Medicalizar la mente: ¿Sirven de algo los tratamientos psiquiátricos?

by Richard P. Bentall, Nuria Cañete Colmena (Translator), Jorge L. Tizón (Prologuista)

¿Existe alguna prueba de que la psiquiatría haya tenido un impacto radicalmente positivo en el bienestar de los seres humanos?

Sorprendentemente, según el destacado psicólogo Richard P. Bentall, parece que la respuesta es negativa. Mientras que la historia reciente de la medicina somática ha estado marcada por grandes y espectaculares avances que han conducido a un aumento significativo de las probabilidades de supervivencia en casos de enfermedades potencialmente mortales, no existen pruebas de similares avances en la capacidad para tratar un trastorno mental grave.

En Medicalizar la mente, el autor nos revela la cruda realidad que se halla tras los sistemas de atención a la salud mental en Occidente, donde según la OMS los pacientes se recuperan con mayor dificultad que en los países en vías de desarrollo. Dado que la atención psiquiátrica se construye con frecuencia sobre la base de mitos y confusiones sobre la locura, los pacientes de este sistema, especialmente vulnerables, no tardan en descubrir la fuerte dependencia que la psiquiatría tiene de los fármacos.

Bentall aboga fervientemente por una nueva forma de atención al paciente, una atención que considere a cada persona individualmente y establezca un intercambio comunicativo con ella, replanteando así nuestra forma de entender los trastornos mentales y su tratamiento en el siglo XXI.

Genres: Psychology, Nonfiction, Psychiatry, Science, Mental Health, Medicine, Health

528 pages, Paperback

First published January 1, 2009

Reviews

[Trevor · Rating 5 out of 5]

What is madness? This is not nearly as easy a question to answer as you might think. Firstly, you might want to say that to be mad is to act in a way that is different from those around you – but you might also want to say that acting differently to those around you is often a pretty good definition of being sane too. Okay, so perhaps you could say that being mad is to act irrationally, but again, one man’s reason is another woman’s insanity, so who is to judge?

If you were a psychiatrist you might want to say that madness is a genetic dysfunction causing an imbalance of brain chemicals that causes predictable behavioural abnormalities and mental states, both of which can effectively be addressed through appropriate drug therapies. That is, chemical imbalance in brain needs to be re-balanced using drugs. This book is mostly opposed to precisely this definition of madness.

I have known for years that there was a serious turf war between psychiatrists and psychologists. Having studied philosophy I have generally thought both sides to be nutcases and more in need of treatment than being allowed to treat others. This book calls into question the whole idea behind psychiatry – and I think very convincingly. It also makes me very, very glad that I do not have a mental illness, at least, not one evident enough to make me conspicuous to these bastards.

The medical paradigm – that diseases (including mental ones) first need to be diagnosed (given a name), before a prognosis (how long you are likely to be sick) can be given and a treatment strategy developed to show a ‘pathway to wellness’ – has proven to be remarkably poor at improving mental illness. In fact, while medical science has measurably improved the lot of cancer sufferers and heart attack victims, the lot of the mentally ill has not really improved at all over the last century. This should be a scandal, but instead it is passed over mostly in silence.

Let me start by saying that I do believe people suffer from mental illnesses and also believe things can and should be done to help these people – but I also want to stress that the medical paradigm I would prefer to see applied in such cases is the one that says, “First, do no harm”. This has not been something the history of psychiatry can proudly point to. It has been a history of disgusting human experimentation, and not just in Nazi Germany - lobotomy, insulin shock, electric shocks to the brain, barbaric surgery (including genital mutilation) and punishing incarceration are but the tip of a very deep iceberg. A history such as this ought to give society reason to pause, but its current excesses, particularly in the use of chemicals to ‘treat’ illness, show, if nothing else, that we learn nothing from history.

Most people would agree that if you are mad it must have something to do with your brain and that to fix the problem will involve somehow fixing your brain. But what could be wrong with your brain? When psychologists first went looking they hoped to find something big and obvious (like an on/off switch in the head conveniently turned to Off) – at least as obvious as the symptoms they saw manifested. Illnesses such as schizophrenia and bi-polar disorder are mentioned so often that you might assume that these are clearly defined and easily recognised disorders. Nothing could be further from the truth. There is little agreement about what constitutes any mental illness. A better path than the one we are on at present would be to see such disorders not as convenient boxes to place people into, but as spectrum disorders where the boundaries between ‘normal’ and ‘ill’ are not at all easy to define.

Except that we do have a preference for believing in the all-powerful gene. This is another myth that is attacked in this book. Once again the tricks and lies of those who are obsessed with finding genetic causes to every complaint, real or imagined, is displayed in stark relief. I would suggest that if someone tells you that something even as innocuous as the fact that hair colour has a genetic basis that you would be better off doubting them – better to doubt than to end up believing half of the nonsense that passes for ‘the science of genetics’ – oh Mr Pinker, that includes you. The infinite evil that has been perpetrated in that science’s name is once again documented and what a sorry history it has been.

I had no idea how much money drug companies make out of the drugs they peddle – how infinitely profitable making the lives of the mentally ill even more miserable could be. Come the revolution, of course, we are going to need a particularly long wall. The chapters in this book on how psychiatry has become an aloof medical science not so much interested in the patient as in their symptoms and even then only in how to stuff them full of expensive drugs that chemically lobotomise them is infuriating. Apparently, drug companies make up the ten most profitable companies on the Fortune 100 and, although they claim to need to make the obscene profits they make to help them develop new and more effective drugs, actually most of the private money used in developing drugs is to make drugs that are chemically similar to already existing ones to get around patent laws. Most new drugs are developed using public money. These companies spend much more on advertising than on developing drugs. If you needed a synonym of evil then ‘multi-national pharmaceutical company’ would be as good as any other.

There are heavy-duty backers to the idea that mental illness is a medical condition that needs to be treated using drugs – follow the cash. This book, referenced to within an inch of its life, points out that on virtually every level the assumptions psychiatry makes about mental illness are both wrong and increase the suffering of those unfortunate enough to be treated according to this paradigm. I don’t know if treating people in the manner the author suggests (that is, with kindness while seeking to understand the patient) would be an effective treatment or not – but by god it seems to make a hell of a lot more sense (and cause a hell of a lot less damage) than what has been tried to date.

This is a fascinating, important and infuriating book. If you are even a little bit interested in this subject I can’t recommend it too highly.

[Muriel (The Purple Bookwyrm) · Rating 3 out of 5]

I'll preface this by saying that I really appreciate the fact the author had the honesty of admitting the presence of personal bias in favour of clinical psychology. It really helped me to moderate my annoyance at some parts of this book. Thank you.

I'll also add that I'm writing this as a person who has suffered from chronic depression since the age of twelve, and been treated in a non anglo-saxon EU country. As such, my experience of psychiatry has not been absolutely dominated by Big Pharma (thank goodness). I've been researching psychiatry, anti-psychiatry, and looking to critical psychiatry for a while now and thus took to reading this book with a pinch of salt at the ready.

I was ready to dump it before even starting it when I saw a review mentioning it as a great asset to the anti-psychiatry movement. I really have no patience for it. A lot of it is made up of fanatics who cry "pseudo-science" at psychiatry when they themselves know little about the nuances of scientific research, or the complexity of it when it adresses the amazing organ that is the brain. A lot of them are also mental illness denialists who have no more compassion for sufferers than the pharmadocs they despise so much.

But I decided to give the book a try anyway. Now that I've finished, I'm pretty confident that the author is not, in fact, (really) anti-psychiatry. Although this was absolutely not apparent at first (or even at middle). I'll come back to that.

I'll start with what I enjoyed about the book:

1) The historical information was very interesting (good History is always fun), and though I knew a bit of it already, I enjoyed learning new things. I was somewhat familiar with Kraepelin and Meyer, but have now a much clearer understanding of their founding roles in psychiatric thought/theory.
2) The author presented a very clear and concise analysis of antidepressant and antipsychotic research. Confirming what I already knew and/or suspected regarding long-term use of psych meds, from the useless to the outright dangerous.
3) There were interesting tidbits about the current theoretical frameworks used to understand the different aspects of psychosis, which I found really convincing. Although I don't see how these psychological mechanisms exclude the role of (intrinsic) biology for some people!
4) His concluding chapter envisioning a holistic, psychobiosocial reform for the treatment of mental illness, and the maintenance of good mental health.

Ironically though, that last point is problematic for two reasons:
a) I know for a fact that this method is already being put into practice, and has been for some time. Since I encountered it both when I was in hospital at age 12, and when I went back last year (I'm now 25). As far as I know, the multidisciplinary approach is the only one to be found in my city, even my country. So clearly, on an international level (in developed countries), we're dealing with a straw man here. If he were talking exclusively about the US, or even Britain (though even according to him it's not as bad), then yes, I would concur. Although not entirely either since I've read several accounts of good care in the USA as well. On the other hand, I will certainly agree that the influence of Big Pharma is ever growing, again especially in the States, it's HQ.

b) That last chapter's tone in particular seemed to be in direct conflict with most of the rest of the book's. But even throughout, the author's contradictory feelings and conclusions were really grating at times.

Which brings me to what I didn't like about this book:
1) The author's inconsistency. It's as if he couldn't really make up his mind about his feelings and conclusions regarding psychiatry. Honestly, if I hadn't finished the book, I would've come away with the conclusion that he was the definitely part of what I call the "Church of Psychotherapy" branch of the anti-psychiatry movement. But the book's last chapter was really quite beautifully nuanced, so I've decided he's more in the critical psychiatry camp (though in a more clearly biased way than I am myself).
2) The differing amount of detail awarded to his critiques of medication and therapy. The author does a pretty decent job of critiquing the role of medication in the treatment of mental illness, but clearly didn't go in as deep with psychotherapy (not as many notes and references, for one). This is probably the result of his personal bias. And while he gets more nuanced towards the end of his book, most of his remarks regarding meds vs. (mostly CBT, big surprise) psychotherapy are just too black and white. Either "medication is a spectacular failure unworthy of further research" (which I find disturbingly unscientific to say), or "psychotherapy undoubtedly demonstrates very high amounts of success". Which is all the more confusing when he admits, on the very same page, that conducting objective research on it's efficacy is even more difficult than it is for psychopharmacology.
3) I found some of the evidence unconvincing. In fact, I find it funny that, despite looking at the same data, the author and I came to different conclusions as to their meaning for patient care. I also found some of his interpretations to be based on faulty premises, chiefly that the mind and brain are separate, and that just because something can be influenced, even "caused" by our environment and life circumstances, it means it's all about nurture and not about nature (i.e. mis-wiring of the brain). Again, he seemed to agree with me on this one towards the end of the book, so maybe this is all a question of either poor writing, or poor editing.
4) Putting what I mentioned about the author's contradictions aside, I was also annoyed about what seems to be a generalised misunderstanding of the role of genetics and brain structure in all of this. Genetic predispositions for mental illness (and many others, I might add) don't automatically lead to actual mental illness. In fact, epigenetics, an even more interesting field of study to me, would agree that genes clearly have a complex relationship with our environment and life circumstances. There is no mutual exclusion here. The same goes with brain structure (and even brain chemistry, to a certain extent, although I don't subscribe to the chemical imbalance theory either, it's too simple), which can and is affected by our life experiences. Ever heard of neuro-plasticity? Is it so unreasonable to think that trauma, or repeated negative experiences, can shape neural pathways and biochemical mechanisms in such a way as to make it increasingly difficult to get out of toxic, depressed, anxious, even psychotic, thought patterns and processes? (Which is also why I'm convinced CBT alone will not work with severe long-term mental illness, certainly not if it lasts a mere 6 months). Is it so unreasonable to think that some people have genes that, if activated by certain life events, will make the development of mental illness more likely or more severe? Otherwise, you would see the same reactions or lack thereof in people who've had bad experiences! And you wouldn't find family trees with a ridiculous amount of actual mental illness either.
5) The straw-manning, which I've already mentioned. a) A lot of the faults attributed to psychiatry can be attributed to other branches of medicine (the author does acknowledge this, so I wasn't so annoyed by this by the end of the book). b) Like I said, I've never encountered a psychiatrist who said that mental illnesses are genetically determined diseases of the brain. Never. Not once. I'm not saying they don't exist, but clearly that statement doesn't represent a universally agreed upon consensus. c) Different branches of medicine have also caused incredible harm and more importantly, taken time to get where they are today. The first example that comes to mind is the field of oncology. In fact, cancer research still has a long way to go! Imagine then, what this means for the branches of medicine (psychiatry and neurology, which should perhaps fuse in some cases) that study the most complex organ we have! Of course we're not there yet! We need more research, not less! To say that, just because we haven't found (enough) convincing evidence for the biological underpinnings (a better word than "causes") of mental illness, we should abandon all research is downright shameful coming from the mouth of a scientific researcher! If science should only to be conducted when there is an assurance of finding an immediate application, then theoretical physics departments, for example, should all be shut down.
6) The naiveté of the author regarding the importance of a warm and caring relationship between a psychotherapist and his/her patient. I mean, really? That we need decent human relationships with our doctors and therapist is pretty self-evident. Bedside manners are fundamental, compassion should be a requirement. But it only goes so far. It's not a panacea. Moreover, it will always be fake, to a degree. Why? Because money is involved. It might be a very cynical way of seeing it, but I think it's realistic. Money doesn't prevent someone from caring or being kind, of course. But it puts up a barrier that needs to be recognised. A shrink is basically a friendship prostitute (note, I have nothing against prostitution). If you're lucky, they'll have actual therapeutical tools, backed by at least some theory and evidence, that can help. Although you might as well buy a CBT workbook and do it yourself. But this is why I disagree with the Dodo conjecture. Simply being nice to your patient/client, and taking 30-40 € from them (which in my country, is not even covered by healthcare) is not going to improve their symptoms or quality of life, not on the long-term at least. To think otherwise is ridiculous. If it's that simple, why can people with relatively good life circumstances still suffer from mental illness? Conversely, why aren't sufferers automatically cured as soon as their life circumstances improve?
7) The author's qualms with classification. This didn't bother me too much to be honest. I get it: I hate the DSM too. But I don't think attempts at classification are entirely misguided (again, there have been issues with this in other branches of medicine). The real problem with the DSM is that it is used as a bible, not as a set of guidelines, and that it's been heavily corrupted by Big Pharma. And yes, discrete categories can be problematic, although if the author dislikes them so much, why does he insist on separating symptoms and quality of life as if they had nothing to do with each other?

Like I said, I liked his concluding chapter. Well, except when he lapsed back into "mental illness is all nurture" mode and said that it basically boils down to problems with human relationships (it's almost as bad as the "it's the mother's fault" explanation for autism). I mean, yes, they're very important. The world is rife with problems. Kindness is in short supply. But until we get the Revolution going, simple answers to the complex issues of mental illness simply won't work. I should know.

Psychotherapy can be just as good, just as bad, and just as useless as medication, for different people. Okay, granted, antipsychotics are probably more physiologically dangerous than any kind of therapy (except when it's so pointless that the patient, stuck with despair, ends up killing himself). Psychiatry has not crushed my hopes. It simply hasn't given me any. There's a significant difference here. And it's as true for medications as it is for psychotherapy. In my case, they're both, largely, BS. Not entirely, but largely.

I firmly believe that the holistic approach to psychiatry (and medicine in general, really) is the best one. As of now, it's woefully incomplete and short-sighted. We need more research (yes, more, more for every aspect of the problem) on brain function and the emergence of what we call the mind. Neuro-plasticity, I think, holds the key for many sufferers. Which is why I look up to psychedelic medicine as the potential redeemer of psychobiosocial psychiatry. No to mention it's the only thing giving me any substantial hope right now.

[Dovilė Stonė · Rating 3 out of 5]

Apie "cheminį disbalansą":

"In fact, both the dopamine and the serotonin theories were based on indirect evidence, often from animal experiments, mainly the effects of drugs on the brains of animals that could be killed for the purposes of science. Researchers realized that direct observation of abnormal biochemistry in the brains of living patients would be necessary to firm up their theories. Obtaining this evidence proved difficult because the brains of patients could not be observed directly and, in any case, the drugs the patients were by then inevitably receiving interfered with the very biochemical processes that researchers wanted to study. Although some evidence has emerged to support the role of dopamine in psychosis, direct support for the serotonin hypothesis has remained elusive to this day. Nonetheless, the chemical imbalance theory of depression has continued to be enthusiastically promoted in drug advertisements (sometimes targeted directly at consumers rather than professionals: ‘Celexa helps to restore the brain’s chemical balance by increasing the supply of a chemical messenger in the brain called serotonin’) and by the popular press. Perhaps this is partly because the idea is so easy to understand, but it is also because this type of explanation for mental illness serves the interests of biological-orientated psychiatrists and drug companies very well."

Apie "genetinę predispoziciją":

"Genetic researchers in the meantime have increasingly turned to new technologies in the hope of finding evidence to support their theories, and especially to new molecular techniques that have become available over the last twenty years. Unlike the methods of behavioural genetics that we have considered thus far, these techniques can show how particular types of behaviour and experience are related to specific genes, coded in sequences of bases on stands of DNA and located on specific chromosomes.
Before considering this development, it is worth reminding ourselves that genes cannot determine human characteristics directly. Rather, they control the synthesis of proteins in the body, which in turn helps to determine the way that the individual grows and develops. At each stage in this complex and as yet incompletely understood process, there are opportunities for the environment to influence what is happening. In short, there is a long and incredibly complicated causal pathway running from the DNA we inherit from our parents to our behaviour in adulthood and, under these circumstances, it is perhaps naive to imagine that there are genes ‘for’ any particular trait.
[...]
Since the very earliest days of professional psychiatry, researchers have systematically exaggerated the extent to which serious mental illness is caused by genes, and underestimated the importance of environmental influences. Recent evidence collected by molecular geneticists gives us no reason to doubt this conclusion, because the only findings that have proved to be even marginally replicable concern genes that confer only a very small risk of psychosis and which are absent in the majority of patients (and even these findings are questionable, given the results of the recent large European study). If there were any genes with more direct and marked effects, they would have certainly been discovered by now, so we can confidently assume that they do not exist.
[...]
I should perhaps make it clear at this point that I am not opposed to research on the way that genes influence behaviour, but it seems to me that resources should be allocated in proportion to the likely benefits that will be obtained by individuals and society.
In this context, it is important to note that no patient, not a single one, has ever benefited from genetic research into mental illness, although many have been indirectly harmed by it (because it has discouraged the development of adequate services for patients and, during one shameful period, was used to justify their slaughter). No effective treatments have so far been devised on the basis of genetic information and, given what we now know, it seems very unlikely that further research into the genetics of psychosis will lead to important therapeutic advances in the future. Indeed, from the point of view of patients, there can be few other areas of medical research that have yielded such a dismal return for effort expended."

Apie būklės pagerėjimą:

"Importantly, this research has shown that recovery is a multifaceted phenomenon. For example, some patients are liberated from their symptoms by their drug treatment but continue to struggle with severe social disabilities, whereas others function perfectly well despite the persistence of voices and unusual beliefs. It is therefore difficult to devise a universally acceptable definition of recovery, but defining it merely in terms of symptoms – still meeting the diagnostic criteria according to the DSM or the ICD – seems hopelessly narrow. Patients more often highlight the importance of improved quality of life, the sense of being empowered to rebuild their relationships and careers, improved self-esteem and hope for the future.
Recovery must therefore be seen as an evolving and unavoidably subjective process. William Anthony, a psychologist specializing in the rehabilitation of chronically disabled patients, has described it as ‘A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life, even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.’ Anthony has argued that the evidence-based medicine movement, with its emphasis on randomized controlled trials in which the outcome measured is usually symptoms, has had little impact in psychiatry precisely because it has failed to seek evidence that is meaningful to patients. Instead of conventional trials, he suggests that researchers should focus on those domains of functioning that patients think are most important (for example, quality of life), using methods (for example, interviews) that allow subjective outcomes to be measured, administered as far as possible in real-life settings. He also argues that researchers should make more effort to study the impact of the therapeutic relationship."

[Sasha · Rating 4 out of 5]

its interesting but very similar and kind of an expansion on his previous book madness explained. It's quite a strong critique of how schizophrenia is treated (with a wider conversation about whether or not it's even worth calling it that) and considered generally. interesting critiques also of medical and drug based treatments of mental health problems. author has a habit of muddying data which he disagrees with - lots of question raising about models he disagrees with and then saying something like 'there may be something here but I guess we can't know' which feels a bit tricky. I think considering how long he wrote about and considered treatments and ideas he disagrees with versus ones he agrees with is probably an example of this. he also will just say his opinion in a way that's readable but feels very biased i.e. saying something like 'these complaints are mostly scrupulous' etc etc when it should probably be for the reader to decide. the human stories were good to read and I found the ideas very humane. I do think it's annoying how often the author says something like "this will be covered/ looked at/ analysed later". this happens enough to be noticeable. it's a slimmed down version of madness explained that I think is designed to talk more about medication and also to expand on previous ideas but I think madness explained is probably a bit more worth while to be honest.

[Neal Alexander · Rating 3 out of 5]

My edition is subtitled ‘Why psychiatric treatments fail’. So, why do they? (_If_ they do, that is, which isn’t always.) The book’s answer is that such treatments are aimed a supposed chemical imbalance, rather than a person whose condition is part of their personal and economic circumstances.

I agree with almost everything in the book but it’s not very original. In the final chapters he propounds what he calls the ‘autonomy promoting’ model of psychiatric care - - e.g. the right to decline treatment - - as opposed to the current ‘paternalistic-medical’ one. He’s mentioned Thomas Szasz a few times earlier, but here the sentence ‘These arguments are not mere philosophical posturing: they are utilitarian and practial’ is footnoted ‘My approach is therefore somewhat different from that of ‘Thomas Szasz, whose objections to coercion seem to be based on a deontological conception of human rights’. Anyone familiar with Szasz’ life and work will know that the implication of ‘mere posturing’ is false, so this passage comes over as a failed attempt to get out if his shadow.

[Kira · Rating 5 out of 5]

This book is highly accessible and accomplished piece of writing which stands out because of Bentall's uncompromising courage to take on some of the most strongly held beliefs concerning both psychological and psychiatric treatments of mental illness. The author depicts some of these current approaches as moments of distorted, premature hubris which pose the risk of being extremely harmful in the long run. This view is backed with ongoing review of scientific research, and it should be noted that the narrative remains neutral throughout, steering clear of scaremongering. As a whole, this book presents a rather unpleasant picture of how the pursuit of prestige commonly associated with medicine can ultimately lead to detrimental results in the field of mental health.

Very refreshing and thought-provoking read.

[sydney · Rating 4 out of 5]

this book talks about unsatisfactory endings w psychiatric patients when taking meds and how sometimes having hope in allowing things to take their course is perhaps more beneficial, plus loads of other discussion q’s. pretty good 🪄

[Doreen · Rating 4 out of 5]

Excellent and would be worrying if you did not already suspect that medication outruns the evidence to support its use. The upshot is that the more intrusive treatments have in the past been held to be helpful when they were not: leucotomy, insulin coma, ECT and that drug treatments are often pursued at damaging levels since individual variation is not adequately allowed for. Talking therapies are less intrusive but there is no evidence that any one sort works better than any other sort and perhaps the magic ingredient is kindness. Many people have symptoms similar to those demmed mentally ill, without ever feeling the need of a psychiatric service. A bit more humility all round would seem to be the order of the day.

[Aurélien Thomas · Rating 3 out of 5]

The medical world has made considerable progress over the past few decades, yet not every fields has been that much impacted. It's particularly the case with psychiatry, as mental illnesses still are treated with all sorts of different medications, but, the illnesses themselves have not been cured. Why so?

Richard P. Bentall, a clinical psychologist, outlines here a few reasons by retelling the history of psychiatry itself, its ongoing battles against clinical psychology, and, its apparent failures in treating patients. Being on the clinical psychologists side, of course, the book suffers a serious lack of balance and is biased all throughout! The author, thought, and to his credit, is not denying it. Being biased, however, doesn't mean his points are irrelevant.

First of all, I confess: I am biased too. I felt he was pushing all throughout in claiming that medication are mostly unnecessary (although he pays lip service to clozapine -the 'jury is still out', apparently...). I personally disagree, or, at least, I felt this point ought to be more nuanced. As someone who has been diagnosed as being on the bipolar spectrum, I know full well indeed how it feels to live pre-diagnosis (without med) as opposed to post-diagnosis (with med), and so, as much as I fully respect his views against the biological model and its reductionism, such model is not all completely flawed either.

That being said, he surely makes very strong points against, well, the more often than not reductionist approach of the biological model, which has underpinned psychiatry to the extend of having hijacked the field (or so he claims -I am not a professional, so I will leave this here...). There's no doubt indeed that the neo-Kraepelian model and how we define various mental illnesses seem pretty arbitrary and subjective, while the industry benefiting from it (the pharmaceutical industry) keeps peddling without making much innovation. Here's not yet another looney, on about conspiracy theories whereas Big Pharma are evil out to get us all! Here's merely a statement of fact: such industry has been churning more 'me too' drugs that new and innovative pills, it spends more on marketing than on research, and its overall approach to promote itself at times begs ethical concerns.

What about the alternative, then? Well, Richard P. Bentall regrets the obvious, that we came to see patients as 'bearers of symptoms rather than as people with histories and stories to tell.' Dealing with symptoms, he discusses how our lumping on some over others altogether to define some illnesses over others is unhelpful and questionable (psychosis and hypomania are cases in points). He also tackles the relevance of psychoanalysis, psychotherapy, and behavioural therapies (of which CBT has become the flag bearer) in chapters which, if strongly biased, nevertheless show them as more in line with our prevalent person-centred approach in care than the medical model ever was. As far as I am personally concerned, we go here full circle since, although I take pills to address my personal condition, I am also aware of my triggers and so applies many of the precepts outlined by such views. My environment matters as much as my biology, and it would be foolish indeed to rely only on pills.

Would it be foolish to rely only on clinical psychology? Sadly, I didn't feel as if the author was tackling the topic as critically as he targeted psychiatry. It's a pity, because doing otherwise would have turned this read into a well-rounded view of how various professionals and experts are dealing with mental health.

In the end, here's a book full of insights, challenging many preconceptions, and which ought to reconciliate biology and genetics with psychology. Has he succeeded? I personally felt he was harsher towards the biological model than against clinical psychology, an approach which is understandable considering his own professional background, but, which also makes it seem like his view lacks in balance -while they aren't. Oh, well! It still is a enlightening take, by an author I strongly recommend (if you're interested, Madness Explained: Psychosis and Human Nature is a must-read as far as I am concerned...).

[Cal Davie · Rating 5 out of 5]

Insanely good.

Very readable, meticulously referenced and we'll argued.

Bentall's experience as a Clinical Psychologist shines through as he brings the case of anti-psychiatry to the modern world. The myth of genetic and brain diseases for mental suffering is still ever present, and this book goes a fair way to quashing it.

Of particular interest was explanations of schizophrenia, breaking it down in a way that is relatable for "non ill" folk, as schizophrenia is usually the go-to for the disease-model. The book argues radically for compassion, and how power has been abused in the name of treatment. Bentall is generous and nuanced on the literature regarding psychiatric drugs arguing that anti-psychotics aren't necessarily bad, but depends on the individual.

A wonderful polemic. Very powerful and informative. Extremely important read.

[Andrew Pratley · Rating 5 out of 5]

Thought provoking book concerning the current understanding of our minds by science & the medical profession. What becomes evident is that the human mind is still mostly seen as a black box. Medical professionals understand a bit & have lots of theories but precious little real hard evidence even after all those medical trials. My own personal experience backs this up. I wouldn't say they are all clueless but there is an awful lot of well meaning stumbling about in the dark. In centuries to come I'm sure our descendants will hopefully shake their heads at our primitive beliefs & lack of understanding as how the human mind operates. For now as Richard Bentall points out a bit more humility all round wouldn't go amiss.

[Cricri & les chats · Rating 4 out of 5]

J'ai lu cet ouvrage il y a une dizaine d'années.
Des considérations importantes en lien avec les antipsychotiques (surtout) y sont soulevées, par exemple les biais d'études comparant les différentes générations d'antipsychotiques. C'est un point de départ intéressant pour amorcer une remise en question nécessaire.

[Thom XRobson · Rating 4 out of 5]

Very interesting book, arguments clearly laid out. Attentive to the readers understanding. Argues against medical models of psychiatry. I'd like to see the counter debate next.

[James Colvin-Jarvis · Rating 4 out of 5]

'Just because you are paranoid, does not mean that they are not out to get you'

[Sweetmiky · Rating 5 out of 5]

super good and i hope everyone read it

[smoonf · Rating 4 out of 5]

Criticisms so true, although conclusions weak 🥲

[Demetrelli · Rating 5 out of 5]

I bought this book for its antipsychiatric spirit and now I simply love it for the philosophical, practical and clinical questions it poses for psychology. Bentall has managed through a great structure and sequence of his thinking to take the reader (even one who is not professionally connected to psychology) from the origins of the antipsychiatric movement to the modern day applications in autonomy enhancing facilities/services. I was impressed by the body of literature he presents to support his arguements. He also doesn't hesitate to comment on those parts who are missing or problematic for both sides of the psych-med debate.
His criticism on prescribing psychiatric medicine is not merely ethical/humanistic as was the one by Thomas Szasz, but extends to the politics of pharmaceutical industries with their profit-oriented goals and the deep undoubtedly political wish of psychiatrists to hold their status quo in the field of mental health.
Nevertheless, Bentall is never dogmatic and recognizes the benevolent intent of psychiatrists to help their patients. Furthermore I loved the way he deconstructs the claim that psychiatric meds actually improve the life of a patient in contrast to the seemingly unsupported results of psychotherapy. Through a lengthy presentation of clinical trials (it might have been the only tiring part of the book) the writer proves that psychotherapy is not hokus pokus and has substantial characteristics that can apply to every day relationships and help a patient live a functional, happy life.
I could write a ten page review on all my thoughts regarding this book and I still wouldn't be done.
If you are (hoping to become) a psychologist, I suggest you read this.

[Beverley · Rating 5 out of 5]

Doctoring the Mind by Richard P Bentall is a book of big words and lots of them. Although a densely packed book it full of insight.

Benthall is a research psychologist and goes through the history of psychiatric treatments in relation to psychotic illnesses, such as bi-polar and schizophrenia, although he does touch upon depression. What if any benefit these treatments have had on the patient in the past or even now. From the early days of Freud, asylums and Elective Convulsive Therapy to the introduction of psychotic drugs, such as Chlorpromazine and back to the 'kindly face' and Cognitive Behaviour Therapy, he covers the lot and does so very well.

I think this book should be read by anyone who is directly involved with people who have suffered a psychotic episode. This could mean the medical staff or even the relatives or the patients. He leaves us with the question 'What kind of Psychiatry do you want?'

[Ann · Rating 5 out of 5]

A must for those who question the medical model of 'mental illness' and those who don't!

[Sarah · Rating 4 out of 5]

Still going! Completely fascinating but a struggle for my non-scientific head now and then. Brilliant all the same. Will finish it....

[harrie kd]

i'm dipping in and out of this as opposed to reading straight thru but it's really interesting and a useful read for anyone interested in mental health issues

[John W · Rating 4 out of 5]

Rah rah. A truly fascinating critique of the medical paradigm, as well as a collection of hard facts that must be addressed.

[Mafu Goonbag · Rating 4 out of 5]

Some good points in particular his criticism of the genetic studies GWAS with Ill defined parameters. He goes overboard at times tho, which I feel lessens his argument overall.

[Michael Kubat · Rating 5 out of 5]

The more in work in the so-called helping so-called professions, the more I am convinced that Bentall's critique in right on the money.

[Jasper · Rating 4 out of 5]

nice, but somewhat lacks the profoundness of the previous, though thankfully tackles different and interesting areas

[Jbussen · Rating 2 out of 5]

WE KNOW NOTHING JOHN SNOW.