In 1988, Richard Bentall was on his way to becoming one of Britain’s most influential clinical psychologists. He was 32 and had developed an early fascination with psychosis, where patients can become detached from reality, often leading to hallucinations, delusions and suicidal thoughts.
While spending time on psychiatric wards during his training, Bentall felt that psychotic patients were poorly treated. The prevailing view was that psychosis was a genetic brain condition that could only be diagnosed and medicated. Life experience, including childhood trauma and social deprivation, was neglected as a possible cause.
Bentall would devote his career to changing the way severe mental illness is seen. He would help to revolutionise the way psychosis is treated – showing that talking therapies could work and pioneering a movement of compassionate psychology in which clinicians asked not: “What’s wrong with you?” but: “What happened to you?”
Unafraid to challenge orthodoxy, Bentall would later say that broad diagnoses, such as schizophrenia, are “hardly more meaningful than star signs”. He would call out the pharmaceutical industry for “peddling medicines that … are not much more effective than snake oil”. He would make headlines by proposing that happiness be classified as a psychiatric disorder.
But long before all that – before the bestselling books and his election to the British Academy, before his most recent work on the mental health impact of the pandemic – Bentall’s phone rang on a grey Sunday in October 1988. It was a call to say that his brother had killed himself at his block of flats in Sheffield.
Andrew, who was 18 months younger than Richard, had been struggling for years with mental illness and drug abuse. Bentall thinks he may have been psychotic. His death at 30 came just two years after their father had died in a car crash.
“I remember we were sitting with the vicar and he turned to me and said: ‘It must be especially difficult for you, given what you do,” says Bentall, who had driven to Sheffield, where he had grown up, to be with his mother. “I think he meant that somehow I would blame myself because I hadn’t had a solution. And I think I did blame myself. For a long time, I just never talked about it.”
I meet Bentall, 64, in his small study at home in Liverpool. He is lean, with Warholish white hair and glasses. He lives with his partner, Samantha, whom he met 10 years ago, and her two teenage boys from a previous relationship (Bentall has grownup twins of his own). There are piles of books spread around; a painting above a fireplace shows waves crashing on to a shore.
This home office has been a boon for Bentall, now a professor of clinical psychology at the University of Sheffield, 60 miles east, beyond the Peak District. It has also encouraged reflection on a long career, a sometimes fraught family life – and the foggy space where they have overlapped.
Bentall says people in his profession often struggle to know themselves. “There’s that old joke about two psychologists meeting and one says to the other: ‘You’re all right, how am I?’” he says. “I don’t think anybody ever studies psychology and successfully uses it to fix themselves.”
But Bentall says he does not see his career as a grief-driven mission to rescue his little brother postmortem. If anything, the denial that was his response to Andrew’s death threw up boundaries; he has avoided suicide as a research subject, for example. Yet that overlap has been impossible to escape entirely.
Bentall is working on a book about the history and psychology of belief. He is fascinated by the way a search for belonging – and the fear of not belonging – can drive people towards mental illness, irrational belief systems, or both. Andrew had begun to latch on to occultism and mysticism as his mental health deteriorated.
Not long after his brother’s death, Bentall visited the tower block where Andrew had lived alone. “It was early on a Sunday morning when he died and I still often think: what was it like?” he says. At the funeral, a friend of Andrew’s said something to Bentall that still haunts him. “He told me that all Andrew ever wanted was to be ‘an acceptable failure’,” Bentall says. “In other words, he had just wanted to belong.”
Bentall grew up in a leafy suburb of Sheffield. His grandfather was a left-leaning church minister. For reasons that Bentall can’t fathom, his father, a dentist, became a conservative authoritarian with racist beliefs. The brothers, whose older sister became a teacher, were competitive. “I think we were competing for a limited resource, which was parental attention,” Bentall says.
When Bentall was 13, his parents used all their savings to send the brothers to Uppingham, then a forbidding boys’ boarding school in Rutland, which they hoped would give them a good start in life. Instead, Bentall was bullied for his Yorkshire accent and poor athletic performance. “I was basically mocked every day of my life between the ages of 13 and 18,” he says.
Bentall struggled academically, but discovered Sigmund Freud while hiding in the school library, where he soon exhausted the psychology section. He wonders if he was trying to understand his misery. Anxious to know more, he stunned tutors by taking an evening class in psychology at the local technical college. “I still have a school report that says: ‘Richard is far too interested in psychology for his own good.’”
After flunking his A-levels, Bentall organised his own resits at the local comprehensive and went to what is now Bangor University in north Wales to read psychology. He began to excel. Academia gave him the happiness, sense of belonging and social security that he had craved. “I never looked back,” he says.
Andrew had found school even tougher. Bentall now thinks he stole other boys’ money as a kind of protest. He was expelled at 15 and then dropped out of state school without qualifications. He found comfort in drugs and the guitar.
Richard says he felt responsible for his brother at school and became exasperated by his rule-breaking. He felt flickers of his father’s authoritarianism in his own dealings with his brother. Later, he avoided seeing Andrew. “I didn’t pay him much attention because, if I’m honest about it, I thought he was a pain in the arse and it was too difficult,” he says. He describes the tower block where Andrew lived and died as “a desolate place”.
In some of his earliest work, Bentall looked at auditory hallucinations. He believed these voices were the result of a failure by the receiver to recognise them as their own inner speech. His elderly mother has only recently started to talk about Andrew’s death. “One of the things she has said is that he heard voices,” Bentall says. “He never told me that.”
After finishing his undergraduate degree, Bentall was given a room in a nursing hostel at a psychiatric hospital near Bangor. He wanted to find a subject for a PhD. But while talking to patients with a range of diagnoses, including schizophrenia, he struggled to pin down an idea. This seeded doubt about the way people with mental illnesses were categorised. (After his doctorate, Bentall qualified as a clinical psychologist at the University of Liverpool in 1984.)
In those days, Bentall says, there remained a broad divide between psychiatrists, who treated psychosis as a brain disease, and psychologists, who treated neurosis – common disorders such as depression and anxiety. Drawing on a curious naivety and the confidence of youth, Bentall wondered who this divide was helping.
He explored this further at Ashworth hospital, then a notorious high-security psychiatric hospital that housed Ian Brady, the Moors murderer. He says about half the inmates had schizophrenia, yet they had a complex array of symptoms. “I realised that schizophrenia wasn’t a thing,” he says. “It was just this name, which had been invented for a ragbag of different symptoms.”
Bentall worked with a patient who had almost murdered his father. He says the man – who sustained a disability after attempting suicide after the attack – reminded him of his brother, who was still alive at the time; they both had hippyish long hair and played the guitar. The patient heard voices telling him, over and again: “Give cancer to a crippled bastard.” The man couldn’t make sense of them, but to Bentall it was clear: he was talking to himself, consumed by guilt and self-loathing.
Bentall learned more about the man in conversations that defied convention. “It sounds crazy now, but we just had no idea how to be in a room with a mad person,” he says. “And it turns out, the way to be in a room with a mad person is exactly the same as with a non-mad person. These are people who have had huge misfortune in life and they are trying to make sense of their world. And you can have a conversation with them about that.”
A small group of other young psychologists were coming to similar conclusions. They began to experiment with therapy. Could it be an alternative to drugs with potentially terrible side-effects? Could patients learn to live with symptoms rather than trying to crush them with chemicals? Clinical trials followed. Eventually, in 2002, cognitive behavioural therapy (CBT) was approved to treat psychosis.
While the trials showed that CBT could be effective, Bentall himself says it was never going to be a magic bullet. He began to look for other shifts in thinking. He examined the significance of the relationship between patient and therapist. He found that the quality of this “therapeutic” alliance predicted how well the patient improved regardless of the type of therapy used. The analysis also showed that a bad relationship could harm a patient.
Bentall’s compassionate approach also included a greater consideration of poverty, racism and childhood trauma – and of the role of debt or marriage counselling, for example, in helping to treat mental illness. He sees clinical psychology as an exercise in public health. “Arguably, the biggest cause of human misery is miserable relationships … conducted in miserable circumstances,” he has written.
Viewing mental illness as biological tempts us to categorise people as either mentally well or ill – and to assume that each of us is either doomed or impervious. “It also encourages the idea that there is a simple fix, maybe a chemical,” Bentall says. He says mental illness is a continuum – one that all of us are on. It was on the basis of this continuum that, in a 1992 paper, he proposed that happiness could be categorised as a psychiatric disorder.
Bentall is pleased that mental health has become such a prominent cause in recent years, but he takes issue with some of the framing. The biological approach, for instance, which also encourages well-meaning comparisons between mental and physical illnesses, can heighten stigma. “The more we think of mental illness as a genetically determined brain disease, rather than a reaction to unfortunate circumstances, the more we shun psychiatric patients,” he says.
In his second book, Doctoring the Mind: Why Psychiatric Treatments Fail, published in 2009, he took on big pharma and the way psychiatric drugs are trialled, marketed and prescribed. Yet he insists that he believes in using psychiatry and psychiatric drugs when more humane treatments, as he sees them, have not worked. He says relations between the professions – and training in both – have transformed since he started out. “Students are now constantly evaluated for their clinical skills, because we now recognise the importance of that key ingredient – the therapeutic alliance,” he says.
When the pandemic struck, Bentall worked quickly with colleagues at six universities to monitor its effects on mental health. During the first UK lockdown last year, psychiatrists warned of a “tsunami of referrals”. Bentall’s study, based primarily on a large ongoing survey, has shown that more than 20% of people have struggled, mostly as a result of loss of income. He says that, while significant, this does not amount to a tsunami. “The psychological lessons of the pandemic are to look after people who lose their incomes, young people and parents – particularly women – who are at home with young kids,” he says.
Bentall says the pandemic defied predictions of gloom for many – or even provided a fillip – because it offered something we all crave: a sense of belonging, even in extremis. “People have formed closer social bonds,” he says.
Not long after Bentall qualified, his mother told him that she thought Andrew might be suicidal. “I kind of just dismissed it,” he recalls. “And I don’t feel good about this …” He struggles to find the right words, his voice cracking. “I think it was just … too difficult.”
Looking back at his career, Bentall thinks his guilt and loss may have guided him in ways he will never understand. “I know that I care about people with psychosis,” he says. He feels as though he lacked compassion for his brother, but he has found it in spades in his profession. “People with psychosis are all struggling to make sense of the world, which is what we’re all doing,” he says. He looks around his study, replete with books, including his own, and awards on the walls. “I don’t know, maybe all of this is because of my brother.”