The court order authorizing electroshock treatments for Ray Sandford says that when he arrived at a psychiatric hospital early last year, he was "grossly psychotic" and violent toward staff and other patients.

Sandford, who has been declared legally incompetent, said he agreed to the treatments at first, but 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.

The court disagrees, but advocates of the mentally ill who call themselves the "mad pride" movement have rallied to his defense.

"This is worse than waterboarding," said David Oaks, executive director of MindFreedom International, who led about two dozen people in a rally at the Minnesota Capitol this month to draw attention to Sandford's case.

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

Sandford's caregivers persuaded a judge to order 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," said Sandford, 55, who has been in and out of mental hospitals for nearly four decades.

MindFreedom, based in Eugene, Ore., opposes involuntary psychiatric treatment and all use of ECT, but mental-health professionals 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."

Representatives of 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.

"Frankly, here's a man with capacity issues who doesn't understand all that this is doing to his life," Jonsgaard said.

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

McDonald described a process in which 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, who sounded 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.

Sandford now lives in a small assisted-living home in suburban 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.

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

The order adds that while at the hospital that time he "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 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.

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 are hard to justify, but can be 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'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 have 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 he thinks 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.

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On the Net:

MindFreedom International: http://www.mindfreedom.org/

American Psychiatric Association: http://www.psych.org/