I, on the other hand, do.
Richard Bentall’s book approaches the mysteries of psychosis from a psychological rather than a psychiatric angle, believing there are fundamental flaws in the whole psychiatric approach. It’s a solid read for a non-specialist, and I am not qualified to adjudicate in his spat with psychiatry, but there is much to enjoy: Bentall is witty and humane, if you don’t mind the sense of someone going into battle, and the research he summarises is fascinating and important.
One strand of his argument is that the definitions of psychotic conditions (schizophrenia, mania etc.) found in DSM-V, widely used to diagnose patients, are ineffective and unscientific, because they draw imaginary lines around non-existent medical conditions, and that psychosis is better explained by symptom clusters which do not coincide with the existing boundaries. A diagnosis in DSM-V terms may well, therefore, be meaningless. Bentall summarises this with a slightly sardonic zest:
At the beginning of this chapter I suggested that astrological predictions provide a fool’s-gold standard against which to evaluate the predictions achieved by psychiatric diagnoses. We are now in a position to apply this standard. While diagnoses clearly are superior to star signs, this superiority is not striking … (p.87)
Another strand is that psychiatrists have used a medical disease template to model their approach to mental illnesses. Biological and anatomical explanations are sought, and drug therapy is the first and perhaps only option considered for treatment. Bentall argues that the actions of the mind literally shape the brain and its chemical cascades, creating a feedback mechanism in which physical aspect of the brain affect the mind and the mind modifies the brain. He suggests that psychiatrists have neglected to consider psychology and how it can give insights into the symptoms of psychosis.
We should abandon psychiatric diagnoses altogether and instead try to explain and understand the actual experiences and behaviours of psychotic people … I will argue that, once these complaints have been explained, there is no ghostly disease remaining that also requires an explanation. Complaints are all there is. (p.141)
Bentall works through symptoms such as paranoia, hearing voices and hallucinations and considers how these relate to moderately-well-understood ‘normal’ psychological processes. He also suggests that these symptoms are widely distributed in ‘normal’ populations, and that it is symptom frequency/intensity, personal distress, and cultural interpretation which determine when they are regarded as abnormal or marks of insanity.
The current state of knowledge about the influence of biology, genetics and environment on the development of psychosis is presented in summary form, and areas of continuing ignorance are noted. There’s far too much here for me to describe, but the detail is intriguing, and some of the research is disturbing – I felt considerable doubt about the ethics being applied by ethics committees, to be honest.
Most importantly, Bentall is advocating for a population which he feels has been failed by current psychiatric regimes.
It also places patients in a terrible double bind, in which their objections to unsatisfactory aspects of psychiatric care are seen by the clinician as further evidence that treatment is imperative. Indeed, the notion that patients lack insight is routinely used to justify cajoling, threatening or misleading patients about their rights … (p. 496)
This title, published in 2004, now has a companion piece: Doctoring the Mind, 2010, which tackles the question of treatment. Definitely on my reading list. You never know when the information might come in useful.