Strategies of Living Well: Four Secrets in Plain Sight

JAN. 04, 2017

By Lloyd I. Sederer, MD


I want to help clinicians improve the lives of their patients—and patients improve their own lives. As a psychiatrist, public health doctor and advocate for people with mental and addictive disorders, I have seen how those affected and their families struggle to access quality services and providers who believe in recovery and will work with them as partners. I have also come to learn that recovery from any illness—psychiatric or not—is far more likely when patients learn how to manage their own lives and relationships.

I believe that the greatest gains in the next ten years for people with mental and addictive disorders will come from better execution on what we actually know right now. We must also close the gap between what we know and what we do—clinically as well as in self-care. And recently, I’ve been wondering: What improvements could we—patients, families, clinicians—make if we implement all the treatments and self-care that now exists?

The answer seemed strikingly clear to me once I asked the right question. I realized I already knew four ways that mental health could be improved, not tomorrow but right now. Because these ideas were hiding in plain sight, I call them “secrets.” I then wrote a new book about what actions can be taken by patients, families and clinicians while we wait for the scientific discoveries of the future. The four foundational truths I offer, which are all eminently actionable, are:

  1. Behavior serves a purpose. Often we see behavior in others (sometimes ourselves) that perplexes us, even seems contrary to one’s best interests. Yet, all behaviors serve a purpose. We need to search for behaviors that can begin a conversation—that can replace darkness with light, blame with tolerance and dismissal with discussion.
  2. The power of attachment. Relationships are often the royal road to remedying human suffering—both individual and collective. By harnessing our connection to others, we can help them (and ourselves) begin and sustain the hard work of recovery. 
  3. As a rule, less is more. Mental health treatments have often been aggressive, from high doses of drugs to intensive individual and group therapy sessions. Unfortunately, these efforts often have unwanted and problematic effects. In fact, my good friend, Dr. Bob Drake and I wrote two papers in the 1980s on the adverse effects of intensive therapies with individual patients and their families. Prudent use of medications and problem-solving interpersonal therapies are safer and more effective, in most instances.
  4. 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 health conditions. However, chronic stress can be recognized and a host of non-medicinal interventions, including exercise, meditation, slow breathing, and time with others we care about and who care about us, can reduce its damage.

I truly believe that understanding and acting upon each of these four secrets can give individuals and families greater peace. People with mental or addictive disorders and their loved ones—as well as all of us wanting to live healthy and long lives—have the power to improve how they feel and function today, right now.


Lloyd I. Sederer, M.D, is an Adjunct Professor at Columbia/Mailman School of Public Health; Chief Medical Officer, The NYS Office of Mental Health; and Medical Editor for Mental Health, The Huffington Post. For more: , or on Twitter @askdrlloyd

Dr. Sederer’s new book is Improving Mental Health: Four Secrets in Plain Sight


JAN, 07, 2017 12:47:02 AM
Sandy Casey
Pam, I am so very sorry for your loss. I am afraid that we are going toward that same end on a different path. My son turned 30 this past Nov, 2016. He has been confused and for long periods absolutely tormented by delusions - but he has no "insight," as they say. Because he doesn't appreciate the nature of his issues, the only treatment he has ever had is two drugs. He has been hospitalized a number of times. When he gets really scared he is going to hurt himself he has called 911. He's depressed because he wants to live on his own (he lives with his dad) but he's never worked. I have tried everything that the laws allows. The doctors gave up on him and that's what people tell us to do. I feel like it's just a matter of time.

JAN, 04, 2017 08:50:47 PM
Barbara Ricci
Thank you Dr. Sederer. These are important factors and need to be practiced by clinicians and caregivers. Sometimes the simple, steady, day at a time approach is the best medicine.

JAN, 04, 2017 04:22:12 PM
Pam Hoffmann
On this day that would have been my son's 33rd birthday, I am comforted to read your blog post. My son died by suicide in May 2016 after three years of sometimes intensive, sometimes nonexistent medicinal and psychotherapeutic treatment. He badly wanted to participate in his own treatment, in understanding it, and he wanted our involvement as his parents and part of his support system. He worked harder at his own recovery than anyone I have ever seen, and I am a retired clinical social worker. The four 'secrets' you outlined sound practical, effective, and eminently doable. I saw vestiges of them during the time my son was in active treatment. Because the system with which he was affiliated offered neither consistent nor very 'attached' service, my son attempted to establish his own treatment team outside of the one that failed. Details of our story aside, I must say that the most consistent attachment he had was his NAMI advocate, who worked tirelessly on his behalf.
My hope is that more people in the mental health professions will take heed of your ideas.

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