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      Minn. patient wants right to refuse electroshocks

Ray Sandford doesn't like electroshock treatments.

After more than 40 of them, he finds it hard to remember names and other
things. His bipolar disorder is under control, he says, and he should
have the right to say no.

But at age 55, after being in and out of mental hospitals for nearly
four decades and being declared legally incompetent, Sandford has no
choice. His caregivers persuaded a judge after he hit a low point last
year that he had no alternative but electroconvulsive therapy (ECT) plus
a combination of anti-psychotic drugs.

"I just don't like the idea of them being able to force these
treatments," Sandford said.

Now a group in the "Mad Pride" movement that advocates for the mentally
ill has taken up Sandford's cause, arguing that nobody but him should
dictate how he's treated.

David Oaks, executive director of MindFreedom International, led about
24 people in a rally at the Minnesota Capitol in early May to draw
attention to Sandford's case. The Eugene, Ore.-based group opposes
involuntary psychiatric treatment and all use of ECT, and Oaks calls
Sandford a victim of torture.

"This is worse than waterboarding," Oaks said. "Offer somebody the
choice between waterboarding or forced electroshock and a lot of our
people who know what it is will say waterboarding."

But defenders say ECT is safe and effective in many severely depressed
patients for whom drugs have failed.

"It's not torture," said Dr. William McDonald, a psychiatry professor at
Emory University who chairs an American Psychiatric Association
committee on ECT. "That's a completely unfair characterization. It's
inflammatory."

Sandford's legal guardian, Lutheran Social Service of Minnesota, mostly
declined to talk about his case because of privacy rules. Eric
Jonsgaard, senior director of its guardianship program, said ECT was the
court's decision, not the agency's.

"We would love to be able to say here's what's going on in this case,
but we have to look out for his best interest," Jonsgaard said.
"Frankly, here's a man with capacity issues who doesn't understand all
that this is doing to his life."

Experts aren't sure why ECT works. It triggers a seizure, and one theory
is that it somehow "resets" the brain.

McDonald said ECT patients typically are put under general anesthesia
for about 10 minutes and given muscle relaxants to prevent spasms. He
said they get just enough electricity to cause a seizure. When patients
wake, they have little or no memory of being shocked. Some patients have
side effects such as temporary memory loss, headaches and nausea, but
they are manageable and there is no brain damage, McDonald said.

ECT is given to selected people suffering severe depression including
bipolar disorder, not generally for other mental illnesses. McDonald
said it can be 80 to 90 percent effective in causing at least a
temporary remission in a patient's disorder. Most of the thousands of
patients who undergo the treatment every year do so voluntarily, he said.

Sandford did, too _ at first.

Sounding lucid and alert in a phone interview, he said he "agreed very
nicely" to the treatments at first, even though he found them
frightening. He thought he would get only three, he said.

"It just went way beyond that," he said.

His mother, Marilyn Sandford, said she also supported a few treatments
for her son. A retired nurse from Edina, she was familiar with ECT
because she actually helped administer it during her career and had seen
its benefits. But she said the more than 40 he has received is unjustified.

A court order authorizing ECT for Sandford said he has been admitted
more than 30 times to the Anoka-Metro Regional Treatment Center over the
years. When he arrived at the psychiatric hospital in January 2008, the
order says, he was "grossly psychotic, yelling violently, smearing feces
all over, urinating whenever and wherever he felt like it."

While at the hospital that time, the order said, Sandford "required
seclusion and restraints on many occasions. His behavior was
unpredictable and uncooperative. He was violent, striking out at staff
and other patients, and he exhibited delusional and grandiose behavior."

Two court-appointed examiners _ a psychiatrist and a psychologist _
reported to the court last summer that Sandford had improved
significantly as a result of the subsequent ECT and drug therapy, but
they agreed he remained a danger to himself and needed continued ECT. He
failed to persuade a judge last December to stop the treatments.

Sandford now lives in a small assisted-living home in Columbia Heights,
and undergoes ECT once every 30 days.

"They can actually tie me up, take me by ambulance to the place and give
me the shock treatments if they wanted to do that," he said.

Pamela Stuntz, a psychology professor at Texas Christian University who
hasn't been involved in the case, said the fact that Sandford was moved
into a less restrictive setting suggests that "the people who've been
treating him have been doing a very good job."

Arthur Caplan, director of the Center for Bioethics at the University of
Pennsylvania, said unwanted invasive procedures can be justified if
they're in the patient's best interest, are something they'd want if
they were competent, and if nothing less intrusive would work.

"The real issue for the family, the guardian and the court is, 'Is it
working?' And if it is working, how do we get him the minimal amount
that keeps him functioning. And I would say that about any treatment,"
Caplan said.

Oaks said Sandford acknowledges he needs help, but he considers Sandford
competent enough to refuse ECT. He noted that Sandford was functioning
well enough to use the Internet to find his group and ask for help.

"He's been consistent and focused and clear and reasonable about why he
doesn't want shock. ... No should mean no for extreme, controversial,
potentially irreversible, intrusive procedures," Oaks said.

The "Mad Pride" movement includes groups and individuals that seek not
only an end to forced treatment, but to redefine their conditions as
something to be respected instead of diseases to be suppressed.

Most members of MindFreedom International are "psychiatric survivors"
who've been abused by the mental health establishment, said Al Galves, a
MindFreedom board member and psychologist from Las Cruces, N.M.

Caplan, the ethicist, said it's good that groups like MindFreedom are
trying to reduce the stigma faced by people with mental illnesses. But
he said it's wrong to lump all mental health challenges together.

"The mental health area is a big tent, but some of the people in the
tent really do have severe problems and I'm not sure one-size-fits-all
is the right answer," Caplan said.

(Copyright 2009 by The Associated Press. All Rights Reserved.)