Saturday, May 19, 2012

Doctoring the Mind - Richard P Bentall

The full title of the book is 'Doctoring the mind - why psychiatric treatments fail' , and that perhaps says a good deal about whats going to follow in the book. Good read overall.

The book raises some some interesting questions. Firstly, the description of metal diseases itself can be relooked at. It builds up a case of how the neat slotting of schizophrenia , bipolar etc doesn't always hold ground. And a continuum probably exists for the symptoms, rather than a clear demarcation of 'healthy' to 'ill', rather than a neat demarcation of where health ends.

Another area to reconsider is the simplistic descriptions about genetic causes, imbalances in dopamine etc. Its  an area not fully understood, and there are various complexities to deal with, if you treat dopamine like it was hemoglobin or something.

Then there's the whole area of clinical trials data , and how the data is open to much simplification, glamorisation, and plain misreading. If someone's never worked on any areas of data mining/number crunching, that part itself can be rather eye opening.

The parts where he was building up the case of psychiatry's limitations, ( and why psychiatric treatments fail) was fair and information enough.

However, the author is a psychologist, and one can see quite clearly, where his sympathies are. The problem is, that the arguments against the simplifications of clinical psychiatry, don't automatically mean scored points for psychologists or the alternative forms of therapy. In fact, I couldn't really find any convincing case in the book against the so called dodo bird theory, which claims that all forms of psychotherapies are equally effective. Its important to note the distinction between ineffective and equally effective, the therapies do seem to be effective.

On the minus side of psychotherapies, which he's mentioned, and I've read in numberous other places as well, is the much larger burden that falls on the effectiveness of the psychologist , rather than the branch of therapy that she/he aligns with. Its something that can't be underlined enough. While we're beating down the effectiveness of dopamine blockers and SSRI's or the seeming cruelty to ECTs, you can't underestimate how psychotherapy will also vary hugely based on the effectiveness of the therapeutic alliance.

My own take has been that the two things are needed in conjuction, and in various situations one or the other can be more effective. And its noteworthy that effective doesn't always mean a cessation of symptoms, it can sometimes mean just the ability to cope. Thats something psychiatrists often underestimate, guided as they are by a very symptomatic view of illness, and their general low opinion of things 'touchy feely'.

Interesting book overall, but it seemed to be a little lopsided, since it was more of a reaction to the blinkered view that psychiatrists often take. But for someone who's just interested in what makes the brain tick ( or not) and doesn't really have a dog in the psychiatrist vs psychologist fights, it won't come across as a balanced book.

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