Listen to the wounded healers -- Thomas 336 (7650): = 960 -- BMJ

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Home > Comment > BMJ=20 2008;336(7650):960 (26 April), = doi:10.1136/bmj.39559.417106.3A

BMJ 2008;336:960 (26 April),=20 doi:10.1136/bmj.39559.417106.3A

Views & Reviews

Review of the Week

Listen to the wounded healers

Philip Thomas, professor, Institute for = Philosophy,=20 Diversity and Mental Health, University of Central = Lancashire=20

pfthomas{at}uclan.ac.uk

A drama documentary examines the story of a = mentally ill=20 juniordoctor who rejects conventional treatment but is=20 determinedto stay in medicine. Philip Thomas = reviews⁼²⁰

"I can=92t be a doctor and hear voices," says Ruth, the⁼central=20 figure in Leo Regan=92s powerful dramatised documentaryabout = the work=20 of the clinical psychologist Rufus May, knownfor his = unconventional=20 approach to treatment of mental disorder.The film tells the = true=20 story of Ruth, a junior doctor, whohas begun to hear a male = voice=20 telling her to kill herself.Suspended from her job, she = turns to=20 May, who believes thatthere is no such thing as = schizophrenia and=20 that drug treatmentcan be harmful. He tries to help her = understand=20 the meaningof her voice.

Even if you set aside any views you might have about the merits⁼or=20 otherwise of May=92s work, the film raises important⁼questions. How=20 should we understand and respond to madness?To whom are=20 practitioners accountable=97their patients,employers, the = public, the=20 state? What should we do with sickdoctors: sack them or help = them to=20 maintain a valuable rolein the profession? The film=92s = greatest=20 challenge, however,is to our complicity with stigma. We like = to see=20 ourselves asrational beings guided by science, progressive = ideas,=20 policies,and practices=97but are we really? We may be = doctors,=20 butas citizens we also share the values and assumptions that = characterisea culture and are just as likely as anyone else = to hold=20 stigmatisingattitudes to people who are identified as = mentally=20 disordered.We like to believe that our scientific knowledge = about=20 the brainsets us apart from the popular distortion of the = "mad=20 axeman,"but in reality this is not so.

Ruth heard voices and believed that bubbles in a goldfish bowl⁼²⁰acted like an electrocardiograph, conveying information about⁼the cardiac function of the residents of the care home she = worked⁼²⁰in. Ruth=92s struggle to accept herself and her experiences⁼lies=20 at the heart of this film. The power of stigma is suchthat = it is=20 almost impossible for her to do this, because shecannot be = open with=20 others about her experiences, especiallyat work. If others = regarded=20 her as "genetically different" or"degenerate" (as May puts = it) then=20 how can she possibly respectherself? The value of May=92s = work is that=20 it enables Ruthto start the process of constructing a = meaningful=20 narrativeof the time before the chaos and madness began. = When she=20 was15 her younger brother had a cardiac arrest playing=20 football.Gradually she puts the pieces back together=97her = loss,⁼²⁰her anger, her voices, and her beliefs about goldfish bowl = bubbles=97to⁼²⁰reveal a hidden narrative. As she does so we begin to = understand;⁼²⁰we can empathise with her.

Ruth=92s determination to get back to medicine leads her⁼and May=20 through dangerous waters. Some will think that their⁼agreement that=20 she should not be open with her employers abouther = experiences is an=20 inexcusable conspiracy. But much is atstake, and not just = for Ruth=20 and May. Standing alongside thecontemporary figure of the = mad axeman=20 is an older, more powerfularchetype: Asclepius, the wounded = healer=20 who founded the healingsanctuary at Epidauros in recognition = of his=20 own wounds. Thismyth has inspired many, such as Carl Jung = and, more=20 recently,the US psychiatrist Arthur Kleinman; Rita Charon, a = US=20 physicianand a pioneer in the field of medicine and = literature; and=20 ArthurFrank, the Canadian sociologist. At the heart of the = story=20 isthe idea that the physician=92s ability to acknowledge = his⁼²⁰or her personal suffering strengthens the empathic bond that⁼²⁰exists with others who suffer. Mike Shooter wrote movingly = about⁼²⁰his experience of depression before he became president of = the⁼²⁰Royal College of Psychiatrists: "In the process, I=92m = convinced⁼²⁰that recognising my own vulnerability has made me better able⁼to help others, not by offering false =91hope=92 from⁼my own=20 experience but by being able to share the blackness inthe = middle of=20 the tunnel when they cannot possibly see the lightat the = end."⁼²⁰

Of course, such acknowledgment has risks. Risk dominates our⁼²⁰landscape. It forces itself into all aspects of our lives. = Risk⁼²⁰of what=97of death, murder, madness, and destruction? Our⁼²⁰preoccupation with risk deludes us into believing that it is⁼²⁰possible to avoid suffering. Ruth=92s voice tells her to⁼kill=20 herself. It tells her to kill others. She goes missing.Has = she=20 killed herself? Risk has come to represent a particularset = of values=20 that are tied to the belief that rational thoughtcan solve = all our=20 problems. But such a view has no place forour human ability = to heal=20 through compassion, kindness, andlove. Risk makes it almost=20 impossible for us to work with ourpatients in ways that are=20 genuinely healing. I only hope thatRuth=92s courage (for, = whoever she=20 is, she has great courageto have allowed this film to be = made) will=20 encourage those psychiatristsand doctors who have = experienced=20 madness to continue their work.We could make it that much = easier if=20 only we could follow themoral in this film and learn to = value the=20 wounded, sick, madparts of ourselves.

At the = heart of=20 the story is the idea that the physician=92sability to = acknowledge his or her personal suffering strengthens⁼the=20 empathic bond that exists with others who suffer =

The Doctor Who Hears Voices

Channel 4, Monday 21 April, 10 pm⁼

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