I wrote a post about this the other day before I’d actually seen it and I’ve watched it now.
For anyone who didn’t see it, ‘The Doctor Who Hears Voices‘ was a film shown during the past few days on Channel 4. It concerns a doctor called ‘Ruth’ – her identity has been changed, but we are told that the documentary is a mix of film of Dr May taken throughout the actual treatment, spliced with reenactments of Dr May’s sessions with ‘Ruth’ with Ruth being played by actress Ruth Wilson. Ruth has no wish to take psychiatric medications and is currently off work with depression; she has a diagnosis of bipolar disorder. She is sure that if she tells her work that she is ‘hearing voices’ then she will be sacked and sectioned.
I thought that I’d start this post by listing the things that I liked about the documentary. So far I’ve only been able to think of one – that it’s good that mental health issues are being given airtime by a major television channel.
There were lots of things I found objectionable about the film.
1. The subject’s suitability was questionable:
Was it really suitable to film a documentary over a seven month period of a vulnerable patient having a mental health crisis? I cannot believe that this helped in her recovery, and I suspect that it simply served to raise Dr May’s profile. Sure, she must have consented before broadcast, but by then the damage could have been done.
2. The film is misleading
Dr May is described as a doctor – whilst this is strictly true, he has a doctorate, most people would interpret this as meaning that he is a medical doctor. He is not, he is a psychologist.
The film implies that people who have voices are always sectioned, this is not the case. The film also gives the impression that were ‘Ruth’ to admit to be suffering auditory hallucinations, then she would be sacked and sectioned on the spot. In fact her dismissal would have to be sanctioned under employment law, and if she were to be sectioned, this would require two independent doctors and an appropriately qualified social worker.
No attempt is made in the film to put the treatment of this patient in context. All that one can legitimately say about this film is that Dr May’s interaction with this patient coincided with partial recovery for this patient during one of her relapses. Many people will leave this film thinking that because of Dr May’s limited ‘success’ that current mental health treatment is all wrong. This cannot be concluded on basis of one case.
3. The film is unrepresentative and unrealistic:
‘Ruth’ is not a particularly representative patient. She is above average intelligence, and I cannot help but notice, is played by a young and beautiful actress. I wonder if this film would have been made if its subject matter was a typical London inner city patient.
Whilst Ruth Wilson played the role believably, her depiction was not challenging to the viewer. The most chaotic thing she does is put her head under a stream and walk out in front of a slow moving lorry. She remains coherent and well turned-out throughout. What if she did other things less palatable to the body beautiful: neglected personal care, started to have sex with (unattractive) strangers or lived in a filthy house? Let’s consider how much publicity a conventional psychiatrist, offering medications to a patient who would go home much better the following week, would muster – not much I expect.
Early on, we are told that Dr May sees Ruth in an unofficial capacity in addition to his NHS work. Even if it worked, about which I remain dubious, there is simply not the capacity within the health service to allow all patients with serious mental health problems this sort of intensive input.
At the end of the film, we are encouraged to think that ‘Ruth’ has managed to return to work successfully, despite continuing to have auditory hallucinations. It is implied that this is because Dr May and ‘Ruth’ manage to pinpoint the identity of the voice which is troubling her; this is over simplistic. We are told nothing of the long term outcome of this case. Remember that both bipolar affective disorder and schizophrenia (the two terms are used interchangeably during the film) are chronic disorders of a relapsing and remitting nature.
4. Dr May is deeply unprofessional:
Dr May shows a total distain for other professionals working in the psychiatric field. Informed by his own experiences, he says that people who work on psychiatric wards consider their patients to be ‘degenerate’. Psychiatric wards are not nice places, but they are staffed in the main by caring people who do an extremely difficult job with very difficult patients. It is insulting to suggest that, to a person, they all consider patients with mental health problems in this way.
Dr May’s relationship with ‘Ruth’ seriously blurs the boundary between patient and professional. Ruth is seen to stay with his family and there is no mention of any other important relationships in Ruth’s life, for instance the support which might be available from parents or friends. Instead, Dr May positions himself as a svengali character and it appears that his professional zeal for alternative psychiatric treatment may be an expression of his own personal distaste for the psychiatric profession with Ruth as a unwitting pawn.
Ruth is an extremely vulnerable patient. The programme takes place over the course of seven months, during which time who, if anyone if managing the risks she poses to herself and others? At one stage Dr May admits that she has been told by the voice that she hears that she should kill her parents. He simply considers this to be ‘useful’. At another Ruth goes missing and Dr May is concerned that she may have committed suicide. When asked about why he is reluctant to talk to camera about this he admits that he is reluctant, in our risk adverse age, to implicate himself on camera, perhaps realising how far out on a limb he has gone. He is also described as using a technique which many psychiatrists think ‘irresponsible and dangerous’. Imagine if your surgeon told you he wanted to try a procedure on you that other surgeons thought ‘irresponsible and dangerous’ – you would not be impressed, and neither should we be.
In discouraging Ruth from seeking any professional advice but his own, Dr May steers her away from evidence based (but I grant, imperfect) methods of treating mental illness, towards his own paradigm. In the film she is portrayed as manic for in excess of six months, and would have been unlikely to have been so were she on appropriate medication. In addition to not seeing a psychiatrist, in isolating her, Ruth would also not be helped by the array of other professionals who work in community mental health. We see her at the end, apparently recovered, but where on earth is her follow-up?
Dr May has a professional case to answer in his attitude to the panel that is to decide whether Ruth is safe to be practicing as a doctor. This panel is not there simply to get in Ruth’s way, but to make sure that vulnerable patients are to be treated safely by competent doctors. Whilst being aware that Ruth has symptoms of serious mental illness, Dr May encourages Ruth to lie to the panel and also coaches her to do so.
This is in direct contradiction to the GMC good practice guidelines which state:
‘If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patients.’ (my italics)
I don’t doubt that a lot of patients are not keen on taking antipsychotic medications. It’s widely known that people with mental health problems have trouble finding and keeping employment. If Dr May’s work aims to help people with their mental health problems get back into employment and deal more effectively with their illness, they we’re on the same side. And perhaps there’s a four hour version of this film which would clear up all of the above concerns. But this film is unbalanced and unhelpful.
Here’s a guardian review of the TV show and some interesting comments.
Kathryn Flett in the Observer didn’t like it much either
Addendum: Dr May has kindly commented on this piece below. There’s a BMJ review of TDWHV available on his website, which raises some interesting points.