Not everyone likes Stephen Grosz's The Examined Life



NY Review of Books 

"But what are we to say of the likes of Haruki Murakami? Or Salman Rushdie? Or Jonathan Franzen? Or Jennifer Egan, or recent prize-winners like Andrés Neuman and Eleanor Catton, or, most monumentally, Karl Ove Knausgaard? They are all immensely successful writers. They are clearly very competent. Knausgaard is the great new thing, I am told. I pick up Knausgaard. I read a hundred pages or so and put it down. I cannot understand the attraction. No, that’s not true, I do get a certain attraction, but cannot understand why one would commit to its extension over so many pages. It doesn’t seem attractive enough for what it is asking of me.

Take Elena Ferrante. Again and again I pick up her novels and again and again I give up around page fifty. My impression is of something wearisomely concocted, determinedly melodramatic, forever playing on Neapolitan stereotype. Here, in My Brilliant Friend, the narrator is remembering a quarrel between neighbours:

As their vindictiveness increased, the two women began to insult each other if they met on the street or the stairs: harsh, fierce sounds. It was then that they began to frighten me. One of the many terrible scenes of my childhood begins with the shouts of Melina and Lidia, with the insults they hurl from the windows and then on the stairs; it continues with my mother rushing to our door, opening it, and looking out, followed by us children; and ends with the image, for me still unbearable, of the two neighbors rolling down the stairs, entwined, and Melina’s head hitting the floor of the landing, a few inches from my shoes, like a white melon that has slipped from your hand.

What can one say? Making no effort of the imagination, Ferrante simply announces melodrama: “Harsh, fierce sounds”; “One of the many terrible scenes of my childhood”; insults are “hurled.” The memory is “for me still unbearable” though in the following pages the incident is entirely forgotten. Is “entwined” really the right word for two people locked in struggle on the stairs? As in a B movie, a head hits the floor a few inches from our hero’s shoes. Then comes, the half-hearted attempt to transform cartoon reportage into literature: “like a white melon that has slipped from your hand.”

I can’t recall dropping a melon myself, but if the aim of a metaphor is to bring intensity and clarity to an image, this one goes in quite a different direction. The dull slap of the soft white melon hitting the ground and rolling away from you would surely be a very different thing from the hard crack of a skull and the sight of a bloody face. I’m astonished that having tossed the metaphor in, out of mechanical habit one presumes, the author didn’t pull it right out again. And even more I’m astonished that other people are not irritated by this lazy writing.

It’s not only fiction that does this to me. I am told, for example, that Stephen Grosz’s book The Examined Life—a psychoanalyst giving us his most interesting case histories—is a work of genius and is selling like hotcakes. I buy a copy, and halfway through I toss it away, literally, at the wall, in intense irritation. How can people like these stories, with their over-easy packaging of what are no doubt extremely complex personal problems, their evident and decidedly unexamined complacency about the rightness of the analyst’s intervention?"

Madness in Civilization -- Andrew Scull

This shining review of Andrew Scull's Madness in Civilization is particularly noteworthy, given that the reviewer, Daniel Pick, is a psychoanalyst, and Scull is habitually dismissive of psychoanalysis. Veterans of my Abnormal Psychology course should pat themselves on the backs for already knowing about Henry Cotton, Walter Freeman, and Julius Wagner-Jauregg (malarial treatments).

"If there is a subtext to Scull's mostly cool and appraising survey, it is indeed the propensity of the doctors to go mad for their theories and to regard abandonment of doubt as tantamount to professional strength. The notorious surgeon Henry Cotton, who was allowed during the interwar years to bring havoc to the lives of his patients in New Jersey, was already the protagonist in one of Scull's earlier books, Madhouse (meaning not so much a residence for the mad, but a site of mad operations). Cotton's reign at the Trenton State Hospital is also briefly recapped here. His crazed surgical practices were based upon his settled view that the patients were almost invariably suffering from sepsis; their condition often required, in his eyes, the excision of parts or the whole of their internal organs. He caused much misery (and many deaths) with his unfettered assaults upon stomachs, spleens, cervixes and colons. Despite the serious misgivings of colleagues, nobody seemed able to stop him or blow the whistle. Such institutional failings and cover-ups, a collective incapacity to curb the lunacy of the individual or coterie, as we know all too well from more recent scandals, provide the most shocking story of all.

From Cotton we move on to the vicissitudes of insulin treatment, the sagas of those experiments to deliberately infect physically healthy patients with the blood of malaria sufferers, and so to the postwar brain operators such as Walter Freeman, who so refined the treatment that he boasted of how he could deal with a dozen or more people in sequence in a single afternoon. Scull's description of Freeman's fast-track 'transorbital lobotomy' is not for the faint-hearted. Few would defend this now, but ECT remains in existence, refined from the earlier experimental phases and a subject of division and debate in the psychiatric profession.

...

Scull is a good storyteller and not shy of expressing his own opinions. He offers up the best and worst of what has been thought and imagined, and what has been done, in the name of mental healing. Given the forest of monographs, theses and grand theories that faces any new entrant to what we might call 'history of madness studies', it would be hard to imagine a more useful single-volume synthesis. Well researched, strong on details and alert to the big picture, this book certainly deserves to find a wide readership. It sits well with other moving testimonies to the dilemmas of the doctors and the possibly counterproductive effects of certain weapons in their arsenal. It complements the accounts of success and failure by various surgeons themselves, in dealing with physical rather than mental illness. In fact the recent bestselling works Do No Harm and Being Mortal might well be read alongside Madness in Civilization; all three would be on my recommended reading list for aspiring medical students and therapists alike."

Julian Jaynes -- The Origin of Consciousness in the Breakdown of the Bicameral Mind

 

 

 

 

 

 

 

 

Another excerpt from a great Chronicle of Higher Education feature on What Book Changed Your Mind?

"For me, that book was by Julian Jaynes. The Origin of Consciousness in the Breakdown of the Bicameral Mind (1976) is one of those lush, overambitious books that gets many things wrong, but in such an interesting way that readers, on finishing it, find that they think about the world quite differently. At least I did, although I think the book crept up on me year by year until I suddenly decided that this odd book I’d read in college had a fundamental insight—and had presented to me the puzzle that became my life’s work.

Jaynes taught psychology at Princeton, back in the days before psychologists had walled themselves off from literature, and he noticed that in the Homeric epics, the gods took the place of the human mind. In the Iliad we do not see Achilles thinking. Achilles acts, and in moments of strong emotion, he acts as the gods instruct him. When Aga­memnon steals his mistress and Achilles seethes with anger, Athena shows up, grabs him by the hair, and holds him back. Jaynes argued that Athena popped up in this way because humans in archaic Greece had no words for inner speech. So when they felt compelled by this strong internal force, they attributed that sensation to the gods. "The gods take the place of consciousness."

Moreover, Jaynes thought that in these moments, the ancient Greeks heard with their ears the gods speak. He thought that the inability to name the sensation as internal altered the sensation so that in moments of powerful feeling, moments when one feels pushed from within by one’s own overwhelming rage or joy, the Greeks heard the cognitive trace of that emotion audibly, as if it were coming from outside. "Who then were these gods that pushed men about like robots and sang epics through their lips? They were voices whose speech and direction could be as distinctly heard by the Iliadic heroes as voices are heard by certain epileptic and schizophrenic patients, or just as Joan of Arc heard her voices."

Well, maybe yes and maybe no. To me the point was that the way we pay attention to inner sensation changes the nature of the sensation, sometimes profoundly. The way we recognize mental events and deem them significant, the way we reach for what we take to be real—those differences shape what we know of God and madness.

The book begins: "O, what a world of unseen visions and heard silences, this insubstantial country of the mind!" I feel drab in Jaynes’s company. I just want to get the facts right. But this was another of his lessons. He taught me that data can sing.

 —T.M. Luhrmann is a professor of anthropology at Stanford University."

See here for an earlier post on this book.

First person accounts of mental illness

These are from the syllabus of Dr. Aaron Pincus' Penn State seminar, Madness in the First Person (Fall 2009):



1. An Unquiet Mind: A Memoir of Moods and Madness, Kay Redfield Jamison. Bipolar disorder (manic-depressive illness).




2. Drinking: A Love Story, Caroline Knapp. Alcoholism.




3. Wasted: A Memoir of Anorexia and Bulimia, Marya Hornbacher. Eating disorders.




4. First Person Plural: My Life as a Multiple, Cameron West. Dissociative Identity Disorder.




5. The Quiet Room: A Journey out of the Torment of Madness, Lori Schiller & Amanda Bennett. Schizophrenia.




6. Students in the seminar also read Am I Okay?: A Layman's Guide to the Psychiatrist's Bible by Allan Frances and Michael First.


I've only read the first book on the list, but I would gladly read any of these over any weekend.

What did you do during your summer vacation?

This snapshot was sent to me by a student of mine who is completing a summer program at Oxford University. This is the reading list for ONE WEEK of class.

Here are a few of the books that the students were expected to have familiarized themselves with: Instruments of Darkness; Religion and the Decline of Magic; The Witch-Hunt in Early Modern Europe; Mystical Bedlam looks pretty awesome, as does The Bewitching of Anne Gunter, just in case anyone out there wants to get me an early Christmas present.

Escape from Freedom -- Erich Fromm

"Most psychiatrists take the structure of their own society so much for granted that to them the person who is not well adapted assumes the stigma of being less valuable. On the other hand, the well-adapted person is supposed to be the more valuable person in terms of a scale of human values. If we differentiate the two concepts of normal and neurotic, we come to the following conclusion: the person who is normal in terms of being well adapted is often less healthy than the neurotic person in terms of human values. Often he is well adapted only at the expense of having given up his self in order to become more or less the person he believes he is expected to be. All genuine individuality and spontaneity may have been lost. On the other hand, the neurotic person can be characterized as somebody who was not ready to surrender completely in the battle for his self. To be sure, his attempt to save his individual self was not successful, and instead of expressing his self productively he sought salvation through neurotic symptoms and by withdrawing into a phantasy life. Nevertheless, from the standpoint of human values, he is less crippled than the kind of normal person who has lost his individuality altogether."

 

 

A lot of people use Orwell's 1984 in order to try and explain the modern age. In my opinion, Fromm's Escape from Freedom would be a far more appropriate book to turn to. And if you are like me and have never admired Martin Luther or John Calvin, you are in for a treat.

 

That's quite a blurb from the Washington Post on the front cover: "Fromm's thought merits the critical attention of all concerned with the human condition and its future."

 

 

 



Nicholas Cummings -- Time for Psychotherapy to Take on Pharmacotherapy

An impassioned plea from former APA President Nicholas Cummings. This one line really grabbed me: "How long has it been since you have seen a patient who came to you who had not already been medicated by the primary care physician or a psychiatrist?" This is such a striking observation that you don't realize it at first because it is so "normal." That is, it is normal for a primary care physician to begin "treating" a patient for anxiety or depression even before a thorough psychological assessment has been made by a mental health specialist. They write the prescription and then they refer for psychotherapy (if they refer at all, which they rarely do).

"We are seeing in the second decade of the 21st Century two forces converging that create both an imperative and a golden opportunity for psychology. The first is the continued steady decline of psychotherapy which has been largely replaced by psychotropic medication. How long has it been since you have seen a patient who came to you who had not already been medicated by the primary care physician or a psychiatrist? Antidepressants are ubiquitous, prescribed not only for the Monday morning blues or any degree of sadness, but also for such off-label conditions as erectile dysfunction, smoking cessation, obesity, obsessive compulsion, and even bereavement, with the latter practice unfortunately interfering with and severely prolonging nature’s healing process. It did not used to be that way prior to the medicalization of mental health. Rather, the patient first saw a psychologist, psychotherapy was the first line intervention, and in those instances when the psychologist determined medication was necessary, it was arranged through a cooperating psychiatrist. But the psychologist’s evaluation always came first. 

 

Psychotherapy was not only effective, numerous researches over decades repeatedly revealed it saved medical/surgical dollars. There was a high regard for our services among the general public, which was heralded in the media, movies and government sponsored programs such as the community mental health centers. It was usual for highly sought psychotherapists to have long waiting lists of those who clamored but patiently waited for their services, not only because of need, but also for self-improvement. Psychiatrists medicalized because they wanted tobe “real doctors.” They abandoned psychotherapy, and became essentially a prescribing and hospitalizing profession, thus making psychology the booming, preeminent psychotherapy profession. The American Psychiatric Association cleverly responded by joining Big Pharma with its grants, subsidies, and other goodies, and then captured the National Institute of Mental Health (NIMH) with a sweeping “changing of the guard” at the highest levels. The DSM threw out all psychopathology to fit into the new theories of serotonin and dopamine receptor imbalances in the brain. It promised to cure mental illness through a rapidly evolving series of psychotropic meds. On the basis that medication would thus solve the problem, our state hospitals were deinstitutionalized by releasing hundreds of thousands of schizophrenics with nowhere to go and only a supply of medication. Overnight the street and the prison became our de facto mental hospitals and remain so to this day in spite of new generations of highly touted antipsychotics.

 

 

The second force is the rapidly developing backlash among the public resulting from mounting and often serious side-effects, the over-prescribing of medication for minor conditions and especially for children, revelations of tampering with clinical trials by throwing out studies with negative or neutral findings, and, worst of all, psychiatrists conducting the research and those promoting various drugs have been subsidized or even directly hired by the pharmaceutical companies. Additionally, the cherished “brain chemical imbalance” theories are being called into question by numerous studies and are chronicled in two best-selling books published in 2010. The DSMs have successively abandoned any validity to actual brain diseases, becoming arbitrary collections of symptoms that are grouped into syndromes given clinical-sounding names, and with every syndrome needing a medication or class of medications. Psychotherapy is disdained as ineffective and even irrelevant “talk therapy.”

 

 

But now Big Pharma has never had a lower public image, giving us an opportunity made in heaven for us to make a comeback. This is the time to mount an extensive campaign to educate the American public on the effectiveness of psychotherapy and to restore it as the first line intervention in behavioral health. Such a campaign would not only be directed through the media, but it would involve the most recent communication innovations such as YouTube. Can we afford to do this is not the question. Rather, it is, “Can we afford NOT to do this?” If we miss this golden opportunity psychotherapy will continue to decline and psychology as a direct service profession will become a relic that someday economic paleontology can unearth and dissect, seeking to answer why the most admired profession of the 20th Century died in the 21st."

 

 

References

Carlat, D.J. (2010). Unhinged: The trouble with psychiatry - A doctor's revelations about a

profession in crisis. New York: Free Press.

Whitaker, K. (2010). Anatomy of an epidemic. New York: Crown.

(Reprinted by the author from The National Psychologist, 20(1), p. 8, January/February 2011.)

 

 

 

 

 

Dan Ariely -- Predictably Irrational

I recently signed up with this great email service called delanceyplace. Everyday they send you an email with a short excerpt from a nonfiction book. I don't read every one they send, but the ones I do read I usually find interesting, even to the point of considering reading the entire book. Below is a recent sample from them. It is from behavioral economist Dan Ariely's book, Predictably Irrational. By the way, Ariely's article on "Why we lie" is among one of the best psychology pieces I have read in the popular press in the last couple of years.

In today's selection -- the decoy effect. Suppose, as suggested by psychologist Daniel Ariely, someone is given a choice between two vacations -- a week in either Paris and Rome at the same price with free breakfast each day -- where they are equally likely to choose either one. Then further suppose that a third choice is added -- Rome at the same price without the free breakfast. With that third choice, that same person will become much more likely to select the option of Rome with the free breakfast. That is because relativity helps us make decisions in life -- he or she now has a better basis for assessing the value of the Rome package: "it's the same price plus I get free breakfast so it must be a good deal." This is known as the "decoy effect," and knowledgeable psychologists and marketers realize it extends to most choices in life -- from buying a house to selecting someone to date. It is the same phenomenon that causes some restaurants to include a highly expensive entree on the menu even though few will order it, simply because it results in more patrons ordering the second most expensive entree on the menu:

 

"I asked [25 MIT students] to pair the 30 photographs of MIT men and the 30 of women by physical attractiveness (matching the men with other men, and the women with other women). That is, I had them pair the 'Brad Pitts' and the 'George Clooneys' of MIT, as well as the 'Woody Allens' and the 'Danny DeVitos' (sorry, Woody and Danny). Out of these 30 pairs, I selected the six pairs -- three female pairs and three male pairs -- that my students seemed to agree were most alike.

 

"Now, like Dr. Frankenstein himself, I set about giving these faces my special treatment. Using Photoshop, I mutated the pictures just a bit, creating a slightly but noticeably less attractive version of each of them. I found that just the slightest movement of the nose threw off the symmetry. Using another tool, I enlarged one eye, eliminated some of the hair, and added traces of acne. ...

"For each of the 12 photographs, in fact, I now had a regular version as well as an inferior (-) decoy version.

"It was now time for the main part of the experiment. I took all the sets of pictures and made my way over to the student union. Approaching one student after another, I asked each to participate. When the students agreed, I handed them a sheet with three pictures. Some of them had the regular picture (A), the decoy of that picture (-A), and the other regular picture (B). Others had the regular picture (B), the decoy of that picture (-B), and the other regular picture (A). ... After selecting a sheet with either male or female pictures, according to their preferences, I asked the students to circle the people they would pick to go on a date with, if they had a choice. ...

"What was my motive in all this? Simply to determine if the existence of the distorted picture (-A or -B) would push my participants to choose the similar but undistorted picture. In other words, would a slightly less attractive George Clooney (-A) push the participants to choose the perfect George Clooney over the perfect Brad Pitt?  

"There were no pictures of Brad Pitt or George Clooney in my experiment, of course. Pictures (A) and (B) showed ordinary students. ... Would the existence of a less perfect person (-A or -B) push people to choose the perfect one (A or B), simply because the decoy option served as a point of comparison?

"It did. Whenever I handed out a sheet that had a regular picture, its inferior version, and another regular picture, the participants said they would prefer to date the 'regular' person -- the one who was similar, but clearly superior, to the distorted version -- over the other, undistorted person on the sheet. This was not just a close call -- it happened 75 percent of the time (out of a sample of 600). ...

"Let's take a look at the decoy effect in a completely different situation. What if you are single, and hope to appeal to as many attractive potential dating partners as possible at an upcoming singles event? My advice would be to bring a friend who has your basic physical characteristics (similar coloring, body type, facial features), but is slightly less attractive (-you).  

"Why? Because the folks you want to attract will have a hard time evaluating you with no comparables around. However, if you are compared with a '-you,' the decoy friend will do a lot to make you look better, not just in comparison with the decoy but also in general, and in comparison with all the other people around. It may sound irrational (and I can't guarantee this), but the chances are good that you will get some extra attention. Of course, don't just stop at looks. If great conversation will win the day, be sure to pick a friend for the singles event who can't match your smooth delivery and rapier wit. By comparison, you'll sound great. ... 

"Relativity helps us make decisions in life." 

 

 

 

Author: Dan Ariely

Title: Predictably Irrational: The Hidden Forces That Shape Our Decisions

Publisher: Harper Perennial

Date: Copyright 2009 by Dan Ariely

Pages: 11-15

Civilization and its Discontents -- Freud

 

"The element of truth behind all this, which people are so ready to disavow, is that men are not gentle creatures who want to be loved, and who at the most can defend themselves if they are attacked; they are, on the contrary, creatures among whose instinctual endowments is to be reckoned a powerful share of aggressiveness. As a result, their neighbour is for them not only a potential helper or sexual object, but also someone who tempts them to satisfy their aggressiveness on him, to exploit his capacity for work without compensation, to use him sexually without his consent, to seize his possessions, to humiliate him, to cause him pain, to torture him and to kill him. Homo homini lupus."

 

 

 

"That the education of young people at the present day conceals from them the part which sexuality will play in their lives is not the only reproach which we are obliged to make against it. Its other sin is that it does not prepare them for the aggressiveness of which they are destined to become the objects. In sending the young out into life with such a false psychological orientation, education is behaving as though one were to equip people on a Polar expedition with summer clothing and maps of the Italian Lakes. In this it becomes evident that a certain misuse is being made of ethical demands. The strictness of those demands would not do so much harm if education were to say: 'This is how men ought to be, in order to be happy and to make others happy; but you have to reckon on their not being like that.' Instead of this the young are made to believe that everyone else fulfills those ethical demands -- that is, that everyone else is virtuous. It is on this that the demand is based that the young, too, shall become virtuous."

 

 

 



The Mind-Body connection (Dr. John Sarno)

This clip from the show 20-20 makes 1999 seem like a really long time ago but it is still worth viewing for its coverage of Dr. John Sarno's treatment for low back pain. His book, Healing Back Pain, is a classic that has helped many thousands of people. Amazon reviewers also love his book, The Mindbody Prescription.

Many people criticize Sarno and others because they are not "mainstream." (Sarno is even more open to criticism because he thinks you can't understand somatoform disorders without an appreciation of Freud.) But the mainstream approach to pain management is to get people addicted to pain killers, often resulting in their deaths.

Still skeptical about psychological approaches to treating medical conditions? (Good!) Check out: 1) MRI study reveals that there is no association between degree of spinal abnormalities and degree of reported pain; 2) clinical controlled study shows that 32% of hypertensive patients able to stop taking blood pressure medication after an 8 week course in stress management; 3) Meta-analysis shows that males who have had a heart attack and subsequently receive psychotherapy are 43% less likely than heart attack survivors in a control group to have a second heart attack, and 27% less likely to die during the ensuring two years. Psychotherapy saves lives!

The Center Cannot Hold -- Elyn Saks

Psychiatric Times published an excellent review of the great personal memoir by Elyn Saks, a U.S. law professor and MacArthur "genius" grant fellow who also happens to suffer from chronic schizophrenia. Read the review in its entireity if you like -- it won't spoil the book. Saks' memoir is probably the best first person account of psychosis that I have encountered and I strongly recommend it. (If you are interested in drug-induced psychosis, this is not to be missed.)

From the Psychiatric Times review:

As she brings her story to an end, Elyn is still taking clozapine and is told by her psychopharmacologist that she will most likely have to take some antipsychotic medication for the rest of her life. She credits both psychoanalysis and psychopharmacology for the progress she has made. “While medication had kept me alive,” she acknowledges, “it had been psychoanalysis that had helped me find a life worth living.” For someone so long and so tightly in the grip of a psychotically transformed world as Elyn has been, the challenge of breaking that defensive structure is probably in some ways akin to breaking an addiction to a chemical substance.

Elyn’s descriptions of her psychotic (and normal) experiences are taken here to be primary data, in the way that numbers, and the statistical elaboration of these numbers, are considered data in the empirical approach to studying psychopathology. Hermeneutic analysis of what Elyn tells us about her fall into psychosis and her efforts to have a career and a life—her story—reveals the phenomenon of one of the phenotypes of the heterogeneous illness we call schizophrenia. Her narrative draws us into the interior world of the psychotic person, territory that few clinicians attempt to access or assess.

Here's a link to her TED talk, which is well worth watching (why not learn something during the next 14 minutes?). She does a great job depicting the loose associations that are the hallmark of schizophrenic speech.

 

 

 

 

What are the best psychotherapy books that you have read in the past 3 years?

Cook, Biyanova, and Coyne (2009) surveyed over 2,400 North American psychotherapists and asked, "What are the best psychotherapy books that you have read in the past 3 years?" Here are the top results:

Psychologists made up only 16.7% of the sample (Social Workers = 35.7%; "Professional Counselors" = 22.4%; Marriage and family therapists = 16.6%), which was 75.6% female and 91.4% White. The mean age was 51 years. Over 11% of the self-identified psychologists did not have a doctoral degree (you see this sometimes with "school psychologists").

This study was a partial replication of Smith (1982). Smith's sample was 85% male, versus 34% in the 2009 study. This isn't sampling bias, it's just reflective of the "feminization of psychology."

 

Definitely read

The book that I would most certainly recommend to anyone with an interest in psychotherapy, or an interest in finding out what psychotherapy is really like, is Irv Yalom's The Gift of Therapy. (It came in third among psychologists.) Yalom is an existential psychotherapist with a real gift for writing about patients and the psychotherapy encounter. I have liked all of his books, but Gift of Therapy is the best place to start. The chapters are very brief, as if intended to be read during the 10 minutes we schedule between one patient and the next (the "fifty-minute hour").

Sure, go ahead and read

 

The books by Linehan certainly deserve to top the list. I think that even an interested undergraduate could benefit from reading the DBT skills manual (and trying out some of the techniques). Siegel's books are extremely popular (and I have to admit that I am usually skeptical of anything that is popular); nevertheless I am assigning Parenting from the Inside Out in my next Developmental Psych course. The Motivational Interviewing book is certainly important, but if you don't actually have patients to try the techniques on, I don't think the book would be very interesting. I like John Gottman's empirical approach to marital therapy, and many people say that his 7 Principles book is a great gift for young newlyweds or soon-to-weds. David Burns' Feeling Good handbook is a great compendium of cognitive-behavioral techniques and has demonstrated efficacy as a bibliotherapy for mild depression. That is, reading the book and using the techniques described can effectively treat mild depression (no drugs and no therapist required).

Not interested

I never read the book by Harville Hendrix (Getting the Love you Want). I had a colleague who was treating a couple who insisted that he read this book in order to treat them properly. Can you imagine? The best that can be said of such people is what Samuel Butler wrote about historian Thomas Carlye and his wife: "It was very good of God to let Carlye and Mrs. Carlye marry one another, and so make only two people miserable instead of four." That's why I don't do couples therapy -- why make three people miserable instead of two?

I have owned Trauma and Recovery for years but I have never finished it, despite my interest in PTSD. I think that says a lot. I have never read The Body Remembers, again despite my interest and work in PTSD. I can't recall a single scientific study that cites that book as a reference.


BUT MY ALL TIME FAVORITE BOOK ON PSYCHOTHERAPY IS:


The Art of Psychotherapy, by Anthony Storr

Unspeakable, Unbearable, Horrible Truth

The following excerpt is from the remarkable book, Facing Human Suffering, by Ronald B. Miller (2004, pp. 184-185). [Emphases added.]

"People who are difficult to get to know often are that way for very good reason. They are concealing aspects of their lives that they believe it would be dangerous to reveal. The information they possess involves aspects of human relationships that are regarded as shameful and immoral, if not illegal (child physical and sexual abuse, illicit sexual affairs, deviant sexual interests, cheating and dishonesty in business, etc.). There is a qualitative difference between the content of the knowledge that is concealed regarding other people and knowledge that nature conceals in the natural sciences via mystery and complexity. Only in a relationship that contains certain moral features -- trust, safety, respect, and confidentiality -- can these critical features of human existence be revealed and discussed. A psychology that wishes to go beyond the surface of social pretense and masks must provide a methodology for exploring the taboo and forbidden aspects of human relationships (Faberow, 1963). Freud (1920/1966), writing in the Introductory Lectures on Psycho-Analysis, made the point that the data of clinical psychoanalysis -- and, by implication, psychology -- are vulnerable to this sort of distortion:

The talk of which psycho-analytic treatment consists brooks no listener, it cannot be demonstrated (to the audience). A neurasthenic or hysterical patient can of course like any other, be introduced to students in a psychiatric lecture. He will give an account of his complaints and symptoms, but of nothing else. The information required by analysis will be given by him only on condition of his having a special emotional attachment to the doctor; he would become silent as soon as he observed a single witness to whom he felt indifferent. For this information concerns what is most intimate in his mental life, everything that, as a socially independent person, he must conceal from other people, and beyond, that as a a homogeneous personality, he will not admit to himself. (pp. 20-21)

Rollo May (1969) concurred in Love and Will and quoted H.S. Sullivan as expressing a similar position:

But neither these psychologists in their laboratories nor those philosophers in their studies can ignore the fact we do get tremendously significant and often unique data from persons in therapy -- data which are revealed only when human beings break down their customary pretenses, hypocrisies and defenses behind which we all hide in "normal" social discourse. There is also the curious situation that unless we are oriented towards helping the person, he will not, indeed in some ways cannot, reveal the significant data. Harry Stack Sullivan's remark on research in therapy is still as cogent as when he first made it: "Unless the interviews are designed to help the person, you'll get artifacts, not real data." (pp. 18-19)

Whether one wishes to join the more psychoanalytic observers in believing that all clinical problems have at their core such unspeakable elements, or whether one takes the more moderate position that many, if not most, do, it is clear that the clinical method of gaining knowledge in psychology is, for all its limitations, the only game in town."

The Art of Psychotherapy -- Anthony Storr

"I once had a conversation with the director of a monastery. 'Everyone who comes to us,' he said, 'does so for the wrong reasons.' The same is generally true of people who become psychotherapists."

-- Anthony Storr, The Art of Psychotherapy (1990), p. 169

I picked up Anthony Storr's The Art of Psychotherapy while I was in grad school and found it to be one of the most useful, practical books I read during my training. I can think of no better introduction to the practice of psychotherapy. Storr devotes the first bit of the book to the "how" of psychotherapy -- chairs or couch? what kind of office decor? tissues? diploma displayed? Call me Dr. or Call me Tony? -- in a non-prescriptive manner that conveys how important all these details can be. This is an  appropriate prelude for Storr's discussion of how to attend to the details of the patient's narrative, how to listen to the slips, the silences, the misdirections. There is a great chapter on dream interpretation (Storr is a Jungian, but apparently not a doctrinaire one). Throughout, the reader gains an insider's look into what it is like to be a psychotherapist, and psychotherapists (even those with much experience) pick up practical tips on how to improve their craft. I used this as a text in my Introduction to Counseling and Psychotherapy course and it was one of the rare times that a text got rave reviews in my teaching evaluations. The chapter on The Personality of the Psychotherapist should be required reading for anyone seeking graduate training in a mental health profession.

 

Among the insights that stays with me is Storr's recommendation for what makes a good psychotherapist: "a broad-based liking for people." If you don't have that, do us all a favor and choose another field.

 

"In spite of Freud's hope that he would make it so, psychotherapy cannot be a scientific enterprise. Although the psychotherapist needs to retain a measure of objectivity in relation to his patient, he must allow himself to be affected by the patient if he is to understand him. Since the therapist forms part of the reciprocal relationship, albeit of a specialized kind, he cannot maintain the kind of detachment which characterises the scientist conducting a chemical experiment. Understanding other people is, inescapably, a different enterprise from understanding things; and those who attempt to maintain towards people the kind of detached attitude which they might adopt towards things render themselves incapable of understanding others at all." (p. 149)

 

By the way, I have no idea why the book is so expensive on Amazon. It's just a little paperback -- buying it used would probably be fine as long as it isn't marked up too much.

If you are an introvert (or a genius, or a genius-introvert), I also highly recommend Storr's book Solitude: A Return to the Self.




The Bicameral Mind -- Julian Jaynes (1976)

Here is an interesting review of psychologist Julian Jaynes' "bizarre and reckless masterpiece" The Origin of Consciousness in the Breakdown of the Bicameral Mind (1976). The main idea is this:

"Jaynes began inspecting the world’s earliest literature for the first signs of human consciousness. “I started off like in a detective story,” he told a reporter for the Princeton radio station. As he moved backward through the centuries, he saw that consciousness, as he had defined it, disappeared somewhere between the Odyssey and the Iliad. Odysseus is a modern hero, introspective and deceptive. In the Iliad, the writing of which scholars date some three hundred years earlier, the characters are passive and mentally inert. They have no concept of a private mental space. The word “psyche” referred only to actual substances in the body, breath, and blood, which leave the warrior’s body as soon as he dies. The gods, emerging from mists or clouds or the sea, handle the warrior’s decisions. When Achilles accuses Agamemnon of stealing his mistress, Agamemnon insists he had no agency. “Not I was the cause of this act, but Zeus,” he explains. “So what could I do? Gods always have their way.”

Critics have interpreted the meddling presence of the god as poetic devices, but Jaynes accused translators of imputing a modern mentality to people with subjectivities foreign to us. “The gods were in no sense ‘figments of the imagination,’” he wrote. “They were man’s volition. They occupied his nervous system, probably his right hemisphere.” Jaynes drew on research with patients with severed corpora callossa, the band of fibers that separates the two hemispheres of the brain, which showed that the two chambers can function independently, without conscious awareness of information processed in the other half. Jaynes proposed that the Trojan War was fought by men with a kind of split brain, a “bicameral mind.” In moments of stress, the left hemisphere, “slave-like,” perceived hallucinated voices in the right hemisphere—the god hemisphere—as direct commands.""

 

I am not sure how certain scholars are about a "300 year" gap between the writing down of the Iliad and the Odyssey. (I am partial to the idea that the Odyssey was written by Homer's granddaughter.) Nevertheless, Jaynes' book seems to have a boldness and originality sorely lacking in contemporary psychology. There is very little published in the field today that could be called "startling".

But the main reason that I plan to read this book, and the reason for this post, is the statement that Jaynes "wanted to revive the 'disappearing idea that a psychologist enters his profession almost like a religious order, making himself a part of his own subject matter, and baring his soul.'"

I wonder how many psychologists today even understand what Jaynes meant by comparing entering the profession of psychology to taking holy orders? How many felt a calling to the profession? For how many is being a psychologist just a job like any other?

Can you prevent PTSD?

This is a decent article on efforts to manage PTSD in the U.S. Army. It includes some rather cool Rorschach-type images:

"In every 20th-century conflict the U.S. has fought, more American soldiers
have been psychiatric casualties than have been killed in combat."

 

The article mentions some of the doubts about the efficacy of "resilience" training as a means to prevent PTSD in combat troops. Martin Seligman is the fellow behind that particular boondoggle -- it's the sort of thing that everyone hopes will work, but so far there just isn't much evidence to support it.

 

The article borrows liberally (without attribution) from Dave Grossman's classic book, On Killing. I recommend the book to anyone interested in the subject (even though I part ways with Grossman when he opines about media-influenced violence, and I have my doubts about the Slam Marshall WWII "research" that is used to back up some of Grossman's claims).

 

But On Killing is one of the books that got me WAY interested in psychology when I was an undergraduate. It also includes one of the best explications of operant versus classical conditioning that I can think of. I was recently looking at a copy of a new book by a former SEAL training officer, and there was an appendix ("The Warrior's Bookshelf") that included On Killing as required reading.

Daniel Kahneman

There aren't many psychologists among Nobel Prize recipients. Daniel Kahneman (born March 5, 1934) is one (although, annoyingly, he was awarded the Nobel Prize in Economic Sciences in 2002). Everyone should become familiar with his work on judgement and decision making. He (and his now deceased colleague Amos Tversky) essentially created the field of behavioral economics.

 

 

 

Daniel Kahneman (b. 1934)

Two of Tversky and Kahneman's original papers, published for general scientific audience in Science, are available here (1974) and here (1981). They are certainly worth working your way through. This chapter (1973) is somewhat more accessible. However, if you want the popular version of his work, his recent book, Thinking Fast and Slow, is excellent. You will, almost effortlessly, feel smarter after reading this book.


This article by Freeman Dyson in the New York Review of Books is also fun to read, with interesting anecdotes about military personnel selection, the survival of bomber crews over Germany, and a surprising (and very effective) defense of Sigmund Freud.




Excerpt 1:

"At the age of twenty I was doing statistical analysis of the operations of the British Bomber Command in World War II [writes Dyson]. ...[T]en years before Kahneman discovered it and gave it its name...the illusion of validity was already doing its deadly work. All of us at Bomber Command shared the illusion. We saw every bomber crew as a tightly knit team of seven, with the gunners playing an essential role defending their comrades against fighter attack, while the pilot flew an irregular corkscrew to defend them against flak. An essential part of the illusion was the belief that the team learned by experience. As they became more skillful and more closely bonded, their chances of survival would improve.

When I was collecting the data in the spring of 1944, the chance of a crew reaching the end of a thirty-operation tour was about 25 percent. The illusion that experience would help them to survive was essential to their morale. After all, they could see in every squadron a few revered and experienced old-timer crews who had completed one tour and had volunteered to return for a second tour. It was obvious to everyone that the old-timers survived because they were more skillful. Nobody wanted to believe that the old-timers survived only because they were lucky.

...I had the job of examining the statistics of bomber losses. I did a careful analysis of the correlation between the experience of the crews and their loss rates, subdividing the data into many small packages so as to eliminate effects of weather and geography. My results were as conclusive as those of Kahneman. There was no effect of experience on loss rate. So far as I could tell, whether a crew lived or died was purely a matter of chance. Their belief in the life-saving effect of experience was an illusion.

...As Kahneman found out later, the illusion of validity does not disappear just because facts prove it to be false. Everyone at Bomber Command, from the commander in chief to the flying crews, continued to believe in the illusion. The crews continued to die, experienced and inexperienced alike, until Germany was overrun and the war finally ended."

Excerpt 2:

"One thing that is notably absent from Kahneman’s book is the name of Sigmund Freud. In thirty-two pages of endnotes there is not a single reference to his writings. This omission is certainly no accident.

...

Freud is now hated as passionately as he was once loved. Kahneman evidently shares the prevalent repudiation of Freud and of his legacy of writings.

Freud wrote two books, The Psychopathology of Everyday Life in 1901 and The Ego and the Id in 1923, which come close to preempting two of the main themes of Kahneman’s book. The psychopathology book describes the many mistakes of judgment and of action that arise from emotional bias operating below the level of consciousness. These “Freudian slips” are examples of availability bias, caused by memories associated with strong emotions. The Ego and the Id decribes two levels of the mind that are similar to the System Two and System One of Kahneman, the Ego being usually conscious and rational, the Id usually unconscious and irrational.

There are huge differences between Freud and Kahneman, as one would expect for thinkers separated by a century. The deepest difference is that Freud is literary while Kahneman is scientific. The great contribution of Kahneman was to make psychology an experimental science, with experimental results that could be repeated and verified. Freud, in my view, made psychology a branch of literature, with stories and myths that appeal to the heart rather than to the mind.

...

It is understandable that Kahneman has no use for Freud, but it is still regrettable. The insights of Kahneman and Freud are complementary rather than contradictory. Anyone who strives for a complete understanding of human nature has much to learn from both of them. The scope of Kahneman’s psychology is necessarily limited by his method. His method is to study mental processes that can be observed and measured under rigorously controlled experimental conditions. Following this method, he revolutionized psychology. He discovered mental processes that can be described precisely and demonstrated reliably. He discarded the poetic fantasies of Freud.

But together with the poetic fantasies, he discarded much else that was valuable. Since strong emotions and obsessions cannot be experimentally controlled, Kahneman’s method did not allow him to study them. The part of the human personality that Kahneman’s method can handle is the nonviolent part, concerned with everyday decisions, artificial parlor games, and gambling for small stakes. The violent and passionate manifestations of human nature, concerned with matters of life and death and love and hate and pain and sex, cannot be experimentally controlled and are beyond Kahneman’s reach. Violence and passion are the territory of Freud. Freud can penetrate deeper than Kahneman because literature digs deeper than science into human nature and human destiny."

 

 

Here is Kahneman speaking at a TED conference:

And here he is at GoogleTalks, which have to be the best brown bag lunchtime talks in the world. If you want to get the gist of Thinking Fast and Slow in a hour, this is probably the best way to do so.

Jonathan Kellerman

Jonathan Kellerman, a former clinical psychologist himself, created a memorable detective-psychologist -- Alex Delaware, Ph.D. I read several of these novels as an undergrad and in the first year of grad school. I won't go so far as to say that Alex Delaware is a "heroic ideal" for a clinical psychologist, but Kellerman makes him look pretty good (and thus the profession in general). As I recall, each book's plot involves a different interesting psychological/psychiatric phenonomenom, e.g. Munchausen's syndrome, child geniuses, school shootings, etc. I won't go so far as to say that you will learn a lot about the profession from reading these crime novels, but your interest in the field might increase substantially, as mine did.

Kellerman also wrote a interesting book called Savage Spawn. It was written in the wake of Columbine and said some refreshingly harsh things about child psychopaths. It's a quick, bracing book to read, and much at odds with the usual touchy-feeling stuff offered up by psychologists.


Here are synopses of the first five Alex Delaware novels (I always prefer to read a series in the order in which they were published). It looks as if they are re-issuing the first novel, so the timing of this post is pretty good.

When the Bough Breaks (1985)

Kellerman introduces Alex Delaware, Ph.D., in When the Bough Breaks. Kellerman characterizes Delaware as a successful (albeit retired) child psychologist suffering from burn-out after working on a case of systematic child molestation that culminates when the offender commits suicide in Delaware's office. Detective Milo Sturgis urges Delaware to come out of retirement and interview a seven-year-old child who may have witnessed a crime. Sturgis appoints Delaware as a "special consultant" to the Los Angeles Police Department.^[7] Kellerman's timing in this novel coincided with news stories about child abuse in child care facilities.^[8]

Blood Test (1986)

In Blood Test, Alex Delaware acts as a consultant in the divorce and child custody case of Richard Moody, a bipolar and potentially dangerous father of two. At the same time, Delaware is contacted by a former colleague, Dr. Raoul Melendez-Lynch, of the oncology department at Western Pediatric Medical Center. Dr. Raoul Melendez-Lynch asks Delaware to consult with Mr. and Mrs. Swope whose child, Woody, needs treatment for cancer. Before Delaware has the opportunity to visit Woody, he vanishes from the hospital and the parents turn up murdered. Delaware sorts through a maze of clues to find the child.^[9] Additionally, Kellerman highlights the issue of established medical treatments and new "cult cures" for children.^[8]

Over the Edge (1987)

In Over the Edge, Kellerman presents Delaware's back story as a researcher in the study "Project 160", that involved the treatment of gifted children. As the novel opens, Delaware receives a phone call from Jamey Cadmus, who had been involved in the research project. Jamey has been arrested and accused of being a serial killer who preys on young male prostitutes. Delaware is hired by Cadmus' attorney to investigate. In this novel, Kellerman examines preconceived notions about homosexuality; and he examines how others perceive Delaware because of his friendship with Milo Sturgis. In the course of the investigation, Delaware eliminates the obvious clues and discovers a greater evil than he imagined.^[10] Additionally, Kellerman investigates psychological problems resulting from childhood genius.^[8]

Silent Partner (1989)

In Silent Partner, Kellerman has Delaware involved in a romantic interlude with a former girlfriend. Delaware's lover apparently commits suicide, and he begins an investigation into her death. His lover's identity becomes the focus of the investigation, as Delaware peels away layer after layer to discover a maze of childhood abuse.^[8]

Time Bomb (1990)

Time Bomb highlights a school shooting at a Los Angeles elementary school; although the only fatality is the shooter herself, Holly Lynn Burden. Holly's father contacts Delaware and asks him to perform a psychological autopsy. During the course of the investigation Delaware encounters dysfunctional families and political extremism as he races to unravel the real villain as he pulls together all the threads.^[11]


More here.