Confession 1:I am a Psychiatrist.
Confession 2: Before I started this book I was expecting a deeply negative perception of modern psychiatry and little in the way of concrete evidence to support any alternative hypothesis. I anticipated this book to he read mainly by other psychologists, anti-psychiatrists and disgruntled patients.
However, I rapidly discovered that this is not the start of a new anti-psychiatry movement but in fact a fascinating, open-minded review of the current thinking about madness.
The first third of this book should be read by everyone involved in or interested in psychiatry, psychology, or just madness. It is a brilliant and genuinely gripping synthesis of the journey from dark age beliefs about madness to the current concepts. The author makes this potentially dreary history lesson vibrant, relevant and insightful and brings alive many of the key players whose legacies have outlived them, whether deservedly or not.
After this the author then goes on to explore in quite significant detail, the psychological and biological research into psychosis and related conditions. This is predictably heavier going but worth persevering with for the exciting and occasionally startling revelations.
As a result, he fairly comprehensively dismantles the traditional model of psychiatric classification but manages to bring even the most sceptical reader with him through this process.I did not find this as controversial as I expected, as most practising psychiatrists are already aware of the significant overlap in diagnoses and symptoms of these disorders. Richard Bentall then formulates draft models for approaching particular psychiatric symptoms.
There is much less controversial material in this book than I expected. The research discussed is reasonably balanced and the conclusions are tentative and never fundamentalist.
However, although interesting, evidence-based and realistic, the practical applications of the symptom-directed approach are not at all clear. Abandoning traditional psychiatric diagnoses altogether would at present leave patients, carers and health professionals with even less framework for approaching treatment, suggesting aetiology or predicting prognosis. This book may encourage us to be more flexible and patient-centred but I cannot yet see it changing frontline mental health care.