non-drug approach provokes reaction storm
by Angela Hussain
non-drug therapy used by a clinical psychologist when working with
a voice-hearing client has provoked a storm of mixed reactions.
Channel 4 docudrama last month centred on the work of Bradford NHS
psychologist Rufus May as he attempted to help a real-life junior
doctor who was suspended from her job after hearing voices telling
her to kill herself.
Outside his NHS work, May used psychological and physical techniques
to help the woman, "Ruth", who had been diagnosed with
bipolar disorder, to cope with sleep problems, voice-hearing and
her moods. Ruth, now back working as a doctor, did not take any
some psychiatrists have reacted furiously, calling May’s approach
“dangerous” and "damaging”.
leading psychiatrist as well as other mental health professionals
have, however, strongly defended May’s intervention, arguing
it is based on more than 20 years of research.
health charity Mind has also nominated May for its “Champion
of the Year Award” for his efforts to "improve public
understanding of mental health issues"
who works with Bradford District Care Trust’s assertive outreach
team, was himself diagnosed with schizophrenia at the age of 18.
Against his doctor's advice he came off all his medication and later
trained as a clinical psychologist.
In the film, entitled The Doctor Who Hears Voices, he was shown
speaking directly to Ruth's voices, a technique backed by the UK
charity, the Hearing Voices Network.
But, reflecting deep and long-running divisions in mental health
practice, May's approach angered some professionals.
biggest concern for me was his [May’s] assumption that …
schizophrenia doesn't exist, based on his own experiences of his
treatment at 18 for a psychotic episode," wrote consultant
psychiatrist Catherine Wainhouse on the bulletin board of doctors.net.uk,
a site for doctors registered with the General Medical Council..
clouded every judgement he made and made him very dangerous. The
risks he took with that young woman's life were appalling.”
consultant psychiatrist, Nicholas Bescoby-Chambers, said: “I
am alarmed by his approach. He was advising a young, dare I say
naïve, doctor to jeopardise her career...
suggest he has probably harmed not only his career, but, as a consequence,
the young doctor’s, as she should have come under an early
intervention approach which works holistically anyway, and encourages
compliance with medication as one facet in multidisciplinary treatment.”
approach used by May was praised by psychiatrist Marius Romme, visiting
professor at the Mental Health Policy Centre at the University of
Central England in Birmingham.
Romme urged psychiatrists and other professionals to use the approach
used by May to help patients understand their experiences. He also
denied the therapy was dangerous.
programme shows that by simply sitting down and talking to a voice
hearer about their experience, validating the reality of what is
happening to them and working alongside them to better understand
the message the voices bring, then dealing with these issues, a
person can start to live their life again,” said Romme.
"This approach is not controversial or dangerous. It is based
on over 20 years of research and action and now with initiatives
in 19 countries across the world.
"It represents a major challenge to the approach used by psychiatric
However, another consultant psychiatrist, Russell Lutchman, wrote
at doctors.net.uk that he feared the programme was unbalanced and
risked causing "unquantifiable damage” to patients diagnosed
film did not make any reference to the large body of research that
points to schizophrenia having much of a biological foundation,”
of May’s NHS trust colleagues, Richard Nisbet, an assistant
ward manager, was also critical, accusing May of "empire-building"
May's ignorance and bitterness at his own experiences (with which
I empathise) seem to have coloured his judgement to such a degree
that I do not understand how anyone can take his mantra of "no
drugs good, all drugs bad" remotely seriously," he told
building and flagrant self promotion to indulge one's grievances
at the expense of others is not an attractive quality," he
Brownell, a consultant psychiatrist at Queen Elizabeth Psychiatric
Hospital in Birmingham, questioned Mind's decision to nominate May
as a "champion". Mind
says May is "revered in his field".
you imagine someone saying that we should stop treating people with
cancer with medication and close down all the cancer centres and
then be nominated for an award by a cancer charity?,” she
wrote at doctors.net.uk
course we should treat our patients with respect, and dignity, and
holistically, and as individuals. Like all docs should treat all
patients. Like oncologists treat their patients. But to say that
in order to do this we should deny them appropriate medical intervention?”
let him anywhere near me if I become mentally ill,” she added.
head of media relations Claire Ashby said: "Rufus' s pioneering
approach gets remarkable results and shows that people can recover
to lead a full life."
mental health professionals and service users told psychminded they
supported May's work.
you, Rufus, for acting with the courage of your convictions in this
very difficult situation." said Mary Maddock, from Cork in
Ireland, who once was prescribed neuroleptics and antidepressants
"Medical 'treatments' such as psychotropic drugs and electro
shock can cause brain damage.
"Since there is no evidence that chemical imbalances in the
brain can cause psycho/social difficulties then it does not make
sense to uses drugs or electro shock as a solution.
"I hope that [the programme] will help many people to escape
the chemical lobotomy I received for almost 20 years."
Afroza Ali, a support worker with the Beside mental health charity
in Tower Hamlets, London, said: "I hope this documentary encourages
other mental health care professionals to look at the experience
of hearing voices from a humane perspective.”
April 18: Underground
recovery - Clinical psychologist Rufus May explains why, when
using a non-drug approach to help a doctor who heard voices, he
had no choice but to work in secret.
medication + Service
Victoria Collins, Health Care Support Worker, South Staffordshire
May 2, 2008
As an undergraduate studying psychology with the aim of becoming
a clinical psychologist, working within the NHS, and knowing people
in my social network who have been diagnosed with schizophrenia
I found Dr May's work to be inspirational.
should face up to the facts that medication and hospitalisation
are not always necessary or particularly helpful.
evidence for voice dialogue
Louise Pembroke, survivor activist, London
May 5, 2008
The criticisms of The Doctor Who Hears Voices are aimed in the wrong
direction. There IS a body of evidence which demonstrates that accepting
voices, working within a person's own frame of reference to understand
and make sense of them IS possible without a lifetime of medication.
The Royal College of Psychiatrists has a Spirituality Special Interest
Group with psychiatrists practising 'spirit release' work, which
is similar to 'voice dialogue'. The TV programme didn't work not
because non-medical approaches don't work to help people, but because
the programme focussed on Rufus instead of the issues. The issues
are far bigger than Rufus but the programme focussed on the "maverick"
and assumed too much of the viewing public with no experience of
Intervoice or the hearing voices movement. Voice dialogue wasn't
explained. Without explanation it would just appear like something
out of The Exorcist film, whereas the 'Am I normal?' programme EXPLAINED
spirit release before demonstrating it. Likewise, it is entirely
fair to state that antipsychotic drugs can ruin lives as Rufus did,
but NOT without backing that up with the evidence and an explanation
as to why!
claims could have been substantiated but the programme failed to
do this, and this is why it failed. Not because of the subject matter
at the heart of it but because a personality was promoted instead
of the issues. A missed opportunity..
mental health blogger,
May 5, 2008
May's work and ethos of validating and creating a better "hearing"
of the internal world of those who have different experiences of
themselves (hearing voices) is really positive ..
reactive rant from some professionals is to be expected since it
unseats their purely "illness-model" approach ...
disturbances can be made less when social taboo against them is
lifted and a "hearing of voices" is heard and shared and
given a "social" place of joint tolerabiility.
is not like oncology
Daniels, Citizens Commission
on Human Rights, Church of Scientology, East Grinstead, West
May 14, 2008
wonder psychiatry has such a bad name: there are no standards in
the psychiatric profession, hence no agreement on what is right
Dr Lisa Brownell's comments struck a particular chord. She said,
"Can you imagine someone saying that we should stop treating
people with cancer with medication and close down all the cancer
centres and then be nominated for an award by a cancer charity?”
Dr Brownall makes the assumption that psychiatry in is the same
field as oncology. It isn't. Cancer is a physical condition. Psychiatry
is an opinion. And the fact that there is such a diversity of reactions
to the docudrama confirms this.
Dr Russell Lutchman's comments were also interesting. He said that
"...he feared the programme was unbalanced and risked causing
"unquantifiable damage” to patients diagnosed with psychosis."
In response, here's a listing from the British National Formulary
web site for the side effects of atypical antipsychotics:
"Side-effects of the atypical antipsychotics include weight
gain, dizziness, postural hypotension (especially during initial
dose titration) which may be associated with syncope or reflex tachycardia
in some patients, extrapyramidal symptoms (usually mild and transient
and which respond to dose reduction or to an antimuscarinic drug),
and occasionally tardive dyskinesia on long-term administration
(discontinue drug on appearance of early signs). Hyperglycaemia
and sometimes diabetes can occur, particularly with clozapine and
olanzapine; monitoring weight and plasma glucose may identify the
development of hyperglycaemia. Neuroleptic malignant syndrome has
been reported rarely."
Rather than using weasel words like "unquantifiable",
the side effects listed indicate the "quantifiable damage"
to patients diagnosed with psychosis.
facts right over side effects
Russell Lutchman, consultant forensic psychiatrist, Berkshire.
June 17, 2008
Brian Daniels' comments lack focus and balance. Why? He
chooses to compare "unquantifiable damage" caused by Rufus
May's rubbish against a bunch of side-effects listed in a BNF.
May's position was inherently unbalanced. The evidence for that
was glaring. There was no discussion or evidence on brain pathology
in schizophrenia. The evidence is plenty. So for the programme to
exclude the issue entirely is most interesting.
amazing historical fault with the BNF is that it does not state
the incidence of side-effects against various medications. Patients
and idiotic anti-psychiatry groups are therefore totally misinformed
when looking at side-effects. All the BNF does is to list side-effects
- no more.
10 years ago I investigated a report in the BNF of a drug possibly
inducing asthma. When I check up on it the incidence was one in
a million prescriptions. Point? The BNF does not inform about the
degree of risk - it only gives lists (in most cases) of side-effects
or adverse effects etc.
the side effects listed in the BNF do not indicate the "quantifiable
damage" to patients diagnosed with psychosis. Why? Because
there is no quantification at all.
healed without medication
Lu Bowen, support worker, Mind charity
July 30, 2008
agree with Rufus May. I too experienced psychotic episodes and voices
many years ago and was too scared of what would happen to me if
I went to the GP. So I undertook differrent styles of alternative
therapy - such as healing and crystals, and the positive attitude
that I would get better because I was determined. I succeded.
What I was experiencing was a total clearout of negative past experiences
all coming off me at once, which threw me off balance and left me
terrified of what I was experiencing.
someone had explained this to me and talked me back to rebalancing
myself again I feel I might have got better quicker. I too did not
believe in taking medication and so did not. I carried on working
as this grounded me and kept me from thinking too much. Isolation
is the worst thing that can happen when in this state.
enough value is taken on past negative experiences which triggers
mental health problems - unless it's organic, where brain damage
has occured. I feel sure - after I healed myself it like May - that
it can be done with out too much medication, if any at all.
May is not
Andrew Al-Adwani, psychiatrist, Great Oaks Adult Mental Health Unit,
March 11, 2009
"The reactive rant from some professionals is to be expected
since it unseats their purely 'illness-model' approach", says
Mr. Tovey of mainstream mental health workers. Since patients have
illnesses and doctors diagnose diseases an 'illness-model' is by
definition patient-centred. If Mr Tovey means disease-centred then
he fall into a rather circular trap as doctors are, by definition,
are completely free to stand under pyramidal crystals, consult oracles,
take mega-doses of vitamins, be exorcised, read tea leaves or pray
to icons, but when a person tortured by a psychotic depression kills
themselves and their doctor has been 'speaking to their voices'
rather than treating them with proven medications there ends that
patient's corporeal life and that doctors professional life. Mr
May does not have to worry about this because he cannot prescribe
medication and so is not accountable, but I wonder how many of his
patients have died for want of a tablet.
have yet to come across an extreme view that is right and this is
side effects are themselves medical conditions
Huw Green, psychosocial officer, Africa
and Middles East Refugee Assistance, London
May 11, 2009
'unquantifiable damage' cited by Russell Lutchman still has to be
weighed carefully against the side effects of psychiatric medication.
While what he says about the BNF is correct, it is also slightly
misleading. The side effects of anti-psychotic medication are not
only common, but so severe that they create conditions at least
as significant as those they are intended to treat.
client I encountered, while working in therapeutic communities for
psychosis, was suffering from extremely severe Tardive Dyskenisia
as a result of being on typical (1st generation) anti-psychotics.Once
she'd acquired this problem, there was no way to eradicate it, she
could only be administered new medication to counter the issue.
She effectively had a new, and very serious, medical issue that
would plague her for the rest of her life and that had been caused
many psychiatrists regard this as a mere 'side effect' while viewing
the initial psychosis as more grave. If there is evidence that a
different approach can be employed for sufferers for psychosis,
then this needs to be fully explored before drugs with such severe
side effects are administered.
is standard practice to explore other pharmacological options prior
to administering Clozapine, because this drug carries risk of white
blood cell depletion that could be fatal. It is only a failure of
logic that stops us extending this caution to non-pharmacy interventions
May's doing no more than I do
From: John Hoggett, Chair, Rose and Thorn Theatre Company
Date: November 16, 2010
It seems to me that Mr May was doing no more than I have done for friends who are psychotic. He may be a qualified professional, but it was a friend who he helped. He may have been using the techniques he learnt as part of his professional training and from his extensive reading but that is all I do too.
My training is considerably shorter and I like to offer drawing to my friends as ways of expressing and understand their experience and not Voice Dialogue, however the basic idea of offering sympathetic understanding of our friends experiences seems to be what we both do.
As Mr May was offering his loving support to a friend in his own time I doubt that the enraged professionals have any complaint worth pursuing. They have no cause to worry that if suffering psychosis themselves they would be offered such intensive and committed support - after the initial crisis, drugs and a 20 minute chat from a social worker once a fortnight is the usual treatment. It keeps most of the people I know on benefits for most of their lives.
Once you have the idea that the most helpful things you can do for people in extreme mental distress is offer a welcoming and calm atmosphere and sympathetic understanding then any technique and lots of reading and research into what causes people to be distressed, how they experience this can be useful in offering a sympathetic understanding them and their situation.
From reactions to the programme and comments on this page it seems many professionals do not have this understanding. Quite how many is a question that interests me.
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