Book reviews, February 2010

Doctoring the Mind: Why Psychiatric Treatments Fail
Richard Bentall
Allen Lane; 2009; Hb £25.00

Richard Bentall is one of the leading British psychologists researching into the nature and treatment of severe mental illness. His previous, already classic, book Madness Explained won the British Psychological Society's Book Award in 2004. While that book was essentially explanatory and demystifying in intention, this successor has a more critical edge, as the subtitle suggests: have psychiatric treatments indeed failed?

Doctoring the Mind differs significantly from the previous volume in a number of respects. It is written to be more accessible, so the writing style includes stories about patients and about researchers, and not least about Richard Bentall himself. But crucially it is a broad-ranging critique both of the effectiveness of psychiatric treatments for psychosis, and of the underpinning biomedical foundations for those treatments, explaining clearly a range of the complex technical issues involved.

Three approaches substantiate this critique. The first section of the book is essentially historical, reviewing the successive emergence of new physical treatments within the then asylum system, from the burst of heroic procedures in the late 1930s, such as pre-frontal leucotomy, through to the first use of chlorpromazine in France in 1951, with a detour via the first antipsychiatrists, Ronald Laing and Thomas Szasz. The second section is essentially methodological, examining critically the validity of present psychiatric diagnostic systems, and the evidence for the assumptions that psychotic disorders are genetically determined brain diseases; a feature of these chapters is the 'forensic' care taken to analyse key individual research studies. The last section is a counterposed analysis of the role of the pharmaceutical industry and the methods of drug trials, against studies of the importance of the therapeutic alliances constructed by professional staff with individual service users.

Bentall's approach is, unusually in books covering this territory, rooted in both the realities of how everyday NHS mental 'health' services are experienced by those who use them, alongside careful analysis of the scientific rationale for the treatments offered them. He presents a new version of antipsychiatry that is not, however, an entirely comfortable ride for psychologists. He is sceptical about claims for the effectiveness of specific forms of CBT, and critical of what he calls the tribalism of mental health professions, contributing to the tensions between psychiatrists, and those (mostly clinical) psychologists and members of other professions also working with people with psychosis.

Bentall essentially examines three interrelated issues: the fundamental nature of psychotic disturbance, the way in which those disturbances are classified, and the appropriateness and effectiveness of current interventions; and he concludes that psychiatric treatments have indeed failed. He sees possible ways forward as derived from his vision of 'autonomy-promoting' psychiatric care, which he sees as diametrically opposed to 'paternalistic-medical' care. He sees the creation of therapeutic alliances with patients, fully informed about the advantages and limitations of the interventions offered them, as the only sound basis for designing mental health services that people in need will want.

Other British psychologists and psychiatrists, such as Oliver James and Joanna Moncrieff, have very helpfully addressed a number of these issues. But Richard Bentall's authoritative background as a major researcher in this field, and the humanity and clarity of his writing, place this book in the front rank of accessible reading on psychological contributions to the field of psychosis. This rational and radical critique of conventional psychiatry is a landmark resource for both patients and professionals in the continuing struggle to improve the acceptability and effectiveness of services available to people with psychosis, not least in the light of New Horizons, the government's new 10-year plan for psychiatry.  

Reviewed by John Hall, who is Visiting Professor of Mental Health at Oxford Brookes University

Human Potential
David Vernon
Routledge; 2009; Pb £19.95 

From simple tasks, such as remembering a shopping list, to complex behaviours, such as the ability to learn a new language, Vernon highlights an individual's ability to move beyond a normative level, to achieve peak or optimal levels of functioning.

In the first section of the book Vernon outlines a range of passive techniques for enhancing human performance including hypnosis, sleep learning, subliminal training and audio-visual entrainment, all of which are critically evaluated in light of the classical and contemporary research in each area. The second section is concerned with active techniques, including meditation, mnemonics,
speed reading, biofeedback, neurofeedback and mental imagery practice, each presented in a clear and logical manner.

Vernon draws these two sections together in a summary chapter, in which he concludes that although certain techniques prevail, mediating factors such as individual and procedural differences still have a substantial impact upon their effectiveness. This is an inspiring read that conveys the vast potential for human development in a variety of situations, and by employing a multitude of techniques.

Reviewed by Helen Henshaw

Applied Sport Psychology:A Case-based Approach
Brian Hemmings & Tim Holder
Wiley-Blackwell; 2009; Pb £24.95

'Doing sport psychology' texts are particularly underweight within sport psychology literature. Hemmings and Holder tackle this gap head-on with a book that describes the real-life approaches of prominent sport and exercise psychologists.

The bulk of the book comprises case studies across a variety of sports (indexed by individual and team sports). In addition, there are three chapters dedicated to experiences of working with support staff. Each case study includes a description of the nuts and bolts of a consultant's work (needs assessment, intervention and evaluation); within this structure the scientific rigour, style, and ethos of each consultant can be easily grasped and contrasted.

A strength of the book is the emphasis given to reflective practice. The best case studies, (e.g. Hemmings, Katz and Holder) explore evaluations of intervention(s) and consultant effectiveness in depth and demonstrate the importance of relationship aspects of consulting. These sections within the book are essential reading for students and would likely benefit a far-reaching audience of practising psychologists in any field.

Reviewed by Jonathan Bint
who is a Chartered Psychologist working in sport and exercise

Research Methods in Applied Settings: An Integrated Approach to Design and Analysis (2nd edn)
Jeffrey A. Gliner, George A. Morgan & Nancy L. Leech
Routledge; 2009; Hb £50.00

As a trainee clinical psychologist planning a doctoral thesis, I found this book extremely useful. The reader is taken through the research process: from planning and thinking about a research project, to communicating the outcome of the research in a report. Along the way there are sections on research design, on practical aspects of sampling and data collection, and on analysis and interpretation of data.

The book can appear daunting initially: the text is small and dense, and there aren't many diagrams or pictures. However, the authors make up for this with the clarity of their writing. I now have an understanding of aspects of research that have previously eluded me, thanks to them.

Gliner and colleagues use examples from their own experience of designing research in an early chapter. It would be nice if they had continued to do this throughout, as this was the book's most engaging aspect.

I would recommend the book to anyone conducting psychological research. I will certainly continue to refer to it as I design and implement my own thesis project.

Reviewed by Joe Judge who is a trainee clinical psychologist, University of Edinburgh

Memory Rehabilitation: Integrating Theory and Practice
Barbara A. Wilson
Guilford Press; 2009; Hb £32.50

Barbara Wilson is a renowned authority in memory research. She has also developed a functional clinical approach for helping patients with memory impairments manage their everyday lives. This latest book is true to her philosophy of integrating theory and practice. Many other texts in this area aim to teach memory tricks or 'mnemonics' in the hopes of improving patients' memory function. Wilson suggests that the use of such techniques in isolation often meets with minimal success in reality. The present book advocates gaining an appreciation of each individual's difficulties and then shaping realistic goals for rehabilitation and compensation in order to improve quality of life.

Wilson first introduces psychological theories of memory and stresses the importance of understanding the neurology associated with different degrees of memory loss. This way we can learn how different patterns of brain injury or neural degeneration are likely to influence future behaviour. For a student, teacher or practitioner of neuroscience/psychology this section of the book is thorough and engaging. The majority of the text is then concerned with comprehensively examining strategies designed to alleviate day-to-day difficulties. These include using appropriate assessment and evaluation throughout rehabilitation as well as sensitive management of emotional disorders, memory aids and support groups. Informative case studies are provided, as well as goal lists and chapter summaries.

Whilst parts of the book might be a little dense at times for patients or their carers, it is an insightful, wide-ranging and practical introduction for professionals interested in the rehabilitation of memory. 

I    Guilford Press; 2009; Hb £32.50
Reviewed by Victoria Williamson who is an ESRC Postdoctoral Fellow at Goldsmiths, University of London