The doctor who hears voices

 

Addendum: I’ve now seen this film and it annoyed me so much that I’ve written another post about it 

Tonight there’s what may be quite an interesting programme on television – Channel 4 2200.  I can’t watch it as I don’t have a TV, but here’s the blurb:

‘The Doctor Who Hears Voices tells the true story of Ruth, a junior doctor, who has begun to hear a male voice telling her to kill herself. Suspended from her job, she turns to clinical psychologist Rufus May who is known for his unconventional approach to treating people with severe mental health problems.

Although she admitted feeling depressed and suicidal to her employers, Ruth knows they would have sacked her immediately if she had told them about the voice.’

Furthermore:

‘Rufus May is a maverick psychologist. He believes there is no such thing as schizophrenia, that medication can destroy lives and that there’s nothing wrong with hearing voices. Rufus is an authority on the subject. He was diagnosed with acute schizophrenia aged 18.’

I hadn’t heard of Rufus May until this evening; I’ve now looked at his website so I’m getting clued up.  He’s a little bit more circumspect than the Channel 4 would have him:

‘I am not against people using psychiatric medication I just would like people to be able to make informed choices and have the chance if they so wish to try out other approaches to their mental health problems.’

Which sounds a little more balanced, but also less exciting.

It’s rather a poor show to criticize a TV programme I haven’t seen, although this never stops politicians.  I’ve got quite a lot of sympathy for people who say that schizophrenia doesn’t exist.  In a way it sort of doesn’t, in that our understanding of its aetiology is patchy and it could easily be a number of similar diseases based on different genetic defects.  If he is helping people to deal with their psychosis with means other than medication, this is also to be applauded. 

As usual though what’s necessary for the highest level of evidence for May’s methods is a controlled trial and I can’t see him having been involved in one of those.  If he chooses the patients he treats, he can thus pick the ones he would expect to have a better outcome - those that have a higher intelligence and better social support.  There are a lot of patients out there with psychosis and May has treated but a few of them.  Twenty % of schizophrenia patients make a full recovery without any psychiatric intervention.

As a final thought, if the doctor in question had a serious psychosis then you could also argue that he would have had a duty of care to reporting her to the GMC.  

Like I say, I’d better watch it. Here’s Rufus May’s Bradford page

PS. There’s an interesting transcript on the Rufus May website of a debate entitled ‘Psychiatric drugs do more harm than good’ For: Dr Peter Breggin, seconded by Dr Joanna Moncrieff.  Against: Dr Mark Salter, seconded by Dr Trevor Turner 

 

8 Responses to “The doctor who hears voices”

  1. Sanctimonious Whelp says:

    I watched it. I hadn’t heard of Rufus May until this program, either, and it really made him seem very anti-medication. I think the program’s makers deliberately played up the whole, ‘HE’S RADICAL AND CRAYZEE!’ angle to the point where it was awkward, and they seemed to be milking it for controversy.

    The whole thing got me wondering about how doctors, nurses and psychologists with mental health problems are treated within the NHS, though. I have atypical depression and, like a lot of nutcases, I’d like a career in mental health, ideally psychiatry (simply because I want to help people, not because I think it’d fix my own problems) It’s got to the point where my suicidal thoughts are pretty much background noise. I’d never act on them, but they’re still there, and it makes me antsy when I consider that, if people knew about them, they’d consider me unfit to practice medicine. Going by Mental Health and Ill Health in Doctors, mental illness seems pretty rife within the profession and, as with any other job, I bet there’s a pretty strong ‘don’t ask, don’t tell’ policy.

    They never specified what kind of doctor Ruth was, so are some areas of the NHS more/less tolerant of mental illness in its workers than others? I’d hope that a bunch of psychiatrists would be more understanding and empathetic than, say, a bunch of surgeons, but I really don’t know.

  2. NorthernIrelandExile says:

    I only saw the last 15 minutes of this due to social activities involving curry and wine as opposed to the tv :>

    However, in those last 15 minutes I saw what looked like a very upset girl struggling hard with impulses and voices, telling her to hurt herself and other people.

    She is clearly a very intelligent girl, and at times definately had a lot of insight into what was happening to her. However, she also seemed at times to lack insight and to struggle with the voice she was hearing.

    Surely it was rather irresponsible for her and her ‘psychologist’ to lie to her bosses in view of her unstable state; especially as it did not appear that any form of long term care had been put in place for her?

  3. Oliver says:

    I watched all the the documentary , an i found it to be one of the most refreshing things on modern T.V.

    Finally a Dr with an open mind and not ready to stand and be told what things to say or do , or in this case what drugs to prescribe.

    I find Dr Rufus May to be one of the greatest Psc to be alowed to practice an i find it very refreshing that Rufus is about , this guy is pioneering a form that most psy’s have nightmares about.

    How did we ever think that Drugs can stop a Human things O.K , i agree drugs may slow down and stop , but truely they do not face the true problem.

    Rufus is a great guy and i think any who oppose his ideas are simply irgorant, thank god for Dr Rufus May!

  4. Frontier Psychiatrist says:

    I still haven’t watched it, but I did get my dad to record it on his computer using some clever technology, so I will have the opportunity soon.

    In the meantime, I know that the point of the piece appears to be someone offering an alternative to drug treatment, but I can’t resist making the pedantic point that Dr May is a psychologist, so couldn’t actually prescribe drugs even if he wanted to.

  5. Sanctimonious Whelp says:

    ‘I can’t resist making the pedantic point that Dr May is a psychologist, so couldn’t actually prescribe drugs even if he wanted to.’

    Perhaps, but he was pretty resolute about his patients not taking drugs. Rufus May is 1) charismatic, and 2) in a position of authority, so he still has a huge influence over his patients’ compliance/noncompliance.

  6. Frontier Psychiatrist says:

    I’ve seen it now and see my latest post for details. It really annoyed me actually.

    Just to answer the posts above.

    Sanctimonious Whelp: I agree that they did try to make him appear as alternative as possible; whilst trying to make the psychiatrists as monstrous as possible (I’ve met Dr Turner and he’s alright). I would argue that Dr May’s approach is actually quite dangerous and he did not seem to take the risks he was taking in this patient’s care at all seriously.

    As for suicidal thoughts, I think that it’s an exaggeration to state that if you have suicidal thoughts then you are unfit to practice medicine; the GMC guidelines state that your thoughts have to affect your judgement or performance in order to be a problem. A lot of people have suicidal thoughts, and its the degree that is important.

    Psychiatry is a very interesting subject and worthy of a career (and a blog…) I’m glad that you are not coming into psychiatry as self-help/containment as I don’t think that that is a good idea.

    I’m not sure why Dr May being charismatic is important, but he clearly does have a lot of influence over his patient in the film. The film may be unrepresentative, but I think he’s taking a lot of chances, and most patients as sick as ‘Ruth’ are looked after by a team of nurses/doctors/psychologists and not one ‘maverick’.

    Oliver: I don’t think that it’s helpful to say that anyone who opposes that Dr May says is ignorant. I don’t know him personally, but I disagree with a lot of things in the film he has made. I don’t think that he’s ignorant however and I hope he (and you) would extend the same courtesy to me.

    NorthernIrelandExile: I agree that it is concerning that this doctor was lying to her employers and appeared to have no long term care. I thought that this was one of the most disturbing sections of the film. I have no problem with anyone with mental health problems working in healthcare services but with appropriate care and support both of which were lacking to my mind in this case.

  7. grilled trout says:

    How we love a bit of controversy. I do know rufus and he is indeed a genuinely charming man, he also provokes argument, which is a healthy thing. I have worked in mental health care and believe that the most useful progression for the provision of care is for these issues to come out of the darker recesses of media sensationalism and public ignorance. It is very easy to focus on the polarised dynamic of Rufus vs Psychiatry, but what is really crucial here is giving mental and emotional health issues the open forum that it requires for people to recieve the interventions that are going to be most useful for them, whether medically based or not.

    As for randomised controlled trials, there are many incidences in health care where an intervention is used without rigorous RCT testing (talk to any neuro OT about the cone splint.) It is notoriously tricky to apply quantitative research to mental health, and Rufus’ qualitative approach provides a fresh alternative to the historical wholesale use of medication.

    Don’t forget that there is a huge marget in psychiatric medication, and I would advise anyone to see a sales pitch from a drugs rep, to understand how much they push their products.

  8. gary says:

    I agree with NorthernIrelandExile. Seems very inappropriate.

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