Richard Bentall: Psychiatry's poor record of success

From a lecture by the professor of experimental clinical psychology at Manchester University

It is difficult to view the history of psychiatry with any sense of ease. Whereas the history of physical medicine is littered with clinical and scientific breakthroughs, psychiatric medicine has few achievements to boast about.

At times psychiatrists have advocated treatments that can fairly be described as cruel and barbaric. Of course, when reminded of these dreadful episodes, most doctors will retort that we live in better times. They will say that modern psychiatry is practised with due concern for the patient's distress, and with the specific aim of returning the patient to a happy, productive life.

None the less, when we look at the practice of psychiatry today, we find that, in the case of the most severe mental illnesses at least, the outcomes obtained are little, if at all, better than those obtained at the end of the 19th century. Astonishingly, cross-cultural comparisons show that patients in the developing world do rather better than those in the industrialised nations, and have a greater chance of recovering from their difficulties.

The discovery that many people live relatively happy lives despite their psychotic experiences raises the possibility that some patients may do best without any treatment. Marius Romme, a Dutch social psychiatrist, has formed a national organisation for people in Holland who hear voices, many of whom live productive lives without clinical intervention. When I met Marius on a trip to Maastricht some years ago, he told me that he liked my research into hallucinations, but that he thought that "voice-hearers" were really like homosexuals in the 1950s, and were more in need of liberation than cure. Now that is a radical thought!