January 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: www.askdrlloyd.com , or on Twitter @askdrlloyd

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

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