The Grassroots Campaign To Save a Man From Court-Ordered Shock Therapy
Despite severe risks and without a crime committed, a Minnesota judge authorized doctors to forcibly administer electroconvulsive therapy—while barring key witnesses from the hearing.
Last May, at the start of a court hearing conducted over Zoom, David Russell brought what he felt was a pressing matter to the judge's attention. "I had two friends that were going to testify on my behalf, Vassil Vutov and John Mayo, and I don't see them," the 44-year-old computer programmer pointed out. "In addition, I was aware that a bunch of other people planned to show their support, joining this hearing as observers."
Russell wasn't in court because of a crime he had committed; he was there to defend his right to refuse an invasive medical treatment. Due to his alleged "medication non-compliance and psychosis," clinicians from Rochester, Minnesota's renowned Mayo Clinic were seeking a court order to administer electroconvulsive therapy (ECT) over Russell's objection.
If Russell lost in court, the clinicians would be granted permission to administer up to 30 rounds of ECT over a six-month span. Assuming they followed standard protocol, a team of hospital staffers would start each session by sedating Russell with an anesthetic, attaching electrodes to his head, and applying approximately 120 volts of electricity for between one to six seconds, long enough to produce a brain seizure lasting around one minute.
Serious Risks, Few Precautions
ECT is often given to consenting adults battling severe depression who have exhausted more conventional treatments like antidepressant medication and talk therapy. Sometimes, though, doctors seek court orders to perform ECT on unwilling patients. In states like Minnesota, the procedure can be court-ordered even if patients don't pose a danger to themselves or others. Instead, after weighing "the risks of adverse side effects compared with potential benefits to the patient," a doctor merely needs to convince a judge that "the treatment will produce the desired effects."
Those "adverse side effects" doctors must weigh aren't minor and most notably include severe memory loss, a fact the Mayo Clinic acknowledges on its website. Somatics, one of the two ECT device makers in the U.S., likewise discloses in its user manual that the procedure has been linked to a long list of "serious adverse events," including but not limited to "cognition and memory impairment," "brain injury," and a litany of cardiac complications. "The long-term safety and effectiveness of ECT treatment," the device maker warns, "has not been demonstrated." (After Russell complained in court about the possibility of "cognitive impairment, permanent brain damage [and] memory loss," a Mayo Clinic doctor inauspiciously replied that "we would not be expecting there to be brain damage in a way that one would not remember past events.")
Later on during his ECT hearing, Russell reminded the Minnesota District Court judge that his witnesses were not on the Zoom call:
I have two friends that said they would attend…Vassil Vutov, who would testify I'm not a threat to myself or others, I get verbally upset and angry but never am I violent, and further, that he is adamantly against electroconvulsive therapy; as well as another friend, John Mayo, both of whom I've known for over 20 years [and] are vehemently opposed to forced electroconvulsive therapy. I don't know where they are. I could call one of them because I have their number. The other one would require a computer to get in touch with.
What Russell didn't know was that Mayo, whom I spoke to in November, had logged onto the Zoom call in order to testify, as had his other supporters who sought to observe the hearing. The judge simply refused to let them into the virtual courtroom, or to allow Russell to call Vutov—the witness who wasn't there—because, she said, Russell's court-appointed attorney never "made specific requests of [their] identities." (Ironically, had Russell been charged with a crime, the Sixth Amendment would have guaranteed him the right to call witnesses on his own and to invite supporters into the courtroom.)
About 90 minutes after the hearing began, the judge issued her ruling: The Mayo Clinic was permitted to shock Russell up to 30 times over the following 6 months. "A reasonable person would authorize the treatment," the judge proclaimed, adding that Russell "doesn't understand the risks, benefits, or alternatives."
Russell, who was ultimately forced to undergo 17 ECT sessions, subsequently developed three potentially fatal blood clots in his right arm, for which he is still undergoing treatment. He also told me that he continues to experience significant gaps in his memory.
The Legal 'Defense' That Failed Russell
Before being court-ordered to undergo ECT, Russell had reached out to MindFreedom International, an advocacy group whose mission is to protect the civil rights of psychiatric hospital patients. After examining the transcript from the May court hearing, MindFreedom Secretary/Treasurer Jim Gottstein, a Harvard-trained lawyer who has litigated numerous landmark Alaska Supreme Court cases, uncovered critical flaws with the defense strategy of Russell's court-appointed attorney. "In short," Gottstein noted in a letter to the judge, "[His attorney] submitted not a single piece of evidence, nor made a single argument against electroshock being administered to Mr. Russell against his will. He did not even ask for the petition to be denied. He only said that Mr. Russell opposed the petition." Gottstein concluded that the court-appointed attorney "abjectly failed to effectively represent" Russell and "actively acted against" his objectives, "violating his ethical obligations under the Minnesota Rules of Professional Conduct." (The judge, who falsely accused the MindFreedom supporters wanting to attend the hearing of "opposing all forms of mental health care," did not read Gottstein's letter, according to a court administrator).
This wasn't the first time MindFreedom had intervened on behalf of a Minnesotan objecting to shock therapy. Five years earlier, the organization advocated on behalf of 21-year-old Charles Helmer, who had undergone at least 20 rounds of involuntary ECT. Helmer's mother, according to MindFreedom's summary of the case, said her son appeared to be in a "vegetative state" after the shock treatments and accused doctors of locking her out of the decision to administer ECT, despite her status as Helmer's legal guardian.
In 2008, NBC News and Minnesota Public Radio covered MindFreedom's campaign for Ray Sandford, who was forcibly shocked for nearly a year after a doctor he had met "only briefly" testified in favor of the procedure in a courtroom located inside the basement of a hospital.
In 2020, I published a report for Reason about two Connecticut hospital patients court-ordered to undergo the medical procedure, including a woman who had allegedly been shocked approximately 500 times in a five-year span. The Connecticut hospitals "can constantly petition [for ECT] for years and years, and no one is going to tell you to stop," the patients' attorney, who said she regularly receives calls from individuals facing forced ECT, told me. "It's a flaw in the system that doesn't protect people."
Patients forced into ECT aren't the only victims of a flawed psychiatric hospital justice system. Last year, The New York Times published an exposé about a leading chain of psychiatric hospitals that illegally "traps" people in their facilities, in part by coaching employees to use buzzwords like "combative" in medical charts while avoiding terms like "calm" and "compliant." "Unless the patients or their families hire lawyers," the Times reported, "[the hospital] often holds them until their insurance runs out." Patients, hospital staffers, and government regulators have accused many other psychiatric hospitals of engaging in similarly nefarious schemes.
Another Hospital, Another Fight
In October, after undergoing the 17 court-ordered ECT treatments at the Mayo Clinic, Russell was discharged to a residential facility an hour's drive from Rochester. Within weeks of his release, though, he was recommitted to a locked psychiatric unit inside Regions Hospital in St. Paul, Minnesota. Almost as soon as he arrived, a Regions' doctor petitioned the same district court judge who presided over the earlier hearing for more ECT. Russell, the doctor wrote in her petition, needed more treatments because he was "not responding" to antipsychotic medication.
I had met Russell two months earlier after learning about his case from MindFreedom's Gottstein. Initially, I helped Russell write a short article about his Mayo Clinic ECT experience, which I then shared with editors at major newspapers and magazines around the country.
After Regions' doctors submitted their ECT petition, though, I began doing whatever I could to save Russell from getting shocked again. I found a clinical psychologist willing to examine Russell and potentially testify on his behalf in court, all at no cost (Infuriatingly, because Russell's court-appointed attorney refused to return our phone calls, there was no way to arrange the doctor's exam or testimony); I paid a protestor I found on Craigslist $250 to stand outside Regions Hospital for an afternoon with a sign that read, "Don't Shock David"; and I enlisted the Citizens Commission on Human Rights, the controversial antipsychiatry group founded by the Church of Scientology, to launch a letter-writing campaign pleading with Regions' administrators to stop the shock treatments.
Thankfully, less than a week before the new ECT hearing, my efforts seemed to pay off. One of the lawyers I cold-called to replace Russell's court-appointed attorney agreed to take the case for a relatively modest fee, which Gottstein generously covered. The new attorney promptly convinced the judge to delay the hearing one week in order to obtain Russell's medical records from the Mayo Clinic. Later that week, after I had emailed and called thousands of journalists from across the country, WCCO-TV, a CBS affiliate in Minneapolis, agreed to air a two-minute segment about the case they headlined, "Man undergoing electroshock treatment fights to end medical procedures."
Four days later, Regions withdrew its ECT petition. "It is of our current medical opinion that ECT is no longer indicated nor being recommended as part of the treatment plan for David Russell," one of the hospital's doctors wrote in a letter to the court. "He is responding to the current medication neuroleptic regimen."
The court hearing wasn't canceled, though, because the hospital hadn't dropped its petition to add another antipsychotic drug, Clozaril, to Russell's medication regimen; like ECT, Clozaril is linked to at least 10 severe health conditions, including seizures, myocarditis, and increased vulnerability to potentially fatal infections. This time, the judge allowed Russell's supporters, including myself, into the Zoom courtroom. At the start of the hearing, Russell's new attorney argued that, because of numerous flaws with the hospital's petition, "the court does not have any basis to proceed today." In response, the hospital's attorney confessed he wasn't aware he was due in court until just before the start of the hearing. "I don't have any real counterarguments," he added. The judge swiftly dismissed the medication petition and ended the hearing. The hospital approved Russell's discharge the next day and released him three days later.
I recently asked Russell—who's been hospitalized for mental health treatment numerous times in the past decade—if he was ever aware of the possibility that doctors could force him to undergo ECT. "No, not until they actually started the petition for it," he replied. "To be honest, I didn't think it was still done."
*CORRECTION: This post initially misidentified Gottstein's role at MindFreedom.
