I can’t believe I’d ever had to write an entry like this. It turns my stomach.
On Friday, MindFreedom, a non-profit human rights organization for people labeled with psychiatric illnesses, published the disturbing story of Ray Sandford, a 54-year-old resident of Columbia Heights, Minnesota.
Sandford’s sad story is amazing and haunting. He is undergoing electroconvulsive therapy (ECT) for severe depression. We don’t know the full back-story, but the fact that he lives in a sheltered living home called Victory House suggests he’s had a rough life of it so far.
Lots of people undergo ECT, although I’m not a big proponent of it. I believe that because of the unpredictable memory loss associated with this “treatment,” it is not only a treatment of last resort in depression, it should probably be done away with as a treatment altogether except in extreme cases. Proponents of ECT claim the memory loss associated with ECT is always around the time of the ECT itself, yet there are thousands of documented cases (many of which appear in the published literature) that show that the extent and severity of memory loss is random and unpredictable. You could lose memories associated with your childhood, or best friend, or even a spouse. No one can tell you what your experience will be. So in effect, the treatment can be nearly as painful as the disease itself.
Which isn’t to say that ECT hasn’t helped people. But so did amputations prior to the 1800s, because medical science had no understanding of infection, bacteria, or sterilization. I would humbly suggest our understanding of the brain is about where medical science was 200 years ago. And to apply electrical shocks to it to combat depression is akin to amputating your leg because you suffered from a scratch while walking in the woods, which later got infected. It works, but it’s the crudest method imaginable. (Frankly, I put it a small step up from trepanation.)
So ECT is a treatment option and since science has shown it works (just as science once showed that leeches applied to the body “worked”), it’s available to anyone who is informed of its risks and chooses it as a treatment for depression.
But ECT is rarely administered against a person’s will in modern science. Most professionals and states recognize that a person’s Constitutional rights would likely be violated if they were to be forced to undergo a controversial treatment procedure that even the scientific community doesn’t agree upon. Sadly, Ray Sandford lives in Minnesota, and apparently Minnesota doesn’t much care about a person’s Constitutional rights if they’ve been relieved of them by a court. Ray Sandford doesn’t want the ECT treatments, but he no longer has a choice or say in the matter.
Ray Sandford has a legal guardian — a court-appointed conservator — whose name is Tonya Wilhelm. Wilhelm works for Lutheran Social Service of Minnesota and it is Wilhelm who authorized the forced treatment of the person she is legally bound to protect and look out for his best interests. Of course she didn’t do this on her own, a doctor experienced with ECT treatments recommended it to her (or the courts), and she agreed (on behalf of her client). And why not? What does Wilhelm have to lose since it’s not her brain they’re treating?
The transcript with MindFreedom’s David Oaks is chilling:
Ms. Wilhelm said, “We are following the letter of the law.” She said the State of Minnesota had secured a variety of court orders that require Ray to have forced electroshock against his expressed wishes. Ms. Wilhelm says it’s all legal and she can’t do anything about it.
Well, of course you can do something about it — you’re charged with protecting the person that you agreed to act as conservator to!
Lutheran Social Service of Minnesota is the largest, statewide non-profit social service organization in Minnesota with over 2,200 employees who serve in 300 communities. It has an annual budget of $90 million. So this is not some mom-and-pop organization, but rather a far-reaching Christian-based organization that should know better. And, you’d think, would be against forced-treatment of this nature.
Agree or disagree with me about ECT. Agree or disagree with me about forced treatment. But I think most of us can agree that if that were our loved one who was being forced to undergo a controversial treatment with questionable and sometimes disturbing side effects, we’d take a step back and ask such treatments to stop. I thought the barbaric practice of forced electroshock treatments went out in the 1960s, as we began to better understand the human dignity and rights of people with mental illness and close down the huge public psychiatric hospitals. Nobody should undergo a forced medical procedure that they don’t want, regardless of the outcome. That is a right embodied in our rights to “life, liberty and the pursuit of happiness,” the foundation of our Constitution.
We don’t know all of the details of this case (like Sandford’s previous history, other treatments, and why he has a conservator). So perhaps an important piece of the puzzle hasn’t been provided. But I can’t imagine what additional information would make forced ECT treatments “okay.”
We call on the good people at Lutheran Social Service — Mark Peterson, Jodi Harpstead, Joyce Norals, Kenneth Borle, Ember Reichgott Junge, Jeri Schoonover, and Rod Brown, all of whom are the executives of Lutheran Social Service — to look into this matter more closely and determine whether Tonya Wilhelm is indeed acting in the best interests of her conservatee, and reply to the allegations that Ray Sandford is being forcibly made to undergo ECT treatments he does not want.
By the way, Minnesota is one of those states that agrees with forced outpatient treatment and has codified it into law. The Treatment Advocacy Center calls such forced treatment as “assisted outpatient treatment.” That’s like calling prison an “assisted living community.” According to TAC’s site, the forced treatment has to be court-ordered because the person has a high likelihood of being a danger to himself or to others.
Read the two articles on Furious Seasons (hat tip!) about this: Help Stop Forced, Involuntary ECT In Minnesota and Neuroscientist Defends Forced ECT
Read NeuroSkeptic’s response: Shock and Cure
Read MindFreedom’s article which has a call to action in it: If it’s Wednesday, then Ray Sandford is Getting Escorted from His Home for Another Forced Electroshock
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Links to This Article
From Psych Central's World of Psychology:
What if Ray Sandford Were Your Brother? | World of Psychology (5/24/2009)
What if Ray Sandford Were Your Brother? | Momscreed - Pregnancy & Parenting Guide (5/27/2009)
What if Ray Sandford Were Your Brother? | Mental Health Blogs (5/29/2009)
19 Comments to
“Forced ECT is Wrong in Minnesota, World”
I, also, hold the opinion that this type of treatment needs to be banned. Once it is no longer a crutch for psychiatrists to lean on when they can’t bother to look for something better, then maybe they will be forced to find that “something better.”
I can’t hold this Christian group responsible, and your holding that out as a determinant is disturbing.
The people that need to be held responsible are those who put this law into effect in MN. If it was publicly voted, then they live by their actions, as we all do.
If this gentleman has a guardian, it’s for cause. He isn’t able to make sound decisions.
If the guardian doesn’t follow doctor’s recommendations, then she puts herself in the place of being liable and playing “God” over the advice of experts.
Wouldn’t you condemn someone who prevents a doctor from treating their charge just because the incapacitated person said they didn’t want it? That’s why we have guardians, to make those tough decisions as best they can.
Also at the core of this is the problem with most people not making any kind of advance arrangements, and thus becoming a ward of the State. Urging everyone to write down their wishes, to make an advanced directive that is more than the simple form available, and to talk to their relatives about choices, would be a good blog entry, in my opinon.
If any group puts themselves in a situation where they are defending the State’s request for a “treatment” such as ECT against the patient’s will, that group has something to answer for. Who are they protecting? Themselves, or the patient’s rights? Are you honestly suggesting that someone who doesn’t want forced ECT should get it anyway?
When people decide not to fight injustice like this because it’s easier to “go along with it” than it would be to argue against it, that’s disturbing. If you see injustice or evil in the world, you work to try and stop it.
Especially for the person whose protection you are responsible for.
As a survivor of ECT, I find drjean’s comment about an advanced directive both insulting, misguided and patently offensive.
I live with a primary MH diagnoses of Bipolar II Disorder. I cannot tell you exactly when, but around the turn of the century, I started being hospitalized for suicidal depressions.
The doctors told my best friend and boyfriend that I was hopeless, that it was just a matter of time before I killed myself. Around the third stay within a year or so, I agreed to ECT.
My friends and boyfriend tried to talk me out of it, knowing in my healthy mind I am against it. I don’t remember much of this. In fact, after over twenty-two “treatments”, I cannot remember but slivers of the years 1999-2002.
My friend would bring me in for the shock, point out that I was still slicing my wrists open and they’d smile and shock me again. I do recall enjoying the guy holding up the knock-out needle and smiling, saying, “Small prick.”
I loved being knocked out because I was in such bad shape. But I don’t remember those years. I watched as 9/11 unfolded, but I don’t remember it at all. Some might say that’s a blessing, but it’s not. Imagine, if you will, a random three years of your life were wiped out.
I’m not even talking about the recovery time. Where my best friend watched the same documentaries that I picked, four or five times before a glimmer of recognition came to me. The crosswords I struggled with. The slowing of my brain that used to be photographic in memory.
This is the end of the second year that I have not spent at least two months on a psych ward. I cannot credit ECT with this, whatsoever. In fact, it might have happened sooner, had it not been for my brain damage.
I had to spend down all my savings to go on SSDI, a state of living which is not helped by the majority of public servants. I would like to thank Phylis Hilly of The PA Advocacy For Workers With Disabilities. Over the last decade, she has shone with her kindness.
But about that advance directive that drjean posits. I didn’t know how quickly I would crash and lose everything. As a single, successful female, I never imagined the position I found myself in. Maybe the good drjean cannot, either.
My best friend ended up being a “rep payee” for my SSDI check, in case I was in hospital. I also gave her my Medical Power of Attorney a few years back. Turns out the MPA does not apply to mental health.
How do I know? I was in a psyche ward for three months December 2006-February 2007, receiving treatment my friend thought was detrimental. They laughed at her.
We now have to find a lawyer to draw up separate MHMPA. Maybe drjean might like to recommend one.
My mind is part of my body. Why the hell is it not included in a Medical Power of Attorney? drjean?
ECT is a treatment that is very helpful for some but can have significant side effects. Instead of beating up on the treatment, why not just criticize the legal oversight that has permitted its apparent illiberal use in this case?
arspsychiatrica.blogspot.com
ECT for depression I believe has to put in right manner, in the opinion on sciences some might help, but to overcome depressions, there is only one way to pray to God and daily meditations.
A guardianship ward is stripped of all rights: the right to decide where to live and whom to associate with, how to spend (or save!) ones own money, accept or refuse medical treatment - or even ask for a second opinion - marry, vote, etc., and the most important right of all: the right to complain.
This is what is going on in this case. Just as ECT should be a last resort, so should guardianship.
As it states in the article, it’s not the guardian’s brain they’re “treating” But because of the guardianship, Ray Sanford doesn’t even have the right to protect himself.
For more information on unlawful and abusive guardianships, visit NASGA at http://www.StopGuardianAbuse.org and the NASGA blog at http://NASGA-StopGuardianAbuse.blogspot.com.
Yours,
Elaine Renoire
NASGA
Definitely because my doctors applied ect 7 times when i got stick.. Thank you so much for information.
@Novalis — Because research shows that medical students (who later become doctors) don’t even understand the side effects of ECT and up until 2007 — nearly after 7 decades of use of this “treatment” — the first comprehensive study was finally done on cognitive deficits after ECT treatment. One of the findings from that study is also eye-opening — there are so many variations and accepted ways to perform ECT that you’re unlikely to find any two efficacy studies actually performing the exact same type of ECT.
ECT is a treatment of last-resort. Always. And because it is poorly understood why it works and what kind of cognitive and memory impairments a person who actually have, it should never be forced on another human being. It’s barbaric, there’s no other way to describe it.
Forced ECT is legal in most states as far as I know. It is legal in Virginia, legal in New York State, I could do a search of all state laws but don’t want to spend the time. Once any forced MH treatment is allowed there is no reason ECT will be an exception. The only exceptions in Virginia’s law are forced psychosurgery and forced abortion and forced sterilization.
I’m not sure what the problem with my reply is.
I agree that forced ECT is wrong. I also agree that MN is wrong and needs to reevaluate it’s law.
However, I won’t condemn the society nor the guardian. The guardian IS now the will of the patient, whether we like it or not. She has the responsibility to make an informed decision, and obviously the doctors -the experts in this case- have urged the ECT for their patient.
How else is she supposed to make these types of decisions, if she is left to her own knowledge and ignores medical advice? If the patient isn’t given the advised treatment and then suicides, aren’t you going to hold HER responsible? She can’t win according to your rules. Wouldn’t you condemn a guardian for going along with a patient’s decision that goes against medical advice, even though she is there because the patient has been determined not to be able to make such decisions.
By the way, with the influx of federal monies (though I’m not sure of this particular case) the government requires even Christian organizations to hire everyone qualified, whether they are Christian or not. The original entry appeared to assume that the guardian, because of her employment with the Lutheran Society, should act like a “Christian” and not force such a barbaric treatment on her charge.
I think the crux of this issue is that you don’t agree with ECT, and you’re taking it out on the society and the guardian.
Fight the law that allows this situation, not the people trying to do what’s best for the patient. Fight the treatment altogether. I’ll back you on those battles!
Dano, you are correct on many levels. One never knows what is about to happen. Everyone needs to make out their trust, and their medical directives. The reason I said not to just use the basic form is because it doesn’t cover enough, and doesn’t allow for different decisions in different situations. You can add mental health to the directive as well, and you should, imo!
When there’s an issue or treatment we are personally against, such as ECT, then most certainly list that on the directive as NOT being allowed under any situation.
I know some have posted without any personal knowledge of guardianship, and how difficult those decisions become. I don’t hold it against them. Everyone does the best they can for the time and place. At least that’s what I count on. 
“By the way, Minnesota is one of those states that agrees with forced outpatient treatment and has codified it into law.”
I’m a little confused how the subject of AOT entered an exposition on ECT. Far as I know, ECT cannot be mandated under any AOT law.
It would be one thing if Minnesota having AOT made it seem draconian compared to other states, but a total of 42 states permit such outpatient orders.
Dr. G,
I for one am a proponent of ECT administered only with consent but readily acknowledge that memory loss can be severe. Nothing I’ve ever experienced has come close to the pain I suffered from depression in the eighties.
For you to compare depression to a scratch in the woods that became infected is far more egregious than anything I’ve heard any psychiatrist say about ECT.
Surely you’re aware of the high suicide rate among those with clinical depression. How many cases can you cite of death from an infected scratch?
By comparing it to the medical use of leeches you perpetuate the stigma suffered by those of us who’ve had ECT.
Many, if not most, of us feel we must keep our treatment a secret because people like you portray it so ludicrously. That turns my stomach.
If someone knowlegable as you supposedly are ridicules the treatment we chose, how can we expect the rest of society to refrain from judging us for having undergone the treatment?
With such talk of leeches and amputation you trivialize the suffering of those who’ve experienced the severest forms of depression.
I didn’t hesitate when I was offered a second chance at life. Years later I still consider it the best decision I’ve ever made and I know others who feel the same.
“..this type of treatment needs to be banned.”
drjean, I hope you were referring to the administration of ECT without consent and not to ECT in general.
I chose ECT as a last resort and am grateful for having had access to it. It’s been twenty years since my last treatment but some memories have never returned. What a small price to pay for having my will to live restored.
Wound infection — from scratches, bullets, stabbings, broken limbs, etc. — was one of the leading causes of death in the world until antibiotics and wound care were discovered. And amputation was a common procedure for dealing with infected wounds before the 1800s, so as to save a person’s life. So it’s no small comparison to make, since both an untended wound (no matter what its source) and depression can lead to death.
ECT is a treatment of last resort for depression because of its unpredictable memory and cognitive side effects, plain and simple. The problem is that professionals who either have a direct financial interest in forwarding ECT as a mainstream treatment (e.g., they make the ECT machines), or professionals who’ve staked their entire lives and reputation on the procedure (and so their conflict of interest is one of reputation, ego and pride), and the main proponents of this treatment.
It can be hard to find an objective source for ECT information when you go in for the treatment, because the professional who’s usually recommending it doesn’t appreciate the long-term potential side effects (side effects, I might add, that are virtually unheard of with any other modern psychiatric treatment).
ECT is an option, but it’s definitely not the first option for depression treatment and it’s something one needs to serious consider before undergoing.
Please give me an example of ECT being used as a first line treatment for depression in the past twenty-five years.
It’s possible, but it’s also likely that some unusual circumstance surrounded its use, such as a contraindication for meds.
You said:
“And to apply electrical shocks to it to combat depression is akin to amputating your leg because you suffered from a scratch while walking in the woods, which later got infected. It works, but it’s the crudest method imaginable. (Frankly, I put it a small step up from trepanation.)”
You compared amputating a leg to treat an infected scratch in today’s world to using ECT to treat depression. So, am I correct in taking your response to mean you are retracting the above quote?
Do you still maintain that treating depression with ECT is akin to treating illness with leeches?
I’m acutely aware of both the up and down sides of ECT treatment. Since having it twenty plus years ago I’ve shared experiences with countless others.
You’ve once again make a claim that doesn’t jive with my own experience or with that of others I know.
The side effects I experienced from ECT were a walk in the park compared to those of the antidepresants I took prior to ECT. Those were miserable and, in some cases, life threatening.
ECT never caused me life threatening side effects. On the contrary, It may well have saved my life. It never caused physical illness other than the post treatment headache which lasted most of the day.
The memory loss I experienced from untreated depression was on par with that caused by ECT. Prior to my ECT, family and coworkers related incidents for which I had no memory.
Again, I’m against ECT administration without informed consent and I agree that many psychiatrists don’t provide appropriate information. However, when you hold it up for ridicule, you may influence people to make choices that cost them their lives:
“So ECT is a treatment option and since science has shown it works (just as science once showed that leeches applied to the body “worked”), it’s available to anyone who is informed of its risks and chooses it as a treatment for depression.”
Again, I agree that it shouldn’t be forced on anyone and that it should only be used in extreme cases. I don’t agree that I made a decision on par with one to be treated with leeches.
In your original post you neglected to mention the life saving properties of ECT. Why no concern for the risk of suicide until I raised the issue?
I’m not disagreeing with you on the circumstances under which ECT should be administered.
I do object to your portrayal of those of us who willingly took the risk in hopes of returning to a productive life as those who would also resort to amputation for an infected scratch or leeches to treat any ailment.
Having the courage to undergo treatment is something I’m proud of yet those of your ilk reinforce society’s view that we should feel shame for submitting to a treatment you consider “…a small step up from trepanation.” We deserve better.
You’re taking my words out of context of the larger argument — our understanding of why ECT works on the brain is akin to our understanding of why amputation (or leeches) “worked” for wounds or illness 200 years ago. It’s a procedure that I believe, with more knowledge and time, will eventually go the way of these other procedures, because while it “works,” it does so in a only the most generalized manner possible.
Indeed, it takes courage (and risk) to seek out any type of psychiatric treatment today, regardless of the type. And I said nothing of such courage, related to this or any other type of treatment. I also said nothing of shame. These are all things you appear to be reading into an entry about forced ECT treatment on a patient who doesn’t want it!
Sorry, but forced ECT is wrong and that’s primarily what this entry is about. I’m not going to argue any further about ECT’s benefits and drawbacks, which I think are pretty clear from this exchange already.
I know this is an old post, but I feel strongly enough about my opinion to post anyways
From the looks of it, John M. , Psy.D. has absolutely no concept of sever depression.
‘gardener’ is correct in saying that he has trivialized the matter significantly.
Additionally, I feel that in the case of severe depression, ECT should be OFFERED if other treatments have failed. If your depression is actually severe, memory loss is a very small price to pay. (When I was severely depressed, i asked about ECT because I was willing to sacrifice ALL my memories to get rid of the depression)
BTW, gardener: 1, Grohol: 0
Yes, if people’s lives were a game, your score may indeed be correct.
But I don’t think people’s lives are a game for others to play with, especially when it comes to unwanted ECT treatments being given them against their will.
I agree that *all* currently allowed depression treatments can and should be OFFERED. But as you noted, that’s the key differentiation — offered. Not forced.
As for ECT itself, it’s always an option. But one that one should get all the information about its pros and cons before undergoing the procedure. I surely hope no one is making a decision about ECT based upon something they read on a single blog…
I need help. There is a court order to adminster ECT against my will. It’s been over a year now that I have been getting this horrid treatment every week and if I end up in the hospital I get it three times a week. I took a deal that I should not have taken when they went to renew the Price Sheppard. They offered to drop the Jarvis but they said that I would get a limited amount of treatments. Since August 09 when I took the deal they have given me so many I can’t even count that high. Last time I was in the hospital (HCMC) in Oct 09 they gave me three in a week. The first time that week they had to put me in restraints to bring me down to the room where they perform the procedure. Dr. Silver is the Doctor that is doing this to me at HCMC in Minneapolis. After my third course that week my brain was so fried that they got scared and stop giving me the procedure for four weeks. However, on November 12, 2009 they are starting them up again against my will. Dr. Silver will not talk to me and he has been doing this for a year and a half. I do not get any benefit from the procedure and since I have been off the ECT for a month I have been fine and mentally stable. I get a high dose of haldol in shot form and have not missed a shot in 7 years. That should be enough. I do not understand why the give me so many ECT treatments with no benefit. I have lost memories of my past and cannot function in life with this over my head. Why is doctor Silver and HCMC do this to me ? What benefit do they get torturing me like this? Please help me if you can?
I can’t go on like this for the rest of my life. I should have a idea of when this is going to end. The haldol shot is all I need. If they want to give me more meds I would be willing to take them just to have this nightmare end.
Sincerely Yours,
David Joseph Fox
612 840 7981
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Last reviewed: By John M. Grohol, Psy.D. on 11 Nov 2008
