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Customer Review

2 of 2 people found the following review helpful
5.0 out of 5 stars Outstanding book but with at least one important omission, 7 Aug. 2011
This review is from: Smile or Die: How Positive Thinking Fooled America and the World (Paperback)
Having just finished Smile or Die and I have to say I found it a joy to read. It is impeccably well researched and written in a balanced, engaging way. The only point I would call referee on is Ehenreich's seeming conviction that antidepressants have been perfected and that talk therapy has been finally displaced by them.

As an instance of this, I quote her on page 149 (of my 2010 UK paperback edition) as saying, "Effective antidepressants had become available at the end of the 1980's and these could be prescribed by a primary care physician after a 10 minute diagnostic interview, so what was left for a psychologist to do?" She elsewhere acknowledges that the US currently consumes two thirds of the world supply of antidepressants (page 3). It's strange that she doesn't ask the obvious question: if antidepressants are so effective then why is the US not the happiest and most mentally balanced place on earth? Why, as antidepressants are been prescribed like sweets, are mental distress rates going through the roof in recent years there? The jury is still out on the benefits and limitations of currently available antidepressants at the time of writing.

The corollary of this is the omission of an examination of cognitive behaviour therapy (CBT), as another reviewer has noted. CBT is a mainstream psychological treatment that is a lot older (dating to the 1970's) and much more influential (currently it is highly regarded by national and international health organisations) than positive psychology. It has a lot of empirical studies attempting to measure its effectiveness against other talk therapies and against medication for a variety of mental disorders. The cognitive aspect of it is heavily invested in thought monitoring and thought management. It seeks to identify and replace various 'negative' thoughts (which, according the theory, 'cause' negative feelings) with broadly 'positive', constructive thoughts. For instance, check out David D. Burns' "Feeling Good" to see this presented. Most crucially, it locates a person's mental problems in the person's own head, and places the burden on the patient to "work on" and "fix" their own "faulty" thinking patterns. Although CBT is more sophisticated than the more dumbed-down positivity streams, it bears some striking resemblances to this conceptual gene pool. This is right in the territory of Ehrenreich's book, but it is overlooked.

Crucially, CBT typically balances the cognitive "thought monitoring/thought management" aspect with an action orientated behavioral therapy element. This is closer to where Ehrenreich sees the right location for one's energies to be targeted, albeit she would urge community-based collective action while CBT usually urges individualist efforts. A critical review of this topic and its place within her thesis would have been fitting, but we will have to seek it elsewhere it seems.
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