There have been enough supposed remedies for mental illnesses over the years to persuade the most gullible hypochondriac that, as yet, most of them are incurable. Vulnerable patients with disordered minds have been subjected to a bewildering variety of talking cures and drugs as well as savage treatments such as lobotomy, insulin shock and electroconvulsive therapy (ECT). As if that weren’t bad enough, smug philosophers such as Michel Foucault have emerged to tell us the mad aren’t really mad at all, it’s society that’s at fault.

Judged by outcomes, the medical profession has achieved almost nothing in this field. We get better at treating cancer, worse at treating schizophrenia. As Richard Bentall points out in this gripping polemic, mental illness is on the increase and sufferers in the developed world with access to psychiatric care actually fare worse than patients in poorer countries.

The problem is fundamental. Science looks at the two handfuls of fat, protein and water between our ears and assumes it must be fixable. The Freudian, psychoanalytic and psychological traditions talk through the mess until its dysfunctions emerge into the clear light of day; the psychiatric tradition attempts physically to fix the brain as one might any other organ — with drugs or surgery.

Bentall is a psychologist, an adherent of the talking cure and one of psychiatry’s most eloquent enemies. His first book on the subject, Madness Explained, caused a firestorm; this will cause another. “Psychiatry,” he writes, “has been profoundly unscientific and at the same time unsuccessful at helping some of the most distressed and vulnerable people in our society.”

Psychiatry’s record is appalling. Patients have been coerced into treatments that have wrecked their bodies and minds. Bentall tells harrowing tales of patients bludgeoned with drugs when warmth and sympathy would have worked better. Justifying this coercion has been a diagnostic system that, Bentall says, is entirely meaningless. Psychiatrists use reference books that sub-divide mental disorder into ­categories — most familiarly manic depression (bipolarity) and schizophrenia — that are, in fact, simply ways of making mental illnesses as definable as physical disorders. Bentall’s most serious charge is that this is done under pressure from the pharmaceutical companies wishing to shift product. “We shall see that vested interests have often played a greater role than rational argument…[that] ­objections made by patients to cold and ineffective treatments have more often been ignored than heeded, and that there has been a proliferation of ­systematic misinformation about the effects of some of the most widely used psychiatric treatments.”

Bentall’s targets are, of course, the spectacular failures of the past — insulin shock and so on — but, more urgently, he is fighting the wave of drug treatments that followed the discovery of the effects of chlorpromazine from the early 1950s onwards. This seemed to work against psychosis, the most alarming of mental-illness categories, and its apparent success inspired half a century of drug innovation.

From antipsychotics to antidepressants, the new drugs seemed to conquer all. “For many psychiatrists they seem to be the only tool available…It is not uncommon to find patients who have been ­prescribed two or three different kinds of antipsychotics, or an antipsychotic in combination with an antidepressant and a benzodiazapine, surely evidence of a clinician who is destitute of ideas.”

But, says Bentall, the drugs don’t work and most are, in fact, based on bad science. For example, ­Prozac and its imitations and derivatives, he argues, are based on a questionable ­theory — that lack of the neurotransmitter serotonin in the brain is a cause of depression. The apparent effectiveness of these ­compounds, he suggests, is due to the fact that they have become powerful placebos.

At this level, Bentall will find many supporters. Fewer will nod in agreement at his scepticism about antipsychotics such as Clorazil, Zyprexa and Zoleptil. Although he acknowledges that these ferocious compounds may sometimes be useful, he questions the trials that have formed the basis of their use and suggests they are ineffective over the long term. Doctors confronted with the most florid psychotic conditions are likely to have little patience with these doubts. Full-blooded psychosis needs urgent treatment.

But the talking cure, for Bentall, works even for manic depression and schizophrenia, which, for all their debilitating intensity, can be shown to have their roots not in the patient’s genetics but in his experience. The present wave of enthusiasm for cognitive behavioural therapy, the quickest and most practical version of the talking cure, suggests he is not alone.

Bentall’s are revolutionary ideas, aimed at a profession in thrall to the products of the collective of companies known as Big Pharma. I am not qualified to say he is right. But I am qualified to say that, having read this book, I’ll be avoiding psychiatrists until my anger has subsided.

Doctoring the Mind by Richard Bentall
Allen Lane £25 pp364

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