A dialogue with myself
When Ruth began hearing voices, she turned to a controversial drug-free therapy programme. Now, her story is told in a powerful TV film, says Jeremy Laurance
Published 15/04/2008 | 14:55
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.
The Doctor Who Hears Voices, Channel 4, Monday 21 April, 10pm