In the U.S., there is growing concern that doctors are overprescribing medicine as the answer for patients with mental health and behavior problems. FIn the U.S., there is growing concern that doctors are overprescribing medicine as the answer for patients with mental health and behavior problems. Feelings of sadness, behaviors like restlessness, which were once seen as normal aspects of being a human being, are now diagnosed as health problems like depression or attention deficit hyperactivity disorder, the argument goes, and treated away with prescription drugs.
Psychiatrist Daniel Carlat does not necessarily endorse this, but he does offer reasons from his own personal experience as a psychiatrist--as to why medications are so commonly prescribed and advances a compelling argument for a more holistic approach that emphasizes talk therapy equally if not more than medicine. Medication does work, Dr. Carlat says, but it should not be the only answer, and part of the reason why medication is so often prescribed is because of the commercial power of pharmaceutical companies and the reimbursement practices of insurance companies. Dr. Carlat says he and his colleagues are reimbursed better if they see patients for 15-minute medication management programs than 45-minute talk therapy programs--even though therapy works as well if not better than med management for treating depression.
Dr. Carlat gives us a firsthand account of his own experiences as a paid shill for a drug company, as well as a review of the evidence on what research says about the efficacy of psychiatric medication. He offers some very constructive suggestions for how to balance the system so that there is not an over-reliance on prescribing. He argues that psychiatrists should re-integrate talk therapy in their practices and talks about his own experiences struggling to help patients who he can only see for 15-minute medication sessions. This focus on his experience gives the reader a very tangible picture of what the problem is and what the solution could look like. To his credit, he does not dismiss psychologists, licensed social workers, and nurse practitioners but rather encourages psychiatrists to extend an olive branch to them.
What might surprise some people is how little is actually known about behavioral and psychiatric disorders compared to just about any other kind of health problem, like cardiovascular disease, cancer, asthma, etc. There is no clear scientific explanation for WHY antidepressants work either, which people might find hard to believe. This doesn't mean we shouldn't do anything if we do suffer from mental health problems or that they aren't real, it just means that we shouldn't trust anyone who promises a silver bullet for these complex issues. Really recommend this book for anyone who is wondering how to deal with a mental health issue--their own or family and friends....more
Research is increasingly showing that there are several kinds of depression. One of those kinds is anhedonia--the inability to feel pleasure. In thisResearch is increasingly showing that there are several kinds of depression. One of those kinds is anhedonia--the inability to feel pleasure. In this book, Dr. Hart examines modern anhedonia, positing that it is at epidemic proportions. Today, anhedonia is paradoxically a result of too much pleasure. That is, our society has available so many tools that give us a temporary rush of pleasure (dopamine)--from smart phones to video games to food to porn--that we overload our pleasure feedback loop to the point that we have a harder time feeling pleasure and need more of it to get the same sensation. Things need to be increasingly more novel or more stimulating or more excessive. If this sounds a lot like addiction, that's basically what Dr. Hart says is going on when we say, check our email for the 50th time in one day. Eventually our ability to feel pleasure is corrupted or depleted. This book may explain why modern folks have trouble sitting still, enjoying a sunset, engaging with people, and in general doing things that do not provide immediate gratification. It all rang very true to me. The author infuses his religious background in a way that I did not find moralistic. In fact, it makes sense that religion would be an outlet for those who are looking for meaning beyond the kind of pleasure-seeking that much of American secular society (entertainment, advertising, consumer culture) promotes.
Like some psych books I read, this one could have benefitted from more research and description of what this anhedonia-stricken society looks like. What are Americans doing that is causing this epidemic of anhedonia? Sometimes these ideas can get abstract or not relatable if we aren't given real life stories beyond just the case studies of the doctor's patients. Still, a very useful fundamental insight that I think could help a lot of people....more
Women AND men should read this. Lerner's book presents anger not as something to fear but something to observe, tap into, and use constructively. SheWomen AND men should read this. Lerner's book presents anger not as something to fear but something to observe, tap into, and use constructively. She tells us that our culture raises women and men to handle anger in very different--and yet equally not constructive--ways. Women are never supposed to show their anger because they will be viewed as unattractive and hysterical. Meanwhile, for men, the only emotion they're supposed to have is anger. After leaving us with this idea, Lerner goes into many common ways that couples, friends, and families deal with or don't deal with anger, based on stories from some of her patients. Ultimately she shows us that acknowledging rather than suppressing anger gives women agency and that one's feeling anger does not mean s/he has to start bitter and corrosive arguments. As I've learned from many psychology texts and my own life, thought and emotion suppression tends to backfire. Mindfulness--being present and accepting one's feelings while not always acting on them--is an approach that has been much better for my own personal health and well being and one I continue to work on....more
I'm giving this four stars because it really hit home. I've long known that I'm a guilt-ridden person. Given my background, this may not surprise. ButI'm giving this four stars because it really hit home. I've long known that I'm a guilt-ridden person. Given my background, this may not surprise. But I had not until reading this book observed how pervasive guilt can be, how present it is in so many of our relationships, and how it has been the driver for decisions and behaviors I would have never on my own connected with this terrible feeling. As with so many psychologically constructive books, this one proves that awareness of feelings and subconscious motivation is at the beginning of the road toward being at peace with oneself and consequently, with others. I have benefited enormously from the perspective imparted here even in the few weeks since I've read this....more
A very quick read, Triburbia presents the kind of social milieu that makes anyone struggling to make it creatively quite jealous: here are the artistsA very quick read, Triburbia presents the kind of social milieu that makes anyone struggling to make it creatively quite jealous: here are the artists/writers/chefs who can afford to live in TriBeCA, the ones who dress well, whose kids dress even better, who live in multimillion dollar lofts, who congregate at breakfast spots on weekdays as if they don't have jobs. Who are these people?
It turns out they're not that interesting. Triburbia is somewhat funny, somewhat fleshed out, not particularly deep. Taro Greenfeld's characters felt flat. Though he writes from different characters' perspectives, both women and men, they didn't feel distinct. They all exude a similar feeling of emptiness to them, like they were missing whatever it is that gives people life and vitality. Perhaps this is the point. But it's a point that has been done better and more satisfyingly. ...more
I'm not a fan of self-help books that offer a silver bullet mantra to succeed. Despite the kind of schmaltzy cover, this is not such a book. Instead,I'm not a fan of self-help books that offer a silver bullet mantra to succeed. Despite the kind of schmaltzy cover, this is not such a book. Instead, it is a meditation on the value of psychotherapy, a collection of ideas and anecdotes on the importance of dealing with pain and problems in order to grow, a revelation on the stunting behaviors and personality disorders that hinder growth, and a call to challenging yourself if you want to live a meaningful life. There's little I can say about this book that could be said as well as what Scott Peck has written. This is a challenging book. Dr. Peck does not let his reader off easy. And he's not giving out any prizes to people who choose to use his book as a guide. But to those of us who have thought a lot about why we are here, who have been wracked by neurosis that seems to be blocking us from something greater, who wonder what we are meant to do in life, and who want to get something beyond what America's "money culture tells us we should buy" (to quote the president), I'd highly recommend this book. ...more
First of all, I'm surprised and a little saddened that so many people call narrator Nora Eldridge an unlikeable character. While she isn't always pleaFirst of all, I'm surprised and a little saddened that so many people call narrator Nora Eldridge an unlikeable character. While she isn't always pleasant or kind, I think her situation is very relatable, especially for women. Take the book's opening sentences from Nora:
"I'm a good girl, I'm a nice girl, I'm a straight-A, strait laced, good daughter, good career girl, and I never stole anyone's boyfriend or ran out on a girlfriend...It was supposed to say 'Great Artist' on my tombstone, but if I died right now, it would say such a good teacher/daughter/friend instead; and what I really want to shout, and want in big letters on that grave, too, is FUCK YOU ALL. Don't all women feel the same?...My worry now is we're brainwashing them from the cradle, and in the end, even the ones who are smart will be damn foolish. What do I mean? I mean the second graders at Appleton Elementary, sometimes the first graders even, and by the time they get to my classroom, to the third grade, they're well and truly gone--they're full of Lady Gaga and Katy Perry and French manicures and cute outfits and they care about how their hair looks! In the third grade. They care more about their hair or their shoes than about galaxies or caterpillars or hieroglyphics."
I think a novel by a woman that explores these themes of woman being socialized to stifle their internal drive and intellect is quite rare. Messud channels Ralph Ellison's Invisible Man and several male authors who have created alienated male characters. Nora like many of us, especially us women, has subsumed her desires for years and years, to the point where she can only begin pursuing her artistic dreams again when she is given a kind of permission by a new woman in town, an artist named Sirena Shahid whose husband Skandar is a visiting professor at Harvard. (The book is set in Cambridge, Mass.). Nora finds herself falling in love with the whole cosmopolitan family: Skandar, Sirena, and their son Reza in a mix of affection and envy, and her long-squelched passion finally awakens. The book features a powerful theme, both readable and fluidly and brilliantly written, and yet I was left feeling something was missing.
I think it was how singularly Nora's identity drama played out around this family. As the book progresses, we get really involved in the world of the Sahids and lose a sense of how the rest of Nora's life is going. We are made to believe that she can continue as normal at school, do her job as competently as she always has, while her profound loneliness is made worse by her obsession with this family. We are told how likeable, competent, and friendly Nora appears to others, but I felt we rarely saw it. Of course, the point of the book is to show us that the woman upstairs is not really who we think she is, but I was not always convinced that she was who we were told others thought she was. I think this could have been done more through internal monologue. Wouldn't, given her straight-A, people pleaser persona, that monologue have contained more anxiety about how she came off to people, even as she battled in vain for her true, angry, passionate self? I think also we could have gotten a better sense of external Nora by seeing more character reactions to her over the course of the book--by her colleagues, by the kids, by Skandar, Sirena, and Reza. In conversation, she usually comes off as a bit cold and aloof--not necessarily the kind of person who everyone would think was too sweet to have real feelings and passions.
Still, I marveled the whole time at the writing, and I think Messud deserves to be applauded for tackling this theme and giving us a character who she must have known would not be sympathetic to many people....more