BOOK REVIEW: The End of Trauma by George A. Bonanno

The End of Trauma: How the New Science of Resilience Is Changing How We Think About PTSDThe End of Trauma: How the New Science of Resilience Is Changing How We Think About PTSD by George A. Bonanno
My rating: 5 of 5 stars

Amazon.in Page

Out: September 7, 2021

The central idea of this book is that not everyone who’s exposed to traumatic events has long-term mental health effects. On average, two-thirds of those who suffer traumas show resilience. Bonanno’s experience working in the mental healthcare sector in New York City in the aftermath 9/11 impressed this truth upon him. The anticipated mental health tsunami never came; most people recovered and moved on with their lives.

It is hard to predict who that one-third is who will suffer long-term mental trauma. While there are some traits that correlate more to resilience and others to a proclivity to be traumatized, the fact that humans are complex and there are many confounding variables makes it immensely difficult to anticipate the impact of a trauma.

Given this difficulty, it’s beneficial to figure out how one can increase any victim’s resilience, and that’s the task the book engages. Bonanno discusses an optimal mindset for resilience that he calls the “flexibility mindset,” and he details a corresponding sequence (i.e. the “flexibility sequence”) that he suggests is the best known approach to reducing the adverse effects of trauma. As the key word, “flexible,” suggests, this approach requires adaptability. It’s not a one-size fits all approach, but rather hinges upon determining what coping strategies a person has access to, and then evaluating the degree to which they are working.

If found this book to be full of food-for-thought. I thought there could have been more elaboration of the dangers and limitations of distraction as a coping mechanism. To be fair, there is a discussion of this as he presents another therapist’s experience with, and thoughts upon, the “flexibility” approach, but that’s a bit late in the book. That said, I learned a great deal in reading this book, and thought it offered some excellent insights.

View all my reviews

BOOK REVIEW: Shamans, Mystics and Doctors by Sudhir Kakar

Shamans, Mystics and Doctors: A Psychological Inquiry into India and its Healing TraditionsShamans, Mystics and Doctors: A Psychological Inquiry into India and its Healing Traditions by Sudhir Kakar
My rating: 5 of 5 stars

Amazon.in Page

In this book, Freudian psychoanalyst Sudhir Kakar examines a range of alternatives to mainstream psychiatry / psychotherapy that are pursued across India. They are largely traditions that predate psychiatry, and which weren’t developed primarily as a path to mental health, but rather as methods to develop mind and spirit – but which came to fill a void. Included in this exploration are a Sufi Muslim Pir, a Balaji Temple exorcist, an Oraon bhagat, Tibetan Buddhist / Bon healers, cultists, tantrics, and Ayurvedic doctors. The chapters are organized by the type of healer, and the ten chapters are split between shamans (Pt. I,) mystics (Pt. II,) and Ayurvedic healers (Pt. III.)

This book is at its best and most interesting when it’s describing the author’s visits to various temples, shaman huts, and other places where healers reside. He tells what he learned and experienced at these places, which ranges from reassuring (shamans and healers getting at least as good a result as their mainstream psychotherapeutic counterparts) to mildly horrifying (people chained to cots, or being blamed for their condition — i.e. being told their faith is inadequate.) I found many of the cases under discussion to be fascinating, and learned a lot about how mental illness is perceived by different religious and spiritual traditions.

While Kakar is trained in a Western therapeutic system, he maintains a diplomatic tone about these indigenous forms of therapy – some of which are quite pragmatic but others of which are elaborately pseudo-scientific. I found this book to be insightful about various modes of treating the mind that are practiced in India

View all my reviews

BOOK REVIEW: (Mis)Diagnosed by Jonathan Foiles

(Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health(Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health by Jonathan Foiles
My rating: 4 of 5 stars

Amazon.in Page

Out: September 7, 2021

I’m fascinated by the challenges of mental health diagnostics. From the Rosenhan experiments (mentally well researchers checked into psychiatric hospitals) to the perpetual disappointment with new editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM,) a lot has been written about the difficulties of diagnosing disorders that largely express themselves through subjective experiences. Foiles’ book looks at how this challenge (combined race, gender, and gender identity biases) leads to differential diagnoses between various demographic groups.

The book serves as a call to action to be more aware of biases, and how they play into diagnoses. Though, in some cases it does a better job of that than in others. The six chapters present six faces of the problem: race and psychosis, race and ADHD [Attention Deficit Hyperactivity Disorder,] sex and Borderline Personality Disorder, and changing (though skewed) views of gender dysphoria, trauma, and intelligence.

Overall, I felt I learned something from the book, but sometimes it wasn’t as strong in supporting assertions and objectively presenting evidence as other times. For example, Chapter three examines how borderline personality disorder was (at least until recently) overwhelming seen as a female disorder. It went on to say that now it’s believed to have the same incidence in males, but that men present with different symptoms. To a neophyte, this sounds a lot like: “The Smiths eat meatloaf 50% of the time for dinner on Wednesday. Until recently, it was thought that the Joneses only ate meatloaf 10% of Wednesdays, but then it was discovered they also had meatloaf 50% of the time – but the Joneses meatloaf was made of ingredients such that it usually looked like chicken pot pie.] What?

For the most part, I found this book intriguing and informative, and would recommend it for those interested in the issue.

View all my reviews

BOOK REVIEW: Madness: A Very Short Introduction by Andrew Scull

Madness: A Very Short IntroductionMadness: A Very Short Introduction by Andrew Scull
My rating: 5 of 5 stars

Amazon.in page

 

This is yet another of the many “Very Short Introduction” books from Oxford University Press that I’ve been pleased to read and review. The series offers concise overviews of a wide range of topics that are presented by scholarly experts. This particular book is a historical examination of the changing approaches to mental illness from the ancient world where such a condition might be attributed to demonic possession to more recent times in which drugs and decarceration / defunding of asylums have become the dominant approaches to mental illness. Along the way the book shines a light on the immense difficulty experts have had in understanding what mental illnesses are and how they can best be dealt with. The book not only looks at the real-world response to mental illness, but also explores how it’s been treated in fiction from “Hamlet” to “One Flew over the Cuckoo’s Nest.”

The book consists of six chapters. As one would expect of a book from a historian’s-eye view, its organization is chronological, but the arrangement of time periods by chapter reflects changing approaches to mental illness. Chapter one focuses on the ancient world, during which we begin to get glimpses of madness in the written record. Chapter two, entitled “Madness in Chains,” focuses on the 16th through 18th century, during which Bethlem [Bedlam] Hospital was the cutting edge. That the institution’s nickname becoming a synonym for chaos and confusion says a lot. It was a time of brutal measures that did little to reduce the trauma of mental illness. The chapter also discusses madness in Elizabethan literature, famously that of Shakespeare.

Chapter three shifts to the 19th century, an era in which incarceration became more widespread as well as coming to be thought of as the best that could be done for the insane. In Chapter four, we learn about the rise of psychoanalysis as well as the increasing employment of treatments that involved the physical body – infamously, the lobotomy.

Chapter five is one of the most intriguing parts of the book. Entitled “Madness Denied” it opens with an exploration of the difficulties that arose from all the war-related cases of mental illness that came about as a result of the two World Wars (and others.) It also discusses a movement to overturn the prevailing approach to insanity, most famously and vociferously argued by the Scottish psychiatrist R.D. Laing, a clinician who had a mix of promising and disastrous results from his experimental approach which used LSD, but few other medicines. What I found most interesting, however, was the discussion of the growing recognition that there was a false front in the idea that psychiatry was beginning to really understand mental illness and its treatment. This was exemplified by the Rosenhan experiments in which sane volunteers checked themselves into asylums and, for the most part, the doctors and staff couldn’t tell that they were sane (though, interestingly, in at least some cases the other patients did call it out.) The troubles in classifying and diagnosing mental illnesses have also seen in the vexed history of the “Diagnostic and Statistical Manual of Mental Illness” [DSM,] a guide meant to get mental health experts on the same page about what’s what. [As opposed to ten psychiatrists offering ten different diagnoses of a given patient.] While a worthy attempt, the DSM has not – thus far – succeeded, though it could probably be argued that progress has been made.

The last chapter brings the reader up to the current period, a period dominated by two trends – first, mental illnesses being treated overwhelmingly pharmaceutically; and second, the closing of asylums and the concurrent ill-effects that have come about, societally speaking.

The book has a few graphics, mostly black and white art and photos used to enhance the reading experience. There are also appendices of references and recommended readings.

If you are interested in the history of psychiatric medicine, I’d highly recommend you check out this brief guide. It may not give you all the information you’re looking for, but it’s a good first stop to organize your thoughts on the subject.

View all my reviews

BOOK REVIEW: Neurotribes by Steve Silberman

NeurotribesNeurotribes by Steve Silberman
My rating: 5 of 5 stars

Amazon.in page

 

A combination of mystery and proclivity for lightening storms of controversy surrounds autism and related conditions (e.g. Asperger’s.) On one hand, it seems like the number of cases has skyrocketed in the past few decades. On the other hand, it’s hard to tell because long after autism began to be seen as a condition in its own right, children were being diagnosed with a range of other conditions from schizophrenia to brain damage to just plain “being difficult.” So, the question of the degree to which autism is more prevalent versus being more visible and readily-diagnosed remains.

Tellingly, Silberman’s first chapter describes an 18th century English scientist named Henry Cavendish as a way of refuting the notion that Autism is a wholly new phenomenon. The appearance that Autism is new and growing at epidemic proportions has facilitated some spurious thinking, most famously the idea that childhood vaccinations cause of autism. [To be fair, it’s easy to see why parents would want to find a simple, single-point cause, given that one of the previous hypothesized causes (which turned out to be also wrong) was that autism was caused by cold and detached parenting.] However, decades of intense investigation without a consensus conclusion suggests that a simple, straightforward cause-effect dynamic is unlikely and that more complexity is involved.

But the controversy doesn’t stop there. As within the deaf community, an argument has been on the rise that autism shouldn’t be treated as a disability to be cured but rather a difference that can be managed and which offers strengths that can be leaned into. And one of the most intriguing aspects of Autism and Asperger’s Syndrome are the mental strengths that can accompany the condition. Anyone who’s seen “Rain Man” (a chapter is devoted to it) will be aware of how savant-like mental capabilities can accompany the immense social difficulties displayed by people on the Autism Spectrum. Silberman takes on all of this and more as he presents a history of Autism.

The book is arranged into twelve chapters. As mentioned, the first chapter proposes that autism is nothing new and can be seen if one looks closely into select biographies, such as that of Henry Cavendish. While appearances in the historical record may be rare, the fact that some autistics have great mental capacities has resulted in instances in which they produced results so impressive that they remain noteworthy across the ages, despite the fact that such people were often socially isolated. The book next looks at modern-day examples of autistics who are changing the world. After that, having hooked the reader, Silberman proceeds chronologically through the advancements in understanding of autism — giving extensive attention to the work of Hans Asperger, Leo Kanner, and Bernard Rimland — but also addressing others such as Oliver Sachs and Bruno Bettelheim. In addition to discussing the research (which presents many of its own controversies,) Silberman shows how societal views of autism have changed from being considered either a form of retardation or of psychosis to being seen as a difference in abilities that should be respected.

Along the way, one learns a bit about the history of eugenics, and not just among the Nazis. (Hans Asperger’s reputation was sullied by the widespread belief that he’d worked with the Nazis.) Silberman explores the Second International Eugenics Congress that was hosted by the American Museum of Natural History in New York City. We also learn about the movie “Rain Man” and how Dustin Hoffman prepared for the role, and how the movie became a game-changer for the autistic community.

The final chapter shifts gears from what has been happening with autism to how to move forward. It presents the idea of neurodiversity, and considers how it can be accommodated. There is a brief epilogue that revolves around the son of Bernard Rimland. Rimland, while already a psychologist, shifted into the study of autism because he had an autistic child of his own.

I found this book quite intriguing. It is a fascinating exploration of the spectrum of states that we think of as autism. If you have any interest in the mind and neurological conditions, you’ll likely find it an educational read.

View all my reviews

BOOK REVIEW: Understanding Mental Illness by Carlin Barnes and Marketa Wills

Understanding Mental Illness: A Comprehensive Guide to Mental Health Disorders for Family and FriendsUnderstanding Mental Illness: A Comprehensive Guide to Mental Health Disorders for Family and Friends by Carlin Barnes
My rating: 4 of 5 stars

Amazon page

 

This book is a concise overview of mental illness for individuals who don’t know much about the subject, and who may hold misunderstandings about mental illness and the mentally ill. If that’s what you’re looking for, you’re in the right place. If you’d like to know more about the variations in particular disorders or about relatively obscure conditions, you’ll probably find this book doesn’t meet your needs. The book advocates for doing away with the stigma associated with mental illness and having a better idea of the nature of mental disorders.

The book has fourteen chapters that are mostly logically organized. I say “mostly,” because chapters three, ten, thirteen, and fourteen deal in unique situations facing specific demographics (children / teens, the elderly, women, and professional athletes, respectively.) I’m not sure why these are spread out with topics that have a tighter logic interspersed in between them. I also am not sure why there is a chapter specifically dealing with professional athletes. Mind you, I understand the author’s argument about the unique mental health risks afflicting professional athletes and retired pro athletes. However, it seems like there are other careers that create unique problems (e.g. air traffic controllers) that touch more lives. Given the fact that an important part of the author’s message is about how those with mental health issues are frequently misunderstood and stigmatized, it seems like if one had to pick one career group to represent in the book, one would find one that is bigger and more relatable (e.g. military personnel, cops, social workers, therapists, or even poor / unemployed people.) If it was done to appeal to the general readership’s interest in celebrity, it’s a fail.

Chapters 1 and 2 set the stage by discussing what exactly a mental illness is, how it can be distinguished from the quirks that we all have in varying ways and degrees, and what the various causes are. Chapters 4 through 9 are the heart of the book, and present information on various mental illnesses by type (i.e. mood disorders, anxiety disorders, psychotic disorders, personality disorders, eating disorders, and substance abuse, respectively.) Chapters 11 and 12 discuss suicide and mass shootings, both are worthy inclusions.

The chapters discuss the clinical criteria for various ailments (which often seem arbitrary, but that’s part of the need for such a book – to give readers an understanding of the difficulty of diagnosing the mentally ill.) There are brief case examples included throughout to help the reader recognize the signs. That said, there isn’t a lot of room to deal in the tremendous levels of variation seen within given disorders.

There is an appendix with resources and links. Otherwise, there isn’t much ancillary matter in the book.

I would recommend this book if you are looking for a quick overview of mental illness with some presentation of typical examples. Particularly if you want a handy convenient guide without a lot of searching about. [Which is to say, I don’t think there’s a great deal that one would get from this book that one wouldn’t find doing some internet research.]

View all my reviews

BOOK REVIEW: The Collected Schizophrenias by Esmé Weijun Wang

The Collected Schizophrenias: EssaysThe Collected Schizophrenias: Essays by Esmé Weijun Wang
My rating: 5 of 5 stars

Amazon page

 

Schizophrenia is ill-understood, and that’s just by psychiatrists and psychologists, the rest of us tend to downright misunderstand the condition. Wang’s book collects thirteen essays on her experience of living with schizo-affective disorder. I found Wang’s prose to be clever and engaging, though she does get into the weeds of technicality a bit in some of the early chapters. The book is not only well-written, it’s also brutally forthright. We hear a lot of how the author uses her alma mater (Yale) as a combination of sword and shield to combat the ever-present assumption she will be a stark-raving – not to mention dangerous — lunatic.

The book begins with discussion of diagnosis, but it doesn’t begin with her being diagnosed as Schizo-affective, but rather as Bipolar [formerly know as, manic-depressive.] There’s a great deal of discussion of the inexactitude of psychiatric science, and the fact that — to be fair — it’s not like every case is presents the same. The set of symptoms seen may create the potential to classify the same individual in different ways; hence, psychiatric diagnosis is often a long and winding road.

To list the essays with descriptions wouldn’t do them justice, so, instead, I’ll present some of the highlights. There’re a couple of chapters that look at how Wang tried to cope with, or counteract, the impression of people finding out she had schizophrenia. One of these involved the aforementioned repeated references to the Ivy-league institution that ultimately kicked her out and wouldn’t let her back in once she’d been treated and stabilized. Another was attachment to the label — and the idea — of “high-functioning,” which can be a hard sell for a condition like Schizophrenia. (Though not uniquely so. I once had a conversation with friend who didn’t understand that there could be such a thing as a “mild stroke.” This person believed that if one had any stroke one would surely be unable to talk correctly or have adult cognitive functioning. Though it occurs to me that my analogy is not entirely apt because anyone with a diagnosis of Schizophrenia will at some point experience severe symptoms – e.g. hallucination, delusion, etc. – otherwise they would be unlikely to be [rightly or wrongly] so diagnosed.)

There’s a chapter that deals with the question of having children. This brings up the twin questions of whether the schizophrenic can be a good parent throughout the development of the child, as well as how likely they are to pass on the trait through genes. [Those who’ve watched “A Beautiful Mind” will remember a scene in which the bathwater is rising on the baby because Nash is having an episode.]

Wang uses a number of sensationalist cases – e.g. murders – both to counteract the notion that all Schizophrenics are dangerous by contrasting with her own [more typical] experience, but also to let the reader know such extremes do exist. It should also be pointed out that one of these cases was the murder of a Schizophrenic by a family member who was living in terror that said schizophrenic (her brother) would ultimate kill her and her daughter, given the things he said and the auditory hallucinations he was said to have had.

One of the most interesting discussions for me was Wang’s description of leaving the Scarlett Johansson film “Lucy” asking her boyfriend whether what she saw was real. Everybody has that situation of being drawn into a film in an edge-of-the-seat fashion, but is fascinating to imagine a person who can’t disentangle from that state.

Chapter ten talks about the author’s experience with Cotard’s Syndrome. Cotard’s is a condition in which the individual believes they are deceased. I’ve read of Cotard’s in popular neuroscience books, but Wang’s first-hand account provides an extra level of connection to it.

The last essay discusses Wang’s pursuit of spirituality. It should be noted that in many tribal societies, Schizophrenics have been made shamans and are seen as having special powers. Wang doesn’t talk about this in great detail though she does a little [it is the premise of the series “Undone” on Amazon Prime], but it’s interesting to consider how religion and spirituality might influence the Schizophrenic mind.

I found this book fascinating and the writing to be elegant. I would highly recommend it for anyone with interests in the mind, mental illness, or just the experiences of other people.

View all my reviews

BOOK REVIEW: Psychotherapy: A Very Short Introduction by Tom Burns & Eva Burns-Lundgren

Psychotherapy: A Very Short IntroductionPsychotherapy: A Very Short Introduction by Tom Burns
My rating: 4 of 5 stars

Amazon page

 

The word “psychotherapy” conjures images of a patient on a burgundy recamier-style couch, a psychoanalyst in a matching stuffed armchair, neither one looking at the other as the analyst uses terse questions and monosyllabic acknowledgements to coax out the patient’s problems through interrogation about his or her childhood. While that approach, Freudian psychoanalysis, stubbornly maintains a following, there have blossomed many other varieties of therapy using talk as a tool to ease maladies of the mind. This “Very Short Introduction,” put out by Oxford University Press as part of a large and diverse series with the same subtitle, presents an overview of the various approaches to psychotherapy and its less formal cousin, counselling.

The book consists of eight chapters, and begins with a preface. The preface covers various and sundry topics useful for the reader, but most importantly it takes a step back from psychotherapy to situate this therapeutic approach in a context of psychology and psychiatry, which are subjects often confused in the popular mindset.

Chapter one continues with the basics by defining psychotherapy and offering a thumbnail of the various approaches that will be expanded upon throughout the book. The second chapter pays homage to Freud and his psychoanalytic approach. The authors maintain a diplomatic approach to psychoanalysis though it has fallen on hard times for a number of reasons, both practical (e.g. it’s a huge drain on time, often involving five hours a week for months or even years) and theoretical (e.g. it places a great deal of emphasis on the past, whereas many currently popular approaches favor the present as the relevant time.)

Chapter three explores a number of post-Freudian psychotherapists including Jung, Adler, and Erik Erikson. Chapter four moves on to what is called “Time-Limited Therapy.” As suggested in the preceding paragraph, psychoanalysis placed huge demands on a patient’s [and therapist’s] time and could go on and on with no end in sight. Time-limited therapies focused more on finding a present-day solution for the current problem, and not so much ceaselessly trolling one’s distant past for traumas.

Chapter five is about counselling, which is very much related to psychotherapy in that it involves getting a person to talk out his or her problems. The difference is that it needn’t necessarily involve a therapist with extensive training, but rather someone briefed and / or sensitive enough to know how not to become sidetracked into dangerous territory. Chapter six discusses cognitive behavioral therapy, its principles, and its variations (such as Mindfulness-Based Cognitive Therapy [MBCT], which combines elements of Buddhist mindfulness with the cognitive behavioral therapy approach to form a popular and successful therapeutic approach.) Cognitive behavioral therapy is rooted in the premise that distorted thoughts cause emotional and behavioral problems, and that one must address the thought to change the outcome. It also famously requires “homework” to be done between sessions rather than the work being contained within sessions.

Chapter seven moves away from the one-on-one therapy discussed so far, and investigates the various ways in which therapy can be carried out in groups. Groups can be beneficial because they allow the patient to see that they aren’t unique in their woes, which people often believe themselves to be. Family therapy is also discussed as it all allows family members to chip away at their problems as a familial unit. Also, there are numerous interactive forms of therapy in which patients might use various art forms to work out their problems.

The last chapter looks at where psychotherapy stands, and where it appears to be going. One of the important considerations discussed is the influence the advance of neuroscience is having on therapy. For few decades since the famous decade of the brain (i.e. the 90’s,) neuroscience has dominated the discussion of the realm of the mind. There has been less-and-less thinking in psychological terms and more and more in physiological terms. However, there still seems to be a widespread belief that solutions need to combine a recognition of both areas.

Like other books in the series, this one employs a variety of graphics (cartoon, photographic, and diagrammatic), and it also presents brief references and further reading sections to help the reader continue his or her study through other works.

This book offers a solid overview of the various approaches to psychotherapy. I would recommend it for neophytes who need to start with a concise outline of the field.

View all my reviews