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Madness Explained: Psychosis and Human Nature
Part of a Growing International Movement to Change the Face of Mental Illness.
Is madness purely a medical condition that can be treated with drugs? Is there really a clear dividing line between mental health and mental illness - or is it not so easy to classify who is sane and who is insane?
In Madness Explained leading clinical psychologist Richard Bentall shatters the modern myths that surround psychosis. This groundbreaking work argues that we cannot define madness as an illness to be cured like any other; that labels such as 'schizophrenia' and 'manic depression' are meaningless, based on nineteenth-century classifications; and that experiences such as delusions and hearing voices are in fact exaggerations of the mental foibles to which we are all vulnerable.
We need, Bentall argues, a radically new way of thinking about psychiatric problems - one that does not reduce madness to bain chemistry, but understands and accepts it as part of human nature.
'Bentall destroys many of the foundations underlying psychiatric thinking' - Oliver James
'A monumental study ... brave, well-researched and accessible' - Scotland on Sunday
'Bental demystifies psychosis and restores the patient to a proper place with the rest of humankind' - Aaron T. Beck
Is madness purely a medical condition that can be treated with drugs? Is there really a clear dividing line between mental health and mental illness - or is it not so easy to classify who is sane and who is insane?
In Madness Explained leading clinical psychologist Richard Bentall shatters the modern myths that surround psychosis. This groundbreaking work argues that we cannot define madness as an illness to be cured like any other; that labels such as 'schizophrenia' and 'manic depression' are meaningless, based on nineteenth-century classifications; and that experiences such as delusions and hearing voices are in fact exaggerations of the mental foibles to which we are all vulnerable.
We need, Bentall argues, a radically new way of thinking about psychiatric problems - one that does not reduce madness to bain chemistry, but understands and accepts it as part of human nature.
'Bentall destroys many of the foundations underlying psychiatric thinking' - Oliver James
'A monumental study ... brave, well-researched and accessible' - Scotland on Sunday
'Bental demystifies psychosis and restores the patient to a proper place with the rest of humankind' - Aaron T. Beck
656 pages, Paperback
First published June 5, 2003
156 people are currently reading
3312 people want to read
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Displaying 1 - 30 of 46 reviews
March 18, 2013
I would have given this book four and a half stars were I able.
In any case, I found Bentall's book very accessible from a non-specialist's point of view. Throughout, he argues that Emil Kraepelin's foundational schema for classifying madness (into manic depressive and dementia praecox) is fraught with a number of problems and should be abandoned. In its place, psychiatrists should take a symptom-oriented approach. Rather than diagnosing a patient with schizophrenia or bipolar disorder, psychiatrists should diagnose their patients as having delusions, paranoia, episodes of mania, and treat them accordingly. There is little convincing evidence of there being a single underlying cause/disease behind the various and differing complaints afflicting patients with schizophrenia, for instance (bipolar disorder, it seems, is a much more unified problem than schizophrenia since the latter encompasses symptoms ranging from paranoia to disordered speech to catatonia; this being said, Bentall would still have a problem with grouping together all those who have experienced episodes of mania).
When I checked this book out of the library (along with a few of R. D. Laing's works) I didn't think I'd end up reading the whole thing. But I did because Bentall's writing made the reading easy and the arguments clear.
Three things I want to point out:
(1) More research should be done on bipolar disorder: as Bentall states a number of times, much more effort has been put into studying families and groups of people affected by schizophrenia than has been put into studying those with or affected by bipolar disorder.
(2) Drug companies are . . . companies and want your money. So though some drugs are useful for some people (I would never dispute this point), drugs are not always necessary. Sometimes therapy or generic medications are better. Bentall does a good job of dispelling the myth that studies always (or even often) reveal the truth about medication and disorders.
(3) Bentall could have spent some time on auras as, for instance, they are experienced by those with migraines and/or epilepsy. More needs to be said about how these two problems relate to mental illnesses. Is there a continuum between them or are they discrete phenomena? I already know that Bentall would reject the latter option. But how might auras and madness be connected?
In any case, I found Bentall's book very accessible from a non-specialist's point of view. Throughout, he argues that Emil Kraepelin's foundational schema for classifying madness (into manic depressive and dementia praecox) is fraught with a number of problems and should be abandoned. In its place, psychiatrists should take a symptom-oriented approach. Rather than diagnosing a patient with schizophrenia or bipolar disorder, psychiatrists should diagnose their patients as having delusions, paranoia, episodes of mania, and treat them accordingly. There is little convincing evidence of there being a single underlying cause/disease behind the various and differing complaints afflicting patients with schizophrenia, for instance (bipolar disorder, it seems, is a much more unified problem than schizophrenia since the latter encompasses symptoms ranging from paranoia to disordered speech to catatonia; this being said, Bentall would still have a problem with grouping together all those who have experienced episodes of mania).
When I checked this book out of the library (along with a few of R. D. Laing's works) I didn't think I'd end up reading the whole thing. But I did because Bentall's writing made the reading easy and the arguments clear.
Three things I want to point out:
(1) More research should be done on bipolar disorder: as Bentall states a number of times, much more effort has been put into studying families and groups of people affected by schizophrenia than has been put into studying those with or affected by bipolar disorder.
(2) Drug companies are . . . companies and want your money. So though some drugs are useful for some people (I would never dispute this point), drugs are not always necessary. Sometimes therapy or generic medications are better. Bentall does a good job of dispelling the myth that studies always (or even often) reveal the truth about medication and disorders.
(3) Bentall could have spent some time on auras as, for instance, they are experienced by those with migraines and/or epilepsy. More needs to be said about how these two problems relate to mental illnesses. Is there a continuum between them or are they discrete phenomena? I already know that Bentall would reject the latter option. But how might auras and madness be connected?
December 4, 2023
Is madness really what we think it is? The whole psychiatric industry relies upon the Kraepelian paradigm, whereas there is a well-defined variety of mental illnesses, clearly clear-cut from mental health, each with their own set of symptoms that, eh oh!, specific pills can address like we address a cold or a flu. Isn't it wonderful? Well, such simplistic view surely serves a whole flourishing and more than profitable market. Yet, is it sound? The question must be asked, because, in the end, it's how we treat patients which is at stake.
Richard Bentall, an influential clinical psychologist, is cutting here right through the bs in this lengthy book, detailed, well-researched and engrossing even if at times quite challenging. I loved it, because such demystifying and debunking is more than needed!
What are mental illnesses? Well, he starts by detailing the work of Emil Kraepelin, the brilliant German psychiatrist who, at the turn of the 20th century, had defined such conditions as dementia praecox and manic-depression. This approach was brilliant in discerning different symptoms as patterns to different illnesses, but, this obsession to classify, according to Bentall, is also what failed Kraepelin... and what has been failing psychiatry ever since! Indeed, dementia praecox is now known as schizophrenia, manic-depression as bipolar, and the way we define both doesn't bear much ressemblance to how Kraepelin himself had described them! How such conditions came to be studied, described, and redefined over the past century is in fact a telling lesson about how fleeting and arbitrary such labellings are. This is where he then goes on straight to the point: focusing on some features at the core of their definitions (eg psychosis, language and communication issues, behaviours like mania and hypomania...) to demonstrate that, the clear-cut divide between sane and insane, 'normal' and not, might not be so clear-cut after all... Here's to another blow against the Kraepelian paradigm: not only our defining of specific illnesses remains vague and unhelpful, but, the supposed well-defined line between 'madness' and 'normal' (psychosis are a case in point) is blurred to say the least.
Now, let's be very clear: he doesn't in any way dilute or minimise the challenging and harrowing fate of sufferers, and this is not an anti-psychiatry manifesto. What he does by challenging how we define madness, and so various mental illnesses, is to show that, as a result, patients are being failed. Being a clinical psychologist himself, his indictment can seem harsh. And yet...
The problem with modern psychiatry is not only that it meaninglessly tries and fit people into very ill-shaped boxes ('schizophrenia', 'bipolar'...). The problem is that diagnoses are based on a flawed view of mental illness, whereas such disorders are perceived as being solely due to chemical imbalance in the brain, which, therefore, can only be addressed by chemicals prescribed to restore such balance. Richard Bentall, of course, doesn't reject such biological outlook! He just regrets its reductionism - what about the environment? Not taking into account the background, experience, personal history, and surrounding environment of the patient is to be blind to the underlying reason and triggers to their condition; an approach which cannot but lead to a poor way to address them.
'...psychiatric theories that consider the brain in isolation from the social world are unlikely to lead to a proper understanding of the origins of psychosis. The neoKraepelian project of an exclusively biological psychiatry has been doomed to failure from the outset.'
Indeed, and, so, where does that leave us? If classifying mental illnesses is everything but as straightforward as classifying plants, if what is considered as the main features of mental illnesses (eg psychosis especially) turn out to don't be the sole prerogative of the insane after all, and if persisting in fitting vague symptoms with specific illnesses does nothing but confusing it all even more (the evolution of the DSM is a case in point) then what of mental illness itself? How to define it? How to address it? The author proposes here a ground-breaking and radical new approach:
'We should abandon psychiatric diagnoses altogether and instead try to explain and understand the actual experiences and behaviours of psychotic patients.'
In other words: we should stop ascribing sufferers with arbitrary labels, but, focus on the specific symptoms they experience - address their condition on a symptom by symptom basis, that is, if such symptoms constitutes serious impairments.
I don't know if such approach will ultimately triumph (there are already some therapies out there valuing medications as much as patient history) but here's a radical read which, in depth, throws a bright new light upon what we call 'madness'. Again, it can be tedious and challenging at times, but the arguments put forward to demystify how mental illnesses are being defined are compelling to say the least. Richard Bentall's proposals may or may not turn out to be the founding basis to a new paradigm, but his book here surely is a fascinating read for anyone interested in mental health. Brilliant!
Richard Bentall, an influential clinical psychologist, is cutting here right through the bs in this lengthy book, detailed, well-researched and engrossing even if at times quite challenging. I loved it, because such demystifying and debunking is more than needed!
What are mental illnesses? Well, he starts by detailing the work of Emil Kraepelin, the brilliant German psychiatrist who, at the turn of the 20th century, had defined such conditions as dementia praecox and manic-depression. This approach was brilliant in discerning different symptoms as patterns to different illnesses, but, this obsession to classify, according to Bentall, is also what failed Kraepelin... and what has been failing psychiatry ever since! Indeed, dementia praecox is now known as schizophrenia, manic-depression as bipolar, and the way we define both doesn't bear much ressemblance to how Kraepelin himself had described them! How such conditions came to be studied, described, and redefined over the past century is in fact a telling lesson about how fleeting and arbitrary such labellings are. This is where he then goes on straight to the point: focusing on some features at the core of their definitions (eg psychosis, language and communication issues, behaviours like mania and hypomania...) to demonstrate that, the clear-cut divide between sane and insane, 'normal' and not, might not be so clear-cut after all... Here's to another blow against the Kraepelian paradigm: not only our defining of specific illnesses remains vague and unhelpful, but, the supposed well-defined line between 'madness' and 'normal' (psychosis are a case in point) is blurred to say the least.
Now, let's be very clear: he doesn't in any way dilute or minimise the challenging and harrowing fate of sufferers, and this is not an anti-psychiatry manifesto. What he does by challenging how we define madness, and so various mental illnesses, is to show that, as a result, patients are being failed. Being a clinical psychologist himself, his indictment can seem harsh. And yet...
The problem with modern psychiatry is not only that it meaninglessly tries and fit people into very ill-shaped boxes ('schizophrenia', 'bipolar'...). The problem is that diagnoses are based on a flawed view of mental illness, whereas such disorders are perceived as being solely due to chemical imbalance in the brain, which, therefore, can only be addressed by chemicals prescribed to restore such balance. Richard Bentall, of course, doesn't reject such biological outlook! He just regrets its reductionism - what about the environment? Not taking into account the background, experience, personal history, and surrounding environment of the patient is to be blind to the underlying reason and triggers to their condition; an approach which cannot but lead to a poor way to address them.
'...psychiatric theories that consider the brain in isolation from the social world are unlikely to lead to a proper understanding of the origins of psychosis. The neoKraepelian project of an exclusively biological psychiatry has been doomed to failure from the outset.'
Indeed, and, so, where does that leave us? If classifying mental illnesses is everything but as straightforward as classifying plants, if what is considered as the main features of mental illnesses (eg psychosis especially) turn out to don't be the sole prerogative of the insane after all, and if persisting in fitting vague symptoms with specific illnesses does nothing but confusing it all even more (the evolution of the DSM is a case in point) then what of mental illness itself? How to define it? How to address it? The author proposes here a ground-breaking and radical new approach:
'We should abandon psychiatric diagnoses altogether and instead try to explain and understand the actual experiences and behaviours of psychotic patients.'
In other words: we should stop ascribing sufferers with arbitrary labels, but, focus on the specific symptoms they experience - address their condition on a symptom by symptom basis, that is, if such symptoms constitutes serious impairments.
I don't know if such approach will ultimately triumph (there are already some therapies out there valuing medications as much as patient history) but here's a radical read which, in depth, throws a bright new light upon what we call 'madness'. Again, it can be tedious and challenging at times, but the arguments put forward to demystify how mental illnesses are being defined are compelling to say the least. Richard Bentall's proposals may or may not turn out to be the founding basis to a new paradigm, but his book here surely is a fascinating read for anyone interested in mental health. Brilliant!
March 24, 2016
The title of this book is misleading. Bentall has no better - but, in my view, a potentially more confusing - explanation of madness then those he wishes to supplant.
He starts fairly well by critique-ing the Kraepelin-ian (=medical/biological) model of mental illness. The reason why this reads well is because criticizing others is easy compared to bringing forth your own ideas. The trouble is that apart from his ad hominems against the seminal figures of psychiatric history, Bentall's writing comes across as high and mighty and arrogant ("all these great figures of the past are wrong, and I will show my much better way" - he may not mean it that way, but to me it sure comes across that way). But then he goes into a rather tedious enumeration of all sorts of (predominantly psychological; hardly any biological) research which show a variety of opposing results and can only lead to conjecture. He then uses these conjectures (by his own admission "highly conjectural") to build up his "explanation" of mental illness. But, in my view, his explanations are no explanations at all, they are just a psychological mapping of symptoms of psychosis. To give an example: there is a lot of research on "formal thought disorder" that Bentall presents as ground-breaking and important; he explains how researchers select from patients a group of thought-disordered patients to compare with patients without thought-disorder, and that subsequently the tests show that this group scored high on tests of certain linguistic abnormalities! Well. How did the researchers select the group of thought disordered patients in the first place? Surely because they heard these patients talk in an unusual way (i.e. in a linguistically abnormal way). So all these psychological tests prove nothing more than that thought disordered patients are...thought disordered (I use this term as it is the one most used in current practice, but I agree with Bentall that it is inacurate).
I'm not sure who Bentall intended as an audience. Surely not professionals like psychiatrists or psychologists when he writes things like "don't worry, you won't need any knowledge of maths to understand what I am going to say". And surely not the general public and possibly those suffering with mental illness, as they will get bogged down in a tedium of research results pro and con, and wont get past the first few chapters. As they will be looking for CLEAR explanations about their condition and some practical advise on how to deal with their problems - and there is none of that in this book.
All in all, this book is a failed enterprise, and not worth the effort.
He starts fairly well by critique-ing the Kraepelin-ian (=medical/biological) model of mental illness. The reason why this reads well is because criticizing others is easy compared to bringing forth your own ideas. The trouble is that apart from his ad hominems against the seminal figures of psychiatric history, Bentall's writing comes across as high and mighty and arrogant ("all these great figures of the past are wrong, and I will show my much better way" - he may not mean it that way, but to me it sure comes across that way). But then he goes into a rather tedious enumeration of all sorts of (predominantly psychological; hardly any biological) research which show a variety of opposing results and can only lead to conjecture. He then uses these conjectures (by his own admission "highly conjectural") to build up his "explanation" of mental illness. But, in my view, his explanations are no explanations at all, they are just a psychological mapping of symptoms of psychosis. To give an example: there is a lot of research on "formal thought disorder" that Bentall presents as ground-breaking and important; he explains how researchers select from patients a group of thought-disordered patients to compare with patients without thought-disorder, and that subsequently the tests show that this group scored high on tests of certain linguistic abnormalities! Well. How did the researchers select the group of thought disordered patients in the first place? Surely because they heard these patients talk in an unusual way (i.e. in a linguistically abnormal way). So all these psychological tests prove nothing more than that thought disordered patients are...thought disordered (I use this term as it is the one most used in current practice, but I agree with Bentall that it is inacurate).
I'm not sure who Bentall intended as an audience. Surely not professionals like psychiatrists or psychologists when he writes things like "don't worry, you won't need any knowledge of maths to understand what I am going to say". And surely not the general public and possibly those suffering with mental illness, as they will get bogged down in a tedium of research results pro and con, and wont get past the first few chapters. As they will be looking for CLEAR explanations about their condition and some practical advise on how to deal with their problems - and there is none of that in this book.
All in all, this book is a failed enterprise, and not worth the effort.
September 16, 2022
I have been a fan of Bentall's ever since the early 1990s, when Harper's published an excerpt from his "Proposal to Classify Happiness as a Psychiatric Disorder." (see http://www.ncbi.nlm.nih.gov/pmc/artic...) I dutifully tracked down the original, and it was just as clever, insightful and deadpan funny as I expected. So when I came across a mention of this book recently, I had to read it.
It was interesting and informative but OMG is it a slog. The book is intended to be intelligible to a lay audience and persuasive for a professional one, so it has plenty of background info to bring average readers up to speed as well as detailed explanations to answer specialists' objections to Bentall's arguments. Here are two small examples of the explanations provided for readers very ignorant of the basics involved in the discussion, including the fact that research into madness occurs in many different countries around the globe:
I am indeed fascinated by that bit of information. But seriously: who doesn't know that oestrogen is "the female hormone"? Why did that label need to be included? I realize it's only three words, but when you have a book over 500 pages long, even three extra words in every single paragraph (and there are indeed at least three extra words in every single paragraph) add up. Likewise, no researchers mentioned in this book are ever just psychologists or psychiatrists--no, they are British psychologists or American psychiatrists or Australian clinicians, or located in Manchester or Los Angeles or Perth. I really don't see why Bentall has to mention the nationality and/or location of anyone whose work he cites, but apparently someone thought it was important. I can't be the only one who just doesn't give a shit and would have preferred to see the text move along more quickly.
Still, I loved Bentall's basic project of questioning "the neoKraepelinian project--that there is an unambiguous dividing line between the psychologically healthy and the psychologically disturbed, that there is a finite and countable number of different mental illnesses and that these types of illness must be explained primarily in terms of aberrant biology." I liked that his approach "allows us to make sense of (in Jaspers' terminology, both explain and understand) the actual experiences of men and women who receive diagnoses such as schizophrenia and bipolar disorder" in that it does seem to respect the humanity of the "mad" in ways that other approaches do not, as when Bentall suggests that clinicians who doubt patients' complaints about the devastating effects of neuroleptics get over those doubts by taking the medication themselves, as some researchers, Bentall included, have done. And I will be continue to ponder his suggestion that not just madness but illness may be culturally determined and that "it just might be possible to be mad in one culture but at the same time sane in another" and that what really matters is how well one functions in society, not whether one's brain fits the Krapelinian idea of biologically "normal."
It was interesting and informative but OMG is it a slog. The book is intended to be intelligible to a lay audience and persuasive for a professional one, so it has plenty of background info to bring average readers up to speed as well as detailed explanations to answer specialists' objections to Bentall's arguments. Here are two small examples of the explanations provided for readers very ignorant of the basics involved in the discussion, including the fact that research into madness occurs in many different countries around the globe:
it has been suggested that the average age at which women develop schizophrenia symptoms is later than the average for men because the female hormone oestrogen confers protection against psychosis (apparently, oestrogen shares some of the pharmacological properties of the neuroleptics, the class of drugs most widely used in the treatments of psychotic patients). (emphasis added)
I am indeed fascinated by that bit of information. But seriously: who doesn't know that oestrogen is "the female hormone"? Why did that label need to be included? I realize it's only three words, but when you have a book over 500 pages long, even three extra words in every single paragraph (and there are indeed at least three extra words in every single paragraph) add up. Likewise, no researchers mentioned in this book are ever just psychologists or psychiatrists--no, they are British psychologists or American psychiatrists or Australian clinicians, or located in Manchester or Los Angeles or Perth. I really don't see why Bentall has to mention the nationality and/or location of anyone whose work he cites, but apparently someone thought it was important. I can't be the only one who just doesn't give a shit and would have preferred to see the text move along more quickly.
Still, I loved Bentall's basic project of questioning "the neoKraepelinian project--that there is an unambiguous dividing line between the psychologically healthy and the psychologically disturbed, that there is a finite and countable number of different mental illnesses and that these types of illness must be explained primarily in terms of aberrant biology." I liked that his approach "allows us to make sense of (in Jaspers' terminology, both explain and understand) the actual experiences of men and women who receive diagnoses such as schizophrenia and bipolar disorder" in that it does seem to respect the humanity of the "mad" in ways that other approaches do not, as when Bentall suggests that clinicians who doubt patients' complaints about the devastating effects of neuroleptics get over those doubts by taking the medication themselves, as some researchers, Bentall included, have done. And I will be continue to ponder his suggestion that not just madness but illness may be culturally determined and that "it just might be possible to be mad in one culture but at the same time sane in another" and that what really matters is how well one functions in society, not whether one's brain fits the Krapelinian idea of biologically "normal."
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December 18, 2022The ending of this book is the very thing that really makes it worth reading. A great place to start if you want to learn more about the psychology aspect and madness and how to deal with all of it.
January 29, 2024
3.7⭐️
Bentall’s work presents itself as a challenging yet insightful read. The book is dense with references to various studies, and while it avoids overwhelming the reader with statistics, the author often concludes these references with remarks about their inconclusive nature. This approach, while academically rigorous, occasionally hinders the flow of the narrative and makes it difficult to grasp the main arguments of each chapter.
The complexity of the subject matter, concerning the intricacies of the human mind and mental illnesses, understandably adds to the book’s density. While the detailed exploration of this complex topic is commendable, the extensive information can sometimes be overwhelming, especially for those new to the subject (like myself).
However, the book excels in providing a comprehensive summary of the history of psychiatry. It effectively narrates the past mistakes in the field and how contemporary scientists view mental illnesses, offering a convincing and critical perspective on the evolution of psychiatric thought.
For novices like myself, the book can feel a bit overwhelming at times, with its in-depth discussions on numerous tests, studies, illnesses, scientists, and new concepts. Despite this, it’s undeniable that ‘Madness Explained’ is an educational journey, enriching the reader’s understanding of the complex topic of madness and providing a valuable perspective on mental health issues.
Bentall’s work presents itself as a challenging yet insightful read. The book is dense with references to various studies, and while it avoids overwhelming the reader with statistics, the author often concludes these references with remarks about their inconclusive nature. This approach, while academically rigorous, occasionally hinders the flow of the narrative and makes it difficult to grasp the main arguments of each chapter.
The complexity of the subject matter, concerning the intricacies of the human mind and mental illnesses, understandably adds to the book’s density. While the detailed exploration of this complex topic is commendable, the extensive information can sometimes be overwhelming, especially for those new to the subject (like myself).
However, the book excels in providing a comprehensive summary of the history of psychiatry. It effectively narrates the past mistakes in the field and how contemporary scientists view mental illnesses, offering a convincing and critical perspective on the evolution of psychiatric thought.
For novices like myself, the book can feel a bit overwhelming at times, with its in-depth discussions on numerous tests, studies, illnesses, scientists, and new concepts. Despite this, it’s undeniable that ‘Madness Explained’ is an educational journey, enriching the reader’s understanding of the complex topic of madness and providing a valuable perspective on mental health issues.
March 12, 2020
Iš lėto skaitydama pabaigiau. Labai insightful knyga, autoriaus argumentai iš visų pusių paremti begale tyrimų. Padeda kiek kitaip pažvelgti į šizofreniją, bipolar ir jų simptomus, kadangi viskas, ką šie žmonės patiria, tėra tik įvairiais atstumais tam tikroje skalėje nutolę taškai nuo to, kas iš tikro yra human nature.
September 22, 2022
One of the most influencial books I've read.
April 9, 2020
I have skimmed most of this book. I believe the title should have been something like "The history of madness. Evolution of psychosis in the psychiatric system of thought" . While the research for this book is outstanding, and the author carefully argued the backlashes of psychiatry in curing psychosis, schizophrenia and manic depression I found myself less interested in it. Why? Because I was hoping to get an understansing of what is particularly different in this individuals that such consequences emerge .
I appreciate his encompasing view of taking into account trauma, neglect, abuse, social-political-economical factors, developmental phases (psychosis and schizophrenia usually appear in adolescence and young adulthood) and of course biological factors, as genes. But, most of the people don't become psychotic or schyzophrenic, many have depressions, severe anxiety, ptsd, complex ptsd, personality disorders, attachment disorders, and many more.
He critiques biological psychiatry simply because this system of thought has been a failure in treating such debilitating mental illnises.
Moreover, he took into account antropology and brought the cultural view of some African tribes which does not stigmatize individuals for "being crazy" or for having hallucinations as the western world does.
In some cultures this type of "abnormalities" is taken as a spiritual journey , a normal reaction to ones personal history of experiences.
This made me think of Carl Jung, the swiss psychiatrist believed that psychosis is psychogenic and the symbollic flood of unconscious content taken over consciousness is possible to bring great healing IF ones know to listen and respect the meaning of the voices, the complexes and understanding what the story is about.
Interestingly, psychotic individuals have very common themes of their dellusions, often there is a grandeur view of onself and also a scenario of a grand scheme that is meant to destroy the individual. (Conspiracy theories of the goverment, aliens, a whole Truman show).
It is in my opinion unbelievable that many psychiatrists don't take into account the facut that these human beings have suffered tremendously, they have been sexually abused, they have been neglected as childs, they come from poor families, they had their needs unmet, they lacked love as babies, or they have been labelled as scapegoats by their unconscious, hurtful patterns of family systems.
In the end, the author quotes philosopher Karl Popper, you can't just explain complexities simply by finding a few causalities. The interaction of genes and environment, life history, experiences, social and economical situation is way too important for understanding one mental illness and it's impossible to rely simply on genes or biology. Even the label you get from a psychiatrist for schizophrenia or manic depression has a signifacnt impact on your recovery.
Anyway, great book, it's scope is honorable the author is very smart, humane, honest, very well researched and poeple interested in the subject will get a much more complex view of the psychosis, schizophrenia, manic depression and the whole history of psychiatry.
I appreciate his encompasing view of taking into account trauma, neglect, abuse, social-political-economical factors, developmental phases (psychosis and schizophrenia usually appear in adolescence and young adulthood) and of course biological factors, as genes. But, most of the people don't become psychotic or schyzophrenic, many have depressions, severe anxiety, ptsd, complex ptsd, personality disorders, attachment disorders, and many more.
He critiques biological psychiatry simply because this system of thought has been a failure in treating such debilitating mental illnises.
Moreover, he took into account antropology and brought the cultural view of some African tribes which does not stigmatize individuals for "being crazy" or for having hallucinations as the western world does.
In some cultures this type of "abnormalities" is taken as a spiritual journey , a normal reaction to ones personal history of experiences.
This made me think of Carl Jung, the swiss psychiatrist believed that psychosis is psychogenic and the symbollic flood of unconscious content taken over consciousness is possible to bring great healing IF ones know to listen and respect the meaning of the voices, the complexes and understanding what the story is about.
Interestingly, psychotic individuals have very common themes of their dellusions, often there is a grandeur view of onself and also a scenario of a grand scheme that is meant to destroy the individual. (Conspiracy theories of the goverment, aliens, a whole Truman show).
It is in my opinion unbelievable that many psychiatrists don't take into account the facut that these human beings have suffered tremendously, they have been sexually abused, they have been neglected as childs, they come from poor families, they had their needs unmet, they lacked love as babies, or they have been labelled as scapegoats by their unconscious, hurtful patterns of family systems.
In the end, the author quotes philosopher Karl Popper, you can't just explain complexities simply by finding a few causalities. The interaction of genes and environment, life history, experiences, social and economical situation is way too important for understanding one mental illness and it's impossible to rely simply on genes or biology. Even the label you get from a psychiatrist for schizophrenia or manic depression has a signifacnt impact on your recovery.
Anyway, great book, it's scope is honorable the author is very smart, humane, honest, very well researched and poeple interested in the subject will get a much more complex view of the psychosis, schizophrenia, manic depression and the whole history of psychiatry.
October 29, 2023
This hefty book at over 500 pages with another 130 pages or so of glossary and notes is not always an easy read but it will be very useful for anyone interested in psychosis whether from curiosity or because they are worried they have symptoms or want to understand better someone who has them.
Unfortunately it tries to do two things simultaneously - to be an exhaustive half-polemic about a particular view of madness against peers who Bentall considers to be locked into a dysfunctional past paradigm and to be a scientifically rigorous attempt to educate the wider public.
This means that the reader can lurch from almost excessively detailed accounts of recent (meaning prior to 2004) research to personal revelation and then to assertion while all the time the author tries to moderate those tentative assertions with admissions as to how little we know.
The main themes - that the 'normality' of many symptoms associated with madness (such as hearing voices) has been underestimated and that (in the author's opinion) madness as dysfunctional is more a matter of environmental than genetic dislocation - can get buried in the quantity of data.
Bentall returns to the family (an idea fashionable in the 1970s) as a source of much of the dynamic behind psychotic mental breakdown although he is wise enough not to overplay the claim. Still, research is highly suggestive of the role of family dynamics.
Its British Psychological Society Book Award in 2004 is well earned. The idea that an almost obsessive analytical attempt to 'diagnose' mental illness has perverted our understanding of extreme mental distress is well argued and plausible.
Similarly, Bentall's determination to build an alternative model of 'madness' almost brick by brick and chart by chart based on evidence derived from scientific research may be exhausting but it serves its purpose. The revised paradigm does seem to fit the evidence better than the old one.
The doubts are two-fold. First, that the scientific evidence remains so tentative in many respects by the nature of the subject and, second, following on from that, his over-emphasis on the environmental is not absolutely justified by what we read. It is still only a well-founded belief.
This is not to say that mental breakdown is by any means genetically predictable but the conformation of minds (as brains) might reasonably be seen as having strong genetic components that predict mental crisis under certain family conditions.
Despite this caveat and the fact that his two very personal interventions about his own state of mind and his family issues create a suspicion of a predisposition to occult angst about the genetic, the environmental aspect has to be considered as the most dominant element in breakdown.
Somewhat defensively, Bentall does not want us to think he is drifting back into the speculations of R. D. Laing. He is at pains to avoid 'blaming the family' (quite rightly) but he is very plausible on the effect of mental well-being of certain types of negative language within families.
There may be a class element to this. Certainly there is a cultural continuity as negative language by parents about children repeats patterns from their own pasts but much work still needs to be done on the precise mechanisms here since not every child from such a background goes on to be unhappy.
There may be more subtle socio-cultural things going on here. Maybe apparently negative language in families works as a stable survival mechanism under some social conditions but breaks down in others or that vulnerabilities appear as individuals transition between classes and conditions.
The book can be seen as a marker of another transition that has become dominant in mental healthcare - from expensive psychotherapeutic 'talking' attempts to cure (whose success rates are unproven) to faster and more focused work on cognition (CBT) to meet specific symptoms.
There is also a welcomed new emphasis on the 'normality' of some apparently 'odd' symptoms such as hallucination and hearing voices so that social stigma is removed, experiences can be taken as just part of life and a wider spectrum of intensity of symptoms be considered.
None of this is to be interpreted as dismissing the real agony of complete psychotic breakdown and misery but it shifts attention to the hidden rationalities within the apparent irrationality of the 'mad' and more interest in how the 'mad' perceive their own situation.
These situations may quite simply be more than some people can bear. It could be argued that we see a dialectic between a society that is 'mad' and individuals who are sent mad by the dissonance between their mental situation and reality where 'reality' is disconnected from human need.
There are no cures in this book only increased understanding which might alleviate the condition of many people who have not yet collapsed into the pit of hell. Where Bentall is most plausible is in clearing away a great deal of professional dead wood thinking in order to rethink madness itself.
If there is one major takeaway from the book, it is that the human mind (and we know how complex the brain is) cannot be categorised in simple terms by diagnosticians. There are no rules that predict individual human variation and behaviour.
One individual may come from the same family background as another and yet the first may go mad and the second be a model of emotional stability. People can move in and out of madness in unpredictable ways. Some never escape their condition. Drugs work for some, not for others.
This is a world of probabilities and possibilities and not of certainties. It is the intellectual challenge of understanding the human mind that drives many clinical psychologists as well as philosophers, historians and others.
Bentall, despite the density of his book, has clarified matters considerably or, rather, he has removed a lot of obfuscatory history to his profession and reminded us that we still do not know enough. We have a great deal of work to do in order to ensure mental health as, in fashionable language, a 'right'.
My own suspicion is that the complexity can only be resolved not merely by understanding better an individual mind or the nature of our species as a bio-cognitive organism but by understanding how our species constructs its mental world under wider social and cultural conditions.
It would be far too simple to say that mental health would be improved with improved material resources (though this would help) because environmental effects include issues of culture and society that involve issues of meaning in the world.
We do not easily understand meaning in the world. Symptoms historically could often be embedded within religious or spiritual models that have now been shattered or at least weakened but this is not necessarily an argument for traditionalism as the solution to mental health issues.
Globalisation and liberalism have attenuated many systems of meaning but people can still invent their own if they so chose. Perhaps that is the way ahead - not to invent one meaning for all but to personalise meaning much earlier in the life of a child, as an act of liberation.
Madness seems often to be a perfectly 'rational' response to intolerable (to the person) pressures so this way ahead suggests not going back so much as going forward to relieve those pressures - in early life, within the dynamics of the family, in social expectations and in lack of resources.
In short, Bentall may be right in his implication - that madness is an environmental and social issue and so possibly a political issue but one where compassion dictates that genetic mental predispositions are accounted for within a prevailing socio-cultural framework.
The solution to madness is thus not just a matter of drugs (though they can alleviate) or even the patching up involved in individual psychotherapy or even CBT before things go too wrong. They may be a matter of a much longer process of human development in continuingly uncertain times.
December 7, 2009
I am going to enjoy this. From the start it exposes that the way out of the epistemological quagmire that surrounds discussions of mental health (or whatever you call it) is to agree to agree with the most rudimentary taxonomies and classification systems provided they have coherence, stability and reliability. Validity need never be in question in a world where pragmatic silencing (in all its meanings) is 'result' enough.
The huge weight of evidence that different psychiatrists using different systems from different cultures, plus other arbitrary factors, makes 'diagnosis' and 'care' a lottery. The conceptualisation of 'madness' is problematised: one small but potent example is that an individual may be highly functioning occupationally and within the role of family nurturer while nevertheless be suffering inner torment. The entire sweep of ideological assumptions going on suggests that we are in the dark (ages) when it comes to understanding the concepts of personal identity and individuality (undivideness).
This is not a quick read. It is textured with particulars and details, but therein is a refreshing and much-needed antidote to the sweepings of commercialised 'cures', teleological control, and damaging gross sentimentality. It may enable a few readers who are service users to gain some perspective on the field, to some extent at least to 'stand above' expertise and hidden assumptions (for instance as evidenced in the unconscious stigmatisations and prejudices within the well-meaning non-statutory support systems and networks) and be able to negotiate a 'recovery' from much broader resources, the 'mental health' field offering a scope of such resources, not any of which need necessarily utilising.
However, I think realistically that this book is not for everybody: those who will find it connects will have made the connection with connection by the arbitrary outcome of their own backgrounds. For me, what I particular appreciate about the book is the central emphasis upon emotion. The expression of an individual has, of course, some relationship with the 'inner feelings', yet for clarity the inner world can be considered as an autonomous region, a place of subjective narratives and mood texture. The apparent 'flatness' )or other mask) of an individual should not and cannot be taken as a totalised encoding of their subjectivity, and hence a therapist's work, and indeed an individual's own interior work, has to be down where the outer social functioning is 'cut through', and this latter phrase is with reference to my review of Janic Galloway's, 'The Trick is to Keep Breathing'.
The huge weight of evidence that different psychiatrists using different systems from different cultures, plus other arbitrary factors, makes 'diagnosis' and 'care' a lottery. The conceptualisation of 'madness' is problematised: one small but potent example is that an individual may be highly functioning occupationally and within the role of family nurturer while nevertheless be suffering inner torment. The entire sweep of ideological assumptions going on suggests that we are in the dark (ages) when it comes to understanding the concepts of personal identity and individuality (undivideness).
This is not a quick read. It is textured with particulars and details, but therein is a refreshing and much-needed antidote to the sweepings of commercialised 'cures', teleological control, and damaging gross sentimentality. It may enable a few readers who are service users to gain some perspective on the field, to some extent at least to 'stand above' expertise and hidden assumptions (for instance as evidenced in the unconscious stigmatisations and prejudices within the well-meaning non-statutory support systems and networks) and be able to negotiate a 'recovery' from much broader resources, the 'mental health' field offering a scope of such resources, not any of which need necessarily utilising.
However, I think realistically that this book is not for everybody: those who will find it connects will have made the connection with connection by the arbitrary outcome of their own backgrounds. For me, what I particular appreciate about the book is the central emphasis upon emotion. The expression of an individual has, of course, some relationship with the 'inner feelings', yet for clarity the inner world can be considered as an autonomous region, a place of subjective narratives and mood texture. The apparent 'flatness' )or other mask) of an individual should not and cannot be taken as a totalised encoding of their subjectivity, and hence a therapist's work, and indeed an individual's own interior work, has to be down where the outer social functioning is 'cut through', and this latter phrase is with reference to my review of Janic Galloway's, 'The Trick is to Keep Breathing'.
January 30, 2014
This book provides plenty of evidence that the current model of diagnosing and treating psychosis leaves a lot to be desired. The author writes as if he's chatting with the reader while citing and footnoting endless research studies and other evidence to support his hypotheses and claims. It sort of reads as a whodunnit in that he starts out investigating, proving and substantiating his assertion that human nature is more than just sanity and insanity, mental health and mental illness. We're not so black and white it seems, and we need to look more into learning how to live in the grey. This involves treating compassionately what we can and accepting more as "normal" what we can't. Because psychosis appears to be part of the human legacy, there is hope that if we learn to deal with it better, we just might evolve to phase it out.
July 3, 2017
A perfect introduction for people interested in a scientific approach to psychopathology
April 21, 2020
The book starts with a very concise history of psychiatry and how sanity is defined by the psychiatric model. It adopts a humanitarian view on what we called insanity, and grounds it within our social/cultural context. It presents evidence on the similarity of different classifications, specifically with schizophrenia, mania and depression, and proposes that we should abandon the Kraepelinian model of classification, and turn to a symptom-oriented model.
Whilst the book suggests that there is an undeniable similarity between schizophrenia, mania and depression, I would be interested to know whether this (symptom-oriented) approach would also be applicable to other classifications on the DSM/ICD. For example, ADHD and ASD are some of the other classifications that seem very different from the disorders discussed in the book. It seems to me that the evidences presented in the book suggest a reconstruction of classification (schizophrenic spectrum) rather than a new approach to classification as a whole.
Another issue that I am interested in is how this new approach may affect the direction of future treatments. How should we treat patients if we classify them according to symptoms? Should we also adopt a symptom-oriented approach for treatments? As is stated clearly in the beginning of the book, a diagnosis provides a general picture for clinician to understand their patients and predict the type of treatments to provide. If we abandon this approach, would we lose a bigger picture for what is going on with the patient?
The book is definitely worth reading as it gives many insights on the matter, especially on how we define sanity and how we should approach those beyond the boundary. The only minor issue for me is that when presenting evidences (especially those with graphs) on certain issues, no significancy was presented (but one!), even though it is rather important for psychology research. Sometimes the differences presented on the graphs between schizophrenia/bipolar/depression didn't seem significant enough for me to consider it valid.
Whilst the book suggests that there is an undeniable similarity between schizophrenia, mania and depression, I would be interested to know whether this (symptom-oriented) approach would also be applicable to other classifications on the DSM/ICD. For example, ADHD and ASD are some of the other classifications that seem very different from the disorders discussed in the book. It seems to me that the evidences presented in the book suggest a reconstruction of classification (schizophrenic spectrum) rather than a new approach to classification as a whole.
Another issue that I am interested in is how this new approach may affect the direction of future treatments. How should we treat patients if we classify them according to symptoms? Should we also adopt a symptom-oriented approach for treatments? As is stated clearly in the beginning of the book, a diagnosis provides a general picture for clinician to understand their patients and predict the type of treatments to provide. If we abandon this approach, would we lose a bigger picture for what is going on with the patient?
The book is definitely worth reading as it gives many insights on the matter, especially on how we define sanity and how we should approach those beyond the boundary. The only minor issue for me is that when presenting evidences (especially those with graphs) on certain issues, no significancy was presented (but one!), even though it is rather important for psychology research. Sometimes the differences presented on the graphs between schizophrenia/bipolar/depression didn't seem significant enough for me to consider it valid.
October 9, 2021
Wowee, reading Richard Bentall's ‘Madness: Psychosis Explained’ over the past few months has been a journey. I have had similar quandaries as Bentall about the classification of mental disorders, however, Bentall backs his ideas up with tons of research and is very coherent with his arguments. Psychosis is illusive to most of us and it is very difficult to explain something that is so alien to most people, yet Bentall does a remarkable job at doing this. Books like this are fantastic – whether you support the author's conclusions or not – because it forces you to at least think differently or from another perspective. It elucidates the important of questioning your own implicit opinion of something. I actually wish there were more stars I could give this book, as Bentall keeps you on your toes, maintaining the reader's interest from start to finish (which is very difficult for a 500-page book).
The primary concept of the book is that the brain and its psychological manifestations are very complex. It is not as though there are people who experience psychosis and those who do not – each of us have differing degrees of vulnerability to experiencing psychosis. Even the most hardened of people who do not feel stress easily may find themselves in a situation that pushes them over the edge to the point where they hear voices, see things or become delusional. Psychosis, and conditions like schizophrenia and bipolar, where psychosis can be found, are more like spectrums. Most people have some of the symptoms of these conditions in small amounts, it is just that those that get diagnosed have many of the symptoms in amounts that makes their lives difficult to lead. This book causes the revered diagnostic criteria of disorders to fracture and is an important read for anyone interested in clinical psychology.
I am taking a class this year that involves clinical psychology and so when I saw this at the top of the reading list, I was over the moon.
The primary concept of the book is that the brain and its psychological manifestations are very complex. It is not as though there are people who experience psychosis and those who do not – each of us have differing degrees of vulnerability to experiencing psychosis. Even the most hardened of people who do not feel stress easily may find themselves in a situation that pushes them over the edge to the point where they hear voices, see things or become delusional. Psychosis, and conditions like schizophrenia and bipolar, where psychosis can be found, are more like spectrums. Most people have some of the symptoms of these conditions in small amounts, it is just that those that get diagnosed have many of the symptoms in amounts that makes their lives difficult to lead. This book causes the revered diagnostic criteria of disorders to fracture and is an important read for anyone interested in clinical psychology.
I am taking a class this year that involves clinical psychology and so when I saw this at the top of the reading list, I was over the moon.
September 5, 2021
Absolutely fantastic!
Psychosis and Mania are usually cited as symptoms that give legitimacy to the brain-disease model of mental illness. In this carefully researched work, Bentall details how this view is mistaken. Step by step Bentall takes us on a journey of how and why people go "mad" taking into account a variety of studies and perspectives. He provides us with a wonderful framework with how to understand those who mentally suffer. Furthermore, it invites the reader to think compassionately, realising that we may not be that sane either.
Very important book.
Psychosis and Mania are usually cited as symptoms that give legitimacy to the brain-disease model of mental illness. In this carefully researched work, Bentall details how this view is mistaken. Step by step Bentall takes us on a journey of how and why people go "mad" taking into account a variety of studies and perspectives. He provides us with a wonderful framework with how to understand those who mentally suffer. Furthermore, it invites the reader to think compassionately, realising that we may not be that sane either.
Very important book.
December 11, 2022
Very comprehensive, a mammoth for sure, but a read I will be forever greatful for. It has given me great insights into many careers involving those who are currently unwell and reasons for and against the many treatments. I should say however the language used like them and us and mad people crazy people, etc. Is quiet triggering until you realise it goes on for the whole book, but this nonetheless does not change the major impact of this work.
January 30, 2023
Book is confused on what is trying to be. Is it an introduction for the layperson or for the scientist? Charts and use of statistics try to reinforce arguments, yet the average layperson cannot make head or tail the reason. Much of the fat of the book were these charts and statistics which could have been cut into the references section for the scientist, while making the book approachable for the layperson.
Still, it was readable.
Still, it was readable.
April 2, 2018
A very good, academic overview of how the problems with psychiatry and its traditional views of madness developed. To me, the final section of the book, which was obviously the author's passion, should have been expanded. This was also obviously his original intention, but he was told to limit it for space reasons (something he mentions in the book). I hope he went on to write other books.
August 26, 2022
Maybe his ideas have already become much more mainstream since the book was written, but the idea that mental health/illness is a) a spectrum and b) the constantly changing result of the interplay between biology and environment (both personal and societal) isn't exactly shocking. Some interesting research brought together in one book though.
August 18, 2024
a low keyed treatise on the subject of mental health with embedded nuggets of epistemology insights.
Bugs( illusions, delusions, hallucinations ) are not breakage of features as far as mental workings are concerned but manifestations of features with wrongly tuned parameters applied in specific scenarios.
Absolutely worth reading.
Bugs( illusions, delusions, hallucinations ) are not breakage of features as far as mental workings are concerned but manifestations of features with wrongly tuned parameters applied in specific scenarios.
Absolutely worth reading.
January 18, 2018
What a book!
August 9, 2018
Finally done. It was informational! Lots to learn:)
December 2, 2018
Truly fascinating.
June 14, 2021
Great premise but very dry to read. Although the book seems to be aimed at the lay reader it is much too bogged down in clinical jargon and statistics.
August 10, 2021
3 starzzz
July 18, 2022
As a psychology student this rocked my world lmao, really enlightening. Just so comprehensive and clarifying, I loved it as an approach that respects the dignity of patients the most
August 7, 2022
Too long and detailed. Bentall's next one is better.
April 12, 2024
A very in depth description of something I've experienced.
April 25, 2025
This guy is a freaking hero
Displaying 1 - 30 of 46 reviews