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Doctoring the Mind

Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?

Richard P. Bentall
Copyright Date: 2009
Published by: NYU Press
Pages: 384
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  • Book Info
    Doctoring the Mind
    Book Description:

    Toward the end of the twentieth century, the solution to mental illness seemed to be found. It lay in biological solutions, focusing on mental illness as a problem of the brain, to be managed or improved through drugs. We entered the andquot;Prozac Ageandquot; and believed we had moved far beyond the time of frontal lobotomies to an age of good and successful mental healthcare. Biological psychiatry had triumphed.Except maybe it hadn't. Starting with surprising evidence from the World Health Organization that suggests that people recover better from mental illness in a developing country than in the first world, Doctoring the Mind asks the question: how good are our mental healthcare services, really? Richard P. Bentall picks apart the science that underlies our current psychiatric practice. He puts the patient back at the heart of treatment for mental illness, making the case that a good relationship between patients and their doctors is the most important indicator of whether someone will recover.Arguing passionately for a future of mental health treatment that focuses as much on patients as individuals as on the brain itself, this is a book set to redefine our understanding of the treatment of madness in the twenty-first century.

    eISBN: 978-0-8147-3914-3
    Subjects: Psychology

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Illustrations
    (pp. vii-vii)
  4. List of Figures
    (pp. viii-viii)
  5. Acknowledgements
    (pp. ix-x)
    Richard Bentall
  6. Preface: Rational Antipsychiatry
    (pp. xi-xx)
  7. Part One: An Illusion of Progress

    • 1 A Smashing Success?
      (pp. 3-25)

      A dank smell pervades the small, windowless interview room whenever Peter comes to see me. I have been trying to help him for too long; the six-month period during which a clinical psychologist would normally expect to see a client passed more than a year ago. Always, it seems, we are about to make an important breakthrough.

      Our meetings, first thing in the morning, always begin with the same ritual. Checking his watch as I rush through the door of the community mental health centre after my long journey from home, Peter looks at me scornfully, then cracks a smile...

    • 2 The Appliance of Science: The Emergence of Psychiatry as a Medical Discipline
      (pp. 26-41)

      Although the idea that mental disorders are diseases of the brain can be traced back to before the Christian era, the profession of psychiatry as we now know it became firmly established as a subspeciality of medicine only in the middle years of the nineteenth century.¹ Despite the rapid advances in the biomedical and psychological sciences that have occurred since then, many of the assumptions about mental illness made by Victorian psychiatrists continue to guide the practice of mental health professionals today, and hence it is important to understand what these assumptions are and how they arose.

      The most important...

    • 3 Therapeutic Innovation at the End of the Asylum Era
      (pp. 42-68)

      Psychiatric patients receiving treatment at the beginning of the twenty-first century are no doubt fortunate that their doctors no longer resort to psychosurgery or insulin coma therapy, and use ECT only sparingly. Most of the treatments that are used instead were developed during a time of intense innovation that followed the Second World War. The discoveries of this period therefore shaped the way that psychiatry is practised throughout the world today. They also revealed a dialectical tension that has been a constant theme in the history of mental health care, between those who have sought technical remedies for psychiatric problems...

    • 4 Dissent and Resolution: The Triumph of Biological Psychiatry
      (pp. 69-86)

      Rosenhan’s ‘On being sane in insane places’ paper was published at a difficult time for psychiatry, which in the early 1970s felt under attack from all directions. Not surprisingly, it did nothing to improve relationships between psychiatry and clinical psychology. In Britain, simmering disputes about the extent to which the work of psychologists should be supervised by psychiatrists eventually led the psychologists to leave the large asylums and set up their own independent outpatient clinics.¹ In the United States, rivalry between the two professions was even more intense, and psychologists sometimes found it expedient to resort to the courts in...

  8. Part Two: Three Myths about Mental Illness

    • 5 People or Plants? The Myth that Psychiatric Diagnoses are Meaningful
      (pp. 89-112)

      Andrew’s letter, asking for my help, arrived on my desk out of the blue. Enclosed was a copy of a letter he had received from his psychiatrist, which read as follows:

      Dear Mr

      Further to our recent letter about your illness, I am writing to confirm that my colleague Dr — shares my opinion about your diagnosis. On this basis, a revision of your diagnosis is not possible. You are, of course, at liberty to seek a private psychiatric opinion. For the record, your diagnosis is one of paranoid schizophrenic illness currently in remission, with PTSD related to a traumatic change...

    • 6 The Fundamental Error of Psychiatry: The Myth that Psychiatric Disorders are Genetic Diseases
      (pp. 113-147)

      The letter from Hannah’s psychiatrist said that she had been suffering from auditory hallucinations for more than a decade. As her voices had not been touched by medication, he wondered whether she might benefit from psychotherapy.

      Patients arriving for their first appointment with a clinical psychologist are often nervous and hesitant, not knowing what to expect from a stranger with whom they will shortly be sharing their most troubling experiences. Those with long-standing psychotic problems are often poorly dressed, a consequence of their impoverished circumstances, or unkempt, having long ago given up the struggle to maintain their appearance. Some who...

    • 7 Brains, Minds and Psychosis: The Myth that Mental Illnesses are Brain Diseases
      (pp. 148-182)

      Short of imprisoning Paul, or following him around for twenty-four hours a day, there was little we could do to prevent him from killing himself. Afterwards, all of us involved in his care – the psychiatrist, the clinical psychologist, the community psychiatric nurse and the social worker – gathered in a dingy office for the formal review of what had happened. Mulling over our notes, we expressed our collective feelings of impotence. With the benefit of hindsight, his death seemed as inevitable as a collision between a rudderless supertanker and distant rocks.

      I had first met Paul in the winter of 1998...

  9. Part Three: Medicine for Madness

    • 8 Science, Profit and Politics in the Conduct of Clinical Trials
      (pp. 185-213)

      Freud once remarked that an important aim of psychological treatment is to transform ‘hysterical misery into common unhappiness’.¹ He was conceding that therapy is powerless to alter the realities of existence; the best we can hope for is that it helps us cope with the inevitable disappointments and misfortunes we encounter in our lives.

      Graham, a patient I saw more than a decade ago, keeps in touch by ringing once or twice a year to tell me how things are going for him. For quite some time now he has been working happily as a teacher, a remarkable achievement considering...

    • 9 Less is Probably Better: The Benefits and Costs of Antipsychotics
      (pp. 214-241)

      Following Laborit’s discovery of chlorpromazine, antipsychotic drugs became widely accepted as the treatment of choice for people with psychosis. They are now used almost everywhere in the world, even (I discovered during a trip to Uganda) in rural Africa, where they are often distributed by health workers who have no formal qualifications in medicine or nursing. Psychiatric services have become so dependent on these medications that, in Europe and North America, researchers wanting to study drug-naive patients usually have great difficulty finding any. When I embarked on such a project in the mid-1990s I soon gave up.

      At about that...

    • 10 The Virtue of Kindness: Is Psychotherapy Effective for Severe Mental Illness?
      (pp. 242-261)

      I do not really want to know how much of my working life is spent in front of computers but it is obviously too much. I spend many hours writing applications for grants to fund my research, many more hours engrossed in the pleasurable but slightly autistic task of analysing the data that is accrued as my projects are completed, and still more hours writing up my findings for publication as papers in scientific journals. The research students and assistants who are in daily contact with the people we study pass through my office, telling me about the problems they...

    • 11 What Kind of Psychiatry Do You Want?
      (pp. 262-288)

      It was late in the afternoon and I was in my office at the University of Manchester. I had spent most of the day tying up loose ends in preparation for starting my new job in Wales. Time had moved slowly as I had sorted a seemingly endless series of files into their packing boxes, each one eliciting a memory, culminatively provoking a heavy feeling of melancholy. I wanted to catch the next train back home to my family, but I knew I had cut things fine. Hastily shutting down my computer and grabbing my bag, I switched off the...

  10. Notes
    (pp. 289-350)
  11. Index
    (pp. 351-364)