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Improving Mental Health

Four Secrets in Plain Sight

Lloyd I. Sederer, M.D.

  • ISBN 978-1-61537-082-5
  • Item #37082

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In Improving Mental Health: Four Secrets in Plain Sight, Dr. Lloyd Sederer draws upon four decades of diverse clinical practice, mental health research and public health experience to create a memorable volume that is as elegant as it is instructive. The book aims to help clinicians improve the lives of their patients—and patients to improve their own lives—by identifying these secrets and taking action in ways that can work immediately, closing the science-to-practice gap. In addition to mental health and primary care clinicians, patients and their families will find the book's many stories, clinical examples and cultural references fascinating and illuminating.

The book's four foundational truths, all hiding in plain sight and all eminently actionable, are

  • Behavior serves a purpose. The search for meaning and the identification and communication value of a behavior are too often overlooked aspects of mental health care and a lost opportunity with and for patients and their families.

  • The power of attachment. The force of attachment as a human need and drive must be harnessed if we are to change painful and problem behaviors. Relationships are the royal road to remedying human suffering—both individual and collective.

  • As a rule, less is more. Mental health treatments, both medical and psychosocial, have often been aggressive, from high doses of drugs to intensive sessions and psychic confrontation in individual and group psychotherapy. Unfortunately, these high risk efforts infrequently provide help and often have unwanted and problematic effects. Primum non nocere—first, do no harm—is the first law of medicine.

  • Chronic stress is the enemy. From adverse childhood experiences to posttraumatic stress, chronic stress can be an underlying factor in the development of many mental and physical disorders. However, chronic stress can be understood and contained, thereby reducing its damage.

Dr. Sederer synthesizes the knowledge gained through his considerable experience as a psychiatrist with insights gleaned from history, research and literature to address the four truths in a systematic, yet lively, manner. The result is a book of rare grace. Improving Mental Health: Four Secrets in Plain Sight will be a touchstone for the clinician and general reader alike.


  • Foreward.
  • Author's Note.
  • Introduction.
  • Chapter 1. Behavior Serves A Purpose.
  • Chapter 2. The Power of Attachment.
  • Chapter 3. As a Rule, Less Is More.
  • Chapter 4. Chronic Stress Is the Enemy.
  • Some Closing Thoughts.


    Patrick J. Kennedy

About the Authors

Lloyd I. Sederer, M.D., is Chief Medical Officer of the New York State Office of Mental Health, the nation's largest state mental health system. He is adjunct professor of epidemiology at the Mailman School of Public Health, Columbia University. Previously, Dr. Sederer served as the Executive Deputy Commissioner for Mental Hygiene Services in New York City. He also has been Medical Director and Executive Vice President of McLean Hospital in Belmont, Massachusetts, a Harvard teaching hospital, and Director of the Division of Clinical Services for the American Psychiatric Association.

In 2013, Dr. Sederer was given the Irma Bland Award for Excellence in Teaching Residents by the American Psychiatric Association, which recognized him in 2009 as the Psychiatric Administrator of the Year. He also has been awarded a Scholar-in-Residence grant by the Rockefeller Foundation and an Exemplary Psychiatrist award from the National Alliance on Mental Illness.

He has published seven books for professional and now three books for lay audiences, as well as over 5000 articles in both medical journals and nonmedical publications. He is Medical Editor for Mental Health for the Huffington Post, where more than 250 of his posts and videos have appeared. He is also writes a regular column on mental health for U.S. News & World Report. He is a regular on Tell Me Everything, the SiriusXM radio show hosted by John Fugelsang.

This is an intelligent, balanced, and very useful guide to becoming a knowledgeable and confident actor in pursuing your mental health. It will also help you to approach mental health professionals as an equal partner.—Andrew Solomon, Professor of Clinical Psychology, Columbia University, and author of Far From the Tree and The Noonday Demon, winner of the National Book Award

This book is a must read for those who experience or have a family member with a psychiatric condition. Dr. Sederer gives moving descriptions of patients and their suffering and sage advice about interventions. His deep experience in working with those afflicted with mental illness comes ringing through, page after page.—Maria Oquendo, M.D., Ph.D., President, American Psychiatric Association, and Professor of Psychiatry, Columbia University Medical Center

Lloyd Sederer has written this book to help laypeople and practitioners see what's right before their eyes, but often unnoticed. He explores four secrets—that behaviors have meaning, that attachment is central to health (and recovery), that doing more often means doing more harm, and that chronic stress may be the most debilitating condition of life...This is well worth reading, digesting, and using as a foundation for interactions between clinicians and the people they aim to serve.—Paul Gionfriddo, President and CEO, Mental Health America

There are secrets hiding in plain sight, so writes Dr. Lloyd Sederer in his new (10th!) book, which can make a real difference in the lives of people with mental and addictive disorders and their families. He is not only right; he reveals these secrets using stories, anecdotes, science, and history. This is a must and wonderful read for clinicians and for those affected by these all so common conditions.—Linda Rosenberg, MSW, President and CEO, National Council for Behavioral Health

Sederer's thoughtful and provocative book could not be timelier. It arises out of a seemingly confusing moment in mental health and poses an immense creative challenge: to draw out the rules, or laws, that govern the psyche as it adapts to an ever-changing world. His laws or secrets—often counterintuitive, yet full of clinical utility—illuminate his profound understanding of patients and their particular predicaments. There's a powerful thread of wisdom that runs through Sederer's writing like a bright red line, reminding us that by identifying the driving tenets of clinical care, we refresh and deepen our engagement with it in the future. I read this book in a single setting, and felt so much wiser at the end.—Siddhartha Mukherjee, Pulitzer Prize–winning author of The Emperor of All Maladies and The Gen

We've been honored to have Dr. Lloyd Sederer as a regular on my SiriusXM show to discuss his writings on mental health and addictions, as well as his film and book reviews. His expertise extends to every aspect of the human struggle with mental problems, from science to history, from popular culture to the drug war, as this Secrets book reveals. He is an uncommonly compassionate medical professional and public servant—and he's a terrific writer too.—John Fugelsang, SiriusXM radio host

A noted mental health professional casts light on some of the dark avenues of our lives.

Writing for his fellow psychiatric practitioners, but in language accessible to lay readers, Sederer (The Family Guide to Mental Health Care, 2013, etc.)—chief medical officer of the New York State Office of Mental Health and the medical editor for mental health for the Huffington Post—identifies what he characterizes as four secrets that illustrate opportunities in plain sight for therapy. One is the thesis that behavior serves a purpose. That purpose may not be readily discernible, but, the author writes, a cornerstone of good psychiatric practice is finding the right language to allow the patient room for self-expression: We have to ask more, in a manner that allows a person to respond, over time, knowing that they will not be judged or harmed when allowing another person access to their private and sometimes previously inaccessible thinking. The challenges are numerous, but Sederer's insistence on there being a discoverable reason for mental illness helps ferret out why, for instance, smart young people should fall victim to anorexia nervosa or what logic underlies manic depression. The author writes that mental health is a product of both nature and nurture; we cannot help our genes, and people have only so much control over whether their families are supportive or they are able to earn a decent living. It is in that scenario of environmental control that another of Sederer's secrets emerges, namely that chronic stress is the enemy. The stress response, like all behavior, has a purpose, but acute inflammation and the endless fight or flight of modern life takes its toll. Blending cutting-edge science with therapeutic art (positive thinking is good protection against stress and beneficial to our health), the author offers an optimistic view of what we can do to improve our well-being.

A helpful owner's manual for those in possession of emotions—and, more to the point, those possessed by them.—Kirkus Review, 05/09/2017

It seems that Dr. Sederer has undertaken two tasks in his book and through his public service:

1. To make mental health issues more accessible to the public through his writings in the Huffington Post. In the book, secrets 1 and 2 pertain to this task by offering more of a psychological-formulation insight that is often overlooked in mental health practices.

2. Secrets 3 and 4 offer more systemic insights as to how to reduce the science-to-practice gap on a system-wide level, which fit with Dr. Sederer's role as medical director for the New York state mental health system.

While the book does not offer insights or literature that were not already known, Dr. Sederer's neat, clear, and succinct packaging of this knowledge into a short 100-page book makes these issues very approachable and practical to lay readers and practitioners alike.—Noa Heiman, Ph.D., Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, American Journal of Psychiatry, 05/01/2017

In the second section of the book, he goes on to examine treatment for the individual, stressing that there is no one right option to fit everyone. He is critical of the fact that (amazingly) 90% of US recovery centres are based on Alcoholics Anonymous, which studies estimate is only effective for 5–10% of those who use it. A doctor's job, he argues, is to help their clients to find whatever combination of treatment works for them, and he takes us through the virtues of various options: 12 step, motivational interviewing, contingency management, and medication-assisted treatment among them. It's reassuring to see his reminder that methadone maintenance can be life-saving; reassuring also that he emphasizes the need to treat mental and physical comorbidities in addition to the addiction alone. UK policy makers would do well to be reminded of this.
No quick-fix solution here, then, just wisdom and humanity. For those who work in the field and are already versed in Sederer's arguments there is perhaps little new information, but it's certainly refreshing to read a book on the subject that contains so much empathy and common sense. For those new to the subject—including medical students and addiction trainees, if there are any of the latter left—it's an excellent eye-opener: I shall be recommending it.—Jenny Drife, Lancet Psychiatry, 07/02/2018

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