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

Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?
by Richard P. Bentall.; New York, New York University Press, 2009, 384 pages, $29.95

Reviewed by Curtis Adams, M.D.; Ann Hackman, M.D.
Psychiatric Services 2011; doi:
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The reviewers are affiliated with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore, and work in the Community Mental Health Division.

There are some good things about this book. It is competently written and quite readable. The text is eloquent in its support of a recovery-oriented approach. Author Richard Bentall advocates for the active involvement of mental health consumers in their own treatment. The book reiterates the excellent case for psychotherapy in the treatment of serious and persistent mental illnesses, including schizophrenia—an argument recently elucidated in poignant and articulate fashion by Elyn Saks in her moving memoir, The Center Cannot Hold (1). Further, Bentall appropriately underscores some of the flaws in current and recent mental health treatment and diagnosis. For example, some of our diagnostic divisions (such as between schizophrenia and bipolar disorder) are less than clear and less than evidence based. Current medications are less than perfect, their use is fraught with side effects, and effectiveness is variable. Our evidence that medications work is sometimes tainted by pharmaceutical company involvement in the research. And even as we move to a more recovery-based approach, we have not eliminated the elements of coercion that have arguably added to fear and stigma.

Despite the helpful treatments recommended and the relevant questions underscored by Bentall's text, we would be reluctant to recommend it to anyone because we found the book to be incendiary and divisive. One central premise seems to be that there is a long-standing battle for supremacy going on between psychology and psychiatry. The text suggests that those in the former profession are educated and trained to understand people and the human experience and to provide healing therapy, whereas those in the latter are indoctrinated with the medical model, have unwittingly carried Nazi-era notions of the genetic origins of psychosis into the present, and are intent on pumping people full of as much useless, dangerous medicine as possible while simultaneously avoiding any conversation. Furthering his argument that psychiatrists improperly medicate patients, Bentall claims that “It is difficult to know how many psychotic patients would be better off without taking drugs, but my guess is that the number might be as high as 50 per cent.”

Bentall also argues that the case for a genetic cause of mental illnesses has been grossly overstated by psychiatrists and that symptoms such as psychosis are much more the result of psychosocial stressors. He cynically claims that those who introduced the term “schizophrenia spectrum disorder” introduced the term to “get the [research] results they wanted.” Further, he indicates that behavior by families may make substantial contributions to an individual's development of a mental illness and that the National Alliance on Mental Illness is funded primarily by Big Pharma. Taking aim at child psychiatrists, he writes that “the long-term impact that [psychotropic] drugs have on the developing brain—as yet unknown—seems not to trouble the doctors who prescribe them.” As is often the case in his book, he cites no source for this claim. He continues to deride child psychiatrists, stating, “My impression is that [medications] are often prescribed without any serious attempt to understand or remedy the awful social circumstances in which psychologically disturbed children often live.”

It may be that Bentall was deliberately provocative in hopes of opening a dialogue about topics that certainly need to be discussed, and it would be interesting to have a conversation with the author in an effort to glean more of his intent. However, he tells his readers at the outset that this book comes out of an earlier, more extensive text and that Doctoring the Mind was written to be more accessible to the consumer than was the earlier book. We will not be encouraging any of the mental health care consumers whom we serve to read this book. It would be unfortunate to take away time from working with them on recovery to address fears raised by the exaggerated issues in Bentall's book.

The reviewers report no competing interests.

Saks  ER:  The Center Cannot Hold: My Journey Through Madness .  New York,  Hyperion, 2007
 
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References

Saks  ER:  The Center Cannot Hold: My Journey Through Madness .  New York,  Hyperion, 2007
 
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