Intended for healthcare professionals

Rapid response to:

Reviews Book

Madness Explained: Psychosis and Human Nature

BMJ 2003; 327 doi: (Published 30 October 2003) Cite this as: BMJ 2003;327:1055

Rapid Response:

Maybe not a definitive critique of psychiatry

As a psychiatrist who has been regarded as more of a clinical psychologist, I was interested in Nigel Lester's review of Madness Explained: Psychosis and Human Nature by Richard Bentall, in which he makes much of the differentiation of roles.1 It is true that the division is unfortunate. Both professions wish to have authoritative status. Adopting the biomedical model of mental illness, which implies that medication corrects chemical imbalances in the brain, reinforces the role of the psychiatrist in prescribing medication. The development of behaviour therapy gave an impetus to clinical psychology. More recently cognitive science has given an empirical basis to psychological research, and this is the perspective adopted by Bentall.

Models of mental illness may be used to defend professional roles, but they are not intrinsically tied to these roles. Bentall's book is an attack on mainstream psychiatric practice, and it arises not merely because he is a clinical psychologist. As other reviewers have pointed out, there are echoes of "anti-psychiatry" in the book.2,3 An excitement may have been created that Bentall may be the modern version of RD Laing. Laing was a psychiatrist and his books, such as The Divided Self and The Politics of Experience and The Bird of Paradise, like Bentall's, were also published by Penguin Books.4,5 They produced a popular wave of enthusiasm for the critique of psychiatrists' use of psychiatric diagnosis, drug and ECT treatment and involuntary hospitalisation. Bentall sets out with a similar aim to Laing to make madness more understandable. He sees his work as a ground-breaking way of thinking about madness and its treatment.

Laing at times may have thought that he was creating a new social phenomenological understanding, but personally he could never accept the grandiosity of such work. As is widely known, his ambition instead was drowned in drunkenness. Richard Bentall, in an interview for New Scientist, when asked how he differed from the anti-psychiatrists, answered that he was a scientist and that by contrast Laing did not know when his ideas were inconsistent. I find it unfortunate that Bentall appears to appreciate the uncertainties of mental health practice, but then seeks to fix them in a symptom-orientated approach. This does not seem to really create more understanding of mental illness, which must be focused on the patient as a person. Nigel Lester may be correct to emphasise the importance of being helpful as well as right, but how we think about mental illness does matter. We might still be waiting for the definitive critique of psychiatry.


  1. Lester N. Book review: Madness Explained: Psychosis and Human Nature. BMJ 2003;327:1055 (1 November) [Full text]
  2. Healy D. Book review: Madness Explained: Psychosis and Human Nature. The Independent, 8 August 2003 [Full text]
  3. Stewart H. Diagnosis uncertain. The Guardian, 4 October 2003 [Full text]
  4. Laing RD. The divided self. Harmondsworth: Penguin, 1965
  5. Laing RD. The politics of experience and The bird of paradise. Harmondsworth: Penguin, 1967

Competing interests:
None declared

Competing interests: No competing interests

05 November 2003
D B Double
Consultant Psychiatrist
Norfolk Mental Health Care NHS Trust, Norwich NR6 5BE