Four Secrets in Plain Sight: Lloyd I. Sederer

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.”

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