Psychology… there’s no future in it

Richard Bentall’s book Madness Explained won the British Psychological Society’s Book Award in 2004. It reignited the controversy over the causes of psychosis, despite what The Independent termed Richard’s ‘unfailing reasonableness and pleasant disposition’. These were in evidence, along with disarming modesty and self-deprecation, when we talked with Richard in the sunny courtyard of the British Library. Richard’s new book – Doctoring the Mind: Why Psychiatric Treatments Fail – was just about to be published, but our interview initially focused on how he became a psychologist in the first place.

‘No future in psychology’
Richard grew up in Sheffield, the son of a dentist and a former nurse. His parents had saved up, going without holidays, to send him to a public school, Uppingham. Like many children in the 1960s who won scholarships or whose parents made similar sacrifices, Richard’s experience at public school was not an altogether happy one. ‘I didn’t enjoy it. I didn’t know what the rules were and I didn’t come from the right culture. Sport was one way to establish yourself but I was no good at sport. There were positives, however. I had good teachers in English and physics – the latter subject, in particular, became a great love of mine. And there was an excellent library. I discovered the psychology section and the first book I pulled out was Freud’s On the Interpretation of Dreams. I was hooked. I read William James and, like so many people of my generation, became fascinated by R.D. Laing. I think The Divided Self was the first book of his I read.’

Richard had one other fascination. ‘Flying – it was a constant when I was young. I nearly joined the RAF. I won a flying scholarship and got a private pilot’s licence at the age of 17 but my house master raised the obvious question – “Do you really want to join the RAF? It’ll be just like here and you plainly don’t like it here very much.”’

Under the influence of his reading, Richard told the careers master that he wanted to be a psychoanalyst. ‘He said that I’d have to go to medical school. As regards psychology, his view was that there was “no future in it”. My last year report comments “Richard is far too interested in psychology for his own good”, a fact perhaps borne out by how badly I did in my A-levels. I had to retake them. So, I went to a local Sheffield comprehensive. At Uppingham, comprehensives were seen as lairs of feral hooligan gangs. The truth was, of course, very different. I felt accepted and got a bit too comfortable – I discovered the local pub, and realised that one half of the world didn’t play rugby. So I wasted a year, apart from two things – I continued flying and I read psychology avidly.’

Why did psychology exert such a fascination for you? ‘It sounds naive but I was trying to understand myself and why I was so unhappy. The early experience of failure didn’t help matters much. I was incredibly lonely at public school, which had the upside that there was lots of time for reading.’

Richard hedged his bets by applying both to medical school and to psychology. With his less-than-stellar A-level performance, he managed to scrape on to the undergraduate course at Bangor. ‘I still remember a sense of growing freedom as I of travelled to North Wales on my 19th birthday. And the course lived up to my expectations – a group of 20 students, who all got on with each other and who were all fascinated by psychology. If we skipped a lecture (not, of course, that we would have thought of such a thing!) it was because we had far more important psychological issues to debate in the coffee lounge. Contemporary students are less intense about psychology. It’s unusual to have a discussion about the political and social implications of psychology with undergraduates now, though I’ve worked with some superb postgraduate students. I suppose clinical psychology has developed all the trappings of a career. It hadn’t developed those structures when I was studying. And it was an exciting time to do psychology.’

The heroic age of clinical psychology?
As Richard comments, behaviourism is now seen as something of an antique – a ‘steam-driven version of psychology’. But in the mid-1970s clinical psychologists were establishing themselves as a profession. ‘The psychologists at a hospital like Denbigh in North Wales where I did my third-year project were seen as heroes. There was a real sense of rivalry between psychiatrists and clinical psychologists. I address this in my new book. I’ve been accused of continuing that battle but, there were and are critical issues at stake – ones which affect the lives of many millions of people.’ A quotation from the Acknowledgements to the book catch his approach well: ‘Perhaps one of the greatest joys of an academic life is that it allows one to work in friendly cooperation with…people whose views on important issues are often completely different from one’s own.’

Richard’s PhD was, initially at least, less happy than his earlier training. He won a scholarship from the Science Research Council and, as was the convention at that time, chose his own topic. ‘I knew my tutor wanted me to do something else but I decided to look at the importance of language in regulating schizophrenic behaviour, an approach that drew on Skinner and Vygotsky.’ Richard spent six months at Denbigh Hospital, trying to understand patients’ problems, living in the nurses home, using the very good library there. ‘Then, I got lost. I realised I didn’t understand what schizophrenia was. More than that, nobody else seemed to understand it either, which didn’t stop them from writing millions of words about the topic. The term seemed to be a fuddle, an amorphous cloud. I panicked. I went back to my tutor and he was glad that I’d reverted to his preferred topic – operant learning in children with different verbal abilities. W.C. Fields said “never work with children or animals”, but I became immersed in experimental psychology and the need to ask fundamental questions.’

Richard is self-mocking about this period. ‘I still thought we would improve the world with behaviourism, like psychiatrists with prescription pads. There was an arrogant revolutionary zeal which fitted with the zeitgeist. I thought I’d eventually train to become a hero therapist who would wisely cure troubled souls through stringent research. But, if truth be told, I was still trying to fix myself.’

Richard then qualified in clinical psychology at Liverpool but found clinical training more difficult than he expected. ‘Cognitive therapy was taking off. I read my textbooks and used the techniques and they didn’t work. The fact is, if you see cognitive therapy as an expert toolbox to surgically remove irrational beliefs, it won’t work. You have to take the patients’ point of view seriously. Good cognitive therapists know and do this. They understand empathy. For the first time I developed a grudging sympathy for Carl Rogers, who looked at the minutiae of the therapy relationship. Again, this is something I look at in Doctoring the Mind. I think it takes a certain sort of person to be a good practising clinical psychologist – one who can sit with people for long periods and can both be simultaneously empathetic and organised.’

Richard was still hugely emotionally committed to psychology. ‘During clinical training a psychoanalyst asked us to reflect on why we were there. I ranted on about how I was applying science, that I had no personal motives. A friend waited then said quietly, “None of what you’ve said about yourself is true. I know you care about your patients very much.” I suddenly realised that my posturing about science and expertise was really about managing how I felt about myself. It was an emotional moment.’

After qualifying as a clinician, Richard received an MA in philosophy applied to health care, and then obtained an academic post at Liverpool after working for a while as a forensic psychologist (‘I didn’t enjoy that’). He has held chairs in clinical psychology at Liverpool and Manchester and is currently Professor of Clinical Psychology at the University of Bangor, Wales. But underlying these career moves is a consistent and growing approach to mental illness. ‘My difficulties in grasping what schizophrenia was during my PhD came back to haunt me. I realised that schizophrenia was not a coherent construct. But what could you replace it with to help people in real pain? Peter Slade, who sadly left psychology in disgrace at the end of the 1990s, raised the issue of the single symptom approach in his work on auditory hallucinations.

I began to extend this approach across the spectrum. Peter Slade’s contribution has become difficult to talk about, but he helped my career hugely. He promoted younger academics by making them principal grant holders on research projects – something I’d recommend to other senior academics.’

Early on in his academic career, Richard successfully applied for £5000 for a junior lecturer pilot research grant. ‘I proposed studying delusions – how we acquire strange beliefs. It was seen as a slightly bonkers approach at a time when cognitive therapy was taking off. But I became more and more committed to developing a satisfactory, coherent  account of psychopathology through symptoms. I initially expected to get shot down in flames by some well-read person who would quote something I’d missed. But it hasn’t happened yet as far as I’m aware!’

Richard wrote an essay for an edited work published by Penguin and they rang him to ask if he was interested in writing a book. ‘Great, I thought. That will take about 18 months. Five years later I delivered the manuscript for Madness Explained. I loved writing it but it transformed from a polemic to a genuine investigation and became much longer, with many more references and footnotes than I’d planned. Doctoring the Mind is much shorter, hopefully more accessible and focusing more on patients.’

Finding research funding is a major part of Richard’s life at the moment. ‘It’s tiring and at times dispiriting. Bad things happening to you definitely increases your chance of being psychotic; specific bad things cause specific symptoms. So, we need to research and understand how developmental pathways are influenced by adversity, because understanding this might help. Genetic research into psychosis is heavily funded but has not led to replicable findings and is unlikely to help patients. By contrast, it’s very difficult to get funding to study the causal role of the social environment in psychosis, even though this kind of research is much more likely to lead to clinical benefits. I’ve been trying for five or six years to get funding for this kind of work, collaborating with a group which includes developmental psychologists, psychiatrists and others. In an odd way it’s all gone full circle. At the beginning research in symptoms was wacky, then it became mainstream. It’s becoming wacky again, because we are looking at social causes.’

During the course of our discussion Richard reacted to a number of topics with the comment ‘I could talk all day about that’. It’s impossible to adequately cover all these issues he raised (and stories he told) in one short article. What comes across strongly on reading Doctoring the Mind (and in talking to Richard about his career) is a sense of recovering the past in order to inform a critical contemporary debate. Members will find Richard’s treatment of the ‘overlooked’ development of clinical psychology at the end of the Second World War of particular interest.

Richard’s approach is less informed by Santayana (‘Those who forget the past are doomed to repeat it’) than by a sense that previous experiences don’t disappear but remain alive, influencing what goes on now. And psychologists, more than most professions, should understand that.