Professor Dean, a psychiatrist with expertise in psychopharmacology and neuroscience, introduces the context of his book by noting that he is adding to the increasing number of books critical of psychiatry that have been published in recent years. He further describes how, despite the heavy use of medication, there is no evidence that morbidity or mortality of mental disorders has dropped in recent decades. Indeed, mortality rates have risen in many disorders, and the outcome in schizophrenia has worsened. There is something badly rotten at the heart of mainstream psychiatric theory and practice, but despite the lack of scientific or clinical progress, practice is largely untouched by the troubling lack of empirical support for our diagnostic constructs and the widespread use of psychotropics. In this, Dean is in accord with the United Nations, in the person of its ‘special rapporteur’, and the World Health Organization, with both organisations recently publishing documents criticising the dominance of biomedicine in mental healthcare and recommending de-medicalised approaches. Perhaps it is now mainstream psychiatry that no longer holds the centre ground for mental health ideology.

The book examines the biological revolution in psychiatry and concludes that this has failed to deliver any meaningful improvement in mental healthcare. Much of the subsequent body of the book focuses on psychotropic medication, particularly antipsychotics and antidepressants, examining numerous studies on aspects such as efficacy, side-effects, polypharmacy and treatment resistance. Dean concludes each of these chapters with some ‘clinical notes’ for the practitioner, that generally urge a more cautious approach to prescribing. His final chapters deal with the failure of current diagnostic systems to establish their validity.

This is a worthwhile book for the breadth of studies (particularly on psychotropics) that it covers, but as a result critical analysis of important studies is missing. This made some of these middle chapters hard going as it felt at times like a long list of study abstracts. I also think that, good as the content of this book is, books by Robert Whitaker and Joanna Moncrieff deal with a similar subject matter with greater depth and coherence.