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

385 Pages·2009·2.83 MB·English

by  Richard P. Bentall

Doctoring the Mind
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Doctoring the Mind
Is Our Current Treatment of
Mental Illness Really Any Good?
Richard P. Bentall
(cid:4)
New York University Press
Washington Square, New York
This book is dedicated to
Sarah Butler
sister and friend
First published in the U.S.A. by
NEW YORK UNIVERSITY PRESS
Washington Square
New York, NY 10003
www.nyupress.org
© 2009 by Richard P. Bentall
All rights reserved
Library of Congress Cataloging-in-Publication Data
Bentall, Richard P.
Doctoring the mind : is our current treatment of mental illness
really any good? / Richard P. Bentall.
p. cm. Includes index.
ISBN–13: 978–0–8147–9148–6 (cl : alk. paper)
ISBN–10: 0–8147–9148–4 (cl : alk. paper)
1. Mental illness. 2. Mental illness—Treatment—Evaluation. I. Title.
RC454.B452 2009
616.89—dc22 2009014687
New York University Press books are printed on acid-free paper, and
their binding materials are chosen for strength and durability. We
strive to use environmentally responsible suppliers and materials
to the greatest extent possible in publishing our books.
Manufactured in the United States of America
10 9 8 7 6 5 4 3 2 1
Contents
ListofIllustrations vii
ListofFigures viii
Acknowledgements ix
Preface:RationalAntipsychiatry xi
Part One: An Illusion of Progress
1 ASmashingSuccess? 3
2 TheApplianceofScience:TheEmergenceofPsychiatry
asaMedicalDiscipline 26
3 TherapeuticInnovationattheEndoftheAsylumEra 42
4 DissentandResolution:TheTriumphofBiological
Psychiatry 69
Part Two: Three Myths about Mental Illness
5 PeopleorPlants?TheMyththatPsychiatricDiagnoses
areMeaningful 89
6 TheFundamentalErrorofPsychiatry:TheMyththat
PsychiatricDisordersareGeneticDiseases 113
7 Brains,MindsandPsychosis:TheMyththatMental
IllnessesareBrainDiseases 148
Part Three: Medicine for Madness
8 Science,ProfitandPoliticsintheConductofClinical
Trials 185
v
contents
9 LessisProbablyBetter:TheBenefitsandCostsof
Antipsychotics 214
10 TheVirtueofKindness:IsPsychotherapyEffective
forSevereMentalIllness? 242
11 WhatKindofPsychiatryDoYouWant? 262
Notes 289
Index 351

vi
List of Illustrations
Photographicacknowledgementsaregiveninparentheses.
1 SoteriaHouse(TheSocietyforLaingianStudies) 24
2 EmilKraepelin(1856–1926),psychiatrist,scientistand
Germannationalist(NationalLibraryofMedicineScience
PhotoLibrary) 29
3 WalterFreemanchangesHowardDully’smind(WGBH
Boston) 38
4 HenriLaborit(1914–1995)(SophieBassouls/Sygma/Corbis) 45
5 B.F.Skinner(1904–1990)(Bettmann/Corbis) 54
6 CarlRogers(1902–1987)(NatalieRogers) 59
7 RonaldLaing(1927–1989)(EstateofFayGodwin/National
PortraitGallery,London) 71
8 ThomasSzazs(1920– )(DavidLees/Corbis) 72
9 JamesLind(1716–1794)andSirAustinBradford
Hill(1897–1991)(WellcomeLibrary,London) 192

vii
List of Figures
1 Thepossibleevolutionofparanoidbeliefs 169
(adaptedfromD.FreemanandR.P.Bentall(eds.)(2008),
PersecutoryDelusions:Assessment,TheoryandTreatment
(OxfordUniversityPress,2008))
2 Amodelofparanoia 176
(adaptedfromR.P.BentallandC.Fernyhough(2008),
‘Socialpredictorsofpsychoticexperiences:Specificityand
psychologicalmechanisms’,SchizophreniaBulletin,34,
1009–11)
3 Amodelofauditoryhallucinations 181
(adaptedfromR.P.BentallandC.Fernyhough(2008),
‘Socialpredictorsofpsychoticexperiences:Specificityand
psychologicalmechanisms’,SchizophreniaBulletin,34,
1009–11)
4 CONSORT diagram 204
(adaptedfromN.Tarrier,S.Lewis,G.Haddock,
R.P.Bentall,R.Drake,G.Dunn,etal.(2004)‘18-month
follow-upofarandomizedcontrolledtrialofcognitive-
behaviourtherapyinfirstepisodeandearlyschizophrenia’,
BritishJournalofPsychiatry,184:231–9)

viii
Acknowledgements
As usual I must thank my numerous postgraduate students and col-
leaguesinclinicalpsychologyandpsychiatryforstimulatingmythink-
ingabouttheissuesdiscussedinthefollowingchapters.Ofmycurrent
and recent postgraduates, I would like to mention Eve Applegate,
Hazel Dunn, Paul French, Becca Knowles, Sara Melo, Michael
Moutoussis, Justin Thomas, Alisa Udachina and Filippo Verase. Of
my colleagues I would like to mention, in clinical psychology, Tony
Morrison, Mike Jackson, Steve Jones, John Read and Sara Tai, in
biomedicalstatisticsGrahamDunn,ChrisRoberts,PaulaWilliamson
and Gill Lancaster, and, in psychiatry, Shoˆn Lewis, David Kingdon,
David Linden, Richard Morriss, Jan Scott and Richard Drake (who,
I guess, would disagree with much of what I have written but who
seem to be relaxed about collaborating with someone who has one
foot in the antipsychiatry camp). I would also like to thank my
assistant Hanneke Booij for keeping me organized during my first
extremelybusyyearatBangor.Aspecialmentionshouldalsobegiven
toPeteSaundersofPCCSBooks(asmallpublishinghousespecializing
in books about psychotherapy) for alerting me to the contribution
of Carl Rogers, which has almost been forgotten by most clinical
psychologists. Self-evidently, none of these people should be held in
any way responsible for any errors I have made. Perhaps one of the
greatest joys of an academic life is that it allows one to work in
friendly cooperation with talented people whose views on important
issuesareoftencompletelydifferentfromone’sown.
I would like to thank my wife Aisling, a clinical psychologist who

worksinanearlyinterventionservice,forhersupportandforendless
discussions about service users, their problems and their aspirations.
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