Rule #3: If you disagree with what your doctors say about treatment in general or your treatment in particular, you're incompetent.

When asked: What constitutes capacity? Azemar replied as follows:

---Capacity depends on the person understanding what the treatment is about.

---Capacity means he understands the consequences of the treatment, and has the ability to assess benefits and risks.

Paul has had over 60 ECTs, but no one thinks this makes him qualified to understand what the treatment is about, or to understand its consequences. Only a psychiatrist can know these things.

Both doctors said Paul was incompetent because he refused to acknowledge that previous ECT had been beneficial for him. Azemar said, "Even when we tell him he is improved, he never accepted the fact that he had any benefit from it."

Both doctors said that Paul was incompetent because he "is unable to assess the risks and benefits of ECT."

Further questioning from Darrow clarified the situation. Did Paul have the mental capacity to understand that his doctors thought he had improved with ECT? Yes. He understood this. "Did he understand what you thought were the benefits and risks?" Yes, the doctors said. Paul was perfectly capable of hearing and understanding what his doctors were telling him.

He just didn't agree with them.

As long as patients and doctors disagree about the nature, risks and benefits of ECT, and as long as doctors get to define the "right" answers to these questions, everyone is at risk of forced ECT. Persons who have previously had ECT, know about it from personal experience, and will not deny what they know to be true, are most at risk.

Dr. Kalani testified that he "knew" about ECT from reading a book. All books about ECT for professionals are written by financially compromised ECT proponents like Richard Abrams, shock machine company owner. Kalani couldn't remember which book he had read...Fink's, Kellner's, Coffey's? He went on to make further blatantly false statements about what he "knew". He knew the FDA had approved shock machines. (Never happened.) He knew the FDA had conducted animal trials of shock. (Not only has it never conducted animal trials, neither the FDA nor anyone else has ever conducted human trials.) Kalani's source was revealed when he claimed that the FDA had studied baboons. The baboon line comes-from Harold-Sackeim, prolific ECT advocate and shock machine company consultant. Even Sackeim, famous for his lies, did not say that FDA studied baboons; his claim was that epilepsy researchers had studied baboons and concluded that seizures didn't damage their brains. Kalani got his misinformation garbled. The Pilgrim shock doctor went on to testify that there have been "lots of" before-and-after MRI studies showing that ECT doesn't cause brain damage. Wrong again. There have been less than a handful, and they don't show that.

Dr. Azemar wasn't any more knowledgeable. He claimed that his own facility did not do "bipolar" ECT (the correct term is bilateral), that this was the "old fashioned way" of doing ECT that's still done in Haiti but not here. In fact, Paul has been getting bilateral ECT at Pilgrim.

If capacity is determined by what you know about ECT's risks and benefits, then both Kalani and Azemar flunked the test, and can now be legally forcibly shocked.

Unfortunately Darrow did not challenge Dr. Kalani's false statements. The judge was left with the impression that ECT has been proven safe because no one contradicted it.

If Darrow had been able to raise doubt about ECT's efficacy and safety---by invoking the FDA classification of ECT devices, for instance---a logical further question would have been: "If it were true that Paul did not benefit from ECT, would he be incompetent? What if Paul is right that the risks of ECT outweigh its benefits? Is he still incompetent?"

The judge got very upset once Darrow made the point that Paul understood but did not agree with his doctors, yelling at him to move on. This was one of three outbursts on the part of the judge that day, each one louder than the last. The judge was very, very loud.

Forced treatment and biological psychiatry go hand in glove.

If biological psychiatry is a kind of law---if we as a society have decided it is the only acceptable or permissible way to think about and treat problems---then it must have its police force for those who don't find it helpful or agree to abide by it. It must have the doctors and judges who force treatment on these people.

Both shrinks testified that drugs and ECT were the only treatments available for Paul. When challenged, however, they claimed to be doing psychotherapy. They were questioned further about what that meant. It turns out that psychotherapy doesn't mean what it used to mean.

"Psychotherapy consists of making him understand his mental illness and accept therapy and understand the impact of medication and ECT. Noncompliance is the issue," said Bob Kalani. He also explained that there had been family psychotherapy, consisting of trying to talk Paul into consenting to ECT.

Dr. Azemar called his brand of psychotherapy "insight psychotherapy". "Insight psychotherapy" consisted of trying to get Paul to accept that "It's all chemicals. There are all these chemicals in the brain---for anxiety, for appetite, for sleep. It's getting him to understand what these chemicals do and what drugs he needs to take."

The drugs he has been taking have caused liver damage and tardive dyskinesia. Dr. Azemar testified that Paul wanted to take a computer class, but his hands now shake so badly that he is unable to type. He characterized TD as a "disorder of the fingers"---it's actually permanent brain damage.

It was nearing the end of the last day of the trial when the topic of drug-induced brain damage came up. Darrow began a dramatic summing-up type question. "They've damaged his liver, they've damaged---" he might have been beginning to say "His brain".