Ruth is a junior doctor like any other, facing daily decisions of
life and death. More than a year ago, she became depressed and
suicidal, was put on medication and suspended from her job. What she
didn't tell her employers was that she had begun to hear voices. She
thought she was going mad.
Most mental health specialists would at that point have said Ruth
should be admitted to psychiatric hospital and treated with drugs,
forcibly if necessary. Hearing voices is regarded as a key delusion
that marks out the insane from the sane. But she feared that if that
happened she might never be allowed to practise medicine again.
Instead, she consulted Rufus May, a clinical psychologist with
the Bradford District Care Trust, who has become something of a
celebrity in the mental health world for his radical approach to
treatment. He agreed to treat her privately (waiving his fee)
because she was from outside the trust area. She stopped her
medication and together they began a six-month course of therapy,
which included a mock fight in the street, getting half drowned in a
stream, chatting in a tree and a visit to May's home.
Her therapy, and its conclusion, was minutely documented and has
been recreated for a Channel 4 film, The Doctor Who Hears Voices, to
be shown next week. An actress plays Ruth. The result is an
extraordinary drama-documentary with a powerful performance by Ruth
Wilson, known for her Bafta-nominated role in Jane Eyre.
The film challenges our notions of mental health and how to treat
it. May doesn't think Ruth is mentally ill and rejects the idea of
treating her with powerful antipsychotic drugs. Instead, he teaches
her to talk back to the voices in her head, with the aim of
identifying and getting a grip on them and ultimately coming to
control them. The voices are abusive or derogatory – "You are a
worthless piece of shit" gives a flavour. It's scary stuff; at one
point Ruth reveals that she is convinced that a fish tank on the
ward is controlling patients' heartbeats.
Would anyone be comfortable having a doctor who suffers such
delusions in charge of their care? Or their child's? Watching the
film, you have to wonder. Ruth has been diagnosed with bipolar
disorder and told she will be on drugs for the rest of her life –
but Rufus May is convinced that she will make a good and safe doctor
without them.
It is a high-risk strategy, which few psychiatrists would be
comfortable pursuing. May has his doubts when Ruth goes missing for
several days and he wonders if she's committed suicide. About 1,200
people with mental problems take their own lives each year, and
another 50 kill someone else, many of them while not taking their
medication.
May is no stranger to the risks. For a decade, he has run
self-help groups for voice-hearers, where he supports a drug-free
approach to treatment. He's softly spoken, thoughtful, yet he has a
cheerfulness that disarms patients and professionals alike. (His
trust has asked him to contribute a blog to its website, recognising
his popularity with mental patients.)
He is himself a "recovered schizophrenic", diagnosed at 18,
treated with drugs and told his problems would be lifelong. Having
found a way back to health, he is committed to guiding others on the
same journey and has become a leading advocate of drug-free
psychiatry. At one point in the film he urges Ruth: "You can
recover. Too many people have been lost. We don't want to lose you."
His nemesis in the film is orthodox psychiatry, represented by
Trevor Turner, a consultant at Homerton hospital in east London. He
is one of few conventional psychiatrists prepared to engage in this
debate. Turner agrees that supporting patients to manage their
voices is helpful – but it is not enough, he says. "No doctor would
dream of saying, 'I am just going to treat the voices.' If I
assessed there was a risk – and in this case 'Ruth' was talking
about suicide and hearing voices and was out on the streets – I
would definitely have taken action to protect her. If there was no
other way, I would have battered down the door and taken her into
hospital."
After a series of crises, Ruth finally has a breakthrough and is
back on the road to recovery. The closing scene shows her sitting in
a car outside the (disguised) hospital where she is back at work.
May asks her if she is competent as a doctor. "Yes," she says. "He
[the voice] is not the problem – it's if people find out, that would
be a problem. The power balance has shifted."
Leo Regan, the director, who spent a year shadowing May, said his
aim was to "challenge people's preconceptions about mental illness"
rather than to promote one approach over another. "I think the
debate between Trevor and Rufus raises some important questions and
will provoke people to think a bit more deeply about how we treat
people who hear voices."
Today, Ruth is still well and working. May insists that she would
have fallen apart if she had lost her career. It was a high-risk
strategy – some would say foolhardy – yet it apparently succeeded.
Rufus May's presence in the mental health system is a necessary
irritant, a constant reminder that orthodox psychiatry needs to be
more consumer-focused. But one cannot help fearing for the
consequences if he pushes his approach too far.