King’s Cross station, London, some time in the early eighties. A man on the end of a platform, shouting. Dirty, pale, young. Commuters backing away as two members of the British Transport Police approach him. They know what they are dealing with. Look at him. What a freak. What a lunatic. What a fucking nutter. They could never guess that, only three months ago, twenty-one-year-old Ron Coleman had been a successful investment banker working the futures market in the city and living in a beautiful flat in West Hampstead. Now here he is: broke, raging at phantoms and contemplating jumping in front of a train. Ron knows he looks crazy. But he can hear them. They’re real! All talking to him, talking about him. He can hear them. And he can hear her, among the others: Annabel, his amazing, beautiful, blue-eyed Annabel, who he misses. Oh, he misses Annabel so much. He can hear her, saying, ‘Go on, Ron. Why don’t you jump?’
The policemen took Ron to the Royal Free Hospital in Hampstead. A psychiatrist told him that he had developed a disease of the brain called schizophrenia. But it was treatable. All he had to do was stay in hospital and take the medication. In ten days, Annabel’s voice would fade.
Ten days passed and Ron did not feel better. ‘I’m getting out of here,’ he thought. But before he could reach the door, the nurse stopped him.
‘Where are you going?’ she said.
‘Home.’
‘Well, you can’t.’
‘Of course I can! The doctor said after ten days, it would work. It’s not worked. So I’m going home.’
The nurse pressed a button. The ward went on lockdown. Ron Coleman was sectioned. It was a terrifying moment, and his first skirmish in a war of ideas that he has been fighting, now, for over thirty years. Since his sectioning, he has become an icon to an ever-growing group of voice-hearers who insist that, actually, there is nothing wrong with them. Voice-hearing, they say, is not a proof of mental illness. Like left-handedness or ginger hair, it is actually just a variation; another version of being human. Like homosexuals in the 1970s, they don’t need curing of a psychiatric illness but rather liberating from a model that says they are sick. One day, they hope, the stigma of being a voice-hearer will vanish, and the world will come to agree with Ron’s dramatic hypothesis: that there is no such thing as schizophrenia.
Most psychiatrists say that schizophrenia is a very real physical disease. They think this for several reasons – perhaps the most persuasive being that they can detect its presence in the brains of sufferers, using scans and post-mortems on deceased patients. But members of the Hearing Voices Network (HVN), of which Ron Coleman is a leader, dispute this. Along with a cadre of rebel psychiatrists, they have come to believe that people hear voices, not because of some disease in their brains, but as a result of traumatic experiences. Professor Marius Romme, the Dutch psychiatrist and the movement’s intellectual godfather, suggests that auditory hallucinations are nothing more than the brain’s attempt at offering advice following an emotional crisis. It is, he has said, ‘a normal response to an abnormal experience.’ If you go hunting for abnormal experiences that might have caused Ron’s voices, you will find two.
He was born in Dundee, in 1958, and raised by good Catholic parents on a bad estate called Kirkton. He loved church and he loved rugby and it was after a match, drinking with his teammates in a notorious pub called the Clep, that he saw her. ‘It was one of those love-at-first-sight things. She was stunning,’ he says, still visibly flushed all these years later. Even in that part of Dundee, the Clep was known as a hard place. Nothing was allowed to distract from the alcohol: not a TV nor a telephone nor even a jukebox. All you got at the Clep were seats, beer and a place to piss. Women never drank there. And yet, there she was, up at the bar – a posh-talking girl with a black fringe and hippy bangles and bracelets, ‘and jeans – very tight jeans. And she had these amazing, penetrating blue eyes. That’s what really got me: those eyes.’
Ron was not quite sixteen. Annabel was twenty-five. He asked her if she wanted to go to the Hong Kong, a late-night Chinese restaurant that had a bar and a dancefloor. ‘It’s not that I was particularly confident,’ he explains, ‘it’s just that it was her.’ When she said yes, he was amazed. ‘I had to ask the captain of my rugby team to have a whip-round because I didn’t have any money.’
Ron and Annabel became lovers. ‘We had a great time together. She showed me a new world. Classical music, rock music, art. She taught me what love was.’ Two years into their relationship, they decided to marry. Then, one day, for reasons he declines to share, Annabel died. ‘And my life became a total misery.’
Still, he had his rugby. He needed his rugby. He needed it because it was the only way he knew how to deal with his life’s other abnormal experience.
As a boy, Ron had dreamt of becoming a priest. When he was ten, a man called Father Adrian joined his local church and quickly became a popular and respected member of the community. The man and the boy grew close. One morning, following mass, Father Adrian told him that they needed to pray. They knelt slowly in front of one another. ‘You are a sinner,’ said the priest, softly. ‘You have led me into sin. What’s going to happen now – it’s because you’ve been tempting me. It’s your fault. And, for doing this to someone like me, you deserve to burn in hell.’
When it happened, Ron felt as if he was looking down on himself. He remembers the smell of incense and Father Adrian’s purple robe. He remembers thinking, ‘Why does God hate me so much?’
The abuse went on for nearly a year, until Ron stopped attending mass. Instead, he would sit on Law Hill, staring down at the church and eating ‘mushie’ – the honeycomb sweets he would buy with the money that was supposed to go into the collection. He would expel his feelings of guilt and shame and rage by imagining his opponent in a rugby scrum was Father Adrian. ‘Rugby wasn’t a sport for me. It was a coping strategy,’ he says. ‘I’d picture his face and try to kill him.’
When he was twenty-one, Ron broke his hip. His doctor told him he would never play again. His coping strategy gone, he was in despair. Shortly afterwards, he was working on some analysis at work, waiting for the computer to finish its calculations. He was sitting there, bored, idling and doleful. And then Annabel said to him, ‘You’ve done that wrong.’ He froze. What the …? He looked around. There was no one there. ‘So, being a good Scot,’ he recalls, ‘I went to the pub and got absolutely rat-arsed.’
He carried on drinking, day after day, more and more and more. In the chaos of his increasing dereliction, he stopped making money for the firm. After eight weeks, he was dismissed with a payout of thousands. He spent the money on alcohol, cocaine, amphetamines and purple hearts to help him come down. The voices worsened. Annabel would beg him, ‘Come and join me, so that we can be a family again.’ Father Adrian would barrack him, ‘You’re a bastard, aren’t you? It’s your fault. I told you: you deserve to burn in hell. You led me into sin and you fucking loved it.’
At first, Ron assumed that he was ill. But soon, he became less sure. When someone suffering auditory hallucinations hears voices, they really do hear them. They sound no different to a true voice. Sometimes they come from ‘inside’ your head, often they come from outside – exactly as if you were sharing a room with someone invisible. Sometimes they talk to you (‘You’re a cunt’), sometimes they’ll narrate your every action (‘Now the cunt is making tea’), sometimes different voices will discuss you (‘Look at that cunt, he’s got nothing left to live for,’ ‘I know, look at him! No one loves him, he might as well just kill himself’).
‘It was just constant, constant, constant,’ says Ron. ‘You’d just want to get away from them. And the problem is, you start to think they’re real. Because you can hear them. You wonder – why can other people not hear them?’
The doctors in the Royal Free Hospital told Ron that he should ignore the voices. ‘You’d say to the nurse, “My voices are really bad, can I talk to you about them?” and she’d say, “Let’s play Scrabble!”’ He noticed that being labelled a ‘schizophrenic’ led to people patronising him. Like the time he was forced to attend a lasagne-making class. ‘I said, “Look love, I might be mad, but I’m not fucking stupid.”’ A nurse followed him everywhere. ‘Bathroom, toilet, the works,’ he says. ‘It’s dehumanising. It starts the institutionalisation. You start to think, If that’s what they expect, that’s what I’m going to give them.’
‘Give them what?’ I ask.
‘Grief,’ he says, smiling. ‘I started telling them to fuck off all the time.’
Ron was forced to take medication that threatened terrible side-effects: tremors, weight gain, sexual dysfunction and the increased risk of diabetes and cardiac arrest. ‘The meds made me drool, slime coming out of my mouth, I’d be stiff. I’d say to the doctors: “You’re just a fucking Nazi; just a pill merchant.” But then one of the older hands had a word with me in the smoke room. He said, “You want to get out of here, yeah? You have to keep your head down. Just tell them you’re feeling better.” That’s how I learned to lie.’
Eighteen months after his sectioning, Ron lied his way to release. He took the first coach out of Victoria coach station and ended up in Manchester. To avoid going back into the psychiatric system, he lived on the streets. When the voices worsened, a doctor gave him a three-month supply of medication. He used them to try to kill himself. He woke up four days later, sectioned once more, in a Manchester hospital. And that is where everything was to change.
A support worker told Ron about a radical-sounding group that was forming nearby. It was inspired by the work of controversial Dutch psychiatrist Professor Marius Romme, who encouraged members not to ignore their voices, but to accept their reality and actively listen to them. ‘By now I’d learned not to rock the boat,’ he says. ‘So I told her it was the craziest idea I’d ever heard. She said that if I agreed to go, we could stop for a beer on the way back. And I said, “This is the best thing that’s ever happened in psychiatry. Let’s go.”’
When Ron arrived at the fledgling Hearing Voices Network meeting, he was told something that ran counter to all the psychiatric lore he had ever heard. His voices were not a disease. They were real. They had meaning. They were a part of him and he needed to listen to them. To Ron this made sense: his principal voices were Father Adrian and Annabel. It was as if the two most terrible events in his life had taken living form; as if he was being haunted, daily, by the saddest things that had ever happened to him. How could they be dismissed as ‘irrelevant’, just a symptom of schizophrenia, as a cough is to a cold? Father Adrian and Annabel were part of him. Of course they were. ‘I felt total astonishment,’ he says. ‘My support worker and I sat in the car outside for hours just talking about that idea. We never made it to the pub.’
It was the beginning of a journey that led to Ron being drug-free and happy. By listening to his voices, negotiating with them and taking a firm parental line against them, he retook control of his mind. Within a year of that first meeting, he was made British national coordinator of HVN. He became known for his ‘Mad Pride’ stance and his ‘Psychotic and Proud’ shoulder tattoo. Today he says, ‘Voice-hearers are not sick. We’re just a variant, a variation, like people who are left-handed.’ He also dismisses the idea that auditory hallucinations are a principal symptom of schizophrenia. ‘There’s no evidence that schizophrenia even exists,’ he says. ‘The diagnostics for any major mental illness are, in my opinion, completely subjective. You can see three different psychiatrists on the same day and get three different diagnoses. If you’re hearing voices and you’ve got a straight face they’ll call you schizophrenic. If you’re laughing they’ll call you manic depressive. If they don’t like you, they’ll call it a personality disorder. These are just catchall terms that psychiatrists use when they’re baffled.’
The story of Ron Coleman is both gripping and exceptional. On his telling, it appears to be a case in which the consensus view of the scientific establishment has been proved wrong – by a movement whose spokesman is categorically, unashamedly and literally mad. As Ron tells his story, I find myself rooting for him. It is as if the biases of my brain are reaching out towards him, a thousand arms, encouraging, cajoling, applauding. All of them are silently lobbying my unconscious to believe the right thing.
Just as Ron’s mind contains ciphers of Annabel and Father Adrian, mine surely echoes with the felt emotions of Gemma Hoefkens and John Mack and my father and a hundred others. Do I want Ron to be proved right because I identify with the irrational ones? Is it because, as I have grown older, I have found an urge to defend my father, to excuse his religious beliefs rather than to scorn them? I ask the questions because I really don’t know the answers. How could I? My biases are invisible to me – I feel them only as a wordless urge, an emotion, something inside me that fountains upwards when I listen to Ron speaking. I can’t see these sensations or analyse them forensically. I can’t locate their source. I can’t alter them.
I wonder, too, if there might be a simpler reason for my unprofessional wish for Ron to be right. His is the perfect story: the kind, poor boy – a churchgoer! – who falls victim to tragedy and a powerful elite. He is locked up against his will. He fights back. At first, he fails. He nearly dies. And then he rises, resplendent, to take on the heartless operatives of psychiatry on behalf of an army of his fellow-repressed around the globe.
Stories are so central to our understanding of the world that their importance can be easy to miss. Like the cats raised in cages without horizontal lines, we are at risk of bumping into the fact that our own stories can lie to us if we are never given reason to consider it. I wonder how often we are seduced by attractive plots that we have happened across in life: tricked into faulty beliefs by our hatred of Goliath.
Gemma’s story also told of a death’s-door underdog, flirting with disaster at the hands of an unfeeling medical profession, only to fight back, then saving herself and, ultimately, others. The Skeptics pitch their battle as a crusade against evil stage psychics who exploit the bereaved and amoral chemists who knowingly hawk ‘sham medication’ as poor, sick children wilt in their beds.
Who are the heroes? Who are the villains? Jesus or Dawkins? Gemma or Randi? Are they of your tribe? Or are they of the repulsed and repulsive other? The explorers of neuroscience and experimental psychology tell us that we make these decisions instantly, underneath the surface of our awareness. Something happens, down there in the unconscious. Some mechanism, some switch, some electrical storm of cognition ranges across the strange territories where we keep our models of the world and where the restless, barracking ghosts of everyone we have met who has affected us still roam: mothers, fathers, lovers, dead wives, abusive priests. This is the place where beliefs are made and where madness gathers. It is the realm of the invisible forces that I have been hunting.
*
Professor Marius Romme settles slowly into his armchair on a late afternoon in winter. The room he has taken, during a teaching visit at the University of Durham’s Institute of Advanced Studies, is darkening quickly as the ancient green and the chapel outside the window fade into the dusk. Even at seventy-seven, Romme is attractive: tanned, tall and fit, his grey hair waxed back in a charismatic sweep. Beside him, his longtime research partner Dr Sandra Escher sits forward, more anxious, alert and eager to please. Romme is the man that started it all, when he met a woman in Maastricht whose life was commanded by gods.
Back in the mid-1980s, Romme was a professor at the University of Maastricht who practised as a psychiatrist in the local Community Mental Health Centre. Then, as now, psychiatrists used one of two ‘bibles’ to diagnose their patients, the most famous of which is known as the DSM. It is like a catalogue of madness, and lists thousands of psychiatric diagnoses along with their accompanying symptoms.
Because of the gods, and all the things they forbade her, this patient had lost friends and the will to do very much at all. According to the DSM, if you are hearing voices and you are isolated and you lack initiative, that is three of the symptoms of schizophrenia – and three ticks means you have it. So that is what Romme told her: ‘You’ve got schizophrenia.’
The patient was not impressed.
‘Well, that’s all very nice,’ she said. ‘But it doesn’t help me. You’ve just given it a name. How can I learn to live with these voices?’
‘I just didn’t know,’ Romme tells me. He arranged for her to meet with another voice-hearer, thinking it might, at least, help with her isolation. He was amazed when they understood each other’s experiences so completely. ‘It was clear that they really did hear voices,’ he says. ‘They didn’t fantasise it.’ He recruited more voice-hearers but, while they enjoyed meeting one another, they couldn’t work out any real strategies for coping with their constant malady. Then Romme had an idea. His work with unusual humans had impressed upon him the almost infinite variety of experience there is out there. What if they made an appeal on television? It was a long shot, but perhaps they would find one person who heard voices and had somehow found a way to manage them.
When they went on a chat show, in 1987, they found not one person who was happy hearing voices – they found more than two hundred. ‘That was really shocking,’ says Romme. ‘My training told me that all auditory hallucinations are signs of pathology. But these people were perfectly happy.’
While interviewing these happy voice-hearers, Romme secretly tried to diagnose them by finding three DSM-listed symptoms to tick. ‘And I couldn’t,’ he says. ‘I was astonished. It was a totally new experience. These people were in no need of help.’
‘What was the difference between the happy voice-hearers and the unhappy ones?’ I ask.
‘We found that non-patients are not afraid of their voices,’ he says. ‘Patients are, and they had more intense and frequent traumatic experience in their young lives. Eighty per cent of patients had experienced traumatic, overpowering situations. For the non-patients, it was about forty or fifty per cent.’
These hugely significant numbers led Romme to his heretical hypothesis: what if hearing voices is nothing to do with a physical disease of the brain? What if it is a natural response, triggered by trauma? And it has a positive purpose, to be like an adviser? An encouraging presence, willing someone to look differently and more creatively at their problem? What if it is actually a good thing?
The objections to this are obvious. What about when they call you a worthless cunt? That doesn’t seem very helpful. ‘The voices reflect the way the person looks at their problem,’ he says. ‘If the person looks negatively at it, their voices join the negative side.’ What about the voices that preach suicide? ‘These voices are saying, “Do something to change your life, otherwise you’ll be dead,”’ he says. ‘It’s a metaphoric message.’
Romme soon came to doubt the rationale of medicating voice-hearers. ‘If you’ve been sexually abused, that’s the problem, not how you react,’ he says. Although he concedes that anti-psychotics ‘help a little bit’ and that ‘a small number’ of patients stop hallucinating, he adds that they work by reducing emotion, which you need in order to learn how to live with your voices. They also kill one in a hundred. ‘Is it worth it?’
Romme’s superiors at the University of Maastricht were not impressed by all this wild heresy. In fact, they reacted in a way that is remarkably similar to that of the Harvard dean who led the attempts at silencing John Mack.
‘They said I was going crazy,’ says Romme. ‘They accused me of hearing voices myself. It soon became clear that they were trying to get me out. I had challenged the medical model and it was not appreciated.’
It took a while, but Professor Romme eventually convinced some of his discipline’s leading thinkers that he wasn’t insane. One of these academics is the University of Manchester’s Professor Richard Bentall, who has been studying auditory hallucinations since 1985.
‘I am a reluctant convert to what I am about to tell you,’ he says. ‘There is incontestable evidence that there’s a wide range of bad things that can happen to kids, including sexual abuse, which increase the risk of psychosis dramatically. Contrary to what you’ll find in virtually every psychiatric textbook and regular papers published in respected journals, the evidence for a genetic determination of these disorders to specific genes is wafer-thin. If there was a gene for schizophrenia they would have found it by now. What it looks like is that there are probably a thousand genes which each produce a small increase of risk. However – and this is also contrary to what you’ll find in psychiatric textbooks – there is a massive amount of evidence of environmental factors playing a role.’
In his book Doctoring the Mind, Bentall quotes multiple surveys of psychotic patients who have experienced ‘very high levels of sudden trauma, including violent incidents and sexual assaults, compared to the experiences of ordinary people.’ A typical example is a 2004 paper in the British Journal of Psychiatry that found the rate of childhood abuse in adults suffering psychosis to be fifteen times greater than expected. He is currently preparing to submit a meta-analysis to ‘one of the world’s top medical journals’ which will compile ten years of large-scale studies into the environmental causes of psychosis. ‘Just to tell you what the meta-analysis will say – the odds ratio is three. That means that somebody who has been sexually abused has a three times greater chance of becoming psychotic than somebody who has had a healthy childhood.’
I ask Bentall what he thinks of Ron Coleman’s contention that there is no such thing as schizophrenia. ‘Isn’t that a bit extreme?’
‘I don’t see it as extreme,’ he says. ‘I’ve said it myself. It’s an utterly useless concept. It hasn’t helped anybody. But there’s a philosophical question to be asked about all this – how do we define mental illness? We don’t have any kind of biological reference for psychiatric disorders in the same way that we do for, say, appendicitis. Even if we did, there’d be an issue of where we draw the line between a psychiatric disorder and not. Virtually all of them lie on a continuum with normal function. It’s not you’re schizophrenic or you’re not – people are more or less schizophrenic.’
At some point in my journey, wherever the line into true mental illness actually lies, I suddenly realise that I have crossed it. I wonder when I did it, and with whom? Who amongst all the people that I have met are just ordinarily irrational? And which are the ones who are ill?
But inside the ermine robes of these lordly judgements hangs a soggy pocket of doubts. What qualifies me to act as this binary-thinking St Peter of the sane? Am I certain that I am on a different side of the line to Margot from Ramsgate? When I was in my early twenties I would sneak back to the flat I shared with my girlfriend, two minutes after leaving for work, so convinced was I that she was having an affair with the man upstairs. I had no reason to suspect this. I didn’t even know who lived up there. As I tip-toed to the door, I would tell myself, ‘You’re fucking mad.’ And yet there I was, leaning in, listening for footsteps. It was the same as the occasions on which I would find myself helplessly phoning premium dating numbers in the local paper, to check if any of the women ‘seeking love’ were her. It was irrational. Delusional. One version of me knew it, while another couldn’t help itself.
I do not consider myself mentally ill, and yet I have behaved in ways that I could neither control nor explain. I have had suicidal thoughts. When things become difficult, I often console myself that simply resigning from the game is ‘an option.’ In that moment I believe it to be a rational judgement – I have my models of the world and I understand it to be an essentially hostile place. If it overwhelms me, then I am overwhelmed. I have done my best and it didn’t work. A decision simply to stop fighting seems reasonable. Fair.
And yet, as I write this, it seems like anything but. It is disorientating. I know that when I feel suicidal, I am convinced that it is my life and my choice and that I am making it in a clear and reasonable condition of mind. But now it seems equally obvious that this is the product of damaged cognition; that to leave my wife and family in this way would be cruel. There they are again, those two people – the one that believes in UFOs and the one that doesn’t; the one that wanted to stop stealing and the one that couldn’t help it; the one that wanted to help the screaming Buddhist and the one that couldn’t; the one that knew the lover was faithful and the one that knew she wasn’t. Which person am I? Am I two people? More?
Mental illness, says Richard Bentall, ‘lies on a continuum.’ It seems to me that, on any given day, we all suffer mild symptoms of many of them. I might hear my wife’s opinion of the fact I have left the washing up, just below the level of my conscious hearing; I might feel paranoid about an uncommunicative newspaper editor who has failed to acknowledge a submission; I might experience a light OCD when I triple-check that the iron is definitely off before I go out. Perhaps a full, debilitating mental illness occurs when one of these ordinary patterns of thinking takes over.
‘That’s exactly correct,’ Bentall says. ‘But the question still remains – when, exactly, do we decide it has taken over?’
I tell Richard that it is as if there are different versions of me, different agents with different opinions, all operating from within the same skull.
‘There are lots of theories about multiple selves and, depending on how you define them, they’re probably true,’ he replies. ‘The brain generates models of the world, and one of the things it does is generate a model of what sort of person we are, what sort of person we’d like to be and also what sort of person we fear becoming. So there are all these different versions of us swimming around in our brain. They tend to come to the fore at different times – you do something which you realise is a bit embarrassing and your feared-self rears up. It’s not a nice feeling.’
‘Is this related to the fact that you’re one version of yourself with your father, and then another with your wife?’
‘Absolutely,’ he says. ‘But it’s important to remember that these are just models. They’re conceptual systems which get activated at different times. Our various selves can be more or less in tune with each other or not. When they’re not, that’s associated with psychiatric problems. So depressed people in particular have a huge gap between how they see themselves and how they would like to be – their ideal self. If you’re not the sort of person you’d like to be, that’s how you get depressed.’
*
This endlessly human and private struggle that we all go through – trying to merge our many selves into one happy and real whole – is a notion that is central to the work of an ideological co-conspirator of Ron Coleman and Professor Romme. From his Bradford base, Dr Rufus May manages to be many degrees more controversial than them both. Not only is he an NHS doctor who encourages voice-hearers to come off their medication, he is also a diagnosed schizophrenic – a fact that he kept secret during his training.
Rufus picks me up from the station in his home town of Hebden Bridge, Yorkshire. It is a freezing November afternoon and as he drives me to the top of a hill, along a narrow cobbled road, I tell him what Richard Bentall had said about the different versions of us.
‘We’ve all got them,’ he agrees. ‘We meet them in our dreams. We have dialogues with them. Most people can’t hear them in waking life, but they might influence us – when you get angry, sometimes it’s like you’re taken over by a demon. In someone who hears voices, it’s just a bit more real.’
We soon arrive at his house, where I am to meet Nutmeg the dog and one of his patients. Deborah is twenty-five, pale, meek and crowded with unwelcome personalities. Under Rufus’s care, she has stopped taking anti-psychotic drugs. Rufus helps her by ‘dialogue-ing’ directly with the other consciousnesses that haunt her. He has promised that I can observe him as he works and, if things go well, I might even be allowed to interview one of Deborah’s voices.
As the kettle rises to a whistle and Nutmeg bounces excitedly around my legs, Deborah pulls the sleeves of her jumper over her hands and studies the surface of the wooden table. In the corner, pouring the tea, Rufus tells of his own fascinating journey into madness, which began on his eighteenth birthday. ‘I remember feeling like I needed to be somebody that I wasn’t,’ he says. ‘I started to get lots of strange ideas. I lost my sense of who I was.’
Rufus had a talent for art and had taken a job, near his parents’ home in Islington, North London, as a trainee draughtsman. ‘I was copying plans of industrial buildings,’ he says. ‘It was really boring, mechanistic. It was like my mind said, “Forget about this, just imagine what else I could be.” So I imagined I was an apprentice spy. When they asked me to deliver parcels, I thought, Maybe they’re secret messages. I started to create a reality that was much more interesting.’
What began as a game slowly took on the sharp corners of a life that was real. It was the time of the Cold War and Rufus fantasised that he was being recruited by the British Secret Service as a junior spy. He had had his heart broken, recently, by a girl called Jane. ‘I worked out that she was probably spying for the Russians.’
‘So that was why she’d left you,’ I clarify. ‘Because the Russians had made her?’
‘Yeah – and not because I was a crap boyfriend,’ he says with a laugh. ‘It protected me quite nicely.’
Rufus would stay up all night, roaming the West End of London with his dog, trying to find the safe house where he and Jane would be reunited. He looked everywhere for clues that he was, indeed, being recruited as a trainee spy.
‘The more you look for evidence to back up your unusual beliefs the more you find them,’ he says. ‘I’d seen films where spies got special messages on the radio, so I’d twiddle around and try and find them. Like this …’ He turns, switches on the radio next to his kettle and begins to randomly dial between clouds of white noise. The first voice we hear is stern, calm, in perfect Queen’s English.
‘ … The British government has a shoot-to-kill policy …’
‘Argh!’ I say.
I jump up from my seat.
‘See what I mean?’ He grins.
‘Was that really just on the radio?’ I ask.
‘That was just on the radio! That’s exactly the kind of thing. So you see, once you seek, you will find.’
On the other side of the table, Deborah mutters, ‘I’m a bit freaked out now.’
‘Once you start looking, these little coincidences become really …’ Rufus stops, unable momentarily to maintain his cool, and glances back at the radio. ‘Fucking hell. Luckily, I didn’t get that one.’ He turns back to face me. ‘So you can see – it’s really exciting and stressful, which means you’re staying up late at night, you’re hypervigilant, and when you don’t sleep, even more coincidences start to happen. My uncle was a Baptist minister. He used to say that God would communicate in strange ways. He’d see messages in advertising hoardings, or he’d open the Bible at random pages and see what the message for him was. I started to do that with driving manuals. I just made this rich fantasy world for myself.’
Rufus began to suffer chest pains. ‘I thought it must be a gadget that had been inserted into my chest by the oppositional forces.’ Oppositional forces meant Russia. And Russia meant Jane. When Rufus told his GP that his ex-girlfriend had placed a deadly gadget in his heart, she told him, ‘You need to see a specialist.’ He assumed that he would be referred to a specialist in spy-gadget removal. What he wasn’t expecting was a psychiatrist.
‘There’s some history of paranoia and psychosis in my family,’ he tells me. ‘My mum’s sister had a diagnosis of schizophrenia and heard voices and my grandad as well. So as soon as the doctors knew that, they were like – ’ he rubs his hands together – ‘job done. This is schizophrenia. It’s a genetic disorder and you’ll have to take this medication for the rest of your life.’
The medication made him feel empty, alien, dead. He could no longer draw a straight line. He could not achieve an erection. Against the advice of his doctors, he tried to halt the medication. The first two times, he ended up back in hospital. The third time, he succeeded. And then a friend of his committed suicide.
‘She jumped off a building,’ he says. ‘She was probably hearing voices and all they did was keep increasing the medication. I was really angry. I thought, I’ve found my mission. I would infiltrate the psychiatric system. Go undercover as a psychologist and expose it from within.’
Rufus describes the voices as messengers who speak on behalf of an individual’s ugliest experiences. ‘Through emotional trauma, someone might split off different parts of their experience, different emotions, different stories that they might have to bury. They can come back as voices. So what I do is help somebody understand different parts of themselves. It’s like a peace-making process. I turn the voices into allies.’
Before we begin the dialogue-ing, Rufus wants to confirm our prior agreement, that I will not only change the name of Deborah in my book, but all of her voices. ‘Is that okay with you?’ Rufus checks with Deborah.
She sits silently, for a moment, as her voices report back.
‘They’re all fine with that apart from Top Dog,’ she says. ‘Top Dog wants his name in.’
Top Dog is Deborah’s dominant voice. He is, says Rufus, ‘a cross between the Godfather and a Kray twin.’ He has threatened to kill Deborah many times. He has tried to convince her into suicide, saying, ‘If you don’t kill yourself, I will kill people you love.’ Rufus defends this behaviour, saying that Top Dog is ‘like a bodyguard. He was trying to protect her by getting her to kill herself, because he thought that the world was a cruel place and not worth bothering about.’
‘Hmmm,’ I say with a nod.
Earlier this year, Deborah nearly went through with it, before changing her mind at the last moment. The next day, a friend of hers died of cancer. Top Dog told Deborah, ‘I killed her because you didn’t kill yourself.’ Deborah believed him. When I ask now if she realises that this cannot be true, she replies, ‘I’m still working on that one. It just seems a bit too much of a coincidence, really.’
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.’