Underground recovery

It took over a year for Leo Regan to make the film, The Doctor Who Hears Voices, about my work. I think it manages to be a documentary about mental health that avoids the usual traps of being a freak show.

I work with adults with mental health problems and believe people are capable of recovering from all mental health problems if they get the right support.

I had a psychotic episode when 18 and recovered despite doctors diagnosing me with “schizophrenia” which they said was a life-long condition and that I would always need medication for.

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. Once he even turned up at my house at 3am!

The film focuses on my relationship with Ruth [not her real name] 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.

Around this time she started to hear an aggressive voice 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 lose her medical career.

I set about supporting her non-medically. 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. I firmly did not believe this 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 diagnosed with bipolar disorder and again told it was a lifelong condition. I don’t agree with such practices. I think the psychiatric diagnostic model often alienates us from our own experiences and breeds fear and helplessness.

I suggested that it might be helpful to not embrace a diagnostic understanding of her problems. Instead, 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 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”. If they don’t want to take medication most psychiatrists and nurses will choose to force people to take medication against their will. In the film Trevor gives a reassuring description of how nurses are trained to forcibly inject patients 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 wrong that many psychiatrists do not see their patient’s ‘mad’ experiences as meaningful.

It is surely wrong that they do not promote optimism and a belief in recovery. It is surely wrong 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 wrong 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.

The ‘real Ruth’ bravely decided to speak out about these kind of injustices by agreeing to have her story documented, hopefully the number of people speaking out about our society’s approach to mental health will continue to grow.

* Rufus May is a clinical psychologist with Bradford District Care Trust’s assertive outreach team, and honorary research fellow with the Centre For Community Citizenship And Mental Health at the University of Bradford. Rufusmay.com

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