Madness Explained: Psychosis and Human Nature

by Richard P. Bentall

In an initial study, she found that patients with a diagnosis of schizophrenia, in comparison with patients with affective disorders, often had the kind of insecure attachment style that is described as dismissing or avoidant.

Perhaps this is unsurprising, as the emotional theme underlying the dismissing style is lack of trust. Evidence supporting Dozier’s

In the adolescent sample of over 1500 individuals, high levels of psychoticism and paranoia were associated with both the dismissing style and a second type of insecure style, known as anxious-ambivalent.19 As the name suggests, people with this attachment style desperately want to have relationships, but feel in their

secure attachment relationships facilitate the development of ‘theory-of-mind’ skills, an observation of some importance given that these skills seem to be compromised in some psychotic patients.

These findings strongly suggest that parents may inadvertently teach their children a depressive style of thinking. As attributions also play an important role in persecutory delusions, it is reasonable to ask whether paranoid thinking is similarly influenced by early relationships with caregivers. Studies have yet to be carried out to test this possibility

Exposure to racial tension, it seems, can drive people mad.

Cross-cultural researchers use the term acculturation to describe the process of psychological transition that occurs when people move from one culture to another.

quite easy to understand from a psychological perspective. Intrusive life events of the kind that are likely to induce paranoid thinking are especially likely to occur in city environments.

there is considerable disagreement about the best way of defining abuse.

Across the thirteen studies, between 51 and 97 per cent of women reported some form of physical or sexual abuse in their lifetime, suggesting that perhaps the majority of mentally ill women have been victimized in this way.

especially hallucinations have been more frequently recorded. For example, in two studies carried out by Colin Ross and his colleagues in Canada, the number of Schneiderian first-rank symptoms experienced by female inpatients correlated strongly with measures of how severely they had been sexually abused.

more recent study carried out by University of Auckland psychologist John Read, the case notes of 92 patients with a documented history of sexual and physical abuse were compared with the case notes of 108 who had not, and hallucinations stood out as the symptom most strongly predicted by a history of trauma.

hallucinations are the consequence of failing to monitor accurately the source of thoughts and images. It is therefore especially interesting that British developmental psychologists Charles Fernyhough and James Russell have recently found an association between efficiency at source monitoring in early childhood and the use of private speech in social settings – children who speak a lot to themselves when other people are present tend to be good at discriminating between their thoughts and other people’s voices.67 Perhaps children learn to tell the difference between the external (‘real’) and the cognitive (‘imaginary’) relatively easily in circumstances in which both types of events can readily

On this account, it becomes possible to see why trauma might later lead to hallucinatory experiences. In Chapter 14 we saw that source-monitoring failures tend to occur when we experience intrusive or automatic thoughts. (This is because the effort taken to generate a thought acts as a cue telling us that the thought is self-generated.) It follows that a person who has poor source-monitoring skills will be most vulnerable to hallucinations when experiencing a flood of intrusive thoughts and images. Trauma (we know from the research literature on post-traumatic stress disorder) often has exactly this effect.

One possibility is that this happens when there is a delay in the production of intrusive thoughts and images.

Another possibility is that stressful events some time after a trauma lead to a further reduction in the individual’s already compromised source-monitoring ability, so that mental events that are initially experienced as intrusive thoughts are later experienced as hallucinations.

However strong the overall influence of heredity on psychosis, no one has yet proven that everyone who becomes psychotic must carry particular genes.

seems that we are presented with something of a paradox. Although there can be no doubt that early brain damage confers vulnerability to madness, it seems to have very little impact on those symptoms which, since Schneider,

British psychologists Chris Harrop and Peter Trower note that these challenges seem to provoke in adolescents traits that are reminiscent of characteristics often seen in psychotic patients: marked shifts of mood coupled with equally dramatic shifts in self-esteem; self-consciousness, egocentricity and grandiosity; magical thinking and a preoccupation with powerful role models and the fable of one’s own life.77 In a study of normal adolescents carried out by Patrick McGorry and his colleagues in Melbourne, Australia, it was found that these kinds of characteristics are extremely difficult to distinguish

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.

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.

the account links the experience of madness to processes that are important in ordinary life, and which are reasonably well understood by psychologists

After two years, a control group of patients who had received simple supportive counselling (emotional support and advice about practical difficulties) were no more symptomatic, and had spent less time in hospital and more time in employment, than those psychoanalytically treated patients who had persisted to the end. Naturalistic long-term follow-up studies of patients who had received intensive psychoanalytic therapy in specialist hospitals, published at about the same time, yielded equally discouraging results.

“neurotics are people who build castles in the air, psychotics are people who live in them, while psychiatrists are people who charge the rent, and psychologists are like Men from the Council who come round once in a blue moon, talk incomprehensible crap, and do damn all”

The origin of this terminology is the paper that started this line of research, written by the distinguished American primatologist David Premack and his colleague Guy Woodruff, which was entitled ‘Does the chimpanzee have a theory of mind?’