What If Richard Bentall Is Right?

As I’ve journeyed through understanding just some of the issues around mental ill-health, various kind health and social care professionals have pointed me towards various books to increase my understanding.  As a young PC I really didn’t think very hard about the “validity” or the efficacy of mental health treatments and interventions.  One assumes that whilst there are constant debates about funding and equity, we nevertheless have a developed mental health system which is underpinned by universities engaged in research and that many of them are acknowledged to be at the forefront of international research in mental illness.  My alma mater, Cardiff University undertake pioneering work in the Neuroscience and Mental Health Research Institute around bipolar disorder and dementia, amongst other things.  Their patron is Stephen Fry, also an honorary fellow of the university, and there are various lectures and resources on the website that you will find extremely interesting.

And then someone told me about Professor Richard BENTALL:  professor of psychology at the University of Liverpool.  I sent off for two of his books – Madness Explained and Doctoring the Mind – and over the course of a few weeks, I ploughed through them.  They very accessible books given that they come loaded with explanations about scientific research methods, genetics and psychology and I stopped studying science at 16.  When I got to the end of them, I just started over and read them again before wondering, “Bloody hell – what if he’s right?!”

BENTALL makes a various claims, but a few I found utterly astounding, hence I had to read it more than once:

  • That recovery from major mental health disorders may well be better in developing countries without the trappings of a developed mental health system;
  • That the science upon which major claims are made about the efficacy of various treatments including anti-psychotics, anti-depressants and electro-convulsive therapies is often quite poor;
  • That psychiatric treatment through drugs brings no long term benefits to patients and that short-term benefits can often be outweighed by side-effects.

He has also written the occasional article for the Guardian, most recently arguing that there is too much coercion in mental health care and he debated the validity and relevance of psychiatric classifications with Professor Nick CRADDOCK from Cardiff University following controversy about the soon-to-be-published DSM-5 – this is the Diagnostic and Statistical Manual from the American Psychiatric Association.

Here’s an obvious point: I haven’t got a barking clue whether Richard BENTALL is right or wrong; my GCSEs in maths, chemistry and biology do not take me far enough.  But what I do know, is that the claims he’s making in his book could be tested – the data upon on which he makes them are available, the sources clearly referenced.  When I read or listen to accounts predicated by psychiatrists of the ‘medical model’ of mental illness, I am usually left with more questions than I started with and I’m often left with the quandary that we take for granted the existence of distinct disease concepts based not upon an understanding of causes but by symptoms that we’ve grouped together and we go from there.

So I would like you to imagine I’m an eight year old and tell me: why is Richard BENTALL wrong?  For that matter, why are the other authors and academics who’ve argued against psychiatric taxonomy wrong, like Allan HORWITZ who wrote “Creating Mental Illness“?

I’d love to learn more about this and the reason I’m interested, is that it strikes me as fundamentally linked to how our society responds to mental ill-health where overlaps occur with the criminal justice system – remember what Professor Jill PEAY said in Mental Health and Crime (2010) … professional work at the interface of mental health and criminal justice is amongst the most difficult that either set of professionals will do:

The arguments that BENTALL and several others put forward are challenging for the criminal justice system.  We have a political preference and a social inclination to divert from justice offenders experiencing mental ill-health where this is not inconsistent with the protection of the public and based on assumptions about diagnosis, treatment and recovery.  So what does it say about efficacy if the science that underpins this assumption is as poorly conceived as BENTALL claims; and what about equity to other offenders who were prosecuted for their actions because no medical model of social / legal deviance has translated them from the criminal justice paradigm to any other metaphysical sphere?

Just thinking out loud … and I’m not trying to focus on Professor BENTALL specifically: but to use him and his writings as a metaphor for the whole non-medical model argument.  If someone thinks they’ve got it all wrong, please let me know why because with all the books thrown at me so far, it seems BENTALL’s argument about actually listening to people living with problems in the real world whilst rejecting much, but not everything, about the medical seems more sensible than anything else I’ve read.


IMG_0053IMG_0052Winner of the President’s Medal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


 

 

 

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33 thoughts on “What If Richard Bentall Is Right?

  1. beautiful 🙂 Richard Bentall, Lucy Johnstone, David Pilgrim, Peter Sedgwick and (to include the more controversial) Rd Laing & Thomas Szasz speak a great deal of sense. Longitudinal data about psychosocial causes of MH problems completely outweighs the (largely) fraudulent claims of the biomedical brigade. The psychiatric factory exacerbates problems rather than helping people and at best encourages a beige compliance of functionalised “better behaviours”. Am so glad people are gaining courage to challenge the “well y;know, dopamine, seratonin and shit, genes…? Chemical imbalances, just the same as diabetes” nonsense that people hope will “remove” stigma but reverts us back to an unthinking eugenics.

  2. Although I live in the US, I believe that what Bentall states is right on target. My personal experience has shown me that psych drug interventions can result in the equivalent of a medical lobotomy, and although it might “protect” society by transforming me into a docile blithering idiot, it harms me. The criminal justice system here is not ready to accept this possibility. I feel the biggest thing our society needs to recognize and carry forward is that no two people suffering from a mental illness are alike, so a cookie cutter approach to treatment is just ludicrous. We need a system that allows the resources needed to examine each individual on a case be case basis, and we do not have that.

  3. Hi there,

    I read your blog today with interest and have to say I absolutely agree with Professor Richard Bentall. Although, I feel there is a much more important issue at stake; besides not being very effective, the side-effects of these psychiatric drugs can include suicide, violence, akathisia and mania, among other awful things. My son killed himself and another young man after 17 days on Cipramil, totally out of the blue and equally out of character.

    I have followed your blog on Twitter for a while as I was intrigued to see that you worked in the police force and also had an interest in mental health. I wonder if you have ever come across this guy Brian (@AntiDepAware) who also worked for the police? His blog details his interaction with various police forces and guidelines he set out for people suffering adverse reactions to medication; http://antidepaware.co.uk/working-with-the-police/

    Brian put together a training pack for members of the police force who find themselves in tricky drug-induced situations. His blog states that 75% of the police-force has requested this pack. His knowledge and experience far surpasses anything I have read so far. If my son had come across a policeman who had learned from Brian’s guidelines, who know what may have been prevented? His story is particularly poignant as it follows his own experiences after the death of his son. I was wondering if you had come across these guidelines within your work?

    Leonie

  4. Sorry, can’t tell you why Richard Bentall is wrong, but I can say something about why I think, in principle, he is right. As a society we have come to believe in the miracle of modern medical science, all ailments can be diagnosed – and if correctly diagnosed – there can be a pill / surgery / intervention that can cure or at least modify the effects of the “illness”, if not now then at some point. It may be that sufferers of mental distress/disorder want a “diagnosis” to explain their problems or as often, if not more, their distressed loved ones do. Society wants an explanation for every “deviation from the norm” rather than having to deal with the anxiety it provokes in them or the demands it makes on them to be uncertain and accepting. None of this is wrong, except when organisations buy into it as the only way forward and we allow pharmaceutical companies to profit from it and put the onus on MH & CJ services to be the arbiters of administrating the application of these overgeneralisations. “Mad or bad” is nonsense.
    It should be noted that many medical personnel have had little training in psychological approaches, and psychologists themselves have been seduced into categorisation theories to explain the behaviour of individuals. Diagnosis has always been contentious in mental health and is often unhelpful in identifying triggers to relapse, symptoms expressed, or risks that arise in specific circumstances, never mind what interventions may be most helpful.
    The NHS and governmental edicts, never mind the media, support a minimal tolerance of risk, leading to a prescriptive checklist approach to treatment – hence coercion, blaming, tick box approach to treatment and diagnosis – and as you have stated hindsight criticism where MH issues may have been one part of any situation.
    Pretty sure this response doesn’t help you resolve your concerns, so apologies again.
    I think the people who need to address this are at a level of government, but if they are ever going to listen, blogs like yours can only help. Thanks

  5. I haven’t read the book and would like to know more – but from my research of over 900 mental health homicides in the UK, many are committed by people who are not taking their anti-psychotic medication and who are floridly psychotic as a result. Studies of mentally ill homicide perpetrators in London have shown that some certainly wished that their care had been for more assertive before they had committed the killing.

  6. An absolute brilliant piece. As a mother of a 25 year old under section who has been on 14 drugs that do not work and classed as chronic treatment resistant I can vouch for the fact these are highly dangerous drugs and if you read Professor David Healy’s book, Pharmageddon you will see that it is dubious how these drugs are passed. It is big money for the pharmaceuticals. In addition I have cds of laughing psychiatrists who openly admit it takes 2 minutes to come up with a diagnosis and I have been questioning the diagnosis of my daughter as she has four different ones and the latest is “chronic treatment resistant”. Take a look at the link below – that says it all. I am now demanding a proper assessment by Dr William Walsh who has a book called Nutrient Power – he has identified 5 bio types of depression and if there someone is undermethylated – there is low serotonin levels and the drugs can work but for instance Folate deficiency – copper overload – high serotonin which means the drugs can make someone worse. I would like a proper reduction done along the lines of how Dr Ann Blake Tracy documents but nothing is done properly here in the UK. There are no centres to safely come off the drugs and my daughter’s life is at risk and |I want something done about it. I have witnessed so much suffering – in each case depression/breakdown was caused by something serious that had happened (nothing to do with the family) – of course if someone tries to take themselves off too steeply from these dangerous drugs it causes psychosis but even whilst taking the drugs you can suffer from psychosis from a condition my daughter described that felt like “crawling out of her skin” – this was whilst she was taking the drugs and suffering no end of side effects and the answer to increase even more the dosage. The professionals do not know what they are doing when it comes to taking someone off the drugs. At the Maudsley – the horrific Bethlem Hospital which I feature on my blog psychiatricabuseuk.com on the Posterous site, this is a horrific research hospital where they use the weakest and most vulnerable patients free of charge and allowed by law under section – where they force a patient to take drugs against their wishes for money because they get funding from the drugs manufacturers and what is more they do not care because I know someone who is on 1300mg of drugs and can only sit in front of the television each day and no way do these so called professionals want to take someone off the drugs as it is risky. It is risky to do this because it can result in death if not done properly. However Dr Ann Blake Tracy gives proper instructions on how to safely come off the drugs. The Bethlem reduced my daughter by 150mg off Seroquel, mixed it with Olanzapine and this causes psychosis – they must have known this would cause adverse behaviour yet they wanted her on Clozapine at all costs for their research. Dr Tracy says “this is how they keep people for their establishments”. Dr Candace Pert in her book Molecules of Emotion documents the shocking dangers and refers to the “monster that she helped create”. The care is shocking and abusive – there is much abuse going on because these are vulnerable patients and I am in touch with a lot of people who have told me the most shocking things and just look at how my daughter has been treated – no one will take responsibility for mistakes made and they stick together – the Bethlem is “all about Clozapine here” Dr MacCabe “Re-challenging patients with blood dyscrasias and cardiovascular problems with Clozapine” . If they want people to take part in their clinical trials they should pay for them to do so but they take advantage of weak and vulnerable people like my daughter who should never have been put on the drugs in the first place and has not got over what happened to her so the drugs do not work. Unfortunately, the drugs are mind altering drugs and my daughter will need care for the rest of her life now – someone who once had a job, was learning to drive, studying and doing normal things and was placid by nature – they have destroyed my daughter. I am appalled by the post above by “Hundred Families” – if only this person could see what is really going on behind closed doors and these drugs are dished out by GPs – anti-depressants for instance and she was allergic to this and tried to take herself off too steeply. I knew nothing about these drugs. What there should be is good facilities like Root and Branch, Chy Sawel and Soteria. There should be other patients involved too. So these drugs can cause psychosis whether the patient has taken themselves off or remained on them – either way they are very dangerous and with all the diagnoses in DSM V what is worrying is that there is a diagnosis for everyone and as you can see from the link above, there is no scientific tests to prove what causes a mental illness and they are having fun guessing. The drugs are given on a trial and error basis and a patient is wrongly told they have to remain on them for the rest of their lives and are ignored if they are suffering terrible side effects. It is like giving a life sentence. Mental illness itself is not what causes such killings read about in the papers – what the papers do not tell you is the truth – how dangerous the drugs are. I suggest you read Pharmageddon and Professor David Healey’s posts – it is the drugs manufacturing companies and the Government that people should be looking at for answers here. It is big profit and big money to keep someone on such drugs for the rest of their lives and that in turn causes pressure to the NHS – the same patients returning time and time again to the acute wards and then the long term health problems. They cause diabetes amongst other serious conditions. If done correctly same as any drug, withdrawal could be successful without any of the side effects and without leading to psychosis. Experts such as Dr Ann Blake Tracy and others should be called upon to help people as you can only come off the drugs by miniscule amounts on a day to day basis over a long period of time 1 – 2 years depending on how long you have been on them. This should not be done in the community but in safe surroundings and other patients as peer support. I am in touch with many who live a normal life – yes it is possible to safely withdraw from the drugs if this is done correctly but no one seems to know how to do things correctly in the UK. That is why I have requested Dr Walsh’s involvement in at least giving a proper assessment. If the drugs do not work then there should be help given to the patients to safely withdraw and there should be Open Dialogue approach like in Finland. – 85% success rate.

    My younger daughter is on top of the world despite diagnosis of Schizophrenia now she is off those chemicals given to her as a child. I am in touch with many patients who have made a full recovery and doing something with their lives – no thanks to the shocking care and abuse some have suffered under the current health care system where the care is mainly drugs.

    Take a look at the following link – this makes you think whether anything is credible.

    http://goforthegold.psychiatrictimes.com

    1. I find it difficult to comment on Bentall as I search for similar answers myself. As a cognitive neuropsychology graduate and working towards a career in neuropsychology, I think it is worth taking the time to understand the history of “the mind” in terms of treatment and diagnoses of medical conditions like psychosis, schizophrenia, etc.

      At the risk of recommending yet another book in addition to those you’ve received (or perhaps you already have this on your list), might I recommend Theodore Millon’s ‘Masters Of The Mind’: http://www.amazon.co.uk/Masters-Mind-Exploring-Illness-Millennium/dp/0471469858/ref=sr_1_11?s=books&ie=UTF8&qid=1362147070&sr=1-11

      I found it to be an incredibly useful resource, especially as it traces threads of developments from various schools of philosophy and medicine, and so is quite interdisciplinary too.

      Twitter: @NeuroWhoa

  7. Sorry, I can’t tell you he’s wrong either! I work in the creative end of mental health, teaching music and offering practical living support to young people with mental health issues. If these interventions work, as they have been proved to, there MUST be more to mental health treatment than the pharmaceutical options. Although I have seen cases where short-term medication can help in a crisis, I have never seen anyone “cured” by these drugs.
    My views were established through my own experience of depression. I was 16, homeless and being homophobicly bullied in the hostel where I was living. My doctor put me on anti-depressants, which gave me panic attacks, so I was given more sedative drugs on top. After a year, I was still homeless and being bullied, and walking around like a zombie, incapable of sorting out my problems. I was lucky: with the help of good friends I was able to stop taking the medication, against my GP’s advice. It wasn’t easy, as some of the drugs I was on were highly addictive. With a clear head, i was able to find place to live, go back to college, and the rest is history! Stopping medication may not be the answer for everyone, but it certainly worked for me.

  8. The problem with antipsychiatry is not that it doesn’t frequently make excellent points and explain some of the barbaric treatments of the past, and current things which we may come to feel are barbaric, but that as a critical voice it offers little constructive or practical solutions about how as a wider society, or as professionals we deal with the mess around Mental Health that has been created.

    As an example I have read that in some developing nations those who would be described as mentally I’ll are simply not allowed to take on a sick role and with a greater acceptance in the community of their ‘strangeness’ are expected to work and participate in community living (with or without medication) and therefore are effectively undergoing ongoing rehabilitation. If their behaviour becomes dangerous or disruptive they are often detained for the sake of containment rather than treatment.
    Well observed and perhaps this tells us something useful about the nature of ‘madness’ but what is it’s practical application in OUR culture. We have a welfare dependent society that also allows us to abdicate from normal life due to our ‘illness’. So how do we go about changing that and would we actually be happy with the outcome were we able to implement it.

    Unsurprisingly medical research generates medical solutions. Alternatives are like to be much more expensive, time consuming, require different types of professionals to those we have now and will not be universally effective – nothing is.

    1. I don’t know the details, so you may have to do your own reading around, but I’m sure some anti-psychiatry proponents argue the opposite: that residential, supported living, often unmedicated except in extreme cases, has proved long-term more successful and cheaper – akin to the developing-world model you allude to. That said, I’m representing what I think others have written and I’m sure some would question the research methods that brought about that conclusion.

      1. You won’t find meaningful research in the western world about medication free treatment of serious and enduring mental health problems (IE schizophrenia and bipolar affective disorder) because it is considered ethically unjustifiable to knowingly allow people to suffer the symptoms and potential harm.

        With increasing withdrawal of resources we are moving towards this model of community care but for the wrong reasons and without the underlying changes in society that would need to make it effective. In the developing world there is often a much greater reliance on family (without ‘carer support’ or benefits).

        Without acceptance of difference and ‘different’ (by which I mean bizarre and potentially disturbing) behaviour in public, clients in residential care or supported accommodation are currently often over medicated to eliminate behaviours and experiences that society finds unacceptable.

        Anti-psychiatry often focusses on therapeutic or positive risk taking but again, as your blog attests to, in large part this is counter to the expectations of the public.

        Changes in attitudes in society can be slow, difficult to manage and unpredictable. We have made great advances towards reduction in stigma towards mental health problems only to find that the ‘worried well’ are able to take on labels such as stress and depression with less stigma but those with more disabling conditions are increasingly feared, ostracised and isolated. Hate crime against the disabled is on the increase.

  9. You won’t find meaningful research in the western world about medication free treatment of serious and enduring mental health problems (IE schizophrenia and bipolar affective disorder) because it is considered ethically unjustifiable to knowingly allow people to suffer the symptoms and potential harm.

    With increasing withdrawal of resources we are moving towards this model of community care but for the wrong reasons and without the underlying changes in society that would need to make it effective. In the developing world there is often a much greater reliance on family (without ‘carer support’ or benefits).

    Without acceptance of difference and ‘different’ (by which I mean bizarre and potentially disturbing) behaviour in public, clients in residential care or supported accommodation are currently often over medicated to eliminate behaviours and experiences that society finds unacceptable.

    Anti-psychiatry often focusses on therapeutic or positive risk taking but again, as your blog attests to, in large part this is counter to the expectations of the public.

    Changes in attitudes in society can be slow, difficult to manage and unpredictable. We have made great advances towards reduction in stigma towards mental health problems only to find that the ‘worried well’ are able to take on labels such as stress and depression with less stigma but those with more disabling conditions are increasingly feared, ostracised and isolated. Hate crime against the disabled is on the increase.

  10. Yep, can’t tell you he’s wrong either, he’s completely right. Have a look at Joanna Moncrieff’s work too.
    As Matthew Ignoramus Crees says, the medical model actually increases stigma. People suffering from mental illness are human beings experiencing normal human reactions to traumatic events.

  11. For me as a service user and mental health professional drugs have been a lifesaver. Due to almost catatonic depression I was unable to function in any sort of capacity in life. With aggressive pharmacological treatment I waas able to retrain, go back to a full time job, function in society and look after myself on a basic level. Yes there were social factors that made my illness worse but they were a result of the illness and cost me dearly in terms of career, family, friends, partners and finances. I spent 7yrs moving from one medication to another doubling my bodyweight. The combination of two antidepressants at high doses gave me my life back within weeks. yes there are side effects but my quality of life was so poor when unwell that I did did not want quantity of life.

  12. I have been in the Mental Health system for 3 years now. The first year they told me (“you don’t have a mental health issue)!
    Just to put it into perspective; I had a good job and had worked for 20 years although, due to the economy my hours were increased until I found myself working 90 hour weeks (that’s not a typo), I also had a husband and owned my own home which I had saved (with my husband to put down a 70k deposit). So I imagine you get the picture, up at 6am home at 10pm and on call every 2nd/3rd week, losing the relationship with my husband who never saw me and losing (not the equity that I couldn’t care less about, it was never mine to begin with). However, the 70k was earned through hard work which just got harder.

    Year two, I completely lost it with the stress off fearing losing my job, my husband and my home became suicidal…..the answer, I drove my car into a tree at high speed breaking my back, ribs and pierced lung. Now MH are taking me serious….a little too late since I have now at this point lost all the things I feared I would loss…job, marriage and home!

    I spent a year on various medications and somehow knew these meds where doing me more harm than good, so I stopped taking them and became (non-compliant). I would like to point out I felt much better off the meds than I ever did on them and while on them had x3 hospital admissions. When I stopped taking them….so far I have had none in over a year!!

    I decided to take a few months and backpack in Asia and all went well until a few weeks before I came home, I started feeling suicidal and my behaviour was erratic to say the least!

    I was advised to go to a proper clinic in Bangkok who prescribed me Valium. Within 10 days I was back to normal!
    I have on average x4 breakdowns a year and explained how brilliant the medics in Thailand treated me and how I would like to continue this regime at home…..2-3 weeks tops off Valium x4 times yearly (takes away any addiction/tolerance issues in my case)!

    It took me 8 months of battles with Psychiatrists who (clearly lose the argument that it is a “serious chemical imbalance)! Too have my care transferred to my GP (who is great)!

    Psychiatric Conversation!

    Psych : How do you feel at the minute?

    Me: Really great, have a festival at the weekend and going with 3 friends to Amsterdam the week after (I don’t smoke anything except cigarretes) they know this, feeling a tad apprehensive since I don’t know everyone at the festival (it was a hen party)! So little anxious but, excited and lots to look forward too!

    Psych : So you are highly anxious and very excitable then?

    Me. : No, I have normal every day apprehensions and I am no more excited than my friends!

    Psych : I think I have to do a young mania scale test on you, as you are clearly over anxious and excitable!

    Me: : Are we having the same conversation, perhaps you should take an “active listening course”! OK OK bitchy I know but, seriously??

    I left her office sharpish before she had the chance to ruin my plans then rung a trusted friend and asked if my behaviour recently had been normal…..she said 100%, we are all excited don’t worry your fine!

    So, entering the office I was fine….leaving her office I am questioning my own sanity???

    Got her letter off her thoughts on the meeting when I came back from my trip (which went perfectly with no problems)! She wrote “patient clearly showing signs of the beginnings off a manic episode and I wonder if her “plans” are delusions? I have never suffered from delusions!! So read letter to friend who clearly laughed after spending two weeks with me!

    I love Bantall’s book and was one off the first I read in my research into MH!

    Ohh, the Valium regime is working well although, have only needed then twice and I now have a placement with the MH Dept…..go figure!!!!!

  13. “If someone thinks they’ve got it all wrong, please let me know why because with all the books thrown at me so far, it seems BENTALL’s argument about actually listening to people living with problems in the real world whilst rejecting much, but not everything, about the medical seems more sensible than anything else I’ve read.”

    I’ve only read Doctoring the Mind and some of his Guardian pieces, but it seems to me Bentall’s position boils down to this:

    (1) we should replace psychiatric diagnosis with a psychological system, and
    (2) we should replace psychiatric treatment with psychological treatment.

    However, these are both wishes for the future, because his proposed psychological system doesn’t exist
    and current purely psychological treatment doesn’t work for some conditions.

    Re: diagnosis, if he does actually sit down and draw up a detailed alternative to DSM and publish it for scrutiny, then I’d be impressed. I also think it would be vulnerable to much of the criticism he launches at DSM, because any attempt to codify all distress/illness is going to necessarily be imperfect.

    Re: treatment, I was pleased that Bentall acknowledges in Doctoring the Mind that antipsychotics can work very well in the short term, and that mood stabilisers are effective for bipolar. It’s a shame that those acknowledgements get lost in the anti-medication material, because they’re important. But, as a service user, of course I would be delighted if Bentall and co do successfully develop a proven psychological treatment for severe conditions.

    Until then, however, I read Bentall’s writings as a psychologist’s very tribal critique of psychiatry, rather than a balanced account. As to whether he’s wrong, I would say he’s got a nice-sounding (though very ambitious) wish-list for the future. It will be interesting to see if he comes up with the goods.

    Thanks for the ever-interesting blog.

    1. Thanks for the feedback – yours in the only comment so far that really attempts to answer my question!! In the spirit of trying to understand why he’s wrong, I’ve ended up having numerous conversations as a result of writing this post. In fairness: that’s exactly what it was for! I’m currently reading a recently published book by Professor Tom BURNS, “Our Necessary Shadow” to see the debate from a psychiatrists point of view.

      I would say, having read Bentall’s two main popular books on this: I didn’t form the views that you did. I didn’t see him asking to replace psychiatry with psychology – he explicitly said so. He specifically stated he just wanted psychiatrists to be better trained and he certainly didn’t appear to argue for a psychological classification system. All good points – will blog about Tom BURNS’s book once I’ve finished it, as counter-balance to this post. Thanks again for contributing!

  14. Thanks for the reply. I’m really glad if you’ve read him as less anti-psych than some others have. (If people think his message is “the drugs don’t work” then that’s a dangerously wrong idea to have floating around.) I look forward to reading your Burns post, you’ve inspired me to read that too. Thanks again for the blog, and tweets.

  15. Bentall is right: The science used to buttress the bio-bio-bio model that has dominated thinking and treatment practice for decades is shoddy, threadbare and flaky.
    No other branch of medicine would even attempt, never mind get away with such poor work.

    Meanwhile, Bentall and many others round the world have been steadily building a body of research that shows how life experiences play a huge role in leading to people becoming diagnosed with mental illnesses and stuck in the legal/ mental heal system. The real tradgedy is teh many of eth people who are subject to huge resources, including a lot of Police time, directed at making them comply with drug regimes are themselves victims of childhood abuse and neglect, or the culmination of a life of being maltreated and discriminated against.

    What we need is a broader understanding based on real and broad based science not drug company funded product testing that is barely more scientific than the old Daz washing powder or Coke/Pepsi test that we saw TV adverts.

    Meanwhile, meds can help but they don’t “correct” anything: instead they create a chemical effect that can be beneficial, but that benefit needs to be balanced with other effects in each case. Check out Dr Joanna Moncrieff for how psych drugs actually work. http://recoverynetworktoronto.wordpress.com/2012/01/06/dr-joanna-moncrief-the-myth-of-the-chemical-cure/

    We are on the cusp of a more hopeful time – understanding how life events can affect us, can leave us with coping skills that work for a while but break down in later life , and how we can learn how to change our response to new events that trigger old painful emotions we may not even recognise: that we can learn new ways to deal with whatever has happened to us and teh effect it left upon us.

    A learning perspective that enables me to live my life contsntly learning new ways to cope or even take advantage of what my experiences can teach me is much more hopeful than a life as a passive or subservient slave to chemicals and a mytholigised biological fault.
    and meds can play a part in that – manipulating teh body’s chemicals can be helpful, to the extent that a person chooses is best for them.

    Here’s a couple more suggestions

    Dr Gabor Mate is Canadian, has written several books, he has a very good way of talking without blaming and in simple language how what happens to us messes us up, til we get stuck – that which we are unable to say “no” to, that is what makes us sick [long term]. He’s perhaps most well known for talking about addictions, which is one way our response to life events can manifest itself – He describes an addiction – he points out “addictive patters of behaviour ” is more accurate description ….as any behaviour we feel compelled to continue in full knowledge of its damaging consequenses…..as he points out: we live in a society with many addictive patterns of behaviour.some are considered socially acceptable- some even make some people very rich.

    Dr Daniel Siegel , psychiatrist, attachment researcher and founder of Mindsight Institute . His work attempts to integrate knowledge from multiple scientific disciplines, and even offers a very useful idea of what “mind” actually is that allows us to put all forms of knowing together in a useful way..

    Kevin

  16. Bentall isn’t making a tribal critique at all. I read Bentall as extremely reasonable – far from an anti-psychiatry extremist.
    His point is exactly what you say Chasing_data – any attempt to classify distress is going to be imperfect. Bentall is proposing formulation. Nowhere does he say medication cannot be helpful. He is just providing a much-needed counterbalance to the Bio-bio-bio model. Currently meds are all and if you dare not to respond to them you are a bad service user. Any form of talking therapy is the poor cousin and people wait for unacceptably long times (see Mind’s campaign).

  17. Hi Michael. Can I suggest that you read Robert Whitaker’s two books – Mad in America and Anatomy of an Epidemic, preferably in that order (also see http://www.madinamerica.com). These not only support Richard Bentall’s general thesis but systematically unpick and undermine the seriously flawed assumptions and dodgy research that purports to back up the biological/medical/pharmacalogical approach to mental health. Whitaker is a scientific jounalist from Boston who was commissioned to write ‘good news stories’ about the latest psych wonder drugs in the early 2000s but then started to question the efficacy and authenticity of these products after talking to the people that were on the receiving end of them.
    Whitaker (like Bentall) acknowledges that meds can be very effective in the short term but the longer you run the follow-up trials the worse the aggregate results get. When you start getting studies looking at 7-20 year comparisons of ‘patients’ on and off meds it is overwhelmingly clear that the ‘off meds’ group is less symptomatic, less disabled and far more likely to be living an active, meaningful life. Furthermore, Whitaker conclusively demonstrates the clear correlation between the growth in psych drug prescribing and the numbers of people chronically disabled by their mental health issues; these drugs have transformed episodes that used to be sporadic and self-limiting into an epidemic of chronic conditions. His analysis is so conclusive that in August of this year psychiatrist Thomas Insel, Director of the US National Institute of Mental Health (bastion of medical-model psychiatry) finally admitted that some people with psychosis may be better off without the meds and that they may do more harm than good.

  18. However, I agree with Matthew Ignoramus Rees that “the problem with antipsychiatry is not that it doesn’t frequently make excellent points and explain some of the barbaric treatments of the past, and current things which we may come to feel are barbaric, but that as a critical voice it offers little constructive or practical solutions about how as a wider society, or as professionals we deal with the mess around Mental Health that has been created”

    Those of us that firmly believe that our current mental health system is counter-productive have to try to work out how we should go about trying to change it. The ideas of Whitaker, Bentall, Moncrieff et al are seriously dangerous to psychiatry as a profession; If mental distress is not a biological illness but a response to trauma and adverse life events requiring intensive psycological/social interventions then we need many more trained therapists/support workers and far fewer expensive medically trained psychiatrists. Mental health services are dominated by psychiatry because of their supposed knowledge and skills in diagnosis and prescribing drugs; but the debacle over DSM5 is severely undermining the validity of psychiatric diagnosis and now the drugs are being shown to be ineffective in the medium to long term, so where does that leave the power base of psychiatry?Tom Burns has recently acknowledged that psychiatry is in crisis and needs to change but can it change sufficiently to remain relevant? Psychiatry won’t give up its pre-eminent position without a fight so how do we move our servicesto a social care based system whilst the RCP has the power and influence in the system? I think economics rather than ideology may well be the driver for change – sooner or later governments will realise that they are paying an army of highly paid professionals to force people to keep taking expensive drugs that are making them disabled and economically inactive!

    It seems to me that those of us that want a different kind of mental health system also have to talk openly about how we deal with the small number of people that become violent when acutely disturbed by their distress, because fear of those people helps keep our coercive medically based system in place. Do we simply accept that there are some people that need locking or drugging up because of their dangerousness and why do we apply different standards to people that commit violence when disturbed to those that do it when drunk? The ECtHR case of X v Finland 2012 says that we may need to lock some people up for their own or others’ protection but that doesn’t necessarily mean we have the right to medicate them against their will. This almost certainly leaves our own Mental Health Act out of step with european law.

    I would like to be having these debates on the Masked AMHP facebook group but Samei would get me kicked off for being unwelcoming to other professionals!

    You will no doubt recall giving a talk at our YAMHP event last December. We are having a YAMHP event in Bradford on 5th November at which Bob Witaker and Richard Bentall will be speaking. Places are tight but if you would like one I’m sure I can swing it – drop me an email if you are interested.

    Steve

    1. You’ve got no idea how much I am chomping at the bit to take the day off work and travel to Bradford! << Not a sentence I've ever written before! 🙂 Unfortunately, I have two important professional commitments that day so can't take you up on your kind offer. The mere thought that you were in the YAMPH audience last December causes me no small amount of intimidation. Your contributions "elsewhere" are most insightful and incisive and to think I was up there banging on at you when I'm making this up as I go along supported only by a music degree, is in no small part disconcerting! Thanks for these comments – will order those books on Amazon, immediately! 🙂

  19. I think what Richard Bentall is doing is setting out a case for change – he’s as critical of some of the things that his fellow psychologists have done in the past as some psychiatrists. Here he is giving a talk about the now very solid research base helps us understand how “environmental factors” contribute to how we go mad…not that biology doesn’t play a part, as he says “we can’t disentangle genes and environment that way. ”
    http://recoverynetworktoronto.wordpress.com/2013/09/24/why-society-makes-us-mad-richard-bentall/

    The gene stuff might take another hundred years till we understand how it works [we’re allways just another ten years from the next breakthrough, and even then it may then turn out to play an important but relatively minor role. meanwhile we do understand the environmental stuff and there is lots we can do to help people — individually and as societies.

    Medicines can help, they are not the answer for everyone or everything, and as someone pointed
    out above, even Dr Tom Insel at [the US] NIMH has now written that we need to develop selective ways of using psych meds and find out who does better on them and who does better with less – what he’s suggesting and mapping out is remarkably similar to what Robert Whitaker argued for only a month earlier.

    As for the violence thing – there are much stronger associations between violence and alchohol than with “mental illnesses” and we do know that the huge majority of especially violent crime is very much associated genes – the male chromosomes in fact. I think we need to be very careful about starting to lock up any group of people before they commit crimes because we predict they might. That would be a huge change to the way our societies work and a huge change to the role of the police in society. [My sister and her husband are retired coppers].

    I hear voices, i’m proud to be part of the hearing voices movement. Many people hear voices – at least 250million; about a billion will at least once; 22% of young people do; and and 50% of married people will hear, see, or otherwise sense their dead spouse. In some cultures its those who don’t hear voices who are regarded as unwell.
    In western society we are demonised and feared simply because we hear voices, when most have no problems and may even find it a valuable experience [or ability, even].

    Yes, some people do undoubtedly struggle, some can become very isolated and then very unwell but when they do ask for help they typically find that no-one knows how to help, that most people are scared of them and simply get their freak on. It is hard, especially alone but people can learn to live with really difficult experiences, even violent voices. We focus on helping people live with whatever they do experience and find ways to be less troubled. It’s not about fixing but about learning to live, take charge of and responsibility for our own lives and what we do.. Maybe if a few more people understood that voices people hear often speak to the frustrations and isolation that people are feeling – as well as the trauma and violence they have experienced in their own lives – 70 plus percent of people who experience violent voices have themselves experienced violent events. [d’oh!] often as victim of violence. Then, maybe, just maybe there night be a few more people around who could actually help people struggling this way before they get desperate and seek a way out through violence, or before they just getting angry or even just a bit erratic in public.

    And, maybe , just maybe, then police officers would have less of these instances to deal with and could focus on where their real skills do lie.
    Here in Toronto many police divisions have special teams of a psychiatric nurse and a cop patrolling together – sadly not round the clock and not across the whole city but where we do have them they work very well…business is good as one said to me. Its a step in the right direction.
    The term used by police here is Disturbed Person Incident, a good first step, I think, would be to keep the initials but understand that disturbed persons are most likely distressed. A Distressed Person Incident might just call for a different response – maybe a different response team – and a different approach from society.

    Kevin

  20. Hi Michael. I did actually speak to you during the break after your presentation but no doubt you don’t remember – you were probably concentrating on trying to thaw out in that freezing pit of a hall.

    Thanks for your kind words but I can assure you I feel likewise. Your breadth of knowledge is very impressive, not to mention the guts it takes to stand in front of a room full of AMHPs and tell them they need to sort themselves out over conveyance! Also, as an amateur blues/bluegrass/rock musician who plays by ear I am deeply in awe of anyone that understands music properly!

    Enjoy the Whitaker books; I’m sure you will. Mad in America really was a ‘eureka’ moment for me and Anatomy of an Epidemic just rubs salt in the wounds of the crumbling psych evidence base (sorry about the mixed metaphors there).

    I an finding it increasingly difficult to square being a practising AMHP with the realities of the system that I am sectioning people into. I manage this dilemma by using my training lead position, and my influence within YAMHP, to try to radicalise AMHPs as far as possible to agitate for a different kind of system. I’m sure that we will always have to deprive people of their liberty in the short term for their own and others’ protection but we need a system that uses meds sparingly and selectively for short periods in low dose and concentrates on listening and helping people make sense of their distress. In the medium/long term that would result in far fewer people being disabled, far fewer repeat sections of chronic patients, much less pressure on psych beds and reduced demands on police time & resources.

    Anatomy of an Epidemic ends with a look at the Finnish Open Dialogue system in Western Lapland that has the best outcomes for psychosis in the world. There is also a DVD by Daniel Mackler entitled Open Dialogue which is well worth a look. I’m showing an edited version of that film after Bob Whitaker’s presentation on 5th Nov. Shame you can’t make it. If your plans for the day change get in touch.

    1. I share your frustration — I can’t help but think I’ve devoted my life to spending time making problems worse and it making it harder for people who already had it tough. Haven’t yet found a method by which to square that one away!

      If you ever need a bass player …..

  21. I differ slightly in my views. I have been working with mental health patients for 19 years the past 8 as a qualified nurse….I also have a significant mental health problem myself so have seen the services from both sides. Now I work in liaison and diversion service. I believe that it is not a simple case of right and wwrong. I have read Bentall and I found some of his insights profound and others to be simplistic. I believe that there is a marriage to be made between the medical models and the holistic models. I also believe that the ethos of a bio-psycho-social is being completely lost in an over stretched NHS where funding for proper holistic care is being slashed and the caseload numbers are ever increasing. I have seen close to miraculous recoveries from medication and ECT and from a personal point of view once I found the right balance of medication I was able to function again both on a personal level and go back to work. I also have seen on countless occcasions patients being detained or coming into hospital informally simply because they have stopped their medication and once it is re-started their illnesses are oncec again under control. However, lets not forget that hospital admission is not just about medication it provides a safe, warm environment where the individual can focus on themselves getting better without having to worry about things like cooking, cleaning, bills coming through the door, neighbours harrassing them etc etc etc.

    There has to be a way where psychiatry and psychology can work effectively together to provide a consistent service treating the biological and medical needs of individuals as well as the psychological and social needs…..only in working together on all of the areas can we begin to hope to see a cohesive long term recovery potential for alot of the people under our care.

    1. But here’s a problem – and I’ve just had to check what I wrote because I wrote it three years ago! … Richard BENTALL in his books doesn’t argue against psychiatry per se, he argues for better psychiatry; and he doesn’t argue against all use of medication, but for better use of medication. Three years on from writing this, especially because of the recent furore when BENTALL wrote an open letter to Stephen FRY after the recent BBC documentaries, I’ve seen various psychiatrists writing blogs and letters to newspapers protesting against him.

      But they always stop short of detail at saying WHY or they misunderstand what he said to begin with! – BENTALL and others have written down his various ideas, so what he said is a matter of record and there to be challenged, as I see it.

  22. I believe that Bentall is right. The psychiatrists have a vested interest in promoting the ‘bio-medical model’- it’s more about power, prestige and money than anything else (the drugs rake in billions).

    1. There are no such thing as mental health! Its all bulls! a money making scam! its MK-ULTRA; schizophrenics are made. please see “Targeted Individuals” electromagnetic torture, microwave torture; Smart meters. “DEW”
      Hillary E. Connell

  23. There’s no ‘what if’ about it. He’s as ‘not wrong’ as science currently allows anyone to be. In science, we don’t aim to prove stuff right: that’d be acting on confirmation bias. We try to prove things wrong, and we have to be overwhelmed with evidence in order to be foced to reject null hypotheses and accept alternative ones.

    On the basis of my educational background with includes psychology, physics, maths, engineering, archaeology, molecular & physical anthropology and so on, I an honestly say that I can find very little to argue against with him. And even what there might be is really inconsequential.

    In a very exciting way, he is ‘right’ (as in ‘seriously ‘not wrong’)!
    Thank you for your article.

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