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Al Galves, PhD is author, mental health consumer, psychologist and on board of MindFreedom International. Al feels strongly that the ongoing, involuntary, outpatient electroshock of Ray Sandford in Minnesota is wrong. Al even flew to Minnesota to be part of MindFreedom protests for Ray. Here is an essay about Al about why he feels the Ray Campaign is a learning moment for us all.

"The Ray Sandford Story Has An Important Lesson for Us": A Psychologist Speaks Out

Date Published:

May 26, 2009 01:00 AM

Author: Al Galves, PhD

Source: MindFreedom

    The Ray Sandford story has an important lesson for us.  It can give us some ideas about how good people working in a system that is designed to help people can hurt them instead.

    Ray Sandford is a 55-year old man who lives in Columbia Heights, Minnesota.  He is being electroshocked against his will.  He says he doesn’t want to be electroshocked; nevertheless, he is being electroshocked – more than 40 times so far.

    Mr. Sandford has been a patient in the mental health system since he was 17 years old.  I imagine he has received numerous diagnoses, including some serious ones indicating the presence of some form of psychosis.  For many years his mother who is now 81 years old, has been his guardian.  Recently she decided that she wasn’t up to that and had guardianship transferred to Lutheran Social Services.  He is under the care of a psychiatrist who has ordered the electroshock.  He has been court-ordered into treatment under a Minnesota law that provides for outpatient commitment.  He has unsuccessfully petitioned the court to vacate the order of electroshock.

    Now I would say that this is about as close to pure evil as you’ll find anywhere in this country of ours.  Here is a man who is grounded and lucid and says he doesn’t want to be electroshocked.  And contrary to his clearly expressed wishes, he is being electroshocked.  He has received electroshock many times in the past so he is aware of the benefits and risk to him, at least in a phenomenological sense, i.e. on the basis of his experience with electroshock.  It’s no wonder that he doesn’t want it.

    Electroshock involves the introduction of up to 600 volts of electricity into his brain for between one-half and four seconds.  That is hundreds of thousand times more voltage than is in his brain in its natural state.  That amount of voltage causes a grand mal convulsion, similar to an epileptic seizure.  That event is presumed to be helpful to Mr. Sandford.  Well maybe it is.  Some people report that electroshock has helped relieve them of their depression.  Of course, the way it may have relieved them is by taking away their capacity to feel anything.  According to psychiatrist Peter Breggin, all psychosurgery disables the brain.  One can imagine that a disabled brain might enable a person to feel better because they have lost their ability to feel much of anything.  Be that as it may, we know that electroshock treatment is associated with very high relapse rates and with loss of memory, brain damage and mental disability.  So it appears that the benefit-risk ratio of electroshock is problematic.  But we know that some people choose to receive electroshock with informed consent.  That’s fine.  But Mr. Sandford chooses not to receive electroshock.  How can we justify subjecting him to it against his will?

    In the answer to that question lies the seed of the evilness of this deed.  The evil resides in the assumption that Mr. Sandford is not competent to know what treatment is good for him.  There is an assumption that he is not sane enough to know what will be helpful to him and what will be harmful to him.

    On what is that assumption based?  How do the experts know that Mr. Sandford is not competent enough to determine what kind of treatment is good for him?  They use a kind of circular reasoning that goes something like this.

Mr. Sandford has reported and/or displayed some behavior that has led him to be diagnosed with a serious mental disorder.

We know what kind of treatment must be used to cure this disorder.

Mr. Sandford doesn’t want to receive the treatment that we know will alleviate this disorder.

Therefore, Mr. Sandford must not be competent to determine what treatment is good or bad for him.

    A more crude way of describing this reasoning would be:  Mr. Sandford doesn’t agree with us so he must be incompetent.

    Now, besides the fact that this is circular reasoning, there is one serious flaw with it.  There is no evidence that the treatment being prescribed will cure the disorder.  There is only evidence that it will result in some patients saying that they feel better or don’t feel as bad after treatment.  There is only evidence that it alleviates the symptoms of the disorder.  There is no evidence that it alleviates the fundamental cause of the disorder.  And, most condemning, the experts have no idea about how it works.  They have no plausible, scientifically-based theory about how the treatment results in a cure or in alleviating the symptoms.  Whatsmore, there is evidence that it impairs the memory and the cognitive functioning of people who receive it.

    So how do the experts determine that Mr. Sandford is not competent to know what treatment is good for him and what treatment is bad for him?

    If they are conscientious, they will do some kind of assessment.  Perhaps, they will administer an IQ test or an MMPI which can be used to confirm a diagnosis or a Millon Multi-axial which can be used to determine the existence of a “personality disorder”.  But wait a minute.  Suppose the experts find that Mr. Sandford has a low IQ, can earn a diagnosis or appears to be suffering from a personality disorder.  What evidence is there that such a finding justifies the assumption that he doesn’t know what is good or bad for him?  There is none.

    A simpler method would be to administer a Mental Status Exam which is designed to determine the degree to which a person is aware of where s/he is, what date it is, the name of the President of the United States and his or her ability to perform feats of short-term memory, i.e. repeating a group of numbers, counting backwards from 100 by 7’s, spelling words backwards.

    But wait another minute.  Suppose Mr. Sandford, for example, doesn’t do very well on the Mental Status Exam.  Is there any evidence to suggest that such an outcome means he doesn’t know what kind of treatment is in his best interest?  No, there isn’t.  After all, human beings have a very powerful drive to survive and to keep their bodies as intact as possible, alive and humming.  Do we have any reason to believe that doing poorly on a Mental Status Exam means they no longer are able to satisfy that drive?  No.

    I met over a five-year period with a woman who was diagnosed with schizophrenia.  I learned that, while she was quite delusional in the safety and comfort of my office, she was very grounded and lucid when talking with a welfare worker, a patient representative or a police officer – someone who could help or hurt her.  When I would ask her about psychotropic medication she would say, “I don’t use that stuff.  It’s poison.”  It turns out that she was right about that.  We now know that people who ingest neuroleptic drugs (antipsychotics) die 25 years earlier than people who don’t and the more neuroleptic drugs they ingest, the earlier they die.

    You get my point.  There is no dependable or scientifically valid way in which the experts can determine whether or not a person is competent to decide what kind of treatment is good for him or her – no way other than the way you or I would do it – observe her or him and make a determination using our common sense and best judgement.  “If it looks like a duck……..”

    If you talk with Mr. Sandford you will find him to be grounded, lucid and rational, to make sense and to appear to have his wits about him.  No matter.  According to the experts, if he doesn’t agree with them, he is not competent to know what is good or bad for him.

    The abuse and maltreatment of Mr. Sandford is not unique or unusual.  Similar abuse and maltreatment occurs over and over again every day throughout the United States.  It is time to put an end to that. 

    The quickest and most practical way to do that is to repeal the outpatient commitment laws that have been adopted by 40 of our states.  Until we find a better way of determining the competence of people to make decisions regarding their medical treatment, those laws will serve mainly as tools of abuse and maltreatment.

Al Galves, Ph.D.

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Judi Chamberlin

Judi (1944 to 2010) was one of the most effective international psychiatric survivor activists. Judi is shown here holding the National Council on Disability report From Privileges to Rights, which her good friend the late Rae Unzicker helped create. Judi served for years on the MFI board. (Photo by Tom Olin)
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