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Madness Explained. Psychosis and Human Nature By Richard P. Bentall London: Penguin Books. 2003. 640 pp. $25.00 (hb). ISBN 0 713 99249 2

  • Julian Leff (a1)
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By Richard P. Bentall. London: Penguin Books. 2003. 640 pp. £25.00 (hb). ISBN 0 713 99249 2

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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Madness Explained. Psychosis and Human Nature By Richard P. Bentall London: Penguin Books. 2003. 640 pp. $25.00 (hb). ISBN 0 713 99249 2

  • Julian Leff (a1)
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eLetters

Madness explained, explained

Richard P. Bentall, clinical psychologist
06 May 2004

In his review of ‘Madness explained’ Julian Leff accuses me of makingsome serious “bloomers” but the bloomers are obviously his. He says that Ifail to realise that psychiatric diagnoses such as ‘schizophrenia’ “have the same status as did dropsy in nineteenth century medicine” and, if I did, I would not be so eager to get rid of them. His choice of analogy is amusing because, of course, dropsy has long since been assigned to the dustbin of ideas that have outlived their usefulness. However, it is actually misleading because most psychiatric diagnoses do not even match the standards of validity achieved by dropsy (that is, they do not correspond to empirically verified clusters of symptoms).

Julian demonstrates that he hasn’t read my book properly when he saysthat I am “sceptical that organic disease will ever be found to underlie psychiatric disturbances”. I actually argue that some of the evidence of neurological dysfunction in adult patients cannot be easily dismissed. However, I caution against the dualist assumption that they must be the consequence of aetiological processes that are purely biological in nature(they may well reflect the brain’s response to abnormal experiences). I goon to argue that only longitudinal research can settle this issue definitively and, in a whole chapter devoted specifically to neurodevelopmental impairments, suggest that the balance of evidence indicates that such impairments confer a non-specific vulnerability to a range of psychiatric difficulties.

As for my discussion of the high rates of psychotic symptoms observedin ethnic minorities, the evidence I review in the book covers much more than the famous (and to my mind important) study by Boydell and her colleagues of Afro-Carribeans living in different areas of London. My suggestion that, “racial tension, it seems, can drive people mad” seems a reasonable interpretation of these findings (not least, because it makes sense in terms of what we know about the psychological mechanisms involvedin paranoia). Of course, this hypothesis is hardly original to me. Come tothink of it, I seem to remember at least one speaker making the very same argument at the excellent conference organised to celebrate Julian’s retirement.

I am not sure why Julian has so badly misread ‘Madness explained’. For the record, its overall argument is that a coherent and satisfactory account of madness can be built by discovering the biological and psychological processes that give rise to particular types of psychotic behaviours and experiences (what psychiatrists call ‘symptoms’). Once thishas been achieved, there will be no need to retain diagnoses such as ‘schizophrenia’, just as there was no need to retain the diagnosis of ‘dropsy’. I imagine that, as physicians were arguing that the diagnosis ofdropsy be abandoned, some of their older colleagues angrily complained that they were being foolish without taking the trouble to understand and engage with their arguments. That’s the way of the world, I suppose.
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