I am very pleased to tell you about the publication of a new book that I have written titled SHRINKTALK. It is based on my experience over many years in the field of psychiatry. It covers a wide variety of subjects such as ethical dilemmas that psychiatrists can face, dealing with anxiety, panic, depression, suicidal thoughts, sexuality, autism, post traumatic stress, psychological issues in regard to the Cornavirus epidemic as well as various medical conditions, my interactions with two U.S. Presidents and many other subjects. Also included in the book are answers to questions that I have provided for a popular website.

You can order the book in printed or Kindle version on Amazon. ( Click here )

I hope you will consider getting the book and if you like it, help me spread the word to your friends and colleagues and also consider writing a positive review on Amazon and elsewhere

Sincerely

Michael Blumenfield, M.D.

Note:

Todays book blog features a book which I had the pleasure of recently co-editing with my colleague Dr. James Strain. I have reproduced below the forward to the book written by Dr. Herbert Pardes.   The publisher has given me permission to offer the readers of this blog a 30 % discount for purchase of it if you use the code in the coupon at the end of the blog

Depression As A Systemic Illness – edited by James J, Strain, M.D. and Michael Blumenfield, M.D.

Forward to book- Written by Herbert Pardes, M.D.  ( Former Director of National Institute of Mental Health and former President of the American Psychiatric Association )

Depression occupies the minds and work of people of diverse disciplines. Prior to the introduction of anti-depressive treatments, depression was widely treated with interventions like electric-convulsive therapy (ECT). In the mid-1900s, the first monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) were introduced. For decades subsequently, much research focused on such treatments. Depression was considered a mental disorder. The focus on these antidepressants was followed over the next five or six decades with few new developments.

This book stresses the breadth of the topic, describing depression as a systemic illness, not just a mental illness. The best thinking today is that there are new tools and concepts in research, awareness of multiple causes, multiple kinds of depression, and increasing recognition of the mechanics and physiology that produce them. The book creates an optimistic and innovative approach to understanding and treating depression.

Brain plasticity is remarkable. Much current focus has been on brain action. However, this text uniquely conceives of depression as systemic, resembling other non-psychiatric chronic illnesses such as diabetes, hypertension, asthma, congestive heart failure, etc.

New research techniques have generated a conviction that integrating diverse lines of research enhances the promise for advances in understanding the disorder of depression. Another conviction among depression experts is that clinicians and scientists should focus on earlier stages of the disorder. Early intervention appears to produce better outcomes. Also, there is a greater focus on the continuing effects of depression.

Brain plasticity and recognition of depression’s pervasive impact throughout the body—McEwen’s “allostatic load”—has induced scientists to examine enduring and long-term effects of depression. More depressive episodes and longer periods of depression appear to be correlated with more serious states of depression.

Contributory causes are multiple—genetics, family history, adverse childhood development, environmental stress, etc. Depression is highly heterogeneous. For example, when youth have persistent anxiety and/or depression as well as mental lability, subclinical mania, accompanied by parents with early-onset bipolar disease, 50% of such children also develop bipolar disease.

The systemic nature of depression with the many interconnections also results in omnipresent comorbidity. This new text explores, e.g., cancer, heart disease, and neurological disorders in this regard.

New treatment approaches being developed make use of neuroimaging, brain stimulation, and substances like ketamine. The latter produces rapid improvement in mood rating in patients resistant to typical antidepressants, but it may have a minimal lasting effect if not serially repeated; it is not as yet FDA-approved for depressive disorders.

There are five different types of transcranial medical stimulation (TMS). In some, TMS generates brain tissue regrowth over four- to six-week periods. Treatments like cognitive behavioral therapy work on circuits. Interpersonal therapy, too, is being used in creative ways in underdeveloped countries. One emphasis is looking for interventions that may foster synaptic plasticity and connections.

The enthusiasm of many scientists is palpable. Some assert that we are undergoing “a scientific revolution in mood disorder research is anticipated.” Encouraged by advances in cancer treatment through precision medicine, some foresee possible application of precision medicine to depression. The rich knowledge being developed from neuroimaging has led to “neuroimaging phenotypes,” which means an imaging picture shared widely by many depressed patients.

These developments are significant for education. The impact on training, the important role of primary health care professionals, the potential of psychoeducation are pertinent educational issues. Should primary care physicians not be able to diagnose and care for “garden variety” depressive disorders, and then, if necessary, refer refractory patients on to more experienced clinicians? Medical school curricula and residency training will need to be altered for non-psychiatric physicians to have sufficient skills to accomplish this.

Depression deserves recognition as an illness of major proportions. It affects vastly different body systems. The World Health Organization ranks it as exacting the greatest burden of illness on the world population. Innovative treatments and ideas provide optimism.

Considering it a systemic illness represents a change from the former perspective that brought patients with depression brief interludes of relief with ECT, psychotherapy, and/or drugs while ignoring the long-term course and its biological accompaniments. We deal with a longstanding illness that needs enduring attention. If treated early, and if one can modify the number, intensity, and length of episodes, we will be likely to produce improved outcomes.

This formulation of depression as a systemic illness, not just a mental illness, may also be welcomed, recognizing the many decades in which psychiatric illness and treatment suffered from stigma. Outstanding innovative leaders from many fields grasping the breadth of depression’s impact are working together, accumulating vast data and manifesting enthusiasm about possible major strides going forward.

This rich book brings experts together and covers extensively the biological, psychological, endocrinological, genetic, and imaging aspects of depression. This collaboration by outstanding scientists and clinicians represents probably our greatest hope for real improvement in the management of depression. It is well described here. While not minimizing how much has to be done, this is an uplifting book, given the excellence of its contributors and their laboratories, and the proliferation of new and imaginative tools and concepts to advance the effort to bring depression under control.

To purchase this book directly from Oxford University Press at a 30% discount please follow the directions in the discount coupon above and use the promo code in that coupon or note this code ” AMPROMD9 “and click here

To purchase Psychosomatics a text book edited by Dr. Michael Blumenfield and Dr. James Strain please click here

To purchase Psychosomatic Medicine ( 2nd edition) a text book written by Dr. Michael Blumenfield and Dr. Maria Tiamson please click here 

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10% Happier: How I Tamed The Voice In My Head, Reduced Stress Without Losing My Edge, And Found Self-Help That Actually Works – A True Story by Dan Harris.

I never had a desire to meditate or develop mindfulness. This may be because in my work as a psychiatrist, I am always exploring the past to understand the present. I also seem to be attuned to capturing the present moment for future reflections rather than be intensely into the present. Frequently, I am moved to take photographs to hold on to a special moment. However, that does not mean that I am not curious to understand why many people whom I respect are into some form of achieving mindfulness. I was not quite moved to go to a retreat or read some esoteric books about Buddhism, meditation, or the like. However, when someone recommended this New York Times bestselling book by Dan Harris, a TV news reporter and anchorman, I thought I would give it a try.

This is a down to earth, humorous at times but a genuine journey by a guy who is bothered by the voices in his head (no real hallucinations), racing thoughts (no apparent manic problem) which he felt made him anxious  a good deal of the time. He had tried what appeared to be a reasonable run at psychotherapy, which may have helped somewhat, but his curiosity about exploring mindfulness persisted.

Mr. Harris met some serious practitioners of various forms of mindfulness and meditation, which he describes in a very readable style. He tried very hard (and I believe he succeeded) in explaining his journey and his personal experience. He gives a blow by blow (or should I say breath by breath account) as he learned to look inward to his breathing and his inner thoughts. He carefully describes the various steps, which he has tried as he learned to meditate and tells how it has been meaningful to him. In a humorous and at times self-deprecating manner, he seems to be quite sincere as he shows and discusses his various attempts and experiences. It appears to have worked for him. Not only has it worked for him, but also I believe he has written a very readable and successful book.

Please leave any comments below

To purchase a copy of this book from Amazon, please click here

This book review originally appeared in The Academy Forum published by the American Academy of Psychoanalysis and Dynamic Psychiatry Vol.62, Number 2,  Fall 2017

Cinema As Therapy: Grief and Transformational Film by John Izod and Joanna Dovalis, published by Routledge, London and New York 2015

Reviewed by Michael Blumenfield, M.D.

Dr. Blumenfield is a Past President of the American Academy of Psychoanalysis and Dynamic Psychiatry and regularly reviews movies at FilmRap.net

This book discusses the following 9 films:

Birth (2004)

Tsotsi (2005)

Million Dollar Baby (2004)

Trois Couleurs: Bleu (1993)

Trois Couleurs: Blanc (1994)

Trois Couleurs: Rouge (1994)

The Son’s Room (2001)

Spring, Summer, Autumn, Winter… and Spring (2003)

Morvern Callar (2002)

The Tree of Life (2011)

I am listing all the films covered because unless you are intimately familiar with these movies (which I was not), I believe it will be very difficult for you to appreciate and follow the detailed discussion of each of them in this book.The authors carefully dissect each movie, often scene by scene, sometimes discussing the camera angles, the music, certainly the dialogue (sometimes word by word), and most important their detailed understanding of the psychodynamics of each character and their interaction with each other. There are frequent references to psychoanalytic writings with a heavy emphasis on Jung.

The difference between this type of an approach compared to a case study is that the latter would be presented in an organized manner where we might have a context to examine the details. In this book, the author assumed that their interpretations and their psychodynamic formulations are correct and they continually build and elaborate on them in their ongoing dissection and discussion of the movie. We have to accept that their understanding of every nuance is valid. Did the screenwriter who created the characters and storyline consciously plan every symbolic twist and turn of the story, choice of phrase, meaningful color of clothes or sky or flowers, appearance of animals or birds, all of which were interpreted by the author of this book as having special meaning. Even if we assume that the psychodynamics are flowing from the unconscious of the screenwriter and director, we still have to do a reality check on how movies are actually made. Sometimes the clothes chosen by wardrobe people based on availability as might be a particular location, which may not be chosen because of symbolic meaning. The red color of the sky may be an artistic coincidence and not a symbolic choice to express anger, etc.

Even if what I believe is a great deal of over interpretation was valid, it would be difficult to understand most of it without knowing the past history and insight into each character. When we are studying a case history in a conference or supervision, the presenter has given us a context by providing the background (parents, youth, previous interaction, etc.) and usually an insight into a psychodynamic formulation, which the presenter wishes us to consider. If we are treating a patient and are formulating our understanding of the psychodynamics, we do this through a process of learning past history and early relationship, transference manifestation and the patient’s response to our interpretations. This is in contrast to having the author unfold a movie story and provide detailed interpretation of nearly every piece of behavior which is unfolding before us on the screen without a previous context.

In the introduction to this book, the authors note that they have chosen to emphasize grief in cinema and they imply (as does the title of the book) that cinema can be used in grief therapy. They seem to be suggesting that transformation and perhaps working through might be achieved by cinema. They note that film allows the viewer to more freely surrender themselves to their feelings. They elaborate that the audience might share a common trait with the character in the movie, which evolves into particular patterns of grieving caused by a devastating and undigested loss. The idea would appear to be that the movie experience would be therapeutic in working through the grief. While some of the movies discussed in the book did have grieving and loss as part of the theme, I did not feel that the authors returned to this idea in any depth in showing how viewing the film might be therapeutic to the audience.

Having said all of the above, I do believe it would be a wonderful experience to attend the movie with the authors and have a subsequent discussion with them about the film that we just experienced. I also believe that the authors would be ideal teachers to discuss the film that students or colleagues who have all viewed the film and could interact with each other about their interpretations. This book could be a textbook for a psychoanalytic class that was going to study one of the movies and have a sophisticated dialogue about possible psychodynamic interpretations. It would be even more of a challenging endeavor if a psychoanalyst would embark upon teaching a group of film students about psychodynamics and use this book and the particular movies as subject matter. In addition, it certainly would be fascinating if the authors could present clinical material where a movie had become a therapeutic experience to a particular patient in helping them work through their grief or other issues.

To purchase this book on Amazon please click here 

The Wisdom of Psychopaths by Kevin Dutton

Kevin Dutton, the author of this book is a PhD research psychologist at the Department of Experimental Psychology, University of Oxford. His principal research interests are persuasion and social influence, and the psychopathic personality. This is his 4^th book and 3 of them also clearly deal with psychopaths

This book is all about the Psychopathic Personality. While all aspects of this interesting entity are discussed from many view points, I don’t believe a clear definition was put forth- probably because there are some disagreements about many of the fine points. For the purpose of this review I will go by the definition of Psychopathic Personality as being a personality disorder characterized by amorality and lack of affect; capable of violent acts without guilt feelings. In the psychiatric literature the term was superseded by “ sociopathic personality ” which then evolved to the  “antisocial personality”

In the latest Diagnostic Statistical Manual-5 ( DSM-5), the term antisocial personality is used and defined as “ A persuasive pattern of disregard for and violation of the rights of others, occurring since age 15 as indicated by THREE (or more) of the following:

• Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
• Deceitfulness as indicated by repeated lying, use of aliases or conning others for personal profit or pleasure
• Impulsivity or failure to plan ahead
• Irritability and aggressiveness as indicated by repeated physical fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another

The individual also must be at least 18 years of age, there has to be  evidence of the disorder starting before age 15 and it should not exclusively occur during the course of schizophrenia or bipolar disorder.

The author describes, to my mind, fascinating research by various authors about this entity. Often various scales are used to define the psychopathic personality that incorporate different aspects of the above criteria. Some would appear to emphasize some criteria and others would favor different criteria. Some researchers used very extensive tests and others would just ask a few questions. Before I go further, readers might was to take an 11 question test to see where they fit in on the psychopathic scale as determined by this short questionnaire.

Another test that he uses is a variation of the classical moral dilemma of the overcrowded lifeboat. Either some people have to be thrown overboard and die in the icy waters or they all will die. Various subjects are asked this question and how fast they answer, what their answer would be and perhaps what part their brain was shown to be active while they were deciding, all might be studies and the results would also be analyzed according to their scoring on a psychopathic scale of one type or the other.

Various components of the psychopathic personality are broken down and studied. For example, the author was interested in the fact that college students are trending to be less empathic and more narcissistic in various research studies.

The author is very interested in epigenetics, which is the change in how a gene is expressed without changing the DNA sequence. This would appear to be looking at how environmental factors influence how the gene is going to be expressed. This could occur to the fetus during pregnancy or I would suggest the same definition could occur by experience in childhood but all impacting on some genes that perhaps had a tendency to produce psychopathy. The author considers also how such things as child abuse might even produce an enzyme that in a susceptible individual might make them more aggressive.

The book is a hybrid between an interesting non-fiction discussion of the psychopath and a scholarly textbook. as would be the case in the latter many references are cited but not in the usual scholarly form but rather by an asterix(*), which leads the reader to the appendix where the topic is superficially discussed. Not knowing the research, we are left with the author’s conclusion about it without any critical analysis. For example we are not told the degree of statistical analytic support (or if there was statistical proof or just a trend) nor are we told if there might be other explanations that might shed light on a particular research finding.

There are many interesting questions raised by the author about the psychopath and various characteristics, which make up psychopathy.

For example, the psychopath often has ability to remain calm and objective under stress with razor sharp focus which might be useful in sports as a quarterback under pressure, a fireman in a dangerous situation and maybe even as a Navy Seal. You might want one in your foxhole unless of course there were a situation where only one person could survive.

There are many unexpected angles that the author uses to approach the analysis of psychopaths. He even makes the case that Saint Paul was a psychopath and that there could be a thin line between Saint and a psychopath. After all isn’t mindfulness an altered state where one is present, open, and alert with all judgment and interpretations suspended?

There is a discussion about empathy, something of which we might imagine that the psychopath would be in short supply. However in the riveting discussion about some sadistic serial killers, it was that exquisite ability to feel their victim’s pain, which was converted to pleasure and drove them to their numerous twisted murders.

So whether you are clinician or a layperson that has been fascinated by the characteristics often defined by the term psychopath, this book will hold your interest and even get you to wonder if deep down you have some of these traits.

To obtain a copy of this book from Amazon, please click here

The following is a book review which I wrote and  appeared in Psychodynamic Psychiatry Volume 41 Number 3  Fall 2016 p 162-166

Getting The Most From Your Therapy by Jeffery Smith, M.D.

Instead of a written review of this book, I have conducted an interview with Dr. Smith in a podcast. Please click the following line to hear this broadcast: Interview with Dr. Jeffery Smith.

To obtain a copy of this book, please click here

What She Left Behind

By Ellen Marie Wiseman

This book is composed of two interweaving stories. Clara, a woman who lived in the 1930s was committed to a mental institution against her will based on her wealthy father’s unhappiness about her Italian immigrant boyfriend and her refusal to marry the rich guy that her father picked out for her. The other story is about a current day teenager named Izzy who is a foster child of Peg and Harry after having lived with several previous foster parents since her mother unexplainably murdered her father. Peg is working on a museum project examining newly discovered suitcases of belongings of former patients (including those of Clara) of a now closed psychiatric facility, in order to gain some understanding of their lives. Izzy helps out with this project and finds the diary of Clara and becomes interested in her life.

Being a psychiatrist, I was initially drawn to this book with the idea that I would gain some insight into the lives and treatments of psychiatric patients living in the first half of the twentieth century. This was the case and it included vivid description of the treatment that was done at that time such as ice baths, insulin shock therapy and electroconvulsive therapy (ECT).

Although I never worked in a state hospital, when I toured them in the late 1960s, such treatments except occasional ECT under humane conditions were things of the past. As far as the possibility of someone spending most of their life committed to a mental institution based on the word of her father when she clearly did not have a mental illness, I would like to think that this would not have been possible. Certainly, in modern times from my experience someone being hospitalized against their will would have to go through a legal hearing with the patient being assigned an attorney if they don’t have one. Once in a hospital with treatment with modern-day medicines (which were not really available until the 1950s) most mental illness can be put at least in temporary remission with such treatment. Today, there would be reviews by multiple doctors with no mandate to keep the person in the hospital against their will unless they were a danger to themselves or others due to a mental illness. I would hope that nothing like Clara’s situation could occur today. Obviously, I can’t speak for every state hospital in the United States and certainly things were different in the 1930s.

There was another aspect of Clara’s case was particularly disturbing to me in that the psychiatrist in charge of her care was depicted as a mean, cruel, selfish man who was mainly responsible for Clara’s lost life. I felt it was an unfair indictment, which suggested all psychiatrists of that time might have been of the same cloth. I understand that the author has the creative choice to develop characters in whatever fashion she chooses. I probably would not be complaining if the character were a dishonest lawyer who did unsavory things in the interest of an interesting storyline but nevertheless, I felt that this book was stigmatizing my profession.

There was particular theme of this book, which also had a special interest to me. Three characters in the book were driven to try to understand their early origins. Izzy, understandably could not fathom why her beloved mother murdered her father. This ultimately led her to empathize with a schoolmate who had some parental trauma. It contributed to her mission to find Clara’s daughter who was essentially separated from her at birth, and hand over her mother’s diaries so she could know about her mother’s story. Clara’s daughter led a life of yearning to know what happened to her mother and Clara similarly went through life wanting to know what happened to her daughter. This is a variation of a theme, which I have seen played out in many people’s lives as well as in some interesting movies. Persons, sometimes separated at birth or when they are quite young often yearn to know their biological parent or parents with whom they may have had no relationship for decades. I have reflected on the psychodynamics of these issues in a psychiatry blog that I write. Therefore, I was particularly interested to see how they played out as major motivating factors in the characters in this book.

I believe the author Ellen Wiseman has created an intriguing story that will hold the interest of the reader whether or not you come from a psychiatric background.

A Common Struggle: A personal Journey through the Past and Future Mental Illness and Addiction   By: Patrick J. Kennedy and Stephen Fried

This is a story, told in the first person of Patrick J. Kennedy. It is really two stories presented to us simultaneously. It is about Patrick Kennedy, son of Edward Kennedy and nephew of JFK and Bobby Kennedy. He has been a US congressman from Rhode Island for eight terms and was one of the staunch advocates for parity legislation, for mental illness, and addiction. Yet at the same time that he was leading the fight in the United States Congress to bring about these major changes in our healthcare system, he himself was secretly battling mental illness and addiction.

An important part of his personal story was a discussion of alcoholism in his family. Not only was the author an alcoholic but his brother, mother, and father, Ted Kennedy also struggled with this condition. It is significant that all of them except his father ultimately recognized their problem and entered various programs to help themselves. His mother battled alcoholism for a prolonged period of time and yet her condition was not recognized by family members despite the fact that they knew about several hospitalizations and treatment programs that she had undergone.

One of the most revealing insights about his father that he revealed in this book is how Ted Kennedy was traumatized by the tragic death of his three brothers, JFK, Bobby Kennedy, and his oldest brother, Joe Jr., who was killed in World War II. An additional major trauma for Ted Kennedy was the death of the young woman in Chappaquiddick, an incident well covered by the press.

It was not a simple pathway for the author to recognize his own problems. Even after a period of therapy with Psychiatrist Peter Kramer, author of the well known book (Listening to Prozac). Kennedy felt this treatment was helpful but did not eliminate his addiction problem or allow full acceptance of his bipolar condition. He vividly described how he would convince himself that he didn’t have any problems if he didn’t drink in public or take “illegal” drugs.

Patrick Kennedy served in the Rhode Island legislature and was elected as the youngest member of the US Congress in 2004 during a period that his addiction and mental illness was hidden from the public. It was also pretty much hidden from himself.

His colleagues in the US Congress ultimately became aware of his attempts to hide his drinking problem. Kennedy describes an important event for him when in 1996, Minority Leader, Dick Gephardt, offered him the prestigious chairmanship of the Congressional Campaign Committee on the condition that he stop drinking. This made him realize how he was denying that he had a problem that was known to others.

It wasn’t until 2005 that he publicly admitted that he was suffering from a mood disorder that was being treated by a psychiatrist. While his own struggle continued, he became more effective in his advocacy in the US Congress. One misconception he believed had to be clarified concerned Nancy Reagan’s “Just Say No” campaign against drugs. He felt that this missed the main point that addiction is not something you can simply say no to, just as you can’t say no to cancer. It is a disease and by implying you can just say no stigmatized people who have the genetic propensity to have this disease.

As much as the story of Kennedy’s recognition of his own illness of addiction and mental disease and how he battled it is quite enlightening, the battle for a definitive bill in the US Congress is just as revealing.The events leading up to the 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act are quite interesting and complicated. They are also quite personal to Patrick Kennedy. It took place at the time that he was relapsing to alcohol and painkillers and also was having an exacerbation of his bipolar condition. While Patrick Kennedy was one of the leading champions in the House of Representatives for this legislation, his father, Ted Kennedy, was a major supporter of this bill in the US Senate. This was also at a time that the senior Kennedy was dying of a brain tumor. Compromises had to be made in the bill and the Senate was reluctant for the legislation to be as comprehensive in various aspects and details of the bill as was wanted by the House of Representatives. There also was a question how the legislation would deal with the new surge of mental health problems occurring in soldiers returning from the war. There was a concern that it should cover PTSD as well as addiction in the returning servicemen. Patrick Kennedy described the dramatic moment that his dying father came to the senate floor to vote for the final version of the bill to the applause of the US Senate.

Even with the passage of this extraordinary legislation, the battle for adequate parity for healthcare support was far from over. The proof and the success of this landmark bill would depend on the implementation by the federal and state governments and certain local rulings are expected to eventually reach the Supreme Court. The 2016 presidential race can certainly also be expected to impact the success of implementation of this legislation. As of this writing, it appears that the Republican candidates may be reluctant to support the implementation of this legislation and provide funding for new programs.

Patrick Kennedy decided to leave the United States Congress in 2010. Since departing from Congress, he has continued to be a leading advocate to bring about implementation of the 2008 legislation for mental illness and addiction. In this regard, among many other things, he has worked with two important organizations in which he plays very active roles. The Kennedy Forum (kennedyforum.org) gathers experts in mental health and addiction and holds important conferences that they hope will ensure implementation of the 2008 legislation. They are also committed to promoting a translation of neuroscience into the preventative and treatment interventions for mental health and addiction. The second organization in which Patrick Kennedy is involved is One Mind (onemind.org), which is dedicated to the promotion and support of “brain health” and creating a fast track for treatment. Their current focus is on new approaches to treat and cure PTSD but they look forward to applying solutions for all brain disease including depression, Parkinsons, ALS, dementia, Alzheimer’s disease, and addictions.

Patrick Kennedy does not bemoan problems. He is clearly a man not only with a vision but with plans and solutions. He concluded his book with a scorecard of how we should rate our public officials who have the opportunity to pass legislation and make changes. Also at the end of the book, he had a section for people who are dealing with their own mental illness and addiction. He tells them not to be alone in this struggle and how important it is to get treatment. Finally, sandwiched in this book was a series of photographs of many well known members of his family. It brought back many memories to this reader of the great accomplishments of many members of the Kennedy family and of the tragic events that they experienced.

It should be noted that at the time that Patrick Kennedy wrote this book, he was three and a half years sober. He has shown that he is a very accomplished and insightful man. I believe we are going to hear a great deal about him in his advocacy. He has provided in this book a valuable historical account of the reasons to fight for the proper care of mental illness and addiction. I am sure he has a bright future and many people will benefit by his skills and his passion.

How We Heal and Grow: The Power of Facing Your Feelings by Jeffery Smith, M.D.

I was recently asked by my colleague and friend Dr. Jeffrey Smith, to write the Foreword for this new book that he has written. I was pleased to find it an excellent book. He offers a fresh and sensible way to look at how people develop dysfunctional patterns and facing feelings that have been avoided is the pathway to healing growth. He covers the full range of human problems from quirks to serous personality issues. He discussed the work of Freud, Mahler, Kernberg and many others including his own work. Interestingly the book is directed towards the lay public and I am sure will be received. However it really also belongs in the hands of therapists and any mental health professional who is involved with therapy. Dr. Smith has been teaching this subject to psychiatry residents and other psychotherapists for many years and is always very well received. He approaches the subject from a development al point of view. He points out how most of us have pockets of immaturity and how to outgrow them. Dr. Smith  discusses how and why the minds resist change. One of the central themes of Dr. Smith’s explanations is the phenomenon of catharsis where our underlying raw unprocessed feelings emerge and lose their power over us and are transformed when we share them with a therapist in the context of connection and safety. He describes this process and how it brings about an almost immediate change to the pathological emotions. I tend to look at the need for catharsis as something that has to occur over and over again which we often refer to as working through process. We do both agree that catharsis is an ongoing part of therapy. While this therapeutic work does require the empathic presence of the therapist. Dr. Smith also examines how some of this work may be able to done singularly when the person is trained in mindfulness in the Yoga and Buddhist tradition. The range and scope of the book is quite wide. He includes discussion of anxiety symptoms, trauma and depression although I felt he was little light on this latter subject particularly in regard to the role of loss. There is fascinating discussion on the dynamics of Multiple Personality Disorder in which he is a one of the few therapists with significant experience treating patients with this condition. Dr. Smith also brings his rich  experience in treating addiction into the book. He shares where dynamics and developmental experience is important and where the here and now social interaction is crucial. Included in the book is one of the best discussions of conscience and superego that I have ever come across. There is also and excellent section on the narcissistic personality and a description of how to understand a parent who had this condition and how to deal with important people in your life who have it. This is really a unique book that should have great appeal to therapists, students learning therapy and people interested in understanding their own emotional issues as well as those around them. I can also picture how this book may be very useful for people entering therapy, It will alert them to what to look for in themselves. It may very well facilitate the therapeutic process. In fact, I plan to give a copy of it to some patients who enter therapy with me. I am very pleased to conclude that Dr. Smith has made an outstanding contribution to our profession and to the education of the public.