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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.

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 Gene

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, MD, PhD

President, The American Psychiatric Association

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. He argues effectively that if we bring these secrets out into the open, we will be more effective at understanding mental health problems and how to solve them. And he concludes – persuasively – that this will encourage greater attention to building safer spaces around us all, with a focus on prevention, earlier intervention, and recovery. In doing this, he puts people first, which is where they should be in any therapeutic relationship. His prose is simple and straightforward, clear and concise, graceful and measured, and nonjudgmental throughout. This is well worth reading, digesting, and using as a foundation for interactions between clinicians and the people they aim to serve.

Paul Gionfriddo, PhD

CEO, Mental Health America

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, PhD

Author of Far From the Tree, Winner of the National Book Award

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