Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?
by Richard P. Bentall. New York University Press, 2009
Despite advances in our understanding of mental illness, treatments leave patients no better off today than they did almost half a century ago—according to British clinical psychologist Richard P. Bentall. In his provocative book, Doctoring the Mind, Bentall takes on the conventional field of psychiatry, arguing that it works in a way that is “profoundly unscientific” and fails to actually help patients who are suffering from mental problems.
The root of the problem is psychiatry’s heavy focus on the biomedical approach, which, research shows, is “fatally flawed,” Bentall writes. Antipsychotic drugs are not working well, and the impression that they do is actually the result of “skillful pharmaceutical industry marketing,” he claims. The same is true for antidepressants, Bentall says, citing studies that found appalling methodological flaws in the drugs’ clinical testing. For example, in some studies “patients were removed and replaced by new patients if they failed to show an early response to the antidepressant.”
But it’s not only the treatments that ail the field of mental health care; the diagnoses themselves can be equally problematic, Bentall says. That’s because the current system of categorizing psychiatric problems is fundamentally wrong, he argues. For example, many patients show both bipolar and schizophrenia symptoms, blurring the boundaries between the two disorders. Such diagnoses, then, are “about as scientifically meaningful as star signs.”
Doctoring the Mind is a very accessible and well-organized book, but what makes it most engaging is the glimpse inside the world of mental illness that Bentall’s patient stories provide. His accounts illustrate the point that a conventional approach often leaves doctors stumbling blindly in the dark. Some of the stories are so bewildering that it is hard to comprehend how they happened. One example is Andrew, who was brought into a facility for psychiatric examination. Presumably in an attempt to find behaviors that fit a diagnosis, health care professionals focused on the fact that Andrew was “excessively polite.” One of the reasons for keeping him in the institution, then, became to work out whether his politeness was “part of his normal personality or his illness.”
So what does it take for mental health care to get on the right track? Bentall thinks part of the answer is taking into account the circumstances that most likely led to mental problems in the first place. But rather than trying to make broad diagnoses such as schizophrenia, we should look at individual symptoms, he says. For example, research has already elucidated potential experiences that may contribute to the development of paranoia. Such an approach, however, would require nothing less than “completely rethinking the values and goals of psychiatric care.”