Psychologist's non-drug approach provokes reaction storm

May 1, 2008
by Angela Hussain

A non-drug therapy used by a clinical psychologist when working with a voice-hearing client has provoked a storm of mixed reactions.

A 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 psychiatric medication.

But some psychiatrists have reacted furiously, calling May’s approach “dangerous” and "damaging”.

One 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.

Mental 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"

May, 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.

"The 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..

"This clouded every judgement he made and made him very dangerous. The risks he took with that young woman's life were appalling.”

Another 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...

"I 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.”

The 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.

"This 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 services."

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 with psychosis.

"The film did not make any reference to the large body of research that points to schizophrenia having much of a biological foundation,” he said.

One of May’s NHS trust colleagues, Richard Nisbet, an assistant ward manager, was also critical, accusing May of "empire-building"

"Mr 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 psychminded.

"Empire building and flagrant self promotion to indulge one's grievances at the expense of others is not an attractive quality," he said.

Lisa 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".

"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?,” she wrote at doctors.net.uk

"Of 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?”

"Don't let him anywhere near me if I become mentally ill,” she added.

Mind's 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."

Other mental health professionals and service users told psychminded they supported May's work.

"Thank 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 for depression.

"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.”

Read also:
EXCLUSIVE:
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.

See also: Psychiatric medication + Service Users

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Inspirational

From: Victoria Collins, Health Care Support Worker, South Staffordshire NHS Trust
Date: 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.

Psychiatrists should face up to the facts that medication and hospitalisation are not always necessary or particularly helpful.

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There is evidence for voice dialogue

From: Louise Pembroke, survivor activist, London
Date: 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!

Many 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..

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Reactive rant

From: Paul Tovey, mental health blogger, Birmingham
Date: May 5, 2008

Rufus 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 ..

The reactive rant from some professionals is to be expected since it unseats their purely "illness-model" approach ...

Distressing 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.

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Psychiatry is not like oncology

From: Brian Daniels, Citizens Commission on Human Rights, Church of Scientology, East Grinstead, West Sussex
Date: May 14, 2008

No wonder psychiatry has such a bad name: there are no standards in the psychiatric profession, hence no agreement on what is right and wrong.

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.

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Get facts right over side effects

From: Russell Lutchman, consultant forensic psychiatrist, Berkshire.
Date: 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.

Rufus 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.

One 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.

About 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.

Factually, 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.

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I healed without medication

From: Lu Bowen, support worker, Mind charity
Date: July 30, 2008

I 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.

If 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.

Not 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.

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May is not accountable

From: Andrew Al-Adwani, psychiatrist, Great Oaks Adult Mental Health Unit, Scunthorpe, England
Date: 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, disease-centred.

Patients 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.

I have yet to come across an extreme view that is right and this is no exception.

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Drugs' severe side effects are themselves medical conditions

From: Huw Green, psychosocial officer, Africa and Middles East Refugee Assistance, London
Date: May 11, 2009

The '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.

One 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 by medication.

However 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.

It 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 as well.

......

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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