Listen to the Wounded Healers by Prof Phil Thomas

26/4/08

I can't be a doctor and hear voices' says Ruth, the central figure in Leo Regan's powerful drama documentary about the work of the 'maverick' clinical psychologist Rufus May. Setting aside any views you might have about the merits or otherwise of Rufus May's work, the film raises some 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 dwell in a cultural world, and thus participate in the values and assumptions that characterise that world. So, as doctors we are just as likely to hold stigmatising attitudes about those identified as mentally disordered as any one else. We like to believe that our scientific knowledge about the brain sets us apart from the popular distortion of the 'mad axe-man', but in reality this is not so. Instead there is something much more sinister; the doctor who visits his elderly patients, bag laden with morphine; the nurse who stalks the children's ward at night with a syringe of potassium chloride.

But the corruption of trust has nothing to do with madness, and Ruth was plainly mad. She heard voices. She believed that bubbles in a goldfish bowl acted like an ECG machine, conveying information about the cardiac function of the residents of care home she worked in. Her 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 as far as work is concerned. If others regarded her as ' ... genetically different…’ or ' ... degenerate ... ' (as Rufus May puts it) then how can she possibly respect herself? The value of Rufus May’s work is that it enables Ruth to start the process of constructing a meaningful narrative where before there was chaos and madness. When she was fifteen 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 is one that leads them both through dangerous waters. Some would see their agreement that she should not be open with her employers about her experiences as an inexcusable conspiracy. But there is much at stake, and not just for Ruth and Rufus. Standing alongside the contemporary mask of the mad axe-man 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, like Jung, and more recently Arthur Kleinman, Rita Charon and Arthur Frank. 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 personal 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 there are risks here. Risk dominates our landscape. It forces itself into all aspects of our lives. Risk of what, of death, murder, madness and destruction? Risk is the enemy of suffering. It 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 there is no place in such a view for the human ability to heal through compassion, kindness and love. Our preoccupation with 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 within this film, and learn to value the wounded, sick, mad parts of ourselves.
Philip Thomas
Professor of Philosophy Diversity and Mental Health