While attending his grandmother's funeral, Andrew - a former soldier in his mid-30s who had been diagnosed as suffering from schizophrenia - became very upset. Fearing a relapse, Andrew's brother called a GP, who in turn alerted the psychiatric services. As a result, Andrew was admitted - against his wishes and with the assistance of six police officers - to a local psychiatric ward. It was here that his clinical psychologist, Richard Bentall, arrived to find Andrew sitting quietly, reading a novel, and apparently completely rational. The ward psychiatrist explained to Bentall that Andrew was to be kept in over the Christmas period for observation. Puzzled about the absence of any psychotic behaviour, Bentall asked the ward staff how Andrew had settled in. "He's excessively polite," a nurse commented, pointedly. "Can you be excessively polite?" Bentall wondered. "Well," replied the nurse, "we're trying to work out whether his politeness is part of his normal personality or his illness."
This darkly comic anecdote, related in Bentall's timely and compelling book, is unlikely to assuage general worries about the desirability of psychiatric treatment. How forcefully would you urge a depressed family member to see a psychiatrist? Almost certainly with less vigour than you'd encourage a trip to a specialist were that same relative to be suffering from a worrying physical problem. And in Bentall's view, you'd be right to be cautious. In particular, he takes issue with the mainstream psychiatric view that mental problems are genetically determined brain diseases that must be treated with drugs. The diagnoses are inaccurate, the genetics and neurobiology overstated, and the drugs oversold and overprescribed. Bentall pulls no punches: "Psychiatry has failed."
As a clinical psychologist, Bentall is of course writing from the other side of an often wide theoretical and clinical divide. But his credentials ensure that the punches carry weight. An internationally renowned researcher now based at the University of Bangor, his work encompasses both experimental studies that test theories of psychological problems and clinical trials that assess treatments. Bentall's Madness Explained was an award-winning attempt to show that severe mental illness is much more understandable than previously thought. In Doctoring the Mind, he turns his attention to the psychiatric techniques used to treat these conditions, tracing the triumph of biological psychiatry, dissecting some hallowed precepts underpinning its view of mental illness, and scrutinising the drug data.
The problems for psychiatry, Bentall argues, begin as soon as the first assessment, in which the clinician tries to get a handle on the patient's problems. Diagnostic classifications were invented, Bentall reminds us, not discovered - and their validity is often questionable. Back in the early 1990s, Bentall published a paper lampooning the psychiatric diagnosis of schizophrenia by proposing that there were stronger grounds to classify happiness as a psychiatric disorder ("major affective disorder, pleasant type"). (This paper, incidentally, was quoted by Philip Roth in Sabbath's Theater, although it is conceivable that this unusual literary pleasure for a psychologist was tempered by being referred to as a psychiatrist.) These sorts of concerns are now filtering into mainstream psychiatric discussion, though not without a marked time lag.
Psychiatry's diagnostic approach to psychological problems has its roots in medical views of physical illness (and of course psychiatrists must first train as medical doctors). One of the consequences, Bentall believes, is an overreliance on genetic and biological explanations for mental illness. While recognising the potential insights these perspectives can offer, he argues that they are generally used in an oversimplified, reductionist fashion. When it comes to treatment, this means an overemphasis on the benefits of medication, and an underemphasis on the side effects, which can be severe. (The powerful influence on all this of the pharmaceutical industry is clearly - and disquietingly - described by Bentall.) The drugs can work, but all too often treatment consists of trying one after another, for too long a time, while failing to listen to the person sitting opposite.
Bentall's challenge to psychiatric orthodoxy is leavened by a touching humility about his own clinical practice ("Sometimes I feel as if I am only pretending to be useful"). That said, his views can evoke a passionate response; at the close of one conference talk, an audience member complained: "Nothing that Professor Bentall has said - not a single word - is true. We have been forced to listen to a wild, antipsychiatric rant!" Bentall's hope is for a more compassionate psychiatry, with the focus on the patient's concerns, proper consideration of the role of life experiences in mental illness rather than simply looking to biology for answers, and much greater availability of non-pharmacological forms of help.
Thankfully, some psychiatric services in the UK do offer such sophisticated care, and there are many exceptional professionals in the health service and universities leading important developments in mental health treatments and services. Progress can sometimes seem slow, and the problems Bentall highlights are real; nonetheless, it is possible to tell a positive story about improvements in psychiatric services.
Of course, our reluctance to consult a psychiatrist isn't simply the result of a cool-headed appraisal of the profession's efficacy; it also stems from widespread confusion, awkwardness and stigma regarding problems of the mind. As such, the importance of Doctoring the Mind lies not only in the salutary challenges it offers to health professionals, but in its demystification of psychiatric illness, helping us all to think more clearly about the nature of these problems and the various options available to treat them.
• Daniel Freeman is co-author of Know Your Mind: Everyday Emotional and Psychological Problems and How to Overcome Them (Rodale).
