WHEN IS IT ACCEPTABLE TO FORCE TREATMENT ON SOMEONE? The Case of Ray Sandford

For some time now, I have been following the case of Ray Sandford. I first learned about him through e-mail circulars sent to me from Mind Freedom International, which said that he was having ECT treatments forced on him at regular intervals against his will, and urged opponents of psychiatric abuse to call or write the governor of Minnesota on his behalf. Unfortunately the circulars did not give much other information about the case: for instance, what sort of ECT Sandford was receiving (bilateral or unilateral), what his official diagnosis is, and what exactly it is that he has done to make the courts believe that he requires forced treatment. Through a phone call to Mind Freedom, I learned that he was being given ECT treatments because antipsychotic drugs had proven ineffective in controlling "social behavior which was unacceptable to those around him." And then just yesterday, I read the transcript of a segment aired by Minnesota Public Radio about Sandford, which answered all my questions except the one concerning the form of ECT. It was also rather discouraging, compounding the impression I had already from Mind Freedom and other patients' rights groups that there is no coherent strategy for defeating the harmful and incipiently totalitarian designs of TAC, the Treatment Advocacy Center.

The facts are as follows. Ray Sandford, a man of 54 years old living in a community care home just outside of Minneapolis, Minnesota, has been having ECT treatments of unknown type administered to him on a weekly or biweekly basis at a nearby hospital. He opposes the treatments, but apparently has put up no physical resistence to them. Instead he took what seems to me the very rational and constructive step of calling his local library for organizations devoted to patients' rights, and obtaining the number of Mind Freedom. His call to the organization's director, David Oaks, made his case a cause celebre among members of the Movement Against Psychiatric Assault. Ray was described by the reporter from Minnesota Public Radio, Lorna Benson, as having hands which shake, "a side effect from some medication he's taking, he says." This is tardive dyskinisia, and proves that he has already had been victimized by neuroleptics, which are almost as dangerous as ECT: even if the latter is stopped, he will have been maimed for life by the drugs. He told the reporter that the ECT treatments were wrecking his memory, which is undoubtedly true, as every recipient of ECT treatments of whatever kind, even those who advocate it such as Kitty Dukakis, has said that it causes amnesia. Sandford' mother, who was also interviewed by Benson, said that she supported the ECT at first, as it seemed to help him. But now she opposes what she views as an excessive number of treatments, especially in view of the accumulating memory loss. Sandford has been diagnosed as having a schizo-affective disorder. He was described by his mother as being "out of control". But how "out of control" was he? His court record describes him as urinating wherever he felt like it and smearing feces on hospital walls. His mother also says that he tail-gated her when she was driving and did "many irritating things having to do with bodily excrement." For this he has been forced to take neuroleptics and have ECT. (http://minnesota.publicradio.org/display/web/2008/12/15/forced_electroconvulsive_therapy)

After Mind Freedom launched its campaign on behalf of Ray Sandford, the Minnesota Disability Law Center took up his cause. Its legal director Pamela Hoopes says quite rightly that whenever a person's right of self-determination is taken away, the courts have to have a good reason. She pointed out that there are different perspectives on how the state should make the decision to force treatment on someone against their will. "Sometimes people say you should use the perspective of a reasonable person... It's assumed that a reasonable person wants to protect him or herself against the relapse of a terrible mental illness..." Janus says that in her opinion, greater weight should be given to what the patient wants, even if it appears that their illness might be clouding their judgement. "Competent or not, not everyone wants to be treated when they're sick." This shows that the Minnesota Disability Law Center has a muddled and misinformed concept of the real issues involved in Sandford's case. In the first place, the drugs and ECT that are being forced on Sandford do not represent a "cure". They are forced upon patients in order to control them at the price of reducing them to a vegetable state, while earning profit for the electronics and pharmaceutical industries which manufacture drugs and ECT devices. However bad Sandford's illness may be, the treatments will leave him in worse shape. He will probably have to take neuroleptics for life in order to be spared the agony of tardive akathisia, a withdrawal symptom which is even worse than the tardive dyskinisia he is already suffering from. And of course the more ECT treatments he has, the more memory he will lose, until he has lost his very identity.

Furthermore, there are only two criteria wich can be reasonably used to justify forced treatment, and they are perfectly clear and objective. The patient must represent a danger-- not just an irritation-- to himself or, more importantly, to others. Some people, including myself, would argue that the "danger to oneself' justification may not always be sufficient, for people have a right to take their own lives for good reason, but since some commit suicide for no good reason, society is justified in preventing them from doing so until they have a chance to think it over, preferably in a more favorable environment than the one in which they have been living. But in any case, the essential criterion must be the threat of violence. This can lead to First Amendment complications, in that citizens have the right to advocate violence in the abstract, so long as there is no direct threat involved-- e.g., inciting a crowd to violence against a person or persons who are present and in a position to be attacked. But when Seung-Hui Cho, perpetrator of the Virginia Tech Massacre, wrote a play suggesting that he had precisely this intention, exactly a year before he carried it out (a play which, incidentally, still has not been released to the public), it would have been justifiable for authorities to keep a close watch on him, as they evidently did not, perhaps because Virginia is TAC's home state. The most important fact that can be argued in Ray Sandford's favor, besides the fact that both neuroleptics and ECT are dangerous, is that he is not violent. His mother said nothing about violent episodes in his past nor did she express any fear of him. Indeed, he is nonviolent to an extent which is almost incomprehensible. Contrary to what the Minnesota Disability Law Center says, many "reasonable" people threatened by such destructive treatments would fight to the death to avoid having them. If there was no way to avoid them, they would commit suicide. Someone who is truly "out of control', like Seung-Hui Cho, would use them as an excuse to attack innocents who had nothing to do with the forced treatment. Ray Sanford has done none of these things. His willingness to passively endure the gradual destruction of his mind and body is nothing short of saintly. And that is why his forced treatment with both drugs and ECT is so unjust.

One of the most disturbing things about this case is that Sandford's diagnosis, 'schizoaffective disorder", falls at least partly into the category of illnesses on the "schizophrenia spectrum" which I discussed in my last blog. Traditionally ECT has been prescribed, on either a voluntarily or involuntarily basis, primarily for depression. But Isaac and Armat, the mouthpieces of TAC, have recommended it specifically for schizophrenia in their book Madness in the Streets (p. 220) This is exceptionally dangerous since the "schizophrenia spectrum" includes disorders which are characteristic of the greatest minds in history, the people upon whom the survival of civilization depends. Some of these individuals-- Vincent Van Gogh is an example-- may be both psychotic and creative geniuses. Others-- usually referred to as schizotypes-- may have never experienced a psychotic episode in their lives. But their superficial resemblence to schizophrenics leaves them vulnerable to mis-diagnosis with its attendant jeopardy. To make things worse, the term "psychosis" has never been satisfactorily defined by psychiatry. The criterion of "being out of touch with reality" is clear enough when one is dealing with beliefs which are demonstrably contrary to fact-- for instance, that an airplane is a flying saucer. But what about-- and I am here quoting from a Wikipedia article on psychosis-- "the belief that one has some special purpose in or destiny (such as to save the world) or is being monitored or persecuted by government agencies"? Who are psychiatrists to say that an individual does not have a special destiny, when this is a religious belief not subject to proof or disproof? As for being monitored by government agencies, in fact today as in Ernest Hemingway's time millions of people are under surveillance for the most sinister of reasons. When we move from using forced treatment to deal with obvious mood disorders such as suicidal depression or homicidal rage to using it to treat so-called "perceptive disorders", there is no longer anything to stop it from being used for the purpose of political repression, and perhaps that is precisely what TAC intends.

Ray Sandford would not be an easy person to live around. I would not want to live around him. But in evaluating his case, we must recognize that ulitmately, what is being done to him can be done to anyone. If we allow people to have treatments forced upon them for any reason other than the imminent threat of violence, then we are opening up the door to an Orwellian nightmare. Today Ray is having forced ECT because he smeared excrement on a wall. Tomorrow it will be someone who smeared excrement on an American flag as a form of political protest. And the next day, someone who has merely publicly spoken out against government policy. With TAC providing the shock troops to enforce the nascent totalitarianism, it is time for us to draw an unequivocal "line in the sand".