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Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? Richard P. Bentall

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Richard P. Bentall

Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? Richard P. Bentall Toward the end of the twentieth century, the solution to mental illness seemed to be found. It lay in biological solutions, focusing on mental illness as a problem of the brain, to be managed or improved through drugs. We entered the "Prozac Age" and believed we had moved far beyond the time of frontal lobotomies to an age of good and successful mental healthcare. Biological psychiatry had triumphed.

Except maybe it hadn't. Starting with surprising evidence from the World Health Organization that suggests that people recover better from mental illness in a developing country than in the first world, Doctoring the Mind asks the question: how good are our mental healthcare services, really? Richard P. Bentall picks apart the science that underlies our current psychiatric practice. He puts the patient back at the heart of treatment for mental illness, making the case that a good relationship between patients and their doctors is the most important indicator of whether someone will recover.

Arguing passionately for a future of mental health treatment that focuses as much on patients as individuals as on the brain itself, this is a book set to redefine our understanding of the treatment of madness in the twenty-first century.

Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? Details

Date : Published September 30th 2009 by New York University Press (first published January 1st 2009) ISBN : 9780814791486 Author : Richard P. Bentall Format : Hardcover 363 pages Genre : Psychology, Nonfiction, Medicine, Psychiatry, Science, Health, Mental Health

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John W says

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

Trevor says

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 PDF File: Doctoring the Mind: Is Our 3 Current Treatment of Mental Illness Really Any Good?... Read and Download Ebook Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?... 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.

talkingtocactus says 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

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

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Michael Kubat says

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.

Doreen says

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.

Jesus (Ego) says

Pocos libros hay tan valientes, documentados y que además sean tan amenos y digeribles como este. Bentall sabe de lo que habla y lo dice muy bien. Me gusta cómo explica la historia de la psiquiatría y sus desafortunadas idas y venidas, cómo la diferencia de la psicología clínica, como defiende un uso racional de los psicofármacos y la necesidad aumentar las psicoterapias y los aspectos psicosociales en el tratamiento de los trastornos mentales graves, es sublime cómo expone las malas artes de las grandes farmacéuticas y cómo ahonda en las alucinaciones y delirios, centrándose en explicaciones alternativas (y necesarias) a la simple química cerebral. Tiene tantos datos y tantas opiniones interesantes este libro... Se lo recomendaría a todo el mundo pero, aun estando escrito de manera sencilla y con intención divulgativa, parece estar orientado a profesionales de la salud mental y afines. No obstante, si te gusta lo que te cuento y quieres profundizar un poco en estos temas, (seas curioso, profesional o paciente) adelante, ponte a leer este libro. No te arrepentirás.

Michelle says

Surprise, surprise: it turns out that empathy and kindness are invaluable to people suffering from mental health afflictions. It shouldn't be rocket science, but sadly it is (I have been offered Prozac after I have explicitly said, 'I just need someone to talk to'). There's lots of other really interesting stuff in here, particularly around schizophrenia and the myths around genetics and so on. Good read and lots to ponder for anyone interested in this topic, or perhaps affected by it.

Muriel Treille-Hawkins says

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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 PDF File: Doctoring the Mind: Is Our 6 Current Treatment of Mental Illness Really Any Good?... Read and Download Ebook Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?... 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 PDF File: Doctoring the Mind: Is Our 7 Current Treatment of Mental Illness Really Any Good?... Read and Download Ebook Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?... 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.

Neal Alexander says

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.

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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.

Sarah says

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

Ann says

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

Beverley Smith says

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?'

Kira says

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.

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Demetrelli says

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.

Jason says

This was the first book I came across that challenged the view that mental disorders are brain disorders; which I guess was somewhat of a shock, in that I didn't know there were professionals out there (at least those who weren't nuts, like Peter Breggin) who actually thought that. I've since read several other books that have this orientation, at least somewhat, to the point where I'm now aware that there a good number of clinicians and possibly researchers who are also skeptical about the medical model. I guess I myself was kind of brainwashed with the medical model and the 'status quo' of the field.

Like a lot of books such as this, there is a brief overview of the history of the field including the major figures of Kraepelin, Carl Rogers, Szasz, and the like, which is nothing new to someone who has a decent understanding of the field, but is of course appropriate for those who know little or nothing about it The book seems mainly concerned with the "serious" mental illnesses (i.e, schizophrenia, bipolar disorder), which is not exactly an uncommon orientation, presumably because these disorders cause the most trouble or are the most prototypical of the traditional conception of mental illness being "insanity". As far as I can remember, there is no discussion of other conditions, with the exception of the part on antidepressant trials. In terms of these antidepressant trials, the book, in its review of them, includes unpublished trials which I had up to that point not come across (I believe I was aware they existed, but I guess I didn't know if they were accessible to the public). Thus, this alone may be of interest to some, although I'm not sure if the specific studies are cited (i.e., a list); as opposed to merely a discussion of the results of broad reviews of them (i.e., meta-analyses); but I think it's the latter. . Coming away from the book, it doesn't exactly seem fair, and seem to be biased in terms of a psychological conception of mental illness, and psychotherapy as the treatment. Evidence presented for this though, is not very rigorous, and indeed, the book is rather thin in terms of detailed critiques and arguments, as well as comprehensiveness (with some significant issues maybe being left out).

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There is at least one tidbit I can think of that is noteworthy in that I had not found it elsewhere (the idea that our conceptions of mental disorders and their cardinal symptoms may be biased by being based on only those who come to the attention of psychiatrists, and there's a citing of a guy (in the early 20th century, I believe) who first acknowledged this possible problem).

Overall, there are books that do a better job at taking a fair, detailed, and rigorous analysis of the field and its issues.

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