Tania starts her story with the dramatic description of her being prepared for ECT while pregnant. She has made an advance decision to have this treatment if she gets unwell during the pregnancy or after giving birth. Such a decision is also known as a Ulysses Pact. She wanted to get pregnant and knew that there was a strong risk of relapse of her bipolar disorder, which would make the pregnancy very risky. The story continues with the description of her life which was affected by episodes of illness that responded to ECT, and subsequent relapses. Over the last few years Tania has been on maintenance ECT and has had more than 200 sessions altogether. This did not prevent her from progressing into a very successful academic career. At one point she was at the Institute of Psychiatry in London, jointly leading a large research project on mental health advance directives, making her uniquely qualified to write on this topic.

CJ experienced mental health problems and trauma during childhood and adolescence. This was treated effectively with psychotherapy. He remembers being exuberant and outgoing. Then, at the age of twenty-one, he developed a severe depressive episode, feeling numb and emotionless, unable to taste anything. Due to the previous history, a diagnosis of personality disorder was suggested, resulting in a delay in starting ECT whilst an inpatient. Relapses followed, the first one in Brazil, where he was quickly offered ECT. Back in the UK, CJ found pervasive barriers to getting treated with ECT, especially maintenance ECT, which he asked for several times, having seen the effect of the acute courses. He had to first try various drug treatments. There was also hesitancy in receiving psychotherapy because it was felt that ECT may affect his ability to engage in therapy. CJ feels that the community team had been inadequately resourced, equipped and educated about ECT to properly support him as an outpatient. CJ finishes the story with a description of his ‘life on maintenance’, which did not stop him from starting studies on a degree and working part-time as a research assistant.

At a fairly early age Lucy was admitted to a psychiatric hospital and then spent years in low-security psychiatric units. After an episode of neuroleptic malignant syndrome, she became physically unwell and stopped eating. When her life appeared to be danger, ECT was suggested. Lucy refused to have it and the first sessions were given under restraint. After eight sessions ECT hadn’t worked, and the team stopped it. A second course was started later, this time with Lucy’s agreement, and it worked. She gradually improved, had psychological treatment, engaged in rehabilitation and eventually was discharged home. She continued with maintenance ECT as an outpatient. She got married and started work as an Expert by Experience for the local hospital.

Liz remembers experiencing episodes of depression since an early age but completed her university degree and worked as a medical doctor for many years. The story starts with the description of a psychotic episode that she experienced for the duration of one summer. Diaries kept from that time were used for the story, giving the episode detail, helped by a poem also written at the time. The depression gradually got worse over the years, despite trying more than twenty different antidepressants and mood stabilisers, regular exercises and prolonged courses of psychotherapy, causing an early retirement and eventually hospital admissions. Finally, ECT was recommended, and it worked despite the very long and resistant type of depression. The improvement was incomplete, though; it required maintenance treatment and caused marked memory problems, which are also described in detail.