Will soaps or science open others' minds?

Philip Thomas
Published: 01 October 2004

Title: Madness Explained

Author: Richard P. Bentall

Reviewer: Philip Thomas

Publisher: Allen Lane The Penguin Press

ISBN: 0 7139 9249 2

Pages: 640

Price: 25.00

There is a lot that is good about Richard Bentall's book, which makes it difficult to fault. The problem is that the means of his argument are unsuited to his admirable aims. The book, which was written as "an act of social inclusion", wants us to see the mad as ordinary human beings. Its starting point is an assault on the holy of holies of psychiatry, schizophrenia. Bentall writes powerfully, taking the concept apart (but not deconstructing it). But his argument replaces one problematic concept with another.

Bentall writes from within the influential tradition of cognitivism. Contemporary cognitive psychology traces its roots back half a century to the work of Noam Chomsky and George Miller. Closely related to this is the work of Aaron Beck, who originated cognitive therapy for depression. The two strands lie at the theoretical heart of Bentall's book.

Cognitivism likens the mind to a computer program that processes information. The assumption is that human experience can be thought of in terms of mental processes that build up inner representations of the outer world of other human beings and things.

This way of accounting for human experience is fraught with difficulties.

Consider dualism. Bentall argues that cognitivism offers a way around the problems of body/ mind dualism that bedevil psychiatry, but he fails to acknowledge the problem of what the philosopher Hubert Dreyfus calls epistemological dualism, or the separation of knowing subject from known-about world. As cognitivism makes the assumption that our mental lives are detached from the social world, it locates the origins of madness in the mind of the mad person, isolated from the social, cultural and political contexts that render madness understandable. Bentall rejects so-called postmodern critiques of science as relativistic, but in doing so he fails to engage with a concern for ethics. His position is that of the modernist who believes that problems such as madness will yield to science.

He has nothing to say about scientific knowledge as power and the ethics of this; how cognitivism is used, by whom and for what purpose.

In any case, I disagree with his assumption (implicit) that cognitivism is better suited than biomedical psychiatry to bringing the mad back into the human fold. If we explain delusional beliefs in terms of disordered attributions, we are left with someone whose mind is faulty. Thus, the only difference between cognitive psychology and psychiatry is that psychiatry regards the brain as faulty. In either case, the difference of madness remains just that, a difference. If we want to end the exclusion of the mad, the task has to be to understand madness, not explain it. Cognitivism is no more capable of rendering the "un-understandable" understandable than psychiatry is.

We achieve understanding through that ancient human process of storytelling. Stories and narrative help us to understand the experiences of others, to identify with them, laying open our shared humanity. This is why soap operas are so popular. Explanations of the workings of the modules, chips, transistors and capacitors in my TV set tell me nothing about a character's feelings.

My point is that Bentall is struggling with different types of knowledge, that which concerns explanations (science) and that which concerns understanding people (narrative). The language of science objectifies and alienates; stories draw us together. Here philosophy offers much - not in providing answers but by helping us to be clear on questions.

Perhaps I am being churlish. Setting aside my serious theoretical reservations, cognitive therapy has undoubtedly done much to help people cope with madness. Psychologists who work in this way are at least encouraging people who hear voices or have unusual beliefs to discuss their experiences, which is far more than my psychiatric training taught me. In any case, we would do well to remember the work of Marius Romme and Sandra Escher in Holland. They have shown that the coping strategies of people who hear voices include many of the cognitive techniques that Bentall and his colleagues have developed. So, who are the real experts?

Philip Thomas is a writer and senior research fellow, Centre for Citizenship and Community Mental Health, Bradford University.