to their son’s illness. “We turned to friends in the medical profession, who gave us a great deal of support and help.”

    A man named Dr Josh Geffen was mentioned, who specialised in ECT at Toowong Private Hospital. Vincent had never heard of ECT before his parents brought it up, but since he was in such a low mental state at the time, he didn’t argue. “I just went with it,” he shrugs. “I cooperated, and followed my parents’ advice. I did what I was told.”

    He hardly remembers a thing about the journey. His mother continues: “We got John down to Brisbane straightaway, and when Dr Geffen saw the state John was in, the first thing he recommended was ECT,” she says. “We were pretty horrified; we’d heard stories from the olden days of ‘shock treatment’ and that sort of stuff. We hadn’t really given ECT a lot of thought. It’s a little bit frightening, because you really don’t know what’s involved. But Dr Geffen explained everything to us, showed us a DVD, and put our minds at ease. We consented to John having the ECT, and he agreed to it, too.”

    They got to work immediately. Doctors warned Vincent that the muscles in his arms, legs and shoulders might feel sore once he came to, after receiving the electric shocks. And indeed, he did feel uncomfortable for a couple of hours – he likens the muscle soreness to the day after a big gym workout – but says, “Afterwards, I felt fine. It took a while for the anaesthetic to wear off, but after that I was OK.”

    Vincent’s story is more common than you might think. Statistics from the Australian Institute of Health and Welfare show that in the 2009-2010 financial year, 26,848 individual ECT sessions were administered throughout Australia – although the exact number of people treated is unclear, as patients tend to have multiple sessions. “A typical course of ECT involves between six and 12 treatments,” explains Dr Aaron Groves, the director of mental health in Queensland, adding that, while ECT can be used on people of all ages, since depression is more common in adults than in children, around 80 per cent of treatments are on patients aged 30 to 80.

    Based on those figures, on any given day here in Australia, 73 people get hooked up to a machine and jolted with electricity in the name of medicine. What’s more, far from being a curiosity from the past that hasn’t quite died out, it’s actually on the rise. Why? Well, because it works.

    ++

    Electroconvulsive therapy has its roots in early schizophrenia research. In 1934, Hungarian neuropsychiatrist Ladislas Meduna saw improvements in schizophrenic patients after seizures were induced with chemicals such as camphor and Metrazol. Three years later, Italian neuropsychiatrists Ugo Cerletti and Lucio Bini discovered that these seizures could be more easily induced by electricity. In a TED.com presentation uploaded in October 2007, an American surgeon and author named Dr Sherwin Nuland relayed an eyewitness account of the first time ECT was performed on a human in 1937.

    “They thought, ‘Well, we’ll try 55 volts, two-tenths of a second. That’s not going to do anything terrible to him.’ So they did that… This fellow – remember, he wasn’t even put to sleep – after this major grand mal convulsion, sat right up, looked at these three fellows and said, ‘What the fuck are you assholes trying to do?’ Well, they were happy as could be, because he hadn’t said a rational word in the weeks of observation. They plugged him in again, and this time they used 110 volts for half a second, and to their amazement, after it was over, he began speaking like he was perfectly well.”

    “It eventually became apparent that it was a much better treatment for depression than schizophrenia,” says Dr Jacinta Powell, clinical director of mental health at the Prince Charles Hospital in Brisbane. “This is how these things develop: psychiatrists make leaps of logic, they try them out, and see whether it works.”

    What they hope for with any treatment is remission. So, how does ECT stack up against other methods of treating depression?

    According to statistics presented in May 2011 at the American Psychiatric Association Conference in Hawaii, 34 per cent of ECT patients were in remission after two weeks of treatment. Four weeks later, that had risen to 65 per cent; and after a full course of ECT, that figure reached a 75 per cent remission rate. Those success rates aren’t just good; they’re remarkable.

    So, why are we still so scared? Perhaps Dr Geffen [pictured right] – the man who treated John Vincent – would have some answers. A stocky, silver-haired man in a dark suit, he leads me into the theatre where John was first treated on Boxing Day. He drags in a couple of chairs from the waiting room, which is adorned with intricate paintings of wildflowers and a poster entitled ‘Understanding Depression’. We sit in the middle of the theatre and begin talking ECT. “Intuitively, it does seem like a worrying thing to do,” he admits, “to pass a dose of electricity through somebody’s brain in order to treat them.”

    And he’s right. A seizure-inducing electrical current sent through the brain, where all our memories, emotions, likes, dislikes, fears and secrets are stored; where our very personality is kept? The mind recoils in horror at the thought alone.

    That’s partly because, for the majority of us, who haven’t had any first-hand experience of ECT, our knowledge is mostly based on what we’ve seen in movies. Take One Flew Over the Cuckoo’s Nest – the 1975 Miloš Forman adaption of Ken Kesey’s 1962 novel.

    You’ll remember the scene when the main character, Patrick McMurphy, played by Jack Nicholson, is judged to be so disruptive to the daily routine of his fellow psychiatric ward patients that doctors see no alternative but to treat him with ECT.

    McMurphy is led to a bed, his hairline coated with a conductive gel and a piece of leather placed between his teeth. Electrodes are applied to each temple, and his brain is exposed to a current of electricity. There’s no anaesthetic, nor is the patient forewarned of what’s about to happen. McMurphy appears to be in severe pain, with several men restraining his wildly convulsing body. It’s unclear whether McMurphy’s treatment is an attempt to ‘fix’ him psychologically, or simply to punish him for being a trouble-maker, but it was a very convincing performance that won Nicholson an Oscar, a Golden Globe, and a BAFTA for Best Actor.

    “It’s a great movie. I love Jack Nicholson; he’s fantastic,” says Dr Geffen, with a grin. “It’s also nothing like modern ECT. It was set during a time when anaesthesia was already involved, so a bit of creative licence has cost us quite a lot of bad press.” He continues with his list of ways the film misrepresents modern ECT. “No treatment electrodes are placed on people until they’re asleep, because it’s not a very pleasant feeling if you’re coming in for your first treatment,” he says. “It’s much kinder for the person who’s anxious about what’s going on.”

    It’s also worth noting that the vast majority of treatments do not induce enormous, full-body convulsions like the reaction portrayed by Nicholson. In most cases, the only physical sign of the electrical current is a slight twitching of the patients’ fingers and toes.

    At the Prince Charles Hospital, Dr Powell shows me a segment from the 1990s-era television program Good Medicine, in which a greying man in his mid-forties is treated with ECT. The footage of his treatment is so incredibly mundane and unremarkable that I can’t help wondering what all the fuss and controversy is about. Particularly given the guidelines adopted by the Royal Australian and New Zealand College of Psychiatrists in 1982, which note that it’s “among the least risky of medical procedures carried out under general anaesthesia, and substantially less risky than childbirth.”

    “It’s a very effective treatment for very ill people,” agrees Geffen. “It’s more likely to get you into remission than any other treatment.” Success rates with medication when used as a first-line therapy are only 30 per cent, he says. After a year of trying different strategies, this may rise to around 60 per cent in a best-case scenario.

    And what about therapy for depression – you know, the kind where you lay on a couch and talk things through?

    “The type of depression we see here, people are too sick to be having much talking therapy. Not that talking’s unimportant, but that’s part of the post-recovery.”

    Yet somehow, even though lying on the therapist’s couch isn’t the right thing, and months of antidepressants aren’t very effective, people are instinctively more keen to stick to those methods than to volunteer to be subjected to a series of electric shocks.

    “A few things soften that,” says Geffen, ever the salesman. “The dose of electricity is quite small; 0.8 to 1 amp. I was treating an electrician, and I asked him, ‘How can I explain it to people?’ He said, ‘Well, it’s about 10 per cent of what a toaster puts out.’ Now I always tell people, ‘Don’t stick forks in toasters, please!'”

    Geffen breaks into a wide smile and continues, “Another way to put it is that the current is enough to light up a 25 watt bulb for about one second. Once or twice in the process, I’ll pass the electricity across my hand, and feel a little jolt. But it doesn’t throw me to the ground.”

    And of course, ECT isn’t the only instance of doctors using electricity to reset an organ that’s not operating properly; cardioversion, for example, applies the same theory to correct a malunctioning heart. “I do wonder, sometimes, why the person who cardioversed Tony Blair is the ‘cardiologist hero’,” Geffen says, “but I can be painted as a ghoul for trying to treat people’s depression.”

    ++

    Part of our reluctance to embrace ECT, though, may well be because, despite years of research, it’s still a bit of a mystery. We know it works best when used to treat severe depression, but when it comes down to it, we don’t really know why. “At one level, that’s true,” agrees Geffen. “We don’t fully understand all of the mechanisms of its action. However, that’s true of many treatments in medicine. We do know how damaging severe depression is to people’s brains and their lives. At another level, we’re understanding a lot more about how it works, as well as the key chemicals involved in depression: serotonin, adrenaline, dopamine, and this – being a powerful treatment – influences all of them. Most antidepressants work on one, or – at most – two of those. ECT is a potent stimulus for brain cell growth.”

    His sentiments are echoed by Dr Daniel Varghese, a Brisbane-based psychiatrist in both the private and public health fields. “I think it’s true to say we don’t really know why or how it works,” Dr Varghese says.

    “But then again, we don’t know why or how people get severe mental illness either, because the brain is clearly an inherently complex thing. That’s something that psychiatrists and people with mental illness have to deal with in a range of illnesses: we don’t really know why, but we do know some strategies and treatments that we’ve found to be helpful.”

    ++

    Of course, it’s important to make it clear that ECT is not a catch-all miracle cure for depression, and some of the fears surrounding its usage are real. It certainly has its fair share of detractors.

    On a chilly morning in the Brisbane suburb of Highgate Hill, I meet with Brenda McLaren, a spritely woman who loves to talk. Her face is riddled with deep wrinkles, which make her appear far older than her 57 years. Her memory is shot, however, and she has prepared notes in an A5 notebook ahead of my visit. Her relationship with ECT has not been an altogether pleasant one. She was first treated in 1988, as a severely depressed 34-year-old. At first she consented, as she wanted to get better and believed that the doctors at Prince Charles Hospital were acting in her best interests. Over 20 years later, she’s not so sure.

    Brenda smokes a cigarette on the sun-soaked front balcony of the Brook Red Community Centre where she works as a peer support worker, and reads her handwritten notes. In 1988, her youngest son was six. “I can’t remember him between the ages of six to 15,” she says. “In some ways, [ECT] must cause some sort of brain injury for that to occur. He talks to me about things, and I honestly don’t remember.”

    “My other children would come up to visit me at that time,” she says, “and I wouldn’t know who they were. This would happen quite regularly after ECT. This made them hate the whole system, which is still a big thing with them. It created relationship problems within the family. I’m not saying there weren’t already problems, but it didn’t help. Because… how can a mother forget her children?”

    She looks up with sadness in her eyes, and it’s clear the memory loss still hits her hard. “It made me feel very guilty. When you really think about it, in some ways you lose your identity,” she says. “You lose who you are.”

    “I would be the most forgetful person here,” she says of her peers at the Centre, which supports people living with mental illness. “I put things down constantly, and never know where they are. I lose things. I believe it’s affected that part of the brain that makes you remember things, long-term. I find it hard to retain information. I find it hard to bring information out. That’s why I’m reading this.” She points at her notebook.

    McLaren says she received “dozens” of courses of ECT in her life, the last of which took place around 13 years ago. “I know they do it as humanely as possible,” she says, “but I think it’s barbaric, and in some ways, it’s a form of torture. If I was told I needed ECT today, they would have to take me screaming. Because I will never sign to have ECT again. Ever.”

    ++

    In an adjoining room to the ECT theatre at Toowong Private Hospital, Dr Geffen and his colleagues have written some literary quotes on a whiteboard to keep them focused on the job at hand. “Diseases desperate grown by desperate appliance are relieved, or not at all” – William Shakespeare. “Diseases of the mind impair the bodily powers” – Ovid. “When you treat a disease, first treat the mind” – Chen Jen.

    I tell Brenda McLaren’s story to Geffen, interested to hear his thoughts. “I feel sorry for her,” he says, after listening carefully. “I believe her when she says that ECT has damaged her memory, and that this affects her sense of identity. Recurrent ECT of this nature is a difficult scenario; if she was severely suicidal or malnourished from depression it may have saved her life, although obviously at some cost.”

    What Brenda described is, he says, a mixture of the common side effect of peri-treatment amnesia – loss of memory of the period around treatment – as well as the rarer retrograde amnesia, which is the loss of memory for “weeks, months, even years” before being treated. “With modern techniques, the peri-treatment amnesia is less severe and retrograde amnesia is even rarer,” he says.

    That’s partly thanks to the more recent side-lining of a variation of the treatment, called bitemporal ECT, in which an electrode is placed above each temple (as seen in One Flew Over the Cuckoo’s Nest). ECT guidelines note that “bitemporal ECT is associated with greater cognitive impairment, but these effects vary from patient to patient. Any memory impairment is usually resolved by 4-6 weeks following ECT, but a number of patients report persistent difficulty with retrograde memory.” The other, now more popular, method is unilateral ECT, where one electrode goes above the temple on the non-dominant side of the brain, while the other sits in the middle of the forehead.

    We return to Brenda McLaren’s experiences. “The issue of difficulty learning new information some 13 years later is more problematic,” says Dr Geffen. “It’s not generally described in the literature, and may be contributed to by age, depression, and the impact of lifestyle factors like smoking. But,” he admits, “it is hard to rule out ECT as a factor.”

    Geffen has been immersed in this world of ECT for more than 15 years. “We start at 6.30am every Monday, Wednesday and Friday, and we’re done by 9am; 10am if we’ve got a long list,” he says. “It’s generally done in the morning; it’s a lot kinder to do it then, as our patients fast from midnight.”

    As he said earlier, it’s a treatment for the very ill, and here in this room, Geffen only sees those closest to the brink. I wonder whether the constant exposure to the severely depressed takes a mental toll on him. “When you see patients who are distressed coming in, or patients who have a really good response, you take that home with you and think about it a little bit,” he says, and then smiles. “My wife works in mental health, so it allows for a bit of pillow talk. She’s very familiar with all of this.”

    What does he say when asked what he does for a living? “I talk quite openly and freely to my children about what my job is, and explain to them about this,” he says, gesturing at his workspace, with a hint of pride. “Although it’s a stigmatised area, there’s nothing terrible that we do here. We help people who haven’t done anything wrong; they have a brain illness. In that sense, in my social life, I do carry on that view that you can de-stigmatise this.”

    ++

    John Vincent isn’t sure whether he received eight or nine treatments of ECT in total, as he, too, experienced peri-treatment amnesia. “I can’t remember a lot of things that happened when we were back at school,” he says with a shrug. “Birthdays, big events, I can’t remember so much. Things close to me I still remember, though.” Childhood camping and fishing trips, for example, take a while to recall, but his foggy mind does eventually reach back to find the details.

    It can be difficult, but he’s philosophical. “I’d rather feel happy, and more myself, than have memories,” he says with a tone of finality. “My health is worth more than having memories.”

    Vincent says his course of ECT made him feel more lively. “I’m not so anxious anymore. I’m not short-fused or jumpy. Now I feel more cooperative; I get along a lot more with people.” Not that ECT was a quick fix. “It was a gradual recovery. It wasn’t as though, when I got out, I was right as rain again. It took a while to slowly get to that stage where I felt comfortable.”

    His parents stayed at John’s bedside for 12 hours a day through his month-long stay at Toowong Private Hospital. His mother remembers that, within 24 hours of John receiving his first treatment of ECT, she and her husband could see a “definite improvement”.

    “John’s had very good results with it. It’s been really quite incredible,” she says. “It’s almost like having a flat battery in a car. You put the jumper leads on and give it a bit of a boost, and it comes back again.”

    She doesn’t really understand how it works, and she doesn’t care: she’s just glad to have her eldest son back again. It’s been two months since his last treatment. “He’s on track, and everything is going well. Geffen says, ‘If you go for three months and you don’t need any more ECT, and the drugs are keeping you level, everything’s good,'” Tina says.

    “We had no knowledge about ECT until John went into this meltdown and went into hospital,” she continues. “I think the more people talk about it, the better it’ll be. The more I can tell people, and the more open you are about it, the more it will become accepted.”

    As for Vincent, now that things are on the up, he’s looking forward to returning to work at his parents’ small business in Townsville. He’d like to settle down with a girl and he can see himself – one day – getting married and having kids, “but they’re a while away yet,” he says with a grin. Vincent isn’t sure what career path he’ll take – something to do with machinery, perhaps, as he’s always had an interest in that area – but he knows that, thanks to ECT, he’s in a better mental state to confront the future than ever before.

    *Names have been changed.

    Note: due to an error in the production process, a photograph of Dr Josh Geffen’s father, Laurence, appeared in the original article, rather than Josh himself. This error has been corrected in this blog entry.

    For more on electroconvulsive therapy, visit Wikipedia. If you are feeling depressed or suicidal, please contact Lifeline on 13 11 14, which is available 24 hours a day.