A thorough – perhaps too thorough – examination of treatment for mental illness by a scourge of the psychiatric establishment.
Richard Bentall is a clinical psychologist who is passionate in his belief that psychiatry has erroneously focussed on the biochemical model of mental illness.
His book describes the history of psychiatric treatment, the nature of mental illness, the effectiveness of modern therapy and makes some suggestions for the future direction of psychiatric care. He describes himself as ‘antipsychiatry’ as opposed to ‘antipsychiatrist’, but describes in some detail the powerful emotions he arouses in the psychiatric establishment, so I think many psychiatrists would regard him as antipsychiatry in general.
The chapters on the effectiveness of psychiatric care are controversial and thought-provoking; demonstrating the pervasive influence of modern global pharmaceutical companies.
As a GP, I use a mixture of biochemical and behavioural models of mental illness to tailor my explanations to individual patients with mental health problems. It may take several appointments for the patient and I to decide that the issue is predominantly mental health related. Perhaps because of the flexibility of the general practice approach, I find his views less controversial than do his psychiatric colleagues. However I find the ‘either-or’ debate about drug treatment versus psychological approaches too limiting. In my view, in the general practice setting neither diagnosis, explanation nor treatment can be so rigidly defined.
This is a long book, and not one that can easily be skim-read. If you are daunted by its length, chapters 8 to 10 describe some of the pitfalls of drug company-sponsored research and look at some of the evidence for the effectiveness of ‘talking therapies’. I do not think many GPs will plough through a book of this length so I think an even shorter version would be helpful if he wishes to spread his ideas at grass roots level.
Dr Clare Etherington is a GP in Harrow in northwest London.
Doctoring the Mind by Richard P Bentall