Poet Sarah James explores how repetitive transcranial magnetic stimulation treated her depression and influenced her art.
Hit by a severe bout of depression, I turned to repetitive transcranial magnetic stimulation (rTMS) as a treatment. For five days a week, over four weeks, short sequences of brief magnetic pulses were targeted at part of my brain.
As a journalist, I wanted to document the experience. As a poet, I wanted to do so creatively.
click, click, click…
my scalp reduced to white cap,
the point of contact precised,
measurements in black
click, click, click…
a woodpecker tapping would not make
more noise than these tacks of
click, click, click…
unsound patterns now twitch my lip,
rezip this & this & this,
the mind’s metal teeth, that too-tight vice-grip
click, click, click…
What was having this treatment actually like? The machine sounded like a loud woodpecker tapping. There were times when the magnetic pulse made my face and arm twitch while the electromagnetic coil was adjusted to the correct position on my head, but this was only temporary. With an ink-marked white cap on my head to show where the machine should target, I suspect the treatment looked and sounded worse than it was.
The procedure’s strangeness spilled over into my wider experience, but it changed with time and circumstances. A surreal sense that it wasn’t really happening to me vanished, as the treatment became part of my routine. Initial tension headaches disappeared as my body adapted to and relaxed into the almost hypnotic magnetic pulses.
As a writer, it seemed important that I do something with this experience. I jotted notes and lines of poetry that became ‘The Magnetic Diaries’ – a narrative in poems, which I later adapted into a poetry-play. For both, I used a fictional character called Emma to create a modern version of Gustave Flaubert’s novel 'Madame Bovary’.
My character Emma and I both found ourselves, “Semi-tranced, | part-thoughts as fishes | in an echo-stream | of half-feeling”. This deep relaxation made us feel simultaneously distant from and very much at one with the surrounding world. The effect lasted beyond the end of each rTMS session. It became a background beat to my time in London, where I went to receive the therapy, and to Emma’s emotionally chaotic narrative.
through the door
my brisk walk
by these adrift
the city’s metal seams
and petal boughs
into a seminess,
a seemness, a one-sameness
and settling & lifting
with the breathing skyline.
- ‘Treatment like hypnosis’
Actress Vey Straker, who played Emma in Reaction Theatre Makers’ production of the poetry-play, describes the “steady electric pulse and precise clicks” as bringing “a regimented pattern and steadier pace to the story”. She says: “Performing as Emma, expressing her experience of rTMS through a poem, is by turns like being under its spell and then fighting against the unerring insistence of the electrical rhythm.”
Neurons sparking, and the pleasure of creation
Neurons are the brain’s basic working unit, specialised cells designed to transmit information to other nerve, muscle or gland cells. rTMS encourages neurons in specific areas of the brain to fire – to send an electric pulse that causes other things to happen.
Imagining the neurons sparked during treatment, my character Emma envisages “a night | more nightly than the moor’s dark-drowning” suddenly alive with “stars that crackle, fizz-bomb, bump-spark”. Recovering from depression is like moving from a sky with nothing but “blown light-bulb stars” to one where billions of fairy lights have suddenly been switched on. When I think about how inspiration works, I imagine something similar.
While personal writing can bring some people catharsis, I can’t create from a place of great pain. That place is too numb, anguished and dark for anything but a few worn and habitual phrases. What drives my writing is pleasure, the delight of pure creation. I also thrive on projects. ‘The Magnetic Diaries’ – recording my rTMS experience within a fictional framework – gave me such a focus. Using Emma, and choosing to construct her experiences as diary entries, offered some objective distance, and the impression of personal record.
Mood diaries can be used as part of the self-evaluation process for someone with depression, and the diary form allowed me to treat my writing as a piece of witnessing – an almost scientific documenting of the day-to-day treatment and routine. Within this supporting structure, some of my emotions seeped through, simply because I was the one observing. I was also able to tap back to my real emotions later on, during the editing, when my mind was in a better state to work creatively, rather than feeling completely numb. Into this, I injected additional elements from the storyline I’d developed based on Flaubert’s novel.
The final book version of ‘The Magnetic Diaries’ is presented to the reader as if put together by a team of fictional researchers, incorporating a mixture of emails, doctor’s notes and experimental poems. It also includes multimedia elements, using QR codes to give readers alternative endings, audio recordings and images that might enhance the experience, and provide a greater sense of what it might be like to be Emma.
Energy lost and found
There is both an irony and an aptness to an invisible treatment – you hear the sound of the rTMS machine, but you can’t see the magnetic waves, or the electricity creating them – being used to treat an emotion-linked illness like depression. Emotions are invisible, too, and what we usually see is the effect they have on our moods and behaviour.
Unlike a broken leg that’s mended, there are no obvious physical recovery signs to show if a treatment is effective. Instead, there are a whole series of small, wide-ranging and not-depression-specific changes. Many are subjective – from laughing again to sleeping less and doing more.
For me, the biggest measurement of rTMS’s success has been energy-related. I didn’t suddenly find a grand purpose in life, but, after treatment, I had enough energy for not having one not to matter. I could enjoy each day, rather than feeling it was one long, overwhelmingly exhausting battle.
Inspiration, too, is mostly invisible – to others at least, until it’s made to do something. It’s often about suddenly seeing something differently. Just as an electric charge is passed from one atom to another, one thought/idea/image/word leads to another and another. In electronics, a circuit must be completed in order for electricity to flow. In literature, the sense of coming full circle is often used to finish a story or poem.
In many ways, the whole of ‘The Magnetic Diaries’ is powered by two circuits of inspiration: the subjective emotional (personal feeling and experience), and the scientific (objective witnessing). Wiring from both realms runs through its narrative, and my poetry in general – as shown in ‘Two Chambers of My Art’.
I’m not, of course, the only writer to link depression with electricity for artistic purposes. In ‘The Dammed’, Gram Joel Davies relates the energy levels in depression to a form of hydro-generated electricity.
He could jolt
his depression, just
as a mountain was bored hollow
then stuffed with turbines
and a lake
is dropped through the mountain,
surging The Grid so a nation
may boil a lake of cups.
This process is very inefficient; it takes more force to restart the machine than it creates in its brief high output. Davies says: “Electricity is power, but power costs too much where depression is concerned; its expenditure, however necessary, leaves a resultant dearth greater than any reward. Powerlessness. Generation (motivation) seems to short-circuit the system. A brief flare, flicker, then hours of outage.”
Any poet writing about depression knows that they follow in the footsteps of Sylvia Plath. She was made to have electroconvulsive therapy (ECT), which passes small electric currents through the brain. These intentionally trigger a brief seizure, causing changes in brain chemistry that seem to reverse some mental illness symptoms. Plath incorporates the treatment into her semi-autobiographical novel, ‘The Bell Jar’.
There is a violence in Plath’s description of ECT that isn’t in my poems inspired by rTMS. The rhythms behind the writing are as different as the treatments. ECT has changed since the 1960s, but Plath’s work echoes through Emma’s fears in ‘The Magnetic Diaries’, as she anticipates her own treatment:
nerves wind their own power,
wiling from electron to electron
through densely packed woulds,
snapped ifs cracking underfoot
luck is not being an eel, electro-convulsed,
slapped neurons pulsed towards a night
more nightly than the moor’s dark-drowning
when the old lunar falls
- Preparations 1: Better Than the Past, ‘The Magnetic Diaries’
Electric language and imagery
Given the links between depression and energy, electric language and imagery is perhaps inevitable. We get a ‘buzz’, are ‘wired’, notice a ‘spark’, or feel ‘switched on’. By contrast, a lack of these things is often used to denote depression and illness, along with the notion of being in a dark place rather than feeling lit up with life.
The language link between life force and electricity is not solely the former borrowing from the latter. We talk about wires being ‘live’, and batteries being ‘dead’. Which world borrows from which when we talk about positives and negatives?
Electric imagery and language are powerful sources of inspiration for me. In my novella 'Kaleidoscope', the main character, Claire, is even more psychologically troubled than Emma. Claire’s mum died from cancer, and her dad was killed in a car crash. Claire has a recurring nightmare where her hospitalised mum’s heart becomes a car battery, and the drip’s transfusion lines become coiled wires, tightening.
My poetry collection 'plenty-fish’ contains post-rTMS poems where electricity is so fused with daily life that it has almost become part of me. At home with my two sons (then aged 11 and 8), I realised we were in the same house, but living in very different worlds, plugged in through our computers.
I pick up my machine, black weight
of electronics, and slot myself in.
Electricity ticks unheard, sparks ignite.
Mesmerised, false lives charm.
People pixelate around us.
Coiled somewhere in the wire tangle,
remnant arcs of bartered words,
that soft-flint of flesh-fingers,
the fused touching of real skin.
- ‘Wired Flesh’
Has electricity itself become so everyday that we usually only notice it in its absence? It’s only when my mobile phone goes missing that I notice how much I rely on it. It’s only when I find myself in the middle of the dark countryside that the magic of pylons and light suddenly becomes so apparent.
The hidden and the seen
Creating art often involves transforming something hidden into something that can be grasped, used and shared. Like atoms passing electrons to each other, we try to pass on, or re-evoke, an experience or feeling to those who haven’t, or can’t, experience it directly. We do this through words, painting, sculpture, dance, song, theatre.
But art isn’t only in the revelation of the hidden. One intriguing aspect of poetry is its ability to create something simultaneously tangible and intangible. By this I mean words that flicker at logic’s edges, and yet somehow still evoke a feeling or emotion or atmosphere that seems perfectly right and complete.
The difficulty is conjuring up intangibility in a tangible way, without destroying the beauty that depends on intangibility.
The following poem is an attempt at this. It draws on the process of writing this article, Sarah Grice’s artwork of a brain made from electrical cables, Wellcome Collection’s 'Electricity: The Spark of Life' exhibition, and a museum-themed workshop held in a cathedral. As such, it’s typical of how inspiration works for me – a lightning bolt, or shock, followed by a more gradual building-up of charge from various sources.
At first glance, you might miss me.
My case is clothed in shadows,
squeezed between a bright spark
and the bare bones of a dead genius
whose brilliance still blinds.
Unlit, I am nothing: a spare bulb
among millions of glass bodies
opaqued by fleshy atoms;
my filament a hidden mesh
of nerve arcs and electric charge
that keep me breathing, feeling,
glowing with light, and dark.
With care, the heart’s dynamo
sets tungsten tingling, fills
thin skin with pulsing wattage.
Whole and unbroken, see
how strongly I shine.
Handle me – all of us – gently:
every word and every touch
switches on. Or off.
- ‘The Museum of (Mostly) Living Electricity’