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Customer Review

on 23 July 2009
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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