Book Reviews

Complete Mental Health
by John Ingram Walker, M.D.
W.W. Norton

This work is a highly readable, in-depth guide to what ails us mentally. Dr Walker's humor is endearing and reflects his own advice to not take oneself too seriously.

He asserts that family doctors need more psychiatric training so they can recognize the underlying emotional problems of their patients. In the interim, Dr Walker created this amazing "Go-to Guide for Clinicians and Patients."

At first I thought this book was a parody. That's because each of the 17 chapters has a flippant (though often clever) subtitle. For example:

  • Chapter 4: The Bipolar Spectrum: Up the Down Escalator
  • Chapter 8: Understanding and Managing Somatoform and Factitious Disorders: Those Low-Down, Mind-Messin', Waitin'-in-the-Doctor's Office Blues
  • Chapter 12: Alzheimer's Disease and Other Age-Old Concerns: Dulled Wit
  • Chapter 13: Sexual Dysfunction and Romantic Resolution: The Viagra Monologues
  • Chapter 15: The Uses and Abuses of Psychiatric Medications: Pills, Poisons, and Placebos.

Within these 350+ pages are quizzes for doctors and patients plus an astounding, detailed view of drugs, psychotherapies and mental disorders.

Hypnosis is favored with one link about it being of possible use in Conversion Disorders. And a whole page for hypnotizing yourself to have a restful sleep.

The author links each illness to details of famous people. For example, the alcoholic authors who died around the age of 40: Dylan Thomas, F. Scott Fitzgerald, Jack London and Edgar Allen Poe.

Dr Walker considers alcoholism second only to obesity as the major health problem in the U.S. He adds: "Substance abuse .. . . is also completely preventable by abstaining from the behaviors that precipitate the disease."

Sprinkled throughout the book are acronyms like this ABUSE questionnaire:

  • "1. Have you ever felt Annoyed by criticism of your drinking?
  • 2. Have you had Blackouts when drinking?
  • 3. Do you drink everyone else Under the table?
  • 4. Do you ever drink Secretly?
  • 5. Do you ever feel Excessively eager to have a drink?"

Case histories from Dr Walker's own practice bring his diagnoses alive.

He contrasts the brain damage done by the use of illicit drugs with the preferable way to stimulate our brains' "pleasure center":

"Delightedly delightful people -- the fulfilled, the contented, the blissful -- trigger the release of dopamine naturally through achievement, athletic accomplishment, and artful endeavors; through the satisfaction of friendships and family; through falling in love and fulfilling altruistic purposes; through experiencing an orgasm, running a marathon, or enjoying music; through the pleasure of hard work or the joy of creativity."

He then contrasts such uplifting behavior with the terrible effects of marijuana:

"Chronic daily use of marijuana can produce lethargy, decreased ambition, social deterioration, and mental and physical sloppiness. Heavy use can produce paranoid psychosis. Marijuana is more carcinogenic than tobacco."

The author provides an exhaustive list of drugs, complete with their street names and withdrawal symptoms.

Superb advice for the therapeutic conduct of psychiatrists engaged in doing psychotherapy with substance abusers is followed by an enthusiastic endorsement of AA and similar programs while Dr Walker claims there is a "lack of evidence-based documentation of effectiveness" of the standard programs such as group therapy, psychodynamically-oriented psychotherapy, CBT and so on. So, where, beyond Dr Walker's anecdotal experience with his patients, is the "evidence-based documentation of effectiveness" of AA and its derivatives?

He recommends patients taking anti-depression drugs also engage in psychotherapy. Following a thorough explanation of the many kinds of depression and the relevant treatments for each, the doctor concludes with a list of "Practical Advice for [Depressed] Patients" along CBT [cognitive behavioral therapy] lines in which he includes this gem:

"Wear brightly colored clothes. Reds, yellows, and oranges enhance mood. These are good colors for women to wear. But, men, if you wear a red suit they will think you are manic and lock you up, which would be very depressing. Wear a red tie instead."

As with all his other topics, Dr Walker provides a clear, detailed round-up of the major psychotherapies (while not putting much stock in the so-called "energy psychologies"). His first-rate list of the 10 elements common to most "legitimate psychotherapies" that produce emotional change should be part of every therapist's training.

According to the author, to be a psychoanalyst in the U.S. "one must first have an M.D., or occasionally another advanced degree, and take extensive course work . . .[including] a personal analysis and direct supervision by a practicing analyst on four controlled cases. It generally requires 8 to 10 years of training following medical school before certification by an analytic institute." All this for what is now widely considered an outdated theory, if not a discredited religion?

He concludes the Psychotherapy chapter with great advice on how patients can make psychotherapy work for them. Great advice, that is, except for the assumption that "transference", one of Freud's inventions, is inevitable.

In the concluding chapter Dr Walker tackles the question of why we are so reluctant to change -- even in the face of overwhelming evidence of the benefits of change. He discusses the twin motivators of change -- pleasure and pain. Finally, he lists some practical measures people who want to improve their lives can take. Above all, he claims, and I agree, that "Attitude is Everything."

A massive list of References adds authority to Dr Walker's personal pronouncements and a comprehensive index allows doctors and patients alike to quickly zero in on their chosen ailments.