Monday, February 6, 2017

The Mind Unlocked, In Two Evenings Or Less

Lloyd I. Sederer, M.D., Improving Mental Health: Four Secrets in Plain Sight

Medically grounded mental health treatment has a history of being very fashion-driven. The lengthy inpatient committals at spa hospitals, made famous during the 1980s, were curtailed in favor of heavy medications when HMOs demanded quick, low-cost fixes in the 1990s. Dr. Lloyd Sederer, who has contributed to mental health treatment as both a researcher and a clinician, attempts to eschew trends and focus on what actually works. The product is readable and frequently eye-opening.

According to his introduction, Dr. Sederer writes for two distinct audiences: psychiatric clinicians dealing with patients suffering significant disorders, as well as students; and the families and friends of such patients, who must monitor their loved ones and provide constant palliative care. As such, Sederer’s prose is frequently dense with scientific concepts, but he never introduces terminology without providing definitions. His mix of official, medical language, with case histories, makes this a very humane exposition.

As the title unambiguously declares, Dr. Sederer distills mental health treatment into four broad “secrets,” or functional approaches. The first is, Behavior Serves a Purpose. All human behavior, even counterproductive, harmful, and seemingly “insane” behavior, means something. Substantial treatment begins, not when we get patients to stop hitting themselves, but when we identify what actual meaning their actions serve. This isn’t always easy, much less straightforward. But it’s more productive than just condemning actions we don’t understand.

Second, Sederer emphasizes The Power of Attachment. Humans are linked creatures, and loneliness can transform our mental functions, especially at early ages. People will remain in dangerous relationships rather than confront loneliness (which Sederer clearly distinguishes from solitude). And our need for relationship influences our ability to heal from illness. Sederer describes the “therapeutic alliance,” the relationship by which therapy actually makes any progress. It isn’t just that therapists help, but how they help, too.

Lloyd I. Sederer, M.D.
Throughout this book, but especially here, Sederer overlaps significantly with the reading on addiction theory I pursued a few years ago. He talks about Bruce Alexander’s Rat Park experiments: laboratory rats in environments designed to resemble their natural habitats wax prosperous, avoid harmful behaviors, and live long, happy lives. Rats raised in cages will gorge themselves on drugs until they overdose and die. Here and elsewhere, Sederer demonstrates that all psychology is linked.

Third, Sederer writes, As a Rule, Less Is More. Remember the spa hospitals and heavy medications I mentioned earlier? Though tilted toward opposite extremes, both options represent a do-too-much attitude of massive interventions designed to overwhelm whatever preëxisting conditions produce undesirable behaviors. Rather, Sederer writes, the therapeutic goal should be to reëstablish optimum natural balances, and often, the least intrusive approach works best. Care providers, including families, should avoid the temptation to overtreat routine conditions.

Finally, Sederer hits the one I find most familiar: Chronic Stress Is the Enemy. This takes different forms in different patients, at different stages of life. Children exposed to chronic abuse or neglect develop defense systems that, as adults, turn maladaptive. Adults subjected to these same conditions develop inflammatory diseases that shatter our defenses and literally shorten our lives. These can manifest in myriad ways. What matters isn’t the particulars, but that stress undermines our bodies and brains.

In describing these operant conditions, Sederer also gives constant indications how to counter them. Some responses are within the patients’ control, while others require physicians, families, and other caregivers to take first initiative. In a few cases, Sederer makes recommendations of medications known to have beneficial effects, but in keeping with his Less Is More philosophy, he dispenses these suggestions only sparingly. It isn’t what goes into our bodies, but how we treat them, that transforms us.

Readers familiar with developments in recent psychology, even as filtered for a generalist audience, will recognize much here they’ve read before. From the effects of isolation and company on our short-term mental health, to how epigenetic influences reshape our brains over the long haul, I recognize from other writers. Johann Hari, Stephen Ilardi, and Gabor Maté cast long shadows over Dr. Sederer’s writing. For well-read audiences, Sederer brings these disparate influences together under one tent.

Counting out Sederer’s works cited lists and liberal illustrations, this book runs barely eighty pages, basically a long article. Ambitious readers undeterred by technical prose will savvy this book in one or two evenings. Yet it never feels underwritten or like it’s forgotten anything. It just stays concise, clearly focused on its topic. If anybody you love is undergoing mental health treatment, consider reading this book. It may open your eyes.

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