51 of 55 people found the following review helpful
A challenging text,
This review is from: Doctoring the Mind (Hardcover)
This is, in my opinion, an important book. Bentall reviews a number of areas related to contemporary psychiatry and clinical psychology, and he highlights some of the major areas of controversy between practitioners in these disciplines. It is beyond my competence to assess whether all his conclusions are correct. Indeed, given the diversity of topics covered, I doubt whether many readers will feel competent to draw definitive conclusions.
The central issue arising from this book relates to the validity or otherwise of reductionist accounts of both normal and abnormal behaviour, i.e. the extent to which behaviour can or cannot be explained in terms of the detailed analysis of brain functioning at the neuronal level. Over the last 40 years mainstream psychology has undergone a "paradigm shift' in which reductionist accounts of behaviour have become less influential. Bentall's book reflects this change, and it represents a considerable challenge to conventional psychiatrists, who typically adopt a more reductionist philosophical approach, focussed in particular on drug treatment.
Since the 1970s there have not really been major advances in psychopharmacology, and some of the major ones such as the development of the clozapine-like "atypical/second generation" antipsychotics seem to be progressively disappearing, after much hype, in a cloud of smoke, leaving some puzzled and confused. In part, as Bentall documents, this is due to the malign influence of the pharmaceutical industry which has done itself no favours at all by e.g. i) Rigging clinical trials by the use of inappropriate (high) comparator doses of older drugs in trials investigating the actions of novel drugs, and ii) Lack of attention to serious adverse side effects such as weight gain and diabetes. A strong case can be made for the psychiatric profession and psychopharmacologists in general paying much more attention to what we often do NOT know about many psychoactive drugs - most efficacious doses, mechanisms of action involved in their therapeutic and side effects, consequences of co-administration of two or often more drugs, effects of drug withdrawal, abuse of antipsychotics when administered at high doses to the elderly, interactions of drugs with psychological therapies et alia. Such studies will clearly not be conducted by the pharmaceutical industry and thus will have to be state funded. The best psychiatrists do address the issues described above, and they attempt to deal with the problem of reductionism by marrying neuronal ideas to functional psychological concepts, although they are relatively few and far between. Ideally, Bentall's book would lead to a rapprochement between psychiatrists and clinical psychologists, although given its rather strident tone this appears highly unlikely to happen at present! In the meantime it is probably essential reading for all trainee clinical psychologists and psychiatrists, for interested lay readers as well as individuals in receipt of therapy.
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Initial post: 18 Nov 2009 08:26:24 GMT
"...Since the 1970s there have not really been major advances in psychopharmacology..."
This profoundly fallacious statement invalidates the rest of your review.
In reply to an earlier post on 2 Feb 2010 20:38:14 GMT
hhhmm depends what you mean by major. antipsychotics still interfere with dopamine systems, but are less prone to epse (and more prone to metabolic side effects), antidepressants went from serotonin and noradrenaline reuptake inhibitors to more targeted serotonin and back to 'dual action' but still barking up the monoamine tree....whether depakote, aripiprazole and these new melatonin targeting medications will be major is perhaps too early to tell. Don't get me wrong, I regularly prescribe these drugs and the news ones are generally cleaner, but not problem free - and we are still following up leads that were kind of stumbled on in the 50s....
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