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Lifting the WeightReview - Lifting the Weight
Understanding Depression in Men, Its Causes and Solutions
by Martin Kantor
Praeger, 2007
Review by James K. Luiselli, Ed.D., ABPP, BCBA
Jul 14th 2008 (Volume 12, Issue 29)

According to its author, psychiatrist Martin Kantor, this book focuses on "the human dimension of depression as it appears in men." His purpose in writing the book is to provide the reader with "an underlying sense of what it feels like to be a man who is depressed." Comprised of 19 chapters, the book discusses cross-gender differences and similarities in depression, examines the etiology of depressive symptoms, and suggests possible treatment and self-help remedies. Although Kantor addresses a critical mental health topic, I found the book uneven and falling short of its stated objectives.

My first hint of concern came early on when, in referencing his treatment orientation, Kantor writes, "I strive to intervene psychodynamically, cognitively, behaviorally, and interpersonally in a supportive interpersonal context." Advocating a multidisciplinary stance may seem appealing but most practitioners adopt a singular treatment modality that is theoretically consistent and integrated conceptually. One cannot, I propose, opine convincingly about depression or another psychiatric disorder based on contradictory explanatory models and incongruent therapy approaches.

Acknowledging Kantor's self-described eclecticism, the book is decidedly psychodynamic in tone and presentation. Depressed men, for example, "display a kind of infantilism," forced as young boys "to prematurely renounce their attachment to their mothers." Depression, we're told, is caused by "ego-ideal dissonance" and excessive or inappropriate guilt among "super ego-oriented individuals." The intrapsychic paradigm Kantor constructs simply will not resonate with clinicians who are persuaded by evidence-based and empirically supported practices.

The book also can be criticized because it pays cursory attention to several contemporary therapies that have been supported by efficacy research. There is reference to cognitive-behavioral treatment (CBT) but it is not reviewed with sufficient detail. Similarly, mindfulness-based interventions such as Acceptance and Commitment Therapy (ACT), and learning-theory strategies such as behavioral activation are overlooked. Kantor includes a 6-page chapter on pharmacotherapy, which gives a reasonable account of medication management, but does not document recent advances in psychopharmacologic treatment of depression.

The content of the book notwithstanding, Kantor's prose frequently is off-putting. He proposes that "men generally find introspection to be overly poetic and hence sissified." Depressed men also "remind us of a crestfallen peacock or a gladiator who has just been vanquished in the last battle he will ever fight." My guess is that the author was trying to express the phenomenology of depression in a kind of "down and dirty" language, unfortunately ill advised for a professional audience. I suggest that many self-help readers also will be discouraged by such writing.

I'm sure Kantor had the best intentions for this book. He is an experienced clinician with much to say about depression in men. It is my opinion, however, that what he says and how he says it makes the book a poor choice for professionals and the lay public.

© 2008  James K. Luiselli

James K. Luiselli, Ed.D., ABPP, BCBA is a psychologist affiliated with May Institute and a private-practice clinician. Among his publications are 6 books and over 200 journal articles. He reviews books for The New England Psychologist.

 


Dr Martin Kantor sent the following response on July 21, 2008, published July 25, 2008.

I raise the following questions about James K. Luiselli's review of my book Lifting the Weight. 

Why is a behaviorist who works for an institute mainly involved with treating autistic children and writes about their treatment assigned to review my book, a general psychiatric book on depression in men, in the first place?

What is wrong with being an eclectic? As the mainstream psychiatrist John Oldham, an eminent psychiatrist affiliated with the New York Psychoanalytic Institute and Columbia-Presbyterian Hospital, writing with Joan Morris, says, "very often a therapist will combine many different approaches to achieve the optimal treatment for his or her patient1 (p. 403) Clearly Oldham and Morris disagree with Luiselli who says, "most practitioners adopt a singular treatment modality that is theoretically consistent and integrated conceptually."

As for "mindfulness-based interventions such as Acceptance and Commitment Therapy (ACT), and learning-theory strategies such as behavioral activation," sure, I overlooked them; they aren't in any of my medical books or journals or seminars. And why should I give behavioral therapy, which I believe doesn't always generalize well outside of the treatment room, and isn't the only approach applicable to depressed men, precedence over therapeutic modalities such psychodynamic psychotherapy and supportive therapy, which I advocate in the belief that they are eminently effective for treating depression in men?

What's wrong with speaking in English and using simple analogies to bring points home for the general clinician and layperson? Too simple for the clinician yet too abstruse for the layperson? That's a hard line to walk. I believe in getting real, not in remaining ivory-tower rarefied. Two of the best books on depression, by Andrew Solomon2, who speaks of the man's depressing attitude of "I am an unworthy, inadequate, unmasculine man" (p 205) and Terrance Real3, who speaks of problems with "images of masculinity" deal with the subject on a very similar conceptual and expressive level. The clinicians I spoke to found my language revealing, containing words that started a conversation with themselves. In contrast they had some trouble relating to "Mindfulness-based interventions such as Acceptance and Commitment Therapy (ACT), and learning-theory strategies such as behavioral activation."

Why should a general book on depression in men that specifically sets out to describe the human dimension of the disorder have a section on the latest pharmacotherapy of depression? Have there been any big breakthroughs since I wrote my text? I must have missed something big even though I read the latest psychiatric and medical journals every month.

Alas, missing something big I fear would put me in a place I wish not to go: in league with my reviewer.

References

1.      Oldham, John and Lois B. Morris. 1995. New Personality Self-Portrait: Why You Think, Work, Love and Act the Way You Do. New York: Bantam

2.      Real, Terrence. 1997. I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression. New York: Scribner

3.      Solomon, Andrew. 2001. The Noonday Demon. New York: Scribner


Dr James Luiselli was offered the opportunity to reply to Dr Kantor's response, but declined.


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