The Doctor Who Hears Voices
You can find out more about Dr Rufus at www.rufusmay.com
Channel 4 is not responsible for the content of third party sites.
The ground breaking film "The Doctor Who Hears Voices" was shown on
Channel 4 on Monday April 21st.
It follows the true story of myself
working with a junior doctor who hears voices and cannot afford to tell
her employers about this experience. The Radio Times have named it as
documentary of the week.
"Leo Regan's superb drama-doc tells the true story of Ruth, a young doctor who was suspended from her job after admitting to feeling suicidal. Ruth's scenes are reconstructed using an actor (Ruth Wilson, who is amazing), and seamlessly woven into documentary footage. Ruth isn't just depressed, she also hears a voice in her head that tells her to do destructive things (kill herself; kill other people), and she has paranoid delusions. Treating her is clinical psychologist Dr Rufus May, a fascinating figure who believes that medicating people like Ruth makes them "stupid" and can destroy lives. Instead, he tries to break the hold the voice has on Ruth by talking to it and working out who it represents. Rufus knows what he's talking about: he was diagnosed with schizophrenia at 18. His imitation of what it feels like to have a voice in your head is shocking, as are the scenes where he engages in "radical dialogue" with Ruth's voice. You're willing for his unorthodox approach to work even as it exposes huge issues over how we treat mental illness and addresses that darkest of questions - what it means to be "mad". "
Mind's Claire Ashby said: "This is an eye-opening documentary that challenges traditional perspectives about the treatment of mental health problems ... It's excellent that Channel 4 has dedicated a primetime programme to this controversial subject and we hope it will raise public awareness and understanding about what it's really like to live with the experience of hearing voices."
If you would like to hear Radio 4's Mark Lawson interviewing myself and film maker Leo Regan on Front Row about making this documentary click here. Mark Lawson introduced Front Row by asking "Is schizophrenia a fiction?" He then described how the programme "argues for a radical new approach to treating the mind" going on later to call "The Doctor who hears voices" a "powerful and unusual film". Its a thoughtful interview: It was nice to see Leo Regan being interviewed and the shoe being on the other foot.
In the film itself I am described as a 'Maverick Psychologist' but I feel it is important to state there is whole school of maverick psychology to which I belong; the international Hearing Voices movement. This movement is combined of voice hearers, therapist academics all on an equal footing. The original Maverick refused to brand his cattle, we similarly refuse to brand people as schizophrenic when they hear voices, instead looking at the voices as messengers about peoples lives. In the film I am shown talking to Ruth's voices. This pioneering approach comes directly from my training with members of the international voice hearing movement. We are an underground network of people who believe we should listen to voices. The film takes this movement to a new audience. Perhaps one day around the world we will all listen to voices!
So, big thanks to the Hearing Voices movement for inspiring us. Special appreciation to my partner Rebecca, for her support. Thankyou also to Leo Regan, Kudos films, Ruth Wilson, Channel 4 and most of all the 'real Ruth' for bringing this true story into people's homes.
I guess for me the film raises a number questions such as:
- Why do people feel they have to lie to the mental health professionals supposed to be helping them?
- Why if you are in a crisis there is nowhere in the UK to go where you can choose whether or not to take drugs and real alternatives are available?
- Can we move towards a society that is more accepting of diverse experiences like hearing voices and willing to engage in a meaningful dialogue about them?
- Why is the fact that mental health problems are rooted in experiences of social injustice and tragedy denied by mainstream psychiatry?
- Does the pharmaceutical industry currently have too much influence on how our society approaches emotional crises and distress?
You can read some of my reflections on the background to the film in a piece I have written called Underground Recovery.
The Sunday Review 18.03.07
The extraordinary story of Dr Rufus May, the former psychiatric patient who inspired our mental health campaign and who guest edits this special mental health issue
Voice of unreason
At the age of 18, Rufus May was diagnosed as an incurable schizophrenic and locked up in a psychiatric hospital. Now, he is a respected psychologist and a passionate campaigner on mental health issues.
He is also the guest editor of this special issue. Here, he tells his extraordinary tale
When I was aged 18, I witnessed first hand how society's approach to mental health wasn't working. I was admitted to Hackney hospital - a psychiatric hospital - and told that I could not leave. On the verge of adulthood, and feeling lost after my girlfriend had left me, I had invested in a spiritual search for guidance. The messages I picked up from the Bible convinced me I had a mission. Seeking to discover what my mission was, I slowly deduced that I was quite possibly an apprentice spy for the British secret service. I was eventually admitted to hospital when I became convinced that I had a gadget in my chest that was being used to control my actions.
Psychiatric hospital was like another world entirely. Queues for the medication trolley punctuated the boredom and general sense of hopelessness. Any resistance to the regime was quashed by forcible restraints and powerful injections. Many friends felt too scared to visit me.
That experience coupled with being given a diagnosis of schizophrenia made me feel like a social outcast. When my parents were told my condition was probably genetically inherited, the die seemed irrevocably cast. Ward rounds felt like elaborate religious rituals conducted by the consultant psychiatrist, with an audience of medical students and student nurses observing, while my insanity was confirmed and long-term drug treatment prophesied. I found the medication made me feel empty and soulless; I could not think past considering my basic needs. The drugs made me physically weaker and affected my hormones so I became impotent.
I was concerned about this. However, to the outside world, because of the mind-numbing effects of the drugs, I was less focussed on my spy and spiritual beliefs. The doctors pronounced that I was responding well to the medication. I was determined to stop taking the tablets and injections as soon as I could find other ways of staying calm and centred.
The majority of fellow patients were revolving-door patients. I myself was told I'd be back. It was true: I was readmitted twice before I managed to escape the role of mentally ill regular customer. But I was luckier than most: as well as my parents visiting me daily, a close friend came back from selling pots and pans to US servicemen in Germany and began visiting me daily too. I started to pick up on her belief that this breakdown, or whatever it was I was having, was something I could get over.
When I was 12 years old, I had witnessed my mother make a strong recovery from a disabling brain haemorrhage, so instinctively I knew that I could turn my life around with the right support. So I decided not to believe in the doctor's wisdom and planned to get a job as soon as I left hospital. While I was still in hospital, I started going to churches and community centres offering to do voluntary work. Although I must have seemed a bit odd, I found many kind people who were willing to give me tasks to do and slowly I started to rebuild some social skills.
When a friend and fellow patient, Celine, took her own life after being heavily over-medicated, it became a turning point for me. It was a Caribbean funeral and hundreds of people turned up for it. It contrasted strongly with the absence of support she had had when she had been alive and hearing abusive voices from her past.
I realised then that I had found a cause that needed no delusions to support it. Like Celine, I had gone through the strange process of being talked to as if I was not there, of professionals trying to suppress my odd and disturbing behaviour with drugs without trying to understand why I was acting as I was. No one seemed willing to think what was it like to walk in my shoes.
We, as a society, were making people madder and maybe I could do something about changing that. What if I could make a different kind of come-back to the psychiatric ward, as a mental health professional? Then perhaps, in Trojan horse style, I could help dismantle the myths of the psychiatric hierarchy. The more I thought about this, the more I realised I would have to keep my former identity as a psychiatric patient strictly under-cover.
When a junior psychologist informally questioned my diagnosis of schizophrenia, suggesting I had had a temporary psychotic episode instead, it made me think maybe psychology was a way of doing things differently. So my mission was becoming clearer: I would train as a psychologist. I knew I needed to sort myself out to some extent before attempting this journey.
My first job, straight out of psychiatric hospital, was working as a night security guard in north London's Highgate Cemetery. I now think that patrolling the heavily wooded grounds in the dark was a deeply therapeutic activity. With no time to daydream, I had to stay aware and face my fears of the dark and the unknown. I also think just walking in close proximity to nature was a very healing process.
It was during this time that I successfully came off my psychiatric medication, against doctors' advice. I then spent several years doing a range of jobs and learning creative ways to express myself, using dance and drama. I shifted my focus from thinking about myself to trying to help others, while making sure I looked after my mind and body. I used the outdoor gym on Parliament Hill, sport and breathing exercises as natural ways to manage my moods. I was careful to avoid unreliable or abusive friends and stick with people who had stuck by me. Studying sociology helped me understand the wider structures of society, demystifying such things as the class system and power relations between men and women.
I was reminded of the prejudice against the subject of mental illness when a right-on community centre refused to support me and a group of amateur drama students putting on a play about a nervous breakdown. Nevertheless, from drama classes I learnt the art of re-inventing oneself through improvisation. I will always remember how one of my drama teachers impressed upon us all the message that "this life is not a rehearsal". My confidence in acting was to become useful over the next 10 years of carework and psychology training, where I chose to keep quiet about my previous role as a psychiatric patient, to avoid the possibility of discrimination.
For me, the dividing line between the mentally ill and the sane was more a question of social boundaries than actuality. I had found some very mad people in hospital very helpful and some of the so-called "well" nurses quite bullying and hostile, it suggested to me that to some extent madness was in eyes of the beholder. I also knew that my own madness had been meaningful; for example, my fantasies about being a spy had given my life meaning and my search for a spying mission was a metaphoric search for a meaningful quest in my life.
My training as a psychologist in the early 1990s, coincided with a time when psychology as a profession was beginning to interest itself in trying to understand and work with madness, an area which was usually associated with the more medical, drug-prescribing profession of psychiatry. For the past 10 years I have been working as a psychologist covering a broad range of mental-health problems. I know that to really help someone who is deeply suffering or confused, we need to be very creative and offer a wide range of resources.
In Bradford we have self-help groups where people are encouraged to help others as well as themselves. We also create spaces where for example art, spirituality and physical relaxation can be explored in a number of different ways. We have Tai Chi classes, dance classes and African art classes, as well as political and cultural discussion groups. If people hear troubling voices, I want to understand these beings that haunt them. I will sometimes communicate directly with the voices and try to facilitate a peace process between the voices and the person hearing them.
I must be living proof that people can resist so-called command hallucinations, because initially many voices feel threatened by me and tell the voice hearer to attack me. I am still unscathed, which is a strong testimony to the fact that people who hear voices can learn to resist the most bullying and aggressive of them. So instead of encouraging people to suppress their experiences, which I think generally makes them worse, I try to assist people to face their demons in their own time.
Is society any madder than 20 years ago when I was in hospital? It seems to me that some things are getting worse and some things are getting better. People are getting bolder in talking about their experiences of distress and madness. This is refreshing; the status quo, in which well-meaning professionals and charity heads are the only experts, is starting to be challenged. Britain is a leading light in this consciousness raising, where people are coming out more and more about their experiences of emotional distress. Consequently, a broader range of ideas and approaches to what helps us heal troubled minds is being listened to.
At the same time, the might of the pharmaceutical industry is stronger than ever before; drug companies are ruthlessly promoting the simplistic and misleading "chemical imbalance" theory of mental distress, while marketing our discontent as diagnosable medical illnesses. In the US, they have been very successful, with roughly 10 per cent of women taking anti-depressants and an astonishing 10 per cent of children being treated for ADHD with the amphetamine derivative Ritalin. Each year in this country, prescription rates rise for psychiatric medication.
While I am not against all use of mind-altering drugs, this trend is worrying. I think that when drugs appear to work, the main effect is that of masking a patient's problems, but as soon as you remove them the problems bounce back, often with a little more oomph due to the fact they have been artificially suppressed. You also need more and more of the drug to achieve the same effect, because our brains build up a resistance to all mood-altering substances. We are then likely to experience the more negative effects of the medication and develop a dependence.
So drugs are limited in their usefulness and are perhaps best used as a last resort and for short periods of time. This is not going to be popular in the board rooms of Big Pharma, the Big Brother of mental health. But if we are going to make progress in our quest for healthier communities, we are going to have to limit the pharmaceutical industry's influence on how we understand our minds and approach the recovery process.
Now we're talking: Tales of breakdown and recovery
These brave people have dared to break one of society's greatest - and unhealthiest - taboos, by speaking openly about their mental health issues.
From well-known figures coping with stress and breakdowns, to lesser-known pioneers finding remarkable ways to overcome sometimes extreme and terrifying psychological difficulties, their stories are here to inspire...
Tim Lott, 51, writer
It started as depression in the mid-1980s, then I had a full-scale nervous breakdown in 1987. I'd always been given to feelings of blackness and anxiety, but didn't realise what it was. Depression was still quite taboo. I didn't really believe in it either; I thought it was the same as unhappiness. I didn't understand it as a clinical illness.
My symptoms were fairly standard: low feelings of self worth, inability to respond emotionally, and a sustained low mood. Not that anyone noticed because I always appeared quite exuberant.
I never sought treatment because I didn't want to be tainted by the stigma of a mental health issue. Eventually I took to my bed and just became a bit of a zombie. I lost the ability to speak for a while. It was very upsetting for everyone around me. The advice I got from friends, very strongly, was don't take any medication. We were living in the aftermath of the intellectual climate of One Flew Over the Cuckoo's Nest and the idea that mental illness was a form of oppression imposed by society.
I got to the stage where I became suicidal - standing on the top of high buildings and so forth. Luckily I never had the guts to do it. My mother suffered depression as a result and killed herself a few months later. By then I was taking medication, so I felt better. I was deeply unhappy about my mother's death rather than depressed. I had got better in the space of a few weeks. I felt better than I had done for years. The medication helped me a lot.
If I had to trace it all back, perhaps it was to do with when I was a baby. I was born with cancer and was very close to death for the first few months of my life. From a psychoanalytical point of view, my early life experience was one in which I was acutely aware of death. On the face of my mother I would have seen terror and fear, and that would have been very traumatic for me and could have left me damaged psychologically. These things do leave an imprint but it's an incredibly complicated issue. I can only guess. I never will really know the reason. No one does. Lena Corner
Meg Mathews, 41, designer
I thought my life was on track but then I hit 40. It wasn't a mid-life crisis but I just had a strong feeling of "is this is it?" I had very low self-esteem and was looking for approval. I became very dependent on certain people and I was really weak. I was living in fear. I put pressure on myself for all the usual things - I wasn't in a relationship, I wasn't a size zero and I'd hit 40. I wasn't at the stage where I couldn't get out of bed in the morning, but even getting dressed seemed like a massive, massive thing to do.
I went to Ibiza and ended up sitting there thinking, what's good about this? I knew I wasn't right and had to get myself better. I'd never been to therapy and I realised I'd never even discussed my divorce [from Noel Gallagher] or any of the madness that was my life. In 1997, I had gone from being a normal girl to being the most written-about girl after Lady Di and the Spice Girls. I'd go to parties, but there was always a shitty piece written about me the next day. I took it all to heart, but there was nothing I could do. I was told to pick myself up, to hold my head up. I had a rock star boyfriend and millions of pounds. All the time I was like "yes, yes everything's totally fine".
I went to see the head psychiatrist at the Capio Knightingale in London - it's a bit like the Priory, everyone's been through there. I said, "I don't feel like Meg any more," and he admitted me the next day. I was resident for a month and then on day-release for another. I went in with the attitude that I'd get out exactly what I put in. I did all sorts: stress management, dependency and cognitive therapy. It's all about starting over and being given the tools of everyday life. It's also simple. The thing I found most helpful was just sitting with other people sharing, talking and letting go of stuff.
I've become really creative. I have a wallpaper line out and am currently working on designing a tea set as well as a jewellery range. I'm also now really in touch with my emotions. I didn't realise, but I hadn't been for years. I'd have three glasses of champagne before I stepped on to a red carpet because I got so nervous. Now if I'm nervous, I just don't go. It's all about being in touch with Meg and being able to sit with Meg. I talk things over with myself before I agree to things - if I don't, I could easily slide off into my old behaviour. Now I'm no longer seeking approval, I'm much stronger and I feel at peace with myself. I believe in myself and I believe in Meg. LC
Sarah Tonin, 38, artist
I don't remember being particularly happy as a child, but it got much worse as I grew up. When I was 18, I was sectioned. A psychiatrist came and off we went for a little break in this terrifying hospital. I think I was there for about a month. After that, all I remember is complete and utter despair and confusion. I used to believe that I was infested with maggots and worms. My arms are covered in scars from trying to dig them out. I still have hallucinations but I've learned to cope with them.
I think I've probably had between 60 and 80 sessions of electro-convulsive therapy (ECT), although I can't remember exactly. It left me utterly confused. I look at psychiatry as a stinking, deluded corpse of abuse. They brutally strip-searched me and I do feel like they've damaged me.
In 2001, I got involved with Southwark Mind. Its philosophy is be proud of who you are and celebrate your madness. Then a group of us started an organisation called Creative Routes, run by the mad for the mad. We were pissed off with victimisation, patronisation and discrimination. Suddenly I didn't feel so cut off. I realised I was a very creative person. Last year we organised an arts event called Bonkersfest and over 2,000 people turned up.
I was in Starbucks last year and a woman was wearing a sleeveless top, and her arms were just as scarred as mine. I said "you're brave" as I always kept mine covered up. She said "try it", and I did. It was an act of freedom. I have also become a campaigner. We are in the process of taking Patricia Hewitt to court because she wants to close the only 24-hour psychiatric emergency walk-in clinic in England.
When you're under the power of the services you don't have any control over your life. Now I do. I realise now, the only way to make a change is to do it yourself. People didn't take us seriously in the beginning, but they do now. We call ourselves the mad miracles. LC
Bonkersfest, is happening on 2 June, Camberwell Green, London. For more information, go to www.bonkersfest.com
Peter Bullimore, 45, trainer
I was seven years old when I first started to hear voices. At first I thought it was like an imaginary friend - but the voice was always external. I started to get other voices too, which continued until I was 13, when they just stopped. I never spoke about it. I got married at 17 and became a father. I was working seven days a week and felt a lot of stress. So the voices returned - only this time they came back tenfold. I also became paranoid. One night Freddie Kruger [from A Nightmare on Elm Street] appeared in the back of my van, telling me he's going to kill me and cut me open. I was petrified.
The voices really started to encompass my life - they became very demonic and dominant - constantly telling me to do stuff. My wife started to notice and told me to get help. I stopped going to work and for three weeks I just curled up in a chair. I didn't wash, eat or shave. I was locked in a world of constant voices, paranoia and depression. It destroyed my life. I was checked into a psychiatric ward, where I stayed, on and off, for the next 10 years.
I was taking 25 drugs a day and I was frightened. My mother died, which I found really difficult - I couldn't cry at the funeral as my emotions had been blunted with drugs. I couldn't grieve and I felt so bad. The voices kept saying "you should slash yourself - slash yourself". If someone tells you something often enough, you have a tendency to do it. So I did.
Eventually I got a worker, Sally, who is an occupational therapist, who started to treat me and not my diagnosis. She was a godsend. When I got discharged, Sally encouraged me to set up a Hearing Voices group with her. I remembered a network I'd visited once, years before, and tracked them down. They told me to read Accepting Voices by Marius Romme and Sandra Escher. It was the most inspiring book I've ever read. It's about people's different ideas on voices - and how you can cope with them.
So I started to listen to my own voices. A lot of the time they'd say stuff like "if you go to sleep tonight we're going to murder your children". So I'd shoot up to the kids' house the next morning, and they'd be alive. It made me ask, "They've been saying this for months and they've never been able to do it - so what can they actually do?" So I started to alter the power balance in my relationship with the voices; I realised they couldn't inflict physical harm.
Once I'd removed the fear, I started to rebuild my life. If my voices say to me "why don't you kill yourself", I'll think "perhaps I'm just feeling a bit stressed". I see them more like a warning sign now. I do a lot of lectures on it now and a lot of individual work with people, usually those that the system can't recover. I've had a lot of success. Adam Jacques
For more information on Peter's Campaign to Abolish Schizophrenia Label (CASL), visit www.asylumonline.net
Trisha Goddard, 49, TV presenter
I was living in Australia, working as a government mental-health advisor and television presenter. Up until that stage, mental-health issues happened to other people. When I had my breakdown, there were lots of things that contributed: two simultaneous careers, my childhood experiences, who I was, and my marijuana use. So it didn't take a lot more to cause the breakdown. In this case, it was my then husband's infidelity.
I didn't see it coming. I'd been to the doctor, they'd put me on anti-depressants. I remember thinking "these bloody things aren't working". I took more, added a bottle of brandy and kept taking other pills, then came to in a locked ward on suicide watch. I felt terrified; I didn't move from my bed for about three days. This is someone who had interviewed the Australian prime minister several times, and Nelson Mandela, but I was too scared to look out at the leaves moving in the wind outside.
There was one nurse there called Elaine. She did everything for me. I couldn't talk to anybody. I was scared of people, scared they could see inside my head, read my mind and see what a loser I was. I had a television and I'd just sit in front of it. Elaine would come in and make remarks about what was on the television - and because it wasn't about me I could talk about the show. She was so, so clever. I had psychiatrists and all the rest, but that lady got through to me.
I then had a mix of weekly sessions of psychotherapy. It was the start of my road to where I am now. I had cognitive behavioural therapy to work out why I did what I did. I was eventually released from the ward and began to learn to live another way. In 1998 I was head hunted to work in the UK. Trisha was the first full-time job I'd had since my breakdown in 1994. But I now had the tools to fashion a life that wasn't exclusively based around work. I know now I am prone to depression. I have an early warning system that is my family. They know if I start working too much, sleeping too little. They'll point it out in a loving way, and I take steps to nip it in the bud. AJ
Jonathan Aitken, 64, former MP
From the moment of being caught out in the libel case to the moment of going to prison, it took just over two years. I went through - in fairly short order - defeat, disgrace, divorce, bankruptcy and jail, all in the glare of a noisy media. I'd been an extremely busy person. Then, after losing the case, I had nothing to do - apart from go on a disastrous downward spiral.
I started to sleep a lot in the afternoons and go to bed early at night. In the morning I wouldn't want to get up. Everything was disintegrating. There were very bad days - I was never seriously suicidal, but it did cross my mind that maybe this would be a good course of action. I felt utter hopelessness - that I had no future and no life ahead of me I could see. I remember thinking, "How am I going to earn my living?"
I did talk it over with my GP, who asked if I was depressed. I said, "Yes, but not heavily." He gave me some antidepressants. I did take them for all of two doses, and started to feel giddy. I threw them away.
Prison was better than I expected; I found my feet in an extraordinary community. It was a survival test but it wasn't an impossible one. One or two inmates were quite hostile on my first night. They started a tremendous chant along the lines of "let's get Aitken", which was terrifying. Probably about halfway through my time in prison I think I'd overcome the worst of my depression.
I sometimes say I coped thanks to my three Fs: family, friends and faith. My family were wonderful and came to see me regularly. People sometimes say in these situations you find out who your friends are, and that is true: my close friends were wonderful in all kinds of ways. And I think adversity can sometimes be the gateway to a deeper faith - which was certainly true in my life. I started visiting a nearby chapel after the collapse of the libel, and ended up going every day. And in prison, it was a source of great strength for me. AJ
Odi Oquosa, 37, artist and shaman
I am from Nigeria, I'm a textile designer and a craftsman, but I am also caught up in two worlds. Elements talk to me and teach me to work with the forces of nature. That's what becoming a shaman is about. I was working in Switzerland when my voices started telling me I have to go home to Nigeria and become a shaman. So I went back in 2000.
At the time a vigilante group - called the Bakassi Boys - organised by the Nigerian government - were killing people, burning down houses and bringing fear. I decided to confront them, by going on television and speaking out. I even went to meet with them. On my third meeting they abducted me, telling me they wanted to kill me.
They tortured me - my body is full of marks. I was strapped down, beaten with machetes and cut all over. My mother called my cousin, who was a representative in the House of Assembly, who in turn called up the Governor and, after a long dialogue, they released me. After that I started having panic attacks. I couldn't sleep. I'd see people chasing me with machetes, even in my dreams. But my voices told me I needed to go through this to understand Shamanism; I had to be wounded to understand about pain. I started painting and writing stuff down about my abduction experience. But then the Bakasi boys came to my office and burned down the whole place. I lost all my pieces - all that energy that it had taken to make all these things and understand stuff, and it was gone. It was hell.
In 2001, I came to the UK and brought a lot of evidence and videos of what these vigilantes had been doing to people. But staying in London made my panic attacks worse. It was a hard time. I'd have panic attacks everywhere. I'd start sweating and all I could hear was negative voices. I'd think the people around me were following me and wanted to kill me. I realised I had to move away from London to the sea, where I would be able to communicate with the elements and get myself better. So five years ago, I moved down to Brighton.
Because of the problems I was having, I had to talk to the doctors, who sent me to a psychiatric ward. They saw me as a mad person, who was delusional, as I was still talking with my voices. My social worker was the only person who trusted me.
As my panic attacks continued, I started getting angry at my voices and myself, then one day they told me, "You have to fight." So I brought an old Egyptian sword and hung it in my flat. It was my tribal sword. Next time I had a panic attack, I saw the machete men, but this time they ran away. I thought, "I've got the key now. There's no need for me to be afraid." It was a symbolic event, and now I am fearless again. I haven't had any panic attacks since.
Now I help others who have had similar problems. I see myself as an African psychologist. The modern, European approach is only geared to the body and mind - not the spirit. These things are not clinical - psychiatrists can not cover it; I think us shamans can. AJ
"I killed the being who gave me life"
When someone in the grip of mental illness commits murder, the true story is often lost in a tide of sensationalism.
In this extraordinarily frank account, 'Jimmy Smith' recalls the breakdown that led him to take his own mother's life, and its shattering aftermath
I swear I felt her spirit as it left her body. There seemed a great expression of "at last I am free of that life". Free from a lifetime of suffering - the unwanted reason for a shotgun marriage, her warring parents, her alcoholic father, her own disastrous marriage, depression, anxiety, low self-esteem, four children born in quick succession - and precious little support. In a sense, the moment I killed my mother I felt the paradox, for what I was inflicting on her, under the influence of madness, was the greatest violence I could muster to destroy her forever, for all that she had grievously inflicted upon me. Yet she had escaped.
I was left. In the most horrible circumstances imaginable. That insight into her soul's flight never helped me one bit in the horrible 10 years that followed. I had killed the being who gave me life. It was New Year's Eve but the story began how many generations back I will never know.
Both of my parents' fathers had difficult lives. One was an alcoholic, the other was left a partial invalid by the horrors of the First World War. On the paternal side, my grandmother was of the Victorian era, cold, brittle, divorced from warmth. On the maternal side, feisty, by one account stirring up trouble wherever she went and described in one word by my mother: "the bitch". As a child I witnessed my mother's parents fight; they stood there enjoyably screaming hate at each other. That was the way they loved each other.
My own parents also had the most acrimonious relationship. Usually taking the form of my father's cruel mental victimisation, the bitterness and hatred within him at times seemed bottomless. Much of my parents' hatred was turned on me. I can feel my mother's energy now as she said things like, "I wish I had strangled you at birth", "you know where you are going to end up" (laden with doom), and the most confounding for an adolescent "you male slut". To my father, I was a great disappointment and worse, I sided with my mother. I also suffered his beatings, but it was the mental, the emotional abuse that was worst of all.
By my teens the damage had already been done. The first tender months I took it as I emerged into my parents' mayhem. It was the environment that created sickness in me. I am a highly sensitive person, the second child and first boy - I sensed my mother's distress as all babies do. The birth had been a bad one, according to my mother, the most difficult of the four children - a long, painful labour for which my father was not present. Perhaps I hadn't wanted to come out, sensing how life was going to be.
Faced with an antagonised, enraged, and unsupported mother, I shattered into pieces. I could never develop a healthy sense of self, faced with this terrifying being. How could she give me the love I needed with the struggle she had? I internalised that rage. In retrospect, trying to puzzle all of this out, I came up with what some psychologists call a core belief, others a primal lie: "I must be evil". It made sense at the time.
As I grew, I learnt that to get my mother's love I had to give up my masculinity, my sense of self. It wasn't OK for me to behave like a boy, and when I did that's when she got hostile and the insults flew. Essentially, this early castration was what led to events on that day 25 years later. Imagine a spring being wound up tighter and tighter, year after year; when the spring finally breaks there is no discrimination over what happens.
I did, though, have a better connection with my father which has given me some strength and now the relationship is very strong, our disaster, ironically, having reunited us.
I was followed by twin boys. They fared better than me, being more robust and having one another. Because they came later, and I was satisfying the emotional needs of my mother, they didn't live with the same dynamic. As teenagers they simply labelled our parents as "Bum and Bad". By being the most sensitive and the weakest, as time went on, I became, willingly, the family scapegoat. The unhealthy emotional load on the family needed to be discharged and it went through the weakest link. Even now the family as a whole doesn't understand what happened and mainly see it all in terms of the illness.
In order to support my mother, I never grew out of an emotionally incestuous relationship with her. I was sucked in and overwhelmed by her. She needed this in order to survive. I remained psychologically enmeshed with her for years after her death. During their marriage, this created added rage and violence from my father towards me, because as one rather famous woman put it "there were three of us in this marriage".
I remember being numbed out in my teenage years, except for bursts of violent creativity, such as throwing stones at buses, later vandalising street furniture and then, with peers, wrecking schools. My life got good when I left home, travelling across Africa and Europe and belonging to the drug culture. I was careful, though; I mainly used cannabis, but I certainly wouldn't blame that on creating my illness - it didn't help, but it's obvious that I always would have broken down.
In the mid 1980s, while working on a fruit farm in Denmark, a woman asked me if I'd fought in the Falklands, as to her I was in the same state as her brother when he came back from Vietnam.
Anyhow, while picking plums and blackcurrants, I decided I wanted more meaningful work and a relationship. I came back to London and began working with homeless people and found a girlfriend. Unfortunately, the relationship and adult responsibilities opened me up to how vulnerable I really was. I began to hear voices and within 18 months had become fully psychotic. Most of my inner circle didn't have any experience of this and it went unchecked, plus I didn't reveal the full, dangerous extent of it. I really didn't want to go into a mental hospital where the chances were I would be treated horribly.
At first I would just hear voices calling me a "wanker" on the bus, but these hallucinations steadily became more terrifying and persecutory through Halloween and onwards when I believed that there were forces that wanted me dead and were messing about with me. I was also at times feeling violent, and believing that other people I met were murderers. This world was a living nightmare. I sometimes believed that this was the reality of adulthood and I had to find some way to get through it and survive - without help.
I asked my GP for help; he asked me if I felt I needed to be hospitalised. Inside I was screaming "yes, yes", but reason said, "No, I just need to get through this bad patch." I broke down and asked my mother for help on the phone, but she didn't know how to respond and didn't pass the message on to my father, as I had asked her to. Our mail was also stolen, so I missed the appointment with the psychiatrist the GP had referred me to.
I took unpaid leave from work and then the worst possible time came up: Christmas. I just became more and more ill, hearing voices all the time, believing that black magic was going on around me and that people were trying to get me to commit suicide. I spent Christmas at my girlfriend's family home, (omega) visibly unwell. Her mother was an experienced social worker but didn't seem able to get involved in her own home. I was left to my own devices.
On the train down to London I thought a black baby was the devil. Although very sick, I kept up a front, but I believe the signs would have been there for the more experienced person. How I wish I had taken my clothes off and run up the train, or some other bizarre act, but I was determined to stay in control and not let it beat me. According to my girlfriend I went from madness to complete lucidity, at which times she thought I was OK.
It had exhausted my girlfriend being with me, so I had made that journey down south on my own. It was a very distressing time as I felt all the people who were closest to me were involved in trying to kill me. Hence I couldn't tell them exactly what was going on. After a night and a day at the family home, I ran out saying, "It's not your fault but I just can't live with the family anymore." I saw my mother as the grim reaper and when I went to the train station, I had to hold very tightly on to a bench as there was a powerful compulsion to jump under the incoming train.
I met my girlfriend on the train as she came down the line. By now I was dangerous to her. Prior to this I had been thrown off a train by the guard who showed me his ID card which I read as "grim reaper". I said, "You don't understand what's happening to me I've got to stay on this train." Having left the train, I nearly went for help, but I thought the police would ridicule me and everyone else - such as the Samaritans - seemed in on the plot to kill me.
Persuaded and calmed by my girlfriend, we went back to my family home the next day. I wanted to give people Christmas presents, to be normal and "good". Finally, while in the kitchen after weeks of persecutory voices and days of no sleep, I lost control and went berserk. At the end of it I had strangled my mother and stabbed my cousin.
The horror for my family was immense. Unfortunately neither my brothers nor my father had been there to intervene. For the family it must have seemed inconceivable that I could become like that. I went to prison and then a special hospital. My father, remarkably, immediately became supportive, sending down his solicitor, and held the family together, encouraging everyone to be supportive. This was important to my survival and recovery and I had many visits over the years.
The years in the hospital were very unpleasant. Total disaster had befallen me. I was confused. I was both perpetrator and victim. I was told I was not responsible, but the atmosphere was one of heavy punishment. The horror of killing was a really traumatic memory and the impact of ending up in such an environment was massive. I had to face my own sickness and a future that had been shattered, in a place where there was very little compassion - in fact many staff were harsh in their treatment, and many were directly abusive. To be kicked when I was down as low as I could get could have finished me off, as it did others.
The media in particular makes a lot of money out of such places and it always used to horrify me the way they would constantly rehash stories about Brady or Sutcliffe which can't benefit anyone in real terms. Fortunately, the friends and family who came to visit me kept me afloat. It hurts me still to recall the times I came back from being visited to go through day rooms where people sat there and never seemed to get visitors at all.
However, there were also some helpful and caring people working in the hospital and I formed close bonds with peers in similar predicaments. These were very sustaining. After four years, I found my way to the most amazing, caring female nurse, called Julie. There was a great connection between us. I spent three years working with her. Prior to this I had been devastated - at the end of it I was ready to leave. So committed was she that she once told me that she saw me more often than her kids.
There were also a lot of activities at the hospital, if you were well enough, and self-motivated. These were very helpful in the recovery I was making. Without them I would have really struggled to recover from the situation. I took full advantage, edited the patients' magazine, played football, did a City and Guilds course in gardening, took part in theatre and so on.
I then moved to a less secure hospital; after the serious prison atmosphere of the last place, this was like a honeymoon. The staff were so much more friendly. I spent about six months there and then went to a hostel.
When I came out, I was very vulnerable, being crippled with guilt, anger and paranoia. Unfortunately, I was then given a specialist mental team who had a great lack of understanding as to why I became ill, who I was and what I was struggling with. Legally, the team were responsible for me. This is very threatening for a psychiatrist as there is such a blame culture (they can have their career stalled or destroyed) in this country, fed by media sensationalism and distortion around schizophrenia.
To then not understand the case he was dealing with and to believe that there was a possibility that I could do the same again quite easily (as he told me more than once), I know the psychiatrist found terrifying. This combined ignorance and fear destroyed the relationship and, sadly, rather than being a support they often disturbed me.
I was fortunate, however, in that I knew what they were like and had very little belief in their limited medical-model understanding. I had been educated in its failings over 10 years. I found an excellent private psychotherapist within weeks of being out. It is to him that I am thankful for my recovery to this point.
As it is now I work, I have healthy relationships with my family, I live unassisted, and I have a wide circle of friends. It is 10 years since I left the Big House. I have invested a lot on my path of healing. I have done many differing things, explored spiritual groups, dancing, Reiki, and martial arts, I've read many self-help books. Fortunately, I have an in-built navigation system which has enabled me to find healing. My experience of forensic mental-health services is that they are largely reductionist, that is, they apply the limited understanding of the medical model and are dominated by risk, medication and punishment. We are routinely oppressed by a system that often refuses to hear what we need, and bends the truth to fit its fundamentalism.
I wonder how many others in the system have similar stories to tell. As a nursing manager I liked once said, so many people are in these places simply because of circumstances that push them over the edge. However, once there, we face stigma, voyeurism, bullying and others' judgement. Most of us just hide when we come out and live lives with our Big Secrets. There is little point in baring our souls to people who can't understand.
It brings to mind the penny slot machines where pennies drop and slowly push other pennies towards an edge, forced there by pressures they have no control over... Bang! Another headline. Or, as Robert Graves put it, "To be mad is not easy, will earn him no money, but a niche in the news."
Jimmy Smith is a pseudonym
Is there a link between madness and creativity? Many illustrious thinkers and poets, including Shakespeare, have believed that genius is only a step away from insanity. John Walsh goes in search of evidence in our contemporary culture
"The only performance that makes it," Mick Jagger's rock star advises James Fox's gangster in Performance, "is the one that achieves madness." This embracing of derangement has been a debating-point in our experience of art for centuries, and is found everywhere today. In Peter Shaffer's Equus, recently revived in London's West End, a psychiatrist called Martin Dysart wrestles with the problem of "curing" the mad-but-ecstatic teenager Alan Strang: how can he force Strang to relinquish his communion with a horse God and return to an "utterly worshipless" normality? Shouldn't the boy be "allowed" to be insane, when it gives him something to worship?
In a much-discussed TV documentary last year, The Secret Life of the Manic Depressive, Stephen Fry explained that hundreds of highly intelligent, creative people have been diagnosed with the condition, before telling the world (with a hint of pride) "I have extremes of moods that are greater than just about anybody else I know." He revealed that many victims of "bipolar disorder" preferred to endure the aching chasms of depression without therapy or drugs, because of the creative high they experienced in the manic stage. "I wouldn't be without it," he said "for all the tea in China." The former pop star Adam Ant (Stuart Goddard) and the glamour model Sophie Anderton have also revealed themselves to be sufferers, as have Robbie Williams and Caroline Aherne.
At Tate Britain, where the paintings of the homicidally mad Richard Dadd are on display, we can inspect Dadd's mysterious The Fairy Feller's Master-Stroke, which he painted while in Bethlem Hospital, sent there after stabbing his father to death in 1843, thinking him the devil in disguise (he thought he was personally under the power of the Egyptian god, Osiris). Many art lovers have looked at his fairy paintings, at the microscopic exactness of his tiny figures, human and grotesque, and concluded that no sane person could have managed such intricacy. They are, it's been said, "positive symptoms of insanity."
Do the mad have access to hidden worlds of imagination, denied to the sane? Is madness the final frontier of art and science? Is genius only a step away from insanity? Many artists and writers, scientists, philosophers and intellectuals have thought so in the past. "Great wits are sure to madness near allied/ And thin partitions do their bounds divide" wrote John Dryden in 1681. The idea of creativity as divine afflatus, the breath of God, turns easily into the divine fire, that ignites the imagination but consumes the thinker. Inspiration may suffice for the minor thinker, writer or inventor; but only the divine furor will do for the world-changing genius.
In the 20th century, as quantum mechanics made the world of physics increasingly unknowable, the "mad scientist" and Einstein-haired boffin became comic figures, men deranged by their excessive devotion to the not-yet-known. In past centuries, poets gave themselves airs as divinely maddened. Celebrating Christopher Marlowe in 1627, the poet Michael Drayton approved "that fine madness still he did retain/ Which rightly should possess a poet's brain." It should? William Wordsworth, never himself a candidate for the funny farm, averred, "We Poets in our youth begin in gladness/ But thereof come in the end despondency and madness." The first line was adapted by Eileen Simpson for her book Poets in Their Youth, a memoir of the poetic circle that surrounded Robert ("Cal") Lowell and John Berryman in the 1950s and 1960s, when they were contenders for the title of America's Top Poet. Lowell suffered frequent bouts of mental illness; Berryman killed himself and left a note that read, "Your move, Cal."
Shakespeare himself identified the connection in A Midsummer Night's Dream, when Theseus reflects on the creative act of turning unknown and unearthly things into words:
"The lunatic, the lover and the poet/ Are of imagination all compact./ One sees more devils than vast hell can hold,/ That is, the madman.../ The poet's eye, in a fine frenzy rolling,/ Doth glance from heaven to earth, from earth to heaven/ And, as imagination bodies forth/ The forms of things unknown, the poet's pen/ Turns them to shape, and gives to airy nothing/ A local habitation and a name."
But what do we make, today, of lunatics and poets, scientists and fruitcakes? Do we still see a link between creativity and madness? For Professor Philip Thomas, of Lancaster University's psychology department, the answer is a qualified yes: "It's certainly interpreted that way. There have always been people in societies and cultures who have different experiences of reality compared with the majority, and there's always been an overlap between people who have those gifts, or insights, and people who are identified as suffering from mental illnesses."
What's the distinguishing factor about the mentally ill writer or scientist? "Strangeness," he says firmly. "It's the strangeness of people's experience, and what they try to communicate about it, that's dangerous, threatening, anxiety-provoking to those of us who have conventional rationalities, if I can put it that way. Those people often seem to be visionaries, shamans, people with privileged access to a world which ordinary mortals don't have access to - either that or they're seen as brilliantly creative. In the past 400 years, there's been a tendency to see certain people, from our own time as well as retrospectively, as great minds, geniuses and brilliant thinkers but also as people who showed signs of mental instability."
Artists, he says, do not have it all to themselves; scientists suffer just as much from "manic creativity". He instances John Nash, as played by Russell Crowe in A Beautiful Mind - a great mathematician who watched himself gradually losing his reason. "He was seeing something denied to the rest of us," says Professor Thomas. "The trouble is, such people are trying to put the unspeakable into words. But since the time of Plato and Aristotle, we've been preoccupied with the idea of the rational, self-aware, speaking self, using language understandable by (omega) others. Those who experience madness are cut off from the mainstream of western thought and society."
How does it feel from the point of view of the sufferer? Sara Maitland, 56, is a prize-winning novelist and short-story writer, the author of several works of theology and gardening, and a teacher in creative writing. She has also, since her teens, suffered from visitations of mental disarray. "I was very young in the late 1960s, and there was a glamour about madness, in those Laingian days. I wasn't eating or looking after myself or 'conducting myself in a proper manner'," she says, emphasising the last words with bolshy-schoolgirl scorn. "I used to react excessively to things. I'd lie down in the street and weep and wail." She went to a mental hospital. "I wasn't sectioned, I took myself there, though I didn't have a lot of choice. I was on drugs off and on. Of course, this was some time before the voices."
It's piquant to listen to this charming, ferociously gifted woman chatting about the voices which settled in her head over the years. "I've never believed it's a completely external, fully embodied voice," she says. "Some people do. I always know that they're something to do with my imagination. I tend to record them, write what they say in notebooks." What do they say? "It tends to be pretty hyper; they talk in fairly Biblical language." Are they male or female? "I've a set of voices and they're very different. I give them names to make them more manageable. Not personal names, but descriptions - the Dwarf, the Angel, the Little Girl. They have vocal timbres to go with their names." Was her writing improved by the voices? "Yes, I think they give me better insights. In my second novel, Virgin Territory, I tried to use the voices directly, to incorporate them. It was exhausting. Once is quite enough for that."
She concedes that some mentally ill people revel in performance. "Patients get into a state where they say, 'I'm more anorexic than you, I'm suffering more, I'm madder than anyone else.' And writers do that too. All artists are show-offs." Did she think mentally disturbed people produced valuable work as a result of their disability? "I don't want to say that evil psychiatrists and the Government are trying to stop the production of wonderful artworks, because it's more complicated than that. But I'd say there's a connection between those kinds of excitements and imaginative excitements. Which doesn't mean every artist has to be psychotic, nor that every psychotic is an artist."
What is Sara suffering from? Don't, if you know what's good for you, mention the S-word near Ms Maitland. "I don't think schizophrenia exists, although there's a long list of symptoms associated with it. I've a friend who was interviewed by a nurse looking for symptoms of schizophrenia. She asked such stupid questions that my friend laughed - and the nurse ticked another box, because 'inappropriate laughter' is another symptom." She whinnies with indignation. "If you sent a supposed schizophrenic to different psychiatric consultants around the country, no two people would come up with the same diagnosis. Well, you wouldn't go to hospital to have your appendix out if they'd given you five different diagnoses, would you?" She sees the word as "a put-down word, that makes you lose your fundamental human rights, makes you have compulsory treatment, makes you take medicine which no one says will make you better and often makes you worse."
What really annoys her is the way that psychiatrists lump different altered states under the same umbrella. "I said to a psychiatrist that there must be something wrong, when people are unable to distinguish between Peter Sutcliffe [the Yorkshire Ripper] and William Blake [who as a boy saw angels sitting in a tree on Peckham Rye, 'bright wings bespangling every bough like stars'] and he said, 'There's no difference.' I said, 'Excuse me, there's a massive difference between writing a lot of beautiful but rather strange poetry and going out and murdering a lot of women." She wants to establish a respectable pedigree for hearing voices. "In the days of Joan of Arc, a whole range of options were advanced about why she was afflicted by voices. That range is dead. Now, if you hear voices, you're a loony. That's what I want to challenge."
Professor Thomas shares her views. He doesn't believe in schizophrenia either, labelling it "a made-up 19th-century-Greek word which has no meaning and no longer has any useful value." He talks instead about "states of mind in intense distress, that exist in a form of psychosis" but is wary of recommending standard treatments. "Some patients find psychiatric treatment helpful, and if they want that, fine. Many find it harmful, in which case they shouldn't be forced to have it. I think psychiatry should spend more time developing ways of helping people make sense of their distressing experiences because, in a way, that's what creativity is about. If we did, we wouldn't get into such hassles over the need to impose treatment and lock people up."
Like a man regretting the decline of novel reading and the rise of the DVD, Thomas sees a lack of curiosity in human psychology. "These days, as part of the wider changes in our culture, we're less interested in ways of understanding the human condition that rely on detailed analyses of people's inner worlds. We're more interested in ourselves as neurochemical beings. Thirty years ago, if you were in a bar in New York at weekends, they'd be talking about what their analyst said the other day. Today, they'll be talking about Prozac and its effects. We're interested in more superficial, glib, easy-fit narratives as ways of understanding ourselves."
Maitland, meanwhile, doesn't want to lose the noisy companions in her head. "The point is not to drug the voices out of existence, but to negotiate with them. Really, it's just the same as having a lot of ill-behaved toddlers in the house. You tell your health visitor, 'My toddlers are driving me round the bend,' and she says, 'Oh, hit them over the head and drown them.' But you don't want to kill them. You just want them to behave."
Ages of the mind
A brief history of treatments for mental illness - from witch-burning to electroconvulsive therapy
Cave paintings from the Stone Age seem to show trepanning - drilling a hole into the skull, and suggest that people thought it would cure mental disorders.
At Memphis, the temple of Imhotep (below), became a medical school. Successful psychiatric treatment was attributed to amulets or gods.
Hippocrates wrote 76 treatises which are still the foundations of modern medicine and psychiatry. He described melancholia, postpartum psychosis, mania, phobias and paranoia.
Plato (above right) proposed a view of the soul (psyche) as a charioteer driving two horses, one noble, the other driven by base desires. The charioteer struggles to balance their conflicting impulses.
Rhazes (865-925), later called the Persian Galen, was chief physician at Baghdad hospital where there was a psychiatric ward. The Arabs had no fear of demons, so patients were treated kindly.
In Salerno university Constantinus Africanus, a Jew who became a Christian, translated Hippocrates from Arabic into Latin. The nervous system was examined and the brain seen as the seat of mental illness.
In the early days of the Bethlem hospital (Bedlam), which began to care for people with mental health problems in the 12th century, patients were treated with concern and issued with arm badges to wear so that they could be returned to hospital if their symptoms recurred.
People with mental health problems were considered to be witches (above) and were the victims of persecution rather than treatment.
Johann Weyer (1515-1588) emphasised that illnesses attributed to witches came from natural causes, and made the revolutionary demand that witches should themselves be sent to physicians for treatment.
There was a belief that if people behaved like animals, they should be treated like animals. Thomas Willis, a neuroanatomist and doctor, said: "The primary object is naturally curative discipline, threats, fetters and blows are needed as much as medical treatment."
Asylums were built to house people with mental health problems separately from houses of correction and poor houses. The wealthy could become a private patient of a doctor or clergyman. The beginnings of psychology as a separate discipline.
Several psychologists developed theories concerning neuroses. Sigmund Freud's ideas are the basis for psychoanalytic theory today. Intravenous injections of morphine began.
Gestalt theory and behaviourism, or stimulus-response, began to merge in the techniques of cognitive behavioural therapy, which is popular today. Chemicals were used to induce deep sleep treatment. Insulin coma therapy saw patients given insulin to induce a coma and convulsions. Camphor injections were also used to induce fits. Electroconvulsive therapy (above) was introduced as a treatment for schizophrenia and soon became widespread. Various antipsychotic and antidepressant drugs were introduced in the 1950s and 1960s. Psychosurgery was used with considerable enthusiasm in the middle of the century.
Mental-health experts are fighting over how best to treat emotional distress, and our minds are their battleground. Dr Cecilia d'Felice looks at the competing factions and asks, who will emerge victorious?
You are probably unaware that a revolution is occurring in the way in which you will receive psychological therapy if, unfortunately, you become one of the many people who will suffer from anxiety or depression this year in the UK. This revolution is not of the velvet variety, with everyone in agreement that "things must change" to meet the exponential demand placed on psychological services. Instead, it is exciting passions, anger and schisms among mental-health professionals across the country.
Traditionally, a GP with a patient suffering from emotional distress would offer medication or, if available, a referral to a psychologist for a talking therapy. For many people, the clichéd image of psychoanalytic psychotherapy is that of a patient lying on a couch being encouraged to talk about their mother. In the 1980s, talking therapies took a different turn as scientific trials - as rigorous as those used for new medications - indicated that shorter-term treatment could be as effective as conventional analysis. Instead of dwelling on the past, patients were encouraged to find more balanced perspectives from which to view their negative and self-limiting thinking. They were also offered support in structuring activities in order to become more active and participate in life more fully. This combination therapy was called cognitive (thinking) behavioural (action) therapy, also known as CBT. Despite the marked differences between analytic and cognitive therapy, meeting with your therapist weekly was expected and uncontroversial, until now.
Today, however, when you visit your GP suffering from anxiety or depression, you might not get to see a therapist at all. A new development in psychological treatment potentially removes the need for one-to-one sessions in a process called "stepped care". This simply means that you enter treatment at the level appropriate to the severity of your problems. If, for example, you are feeling low but have few debilitating symptoms, you might be offered a "book referral scheme", whereby appropriate self-help literature is recommended. You might also be offered "guided self-help", where someone with a brief training in CBT can help you identify goals and direct you to source material and activities that can help you recover more quickly than if left to your own devices. You could also be offered a six-week computerised CBT package, often in your local library or health centre. But - in none of these initial interventions - would you see a trained psychologist at all.
If, and only if, your problems are complex enough to warrant it, will you receive a talking therapy from a mental-health professional. Again, the aim is to keep treatment in the community, so you are likely to see a psychologist or counsellor attached to a GP practice for an average of six sessions. Training psychologists is expensive and there are not enough of them to meet the public's reasonable expectation of receiving psychological help when they need it most, which is when they ask for it. Additionally, NHS budget restraints mean that many psychology posts are frozen or have disappeared altogether. (You may well suspect that this is why we now have new therapies that don't require a therapist.) All of which means that, even with the "stepped care" approach, there is still far more demand for talking therapy than the NHS has the capacity to provide.
David Richards, Professor of Mental Health at the University of York, describes current mental-health provision as "obscene". He says that, of the 164 people in every 1,000 who will face a mental-health problem this year, only 40 will receive any sort of treatment at all, 15 of whom will "get some form of probably ineffective talking treatment" and only two of whom will receive evidence-based CBT. "Obscene" because there are treatments that are available and proven to work which could reach thousands of people, rather than just a handful. He proposes, and is trialling, a radical and innovative CBT treatment that delivers immediate support within 24 hours of requesting help, with community-based case managers working collaboratively with their clients, with 75 per cent of contact being made via telephone.
Instead of the exclusive patient/therapist relationship, costly in both time and money, Richards asks us to "imagine a call centre, where 20 workers can make contact with 300 people a week, spending 30 minutes with each, accessing an informative database. People with mental-health problems say they want help at the moment they pluck up the courage to admit their needs. His system would end, he argues, "the long waiting times, inequality of access to therapy and the corresponding despair of those left unassisted". Richards cites evidence from more than 30 clinical trials to support his concept, which would utilise CBT as a foundation. It would be a mistake to assume, however, that CBT has wide acceptance in the mental-health community.
You don't have to be particularly aware of the levels of psychological support available in the UK to have noticed the current debate concerning CBT. The economist and philanthropist Lord Layard has encouraged Labour to take the nation's mental health seriously and to provide CBT to enable people to get over their emotional problems and get on with their lives. His laudable intentions have often been aggressively misrepresented as a form of psycho-fascism by psychotherapists who do not practise CBT, as was witnessed at the recent "Politics of Well-Being" debate in the House of Commons last month.
Darian Leader, a Lacanian analyst, claimed in the Guardian that CBT is no better than "taking a pill or injection" and is "merely a quick fix designed to get people back to work". More sinisterly, he writes that it was used by the Maoists to brainwash Chinese citizens during the Cultural Revolution - such is the ill-will directed at this scientifically tried and tested talking therapy. (Incidentally, a Lacanian session can last anywhere from five minutes to 90 depending on the "interpretation" given by the analyst, which would make scheduling it as a mainstream NHS therapy somewhat problematic.) Oliver James also claims that CBT is not a "real" therapy, bizarrely likening it to having "a Peter Mandelson spin doctor in your head".
Why is it then that a versatile therapy, effective in verbal, computerised and written form, and scientifically shown to help many people recover from depression and anxiety ends up being vilified, dismissed and attacked by many psychotherapists who all, presumably, want their patients to get better?
The answer may lie in part in the investment that analysts have to make to become trained in what is often felt by other psychological therapists to be a doctrine rather than a model of therapy. Psychoanalytic training demands that trainee therapists receive three to five sessions of psychoanalysis weekly, for eight months of the year, for up to six years, with each session costing approximately £50. Therapists have to invest heavily, both emotionally and financially, and in turn often have an expectation that their patients "should" be in therapy for a minimum of a year and often longer. Clearly, then, this is a therapy that is both practiced and received by the well-off, as there is very little provision for it in the NHS. The harsh reality is that talking therapies are expensive and time-consuming, and the most expensive and time-consuming of them all is psychoanalytic therapy.
It seems obvious that more people need access to therapy, and therapy should be community-based, therefore the way in which it is delivered needs a radical review. Professor Richards goes a long way in promoting his community-based model as a challenge to what could be argued as being an elitist, ethnocentric, middle-class psychotherapy clique, clinging like fundamentalists to the religion of analysis, while attacking other psychological methods as not being "real" despite the evidence to the contrary.
There is growing concern among therapists that the schisms that are polarising the therapeutic community are damaging to all, not least to the patients who look to us for help in their worst moments. It seems odd that professional colleagues, skilled in negotiating difficult subjects, find it hard to converse on this key issue to forge a future for talking therapies that is both viable and sustainable. The Campaign for Therapy (www.campaign fortherapy.org), to be launched this autumn, aims to put aside the arguments as to which therapy is best and highlight instead the common factors that ensure therapy is effective, whatever model is being used.
Just as we expect choice in many areas of our life, just as the Government promotes choice in medical treatment, choice should also be part of the mental-health provision in the UK. Not all psychological therapies suit all people. Some will be appalled by a computerised CBT package, others will find it helpful and life-changing. Some will want to see a therapist for many weeks, working analytically, others will want only a few, focused sessions, while still more will want telephone contact to help them manage their emotional difficulties.
You might not have been aware at the start of this article about the revolution occurring in mental health provision in this country, but you are now, so join the revolution and have your say by contacting the Campaign for Therapy. What sort of mental health service do you want? What would you be looking for in therapy? What sort of therapy would appeal to you and what issues would you want help with? Your voice matters. Join the revolution and let the psychological therapy "experts" hear what you have to say, before they decide it for you.