The doctor who hears voices...

There seems to be an influx of clinical psychologists on TV at the moment with Tanya Byron's "Am I Normal?" series on BBC2 and "The Doctor who Hears Voices" documentary on Channel 4. Both are worth catching on BBC-iplayer or 4OD.

I love Tanya Byron - she is obviously an excellent clinical psychologist, weaving science and practice together, communicating clearly and with her compassionate but ever so slightly sassy way about her. I watch her and think, "One day, I might get to be just a little bit as good as she is." She is easy to watch and I see her as something of a role model. But then again, I can sit back and watch her without having to think because I agree with virtually every word that comes out of her mouth. Last night's documentary on body image was fantastic imho but it didn't make me think differently. Perhaps because I've worked so much with body image issues, that I've already done a lot of reflection. I think she did a fab job of picking apart what is unusual behaviour and what is dangerous and potentially an illness.

Rufus May on channel 4 was a different matter. At some points I wanted to scream at the TV, at other points I wanted to applaud him.

He came across as such a lone-ranger and that is never something I would want to be. I am sure he did a risk assessment, but I got the sense he relished his independence a little too much. I don't consider myself to be particularly risk averse, but I wouldn't want to take on responsibility for a client with such an active psychosis without the support and professional accountability supervision and team-working provides. Then again, I don't know what supervision Rufus had behind the scenes. And then to invite a client home for the weekend is, well....Mr. Shrinkwrapped might have some objections. I see it as healthy to have some therapeutic boundaries and not just for my own safety. I don't see the people I work with as fundamentally different from me (whatever Rufus might have implied). If I wasn't their therapist and we met in another context, I can often imagine that we would probably get on very well as friends. But I am their therapist and they have their own lives to lead outside therapy and I mine. In some ways, I can imagine nothing more depressing than spending a whole weekend with your shrink! I have friends with mental health problems - but they're friends, not clients and that's how they get treated. They can call me in the middle of the night and they can have more than one hour of my time once a week and yeah, they can come round for dinner and sometimes we might not speak for several weeks or even several months and I don't send the CPN round to check they've not done something regrettable.

I like that he challenges the medicalisation of psychosis but I don't like his attacks on psychiatry and mainstream mental health services. I don't know anyone who works in mental health who would immediately prescribe medication for and/or section someone who was hearing voices. People with active psychosis live in the community and many of them live with their voices in positive and creative ways. Most of them use medication and most are happy to. They find it helpful. As far as I'm concerned, if they know the pros and cons, then it is their choice either way and its not my job to intervere.

Medication doesn't preclude me from working with someones voices, exploring their meanings and understanding where they've come from and what role they play in their lives. I didn't think Rufus's approach was all that radical. I've never had a conversation with someone's voices but its standard practice in clinical psychology to think about the meaning of people's voices to them. I've come across nurses "doing CBT" which basically involves having an argument with someone telling them all the reasons their voices or delusions are irrational. That's not what I do and it's not CBT either for that matter. It's bad practice. Meanings, symbolism and exploration is all par for the course in good psychological therapies. Rufus you are not the only psychologist in the village.

I found the narration really irritating. It was basically voices = mad = sectioning, unless you're seeing Rufus, who loves "mad people". By implication, I guess mainstream mental health workers must have it in for "mad people". In case you haven't realised, I don't like the word mad either - its far too stereotypical. People who hear voices don't run around talking to themselves doing crazy stuff or any of the other stereotypical "mad" stuff. To say that voices = madness = sectioning is a terrifying prospect for someone who is hearing voices and the fear of going mad will only serve to exacerbate their difficulties and might stop some people seeking help.

Romme and Escher clearly showed us that voices don't equal madness (http://en.wikipedia.org/wiki/Hearing_Voices_Movement). I was shocked once when I asked a very informed client if she'd heard of Romme and Escher and she hadn't. She was extremely interested and went off to read about it. It's a shame she hadn't been told earlier as it fit so well with her experience and thinking about voices. I am glad I introduced her to the ideas, but disappointed no-one else did years ago. People need to be made more aware of this - both voice hearers and those who work with them.

And voices, even, even ones that tell you to kill yourself or others does not automatically result in a section. People live with voices and never act on them. Ruth clearly recognised her voices as a voice and didn't act on them. I don't think she would have been sectioned in the CMHT I did my placement in, but I'm going to ask my approved social worker friend next time I see her to make sure.

I object to this characterisation of all psychiatrists as the enemy. Don't get me wrong, I have met some psychiatrists who are, to be frank, an embarrassment to their profession. But I have met just as many excellent ones. I worry Rufus's approach alienates those of us who prefer to take a non-medicalising approach from our more medically-minded colleagues. Our approaches can complement and I would rather co-operate than fight.

But what was most frightening of all was the fact that both Rufus and the psychiatrist (Trevor Turner?) advised people to deceive occupational health. That's awful. If voice hearers who hold down jobs and live productive lives within our communities hide, what chance do those who are really struggling with their voices have? Voice hearing isn't a life sentence to mental institutions - it is simply part of the vast range of human experiences. Sometimes it is incredibly distressing and needs treating with medication and/or psychosocial therapy. Sometimes it is a pain in the ass that people learn to live with. Other times, it is life enhancing and positive. We need more voice hearers to go public and help us to rethink our wider cultural perspective on voices. But that is easy to say - if I was a voice hearer, I wouldn't tell you. I have some colleagues I would tell (notably, the ones who work in psychosis) but there are plenty I wouldn't be comfortable telling. I'd like to know how occupational health would assess someone's suitability for work if they had a mental health problem - would they be as obstructive as the programme suggests? I like to think of occupational health as being there to support people in their jobs - not prevent them from doing it, but perhaps I am too naive and idealistic.