Designed for health care workers and others lacking extensive mental health training, this guide provides tools to help diagnose common mental health conditions in addition to guidelines for their treatment or for referrals to mental health experts. Among the information provided is advice on how to differentiate genuine mental illness from the “existential” problems of living, much of which may need psychotherapy but should not legitimately be diagnosed as a true mental illness. The handbook provides a concise compendium of descriptions and treatment options for a variety of psychiatric conditions—pathological anger, anxiety, and depression; obsessive-compulsive disorder; posttraumatic-stress disorder; and schizophrenia—along with a general sense of how the relationship between the psychotherapist and psychiatrist or internist is coordinated.
For 35 years as a psychiatrist, I have had two interests. The first is challenging each and every patient I have encountered with producing a metaphorical description of precisely how it feels to be mentally ill. Within each psychiatric diagnostic category, this has been a work in progress. I would try out my patients' descriptions on each other until I finally began to reach multiple consensuses near the end of my career. Patients began to say, "Yes, doctor, that is exactly how I feel," or, more satisfying, "That is the first time anyone has understood how I feel." This book contains not only the relational fruit of that labor, but I have been working with these descriptions so long that they have become systematized into the metaphor of medical mechanisms. For example, the lack of initiative characteristic of depression is compared to a defensive physical reaction similar to a fever in an infection, and OCD performs the same encapsulating function for generalized anxiety as an abscess does to sequester a diffuse infection (but, as a consequence, both become even more difficult to treat.)
My second interest has been to cut through all the controversies in psychiatric treatments to determine which ones actually worked with the more than 10,000 of my own patients during my career. There is no proof like actually seeing someone get better with your own eyes. A good 80% of effective psychiatric treatment is the sheer intensity of determination not to give up. If this doesn't work, you try that, and if that doesn't work, you try something else. Eventually you learn what works and when to ask for help when it doesn't. This book contains the specific treatments that have worked with my patients.
With the completion of this book, I am now turning my attention to a philosophical interest that has fascinated me my entire career: the insights that are revealed within the nature of mental illnesses about how our uniquely human emotions were evolved through deep time. I am already one and a half years into writing a book on this most fascinating topic with, perhaps, another year to go. In case you haven't noted it, I'm having a ball with my new career!
