Making sense out of the science of insanity

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MADNESS EXPLAINED

Richard Bentall

Allen Lane, 25

IN THE Adventures of Sir Launcelot Greaves, the 18th-century novelist Tobias Smollett wrote: "I think for my part one half of the nation is mad - and the other not very sound." As an estimate of the prevalence of mental illness, it may be thought to err towards the pessimistic; yet, as Richard Bentall shows in this monumental study of the history and science of mental health, we have made astonishingly little progress in the treatment of such conditions since Smollett.

At the core of this book is a call for a radical rethinking of how psychiatric problems are alleviated. Bentall, who is professor of clinical psychology at Manchester University, is well aware that some of his conclusions will not be accepted, and indeed may be positively denounced by his colleagues. His work has already been called "dangerous" and "a politically motivated anti-psychiatric rant". To this lay reader, such assessments seem tantamount to proof of a discipline in denial.

Although most people would claim that Sigmund Freud was the father of psychoanalysis, Bentall argues that the German scientist Emil Kraepelin, born in the same year as Freud, has had the more lasting influence over the academic study and practical profession of psychiatry. Kraepelin’s major work was his Textbook of Psychiatry. His ambition was to be the Linnaeus of madness, to classify the different forms of mental illness - such as paranoia, manic depression, and ‘dementia praecox’, later to become known as schizophrenia.

Kraepelin’s diagnostic system has persisted, in slightly modified ways, up to the present day, and with it, various presumptions about the nature of mental illness. There is, supposedly, a clear line between sanity and madness; and the illness is caused by a biological dysfunction. Hence, various researchers have sought the psychiatric philosopher’s stone, be it the gene for schizophrenia or the cerebral damage that signifies depression.

Such endeavours, Bentall believes, are misguided. Applying the label ‘schizophrenic’ provides no information about the cause, cure or prognosis of the condition; also, consensus between practising psychiatrists is much lower than one might expect. A study showed that, of 85 patients diagnosed with schizophrenia by one (UK) definition, only 19 were considered to suffer from it by another (US) definition.

In the latter half of the book, Bentall proposes various mechanisms to account for many of the typical symptoms of mental illness, such as hallucinations and incoherent speech. By removing, rather than blurring, the line between madness and sanity, he accounts for seemingly intractable delusions by reference to everyday activities undertaken by the sane. Talking to oneself, for example, happens continually: an auditory hallucination can be proven to be a sufferer talking to themself, but misattributing the source.

The volume is not without its faults. Bentall dismisses the work of cultural critics like Michel Foucault as "nihilist"; this is simply not the case. The plea for "joined-up thinking" seems more management-speak than practical collaboration. Fundamentally, though, Bentall’s work is brave, well-researched and accessible. The calls for limiting the use of drugs, preventing institutionalisation, and placing the patient’s experience at the centre of treatment are humane, and, it seems, beneficial.