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Huffington Post Back From The Brink Book Review

The Back From The Brink book review by Dr Loyd Sederer below originally appeared here. Dr Sederer is the Medical Director of the New York State Office of Mental Health.


'Back From the Brink': A Book Review By Dr. Lloyd Sederer

Back From The Brink: True Stories and Practical Help for Overcoming Depression and Bipolar Disorder (2013, New Harbinger Publications)

By Graeme Cowan

A book review by Dr. Lloyd Sederer

"For those searching for evidence of recovery from mental and addictive disorders -- including those affected, their families and friends, and professionals serving them - you have them in Back From the Brink."

When you open the cover of this book you first see a copy of a handwritten suicide note, penned by the author in 2004. The PS of the note reads "I just can't be a burden any longer."

Graeme Green's (fourth) attempt on his life came after having endured an unrelenting five years of depression. He had lost his job, his marriage, his family home and was increasingly distanced from his children. The combination of seemingly inescapable psychic pain, a landscape of losses, and the end of hope had made death seem a desirable answer. His note thanked those that stood by him for their "loving care" and pleaded with them to not blame themselves; there was "...nothing possible that you could have done."

People with mental illness have too few examples of those who have recovered and built a life with community, relationships, purpose and pride. Those with serious mental disorders, and addictions, who have built full and gratifying lives may not be visible. They may not broadcast their illness. They may be uncertain about their gains, fearful of stigma, or want to put the past behind them. They, and their families, need to know about others who have recovered, with illness, and built successful and meaningful lives.

Skip over the first section of this book, I think, because it does not give a full enough description to achieve the chapter title ("Understanding Depression and Bipolar Disorder"). That is a tough feat in 18 pages and might have been best left undone or rendered through words of first-hand experience of those affected by these conditions, rather than an attempt to summarize the causes and treatments of mood disorders.

Go right to the interviews with a wide range of people, famous or illustrative, that the author transcribes, which make up the predominance of the book. Cowan asks many great questions that so many people impacted by mental illness have and may not dare to ask, or know whom to ask. "Did you sense that episode coming?" "Were you able to confide in anyone?" "How did your parents' mental health issues impact the family?" "What was it that gave you hope?" "Was rehab helpful?" "When did you get to the point that you felt you needed to ask for help?" "Beyond medication, what else has been helpful?" "What gives you pleasure now?" "Looking back now, do you see any benefits of what you went through?" "If you could go back and give your[self]... advice, what would that be?" And many more questions specific to those portrayed in the book who were brave and put their problems, and solutions, out into the light of day.

Among his diverse group of interviewees are: former U.S. Representative Patrick Kennedy, son of Senator Ted Kennedy, nephew of JFK, and from a dynasty beleaguered by mental and addictive disorders; Trisha Goddard, with a TV and advocacy career in the U.K. and USA; the extraordinary Bob Boorstin, now public policy director at Google and former speechwriter to President Clinton and advisor to U.S. treasury and state secretaries; Jennifer Hentz Moyer who gives us a clear view into postpartum psychosis and depression, and the path back; Alistair Campbell, a key member of Tony Blair's administration for 10 years, from before and during the period that Blair was prime minister of the U.K.; as well as sports figures from tennis and professional football. These are amazing people who built or recovered lives with major mental illness. They show that recovery is possible.

Many common tools for recovery, for a life well lived, emerge from the interviews of this group of individuals. Principal among them are the critical need for support from people who care; good treatment delivered and adhered to over time; finding meaning and purpose through work or other endeavors; self-care with exercise, sleep and a healthy diet; staying away from alcohol and non-prescribed drugs; spiritual belief; and helping others. Those are prescriptions for all of us.

In the U.S., the Depression and Bipolar Support Alliance (DBSA), is an invaluable resource to people with these illnesses, and their families. An Afterword by Allen Doederlein , President of DBSA, nicely tops off this book about illnesses: he writes "...we don't just talk about eradicating illness; we also talk about creating, maintaining and celebrating wellness."

For those searching for evidence of recovery from mental and addictive disorders - including those affected, their families and friends, and professionals serving them - you have them in Back From the Brink. Thanks to Graeme Cowan for giving us these stories.



Therese Borchard, Top 10 Depression blogger Reviews Back From The Brink Recommendations

Therese J Borchard has been nominated as one of 2014's Top 10 Depression Bloggers . She just posted a review of Back From The Brink. The original review can be viewed here.


Back From the Brink: The Most Effective Treatments for Depression

Graeme Cowan suffered through a five-year episode of depression that his psychiatrist described as the worst he has ever treated. Part of his recovery involves helping people build their resilience and mental fitness as the Director of R U OK? In his book, “Back From the Brink: True Stories and Practical Help for Overcoming Depression and Bipolar Disorder,” he offers advice gleaned from interviews with 4,064 people who live with mood disorders.

He asked the respondents to rate the treatments they had tried and how much each had contributed to their recovery. The following were the top eleven most effective treatments:

  • Supportive psychiatrist
  • Supportive psychologist
  • Support group, emotional support of family and friends
  • Vigorous exercise
  • Psychotherapy
  • Fulfilling work, paid or voluntary
  • Sleep
  • Cognitive-behavioral therapy (CBT)
  • Electroconvulsive therapy (ECT)
  • Reducing intake of alcohol and other non-prescription drugs
  • Belief in God, spirituality, religion

Other helpful treatments include:

  • Mindfulness-based cognitive therapy (MBCT)
  • Acceptance and commitment therapy (ACT)
  • Hobbies, such as gardening, pets, or music
  • Massage
  • Yoga/meditation
  • Medication
  • Relaxation
  • Good nutrition
  • Keeping a gratitude journal
  • Acupuncture

Graeme then categorizes the effective approaches into five major themes:

1. Emotional Support

We are social creatures that crave empathy and connection. That’s why emotional support, reassurance, and compassion from psychiatrists, psychologists, support groups, and family and friends dominate the top ten effective strategies. Graeme’s findings indicate that the emotional support and reassurance provided by psychiatrists and psychologists is judged more important than their treatments, which concurs with previous studies that have shown that the quality of the relationship between a clinician and patient is the best predictor of a successful outcome.

2. Psychological Treatments

Some psychological treatments that were listed as effective: psychoanalysis, counseling, cognitive behavioral therapy, mindfulness-based cognitive therapy, interpersonal therapy, acceptance and commitment therapy, and letting go of unrealistic goals.

3. Lifestyle Strategies

Both vigorous exercise (equivalent of running for 30 minutes 4-6 days per week) and moderate exercise (equivalent of walking for 30 minutes 4–6 times per week) were rated as very effective. Other helpful lifestyle approaches include: getting a good night’s sleep, being able to relax, doing meditation or yoga, engaging in hobbies, getting massages, and reducing intake of alcohol and recreational drugs.

4. Fulfilling Work

Graeme credits his fulfilling work—offering hope to persons stuck in depression– as one of the most powerful tools he uses to stay well. “I experienced personally the benefits of doing voluntary work in my own recovery,” he writes. “My voluntary work involved placing discouraged people (new migrants or people rehabilitating from physical or mental illness) into volunteer positions with charities. I saw how the work lifted their self-esteem and confidence.”

Fulfilling work was rated more highly than cognitive behavioral therapy, which is often considered a highly effective depression treatment. Graeme cites the Gallup poll that found that only 20 percent of employees like what they do, but that people with a high career wellbeing were more than twice as likely to succeed in life overall. Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, and many other positive psychologists believe that a sense of purpose–committing oneself to a noble mission–and acts of altruism are strong antidotes to depression.

5. Prescription Medications

The results of Graeme’s surveys found that, while prescription medications can play a vital role to recovery from depression and bipolar disorder, they should not be relied on as the sole strategy. Pharmacology is still in its infancy. A drug that works wonders for one person might not do anything for another except give her a dry mouth and nausea. Graeme writes: “This stresses the importance of working with a doctor who’s highly experienced in successfully treating mood disorders.”

Stay tuned for my interview with Graeme Cowan on “Getting Mentally Fit For Work.”

Originally published on Sanity Break at



Back From The Brink book review from Medical Library Association

CAPHIS, the Consumer and Patient Health Information Section, is a section of the Medical Library Association, an association of health information professionals with more than 5,000 individual and institution members. MLA fosters excellence in the professional achievement and leadership of health sciences library and information professionals to enhance the quality of health care, education, and research.



Cowan, Graeme. Back from the Brink: True Stories & Practical Help for Overcoming Depression & Bipolar Disorder. New Harbinger Publications, 2013. 312p. ISBN 978-1-60882-856-2. $16.95.

Living with depression or bipolar disorder often means dealing with stigma and isolation on top of living with a chronic medical condition. Author Graeme Cowan comes to the subject with first-hand knowledge of these issues, as a survivor of clinical depression and a mental health advocate.

The heart of the book is a series of interviews with people who have struggled with depression or bipolar disorder. The interview subjects are predominately high-profile people, but the struggles they face and the coping strategies they use will be familiar to any reader who has dealt with mental illness. Their stories serve as hopeful examples of how a fulfilling life is possible for those with depression or bipolar disorder, as well as powerful reminders that mental illness can and does affect people from all walks of life.

Cowan also includes chapters focused on practical advice for overcoming mental illness, calling on both his own experiences and the responses he has gathered from surveying other patients. Although he writes extensively about personal empowerment and lifestyle changes, he is also a strong advocate of professional therapies and the use of medication.  The result is a balanced and patient-centered attitude towards mental health care.

Back from the Brink is written in easy-to-understand, approachable language that will appeal to many patients, whether they are newly diagnosed or dealing with life-long struggles. Family members and friends of those with mental illnesses can also gain valuable insights and hope from the first-hand stories of the interview subjects.

Reviewed by: Jennifer Kaari, University Hospital, Newark, NJ


10 best depression treatments revealed in new book by Graeme Cowan

In preparing his new book, Back From The Brink: true stories and practical help for overcoming depression and bipolar, Graeme Cowan asked 4064 people who had lived with depression or bipolar, what worked best in their recovery.

His survey included most commonly used medications and psychological techniques, but also included a number of lifestyle strategies - 60 options in total.

These were the top 10 (the highest rating medication came in at number 23):

  1. Emotional support from psychiatrist and/or psychologist – Interestingly, the reassurance and support from mental health professionals was rated more important than the specific treatment they provided. If you don’t sense your professional cares about you and your recovery, Cowan recommends finding another.

  2. Peer support groups -  These groups are run by people who have all lived with depression, bipolar, or anxiety. The members are at different stages of recovery, and encourage each other to take small steps each week that assist in recovery.

  3. Moderate and vigorous exercise – Moderate (30 minutes brisk walk 4-6 days per week or equivalent) and vigorous (running for 30 minutes 4-6 days per week or equivalent) were both rated as highly effective for recovery.

  4. Other psychotherapy - involving a process whereby the therapist helps you explore and resolve issues related to past experiences and/or your personality style.

  5. Fulfilling work - paid or voluntary - This surprising finding reinforces a study by the Gallup organisation, that work is essential to our wellbeing. It also highlights how important it is for someone on stress leave to return to work ASAP.

  6. Counselling - not about exploring unresolved themes; a practical process, in which the counsellor may take an educational approach, and involves you and the counsellor discussing strategies for dealing better with day-to-day life.

  7. Emotional support from family and friends – Even though loved ones often feel that they are pushed away by the depressed person, Cowan says this result highlights how essential their compassion and care are.

  8. A good night’s sleep – one of the common symptoms of depression is early wakening or a disturbance to normal sleep patterns. This result shows that depressed people should seek professional help to address this.

  9. Cognitive behaviour therapy (CBT)—focuses on changing negative thought patterns and usually involves doing structured homework tasks, and is normally taught by a psychologist.

  10. Reducing intake of alcohol and other non-prescription drugs – Many people with depression self-medicate with alcohol and other illicit drugs, to alleviate symptoms. Ironically, whilst there can be short term relief; ultimately excessive consumption of these drugs is unhelpful.

A free chapter from Cowan’s book which shows the full results of the research, plus the opportunity to enrol in a 30 Day Mood Boost Challenge which includes daily insights from this research, can be accessed from

Cowan began this research because between 2000-2005, he went through the worst episode of depression his psychiatrist had ever treated. During that period he had four suicide attempts, tried 23 different medications, underwent ECT (shock therapy) on 20 occasions, tried transcranial magnetic stimulation, engaged in cognitive behavioural therapy, and participated in many other conventional programs for the treatment of depression.  After a long path to recovery, he was left feeling that the traditional medical approach to depression was incomplete, especially when the default treatment has become the prescribing of anti-depressants. 


How to Finally Get A Good Night’s Sleep Even When You are Depressed

Depression both causes and is compounded by sleep disruption. The low energy caused by sleep deprivation also impacts on your ability to treat depression. How on earth can you make and attend appointments with experts, exercise or eat properly when you are perpetually exhausted? Find out how to finally get a good night's sleep.

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