One on one...with Richard Bentall

Professor of Clinical Psychology at the University of Liverpool. Includes lots of web-only answers.

One moment that changed the course of your career
Waiting anxiously to see my psychotherapist for the first time, after becoming depressed following a messy divorce, and thinking, ‘My God, so this is what it’s like to be a patient!’

One misconception about my ideological position
I am usually described as belonging to the antipsychiatry camp. A couple of times I have even been compared to Laing, and I can’t work out whether to be flattered or appalled. I think of myself as a fairly hard-nosed empirical scientist and a pragmatic clinician. I’m against the standard way of thinking about mental illness (e.g the reliance on a categorical system of diagnosis and the over-emphasis of genetics) because it is bad science and harmful to patients.

One lesson from the developing world
Mental health outcomes are at least as good in the developing world as in the industrialised West, so either they are doing something right or, at least, we are not doing anything better. Actually, one important thing that people do in the developing world is nothing. Studies in the West show that patients with psychosis who are given minimal medication but good social support do as well as those who receive conventional treatment but, of course, suffer fewer side-effects. Unfortunately, most Western-trained clinicians find it almost impossible to do nothing.

One cornerstone of my own treatment approach
To be a skilled therapist you have to have a particular type of temperament and to keep working self-reflectively day after day, which is very difficult. I don’t count myself as a particularly talented in this way. But if there is a cornerstone of my (broadly CBT) approach, it is respect for the patient’s way of seeing the world and curiosity about what it entails. Even the oddest delusional system is the end point of the patient’s honest attempt to make the best sense of the world.

One hero
When I was a trainee, most discussions about Carl Rogers were along the lines of: ‘Rogers was a nice guy; now let’s talk about CBT’. But he was a pioneer of psychotherapy research and absolutely right in asserting that good relationships are a sine qua non for therapeutic progress.

One regret
Mismanaged relationships with the opposite sex must be at the top of the list. I suspect the same is true for many middle-aged men. If only life was a dress-rehearsal.

One thing that organised psychology could do better
Psychology has begun to address the promotion of mental health, but this kind of work is in its infancy and, of course, involves political engagement. I like the Wilkinson and Pickett (The Spirit Level: Why More Equal Societies Nearly Always Do Better, Penguin, 2009) concept of evidence-based social policy. We should be working hard to supply the evidence.

One nugget of advice for aspiring psychologists
Any young person wanting a research career in psychopathology should be encouraged by how little we know. We do not even know how to describe many psychiatric problems properly. Be bold, question the assumptions found in textbooks, and keep an open mind about methodology (qualitative, quantitative, physiological – they all have their place).

One superpower
The ability to deliver empathy, congruence and positive regard late on a Friday afternoon is an unrecognised superpower.

Web-only questions

One way treatment for mental illness has progressed
Outcomes for severe mental illness have not improved dramatically since the Victorian period. Hence, we can be sure that there have been few genuine technical advances in our ability to care for people with psychosis. In as much as things are better than they were, it is because we are kinder than we used to be, although nowhere near as kind as we could or should be.

One cultural recommendation
If I had to choose a film it would be Blade Runner, an existential scifi thriller about a group of replicants (artificial humans) returning to Earth to confront their creator. The final speech by the replicant Roy Batty (Rutger Hauer in the only role he will be remembered for) as he confronts his mortality is one of the great moments in cinema and still sends a shiver down my spine: ‘I’ve seen things you people wouldn’t believe. Attack ships on fire on the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhauser Gate. All these moments will be lost in time, like tears in rain. Time to die.’

One challenge you think clinical psychology faces
Clinical psychologists have been poor at understanding how people change over time. Most of our studies are cross-sectional. People are more like movies than snapshots – my response to an event changes me in some fundamental way that means that my next response to a similar event will be different. Fluctuations in symptoms and processes, which are often ignored as noise, are meaningful patterns reflecting underlying dynamic mechanisms but decoding these mechanisms is not easy.

One alternative career path you may have chosen
I nearly became a pilot. I’m far too neurotic to be in charge of an airplane so the world should be grateful that I changed tack. (Instead of the laconic, ‘Ladies and gentleman, we seem to have a bit of a problem with our wing falling off, so please tighten your seatbelts as we will be landing shortly’ the passengers would have heard a Basil Fawlty-like cry of despair from the cockpit.)

One misconception about clinical psychology
Every time someone I’m introduced to asks me if I can read minds I tell them that I failed that part of my training.

One way that clinical services have grown
When I qualified, an interest in severe mental illness was considered eccentric. No one seemed to know how to talk to patients with psychosis, let alone how to address their psychological needs (indeed, many mental health professionals assumed that people with psychosis had no psychological needs). Working psychologically with people with psychosis is now mainstream.

One thing that you would change about psychology/ psychologists
I think we should be more assertive in challenging bad practice wherever we see it.

One journal article all psychologists should read
B.F. Skinner’s The operational analysis of psychological terms (Psychological Review 52, 270–277, 1945) is rarely read and even less often understood. Contrary to some misrepresentations of his position, Skinner never doubted that we can describe internal states such as thoughts or emotions, but he wondered how we are able to do this. His answer was surprising, relevant to the practice of psychotherapy, and a challenge to all those who (like some unsophisticated therapists) assume that we can know our own feelings by a simple process of self-inspection.

One thing holding alternative approaches to mental illness back
The pharmaceutical industry has had a terrible impact on mental health care, not only by peddling medicines that, on careful examination, are not much more effective than snake oil, but also by promoting a bio-bio-bio model of mental illness.

One problem that psychology should deal with
Many aspects of human life remain unexamined. For example, inner speech is an almost ubiquitous aspect of our mental life, but has hardly been studied at all.

One hope for the future of psychology

That we don’t become mesmerised by fabulous technologies such as fMRI. Of course they are important, but many UK academic psychology departments are investing in them to such an extent that it is becoming difficult for other subdisciplines (social, developmental, clinical) to thrive.

One proud moment
I smiled when a reviewer of my book, Doctoring the mind, wrote: ‘He does not appear to have a philosophical ax to grind, as do some other writers in this area. I had the feeling reading Bentall that, were the evidence to point in a different direction, he would go in that direction.’

One inspiration
At Uppingham School I had an inspiring but rather serious science master called Dr Garth Wheatley. His main obsessions were physics and cricket. I managed to raise a rare smile from him by using de Broglie’s equation to work out the wavelength of a well-bowled cricket ball.

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