Perfectionism, Overwork and Burnout

I work as a computer programmer, our group leader Dennis is a retired steel worker. After a recent meeting we had an interesting discussion about perfectionism at work and things we can do to address the issue for ourselves.

When I was a student at University I had a habit of working long hours in pursuit of high grades. While some of my peers collaborated on assignments or accepted average grades, I took a different approach where I reduced the number of classes that I took so I could spend extra time on each course and achieve top marks on assignments. In the summer time I caught up by taking electives. During one year of my studies I would regularly work until I had no clean clothes left, no food in my fridge and I was completely exhausted. This was about a 10-14 day cycle, 9-13 days of work followed by 1 day of shopping, cleaning and sleeping. I got As in all my classes that year but was totally burnt out at the end.

Dennis, our group leader, told a similar story about being a crane operator at a steel mill, going into work, and being furious with what he saw as the mess in the yard left by the other guys on the previous shift. He would meticulously reorganize everything in a way that he thought was ideal only to return to work the next day to find yet another mess left by what he called his lazy and unprofessional co-workers. He complained loudly to his supervisor about this, and spent a great deal of time being angry at the other employees and hating his job.

Depending on where you work and whether you are a student, steelworker, restaurant worker, hospital worker or homemaker / family caregiver, you may be struggling with the idea that your work output should be as high as possible. This can lead to anger, frustration, burnout, loss of sleep, and serious mental health issues. If you feel that way I'd like to point out several interesting articles.

Bring back the 40-hour work week is an article published by Salon in 2012 that summarizes the last 120 years of research on the idea of the 40 hour work week, its history, and where it came from. Many of us are aware that in the 1800s when factory work began days were 12 hours long, holidays were a rare thing and pay was low. In the early 1900s trade unions sprang up and I always thought that it was these unions that fought for reasonable work weeks.

While it is true that unions fought for reasonable working hours the Salon article points out that the 40 hour factory work week originates with Henry Ford. We all think of Ford as the first to use the assembly line but as part of inventing modern mass production he also experimented socially with various approaches to the work day. Ford found that the 40 hour week was a sweet spot in terms of optimizing worker output. If workers were on site less than 40 hours per week they tended to lose touch with what was going on. If workers were on site for more than 40 hours they tended to make mistakes and either produced faulty products or hurt themselves. For workers to be efficient and reliable the best strategy was to give them a reasonable pay, consistent weekly hours, and send them home after five days of work to rest and forget about their jobs.

This same research was repeated again and again throughout the 1900s, although in the last 30 years this idea has been lost. Especially in the computing industry we see managers advertise for programmers with "passion" for computing and "dedication" to customers. Last year I was assigned to work under a new manager who talked this way and I quickly learned that these were code words for overtime hours and work from home on the weekend. I work in a salaried environment with no union protection or way to claim overtime so when my new boss suggested that 60 hours per week was really preferred and what employees needed to do to get bonuses this came across as a genuine threat to my livelihood and sanity. Happily I no longer work for this person however the experience was unnerving and for me as a recovering nervous patient this amounted to a serious set back for my mental health.

One of my coworkers previously worked in the game industry where, much like the movie industry, there is an ongoing expectation that you will sacrifice everything for your job. Often young workers are lured in with the idea that movies and games are fun and cool, that it is a privilege to have a job where you get to "play" all day and that you should be willing to sacrifice all of your life to this endeavour. Managers in computing might agree that a 60-80 hour work week is dangerous for factory or construction workers since there are real hazards in operating heavy machinery, but that these same problems don't exist in a white collar environment.

Why Crunch Modes Don't Work: Six Lessons is another interesting article that focuses on the game industry and provides the following graph that summarizes the problem:

This graph shows a correlation between the amount of money a productive worker generates for the company (Y axis) and the number of hours they have been at work (X axis). It is common for work productivity to reach a peak a few hours after starting work, when you get into the swing of things, and then as the day wears on people become less and less productive. Often by the end of a shift output is significantly lower and at a certain point (point "b", start of red zone) output becomes negative and by staying on the job you are actively damaging the company bottom line.

While in the computing industry people don't generally get hurt by heavy machinery it is possible to write a devilishly complex bug as part of a last minute hack that gets shipped to customers. Those kinds of bugs are written by overworked tired out programmers who are pushing themselves beyond reasonable limits. Bugs of this sort can tank a product and create considerable embarrassment and loss of face for the company. Think about Windows Vista if you remember it, or the last game you played that crashed and destroyed your high score.

Perfectionism is a trap. It is a form of unrealistic thinking where we imagine a simple relationship between hours invested in a project and the quality of that project. We imagine that every hour we work on a project is just as good as any other hour, we imagine that despite being made of flesh and bone we can push ourselves to behave like machines, that we don't need a social life, that our friends and family will be there later on, and that with enough will power we can force ourselves to be perfect so that we can perform flawlessly.

We also believe that a job done to the highest standards will mean happiness and a perfect life. We imagine a polished and organized home, a grade report with As in every class that will lead to scholarships and awards, a promotion each year for work conscientiously done, a boss who appreciates our high standards and the respect of our peers and loved ones for our outstanding efforts. Just a little bit more hell today will lead us to a future where everything is just right. When we aren't happy despite achieving some of these prizes we are surprised and feel let down. When the non-stop treadmill of endless overwork follows us home, keeping us awake until 3am and isolates us from family and friends we slide into a state of dull oblivion only to awake at 8am "ready" for more work. In Mental Health Through Will Training Dr. Low writes:

"This is altogether different in the instance of the perfectionist or the person consumed with the desire to achieve exceptionality. To him every puny endeavor, each trivial enterprise is a challenge to prove and to maintain his exceptional stature. His life is a perennial test of his singularity and distinction. For him there are no trivialities, no routine performances. He is forever on trial, before his own inner seat of judgement, for his excellence and exceptional ability. He cannot achieve poise, relaxation, spontaneity. He cannot afford to have the COURAGE TO MAKE MISTAKES. A mistake might wipe out his pretense of being superior, important, exceptional. With no margin left for mistakes he is perpetually haunted by the fear of making them. The fear paralyzes decision, hampers actions and confounds plans. Striving for indiscriminate peak performance and confronted with his pitiful record of jobs undone, unfinished and hopelessly bungled he is horrified by his cumulative inefficiency and becomes confused."

Many of our members struggle with this problem, and many have been hurt by their pursuit of perfectionism. In my case I dropped out of my studies on several occasions after struggling with what I saw as a failure. Each subsequent set back was more severe, more damaging to my sense of self, and ultimately very destructive to my health, social contacts and family associations. Despite my collection of good grades in courses it is a wonder that I finished my studies at all. Ultimately when I went to look for a job my school transcripts only received minor attention during some interviews.

In Recovery we talk about being average, about not comparing yourself to others but only tracking your improvement by seeing how you are doing better now than you were in the past. We talk about having realistic expectations for yourself and for others, and about having the courage to make mistakes.

Dennis changed his attitudes about his coworkers and stopped complaining to his boss about what he saw at work. For him Recovery provided a life changing alternative where he stopped comparing his efforts to the efforts of his peers and learned to accept that there are many average individuals who just do average work and that this is okay. By changing his attitudes Dennis started to enjoy his job. After changing his behavior he realized that his boss didn't actually want to hear him complain about what was wrong with the other guys at work. Dennis stopped hating his job, reduced his stress at home after work, and improved his relationship with his supervisor.

For me, I've learned to accept that 40 hours of work on a computer is really all I can do in a week. I limit my time at work to 8-9 hours per day, I take at least a 30-45 minute break each day where I leave the building and I only work on weekends when something unusual comes up. I no longer pursue promotions or awards and I'm quite happy being an average worker. I've found that not everyone shares my ideas about limiting work hours and I don't discuss the subject with too many people. While I still compare myself to others, and this isn't ideal, I try to improve my attitudes by being focused on my own tasks. I take some comfort in the knowledge that my 40 hour work week allows me to be productive and happy, and that my old boss who lives alone and has sacrificed everything for a career likely isn't any more productive than I am.

If you are suffering from feeling the need to be perfect or have sacrificed it all for work, you can come and talk to us about it during meetings and learn some of the techniques that we suggest.


More Information

A Place Beyond Procrastination

About Recovery Hamilton

Anger and The Primal Scream

I've been aware of Primal Scream Therapy for as long as I can remember. I've never taken it seriously, and this weekend I spent some time reading the classic 1970s book The Primal Scream. There are several editions of this book, the 1990s edition has an amazing cover.



In researching the history and background of this book I found a lot of conflicting accounts describing Primal Therapy. The Wikipedia page on Primal Therapy notes that the technique is discredited and provides multiple links to books and articles that criticize the method and an overview of some of the most commonly cited problems with Primal Therapy. A YouTube search produces a variety of results, including people mocking the method, like Gumball's Primal Scream moment or Quiet Primal Scream. You can also find people who seem to be taking the method seriously, although they don't seem to be following the details that Dr. Janov describes in his book.

The people who misinterpret or make fun of Dr. Janov's method typically reduce it to a statement like; "you have pain, you need to get it out, you can do that by tearing at your hair and screaming in the woods". This is a really unfair reduction of Dr. Janov's ideas. Probably the best YouTube link I found is a 3 minute summary of the method provided by Dr. Arthur Janov himself.



Dr. Arthur Janov is a rather amazing individual. He is 92 years old and from what can be gathered he still writes books, provides interviews, keeps a detailed and popular blog, and continues to practice his method at the Janov Primal Center which lists him as the director. From his interview he says:

"We have needs that we are all born with, when those needs aren't met we hurt. When that hurt is big enough it is imprinted on our system, and it changes our whole physiological system. What our therapy does is go back to that early brain and relive the pain and get it out of the system. Meanwhile that pain has been held in storage, just waiting for its exit. So Primal Therapy is a way to access our feeling brain, and down below to our brain stem to all the hurts in our lives and bring them up into consciousness for connection and integration. ... What Primal Therapy is doing is different, instead of pushing back feelings with tranquilizers and drugs we let the feelings come up. Instead of tranquilizing feelings we are liberating them. Most of psychotherapy is talk therapy, or insight therapy, or therapy with words and Primal Therapy has found that it is not words necessarily that we need to go to. We need to talk to a brain that doesn't talk, that feels, and we have found a way to go to that brain and talk to it in feeling terms and let it communicate itself to the therapist."

If you are reading this page to learn something about Recovery you may be wondering why I'm interested in Primal Therapy given my biases against the method and that as far as I can tell Primal Therapy is not a generally accepted form of treatment.

In Recovery we say "Express your feelings. Suppress your temper". A lot of new attendees focus on the statement calling for suppression and become concerned that we are just trying to get people to stop acting as though they are unwell without actually considering their internal emotional landscape. That is in fact exactly what Dr. Janov's criticism was of psychotherapy methods when he wrote his book.

Dr. Janov's ideas are intuitively appealing. He wrote his book in the 1970s and I think it very much reflects that time when popular culture was realizing the problems with conformity, the need for self expression and the importance of not repressing feelings. John Lennon was famously one of the early advocates of Primal Therapy. The following image is from a book auction where a copy of The Primal Scream signed by John Lennon sold for over $7,000. 



The idea that we need to express our feelings in order to resolve them is definitely a potent one. The notion that suppression leads to neurosis is central to Dr. Janov's thinking and it is something that I think we can all agree on. Dr. Janov explains that neurotic behaviour is the result of unsatisfied childhood needs. Those early unmet needs are in some cases inexpressible because the resulting pain may have manifested at a time when the patient was too young to understand their circumstances and they did not have labels for their experiences. In response they developed symbolic neurotic behaviours to avoid or suppress the pain.

Dr. Janov argues that neurotic behaviours are maladaptive because they seek to address needs that can't be directly satisfied. For example, the pain and suffering that a person experienced during their early development because they didn't receive sufficient encouragement from their father, in adult life might translate into an egocentric individual. That individual might crave public recognition and spend all of their energies in pursuit of notoriety regardless of the cost to their lives. The pain that was caused by the neglectful parent is suppressed or ignored, and the symbolic neurotic behavior is exhibited as a way to feed a need that represents the child's need for love and acceptance. Notoreity however will never be an adequate replacement for a father's support and affection and so the individual suffers because they don't understand why the thing they think they want is so unsatisfying.

The Primal experience is the key that Dr. Janov's therapy provides. By re-experiencing pain from the past the therapist is able to help the patient integrate their real or original selves with their neurotic or constructed self. The reintegrated person is able to accept themselves, is healthier, and free of symptoms like anxiety and depression.

Dr. Janov argues that talk therapy addresses the thinking part of our brain, and that too much reasoning is another route to suppression. This point in particular is a really important one and one to take seriously if you are spending time trying to learn something about Cognitive Behavioural Therapies. Are CBT methods just a fancy route to emotional suppression?

At a recent meeting we were discussing the Recovery method and how it is often the case that when we are angry or fearful, those feelings can be traced back to false beliefs, and that through changing our beliefs we can become less fearful. One of our new members put up their hand and said, "Yes, but I just feel extreme anxiety, I'm not thinking about anything when I'm having a panic attack, I'm just in panic". What he was expressing was very much Dr. Janov's notion of the Primal feeling brain that is just experiencing pain outside of any rational mode.

We emphasize several ideas at Recovery meetings. One idea we often state is that "You are entitled to your initial response". In Recovery terms this is meant to acknowledge that whatever you feel in response to a situation is your feeling and it is valid and okay. If you feel frightened or anxious at a bus stop, for example you are worried that you may not understand the bus schedule, or you may have no idea why you are worried, that is okay. Accept that you have that feeling. One major departure from classical therapy that we take in Recovery meetings is that, unlike Dr. Janov, we are not therapists, and so we don't diagnose one another. We don't try to investigate why you have your initial response, and practically as a peer support group, we don't have the tools to investigate the root cause of your response.

That isn't to say that such an investigation isn't worthwhile. It may be valuable for you to understand the causes of your fears, or your anger, and if you have access to a therapist they may be able to help you investigate those details by talking to you about your personal history.

Our focus in Recovery meetings is helping each other to respond in an average and realistic way. While we always accept our initial internal response to a situation whatever that may be, the Recovery method tells us to ignore our impulses and our temper, and to express our feelings instead. Given the previous example of worrying about public transportation, we would say that castigating yourself because you feel shame about being worried in public is an example of fearful temper and is something that you should not engage in. It is okay that you are worried, it is even okay that you have an impulse to curse or deride yourself, it isn't okay to act on your impulse by beating yourself up about it.

Beating yourself up might involve thinking a lot of self critical things, or telling the person beside you that you are a dummy for not being able to understand the schedule. The problem with following through with an impulse to deride yourself is that this will intensify your symptoms and lead you into greater fear, panic, and anxiety. In Recovery we emphasize that bad habits, like self castigation, will lead to internal mental noise and chaos, in Recovery terminology we call this "The Imagination on Fire". This negative state can result when we allow our mind to run wild and feed our fears through the induction of vicious cycles by expressing temperamental responses to situations.

You can reasonably express your feeling, which might take the form of asking the person beside you when they think the bus will arrive, and even saying that perhaps you don't understand the schedule or are worried that you may have missed the bus. This is a realistic response to the situation, you may find it unpleasant if you don't like talking to strangers, but making a decision and taking some simple action often has a calming effect.

In Recovery we make improvements by taking small steps and working on simple situations that give us trouble. We aren't engaged in a subterranean exploration of the dark corners of our subconscious. There is nothing deeply intellectual, or impressively romantic about the Recovery method. All we are doing is accepting who we are, and working in a realistic and practical way towards a peaceful life, one simple situation at a time.

If you'd like to join us meetings are always open to new attendees.


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Meetings: Activities and Key Concepts

Fear is the Mind Killer

Insomnia, Anxiety and Depression

People suffering from anxiety and depression often have trouble sleeping. When I first found Mental Health through Will Training I skimmed through the table of contents and immediately read the chapter titled "Sabatoging Sleep". The inability to sleep properly plagued me for years. I would lay awake for hours, and often as I approached sleep my mind would become irrationally worried. In a half asleep state my mind would spin on conflicts from the previous day, or anticipated problems in the next.



Abraham Low writes:

"You say you "hate to lie there fighting for sleep."  There is nobody and nothing to fight, and be certain you do nothing of the kind. What you do is to work yourself up to a paroxysm of rage and fury. Against whom do you rage? Presumably against yourself. Or, it is nothing but a blind anger directed against nobody in particular. At any rate, to the original fear of not sleeping is now added this senseless anger that merely serves to accelerate the vicious cycle and to fan the tenseness to an intolerable pitch. Then the brain begins to "rattle." Do you understand that all of this is the result of fear? Fear can be remedied only by the certain knowledge that no danger threatens."

Low's recommendation for nervous patients suffering from insomnia is based on his root method of spotting tempers and applying tools. When you are having difficulty sleeping and the cause is a fearful or angry response to an event from your day, and your mind is spinning, chattering or rattling, avoid the impulse to get out of bed. This recipe is tough to swallow, but there is something to it. If you stay in bed motionless for the entire night you will achieve a measure of rest. Often you will fall asleep for part of the night. The sleep may not be comforting, complete, or fitful and it may come in small unsatisfying snatches. However, lying still and motionless is more restful, than getting up, smoking cigarettes, and reviewing your e-mails while you browse though YouTube videos.

I used to think that the key to falling asleep when focused on worry was to distract myself from the problems that bothered me. In Low's terms this is replacing an insecure thought with a secure one and is part of the answer for me. The key thing to observe is that while getting up and watching television may be distracting its also stimulating. I've found that when sleepy, and plagued by racing thoughts, that a simple exercise like counting breaths will occupy my mind in a way that intrusive thoughts are kept at bay. I count breaths starting at 10, and going down to zero, and then I repeat. I breath slowly. The intuition behind starting at 10 and going down to zero is that it is hard to track how many times you've done this, so you don't get into worrying about how long you've been awake. This is a variation of the old idea of counting sheep. Any simple repetitive mental exercise will do.

Sleep research wasn't a major area of interest when Abraham Low wrote his books. In 1953 REM (Rapid Eye Movement) sleep was first identified. The researchers investigating the problem woke subjects during REM sleep and found that they were often dreaming. In the 1960s sleep research started to take a foot hold, and today most major cities have a sleep clinic you can go to where they will evaluate your sleep patterns. In Hamilton there is a sleep clinic located on Frid street, they have a web site, see: http://sleep-clinic.ca/contact/



There is an excellent book titled No More Sleepless Nights written in the mid 1990s. This book is available from Amazon, the electronic edition is just $10, and well worth it, especially if you are trying to sort out your own sleep problems. It is written by a pair of doctors, Peter Hauri and Shirley Linde, who run a sleep clinic, and they describe simple things that you can do to address your sleep issues.

This book provides several basic pieces of advice that should apply to anyone having trouble getting to sleep. Among them are the following:

• Develop good sleep hygiene habits; this generally means sleeping in a quiet dark place, and going to sleep and getting up at the same time every day.
• Not everyone needs 8 hours of sleep per night. Some people need more, as many as 10 hours every night in some cases, some people need less, as few as 6. If you feel tired all the time, maybe the 7 or 8 hours you are getting isn't enough for you. Don't be concerned about what you think you ought to need, figure out what you do need.
• Be aware of how much caffeine you are consuming. Don't just consider coffee, but also count tea, chocolate, soda, and medications that include caffeine. Caffeine stays in your system for a very long time. Drinking a can of coke with dinner may be what is keeping you awake at 2am.
• Be careful about consuming alcohol before bed, especially if you believe it is helping you get to sleep. While alcohol may calm you down, it almost universally disrupts sleep, either causing people to wake up in the middle of the night, or not reach a fully restful state.
• Be careful about smoking cigarettes. While many people smoke to calm down be aware that nicotine is a stimulant. If you wake up at 4am and have a smoke to try to calm down from a bad dream and get back to sleep, this is helping less than you imagine.

While the above list just covers the basics, many people violate these simple rules. I love drinking strong coffee, however I never drink it past 1pm any more, and I try to keep my consumption down to just 2-3 cups a day. When I struggle with sleeplessness, as I still occasionally do, I dial back my coffee usage. Getting up at the same time every day, workdays and weekends, is always a struggle and its my current focus.

What I really enjoy about Hauri and Linde's book is that beyond just covering the basics in detail, it covers a wide variety of scenarios and acknowledges that insomnia has a huge array of causes.  If you are depressed, that may be the cause of your disrupted sleep pattern. Hauri and Linde's book discusses depression and anxiety, while it is only one of the causes that they consider they point out that there are often several contributing factors to poor sleep. Their book has sections on relaxation techniques, stress management, diet, exercise, and dealing with your sleep clock, and how to reset it. There are also chapters on shift work, jet lag, seasonal affective disorder, how sleep changes with age, sleeping pills, sleep apnea, narcolepsy, sleep terrors, snoring, and night sweats. There are also lots of details for those who are just curious about sleep, how it works, what it does, and what we know about it today.

If you are having trouble sleeping, and you think that you may be suffering from anxiety or depression you can join our discussion group and learn some of the techniques presented in Dr. Low's books. 

More Information

Does Depression have a Physical Cause?

A Place Beyond Procrastination

Anxiety and Depression vs. Feeling Good

Feeling Good is the title of a Cognitive Therapy book written by David D. Burns.



You can borrow this book from Archive.org for free, although I think its entirely worth the regular $10 Kindle price on Amazon. I bought a copy in a used bookstore about 12 years ago. Recently I picked this book up again. In re-reading this book I was pleased to see that the acknowledgments section credits Abraham Low, and Recovery as one of the earliest forms of Cognitive Therapy. Dr. Burns writes:

"The development of cognitive therapy has been a team effort involving many talented individuals. In the 1930s, Dr. Abraham Low, a physician, began a free-of-charge self-help movement for individuals with emotional difficulties, called "Recovery Incorporated," which is still in existence today. Dr. Low was one of the first health professionals to emphasize the important role of our thoughts and attitudes on our feelings and behavior. Although many people are not aware of his work, Dr. Low deserves a great deal of credit for pioneering many of the ideas that are still in vogue today."

Recovery is sometimes described as Cognitive Behavioural Therapy (or CBT), and we say that largely because this phrase is familiar sounding to a lot of people these days. Some clarification is in order though, since this phrase didn't exist when Dr. Low wrote his books.

Cognitive Behavioural Therapy, or as Dr. Burns writes Cognitive Therapy, has its origins as a term in the 1960s. The focus of Cognitive Therapy is to address the depressed patient's negative view of the world and the future and help them to change these thinking patterns.

While certainly this is something that we talk about in Recovery meetings, Cognitive Therapy was originally designed as a tool or method that a therapist would use to work with a patient. As a peer support group we don't diagnose one another, we aren't therapists.

Having said that, there are a lot of interesting parallels between Dr. Burns' book and what you will find in Dr. Low's best known book Mental Health through Will Training, as well as some differences. On the surface the styles are extremely dissimilar. Some people are put off by Dr. Low's writing, it is a little bit stiff in places, somewhat dated, and is really written from the perspective of a medical professional (Dr. Low) addressing a patient (the reader). Dr. Burns book is written in the 1980s, and is entirely different in tone. It is friendly, much of it written in a conversational style that avoids sounding clinical or academic, but at the same time isn't patronizing, but is rather supportive and patient.

Both of these books describe themselves as self-help-books. Both books are written by medical professionals describing methods refined through years of practical work with patients. Both books explain their ideas without using overly technical terms, instead often through anecdotal stories where they describe real individuals and the specific troubles that those individuals faced.

In Recovery meetings we focus on a technique that Low calls "spotting". The idea is that we learn to observe our own behavior when we are at a crisis point, what Dr. Low calls being in temper, and we use that point as a time to be extra careful in how we proceed. We apply tools to these situations. Tools are effectively a list of common mistakes that people make, and are reminders of simple ways to side step those problems.

Dr. Burns describes cognitive distortions in the first part of his book (Chapter 3). While we discuss these in Recovery as well, when I first read Dr. Burns' book I found these to be a tough starting point. It made sense to me that each of the items on the following list was an example of bad thinking, I simply had a hard time understanding how to use this list to make myself feel better. Dr. Burns' list is as follows:

1. All-or-Nothing Thinking: Anything less than perfection is a failure.
2. Overgeneralization: One bad day this week means the rest will be bad.
3. Mental Filter: I focus on a flaw in a house repair, ignoring the rest of the good work.
4. Disqualifying the Positive: If something good happens, it was an accident.
5. Jumping to Conclusions: My friend was late, therefore she doesn't care about me.
6. Magnification (Catastrophizing): I will get fired because I missed a day at work.
7. Emotional Reasoning: I feel like my driving test went badly, therefore I will fail.
8. Should Statements: I should go on a diet, I should read more books and get more exercise.
9. Labelling and Mislabelling: I'm a bad person.
10. Personalisation: I'm the reason my parents split up.

The trouble with this list and the made up examples that I included to illustrate the ideas is that while *these* examples are clearly instances of flawed thinking, *my* thinking seems fine, and doesn't exhibit these problems. That is at least the trouble that I had when I first read Dr. Burns' book. In an intellectual way I understood that bad ideas probably caused bad feelings, but how was I to know which of my ideas were the bad ones? I seemed perfectly reasonable to me.

These are tough questions.

My first experience at reading Dr. Low's book was similar. I understood the words, and the details made sense to me, but it wasn't clear to me how to translate this into a strategy for being well.

The psychiatrist that I met in the late 1990s was certainly a very talented man, but he only mentioned these methods in passing. His primary method of treating me was in the form of prescriptions, yearly blood tests, an occasional ECG, and listening. He was very nice to me, and expressed a lot of concern, and gave basic life advice when it was appropriate or when I asked for it. For a depressed person, having someone patiently accept your situation and talk to you about it means a lot.

My biggest trouble with seeing a psychiatrist focused on a medical treatment of my depression was that it was an entirely passive approach. I met with him periodically, I took the medication he prescribed, and that made my symptoms less intense. While the treatment helped, aside from attending periodic appointments and taking pills, I wasn't doing anything.

When I started reading more about Cognitive Therapies, and actually attending Recovery meetings and talking to other people who had used these methods to change their lives it gave me something to do. It gave me agency in my own getting well process. Ultimately I believe that agency has made a huge difference.

While I didn't fully understand Dr. Burns' book the first time I looked at it, it was a good starting point. In re-reading it I think there are a lot of good ideas in his book and I'm enjoying revisiting this material. In Recovery meetings we keep our focus fairly narrow and stick to Dr. Low's work, but I think its important to know a little bit about how Dr. Low's books fit in with more recent therapy methods. It continues to surprise me how universal the ideas in Dr. Low's books are.

We meet every week and we talk about Dr. Low's method and discuss chapters from his book Mental Health through Will Training. You are welcome to join us.

You can find us at:

Tuesday 7:30pm - 9pm
Binkley United Church, 
1570 Main Street West, 
Hamilton Ontario

Effectiveness of Peer Support for Depression

How effective are peer support groups?

A recent study published in the medical journal General Hospital Psychiatry draws the following conclusion:

"Based on the pooled results from published RCTs, peer support interventions for depression result in greater improvement in depression symptoms than usual care and may have similar efficacy to group cognitive behavioral therapy. ... Given the high level of functional burden imposed by depression world-wide, peer support for depression should also be studied as a potentially low-cost intervention in primary care or other settings where more established but costly depression services are unavailable."

The article has some interesting notes in its introduction where it talks about mechanisms at work in peer support, it says:

"... According to her analysis, peer support interventions may decrease isolation (direct effect), reduce the impact of stressors (buffering effect), increase sharing of health and self-management information (direct effect), and provide positive role modeling (mediating effect)[15]. Yalom describes peer support groups as having many similar features to group psychotherapy: altruism, cohesiveness, universality, imitative behavior, instillation of hope, and catharsis[16]. Peer support programs may also empower patients to play a more active role in their own self-care[17]."

At Hamilton Recovery meetings we are careful to not diagnosis each other, or to give advice. Our primary focus is to teach methods that are helpful in addressing mental health issues. We encourage attendees to seek assistance from a professional. However the reality that many of our members have faced is that psychiatrists covered by OHIP or other insurance policies can be busy and difficult to make appointments with. Paying for counselling outside of an insurance plan can be very expensive.

In the introduction to Mental Health through Will Training Dr. Abraham Low talks about the same reality. In his comments on the availability of psychoanalysis he writes:

"The reason for its restricted availability is the egregious amount of time needed for the administration of the treatment, an overall average of hundreds of hours being required for each individual patient. For patients cared for in private practice there is the added handicap that the time-consuming process involves a necessarily exorbitant expense. Whether the emphasis be on the time factor or the cost element, in either case, the method is all but unavailable for the masses of patients."

Low compares the number of individuals that he was able to successfully treat through group therapy with the number he treated in one-on-one consultation and he makes similar observations to the recent article. He concludes that volunteer based peer support is effective at reaching large numbers, and has benefits that can enhance support provided by a professional.

Low talks about the camaraderie that develops between group members and how new attendees often find people they can relate to. The personal relationships formed between group members can be a powerful antidote to the difficulties of modern life.

We meet every week and we talk about Dr. Low's method and discuss chapters from his book Mental Health through Will Training. You are welcome to join us.


More Information

An Austin Psychologist talks about CBT

The Power of Peers for Brain Health and Advocacy