Aug 14

Four Secrets in Plain Sight (About Mental Health)

The “secrets” I believe that are there for all of us to see and apply are: 1) Behavior serves a purpose, 2) The power of attachment, 3) As a rule, less is more, and 4) Chronic stress is the enemy. Psychiatrist Lloyd I. Sederer, HuffPost, author of Improving Mental Health: Four Secrets in Plain Sight

When Lloyd I. Sederer, MD, wrote last year’s Improving Mental Health: Four Secrets in Plain Sight, he “was inspired by a (short) book by the Pulitzer winning Dr. Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science, about nature, medicine and three rather counter-intuitive laws.”

Intended for both patients and practitioners and only 109 pages, some with photos, Sederer’s book is indeed, as he describes it on author Pete Earley’s website, “mercifully short.”

Also in the above-cited post are the “secrets” Sederer has gleaned from decades in the psychiatry field:

  • Behavior serves a purpose. The search for meaning and the identification and communication value of a behavior are too often overlooked aspects of mental health care and a lost opportunity with and for clinicians, patients and their families.
  • The power of attachment. The force of attachment as a human need and drive must be harnessed if we are to change painful and problem behaviors. Relationships are the ‘royal road’ to remedying human suffering—both individual and collective.
  • As a rule, less is more. Mental health treatments, both medical and psychosocial, have too often been aggressive, from high doses of drugs to intensive sessions and psychic confrontation in individual and group psychotherapy. Unfortunately, these usually well intended but high risk efforts infrequently provide help. And they can have unwanted and problematic effects. Primum non nocere—first, do no harm—is the first law of medicine. 
  • Chronic stress is the enemy. From adverse childhood experiences to post-traumatic stress, chronic stress can be an underlying factor in the development of many mental and physical disorders. Chronic stress shortens our lives and fosters a host of physical illnesses. However, chronic stress can be understood and contained, thereby reducing its damage.

Notes On Each “Secret” By Two Reviewers

Secret #I: Annette L. Hanson, MD, Psychiatric Times, highlights “Sederer’s observation that understanding these behaviors ‘replaces darkness with light, distortion with reason, blame with tolerance, dismissal with discussion, and powerlessness with problem-solving’.”

Secret #2: Hanson says the book’s second chapter “presents a historical overview of attachment and object relations theory from Klein and Freud to Henry Harlow. This is followed by a discussion of attachment styles and an explanation of how disruption of attachments in early life creates adult dysfunction. An excellent discussion of the therapeutic alliance explains how a stable and mature attachment can overcome childhood neglect and trauma.”

Secret #3: Not only about medication but also therapy. “This chapter,” states Hanson, “is a cogent reminder that the wrong psychotherapy, or even an established therapy given for the wrong purpose, can be harmful.”

Secret #4: ACES, or adverse childhood experiences, are addressed in Sederer’s discussion of chronic stress, says psychiatrist Carol W. Berman, HuffPost. “He wisely associates multiple ACEs as risk factors for addictions, depression, heart, lung, and liver disease, STD’s, intimate partner violence, smoking, suicide attempts, and unintended pregnancies.”

Aug 04

July News: Mental Health Days and More

Another sampling of top mental health news from July:

I. Woman Takes Mental Health Day, the Internet Explodes (and Her Boss Had the Perfect 3-Sentence Response). Peter Economy, Inc.

Jena McGregor, Washington Post, called this “The Mental Health Email Shared ‘Round the World.”

A boss actually applauded an employee who informed colleagues she was taking some mental health days. Further explanation from McGregor:

Surveys by the American Psychological Association’s Center for Organizational Excellence show that less than half of Americans (44 percent) say they believe the climate in their organization supports well-being, and that nearly 20 percent of employees say the challenges of their jobs were harder to handle in the past month due to mental health issues such as depression or anxiety. For employers, says the center’s director, David Ballard, ‘the costs of untreated mental health issues, the lost productivity, is actually more costly than the treatment side because people are there at work but not functioning to full capacity.’

II. What We Finally Got Around to Learning at the Procrastination Research Conference. Heather Murphy, New York Times

A few of the things: numbers, a definition, and how to change.

One out of five people, researchers have found, fall into a category they call chronic procrastinators or procs (rhymes with crocs). The proc consistently procrastinates consistently in multiple areas of his or her life — work, personal, financial, social — in ways that attendees describe as wreaking havoc, undermining goals and producing perpetual shame….
It is more complicated than ‘if you do it X number of times a week you’re a proc.’ But if you procrastinate ‘almost every day, at least half of the time you have work tasks,’ that is a solid hint that you qualify, said Julia Elen Haferkamp, a psychologist at the University of Münster in Germany…
Asked to summarize their advice to the procs of the world, most attendees offered a version of the following: Accept that changing will require learning to manage your thoughts and emotions more than figuring out how to manage your time. If it is a severe problem, consider working with a professional who understands procrastination. And for those who have A.D.H.D., the cycle of procrastination may operate differently than for those who do not.

III. Don’t Believe in God? Maybe You’ll Try U.F.O.s. Clay Routledge, New York Times

On an apparent need for many to have something to believe in:

…People who do not frequently attend church are twice as likely to believe in ghosts as those who are regular churchgoers. The less religious people are, the more likely they are to endorse empirically unsupported ideas about U.F.O.s, intelligent aliens monitoring the lives of humans and related conspiracies about a government cover-up of these phenomena.
An emerging body of research supports the thesis that these interests in nontraditional supernatural and paranormal phenomena are driven by the same cognitive processes and motives that inspire religion.

IV. The life-changing science of photographing your clutter, CNN

A take-off on Marie Kondo‘s The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, the title of this article has to do with our collective resistance to unloading stuff. “We have an average of at least 50 unused items in our homes, including clothing, electronic devices and toys.”

What might help:

…In studies conducted online and in person, we found that participants reported that they would experience less identity loss from donating a cherished item if they had photographed it or preserved the memory of it some other way.
Initially, in an online study, we let our subjects choose how to handle this. Nearly two out of three opted for photography, by far the most popular method. The other most common techniques included creating a scrapbook page or making a video about it — the approach taken by 22 percent of our participants — and writing a note or making a journal entry — selected by 13 percent.

V. Eating Too Much Sugar Is Linked to Depression in Men, Poor Things. Lisa Ryan, Science of Us

Brief excerpt:

Good news for women: While added sugar is arguably unhealthy for everyone, and puts your physical health at risk, it turns out women can at least consume it without getting depressed. Tiny victories! But unfortunately for men, that’s not the case; a new study found that ingesting high quantities of added sugar makes men more likely to become depressed.

Jul 24

“Scared Selfless”: Therapist’s Horrific Childhood Trauma

I was raped and tortured and prostituted to countless men. I was used in child pornography. As a result of this abuse, I grew mentally disturbed and was in danger of a wasted existence. But I made a decision not to give into despair. I vowed that, no matter what, I was going to fight for a good, decent, normal life. The journey to that good life wasn’t easy. It was fraught with pain and self-doubt and self-loathing. But I persevered and eventually found the help and love I needed to be happy. Psychologist Michelle Stevens, from her memoir Scared Selfless (2017)

Michelle Stevens, PhD, founder and director of Post-Traumatic Success, a nonprofit that provides education and support to victims of psychological trauma, is the author of Scared Selfless: My Journey from Abuse and Madness to Surviving and Thriving. Scared Selfless is based on her psychology dissertation, one that merited special distinction from her school, Saybrook University.

Stevens’s memoir presents a unique viewpoint: on the one hand, as a therapy client she’s addressed the severe mental health effects of her own horrific abuse; on the other, she’s now a therapist herself, able to offer her specialized expertise to clients who also have trauma histories.

In the brief video below, Stevens explains further:


Kirkus Reviews summarizes what happened to the author early in life:

Stevens was 8 years old when Gary Lundquist came into her life. A primary schoolteacher and toystore owner, his apparent interest was in the author’s impoverished, poorly educated mother. But shortly after the pair began dating, Lundquist declared his intention to develop a ‘special relationship’ with Stevens and took the child home with her mother’s consent. There, he began to ‘train’ her as a sex slave whom he also prostituted to other equally sadistic pedophiles. The abuse, which Stevens could not articulate to her mother, continued for six years.

The toll the trauma and forced silence took was enormous. As the book blurb states, “Michelle suffered from post‐traumatic stress disorder, anxiety, and depression, and made multiple suicide attempts. She also developed multiple personalities.”

“In the end,” adds Kirkus, “it was the empathetic, nonjudgmental kindness of a dedicated therapist—who later became Stevens’ professional role model—that saved her life and gave her the courage to begin the journey toward psychological health.”

Selected Reviews

Sara Corbett, co-author of A House in the Sky“Michelle Stevens has written a fierce, honest account of her life that will stay with any reader long after the last page has turned. This book does more to explain what it feels like to live with the effects of trauma than anything I’ve ever read. It’s the rare book that’s both personal and clinical. It should be a resource and an inspiration not just to survivors but to those who love and seek to understand them.”

Dave Pelzer, author of A Child Called “It”: “a riveting memoir that takes readers on a roller coaster ride from the depths of hell to triumphant success. Michelle’s extraordinary life story and diligent, compassionate work as a therapist teaches us that, with true-grit determination, it’s possible to overcome the worst adversity. Scared Selfless offers courage, strength, and resilience to anyone who desires a better life.”

Joe Navarro, Special Agent (Ret.) and author of Dangerous Personalities“…This is a story about the psychological legacy of abuse, the struggle to survive a troubled mind, the challenges of finding elusive help and about finally and triumphantly finding redemption through the most unapologetic example of personal grit I’ve ever read…”

Jul 17

Impaired Therapists: How to Intervene

Unbreakable Kimmy Schmidt and Gypsy are a couple of the latest TV series, both streaming on Netflix, to feature impaired therapists. Kimmy Schmidt‘s Tina Fey has a minor role as Andrea, an alcoholic therapist who somehow still manages to offer the lead character (Ellie Kemper) tidbits of useful advice. Her impairment, however, has ultimately led to losing her license, one possible outcome in the real world as well.

Gypsy‘s Naomi Watts portrays a therapist who’s been described as unethical and a sociopath.

In real life a relatively small percentage of clinicians in any of the mental health disciplines—which include such areas as social work, psychology, and psychiatry—are likely to be impaired therapists. However, in order to protect the clients who may potentially be affected, rules have to be in place.

Therefore, the various professional organizations whose members are providers of mental health services have pertinent codes of ethics. According to a leading ethical expert in my own field, Fredric Reamer, impairment can not only involve failure to comply with those ethical standards but also incompetence (Social Work Today).

The social work code of ethics specifically states the following regarding steps to take when a colleague is deemed impaired:

(a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

(b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

All of the above takes into account the unfortunate fact that sometimes the nature of certain personal issues—such as addictions, burnout, health issues, and mental illness—can mean they will go undetected by the practitioners themselves.

Pertinent to this is a quote from the NASW Impaired Social Worker Program Resource Book that Reamer cites:

The problem of impairment is compounded by the fact that the professionals who suffer from the effect of mental illness, stress, or substance abuse are like anyone else; they are often the worst judges of their behavior, the last to recognize their problems and the least motivated to seek help. Not only are they able to hide or avoid confronting their behavior, they are often abetted by colleagues who find it difficult to accept that a professional could let his or her problem get out of hand (p. 6).

It’s not only colleagues who have recourse; clients do as well and need to trust their own instincts in this regard. If you notice something is wrong and talking it out with the therapist either doesn’t seem like an option or fails, you can report the impaired therapist to his/her employer and/or professional association and/or licensing board, and/or, if involved in payment for services you’re receiving, your health insurance company.

Jul 14

“To the Bone”: Intensive Treatment of Anorexia

Today is the Netflix opening of Marti Noxon‘s To the Bone, which focuses on anorexia. Both Noxon and lead actress Lily Collins have dealt with eating disorders in their own lives.

Responding to those who’ve criticized the film in advance, Melanie McFarland, Salon, states that To the Bone “is an admirable and empathetic work that does not romanticize anorexia or the young woman being ground into nothingness by the disease, as some have feared.”

Boyd van Hoeij, Hollywood Reporter, sets up the plot and main characters:

Gaunt and expressionless, Ellen (Collins) is first seen making a humorous but also offensive sign at what turns out to be her fourth in-patient treatment, which leads to her being kicked out again. A few quick scenes establish the situation back home in Los Angeles, where her father is never present; her occasionally borderline inappropriate, endlessly talkative but also somewhat frosty step-mom, Susan (Carrie Preston), tries to overcompensate; and Ellen’s half-sister, Kelly (Liana Liberato), is kinder but has secretly been suffering, too, from having to deal with having a ‘freak sister’ with a disorder. Her real mom, Judy (Lili Taylor), ‘a lesbian with bipolar disorder,’ as per Susan, has moved to Arizona to be with her no-nonsense girlfriend, Olive (Brooke Smith).

The Trailer

Depiction of Treatment Program

For her fifth intensive treatment stint, Ellen winds up in a program run by Dr. William Beckham (Keanu Reeves). States Nick Allen,

…Noxon’s narrative gets its main focus when she is brought to the house, where the rules start to take place. There are no doors in the house, no cell phones, and points are earned by doing chores, which can be used to have time away from the house. We also meet other residents of various conditions, like Pearl (Maya Eshet), who is often in bed with a tube in her nose, former dancer Luke (Alex Sharp), who lost a great deal of weight after an injury, and even a character played by Leslie Bibb, who is pregnant despite the thinness of her body, and is working hard to safely deliver the baby. Ellen wrestles with whether she wants to be better, facing her self-hatred, due in part to a disturbing past.

Chuck Bowen, Slant: “Beckham is seen only sparingly, in the sidelines as a paternal ghost who suggests a nicer version of Ellen’s unseen father, who can’t be bothered to attend her family therapy session, which devolves into a litany of accusations.”

Hadley Freeman, The Guardian, is one of those who’s less than impressed:

…[Dr. Beckham] proves his unconventionality by swearing occasionally and insisting his methods are totally different from anyone else’s (they’re not: they rely on therapy and healthy eating, as almost all eating-disorder treatments do). He also clearly enjoys his power over his mainly female patients and a braver, less conventional film would have explored this more. Instead, To the Bone merely accepts the doctor’s version of himself as the brilliant, patriarchal medical professional who can fix women.

Selected Reviews

Boyd van Hoeij, Hollywood Reporter: “…an occasionally harrowing but sometimes also surprisingly warm and funny tale that, while the characters focus a lot on eating (or, rather, not eating), is really more about finding the will and self-love necessary to live rather than about dealing with an eating disorder.”

Peter DeBruge, Variety: “While not downright irreverent, this is the kind of anorexia movie where characters crack jokes about not wanting to visit the Holocaust Museum, lest they feel guilty for starving themselves. ‘To the Bone’ would hardly qualify as a comedy, but it doesn’t take the kid-gloves approach either — in fact, its attitude seems almost ruthlessly pitiless at times…”

Hadley Freeman, The Guardian: “…(W)hen all a movie about anorexia tells you is that people with anorexia have issues with food, and that this makes them thin and unhappy, you have to wonder what the point of the movie is.”