Review: Madness Explained by Richard Bentall

The book is divided into four parts. Part one deals with the history of psychology: it sketches the simplifying effect that Kraepelin’s classification had on the theory and practice of psychiatry and its growth, the triumph of APA, centred around Euro/American-centric ideas, that doesn’t sufficiently take into account cross-cultural differences, and how the production of DSM was greatly influenced by political and economic agendas (particularly DSM-III) as it strove to create a global standard in psychosis and to synchronise with WHO’s ICD, each subsequent DSM growing more fine-grained yet still failing to improve its kappa value.Part two gives a (very) general outline of the biology of mental state, and the dimensional frameworks of emotional circumplexes (Russell’s, and Watson & Tellegren’s models). Part three explains some common “madness”: depression, mania, delusions, paranoia, hallucinations, and thought-disorder. Part four gives general causes and effects, that there’s no one pre-eminent factor (he proposed proximate determinants and maintenance factors instead, some are also elaborated in this chapter), explains (or at least try to) why complaints sometimes cause each other, and discusses some common approaches to psychoses.

Central to this book argument is Bentall’s proposal to abandon psychiatric diagnoses altogether and instead try to explain and understand the actual experiences and behaviours of psychotic people, that this approach will provide a richer account of aetiology than using Kraepelinian paradigm. Madness is a matter of opinion, and psychiatric problems must be approached from multiple perspectives.

I agree to many points Bentall raised, e.g. that:

Fear (kat: and I shoud add, equally, awe) of madness may be a much bigger problem than madness itself and that it ought to be demystified.

Experiences and beliefs that conventionally might appear bizarre to others regularly occur in people who are perfectly content to have them (and treatment should not be encouraged/enforced towards these individuals except when they pose danger).

Exclusive reliability on (and indiscriminate use of) psychiatric drugs is just as shortsighted as the blanket rejection of drug treatment of any kind”, on account of hamful side effects

However, the rather (too many) unnecessary jibes on the biological findings (particularly genetics) are, well, unnecessary. It almost seems as if he has a personal grudge against the popular fallacious predeterministic concept of genes. He rightly denies that concept, of course, and did write that “adequate theories of psychological complaints must show how psychological and biological accounts are interrelated”, stating rightly that environment affects our brains, but really, the bitter, gratuitious disparaging comments on biological research failed to strike that sympathetic balance (grouchy, more like).

Then again, I’m more used to reading LeDoux or Nemeroff. The verdict thus far? It’s a bit too general (and inconclusive, sometimes too speculative to my liking) for its scope, but it offers different insights and perspectives on a topic notorious for its wooliness. I do wish he’d chosen a better title that doesn’t reminisce a screaming headline that he complained about.

Psychosis and Human NatureMadness Explained: Psychosis and Human Nature
by Richard P. Bentall
Penguin Books, 2005
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