Rufus May Blog Thinking Aloud

Reflections on the making of…

When Leo Regan became interested in filming my work as a psychologist he warned me I would soon sick be of him, I didn’t know what he meant. Eighteen months later I now have a clearer idea! Leo always wanted to get underneath the skin of help-giving and often it was quite exhausting for everyone involved! It took over a year for Leo Regan to make the film about my work called The Doctor Who Hears Voices. Leo has tried to show the humanity of working in alternative ways with voice hearing. The result is a film that is both challenging and realistic in its presentation of the dilemmas of giving people real choices about how to manage an episode of intense distress.

Over a million people watched it when it was broadcast in April on Channel 4. Thousands of people are now down loading form several internet sites. It has provoked a strong response from viewers. Many people have been inspired by the film, I have had over 500 emails asking for advice and or praising the film. Others, perhaps who are more in favour of a traditional medical approach to distress have been troubled or even outraged. I think the film is unusual in that it successfully managed to be a documentary about mental health that avoided the usual traps of being a freak show. Partly because the story shows that mental health problems are understandable and meaningful and also shows my vulnerability it crosses the typical boundaries between professional and ‘patient’. A few journalists were quite uncomfortable with this blurring of boundaries. The principle that there is an expertise of experience that can be as valuable as academic or professional expertise is quite new and a bit threatening to mainstream commentators. Nevermind! This idea that personal experience combined with understanding can become a source of expertise will grow in our society, I think.

Working as a psychologist in the NHS working with adults with mental health problems, I believe people are capable of recovering from all mental health problems if they get the right support. I myself had a psychotic episode when I was eighteen and recovered despite doctors telling me I had a lifelong condition called schizophrenia and that I would always need medication. I think originally Leo was interested in how my role as a ‘wounded healer’ might affect how I tried to help people.

With his camera in tow, Leo steadily shadowed me at both work and in my independent role giving talks and campaigning. Leo wanted his footage to be ‘real’ and not contrived. He went to a lot of effort to film me when I was worried and anxious as well as when I was confident and self-assured. On one occasion he even turned up at my house at three in the morning! The final film focuses on my relationship with Ruth who I decided to try and help outside of my NHS work. Ruth was a junior doctor who was suspended from her practice for having suicidal ideas. After the suspension she started to hear an aggressive voice for he first time telling her to kill herself. Coincidentally, she had approached me for advice just before she started to hear voices. She had stopped taking medication some time before. She could not approach her doctors for help with her voice hearing because she feared that she would definitely lose her medical career.

I set about supporting Ruth non medically. My approach is strongly influenced both by my own recovery journey, holistic health approaches and the ideas of the hearing voices movement. It was important to give her lots of psychological and physical techniques to cope with her sleep problems, her voice hearing and her moods. I became the only person she could trust with what was really going on. Leo was very interested in her story and tried to film us working together on these issues but it was impossible because of her need for confidentiality and secrecy. As she put it “you cannot be a doctor and hear voices”. So instead we began to carefully document our meetings so that we could re-enact them with an actor.

Even documenting the work added pressure to Ruth. For example, often after Leo had interviewed Ruth about how she was doing, I would find that she was extremely distressed the next day. On one occasion I banned Leo from meeting with Ruth for over a month. At that point I felt that we would have to keep Ruth out of the film entirely. In the end Ruth and I decided the pain of the film making was worth the gain of telling her story.

I was working totally against the grain of conventional wisdom. Most health professionals believe that when someone starts to hear voices or get paranoid, both of which Ruth was going through, you have to intervene with medication. If you don’t, conventional thinking argues, the person’s brain will deteriorate irreversibly. That is why drug treatment is justified for all first episodes of psychotic experiences and this is usually backed up with the threat of force if it is felt the person needs to be hospitalised. I firmly did not believe that without drug treatment Ruth’s condition would deteriorate resulting in irreversible brain abnormalities, but, at times, supporting Ruth through her crisis as she struggled with suicidal ideas and intense paranoia, I did question my rationale. I wondered whether my approach was making her worse not better. I knew if she did kill herself I could be held responsible. At the same time I saw an intelligent dedicated person who had been let down by a judgmental employment system, who I believed could recover and make a valuable contribution to society as a Doctor.

Ruth had been told she had a lifelong condition called Bipolar Disorder, that her brain was fundamentally different to other people, in other words she would always be inferior to others. I gave her a different model; firstly, that she could recover a good life. Secondly, that her distressing experiences were not the product of a faulty brain but meaningful communications. I suggested it might not be useful to see herself as having a medical condition called bipolar disorder or any other psychiatric label. I believed that all of her experiences including mood swings, critical thoughts, paranoia and voice hearing were understandable reactions to difficult life events. For example, a lot of her paranoia and voice hearing reflected the way her employers were treating her, as if she was a liability, by suspending her and refusing to trust in her ability to be a good doctor. I was suggesting that these so-called ‘symptoms’ were actually ‘messengers’ about past and present hostile environments and that it was fundamental not to blame herself and give up. Importantly Ruth needed to become confident in resisting the prejudice of her employers by lying to them about her mental health. She could not afford to tell them she was hearing voices. This was hard for Ruth as she is an honest person and she felt her integrity was being ripped apart. As we worked on deeper issues I encouraged her to express her emotions and address buried wounds in order to be released from demons of her past. At times she slipped deeper into paranoia and it was on these occasions that both of us had our faith tested in my approach.

The film charts Ruth’s journey though these experiences and also gives us some insight into the more conventional psychiatric approach. Psychiatrist Trevor Turner, former Vice Chair of the Royal College of Psychiatry, outlines the importance of giving people in Ruth’s situation medication whether they want it or not because “miracles do occur”. In the film Trevor gives a reassuring description of how nurses are trained to restrain patients and forcibly inject them with medication “in the most comfortable and supportive way”.

I hope the film triggers a debate not just about the rights of health professionals to hear voices but also about the rights of people in crisis to a force free mental health service. Every week thousands of people are coerced into taking medication that they don’t want and this frequently does more harm than good. Without giving away the outcome of the film, Ruth and I attempted to work on her recovery in a force free way that honoured her right to have a drug free approach. We had to do this in an underground way. This is surely wrong. It is surely questionable also that many psychiatrists do not see their patient’s ‘mad’ experiences as meaningful. It is surely questionable that many mental health workers still do not promote optimism and a belief in recovery. It is surely questionable that psychotropic drugs that impair functioning are seen as the first port of call and that patients have little choice over what goes in their bodies. It is surely not right that many people who stop taking their medication feel they have to lie about this to their psychiatrists. We are supposed to live in a democracy but if you are being treated for a mental health problem in our society you are very often living in a totalitarian regime where choices are severely restricted. Can we move towards something more democratic and more open-minded?

I am very keen to have a dialogue on these issues so please tell me what you thought of the film and we can have a healthy discussion about the issues it raises.

This entry was posted on Thursday, May 8th, 2008 at 6:17 pm and is filed under Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.