Madness Explained

Challenges to the medical approach to madness have a long history. R D Laing promoted the anti-psychiatry movement. Thomas Szasz claimed that mental illness was a myth. In this comprehensively researched overview of madness, Bentall takes a step further along the road to dissent, suggesting that psychiatric diagnoses should be abandoned in favour to trying to explain and understand the behaviour of psychotic people. Emil Kraepelin, founder of the conventional approach, continues to occupy a Newtonian position in psychiatry. Bentall argues that it's time to give his pedestal a shove and undertake some serious revisions of orthodox understandings. He advocates the symptom-orientated approach. To understand madness one needs multiple perspectives including the psychological, sociological and anthropological. Examining the failure of some of the theories about schizophrenia and manic depression proposed by the neo-Kraepelin school, he tackles the thorny problem of biological explanations of psychosis. Substantial advances in technology have enabled brain researchers to see psychiatry as simply a branch of physical medicine. As challenging and exciting as these advances are, researchers still need to understand individuals from social and psychological perspectives. The strong evidence that brain functions may be shaped by experience emphasizes that people possess a 'mind-brain' that is very unlike a computer - it's a living system. The first part of the book is devoted to a damning picture of Kraepelin psychiatry; the second half demonstrates how psychological theories can be used to explain many of the strange behaviours both inside and outside of psychiatric clinics. There are chapters on the psychology of the emotions, on depression, on mania and the pathology of the self, a discourse on the language of madness and an examination of the roots of incoherence. Throughout, the author looks at both historical background and current theories. He provides brief explanations of concepts which may be unfamiliar to the lay reader, examines the case studies of others as well as his own and puts together tentative models, helpfully illustrated with simple diagrams. He draws attention to accounts that are speculative and underlines where he feels on more solid ground. The central argument of the book is that the problems involved in exploring madness will disappear once we have adequately explained the complaints that lead to these diagnoses. If the boundaries between madness and normality are open to negotiation and if current psychiatric services are imperfect and sometimes damaging, why not help some psychotic people just to accept that they are different from the rest of us? asks Bentall. He describes a deliberate attempt to move these boundaries in Holland, where people who hear voices are accepted as being to the far right of the normal behavioural continuum rather than suffering from a disease. It would have been interesting to continue this debate, querying whether a tolerance for eccentricity by earlier generations in our own country has now been supplanted by an intolerance for what is considered anti-social behaviour. Nevertheless, Professor Bentall has succeeded in marshalling a large volume of scientific evidence against orthodox models of understanding and treatment and takes a firm stand against the dehumanization of the individual. (Kirkus UK)