Madness takes its toll. Please have exact change

Last night's TV reviewed: The Doctor Who Hears Voices; Shrink Rap; Waking the Dead

It must be a tad worrying for patients at the Birchfield Hospital in North London to know that one of their doctors treated them while hearing voices in her head. At least it would be if Birchfield Hospital existed, which as far as Google and BT directory inquiries know, it doesn't. The imaginary hospital was part of the considerable subterfuge deployed by Leo Regan, the director of The Doctor Who Hears Voices (Channel 4), to keep hidden the identity of “Dr Ruth Fielding”, a young doctor who probably suffers from schizophrenia.

The programme re-introduced us to that quaint old figure so popular in the 1960s: the maverick psychologist. In this case, he was Dr Rufus May, who doesn’t believe schizophrenia exists, thinks there’s nothing wrong with madness anyway, and regards psychiatric drugs as a plot to keep the mentally ill in their place. Last night we followed his work with “Ruth”, a hospital doctor suspended from her job after telling her bosses that she felt suicidal (although not that the suicide was being urged by a voice in her head which sometimes counselled murder too). For reasons that became obvious, the programme was keen to protect Ruth’s real identity. The reason for the secrecy is that “Ruth” is back working in the NHS.

Not only was Ruth Fielding not her real name, but while everyone else appeared as themselves in this extremely unusual, hugely intriguing documentary, Ruth was played like a wild animal who might at any moment dash under a truck by actress Ruth Jane Eyre Wilson. It was a startling performance with the slight caveat that no actor ever messed up playing a mentally ill character. Wilson used medical records to improvise her scenes. May, now a clinical psychologist in the NHS, was his own manic self; talking, walking and swimming Ruth through her problems by using his own experience instead of medication. Producer/director Regan was a persistent and, sometimes, horrified gooseberry. And there was a fourth person, the voice, which wanted them all dead. The documentary and dramatised sections fitted together like clasped hands.

At first it looked as if we were in for the straightforward tale of a lone hero taking on the dark forces of the medical establishment. Fortunately, though, the result turned out to be much more complicated and interesting than that. For one thing, May’s heroic status increasingly came into question. He, it turned out, had particular insight into Ruth's predicament, having been diagnosed with acute schizophrenia (he does not accept the term) himself at the age of 18. When a more conventional psychologist explained that a patient who could not be cajoled into taking medication would ultimately have to be forcibly injected, May was able to recall the indignity of being held down by five nurses so a syringe could be jammed into his buttocks. But these experiences didn't make him seem like a safe pair of hands. May lied to be accepted for training as a clinical psychologist and even accepted that he might have “a chip on his shoulder”. It was never entirely clear he’d ever been cured – especially when he reacted to moments of crisis by laughing a lot.

So May is still, if not disturbed, disturbing, with galvanic gestures, dislocated language and that loud cackle which, he says, he cultivated deliberately in a mental hospital. The sort of person with whom you would hesitate to share a table at an all-night cafe. In truth, he is either so wrong about everything that he should not be working as a clinical psychologist, or a pioneer of a new approach to insanity. May's tactics are not to be confused with the legendary R. D. Laing's, who felt that calling in a doctor to treat madness was like calling in a TV repair man because you do not like the programme you are watching. May accepted that Ruth was ill but not that she should be treated with drugs. Instead he encouraged her in her manic state and engaged with the voice inside her that was telling her she was being followed, that she was worthless, and that she should kill herself. At times he and Ruth seemed to be mirroring each other, and Regan, hovering helplessly, said, "I'm beginning to worry about both of them."

Meanwhile, Ruth’s condition was getting worse. Without her medication, she decided that she was being followed by cars with her initials in their number plates. Even so, May stuck to his basic plan: that she should tell her hospital’s assessment board she was taking the drugs and generally feeling fine. Ruth conned her way through and I commend her interview technique to you: "Shoulders back, good eye contact and, when they ask how you are, say 'Fine, how are you?'" But her progress was uneven and, once, she simply vanished. May seemed ready to believe she might have killed herself: 1,200 sufferers do so every year; another 50 kill someone else. Regan said, "I know Rufus is thinking she may have killed herself. But he refuses to discuss it." Reluctantly and eventually, May said, "By talking about it to camera I'm incriminating myself." However, Ruth reappeared and they worked out that the voice represented someone who had bullied her at school. The whole frightening switchback was sweetened with the sight of seas and trees and streams.

Some of the re-enacted sequences smacked of The Exorcist. Voice (speaking through Ruth): “I'm like a prophecy.” May: “We'll resist that prophecy.” Voice: “I'll fight you. You are a bloody do-gooder.” May wanted to know who the voice was: a parent, a psychiatrist or perhaps her brother who had died of a heart attack when he was 14? When he found out that it was the bully, May, as Regan noted, seemed almost giddily pleased with himself. He found it hilarious, too, that he had excluded the film-maker from this crucial leg of the therapy. Yet he may have been right to insist that her delusions were not mere “word salad” and held symbolic meanings wherein a key to her healing might be found. The trouble was that by the end, although Ruth was better, her voices were as loud as ever, something she did not tell her superiors. May's response was: “So what?”

Ruth's final assessment at her hospital ("A whiff of the truth and her career is over") was successful, and Regan met her three months later, charming and composed, during a coffee break. She still heard the voice and treated it like a sleeping dog. "He's not the problem. If people find out, that would be the problem. I don't want to be disrespectful to him. We're in this together." May, too, gave the devil his due: "She's become a very strong person, resisting you. So, thanks!"

So we did achieve some sort of progress – and not only because Ruth managed to fool the board and is now a doctor again. She still hears the voice, but apparently realises that she doesn’t have to do what it says. She can even speak of it quite fondly as a kind of exasperating old friend. The programme definitely didn’t leave more orthodox methods looking like a great conspiracy – or May’s looking like the way forward in all cases. Nonetheless, by raising the possibility that some people with serious mental illness might be able to function pretty well, it did remind us that the long debate about how best to treat (let alone cure) madness is far from over.

In an alternative life as an investigative reporter, Leo Regan might have commandeered a front page to expose the NHS for harbouring this woman on its staff. Instead, his clear-eyed, worrying film assaulted our conceptions about the treatment of insanity. Although using drugs to douse down the symptoms of madness is by no means a cure, Regan clearly remained unconvinced that May had the full answer either. I'll forgive him for mocking up a NHS sign reading “Birchfield Hospital”. But when it comes to the ethics of May and Ruth conniving to get her back on staff by lying about her mental condition, I can't suppress the tabloid voice in me that whispers: “They stink.” And all the while questions buzz around your head like hornets. I am sure Ruth will be an unusually perceptive and empathetic doctor. With a bit of luck, not mine.

Such television tends to hit you like a wrecking ball on Mondays. If they spread the misery out a bit, we could bear it better. Last night it was wall-to-wall madness. There was more psychoanalysis in Shrink Rap, in which another troubled woman, Joan Rivers, got the Pamela Stephenson Connolly treatment. "What's she really like when the jokes stop?" asked Connolly at the top of the programme, and of course, as the wife of Billy Connolly as well as a former comedy performer herself, she knows all about the tears of a clown. Nonetheless, I wondered how successful she'd be at drawing out the inner Rivers, and couldn't help thinking of Ken Dodd a few years ago on Radio 4's In the Psychiatrist's Chair. "Ken Dodd, today I'll be attempting to get behind your funny-man's mask, what do you think about that?" said Dr Anthony Clare, soothingly. "I think it's absolutely tattifilarious and totally full of plumptiousness," came the reply.

Rivers was more accommodating; indeed, this was, in some ways, a much more revealing and affecting programme than The Doctor Who Hears Voices, and not simply because of the celebrity factor. Here was a 74-year-old woman who by any standards has suffered emotional trauma – the suicide of her husband followed by estrangement from her only daughter, the death from an Aids-related illness of her beloved psychologist, the meltdown of her career after she had dared to offend America's chat-show king, Johnny Carson – and she talked candidly about each of those episodes. Connolly also asked her what sex was like at 74. "The same as it was at 20," she said. "Disgusting." A short chuckle. "No, it's exactly the same, just that the room is a little darker. You still can get just as hurt, still just as elated."

Given that she goes under the cosmetic surgeon's knife more often than some of us put the bins out (without a hint of a smile on those huge collagen lips, she explained that she was in hospital having liposuction when word arrived that her husband had killed himself), sex with Joan Rivers probably requires the lights on rather than off, on the basis that there can't be anything in the same place as it was when she was 20. But despite all that plastic, she still weeps real tears, and I warmed to her when I saw them. Connolly identified a pattern of betrayal, a diagnosis at which Rivers happily grasped. She was less willing to take the doc's medicine, which was to stop acting as if her body was “betraying” her by getting older. “It's not going to get any Christmas cards from me,” she said. Rivers has her own patent cure: wisecracks.

Finally, In Waking the Dead (BBC1), a prison governor has been decapitated either by two people, one violent and one calculating, or by one person with multiple-personality disorder. Life is never simple for Det Supt Boyd, which amply accounts for his short fuse. Personally I'd arrest the prison psychiatrist and be done with it. Meanwhile, back in the forest, Eve, the forceful forensic scientist, has led the team to a forest clearing where there are seven lush patches of grass. "These areas of bushy growths are what you would expect to see when carbon nutrients are released into the soil." "Meaning what?" asked Boyd, who has to take a lot of this sort of stuff from Eve. "Dead bodies," she said succinctly.