»Use of drugs in psychiatry«

...Because I am saying things a lot of people will not want to hear so it's important to show that my ideas have come from research.

Was some of that research a bit personal?

I was involved in an experiment by a colleague, David Healy, at the North Wales Hospital in Bangor. We took a very low dose, 5 milligrams, of droperidol, very similar to the widely used drug haloperidol. Parts of the study were never completed because nearly everybody had a terrible reaction to the drug. Mine was not the most extreme. There was a psychiatrist who became so deeply depressed that she was put under observation.

What happened to you?

I drank this stuff and I felt lethargic and sedated. I thought I had got away with it. Then a psychologist walked in and said: "Oh, this is embarrassing, Richard, but we'd like you to fill in this test." The embarrassing thing was I had designed the test myself 10 years earlier. I looked at it and I could as soon have climbed Mount Everest. I felt a sense of depression and hopelessness but also an inner sense of restlessness and agitation. It was a combined wanting to do something and not being able to. Then she said: "You don't look too well - would you like some lunch?" I interpreted that as an order - and I've read since that people on neuroleptic drugs take statements as orders. So I said yes. Then she said: "We've a sandwich machine - will that do?" And I said yes because it was all I was up to saying. But I couldn't get the energy to decide what money to use. I just grabbed a coin and it was enough to get a Mars bar, which I was too ill to eat.

Did the drug wear off?

I had to do these neuropsychological tests, and it was embarrassing, but I burst into tears halfway through. I started weeping uncontrollably, so much so that I was given an anticholinergic drug as an antidote and David took me out to get some fresh air. I suddenly felt I had to tell him about all the things I had ever felt guilty about. Then I went back and fell asleep for 3 hours. I woke up with a woozy hangover, like there was a glass wall between me and the world and that lasted for about a week after a single dose. The akathisia - the combined agitation and depression I felt - is experienced by 40 per cent of patients. It tends to go away after about a week, but imagine: you've had a crisis, you're admitted to hospital, you're hearing voices, then someone gives you a drug that makes you feel like that!

But they are designed for sick people...

About 40 per cent of patients have the same experience. That's the great unasked question of psychiatry: what was it like for you? Patients' experiences have been completely ignored.

So are the antipsychotics effective?

It's more complex. There's no doubt these drugs help some people by reducing the hallucinations and delusions. But there are really important caveats. First, something like 30 per cent of patients get benefits from the drugs - and we don't know which ones they will be. Secondly, these drugs have the most horrendous side effects. The old type of antipsychotic drugs produced what we call extrapyramidal effects, including Parkinsonian tremors, tardive dyskinesia (uncontrolled movements of the mouth and tongue) and akathisia.

But surely you just give low doses?

There is a scandal which I must get on my soapbox about - neuroleptic dosage. These drugs were discovered in the late 1940s and in wide use by the 1950s. Bizarrely, the first studies to look at the most appropriate dosage were not published until the 1990s. It turned out that low doses work at least as well as high doses. And for much of that period it wasn't uncommon to find patients on 80 to 90 milligrams of haloperidol. We now consider it irrational to give more than 10 milligrams and better to keep it at 5 milligrams a day, although you can still find patients on higher doses. We've got a massive amount of drug-induced illness - millions of people - and some of them have even been sent to early graves because of the increased risk from heart attacks and various blood disorders. All completely unnecessary.

What about the new antipsychotics?

It turned out the new drugs looked great compared to irrational doses of the old ones, but when compared to rational doses there was hardly any difference. The new drugs don't produce the old side effects, but there are a load of new ones: diabetes, sexual dysfunction, weight gain. I'm not saying drugs never work. If you talk to patients, some will tell you that drugs are a lifesaver and others that drugs have made their lives worse. Quite a few patients now on drugs would be better off without. Perhaps the best thing is to encourage patients to try them and let them decide...

Richard Bentall (1956 -) holds a Chair in Experimental Clinical psychology at the University of Manchester, UK. Born in Sheffield, he attended the University College of North Wales, Bangor as an undergraduate before taking a Ph.D. in experimental psychology at the same institution. After achieving his doctorate, he moved to the University of Liverpool to obtain a qualification in clinical psychology before achieving an MA in philosophy applied to health care from University College Swansea. He later returned to his alma mater of Liverpool to work as a lecturer after a brief stint working for the National Health Service as a forensic clinical psychologist. He was appointed as a professor at Liverpool before his 1999 move to the University of Manchester.

He is particularly well known for his work on psychosis, delusions and hallucinations and has published extensively in this area. He also has an interest in differences between human and animal pedagogy and the treatment of chronic fatigue syndrome.

In 1989 he was awarded the British Psychological Society's 'May Davidson Award' for contributions to the field of clinical psychology.

He has edited and authored several books, most notably the recent Madness Explained.

Currently, he lives with his partner, Aisling, and their twin children Fintan and Keeva.
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Bibliography

•	Bentall, R. P. (2003) Madness Explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN 0713992492

•	Bentall, R. P. & Slade, P.D. (eds) (1992) Reconstructing Schizophrenia. London: Routledge. ISBN 041501574X

•	Bentall, R. P. & Slade, P.D. (1988) Sensory Deception: A Scientific Analysis of Hallucination. Johns Hopkins University Press. ISBN 080183760X

Clinical psychologist Richard Bentall had taken a psychiatric drug as part of an experiment...