doctoringDoctoring the Mind by Richard P Bentall is a book of big words and lots of them. Although a densely packed book it full of insight.

Benthall is a research psychologist and goes through the history of psychiatric treatments in relation to psychotic illnesses, such as bi-polar and schizophrenia, although he does touch upon depression. What if any benefit these treatments have had on the patient in the past or even now. From the early days of Freud, asylums and Elective Convulsive Therapy to the introduction of psychotic drugs, such as Chlorpromazine and back to the ‘kindly face’ and Cognitive Behaviour Therapy, he covers the lot and does so very well.

So what is he saying? Here are a few things i picked up on –

  • Mental ill health is not genetic
  • The brain structure of those suffering from psychosis are no different than anyone else’s.
  • Freud’s psychotherapy did have some merits.
  • ECT is still being used, but is far more controlled and some patient’s benefit from it.
  • Patient’s treatment is too drug orientated.
  • Drugs do not always work.
  • Bigger doses are dangerous to health.
  • Patient’s suffering from prodromal (early symptoms) or first episode psychosis do better with a ‘kindly word’ and a ‘quiet place.’
  • Uni-polar (common depression) patient’s do not need anti-depressants.
  • Anti-depressants do not work.
  • Pharmaceutical companies make them look like they do.
  • Drugs are passed by the FDA after only 2 positive trials. The fact that many more trials have failed are not included in the request to the FDA for approval of a drug.
  • Serotonin re-uptake inhibitors do not work.
  • Double blind trials show this to be true.
  • Dr’s are often paid to use a certain drug.
  • Patient’s are not often told about the side effects of any drug may be and Dr’s prescribing them do not know them either.
  • Chlorpromazine does work in small dose (350 mg per day) higher doses just cause greater side effects.
  • Second generation drugs for psychosis (Schizophrenia and bi-polar) do not work any better than the first ones.
  • For some people anti-psychotic drugs just do not work.
  • Some people like their voices and either do not want to get rid of them or are happy to live with them as they are.
  • Drugs to treat patient’s with mental health issues should be prescribed for a year or less, with added support from some kind of counselling, is of more use to psychosis, at least in the first instance.
  • Patient’s are less likely to have further psychotic breaks if the whole family is involved in their recovery or if they have an adequate support system.
  • Side effects can be more damaging to the body than the psychosis itself, including some that do not go away once the drug is stopped, such as Parkinsonian traits.
  • Patient’s from lower educational and social background are more likely to be diagnosed, because they are more likely to go to see a doctor about the fact that they are hearing voices. However those who are better educated and from higher social class, although they may hear voices too are more likely to research and dismiss their symptoms themselves.
  • First psychotic breaks often happen in the 18-24 year old age group, but they can happen anytime.
  • Those who suffer 2 or more psychotic breaks are more likely to continue to do so.
  • Counselling and support does work, but needs to go on for longer.
  • STOPPING PRESCRIBED MEDICATION ALL IN ONE GO CAN LEAD TO A PSYCHOTIC BREAK – if you want to stop taking any medication you need to see a Dr and slowly reduce the dose of the medication, probably over several weeks.

I think this book should be read by anyone who is directly involved with people who have suffered a psychotic episode. This could mean the medical staff or even the relatives or the patients. He leaves us with the question ‘What kind of Psychiatry do you want?’

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