As it turns out, we have an update to offer the readers on this interesting case. The patient was in fact rehospitalized at our hospital after this article was sent out, and this time a different psychiatrist was able to persuade the guardian, the patient’s brother, to go forward with ECT. The patient presented this time with frank catatonic stupor. He received a total of 24 bilateral ECT treatments at the rate of three per week. His response was dramatic, with marked resolution of stupor. Nonetheless, there remained significant residual symptoms (psychomotor slowing, poverty of speech and content, passive oppositionalism). We believe that he received sufficient ECT because he actually became mildly delirious toward the end of the series, suggesting the maximum tolerable amount of ECT had been delivered. The delirium passed in a matter of days, and the patient went back to the residual state described above. At no time did he ever show a glimpse of mania or catatonic excitement. As to the issue of guardianship, it was our experience that the guardian’s consenting was due to the unique interaction of the psychiatrist’s and guardian’s personalities, which were both very strong and shared several important cultural beliefs. It was fortunate that the brother encountered this particular psychiatrist, and it is unlikely that a different psychiatrist would have had the same success in persuading him—another reason for a more predictable judicial process.