CS: How did you know that you wanted to write 3,000 Pulses Later? Because it is a memoir of your real life, how did you know when you wanted to write this memoir? Did it come at a particular moment or “right time” or was writing memoir something you had been thinking about throughout your recovery?
Martha: When I started to feel relief from the dark feelings of my depression, people who knew about my illness commented at how much better I seemed and wanted to know what I’d been doing to help myself. Whenever I mentioned Transcranial Magnetic Stimulation (TMS) they had no idea what I was talking about. I soon realized that hardly anyone knew about it. My talk therapist suggested I write a magazine article and planted the writing seed.
I eventually decided I should write a memoir to create public awareness not only for TMS, but also for another unknown condition, Treatment Resistant Depression where current drug therapies don’t work for patients who can’t metabolize them. I knew I was taking a huge risk to reveal such a personal, embarrassing story, but my journey through years of depression, an unsuccessful suicide attempt, and new evidence that shed light on the fact that I had Treatment Resistant Depression compelled me. When I had such undeniable success with Transcranial Magnetic Stimulation my enthusiastic response was, “People need to know about this!”
CS: Did you have a clear outline of your book before you began writing memoir, such as what each chapter would detail, or did it take shape as you wrote?
Martha: Since my story has a beginning, middle and an end that is very linear, I relied on the sequence of events for structure. However, I took book writing coach Lisa Tener’s advice and developed an outline to help me stay organized and to make sure I included pertinent details within each chapter. I also knew medical information was important to the drama of the memoir as well as self-help topics I wanted to add at the end of the book. I used my outline as a checklist to make sure I covered everything I thought a reader would want to know about my journey and the actual TMS therapy.
CS: How did you decide on specific aspects and structure of your memoir, such as including the “Questions You May Ask” section at the end? What effect do you think it has on the reader to include this more objective information in the personal narrative?
Martha: The FAQ section of the book is a logical progression for a reader who shares the pain and frustration of dealing with depression, and specifically, people who are seriously looking for an alternative therapy to the usual antidepressant medications most doctors dole out. My story is so personal and readers become so involved with it that they ultimately want to know more about TMS for themselves. I think by the time the reader gets to the end of the memoir we have both shared an emotional experience, and having the “nuts and bolts” about TMS helps bring them back to thoughts of their own condition with answers as to how they might manage it. Originally I described the genre of my book as “a memoir with a little self-help component baked into it.” I hope that is still the case, although the feedback I’m getting is more about the memoir and my survival. The answers to the Frequently Asked Questions guides the reader to self-help and gives them a “reality check” about the TMS experience.
CS: Even though this memoir focuses on your personal experiences, you incorporate outside quotes, poems, and even a newspaper ad of other writers at the beginning of each chapter. How and why did you decide to include these specific quotes? What effect do you think they have on the reader’s experience?
Martha: I felt that having an epigraph at the beginning of each chapter helped to set up the “theme” or “message” within the respective chapter. I kept finding material in other literature that resonated for me as I went through the cathartic experience of writing the memoir. The excerpts from Alice In Wonderland, in particular, put the psychiatric experience in an appropriate perspective. I also wanted to use actual passages from my personal video and written journal while I was in the throes of recovery from the suicide attempt and the TMS experience so as to make the chapter more personal and real for the reader.
CS: 3,000 Pulses Later deals with difficult and personal subject matter you have experienced. As a fiction writer, I admit to being very anxious about writing of my own personal matters for others to read. Did you have to prepare yourself in any way to begin writing so personally and honestly about your depression and recovery? Did you feel any anxiety about writing this memoir or was it something more cathartic?
Martha: There is a part of me that feels the “book wrote me” rather than “I wrote the book.” It was extremely gut wrenching at times, and on other days putting what really happened to me into words was freeing, exhilarating and gratifying. Because I was so focused on spreading the word about TMS, I didn’t feel too anxious about going public with my story. Since I wrote it for people to learn about TMS, my greater purpose eclipsed my worries about what strangers would think of me. However, I did lose sleep worrying about close business associates, long-time friends, and some family members who didn’t know the real reason I was hospitalized, who thought they knew me and would discover that I had been hiding this awful secret from them.
CS: Did you find that knowing others would be reading and learning about your personal experiences affected your memoir writing process? Did you encounter any roadblocks or get stuck while writing 3,000 Pulses Later? What caused these roadblocks? How did you overcome them?
Martha: The only thing that affected my memoir writing process was the concern that I would sound self-indulgent, morose, overly dramatic and inaccurate with the details. Any roadblocks I encountered were self-imposed doubts that people might not really care about a sixty-plus-year-old woman who wanted to give up on life. But then I’d remind myself that I survived the experience thanks to this miracle called TMS, and that when I first heard about it there was absolutely nothing for me to read other than clinical trial articles for doctors and scientists, so I worked through my self-doubt and focused on the good I hoped the book would do for others.
I did stumble over whether or not to spend any time writing about the sexual molestation I suffered as a child since it did contribute to my lifetime of depression. I was conflicted about including details about who did it, when, how it felt, etc. because that person is still alive and I just didn’t want to go there. Someone in my writers’ group strongly disagreed with my decision and urged me to expand on that part of my story, but after much soul searching, I realized the book wasn’t about my childhood abuse. It was about what happened to me after the abuse and the negative effect it had on me. I felt it was sufficient and important to mention it, but not to derail the flow of the narrative with the gory details.
CS: During the memoir writing process, did you find yourself wanting outside support – for example, getting input from friends or family – or was it a more personal and immersive process until the publishing stage?
Martha: For the first draft I consulted with my siblings on a few occasions to make sure I got the details of our childhood days right. I also relied on notes I had taken while I was in the hospital, as well as the video diary I kept during the six weeks I was in TMS therapy. I didn’t press my daughter and husband who stayed at my side through the difficult first days of my hospitalization because I felt it was too much to ask them to relive the experience. I definitely had to get to a “writing zone” to get the book written, however. For me, this meant total immersion and maintaining a sense of blatant selfishness with my time. Housekeeping, cooking meals, and social life became my secondary priority. When I’d get an enticing invitation to an event that competed with my writing time, I’d ask myself, “Is this event more important than getting my book done?” If I answered “yes” then I’d go, but usually it was a resounding “No!” and I’d have no conflict with sticking to my writing.
CS: Lisa [Tener] tells me that your first draft of 3,000 Pulses Later was very well written with a witty style and well chosen words, but that you needed to go deeper into the writing. What did “go deeper” mean to you? What was your process of going deeper with the writing? How did you know that you had gone deep enough by your final draft?
Martha: Once the first draft was completed in Lisa Tener’s Bring Your Book To Life program, I joined a writer’s group with three other authors and massaged every chapter with their generous, insightful, intelligent and compassionate feedback. I couldn’t have finished my book without outside support. It was so emotionally daunting that other peoples’ perspective became a critical ingredient. My writers’ group asked me very compelling questions that I could only answer by diving deeper into the truth of what happened to me in the past and examining how I felt about it in the present.
Lisa’s advice about “going deeper” took some unexpected courage. It meant stepping outside of reporting what happened and writing about the truth of how I really felt, what this shocking, humiliating, and yet, triumphant story meant to me and my family. How I had to own up to the whole mess and realize that what happened is frighteningly commonplace and it needed to be written, read, and talked about. My process was to always meditate before sitting down to write. I had to remind myself to take tea breaks from my computer, walk outside in the fresh air, and sometimes allow myself to cry a bit in order to work through the very personal parts of the book. I knew I’d gone deep enough with my final draft when I had a sense that I felt absolutely clear and emotionally lighter about the entire journey. I also felt filled with gratitude that I had unburdened myself from the mire of remembering all the details.
CS: The voice of 3,000 Pulses Later is very accessible and engaging, and but also conveys a particular personality and perspective of your experiences. How did you determine what voice or narrative style to use in this memoir? Did you experiment with different styles or voices beforehand or did the voice come naturally as you wrote? Do you find that it is similar to your own voice or is it more of an authorial voice?
Martha: This is True Confessions and Full Disclosure time: I encountered two authors whose voices made me feel that I was reading “me”— Mary Karr and Jeannette Walls. I admired how they were able to take unhappy situations and find a note of humor. I wanted to be just like them in my own writing. I also kept hearing my late mother’s voice as she raised my six siblings and me. She was no-nonsense, intelligent, felt things deeply but always put a lighter spin on them, and she never failed to see the irony in life’s events. I think this is why I kept inserting the adages she left us as her philosophical legacy. So my writer’s voice is about as close as a reader will get to sharing a live conversation with me. I write as I see it. I write as I would speak to you either over a cup of coffee or in a formal interview. That’s the only way I know how to write.
CS: Although the book speaks of your battles with depression, it is also a book of recovery and details your experiences both with ineffective antidepressant medications as well as your successful TMS therapy. What was your process like incorporating these more medical and scientific aspects into your personal narrative? How did you make these aspects just as accessible to readers as the rest of the narrative? What effect do you think including this specific medical information, such as statistics and clinical studies, has on the reader?
Martha: I originally thought I could weave all the scientific information about TMS into the memoir’s narrative, but soon realized I had to get creative with my approach. It seemed too disruptive to the flow of the story. This proved to be one of my biggest obstacles. As it turned out, I was able to include some of the technical information through the use of dialogue I’d had with my doctors. I also quoted passages from letters I’d sent to the insurance companies as scientific support to convince them to give me coverage for TMS.
It was important to make sure the content remained “user friendly” to the audience. This meant it couldn’t be too technical, no six-point footnotes and endless bibliography, and it had to be a fairly short book because depressed people are typically unable to focus on long and complicated reads. I made the assumption that most readers would be learning about TMS for the first time (from a patient’s point of view) so it was incumbent upon me to give them as much assurance—both emotionally and scientifically—that TMS is a safe, effective, FDA approved, and evidence based treatment for Major Depressive Disorder. Otherwise, the book might be misinterpreted and leave the reader to wonder, “Is this just some lady’s sad story about her depression and she found this alternative treatment that happened to work for her, but is TMS the real deal?”
I wrote the “Dear Reader” introduction, however, to remind the reader that this book isn’t a sales pitch for TMS and that there are other treatments for depression that are effective and recommended. My overall message is that depression is a chronic illness, that it’s up to those afflicted with depression to do his or her part and find the therapy that helps them manage their illness, but that my “go to” therapy happens to be TMS which is what they’ll read about in this book.
CS: Why did you decide to write a memoir instead of a self-help book or other genre that offers similar medical information? What effect do you think the memoir form has on a reader?
Martha: There’s an old saying, “Misery loves company” that explains why I wrote a memoir instead of a self-help book. Those of us suffering with depression feel misunderstood and that the dangers and pain of the illness are underestimated. I felt that by aligning myself with the reader on a personal, compassionate, empathetic level my story would resonate with their own suffering and allow them to feel less alone, more understood and hopeful that there is a way out of their own dark cave.
CS: How do you think the relationship between the reader and author differs with a memoir, as opposed to another genre, such as a novel or self-help book? Do you feel that a more personal work creates a closer relationship with the reader? Did you find that the memoir form allowed you to be very open in writing or did you prefer to distance the reader a bit from your real life narrative?
Martha: I know that when I’m reading a memoir, I feel privileged to be let into the author’s personal life. When I’m reading a self-help book or a novel, it’s an entirely different experience because I’m being taught rather than included in my search for the information I’m reading. As I mentioned in the previous question, I wanted the reader to know exactly what I went through for no other reason than to help them understand for themselves regarding their own illness, how serious untreated, treatment resistant depression is and how it can happen to someone they’d least suspect.
CS: What are some of the steps you took to get 3,000 Pulses Later published? How did you choose this method of publishing?
Martha: Originally I wanted to find an agent and take the traditional route of getting this book published. Having a “big deal” publisher’s name on my book was important to me since I was a first-time author. That almost happened because there were two agents who expressed interest and who felt they could get me a publisher contract. However, when I discovered that the production/publishing cycle was eighteen to twenty-four months, I decided to self-publish because in my mind, there were too many people suffering with depression who needed this information much sooner. My desire to have the satisfaction of a literary agent and juicy book deal took a back seat. I gambled that the public’s need for the book would prove this was a prudent decision and that a recognized publisher’s name on it wouldn’t matter.
CS: What do you think worked well with this method of publishing as opposed to other methods? What do you think didn’t work as well?
Martha: What worked well for me was having complete control over the schedule and production values, e.g. cover and interior book design, paper stock, size of the book. I have professional experience as an art director and graphic artist, so I was confident I could do a good job. I didn’t want to go with a print on demand vendor because I knew I’d be printing an initial run of 1,500 books and POD is more suited for much smaller quantities. My production experience in New York came in handy as I searched for a reputable printer that I found in the mid-west. I’m also happy to be self-published because I can keep track of book sales. I also found that self-publishing the eBook was easy and profitable, and the fact that there’s no big name publisher on it makes absolutely no difference. What didn’t work so well was by self-publishing and not using print on demand pay-as-you-go services, I had to come up with a few thousand dollars to cover all the pre-press and printing charges. Fortunately the books have sold, and continue to sell as more and more people are hearing about TMS.
CS: There are a lot of choices a memoir writer must make about who to work with on their book, such as publishers, agents, editors, etc. Did you find that having a more personal and honest book affected your decisions on who to work with? If so, how? Did you find it difficult to share your memoir with these more objective readers? What advice do you have for writers on choosing who they work with, particularly if their writing is personal to them?
Martha: I knew that whomever I chose to work with on my memoir had to really care about and have a genuine interest in depression and alternative therapy. I wanted professionals on all levels of writing, editing, production, and marketing.
My advice for writers on choosing an editor, contributor/co-author, designer, and printer is to vet them thoroughly before you allow them to touch your book. By this I mean actually look at what they’ve done in the past, get references from other authors they’ve worked with, ask them every question you can think of that relates to your book, and have in-depth discussions regarding how you work vs. how they work. Specify in writing fees and payment arrangements, scope of work, and project timeline. Don’t sign anything without having another set of eyes review it. A lawyer can be a little expensive for this, but if it means protecting your book, it’s money well spent. Above all, make sure you manage expectations for yourself and whomever you are working with. There is nothing worse than scouring your soul in a memoir for months if not years, only to come down to the final push of getting it produced and discover that the people you’ve trusted to bring it to reality are either incompetent, unwilling, or worse yet, dishonest.
CS: What are some of the positive results or responses you have received since publishing the book? Has writing this book given you a particular insight into your own medical past or the potential role of TMS therapy in the lives of others with similar medical pasts?
Martha: I am happy to say that 3,000 Pulses Later has already sold over 2,000 copies to date, which means at least that many people know about TMS because of it. The response has been overwhelmingly positive with patients contacting me for more information about TMS through my book’s website, and sharing their own similar stories of treatment resistant depression. I’ve learned that I am not alone and that telling my story has become my gift to others who may have felt they are also alone.
CS: What advice do you have for writers working on memoirs? What advice do you have for writers of any genre on writing about personal or difficult subject matters?
Martha: Writing memoir may start out as a simple exercise to “tell the story” but if it’s going to be a really good memoir, one worth the ink and the paper it’s printed on, it has to be much more than personal storytelling. It’s like climbing a mountain or running a marathon. You know there’s a peak to get to, a finish line to cross, but the integrity of the process of reaching the goal is where the truth of a memoirist—or any writer—proves itself. Conjuring the memories in order to tell the story is difficult enough. Finding the words to describe the myriad of emotions attached to those memories—the pain, joy, humiliation, gratitude, rage, grief—requires self-care, courage, and discipline.
Yes, create the outline to keep your thoughts organized and your narrative on track, decide who your audience is and what you want them to remember after reading the last page of your book. But know ahead of time that their experience of reading it may not be what you intended, or what you experienced yourself, or what they even expected to experience when they chose to read it. Be willing to chance that putting yourself out there in the public with a personal story will somehow work itself into a positive notion for your readers, and that you may never know when, why, or how that occurred, but that your story could be a small (or large) part of their own story.
My advice is to be kind to yourself throughout the memoir writing period. I used meditation as my go-to salvation, especially when I didn’t think I could write another word because it was either too emotionally difficult, or it was just plain tedious and I doubted my story’s value for all the effort it took to tell it.Try to keep what you’re writing to yourself in a judicious way so that others won’t take liberties of trying to tell your story for you. Then, at the appropriate time, ask for feedback from people you trust and respect and whose opinions matter to your potential reading audience. Eat right, sleep well, do some form of exercise even if it’s a short walk to get away from the memoir writing. When you find yourself in an emotional pit because of the stirred up memories, don’t wallow in them with regrets and self-recrimination. Work through the emotions by reminding yourself of why you wanted to write the memoir in the first place.
CS: How can our readers reach you?
Martha Rhodes spent over twenty-five years working in New York advertising agencies as a senior-level executive. She is a graduate of Emerson College in Boston and has done post-graduate work at Harvard University as well as The School of Visual Arts in NY. Martha currently devotes her time as a TMS Patient Advocate to patients and health care professionals throughout the United States. She is on the Patient Advisory Council of the ISEN (International Society for ECT and Neurostimulation) and is a member of NAMI (National Association for Mental Illness) and Mental Health America. Her book about her experience with TMS, 3,000 Pulses Later: A Memoir of Surviving Depression Without Medication, has been mentioned in numerous online and offline media, including The New York Times and Psychology Today. She lives in Connecticut with her husband of thirty-seven years and their rescue dog, Josie.