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.

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.

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.

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.

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.