LR Frank on coercive psychiatry

Leonard Roy Frank has published an excellent commentary on a recent article by Dr. Thomas Szasz on Barely a Blog: Read it here.

Patients decide which treatments they would allow

Pact gives mentally ill options
Patients decide which treatments they would allow

October 16, 2006

If you’re hospitalized and unable to make health decisions, a living will can guide doctors about how much medical intervention you want.But what if you have a mental breakdown? A similar document, called a psychiatric advance directive, details the mental health treatments you would prefer.

Psychiatric advance directives, or PADs, have been available for years, and Illinois’ document is among the best, experts say. But PADs are little known and seldom used.

To raise awareness, the National Resource Center for Psychiatric Advance Directives has started a Web site, www.nrc-pad.org, providing state-by-state PAD information and downloadable forms.

A PAD is prepared when a patient is lucid. “The benefit is that the patient feels heard,” said Dr. Marvin Swartz, co-director of the center. “The patient feels empowered.”

The center was developed by Duke University Medical Center and the Bazelon Center for Mental Health Law.

PADs are intended for people with a history of severe and persistent mental illness such as schizophrenia or bipolar disorder — about 3 percent of the population.

Good for three years

The Illinois PAD allows you to state whether you agree to be hospitalized for up to 17 days, and whether you would consent to electroconvulsive (shock) therapy. It also lists what psychotropic drugs you would take. You might, for example, agree to take a certain drug, but only after your doctor has tried your preferred drug.The directive takes effect if two doctors or a court determine you are unable to make reasonable decisions. (You can name one of the doctors in the PAD.) The PAD must be followed, unless there is an emergency or unless a court contradicts your wishes. And you still could be hospitalized, regardless of what your PAD says, if it’s determined you are a danger to yourself or others.

The PAD designates a friend or relative to make decisions about your mental health treatment. It must be signed by two competent adults who attest you were of sound mind when you signed it.

The directive remains in effect for three years. You can revoke it only if a doctor determines, in writing, that you are competent to cancel it.

Illinois’ law is 10 years old but only recently has begun to catch on, the Illinois Guardianship and Advocacy Commission said.

jritter@suntimes.com

Fears for dozens of patients given electric shock therapy against their will

The Scotsman
Oct. 8, 2006
KATE FOSTER CHIEF REPORTER (kfoster@scotlandonsunday.com)

DOZENS of psychiatric patients were given electric shock treatment without their consent in Scottish hospitals last year despite huge controversy over the safety of the treatment.

Almost 10% of patients given electro-convulsive therapy (ECT) underwent the procedure as a compulsory treatment for severe depression, according to figures seen by Scotland on Sunday.

Last night doctors revealed some patients are forcibly held down and anaesthetised for the procedure, prompting grave concerns from mental health campaigners who warn that its side-effects include confusion, headaches and long-term memory loss.

But psychiatrists insist ECT can help some patients with severe depression for whom medication is not working.

An audit of Scottish hospitals in 2005 by the Scottish ECT Accreditation Network reveals 433 patients underwent the treatment. A total of 38 had it without giving their consent. Last night, Donny Lyons, director of the Mental Welfare Commission for Scotland, said he believed it was right to treat people against their will if experts agreed ECT was the best option.

He said: “It is done sensitively and we have to be clear why we think a patient needs it. Any force should be kept to a minimum. Using force is extremely unpleasant and rare. You may get people resisting or objecting. Sometimes some general restraint is required.

“ECT is a good thing because it works in people with severe depression; 70% of people will get very significantly better. The more severe the depression, the better it works. It does work very well and it is a good treatment but it does have its risks and can cause memory difficulties.”

New safeguards on ECT were included in Scotland’s new Mental Health Act, which came into force last October. According to the new law, patients cannot be given the treatment forcibly unless they are deemed too mentally ill to be able to make an informed decision. Yet Lyons said it is too early to say whether the new laws are having any effect on the number of people treated forcibly. ECT involves placing electrodes on the temples, on one or both sides of the patient’s head, and delivering a small electrical current. Patients are treated with short-acting anaesthetics and muscle relaxants.

The current produces a seizure lasting up to a minute and can provide short-term relief from severe depression.

According to the audit, the highest rates of ECT were in Grampian, with 93 patients, and Lothian with 61 patients.

Moira Fraser, head of policy at the Mental Health Foundation urged extreme caution over the treatment because of its effects on the memory.

She said: “ECT is very controversial. The impact varies from individual to individual, so you have to be very cautious. If someone is capable of understanding the decision they are making and they have said no, for example because of the long-term memory problems, then it is only in very rare circumstances that it should be given.”

Sandra McDougall, influence and change manager at the Scottish Association for Mental Health, said: “It’s absolutely vital that people thinking about having the treatment are able to access good quality information about potential benefits and risks so that they can make an informed choice about whether to go ahead with it.

“It’s only possible for someone to be given ECT without their consent where they’ve been assessed as not having the capacity to make a treatment decision, and are being treated under relevant legislation.”

New Zealand: 350 more patients allege abuses

350 former psychiatric patients to seek compensation from government

Oct. 6 2006
New Zealand Radio

The lawyer for 350 former psychiatric patients seeking compensation from the government says there’s no difference between his clients and another set of patients who have already been paid substantial compensation.

The 350 claim they were mistreated at State-run mental asylums in the 1960s and 70s.

Their accounts of abuse are similar to those of former patients at the Lake Alice psychiatric hospital, who are sharing $6.5 million in compensation paid in 2001.

About 200 of the group have already lodged legal claims; and more are expected to do so, saying they suffered physical and sexual abuse. They also say electric shock treatment was used as a punishment.
Govt stance

The new group’s lawyer, Roger Chapman, says that puts the government in a tough position.

He says it’s difficult, morally, to defend a stand of this kind by a government that accepted that it had an obligation to the Lake Alice patients.

The cost of taking the claims through the courts will fall on the taxpayer through legal aid.

The first hearings are a year away, and Mr Chapman expects many more former patients will come forward in the meantime.

Memorandum re: NY Supreme Court forced shock ruling

M E M O R A N D U M

September 21, 2006

A New York State intermediate appellate court, the Appellate Division,
Second Judicial Department, has rejected a challenge by MHLS to a lower
court order authorizing involuntary electro-shock treatment of Simone D.,
a patient at Creedmoor Psychiatric Center, a state hospital in
Queens, New York. The Appellate Division, in its 3-to-2 September 19,
2006 decision, Matter of Simone D. (Anonymous), affirmed the lower
court, with a strong dissent by two justices.

The trial court’s order had authorized the administration of up to 30
shock treatments over a period of six months, with the frequency to be
determined by the hospital’s “ECT team.” Simone D. previously had been
given at least 148 shock treatments over her objection by Creedmoor
under previous court orders.

The testimony of the hospital psychiatrist before the hearing court had
established that previous shock treatment had neither brought about a
remission of Simone D.’s depression nor restored her capacity to make
her own treatment decisions, that the claimed benefits always
dissipated upon the discontinuation of shock, and that the treatment had
never brought Simone D. to a condition where Creedmoor was willing to
discharge her to the community. At the conclusion of that doctor’s
testimony she was asked:

Do you have any hope to offer Simone [D.] . . . other than a lifetime of
court ordered electroshock treatment and depression at . . .
Creedmoor Psychiatric Center?

The doctor answered:

I don‚t have, at this particular time, I don‚t have anything else to
offer her.

Cross examination of the doctor also revealed that shock treatment was
discontinued in 1996, due to a frontal organic brain syndrome secondary
to ECT.

The court severely limited the cross examination of the Creedmoor
psychiatrist by Simone D.’s MHLS attorney, disallowing many questions
about the nature of shock treatment and its effect. For example, when
the doctor was questioned about the nature of grand mal seizures and
epilepsy, objections from the hospital’s attorney were sustained and the
court stated that it was “familiar with that”. At another point, in
precluding questioning about shock treatment, the judge declared, “The
court is familiar with how it is done”.

The court also denied MHLS’s repeated requests that an independent
psychiatrist be appointed to assess the desirability of giving Simone D.
further shock treatment.

The Appellate Division’s majority decision ruled that the trial court
“did not improperly curtail the cross-examination” of the hospital
psychiatrist, noting that the cross-examination covered 44 pages of the
hearing transcript while the direct examination took only 13 pages. The
three appellate justices also rejected MHLS’s argument that the hearing
judge improperly relied upon his own presumed knowledge of shock
treatment. Finally, the panel found the denial of the application for
the appointment of an independent psychiatrist to be a proper exercise
of the court’s discretion.

The two dissenting justices argued that the trial judge “prevented
Simone D. from making a record that could be reviewed on appeal and
instead became a silent witness relying on its own knowledge of ECT.”
The dissent found that to be reversible error, “particularly because of
the extensive course of ECT treatments to which Simone D. has been
subjected since 1995 without long-range benefit.”

Since the Appellate Division decision was 3 to 2, and the ruling was on
points of law and not just on the facts, Simone D. may appeal to the
state’s highest court, the Court of Appeals, as a matter of right. The
Appellate Division had earlier stayed enforcement of the forced shock
order pending appeal, and that stay will remain in effect while the
decision is appealed to the high court.

While we are disappointed with the outcome of our first level appeal, we
believe that Simone D. has a very strong case, and we are encouraged by
the forceful dissent. We hope that, with the support of one or more
briefs from friends of the court, we will ultimately prevail.

New York Supreme Court affirms forced shock ruling

[*1] In the Matter of Simone D. (Anonymous), appellant; Kathleen Iverson, etc., respondent.

2005-11405, (Index No. 501166/05)

SUPREME COURT OF NEW YORK, APPELLATE DIVISION, SECOND DEPARTMENT

2006 NY Slip Op 6574; 2006 N.Y. App. Div. LEXIS 10885

September 19, 2006, Decided

THIS OPINION IS UNCORRECTED AND SUBJECT TO REVISION BEFORE PUBLICATION IN THE OFFICIAL REPORTS.

COUNSEL: Mental Hygiene Legal Service, Mineola, N.Y. (Kim L. Darrow and Dennis B. Feld of counsel), for appellant.

Eliot Spitzer, Attorney-General, New York, N.Y. (Michael S. Belohlavek and Patrick J. Walsh of counsel), for respondent.

JUDGES: STEPHEN G. CRANE, J.P., DAVID S. RITTER, GLORIA GOLDSTEIN, REINALDO E. RIVERA, MARK C. DILLON, JJ. RITTER, RIVERA and DILLON, JJ., concur. CRANE, J.P., dissents with memorandum, in which GOLDSTEIN, J., concurs.

OPINION:

DECISION & ORDER

In a proceeding for permission to administer electroconvulsive therapy to a patient without her consent, the patient appeals from an order of the Supreme Court, Queens County (Rosengarten, J.), dated November 29, 2005, which, after a hearing, granted the petition.

ORDERED that the order is affirmed, without costs or disbursements.

In the instant petition, Creedmoor Psychiatric Center (hereinafter Creedmoor) seeks permission to administer electroconvulsive therapy (hereinafter ECT) to the appellant without [**2] her consent. At a hearing held on the petition, Dr. Ella Brodsky, a licensed psychiatrist and the person who administers the ECT at Creedmoor, testified that the appellant suffers from a “major depressive disorder, severe, with chronic features” and was incapable of making decisions regarding her own treatment. In fact, Dr. Brodsky asserted that during a meeting to discuss treatment, at which the appellant, her Spanish-speaking attorney, Dr. Brodsky, and the treatment team were present, the appellant refused to respond or even make eye contact. Dr. Brodsky testified that, although the appellant had benefitted from ECT in the past, such treatments had ceased and the appellant had “decompensated,” i.e., she had become withdrawn, mute, and nonparticipatory, and spent most of her time in a corner in a fetal position. Further, the appellant was not eating properly and had become aggressive and assaultive toward the staff and her fellow patients. Dr. Brodsky noted that [*2] on a prior occasion, the appellant needed to be fed through a tube, which was a “drastic remedy.” By contrast, Dr. Brodsky testified that after the completion of the last course of 30 ECT treatments, the appellant [**3] had gained weight, was eating, drinking, and interacting with others, and “was not aggressive or assaultive at all.” Dr. Brodsky noted that the appellant would be carefully monitored during the administration of ECT to determine her blood pressure, her EKG, her EEG, and her “mini-mental status.” Dr. Brodsky further testified that many other forms of treatment had been tried and failed, including an extensive course of drug therapy, and that ECT was the least restrictive, clinically appropriate treatment for the appellant available at this time. She added, “[w]e don’t have any other choices.”

On cross-examination, counsel for the appellant questioned Dr. Brodsky concerning ECT treatments administered to the appellant in 1995 and 1996 in an effort to demonstrate that the appellant had suffered possible brain damage from those treatments. Dr. Brodsky testified that she had not reviewed the appellant’s ECT records for that time period. She stated that she did not need to review the “old records” because medical assessments were updated so that she could “find everything in the current record, whatever is important for an ECT.” Dr. Brodsky added that the appellant was “regularly” receiving [**4] ECT since 1996. Thus, she opined that what occurred in 1996 was not relevant in assessing the appellant’s current condition.

Counsel also questioned Dr. Brodsky concerning a variety of potential risks involved in the administration of ECT, including whether increases in blood pressure during treatment could induce hemorrhages in the brain, whether treatment could rupture the blood/brain barrier, how the amount of electric current used is determined, the risks of the anesthesia used during the treatments, and whether the patient feels pain during the treatment.

Based on this record, the petitioner established by clear and convincing evidence that the appellant lacked the capacity to make a reasoned decision with respect to the proposed treatment and that the proposed treatment was narrowly tailored to give substantive effect to her liberty interest (see Rivers v Katz, 67 N.Y.2d 485, 497-498; Matter of Adam S., 285 A.D.2d 175, 178-179; Matter of Mausner v William E., 264 A.D.2d 485; Matter of Adele S. v Kingsboro Psychiatric Center, 149 A.D.2d 424, 424-425).

Contrary to our dissenting colleagues’ view, the Supreme [**5] Court did not improperly curtail the cross-examination of Dr. Brodsky. The nature and extent of cross-examination are matters within the trial court’s sound discretion (see People v Rodriguez, 2 AD3d 464; People v Ayala, 280 A.D.2d 552). Respectfully, the dissent focuses only on certain selectively chosen portions of the cross-examination. When the cross-examination is viewed as a whole and properly analyzed in context, it is clear that the appellant’s counsel was permitted extensive questioning on all relevant areas to be considered under Rivers v Katz (supra). Indeed, while the direct examination of Dr. Brodsky encompassed only 13 pages of the hearing transcript, the cross-examination covered 44 pages.

Moreover, the Supreme Court providently exercised its discretion in denying the appellant’s application for the appointment of an independent psychiatric expert. While a court “may” appoint an independent psychiatric expert (Judiciary Law ß 35[4]), here, an independent expert had already examined the appellant. Thus, the court’s determination that “another [expert] opinion would not be necessary” was entirely proper. [**6] [*3]

We disagree with our dissenting colleagues’ assertions that the court relied upon its own knowledge in reaching its determination. There is no indication in the record that the court based its decision on its own knowledge or became an unsworn witness. To the contrary, the court’s determination is amply supported by the medical evidence presented, including the evidence elicited by the appellant’s counsel during cross-examination.

The dissent’s statement that the appellant has been subjected to an “extensive course” of ECT without “long-range benefit” is incorrect. The benefits to the appellant herein are crystal clear. As Dr. Brodsky recognized, although the appellant may not achieve remission, the treatment has improved her quality of life. Namely, with the treatment, she will not remain in a fetal position, she will eat, interact, and not pose a danger to herself or others. These positive responses to ECT cannot be dismissed or ignored.

Accordingly, under the circumstances of this case, the Supreme Court properly authorized the administration of ECT.

RITTER, RIVERA and DILLON, JJ., concur.

DISSENT BY: STEPHEN G. CRANE

DISSENT: CRANE, J.P., dissents and votes to reverse [**7] the order and remit the matter to the Supreme Court, Queens County, for a hearing before a different Justice to consider the issues anew upon taking testimony and, if it deemed it appropriate, after assigning an independent expert to conduct a psychiatric examination and report relevant recommendations, with the following memorandum, in which GOLDSTEIN, J., concurs:

This is a proceeding pursuant to Rivers v Katz (67 N.Y.2d 485) to determine whether the respondent, Simone D., has the mental capacity to withhold her consent to electroconvulsive therapy (hereinafter ECT).

Simone D. was first admitted to Creedmoor Psychiatric Center in 1994 and suffers from a severe depressive disorder. Since 1995, she has undergone, over her objection but pursuant to previous court orders, at least 148 ECT treatments. Prior efforts to help her with medication failed to improve her condition. After two unsuccessful applications in July and September 2005 for permission to administer ECT to Simone D., the petitioner applied again in November 2005. The petition and supporting papers showed that without ECT Simone D. becomes depressed, stops eating and drinking, and requires nasogastric [**8] tube feeding. Allegedly, the ECT will diminish her assaultive behavior, enable her to eat, enhance self-care, and promote her ability to socialize.

At a hearing on the petition, the court rejected the request of Simone D.’s counsel that it appoint an independent psychiatrist. The petitioner called one of its psychiatrists, Dr. Ella Brodsky, who opined that Simone D. lacked the capacity to make a reasoned treatment decision and that ECT is the least restrictive alternative because there is no other choice.

Trying to undermine Dr. Brodsky’s opinion, Simone D.’s counsel cross-examined Dr. Brodsky extensively. Simone D. claimed that ECT inflicted pain on her. So, counsel tried to focus on the pain a patient undergoing ECT might suffer. On a prior petition that did not result in court-ordered ECT, Simone D. had been examined by an independent expert who suggested the alternative [*4] of psychotherapy with a Spanish-speaking therapist. This therapy was tried, but for only a few weeks. In an effort to show that this alternative to ECT deserved a longer testing period, Simone D.’s counsel attempted to cross-examine Dr. Brodsky on this subject. In addition, Simone D. had experienced [**9] cognitive impairment from ECT, resulting in its discontinuance in 1996. Her attorney, therefore, tried to cross-examine Dr. Brodsky on the extensive course of ECT administered to his client over the years without permanent improvement.

When Simone D.’s counsel tried to ask questions about the physical pain ECT causes, and also about grand mal seizure, the court interceded and proclaimed that it was familiar with the workings of ECT. When counsel sought to elicit information about hemorrhages and the rupture of the blood/brain barrier caused by ECT, the court sustained the petitioner’s objections. Likewise, the court thwarted counsel when he inquired about the dosage and duration of ECT, the Food and Drug Administration risk classification of ECT machines, and the identification of succinylcholine. These were but a few of the limitations the court placed on counsel as he attempted to show that Simone D. should not be forced yet again to undergo ECT.At the conclusion of Dr. Brodsky’s testimony, Simone D. renewed her application for an independent examination. The court denied the application as unnecessary. After closing arguments, the court found that it was in Simone D.’s best interest [**10] to administer ECT even though it acknowledged that she would probably never “get better”: “she perhaps could die. Perhaps she wants to die. But that’s not for us to determine. We must prevent her from dying.”

The court prevented Simone D. from making a record that could be reviewed on appeal and instead became a silent witness relying on its own knowledge of ECT. The appellant, therefore, was unable to demonstrate the side effects of ECT, the risks of this course of treatment, and the potential alternatives that may be available. This was error in the circumstances of this case, particularly because of the extensive course of ECT treatments to which Simone D. has been subjected since 1995 without long-range benefit.

The court’s reliance on its own knowledge was error in three respects. First, it violates the rule prohibiting a judge from considering, absent the parties’ consent, facts outside the record (see Silberman v Antar, 236 A.D.2d 385 ["(t)he court improperly gave great weight to its own knowledge, based on personal observation of certain facts"]; People v Weiss, 19 A.D.2d 900; People v Lawrence, 19 A.D.2d 899; People v Dow, 3 A.D.2d 979; [**11] Prince, Richardson on Evidence ß 2-205 [Farrell 11th ed]).

Second, the court became an unsworn witness whose “knowledge” of the “facts” and the basis those “facts” form for his conclusion was never scrutinized or tested by cross-examination (see e.g. People v Jie Mei Chen, 26 AD3d 344, 345; People v Dow, supra at 980).

Third, the details of the knowledge possessed by the court are not memorialized in the transcript, thus depriving all appellate courts of the ability to review the entire record and evaluate whether the petitioner has sustained its burden, in this case, by clear and convincing evidence (see Judiciary Law ß 295; People v Harrison, 85 N.Y.2d 794, 795-796; Rivers v Katz, supra at 498; People v Degondea, 256 A.D.2d 39, 41 ["defendant was effectively thwarted from creating an adequate record for appellate review"]; People v Robinson, 209 A.D.2d 648, 649). Put simply, there is no way to determine whether the petitioner met its burden because much of the evidence was [*5] contained only in the court’s mind. [**12]For these reasons, I respectfully dissent and would reverse the order and remit the matter to the Supreme Court, Queens County, for a hearing before a different Justice (see People v Jie Mei Chen, supra; People v Dow, supra) to consider the issues anew upon taking testimony and, if it deemed it appropriate, after assigning an independent expert to conduct a psychiatric examination and report relevant recommendations.

State Department Reports on Religious Freedom in China; allegations of forced electroshock

Full report, released September 15, 2006
http://www.allamericanpatriots.com/m-news+article+storyid-16220.html

Excerpts:

In December 2005 a Beijing attorney sent an open letter to President Hu Jintao highlighting abuses of Falun Gong practitioners. The letter described the electric shock torture of Zhang Zhikui, a Falun Gong practitioner arrested for repeated petitioning in Beijing, and the October beating death in Changchun, Jilin Province of Liu Boyang and his mother Wang Shouhui. The letter, and a similar open letter sent by the attorney in 2004, referred to the extra-legal activities of the 610 office, reportedly involved in many of the abuses of Falun Gong. In 2005 the Government revoked the attorney’s license to practice law, and the attorney has claimed repeated government harassment, including an automobile accident that he publicly described as an “assassination attempt.” Foreigners attempting to meet with the attorney have been detained and harassed.

According to Falun Gong practitioners in the United States, since 1999 more than 100,000 practitioners have been detained for engaging in Falun Gong practices, admitting that they adhere to the teachings of Falun Gong, or refusing to criticize the organization or its founder. The organization reported that its members have been subject to excessive force, abuse, rape, detention, and torture, and that some of its members, including children, have died in custody. NGOs not affiliated with the Falun Gong documented nearly 500 cases of Falun Gong members detained, prosecuted, or sentenced to reeducation during the period covered by this report. Credible estimates suggested the actual number was much higher. In November 2005 police at the Dongchengfang Police Station in Tunzhou City, Hebei Province, reportedly raped two Falun Gong practitioners. Reliable sources indicated that Zheng Ruihuan and Liu Yinglan were detained in Shandong Province in July 2005 for practicing Falun Gong. In May 2006, Yuan Yuju and Liang Jinhui, relatives of a Hong Kong journalist who works for a television station supportive of Falun Gong, were sentenced to reeducation for using an illegal cult to organize and obstruct justice, relating to their distribution of Falun Gong materials. Some foreign observers estimated that at least half of the 250,000 officially recorded inmates in the country’s reeducation-through-labor camps were Falun Gong adherents. Falun Gong sources overseas placed the number even higher. Hundreds of Falun Gong adherents were also incarcerated in legal education centers, a form of administrative detention, upon completion of their reeducation-through-labor sentences. Government officials denied the existence of such “legal education” centers. According to the Falun Gong, hundreds of its practitioners have been confined to psychiatric institutions and forced to take medications or undergo electric shock treatment against their will.

More from the US State Department on Falun Gong:
http://tinyurl.com/mg6l6

Bobby Fletcher’s info on China: he believes much of the above is a hoax and is concerned it will divert attention from “real” human rights issues in China:

http://sujiatunfactorhoax.blogspot.com/

Turkey continues its use of unmodified electroshock

Details from the report on ECT use in Turkey, from CPT:

Full report:

http://www.cpt.coe.int/documents/tur/2006-30-inf-eng.htm

C.        ECT and other psychiatry-related issues

1.         Preliminary remarks

58.       As already mentioned, one of the issues focussed on during the December 2005 ad hoc visit were the procedures for the administration of electroconvulsive therapy (ECT) in psychiatric establishments. This subject had been addressed in some detail in the report on the 1997 visit to Turkey (cf. CPT/Inf (99) 2, paragraphs 178 to 182). However, information recently received from various sources indicated that certain of the CPT’s recommendations had not yet been implemented, in particular as regards the discontinuance of the practice of unmodified ECT.  For the purpose of examining this question, the CPT’s delegation visited two State hospitals, Bakırköy Mental and Psychological Health Hospital in I˙stanbul (this establishment, the largest psychiatric establishment in Turkey, had previously been visited by the Committee in 1992 and 1997) and Adana Mental Health Hospital.

In addition to the above-mentioned subject, some comments will be made in this report on procedures relating to involuntary civil placement in psychiatric establishments and living conditions for patients at the Adana Hospital.

59.       At the outset, the CPT wishes to emphasise that relations between staff and patients in the two psychiatric hospitals visited were on the whole found to be positive and tension-free, and many patients spoke favourably about the manner in which they were treated by staff. This is all the more commendable in the light of the often low staffing levels and the paucity of the resources at the staff’s disposal.

However, some complaints were heard of the ill-treatment (notably slaps) of patients by orderlies at the Bakırköy Hospital; allegedly, such acts would occur in the event of a failure to take prescribed medication or of disobedience. Under no circumstances can methods of this kind be tolerated. The CPT recommends that the management of Bakırköy Mental and Psychological Health Hospital deliver the clear message to all categories of staff at the establishment that any form of ill-treatment of patients is unacceptable and will be the subject of severe sanctions.

2.         Electroconvulsive therapy

60.       Electroconvulsive therapy is a recognised form of treatment for psychiatric patients suffering from some particular disorders. However, like certain other forms of therapy, its administration must be accompanied by appropriate safeguards.

The CPT is particularly concerned when it encounters the administration of ECT in its unmodified form (i.e. without anaesthetic and muscle relaxants). As was emphasised in the report on the 1997 visit to Turkey, use of this outdated method entails a heightened risk of untoward medical consequences and can lead to situations which could justifiably be described as degrading.

The Committee also pays attention to whether ECT is being used for the proper indications and to the procedure for obtaining consent to this treatment.

61.       In their response to the report on the 1997 visit, the Turkish authorities stated that they were “paying close attention [to] the discontinuation of the practice of unmodified ECT”.[8] However, in spite of that assurance, the delegation which carried out the December 2005 visit observed a widespread use of unmodified ECT in the two psychiatric establishments in Adana and Bakırköy.

At Adana Mental Health Hospital, ECT is only used in its unmodified form. At the Bakırköy Hospital, there is a single ECT unit with a capacity of 10-15 patients per day, where a part-time anaesthesiologist makes modified ECT possible. However, the great majority of patients to whom ECT is administered at this hospital also receive the therapy in its unmodified form; of the total of 15,877 ECT sessions administered at Bakırköy in 2005, only 512 (i.e. some 3.2 per cent) were modified.

62.       Further, the information gathered by the CPT’s delegation at the Bakırköy Hospital indicated that ECT was being used in an even more extensive manner than had been observed during the 1997 visit. In some units, more than 60 per cent of patients had received ECT in 2005, and the therapy had been administered to 26 per cent of all patients admitted to the establishment during that year. In the CPT’s view, these figures indicate excessive resort to ECT.

Although the management of the Adana Mental Health Hospital was unable to provide the CPT’s delegation with precise statistics on the use of ECT for the whole hospital, it was obvious that ECT was also used extensively there. According to information received from the Director of the hospital, nearly 30 per cent of patients in a female unit had received ECT during the year 2004.

63.       The CPT wishes to make clear that its delegation did not gain the impression in either of the two establishments visited that ECT was being used in a punitive manner or that the patients perceived the treatment as such or had been threatened with ECT. However, the delegation did note that some patients who had received unmodified ECT developed a fear of the treatment, resulting, on occasion, in it being cancelled.

At Bakırköy, the delegation was repeatedly told that the reason for the extensive reliance on ECT was the lack of beds for the high number of patients in need of admission and treatment. From interviews with both patients and staff, it would appear that ECT was sometimes administered only a few times, until the patient was no longer agitated; such a treatment series could commence on the day of arrival of the patient to the hospital. The CPT is very concerned about any possible resort to ECT as a means of quickly subduing agitated patients; this would constitute an improper use of the therapy.

Neither of the two establishments had written policy guidelines regarding the administration of ECT.

64.       In both establishments, ECT was administered out of the sight of other patients, in rooms specifically set aside and equipped for this purpose. However, from interviews with patients at Bakırköy, it would appear that a patient about to be treated may see patients who have already been treated and who are lying unconscious or recovering. This is clearly not desirable.

65.       At the Bakırköy Hospital, recourse to ECT was, as a rule, recorded in both the patient’s medical file and a general ECT book kept on the ward, although at least one of the ECT books only indicated the start of the treatment without mentioning further sessions. At the Adana Hospital, while some wards did have ECT books, in other wards recourse to ECT was only recorded in the patient’s file. Moreover, even in those wards which possessed an ECT book, the registration of ECT sessions was incomplete. A specific (and properly completed) ECT register at ward-level will greatly facilitate supervision by hospital management and discussion with staff about practices followed.

66.       As regards the procedure for obtaining consent to ECT treatment, no written consent was obtained at the Adana Hospital. Special consent forms were used at the Bakırköy Hospital, often signed on admission by the patient, or, in most cases, by his or her guardian or next of kin. However, these forms were often undated, and in a few cases they were signed by the police transporting the patient to the hospital. Further, the examination of patients’ medical files revealed that in several cases no written consent was recorded; the delegation was told by the staff that in certain situations (e.g., in the event of difficulty contacting the patient’s family) the ECT consent form could be signed after the treatment had been started, or even after it had been concluded. It is also noteworthy that some patients did not seem to have been informed about the procedure or the possible benefits and risks involved.

In this connection, it must be stressed that all patients should, as a matter of principle, be placed in a position to give their free and informed consent to treatment, including ECT. The admission of a person to a psychiatric establishment on an involuntary basis should not be construed as automatically authorising treatment without his or her consent. Any derogation from this fundamental principle of consent to treatment should be based upon law and apply only in clearly and strictly defined exceptional circumstances. Of course, consent to treatment can only be qualified as free and informed if it is based on full, accurate and comprehensible information about the patient’s condition and the treatment proposed.

67.       To sum up, the CPT is seriously concerned by the current procedures for the administration of ECT observed in the Adana and Bakırköy Hospitals, and in particular by the continuing frequent recourse to this treatment in its unmodified form.

The Committee’s delegation was informed by the management of the Bakırköy Hospital that two new fully-fledged ECT units would be set up within the establishment in a few months. The Committee takes note of this development. The CPT would like to receive full information concerning these units (in particular, a detailed description of their equipment and staff resources) and to be informed of the planned date of their entry into service.

More generally, the CPT recommends that the Turkish authorities accord a high priority to ensuring that all psychiatric establishments in which ECT is used are provided with the necessary staff, equipment and facilities so that this treatment can be administered in its modified form (i.e. with both anaesthetic and muscle relaxants) and in an effective manner (preferably with the aid of an electroencephalogram).

Further, with a view to ensuring that ECT is only used for the proper indications and is carried out in an appropriate manner, the CPT recommends that a clear written policy on recourse to ECT be elaborated and distributed to each establishment where this treatment is used and that ECT be administered only by staff who have been specifically trained to provide it. As with other psychiatric treatment, recourse to ECT should be part of a written individualised treatment plan, included in the patient’s medical record.

68.       In the light of the other facts found during the visit, the CPT also recommends that:

-           the practical arrangements made for the use of ECT ensure not only that it is administered out of the sight of other patients but also that  patients waiting to be given ECT do not have sight of patients who have just received the treatment;

-           the indications for using ECT, the conditions under which it is administered and the outcome of each treatment session be set out in detail in a special register;

-           the written informed consent of the patient (or of the guardian, if the person concerned is declared incompetent by a court) to the use of ECT, based on full and comprehensible information, be sought and kept in the patient’s file and that, save for exceptional circumstances clearly and strictly defined by law, the treatment not be administered until such time as written consent has been obtained.

C.        ECT and other psychiatry-related issues

 

 

            Preliminary remarks

 

 

            recommendations

 

-           the clear message to be delivered to all categories of staff at Bakırköy Mental and Psychological Health Hospital that any form of ill-treatment of patients is unacceptable and will be the subject of severe sanctions (paragraph 59).

 

 

Electroconvulsive therapy

 

 

            recommendations

 

-           the Turkish authorities to accord a high priority to ensuring that all psychiatric establishments in which electroconvulsive therapy (ECT) is used are provided with the necessary staff, equipment and facilities so that this treatment can be administered in its modified form (i.e. with both anaesthetic and muscle relaxants) and in an effective manner (preferably with the aid of an electroencephalogram) (paragraph 67);

 

-           a clear written policy on recourse to ECT to be elaborated and distributed to each establishment where this treatment is used and ECT to be administered only by staff who have been specifically trained to provide it. As with other psychiatric treatment, recourse to ECT should be part of a written individualised treatment plan, included in the patient’s medical record (paragraph 67);

 

-           the practical arrangements made for the use of ECT to ensure not only that it is administered out of the sight of other patients but also that  patients waiting to be given ECT do not have sight of patients who have just received the treatment (paragraph 68);

 

-           the indications for using ECT, the conditions under which it is administered and the outcome of each treatment session to be set out in detail in a special register (paragraph 68);

 

-           the written informed consent of the patient (or of the guardian, if the person concerned is declared incompetent by a court) to the use of ECT, based on full and comprehensible information, to be sought and kept in the patient’s file and that, save for exceptional circumstances clearly and strictly defined by law, the treatment not to be administered until such time as written consent has been obtained (paragraph 68).

 

 

            requests for information

 

-           full information concerning two new ECT units to be set up at the Bakırköy Hospital (in particular, a detailed description of their equipment and staff resources) and the planned date of their entry into service (paragraph 67).

Council of Europe Anti-Torture Committee publishes report on Turkey

The Council of Europe’s Committee for the prevention of torture and inhuman or degrading treatment or punishment (CPT) has published today the report on its most recent visit to Turkey, in December 2005, together with the response of the Turkish Government. These documents have been made public at the request of the Turkish authorities.

During the December 2005 ad hoc visit, the CPT’s delegation reviewed the situation in practice as regards the treatment of persons held by the law enforcement agencies (police and gendarmerie) and assessed the day-to-day operation of the legal safeguards against ill-treatment currently in force. Attention was also given to developments in F-type (high-security) Prisons, in particular as regards communal activities for inmates and the regime applied to prisoners serving a sentence of aggravated life imprisonment. A third objective of the visit was to examine procedures for the administration of electroconvulsive therapy (ECT) in psychiatric establishments.

Rapor için:

http://www.cpt.coe.int/documents/tur/2006-30-inf-eng.htm

Türkiye’nin cevabı:

http://www.cpt.coe.int/documents/tur/2006-31-inf-eng.htm

Daha fazla bilgi için:

http://www.cpt.coe.int

Forced shock in China over spiritual beliefs

Chris Bond
Yorkshire Post Today
August 24, 2006

Grandmother tortured by Chinese – all for her beliefs

Falun Gong is a spiritual movement that once had nearly 100 million followers in China. But since it was banned by the government, thousands of practitioners have been tortured and even killed.

ZHEN is perched on the edge of the sofa. If she sits back you fear her tiny frame may be swallowed up completely.

Listening to the softly-spoken grandmother it is difficult to comprehend how anyone could bring themselves to harm her – but they have.

The 66-year-old claims she’s been beaten, force fed and suffered electro-shock therapy at the hands of the Chinese police – all because of her beliefs.

Zhen is one of the lucky ones, though, she’s alive.

According to the Falun Dafa (Falun Gong) Information Centre, more than 2,300 followers of the meditation practice have been beaten and tortured to death while in detention in China, although Amnesty International believes the numbers imprisoned could run into tens of thousands.

The Chinese authorities have repeatedly denied allegations of brutality and murder and rejected recent, disturbing, reports of “organ harvesting”, but just what is Falun Gong?
The meditation practice, similar to Tai Chi, is based on the principles of truthfulness, compassion and tolerance and involves a series of controlled exercises. It was introduced in China in 1992 and within seven years had as many as 100 million followers.

Among them was Zhen. Before a friend introduced her to it she claims she suffered various health problems, including anaemia, dermatitis and hepatitis which forced her to retire early. Within a few months of taking up Falun Gong, though, she says her ailments disappeared.

“After six months I became a new person,” she says.

Zhen was not alone in finding Falun Gong a life-changing experience and encouraged other family members to take it up.

But as its popularity soared, the Chinese authorities became increasingly nervous by what they perceived to be a growing cult and in July 1999 Falun Gong was banned from public life.

Since then the communist government has set about systematically eradicating the movement and has reportedly detained thousands of practitioners in “reform” centres where detainees are “rehabilitated”.

Many people, like Zhen, continued to practise Falun Gong and, despite the risks, joined fellow practitioners in Beijing to appeal against the ban only to be arrested.

“They used a lot of methods of torturing us, they beat us up and used electric shock treatment and I was locked up for 22 days,” she says. “They arrested so many there wasn’t enough space so eventually they let go the people who were over 60 and I was allowed out.”

A few days later she was informed she had been secretly sentenced and told the police were coming to arrest her.

“I left my home two hours before the police arrived,” she says. “They left the message that I must come home and be ‘transformed’ (give up Falun Gong], or they would arrest me.”

Along with her husband, she hid with relatives staying for no more than a couple of months in one place until a friend told her about a disused flat where they could stay.
“I learned ways of keeping safe, I dug a hole in the wall behind a shoe rack in the living room and we lived inside the next room.

“This way, if someone came into the flat they would see a layer of dust everywhere and wouldn’t think people were living there,” she says, speaking via an interpreter.
For the next two years they lived in a single room.

“I had to sleep on newspapers on the floor under a quilt, because there was a window and this way if somebody looked in they would just see the empty bed.

“Because the situation was very dangerous I had to gather water drop by drop so this way it would make no noise. Also I could only flush the toilet once a day when other people were asleep.

“We had to keep the windows closed all the time even in the summer when the weather was so hot. In the winter there was no heating and outside the weather was minus 20 degrees.”

Because their pension had been stopped they were forced to survive on what little savings they had.

“We didn’t have any vegetables during this time and because we had so little money we often went hungry. It felt like we had been given a life sentence.”

With the help of friends and relatives, though, the couple were able to buy two passports for £5,000, money raised by selling the family’s flat.

Last October, they escaped to the UK, where their two sons now live, and were granted asylum in May.

But although Zhen, she has changed her name to protect her family, is grateful to have escaped her own nightmare she still has relatives back in China, including one of her two grandchildren.

“I am one of the lucky ones,” she says. “Most of my fellow practitioners who used to practise with me were beaten or killed and some of them disappeared and we don’t know what happened to them.”

It is why she, and a group of fellow practitioners, are travelling throughout the country to raise awareness over the persecution of Falun Gong followers in her homeland.
This persecution has led to claims that Falun Gong practitioners have been used for organ harvesting.

Horrific photographs, reportedly smuggled out of China, show the bruised and battered bodies of alleged victims minus their eyes, with crude stitch marks showing where the organs have been removed.

Last month, Canada’s former Secretary of State David Kilgour and international human rights lawyer, David Matas, published a report into these allegations concluding that they believed large-scale organ removals was still happening.

This has been denied by the Chinese. A spokesman for the Chinese Embassy said there was no persecution of Falun Gong and that stories of organ harvesting were simply propaganda spread by practitioners.

“This is a big lie made by Falun Gong,” he said. “Falun Gong is banned in China and to survive outside China they need to make big lies from time to time.”

Edward McMillan-Scott is vice president of the European Parliament and one of six Euro MPs serving Yorkshire and Humber and has spoken to former Falun Gong prisoners.
He described the treatment of its followers in China as “one of the cruellest religious repressions in human history”.

The Tory MEP also believes there must now be an international inquiry into the allegations of brutality and organ harvesting.

Until this happens human rights campaigners fear that Falun Gong practitioners will continue to be persecuted.

It might be an emerging super power, but in the People’s Republic of China it seems not even grandmothers are safe.

Shock treatment statistic ‘barbaric’ – New Zealand

19 August 2006
By GEOFF TAYLOR
stuff.co.nz

An opponent wants to stop shock treatment for the mentally ill, but medical experts believe it has positive results. Geoff Taylor reports.

More than one in four people at Waikato Hospital who get electric shock treatment do not consent.

One opponent calls the statistic barbaric, but medical staff say her views are based on out-dated ideas of the treatment.

They say electro-convulsive therapy (ECT) is performed under general anaesthetic and allows many mentally ill people to live normal lives.

Hamilton patients rights advocate Anna de Jonge wants all ECT stopped.

Health Ministry statistics show that in the 2004-05 year 93 non-consented treatments were given to patients at Waikato Hospital. This amounted to 30 per cent of all treatments.

Nationally, 23 per cent of the 307 patients who received ECT did not give their consent.

Waikato Hospital staff said that in the year to March 2006, 23 patients received treatment, six of whom did not give consent.

Anna de Jonge called it barbaric slaughterhouse treatment.

“Treatment without consent is assault,” she said.

“You can’t just grab somebody and shock them. Because it’s done in secret behind closed doors that doesn’t make it okay.”

Waikato Hospital consultant psychiatrist John Strachan said the treatment was used for depression when anti-depressants failed or for people who were psychotic or suicidal.

Patients were deemed not competent to give consent if they lacked the ability to understand information, process it rationally and communicate a choice. At this point, a second opinion was needed from another psychiatrist before treatment could start.

No one was ever forcibly held down and given the treatment. Unlike in the 1950s, patients were fully anaesthetised and had muscle relaxants.

Waikato Hospital general manger mental health Chris Harris said Ms de Jonge’s views were based on perceptions of what occurred about 50 years ago. He said it would be wrong to remove ECT as an option. For a number of people it had been a positive, life-changing experience.

Hamilton woman Margaret Parry, who received treatments in the 1950s, disputed that the treatment was better now.

“I think it’s the worst thing you can do to another human being.”

ECT works in the same way as anti-depressants, affecting the messages sent by neurotransmitters in the brain.

Dr. Bonnie Burstow: shock is a form of violence against women

Dr. Bonnie Burstow explores electroshock as a form of violence against women. She is a feminist therapist, an anti-psychiatry and anti-fascist activist. She is also the former co-chiar of the Ontario Coalition Against Electroshock and is the author of Radical Feminist Therapy: Working in the Context of Violence.

Two versions:
An edited version runs just under 30 minutes and the full speech runs just over 60 minutes.

Listen to an edited version (30 min) or full speech (60 min)

130 no-consent shocks given in last two years – New Zealand

Shocks given without consent
15 August 2006
By KIM RUSCOE
Stuff.co.nz

About 130 people have been given shock treatment without their consent in the past two years, a Health Ministry report shows.

Mental Health deputy director Jeremy Skipworth said that, of the 612 severely depressed patients who received electroconvulsive therapy between mid-2003 and mid-2005, only 80 per cent consented.

Two-thirds of those treated were women, most aged over 40.

“Sometimes people are so unwell they are not actually able to give consent,” Dr Skipworth said.

“It’s not appropriate for them to be deprived of the ability to be treated just because they’re so sick they can’t agree to it.”

Those people were committed under the Mental Health Act and given shock treatment after a second opinion had been given from a qualified psychiatrist, Dr Skipworth said.

Family members were also consulted.

Green Party health spokeswoman Sue Kedgley said the controversial treatment was being given without consent more often in some districts than others. The highest rates of unconsented-to treatments last year were given by Tairawhiti, Capital and Coast and Auckland health boards.

Dr Skipworth said no one in New Zealand was given ECT against their wishes if they were competent to make decisions about their treatment.

ECT was proven internationally to be an effective treatment for severe depression, with eight out of 10 patients responding well to it.

It was used when anti-depressant medication, psychotherapy or both had been ineffective, or when medication was too slow or caused severe side effects.

It was also the safest form of treatment when patients were also suffering a physical illness or were pregnant.

Side effects included short-term memory loss, headaches, muscle soreness and nausea.

Methods of administering ECT had improved greatly since its “misuse” in the 1960s and 1970s, when large numbers of people suffering a variety of mental illnesses were given it without anaesthetic or muscle relaxant.

A new treatment for severe depression being tried in the United States had produced promising results, he said. But the trial group was small and it was yet to be seen if the results could be replicated in a larger group.

The US study found a single intravenous infusion of a general anaesthetic agent, Ketamine, could relieve symptoms of severe depression within two hours and remain effective for up to one week. Most medications available at present did not start to relieve the symptoms of depression for several weeks.

Robert Pirsig: Still Zen after all these years

Robert Pirsig: Still Zen after all these years
Author’s 500-page novel Lila about to be reissued
He defined an era with Motorcycle memoir in 1974
Aug. 12, 2006

Toronto Star

Robert Pirsig has a bone to pick with philosophers. As his era-defining memoir Zen and the Art of Motorcycle Maintenance levitated up the bestseller lists in 1974, all he heard from them was grumbling.

This story of a father-son motorcycle trip across America was just a skeleton of a philosophy, they said. What exactly was this “metaphysics of quality” he kept talking about? And who was he to tell them about it?

Seventeen years later Pirsig gave his answer and it came in the form of a 500-page novel, Lila: An Inquiry into Morals. Now, at last, the thinkers of the world had something to tinker with. Their response? “Silence. They have just given me zero support and great hostility,” Pirsig says on the eve of the novel’s reissue in Britain.

“It’s just they don’t say anything.” Now, Pirsig believes that he has one last shot at explaining his philosophy to the public, and if it means coming out of seclusion, so be it.

Sitting in a hotel suite overlooking the Charles River in Boston, a meditation mat at his feet, his wife Wendy at his side, New England’s second-most reclusive novelist does not appear to have sweated much over his celebrity.

At the age of 77, Pirsig is a white-haired, bandy-legged old coot. Years at sea and on the road have given his face a sun-blasted quality. His voice is strong and clear, but when he takes out a pen and paper to demonstrate a concept, his hands shake.

“As I see these two books,” Pirsig says, drawing an oval on a notepad, “there is a Zen circle. You start here with Zen,” he says, marking an X, “and then you go here to enlightenment, that’s what’s called 180 Zen.

“Then you go back to where you started from — that’s 360 Zen — and the world is exactly as it was when you left it.” Pirsig sits back and lets that sink in, then adds: “Well, I felt that Zen and the Art of Motorcycle Maintenance was the journey out, and Lila was this trip back.”

This might explain why Lila was not as universally adored as its predecessor. Zen was a serious feelgood book, a modern day “Thoreau,” written by a man who had been through the wringer, but emerged having identified a better way to live.

It was also as picturesque a tour of western America as one could find between two covers. Lila is an almost noir-like novel about a writer who falls in love with a former prostitute. As they float down a brooding river toward New York City, the writer — whose name is Phaedrus, the name Pirsig gave his insane alter ego in Zen — muses on her nature and on the metaphysics of quality (MOQ).

The novel is structured like a river with many locks — each stage a new level of Pirsig’s philosophy. The mental work it takes to measure these ideas explains why Lila has sold 600,000 copies, hardly a failure, but nowhere near the 4 to 6 million of Zen.

There are two types of Quality, as Pirsig sees it, Dynamic and Static.

“Without dynamic quality an organism cannot grow,” he explained in an essay. “But without static quality an organism cannot last.”

While it became a cultural cliché to say that we have moved beyond good and evil, Pirsig believes just the opposite — and he believes that the MOQ can be a useful tool in bringing order to a chaotic world.

“You know the structure of the MOQ,” he says, bringing out the pad again. “Static quality can be divided into intellectual, social, biological and inorganic realms. Any attempt by a lower order to overcome a higher order represents evil. So those forces which prohibit intellectual freedom are evil according to the MOQ.”

Pirsig’s insistence on the existence of evil has a painful personal note. In November 1979, his son Chris was stabbed to death in a robbery outside the San Francisco Zen Center. He was two weeks shy of his 23rd birthday. Pirsig was living on a houseboat in England at the time. He came home for the funeral, and wrote a moving epilogue about his son — the child at the heart of Zen — and it has been printed in every edition since.

This loss can be felt in Lila and might explain why it took Pirsig almost two decades to write it. “One reviewer said that the shadow of Pirsig’s son’s death seems to hang over this entire book,” Pirsig says, looking bewildered. “I had no idea that was true at the time, but now I see in retrospect. I was very gloomy.”

Born in 1928 in Minneapolis, Minn., Pirsig was a gifted child, whose IQ was measured at 170 when he was 9.

His father was a law professor who studied in England, so Pirsig learned to read and write in England. He returned to Minnesota and entered grade school so young that he was picked on. He entered university at the age of 15, flunked out, then served in the Korean War, coming home with an interest in philosophy. He eventually finished his degree and went on to get a graduate degree in oriental philosophy from Benares Hindu University in India. And here’s where the drifting begins. Pirsig returned to the U.S. in the 1950s and began to study journalism.

To make a living he began technical writing and doing some editing at a university newspaper where he met his first wife. For 20 years they would move around, Pirsig doing odd jobs, raising their two kids.

Without knowing it, he had begun a kind of internal philosophical quest, but the heat of his intellectual searching pushed him over the edge.

In 1960, he began the first of a series of hospital treatments for mental illness. Pirsig’s father obtained a court order to commit him to a hospital where he received electro-convulsive shock therapy. It seemed to work, but Pirsig maintains that he was not insane. “I never thought I was crazy.”

Pirsig took to writing as a life raft. In 1965 he bought a motorcycle, and in 1967 began what he thought would just be a few essays on motorcycle maintenance but the book grew into a fully fledged project.

In 1968 he wrote to 122 publishers offering sample chapters. Only one wrote back. This was enough encouragement for him. He rented a room at a flophouse and would go there from midnight until 6 a.m. to write, then he would go to work.

“When I talk about compulsion in that book,” Pirsig says, “that’s what I mean. I was compelled to write that book.”

Pirsig admits that this regimen had as much to do with his ambitions as with “problems at home,” as he calls them. When the book finally became a bestseller, Pirsig felt he needed to get away. He and his wife bought a yacht and planned to travel the world. Instead they divorced.

Pirsig’s response was to keep moving, and it was in this fashion that he met his second wife, Wendy Kimball, and they started a life of travel together.

That same year Pirsig’s son was murdered. He has moved forward. He and Wendy had a daughter, Nell, in 1980.

The success of Zen has afforded Pirsig and his wife “a very nice life,” he admits, and he doesn’t want to appear ungrateful for this gift. But he says that it is not for his sake that he wants Lila to be read. “I think this philosophy could address a lot of the problems we have in the world today,” he says, leaning forward. “Just so long as people know about it.”

ECT certified order in Minnesota

NoForce Activists –  The following is a scanned copy of a ECT certified
court order that was filed in Hennepin County District Court on Sept. 16,
2002.  I pass this along for informational purposes with permission from the
Respondent who requested that her name and month/day of her birth remain
annonymous.  The Respondent’s desire is to let all concerned about forced
psychiatric treatment see for yourselves what is happening in Minnesota.

At this moment I am not aware that this file has been sealed.  When I called
Hennepin County Mental Health Court at 2:14 PM (CDT) to inquire about the
status of a “Motion To Stay Entry of Judgment and Ammended Findings Of Fact”
that the Respondent’s attorney told me she on September 17, 2002, the clerk
told me that I would have to speak with the Supervisor of the Mental Health
Court about this motion.  I left a voice mail message for the Superviisor to
call me.

When I called back to speak with the clerk again and ask whether the file had
been sealed at 2:45 PM, the clerk was gone and my question could not be
answered by the person who answered the phone.  The Supervisor was in a
closed door meeting,  so I left another message with the receptionist, and I
ensured my messages were recieved by the Supervisor again at 4:17PM.  At the
time this email is being sent I have not heard back from the Court about the
status of the motion or the file, and the Hennipin County Mental Health Court
closes at 4:30 PM (CDT).

I was cut off from seeing the Respondent by the Conservator on Tuesday, the
day before the first scheduled ECT treatment.  The Conservator, who also
prohibited Louise Boute of WellMind-MN from seing the Respondent when she was
warehoused at a Minneapolis nursing home, is not happy with me trying to help
the Respondent to exercise her annual right to petition the court for the
Conservator to be replaced and that she be allowed to go live with her
mother:  The Respondent put her request into writing on July 25, 2002 and it
was given to the staff of the nursing home several days later:  On August 7th
the Respondent was hospitalized and on August 20th the petitions for
commitment and forcedf ECT/Neuroleptics were filed by the hospital.

Given that (1) I purchased the certified copies of this ECT and the
commitment and Neuroleptic orders as it was open to the public, (2) that the
Court is aware that I purchased these copies; (3) that I have recieved
verifiable verbal permission by the Respondent to share this information with
mental health activists/advocates/  professionals/consultants and those
interessted in forced treatment; and (4) that I have not been notified by the
Court that the file has been sealed, I am passing this information on.

PLEASE READ THIS ORDER VERY CAREFULLY.  PLEASE NOTE THAT IT CONTAINS MANY
ERRORS INCLUDING THAT THE RESPONDENT HAS BEEN ORDERED TO RECIEVE UP TO 15 ECT
TREATMENTS FOR FIVE WEEKS WHIICH IS NOT WHAT WAS STATED IN COURT.  LET’S HOPE
THE RESPONDENT’S MOTION TO STAY JUDGMENT IS GRANTED SOON!

Jerri Lynn,
Social Justice Activist/Advocate

Although I intend that the electronic copy of the ECT court order printed
below be accurate and that I have editied out specific personal information
per the Respopndent’s request, I cannot take personal responsibiliy for any
errors that may occur in the electronic scanning and transference of this
court order. The purpose of this distribution of this document is for
educational purposes only.

——————————————————————————

——————————————–
02 SEP 16   AM 10:30

STATE OF MINNESOTA.
FOURTH JUDICIAL DISTRICT
DISTRICT COURT
COUNTY OF HENNEPIN
PROBATE/MENTAL HEALTH DIVISION

In the Matter of the Civil Commitment of: File No: P8-02-60415

FINDINGS OF FACT, CONCLUSIONS
OF LAW AND ORDER AUTHORIZING ELECTROCONVULSIVE THERAPY

Respondent DOB: XX-XX-54

This matter was heard by Patricia L. Belois, one of the Judges of this Court,
on September 12, 2002, pursuant to a Petition for Authorization to impose
Treatment Electroconvulsive Therapy, filed herein on August 20, 2002.

Petitioner, Michael Popkin, M.D., was represented by Elizabeth Cutter,
Assistant Hennepin County Attorney, A-2000, Hennepin County Government
Center, Minneapolis, MN 55487, (612) 348-6740.

Ruth Y. Ostrom, Attorney at Law, 301 Fourth Avenue South, Suite 270,
Minneapolis, MN 55415, 612-339-1453, was present on behalf of Respondent, who
was present in court.

Barabara Jackson, M.D., the Court-appointed examiner, and Derrinda Mitchell,
Respondent’s Court appointed Conservator of Person and Estate were present.
No guardian ad litem was appointed for Respondent because her Conservator
provides that function pursuant to an existing Court order from another
jurisdiction.

Based upon the file and record in this matter, the evidence received,
including testimony from Charles Pearson, M.D., Derrinda Mitchell, and
Barbara Jackson, M.D. and one exhibit, the court makes the makes the
following:

FINDINGS OF FACT
1. Respondent is 48 years old. She was committed dually to the Heads of the
Hennepin County Medical Center and the Anoka Metro Regional Treatment Center
as a person who is mentally ill by Order of this Court filed September 6,
2002. In that Order, the Court found that Respondent was mentally ill with
Paranoid Schizophrenia. Respondent’s present diagnosis is Paranoid
Schizophrenia and Depression, NOS. Her treating physician has also diagnosed
Respondent with Anxiety Disorder, NOS. Respondent is currently hospitalized
at the Hennepin County Medical Center.

2. The Medical Director of Inpatient Psychiatry/Chief of Psychiatry for the
Hennepin County Medical Center, Michael Popkin, M.D. (hereinafter Popkin) has
petitioned the Court for authority to administer up to 15 treatments of
electroconvulsive therapy (ECT) per week for a period of up to five weeks to
Respondent, followed by maintenance treatments at an unspecified frequency
for the duration of the current commitment. Testimony in support of this
Petitioner’s Petition was given by Respondent’s treating physician, Charles
Pearson, M.D.  Petitioner believes that ECT will relieve the symptoms of
Respondent’s mental illness and provide other benefit to her, in particular,
ECT is expected to: resolve Respondent’s psychosis which is refractory to
treatment with neuroleptic medication; improve Respondent’s social
withdrawal; and lead to simplification of her medication regime by reducing
the number of neuroleptic medications she will need to take to control her
symptoms.

3. Krishna Mylavarapu, M.D.,(herein after Mylavarapu), is the staff
psychiatrist at the Hennepin County Medical Center who will administer the
ECT to Respondent. Respondent will be anesthetized prior to the
administration of the ECT. The only pain Respondent should experience from
the ECT would be the minimal pain from the injection of the anesthetic and
perhaps a transitory headache. There is a very remote risk of an adverse
reaction to the anesthetic in the range of 1:20.000-50,000. Respondent may
experience a short-tern memory loss as a consequence of the proposed
treatment This memory loss may be permanent, but the effects of it can be
fully mitigated by relearning the lost information, such as what she had to
eat during the meal before the procedure. ECT does not involve surgical
intrusion. The intrusion comes from electrical impulse directed into
Respondent. s brain to induce a specific type of seizure activity.

4. The use of ECT during inpatient hospitalization is the best treatment,
according to contemporary professional standards, that could render further
custody, institutionalization or other services to the Respondent
unnecessary.  ECT is not an experimental treatment.  It has not been
prescribed for Respondent as part of any research project. Its use is widely
accepted by the medical community of this state.

5. The Court’s examiner, Barbara Jackson, M.D. (hereinafter Jackson),
believes that the use of ECT to treat Respondent’s mental illness is both
necessary and reasonable. She testified that the benefits Respondent is
likely to experience from ECT outweigh its risks to her. Jackson also
testified that Respondent is not competent to weigh the benefits and risks
associated with ECT treatment for herself.

5. Respondent’s Conservator, Derrinda Mitchell, testified that she believes
that the benefits of the proposed treatment, most particularly the
possibility that Respondent’s medication regime could be simplified and the
exposure to medication side effects better controlled that way, outweigh the
risks involved and that the use of ECT to treat Respondent’s mental illness
and that the use of ECT could be in Respondent’s best interests.

6. The Court has considered less intrusive methods of treatment for
Respondent’s illness including the use of various psychotropic medications
both alone and as part of augmented pharmacological regimen. This was
rejected because the use of psychotropic medications to treat Respondent to
date has not sufficiently relieved the symptoms of Respondent’s mental
illness so that she can be released from the acute care facility safely to
which she is now committed.

7. Respondent cannot rationally weigh the risks and benefits involved in the
use of ECT to treat her mental illness because she does not believe that she
is mentally ill and she has an irrational fear of ECT fueled by information
that her mother provides to her about what the mother believes is the lethal
nature of ECT.

CONCLUSIONS OF LAW
1. The evidence is clear and convinces the Court that treatment of the
Respondent’s mental illness using electroconvulsive therapy is necessary and
reasonable.
2. Respondent does not have the capacity to give or withhold consent to the
use of electroconvulsive therapy to treat her mental illness.
3. The benefits to Respondent from the administration of electroconvulsive
therapy to treat her mental illness outweigh the risks associated with the
treatment and justify the intrusion into her privacy as needed to conduct the
electroconvulsive therapy without Respondent’s informed consent.

ORDER
The Heads of the Hennepin County Medical Center and the Anoka Metro Regional
Treatment Center are authorized to administer to Respondent up to 15
treatments of electroconvulsive therapy per week for up to five weeks,
foIIowed by maintenance treatments as often as once per week for the duration
of the commitment ordered September 6, 2002, pursuant to Price v. Sheppard.
239 NW2d 905 (Minn, 1976) and Minn. Stat §253B,03, Subd. 6b.

BY THE COURT:
Patricia L. Belois Date Judge of District Court
Probate/lMental Health Division
9/16/02

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