- Paperback: 272 pages
- Publisher: Summersdale (September 28, 2016)
- Language: English
- ISBN-10: 9781849537544
- ISBN-13: 978-1849537544
- ASIN: 1849537542
- Product Dimensions: 5 x 0.9 x 8 inches
- Shipping Weight: 12.6 ounces (View shipping rates and policies)
- Average Customer Review: 6 customer reviews
- Amazon Best Sellers Rank: #1,328,621 in Books (See Top 100 in Books)
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The Other Side of Silence: A Psychiatrist's Memoir of Depression Paperback – September 10, 2015
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About the Author
Linda Gask is Emerita Professor of Primary Care Psychiatry at the University of Manchester and has worked for 30 years as a psychiatrist. The author of several academic textbooks, she has been an advisor to the World Health Organization, served on the board of the World Psychiatric Association, and is the author of more than 180 published articles and book chapters. Since her teenage years, Linda has suffered mental health problems and has first-hand experience of both pharmacological and psychological treatments for depression.
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by Kay Brugge (Life and Couples Coach, Cape Town, South Africa).
“The Other Side of Silence” (www.summersdale.com) is psychiatrist Linda Gask’s moving memoir of Depression. What is touching is the author’s willingness to be vulnerable through self-disclosure. This makes the things she is sharing, authentic. It’s not just a textbook veiled as an autobiography (or vice versa). However, the book contains some very helpful clinical gems.
The first Chapter, aptly is called “Vulnerability”. Here she makes the insightful observation, “assessing the mood everybody was in at home…resulted in the development of a sometimes crippling oversensitiveness to the actions of others, such that I have learned that I cannot always trust my own instincts in relationships” (p.25). The helpful tip in that chapter that would serve us all well is, “setting simple goals to try to move forward. This is called behavioural activation and is based on the theory that when we get depressed, we stop doing all sorts of things. It isn’t the case of waiting to feel better to get on with life, but rather of acting better to feel better” (p.26). This means to act yourself into a new way thinking; rather than think yourself into a new way of acting.
In Chapter 2 (“Fear”), she highlights the importance of seeking help even if this might feel like loosing the little ‘control’ a depressive person may have. “This need to retain control can prevent a person from seeking assistance when they really need it, as accepting help can also be seen as relinquishing power over one’s own life, of giving in and loosing personal freedom” (p.28). She cautions, “when severe anxiety complicates depression and causes agitation, it is more difficult to treat, and in bipolar disorder the presence of anxiety can also increase the risk of suicide”. (p.44).
An observation in Chapter 4 (“Wounds”) relates to running the risk of emotional re-injury incurred during childhood by engaging in relationships with others. “Most of us need to feel close to some people, with whom we can be intimate; but it is within those very relationships that we can be most at risk of being harmed; emotionally, physically and sexually. The worst emotional wounds are often those inflicted by the ones who are closest to us” (p.60). The author may be a little pessimistic here: As other literature on attachment styles shows, being in relationships with what is referred to as “secure attachers” (about 50-60% of the population) can offer healing to those with attachment wounds (i.e. notably. the vigilant anxious attachers who fear rejection and abandonment). However, she is right that people with childhood “issues” invariably attract those with attachment styles (typically “dismissive avoiders”) that can make them face re-injury: “the most toxic kind of life events that can trigger depression is one that resonated with a particular aspect of the person’s underlying vulnerability. Life almost seems to conspire to match the event to the person, like a key finding the lock for which it was originally cut”.
It has often been said that “anxiety is fear of the future; depression, sadness about the past”. The author makes a striking addition, “if anxiety is the manifestation of the fear that something will happen, depression occurs when that fear become reality” (p.85).
Going into the realm of “Love” (Chapter 5), Linda makes the illuminating comment, “there are curious parallels between being in love and being deluded. The accepted medical definition of a delusion is a false unshakable belief out of keeping with an person’s social, cultural or religious background. Those who are in love and the deluded both inhabit worlds fraught with misunderstanding and apparently irrational behaviour” (p.96). We should all put that bit of wisdom ‘into our pipes and smoke it’. It’s a simple fact that the brain in love throws everything in its biochemical arsenal (and the kitchen sink) at the hapless lovers. It has been recorded that the love chemicals are more potent than cocaine.
The book contains two very helpful tips for clinicians: the one relates to suicide; the other to trust: The author suggests asking a person with suicidal ideas, “What has stopped you from doing it?”. She explains that, “This is an important question. It lets you know whether you can take a deep breath and judge, for the moment at least, if the person is safe” (p.116). The other relates to patients struggling to trust their therapist. The author’s advice: “when a patient finds it difficult to talk, comment on the process”, e.g. “it must have been difficult coming here; talking to someone new after all that has happened” (p.131).
In closing – what I liked about the book is that it calls into question that depression is merely the result of a “chemical imbalance” – a myth perpetuated by big Pharma that has found itself into the popular discourse, ‘Betty has a chemical imbalance – her GP has put her on an SSRI (Selective Serotonin Reuptake Inhibitor)’. (Those of you interested in the topic may want to read the book, “The Emperor’s New Drugs” by Kirsch).
Gask states, “it is hard to believe that the complexities of human thought can be explained by a simple chemical imbalance. I was trained to consider biological, social and psychological determinants of mental illness, and had always leaned toward the latter two…although I did prescribe medication too” (p.177). It is the psychological basis of mental illness that makes it responsive to therapeutic interventions, and specifically so-called ‘transference relationships’. In the case of the latter, humans unconsciously develop powerful feelings for their therapists, which are really strong echoes of feelings they had for meaningful others early in their lives. An astute therapist can utilise these feelings, and by acting like, say, a father (“counter-transference”) can foster healing.
My biggest debt of gratitude to the author is her providing some much needed reality testing regarding the severely reductionist and neuropsychologically poorly rooted Cognitive Behavioural Therapy (CBT). “I think that those who seek to explain depression as not more than ‘understandable distress’ in response to life events are just as guilty of a kind of reductionism as the neuroscientists who pore over the MRI scans and the psychologists who seek to break everything down into instances of ‘negative thinking’, which can sometimes make the sufferer feel as though it is their own fault for not thinking more positive” (p.257). Sidebar: When Dr Aaron Beck first put CBT on the map, Norman A. Harvey, MD published the following parsimonious critique (Jamanetwork, Vol.197, No.10), “Dr. Beck appears to attempt to perpetuate a myth about the nervous system, namely, that there is a dichotomy between thinking and feeling. It seems more realistic to talk of ‘thought-feelings’ or ‘feeling-thoughts.’ We think with our feelings, or they color our thoughts, so that it is almost impossible to separate them”. This raises doubts as to the one-size fits all tenet of CBT, i.e. to address ‘thinking distortions’ (or as the author put, it – “negative thinking”), thereby making the person feel better. (Although, in defence of CBT – it has achieved successes). However, as Linda Gask clarifies, “Depression is related to all of these factors, and at the same time it is none of them. For each person, the parts that the different dimensions of biology, psychology , life events and difficulties (such as grief, physical ill health and social isolation) play in both precipitating depression and maintaining it will be important to a differing degree” (p.257).
So, if you suffer from depression or have a loved one who does, this book is very insightful. Well done, Linda.
Kay Brugge, PhD.
21 November 2016
To have a physician write about her own depression, treatment, and therapy is a breath of fresh air. The organization of this book with its alternating chapters of Gask’s personal story and those of various patients is riveting and focuses with compassion on the human drama of illness and recovery. Reminds one of Oliver Sachs in many ways.