Minnesota mental health patient Ray Sandford forced into electro-shock therapy

Ray Sandford doesn't want to do this.

Lou Fancher and Steve Johnson

photo by Daryl Trones

Ray Sandford

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More About

• Ray Sandford
• David Oaks
• Marilyn Sandford
• Mental Health
• Medical Treatments and Procedures

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On a sunny yet cool mid-April morning, the pear-shaped 54-year-old emerges from the front door of his ranch-style group home in Columbia Heights. Wearing a black windbreaker and gray sweatpants, he grips the handle of his four-pronged cane and plods begrudgingly toward the street. One of Sandford's caretakers, a large woman wearing all purple, follows perfunctorily behind to see him to his destination.

He's told them repeatedly he doesn't want to do this.

He ambles forward. There's nothing he can do now. No sense in fighting it. Not now.

A 20-passenger Anoka transit bus idles along the curb awaiting his arrival. A short, swarthy driver assists Sandford. The bus slowly pulls away and embarks on the 12-mile ride to Mercy Medical Clinic in Coon Rapids.

Upon arrival, Sandford walks through the automatic sliding doors and assumes his position in a wheelchair. He's whisked to a room on the fifth floor where nurses poke an IV through his fleshy forearm. He's given a muscle relaxant and general anesthesia. Within 30 seconds, the room dissolves. He's out cold.

Assistants lay him out on his back. A doctor places electrodes on either side of Sandford's cranium. Cords extend from the electrodes, connecting to what appears to be an antiquated stereo set. A couple of dials protrude from the machine's display. A physician flips an unassuming switch.

A three-second burst of 140 volts blasts through Sandford's brain. While he's totally unconscious, Sandford's torso jerks up and down. His arms and legs writhe only slightly, steadied by muscle relaxants coursing through his veins. Sandford's toes curl downward, as if his feet were trying ball up into fists. He's experiencing a grand mal seizure.

Two minutes later, it's over. Sandford will feel a bit woozy the rest of the day, but there'll be no lasting pain. His short-term memory is the only thing that will suffer.

But he'll still remember quite clearly that he never wanted to do this.

"They can literally tie me up, put me in ambulance, and bring me in to get shock treatments," he says. "I don't fight it, because there's nothing I can do by that time. You want to know how I feel? I don't like it at all."

INTRODUCED TO AMERICA in 1939, electroconvulsive therapy is one of the most controversial medical procedures still in practice. Not much is known about how or why it works. Even so, by the end of World War II, every reputable hospital in the world performed the procedure.

"It was a very useful treatment because there was no treatment like it before," says ECT proponent Dr. Max Fink, widely regarded as the grandfather of American ECT and a professor of psychiatry at Stony Brook University in New York. "At the time, every state was troubled by the fact that they were building bigger and bigger hospitals for the mentally ill. Once ECT caught on, the number of hospital beds for mental illness was reduced sharply."

After the advent of psychotropic drugs in the 1950s, however, ECT appeared to be going the way of the lobotomy. Prescription meds were suddenly viewed as a more reliable and humane alternative.

But by the early '80s, something unexpected happened: antidepressants and other psychotropics turned out not to be the panacea everyone hoped they would be.

"Many doctors had patients who had been given the best care in the major centers of the world with pills, but they still had patients who were very, very sick," says Dr. Fink. "So they turned to doctors who were using ECT devices, and one by one, hospital by hospital, ECT was reintroduced. Most of the reintroduction occurred at the end of the 1980s and beginning of the 1990s. By now, there aren't many psychiatric hospitals that don't have ECT."

Today, between 100,000 and 200,000 Americans undergo the procedure each year. But not everyone is convinced that's a good thing.

"When you induce a grand mal convulsion by sending 100-plus volts of electricity in the brain, you're going to create damage," says Dr. John Breeding, an Austin, Texas-based psychologist and self-described ECT abolitionist. "This is most easily seen with memory loss that many patients experience. You're talking major voltage directly into the temporal lobes of the brain. And the data is very clear that there's close to a 100 percent relapse rate, which means patients have to keep coming back and suffer further brain damage. This is referred to as 'maintenance ECT,' rather than as a failed treatment, which is what it really is."

Even more controversial is the practice of forced, court-ordered electroconvulsive treatment. Neither the American Psychiatric Association nor activist groups have estimates on how many Americans undergo forced ECT annually, but there were 41 cases in Hennepin County last year.

Ray Sandford was one of them. But unlike the others, he's not going quietly, opting instead to take his fight to the public arena. A small army of mental-health activists has now taken up a national-scale PR campaign on his behalf, painting him as something of a real-life R.P. McMurphy from One Flew Over the Cuckoo's Nest.