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Gary Greenberg is a practicing psychotherapist and author of The Noble Lie. He has written about the intersection of science, politics, and ethics for many publications, including Harper's, The New Yorker, Wired, Discover, Rolling Stone, and Mother Jones, where he's a contributing writer. He lives toon meer in Connecticut. toon minder

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20th Century
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male
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Not only enlightening and educational but funny as hell!!!
 
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soraxtm | 4 andere besprekingen | Apr 9, 2023 |
What does it mean to be clinically depressed? Or bipolar? Or have a personality disorder? The DSM, now in its fifth edition, tries to answer that question. If we want to help the mentally ill, we have to decide who they are--and make a stab at deciding what they have.

Without clear biological markers, however, we're left with subjective criteria, and the process for determining those criteria isn't clear.

Greenberg is a strong critic of the APA and the process that has led to the DSM-5. As he argues, by naming a disorder and its symptoms, we make it real. In 1994, we created kids with Asperger Syndrome; in 2013, we took it away from them. The book is strongest when discussing the processes within the APA and the defects of certain diagnoses that were added or subtracted due to the feelings of advocates, be they patients or doctors.

The weak link of the book is that, as Greenberg himself acknowledges, we don't have a better alternative than the DSM. While neuroscience holds some promise, it will likely not explain all forms of mental suffering. As he is a psychotherapist, I expected (and got) some bias against the psychopharmacological model that's grown amongst psychiatrists, and his distaste for the DSM in his everyday work is also apparent (though this is far from unique in my experience).

The book made me think critically about the process of diagnosis and the way we seek labels to explain or define our behavior, even when they have little practical meaning. In daily life, sometimes a Potter Stewart definition is all you need. But it left me wondering about what should come next. Greenberg doesn't have a better answer than the people he criticizes--and maybe that's not all bad.
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arosoff | 3 andere besprekingen | Jul 11, 2021 |
I no longer know who is fooling who anymore. It's charlatans all around. Probably doesn't help that the author is writing with his mind made up from the start that only paying psychoanalysts like him a lot of money will cure you of depression which on one page is and on another isn't a disease.
 
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Paul_S | 4 andere besprekingen | Apr 3, 2021 |
Greenberg's thesis is in the title. He believes that depression can not be reduced to a simple brain disease, amenable to chemicals or cognitive therapy. Certainly there is no proof of a biological basis for depression, hard as scientists have been trying to find such a thing. Even if there were, however, Greenberg would still have to ask (and we should too): what makes the change in the brain? How does it get that way?

In this book Greenberg offers us a history of depression, condensed of course, its definition and its treatment. He then settles into the last fifty years or so, when scientists seriously started looking for brain dysfunction and magic potions to "fix" it. Even today, although the evidence against it is clear, doctors tell their patients that they have a "chemical imbalance" and will have to be on antidepressants all their lives.

Greenberg is no fan of antidepressants, yet he says throughout that they may well help some people and they don't do much physical harm. I beg to differ on this last, and my objection overlaps Greenberg's. He objects to the concept of depression as a disease that can be fixed by tweaking brain chemistry and nothing else. No exploration of personal biography, no compassionate listening, no looking at the real "why" of depression. As I read it, Greenberg prefers that we accept depression as part of living and question why, in each case, it has reared its head. There may well be good cause, external, like the way the world is today, or the way others may treat us. If we give in to the pill or simplistic therapy we avoid looking elsewhere.

I agree with this position. But I go farther, into an area Greenberg only touches briefly: victimization. I believe that when a person believes he has a chemical imbalance or some other brain disorder not within his control, he gives in to the diagnosis and accepts his position as victim of this disorder. It's time we regained control of ourselves and questioned these diagnoses. We need to learn that we have more power than depression doctors would have us believe. We can beat it.

And here is where I also part ways with Greenberg. He went through a week-long course in cognitive behavioral therapy, a course for therapists. He went in suspicious and came out suspicious. He concluded that it is a form of positive thinking, regardless of what the leaders of the movement say. He believes it is good short-term only, does not address the long term. And he concludes that on balance it is no better than any other type of talk therapy for treating depression. I disagree on at least some of these points.

I picked up cognitive therapy from a book given to me by my stepmother when I was in my twenties. I was in and out of therapy at the time, ending in group therapy, where I did learn some skills to deal with depression. I scoffed at the book: A Guide to Rational Living, by Albert Ellis et al.. How could what you tell yourself have anything to do with how you feel? I did read it, however, and before I was much into it I started to become a believer.

Ellis was ahead of the game. He didn't call his treatment "cognitive therapy" but that is what it was. The book is still in print (revised) and still getting rave reviews many years after its first printing. With good reason, in my opinion. I believe it changed my life more than any other book or therapy has.

What it did was to give me the tools I needed in the long term. I still get depressed but now I know how to work my way out of it. This is what Greenberg failed to understand. It isn't a short-term fix. Its real value is that it gives us the tools we need for the rest of our lives.

Greenberg also believes that the current gurus of CBT would not object to depression being labeled a disease. I disagree here, too. One of the most popular books on the subject, Feeling Good, notes that a study concluded that patients actually do better just reading the book than they do with a therapist. Would this be the case if the CBT folks just wanted to rake in the therapy dough? I don't think so. I believe Greenberg went into this training with his mind shut, unfortunately, because he is a therapist of the "old order". I have no objection to his type therapy, but honestly it is a crap shoot, whereas CBT is so standardized that an intern can do it well. Or a book. Many of us like that about it. It does not mean that we are automatons who simply follow little slogans and mindlessly become "resilient". It means we learn to distinguish fantasy from reality. It's a good skill. One many Americans would do well to learn.

Obviously I have a bias here, clearly stated. I disagree with Greenberg on the subject of cognitive behavioral therapy. I agree with his assessment of drugs but feel he does not go far enough. He does not mention the disabling side effects that these drugs can have on some patients. Tardive dyskenisia. Dullness. Other types of brain damage, permanent. Let's not forget strange suicidal tendencies (he does mention this in passing). And the cost is not a small matter. It costs all of us, not just those getting the drugs.

This book is worth reading for those who would like a little history of depression and an alternative view to the standard one in place today. Read it but don't stop there. Also read books by Healy and Valenstein, at least. Get the real, gritty facts about antidepressants. And learn more about CBT.
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slojudy | 4 andere besprekingen | Sep 8, 2020 |

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Werken
5
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2
Leden
404
Populariteit
#60,140
Waardering
½ 3.5
Besprekingen
9
ISBNs
85
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