The Unpersuadables: Adventures with the Enemies of Science (24 page)

As well as being a near-constant presence in Deborah’s waking life, she even sees Top Dog – hallucinates him, so that he stands in front of her. He has silvery hair and claims to be thirty-five, but looks, to Deborah, closer to forty. They meet each other in her dreams. When Deborah was being medicated – her doctors’ attempts at murdering Top Dog with powerful anti-psychotics – he would tell her that if she didn’t stop taking them, he would kill her family. It’s not as though she needed much encouragement – the drugs made her fat, lifeless and incontinent. She used to fall asleep at the dinner table. ‘They were humiliating,’ she says. ‘Dehumanising.’ But whenever she tried to go clean, ‘My voices got really angry. I would basically go insane.’

Now, with the help of Rufus – and against the advice of her doctors – she is off all medication. And slowly, she says, Top Dog is becoming easier to live with. He has even ‘kind of’ admitted that he didn’t kill Deborah’s friend. This, according to Rufus, is a result of his controversial dialogue-ing. ‘Psychiatry will say, “Don’t talk to the voices, because you’ll make them more real,”’ he says. ‘I say it’s already real. There’s a real relationship going on and we need to understand it. We had a breakthrough a couple of weeks ago where Top Dog agreed to be less threatening about killing people and stuff like that,’ he adds cheerfully before turning to Deborah and everyone else. ‘So, welcome, Top Dog. How are you doing?’

‘I thought you’d never ask,’ says the phantom. ‘You’ve been talking about yourself all day.’

‘How do you feel it’s going, this new relationship you and Deborah have got?’

‘Sometimes it goes well,’ says Top Dog. ‘Sometimes I get angry with her. It drives me fucking nuts when she keeps secrets. And she’s always thinking about other people first. People only care about themselves, anyway.’

‘So you’re a good reminder for her to put herself first. How are you finding your new role of adviser?’

‘I’m starting to wonder if it’s a good idea. Sometimes she doesn’t cooperate.’

‘Well, thanks for hanging in there,’ says Rufus. ‘I think you’re learning patience. That’s where we have a friendship – we’re both trying to get Deborah to speak her truth.’

‘Easy on the “friendship”.’

‘Do you get angry when she’s too caring towards other people?’

‘She needs to tell people to fuck off.’

‘Perhaps she can learn from your directness.’

‘Too fucking right.’

‘I wonder if Will would like to ask Top Dog any questions,’ says Rufus.

I lean forward, excited and fascinated, and a series of questions fires out.

‘Are you part of Deborah?’ I ask. ‘Where do you live? Who are you?’

‘I’m not too fucking sure myself at the moment.’

‘Are you her friend?’

‘I’m not her friend. I’m here to make sure she does the right thing.’

‘That implies that you care about her.’

‘Care’s a strong word.’

I swallow drily. Top Dog, I begin to realise, is a bit of a prick.

‘You’re always encouraging Deborah to be direct and not keep secrets but you seem reluctant to admit your own truth. The things that you say imply that you care about her a lot.’

Deborah’s face changes. She looks alarmed. Then embarrassed.

‘He’s being a bit rude about you,’ she says.

As a child, Deborah used to have imaginary friends that were so vivid that she could see them. When I ask about the trauma that caused the voices, she tells me she was sexually abused, between the ages of eleven and twelve, by a man at her riding school.

‘And when did you hear your first voice?’

‘When I was nine.’

‘So the abuse started when you were eleven, but you heard your first voice at nine?’

‘Yeah.’

I look at Deborah. I look at Rufus. They look back at me happily, apparently untroubled by this revelation and what it implies about their theory.

‘So trauma didn’t cause your voices,’ I say to Deborah.

‘Oh, there were other sorts of things I went through before that, that were quite stressful.’

‘What were they?’

‘I was in a state school and I moved to a public school and so my parents were putting me under a lot of pressure to do well academically and, before that, we’d moved house and everything. We’d moved to public school and it was quite scary, there were older boys, um, fourteen, fifteen, and they were just, quite scary, you know.’

I am unconvinced. And I was alarmed earlier, when Rufus casually admitted that close relatives of his suffered from paranoia and schizophrenia. Surely all of this powerfully suggests a genetic cause?

Rufus says, ‘There’s lots of teachers and preachers in my family as well. Is that all genes?’

‘You’re being flippant,’ I say.

‘What I’m saying is, patterns of behaviour do run in families,’ he says. ‘Yes, nature plays a role. But it’s not a genetic vulnerability, it’s a different way of coping with stress. One person might respond to bullying in an anxious way, another in a dissociative way. Society says that it’s more acceptable to be depressed than it is to be living in a fantasy world. But they’re not better or worse, they’re different.’

Before I travelled up to visit Rufus, Deborah and Top Dog I spoke with Dr Trevor Turner, consultant psychiatrist at St Bartholomew’s Hospital in East London. Turner – author of books on schizophrenia and an ex-Vice President of the Royal College of Psychiatry – told me that encouraging schizophrenics to ditch their medication is ‘extremely dangerous.’ He admits that Romme and Coleman’s Hearing Voices Network have been responsible for some good work in ‘improving patients’ positive feelings about themselves’ and acknowledges that trying to turn the voices into a friend is ‘absolutely right.’ But he also has an interesting take on Professor Marius Romme’s complaint that one in a hundred people die on the medication. ‘That’s pretty good, actually, because fifteen per cent of people with schizophrenia die from self-neglect or suicide because of the awful nature of their experiences.’ The reduction in the suicide rate of medicated patients is, he says, ‘fantastic.’

Voice-hearing itself, according to Turner, is the dominant symptom
of 90 per cent of schizophrenics. ‘It’s a bit like having a temperature is a symptom of infection. It’s showing your brain’s overactive and is trying to pick up sounds that aren’t there. It’s playing tricks on you. It’s increasingly well established that schizophrenia is a disease. There’s evidence aplenty. When you give people anti-psychotics, their voices melt away and they become better again. You can do examinations of brains that show clear abnormalities in what’s called the third and fourth ventricle. Scans have shown significant brain shrinkage in people with schizophrenia as well.’

We know that schizophrenia is a physical disease, then, not only because we can see evidence of it in the brain, but because the drugs for it work: anti-psychotics block the chemical dopamine, and this demonstrates that schizophrenics either have too much dopamine, or have too many dopamine receptors. But experts such as Professor Richard Bentall meet all these arguments with the same objection. How do we know these brain abnormalities and the dopamine-system faults are triggered by disease? Perhaps they are caused by traumatic experiences. ‘There’s compelling evidence that traumatic experiences can alter the structure of the brain [in these ways],’ says Bentall. ‘There’s also compelling evidence that the dopamine system can be affected by experiences of unpleasant events. And there’s very good evidence, that has appeared in the last two years, that shows that brain volume shrinks with a lifetime dose of anti-psychotics.’

When I mention Bentall to Turner, I am startled by his reaction. What follows may seem rather mild to the casual observer, but as criticism from one scientist to another, it is on the sharp end of serious.

‘Bentall’s highly selective in his sources and he generally uses individual anecdotal case results rather than carefully structured studies,’ he says. ‘People like Bentall are stuck in the belief system that it all derives from childhood experience. That’s the credo of analytical thinking like his. It’s a well-known trope in the history of anti-psychiatry. The most anti-psychiatry people on the planet are the Scientologists, who regard us as torturers, murderers, Holocaust-deniers. That, to some degree, is where this notion comes from. It’s anti-medical. It’s a belief system, not a scientific one.’

When I bring up Romme’s study, in which he claims to have found
that 80 per cent of voice-hearers have suffered significant early trauma such as abuse, Turner replies flatly, ‘That’s completely untrue. There’s no evidence for that at all. The prevalence of child abuse is in debate anyhow. You can’t find it, you can’t see it, you can’t smell it, you can’t touch it but sometimes, if you spend enough time digging around in therapy, you can get someone to think of things. Thirty per cent of our memories are false memories anyway. It doesn’t matter who we are.’

As Turner has wandered off the point, slightly, so has my concentration. I have a moment of panic when I think I have misheard him. I have to double check what he just said, because I can hardly believe it.

‘Did you just say thirty per cent of our memories are false?’

‘If you look at psychological studies,’ he says, ‘about twenty to thirty per cent of what we think are real memories are probably false.’

I make a hurried note. If this is true it represents a potentially crucial lead in my search for the source of irrational beliefs. Before I let Dr Turner go, though, I have one final question.

‘Have you heard of Dr Rufus May?’ I say.

‘He’s one of these self-appointed-guru-type people who thinks he knows better than everyone else,’ he says. ‘He’s a liar and a charlatan.’

Up on the crest of a rain-soaked Yorkshire hill, the phrase ‘he’s a liar and a charlatan’ clatters to the floor of Rufus’s kitchen like a hundred saucepans hitting the tiles.

‘Wow,’ says Rufus. He takes a moment to gather himself. ‘I guess we’re just pushing in completely different directions. He’s kind of managing people’s distress. I’m trying to help people heal.’

I tell him that Turner said that the voice is a symptom, like a temperature. He turns to Top Dog.

‘How do you feel being likened to a temperature, Top Dog?’ he asks.

‘I want to find this man. He needs to be very afraid.’

Richard Bentall is somewhat less equanimous than Rufus. ‘Turner’s an idiot, frankly,’ he says, when I call him. ‘His comments are stupid on many different levels. Let’s start with one of them. There is no such thing as “the cause” of psychosis. There’s not one cause, there are many interacting causes. I’m not claiming that sexual abuse
or trauma is “the cause”, what I’m claiming is that it is a major causal factor.’

For his meta-analysis – which, at the time of writing, is still undergoing peer review – Bentall found nine studies that looked at the question of whether there is a ‘dose–response relationship’ between abuse and psychosis. That is, do increased ‘doses’ of abuse reflect an increased likelihood of breakdown? ‘All but one of the studies finds a dose–response relationship,’ he says. ‘That is very powerful evidence of cause. So for him to say that I’m being unscientific – he’s being a completely unscientific idiot.’

‘Okay,’ I say. ‘Sorry, I don’t want to cause … but I have to … Trevor also said that you value anecdote over careful study.’

‘I’m not talking about anecdote at all!’ he says. ‘I’m talking about rigorous epidemiological studies. But anecdotes are important – if he listened to a few anecdotes from his patients he might be more convinced himself. The great tragedy about this is that traditional psychiatrists don’t listen to their patients at all. Turner is a very annoying person.’

‘This is the last one. He said hearing a voice was like having a temperature.’

‘I shudder, basically. I really shudder.’

*

From its roots in Maastricht and Manchester, HVN has gone on to help thousands of patients in twenty-two countries get off medication and in control of their voices. Today, you’ll find Ron Coleman about as far away as you can get from that King’s Cross platform without leaving the British Isles. On a far northern corner of Lewis, in Scotland’s Outer Hebrides, he lives with his dog and his chickens and his wife and two children and the other invisible people that he carries around in his head. Rather than submitting to a medicated life in the psychiatric system, he instead sought counselling for the guilt that he felt around his abuse.

‘I found myself innocent,’ he says. ‘And things got better.’ He began negotiating with his voices: telling them to pipe down; you’re wrong; I’ll give you fifteen minutes this evening if you’ll behave for the rest of the day.

They’re mostly gone now. But not entirely.

‘The priest’s still there,’ he says. ‘When I hear him, I know I need a break. His power used to be rooted in the guilt, so I can make him go away pretty easily.’ Other voices are more welcome: they remind him of facts he has forgotten and offer him helpful references when he’s doing his talks. ‘That happens regularly.’ But there is another voice, too. One that he has no desire to shoo away.

Every year, on the anniversary of Annabel’s death, Ron will take a gin and tonic to a private place and sit alone and catch up with her. ‘We just talk about how things are; how my life is,’ he says. ‘I’m happily married now, and I love my wife, but that doesn’t mean I’ve stopped loving Annabel. My wife understands that. If madness is a lifelong condition then love certainly is.’

‘It must be a bit heartbreaking, though?’ I ask.

He sighs, and looks off into the deep horizon, where the blue, domed sky kisses the cold northern sea. ‘I guess there is that element to it,’ he says. ‘But it’s what everyone does, isn’t it? If they’ve lost somebody, they still talk to them. The only difference with me is that mine talk back.’

It took just one minute, on a Thursday morning in the middle of July. One minute, on a grey humdrum day in a small Manchester office. One minute, for the safety and safe memories of a family to be breached.