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Doctoring the Mind: Why psychiatric treatments fail Paperback – 3 Jun 2010
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Bentall is one of psychiatry's most eloquent enemies . . . the drugs don't work (Sunday Times)
It is the very balance of his approach that drives his opponents crazy . . . Passionate . . . a brave book (Observer)
Bentall pulls no punches . . . his credentials ensure that his punches carry weight (Guardian)
Paints a stark picture of a mental health system riddled with corruption and incompetence (The Times)
Wonderful. Everyone personally or professionally concerned with mental health should read this . . . I dearly wish it could be put into the hands of the politicians and their advisors who make decisions about the life and rights of others (Hilary Mantel)
At a time when dialogue in the presence of other human beings is becoming less and less available, this brave book gives a sense of why this could be disastrous (Salley Vickers, Observer)
`At a time when dialogue in the presence of other human beings is becoming less and less available, this brave book gives a sense of why this could be disastrous.' --This text refers to an out of print or unavailable edition of this title.See all Product description
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He explains that “The picture that emerges is much more consistent with the idea that severe mental illnesses are influenced by the social environment, than with the idea that they are genetically determined disorders of the brain.”
It follows that “By focusing on symptoms rather than diagnoses, we can see how the experiences of patients arise understandably from their misfortunes. Far from assuming that abnormal cerebral functioning is the primary cause of illness, complaints-orientated research shows that the troubled brain cannot be considered in isolation from the social universe. Clinically, it leads us to recognize that the stories patients tell us are important, and that there is a very thin dividing line between the ‘them’ who are ill and the ‘us’ who are sane.” As he sums up, “distress in human beings is usually caused by unsatisfactory relationships with other human beings.”
80 per cent of patients who do not receive psychotherapy fare worse than the average patient who receives it. Acutely ill psychosis patients who received just four sessions of Acceptance and Commitment Therapy, a form of cognitive behaviour therapy, compared with those who received none, were about half as likely to be readmitted to hospital during the four months after treatment – ‘a difference that borders on the amazing’.
So the National Institute for Clinical Excellence recommended in 2002 that cognitive behaviour therapy should be offered to most patients with psychosis, and the government announced in 2007 the release of substantial funds to increase depressed and anxious patients’ access to psychological treatments.
Bentall concludes, “Good relationships, it seems, are a universal therapeutic good, and may yet turn out to be the single most important ingredient of effective psychiatric care. Efforts to improve therapeutic relationships are therefore likely to result in substantial benefits for everyone concerned.”
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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