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Home > Comment > BMJ
2008;336(7650):960 (26 April), doi:10.1136/bmj.39559.417106.3A

BMJ  2008;336:960 (26 April),
doi:10.1136/bmj.39559.417106.3A

Views & Reviews

Review of the Week

Listen to the wounded healers

Philip Thomas, professor, Institute for Philosophy,
Diversity and Mental Health, University of Central Lancashire

pfthomas{at}uclan.ac.uk

A drama documentary examines the story of a mentally ill
junior doctor who rejects conventional treatment but is
determined to stay in medicine. Philip Thomas reviews

"I can’t be a doctor and hear voices," says Ruth, the central
figure in Leo Regan’s powerful dramatised documentary about the work
of the clinical psychologist Rufus May, known for his unconventional
approach to treatment of mental disorder. The film 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
May, who believes that there is no such thing as schizophrenia and
that drug treatment can be harmful. He tries to help her understand
the meaning of her voice.

Even if you set aside any views you might have about the merits or
otherwise of May’s work, the film raises important questions. How
should we understand and respond to madness? To whom are
practitioners accountable—their patients, employers, the public, the
state? What should we do with sick doctors: sack them or help them to
maintain a valuable role in the profession? The film’s greatest
challenge, however, is to our complicity with stigma. We like to see
ourselves as rational beings guided by science, progressive ideas,
policies, and practices—but are we really? We may be doctors,
but as citizens we also share the values and assumptions that
characterise a culture and are just as likely as anyone else to hold
stigmatising attitudes to people who are identified as mentally
disordered. We like to believe that our scientific knowledge about
the brain sets us apart from the popular distortion of the "mad
axeman," but in reality this is not so.

Ruth heard voices and believed that bubbles in a goldfish bowl
acted like an electrocardiograph, conveying information about
the cardiac function of the residents of the care home she worked
in. Ruth’s struggle to accept herself and her experiences lies
at the heart of this film. The power of stigma is such that it is
almost impossible for her to do this, because she cannot be open with
others about her experiences, especially at work. If others regarded
her as "genetically different" or "degenerate" (as May puts it) then
how can she possibly respect herself? The value of May’s work is that
it enables Ruth to start the process of constructing a meaningful
narrative of the time before the chaos and madness began. When she
was 15 her younger brother had a cardiac arrest playing
football. Gradually she puts the pieces back together—her loss,
her anger, her voices, and her beliefs about goldfish bowl bubbles—to
reveal a hidden narrative. As she does so we begin to understand;
we can empathise with her.

Ruth’s determination to get back to medicine leads her and May
through dangerous waters. Some will think that their agreement that
she should not be open with her employers about her experiences is an
inexcusable conspiracy. But much is at stake, and not just for Ruth
and May. Standing alongside the contemporary figure of the mad axeman
is an older, more powerful archetype: Asclepius, the wounded healer
who founded the healing sanctuary at Epidauros in recognition of his
own wounds. This myth has inspired many, such as Carl Jung and, more
recently, the US psychiatrist Arthur Kleinman; Rita Charon, a US
physician and a pioneer in the field of medicine and literature; and
Arthur Frank, the Canadian sociologist. At the heart of the story
is the idea that the physician’s ability to acknowledge his
or her personal suffering strengthens the empathic bond that
exists with others who suffer. Mike Shooter wrote movingly about
his experience of depression before he became president of the
Royal College of Psychiatrists: "In the process, I’m convinced
that recognising my own vulnerability has made me better able
to help others, not by offering false ‘hope’ from my own
experience but by being able to share the blackness in the middle of
the tunnel when they cannot possibly see the light at the end."

Of course, such acknowledgment has risks. Risk dominates our
landscape. It forces itself into all aspects of our lives. Risk
of what—of death, murder, madness, and destruction? Our
preoccupation with risk deludes us into believing that it is
possible to avoid suffering. Ruth’s voice tells her to kill
herself. It tells her to kill others. She goes missing. Has she
killed herself? Risk has come to represent a particular set of values
that are tied to the belief that rational thought can solve all our
problems. But such a view has no place for our human ability to heal
through compassion, kindness, and love. Risk makes it almost
impossible for us to work with our patients in ways that are
genuinely healing. I only hope that Ruth’s courage (for, whoever she
is, she has great courage to have allowed this film to be made) will
encourage those psychiatrists and doctors who have experienced
madness to continue their work. We could make it that much easier if
only we could follow the moral in this film and learn to value the
wounded, sick, mad parts of ourselves.

At the heart of
the story is the idea that the physician’s ability to
acknowledge his or her personal suffering strengthens the
empathic bond that exists with others who suffer

The Doctor Who Hears Voices

Channel 4, Monday 21 April, 10 pm

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