Category: Book Reviews

Robert T Muller - Toronto Psychologist

Book Review: Room – A Nightmare, Real and Imagined

00Book Reviews January, 18

Imagine the only world you’ve ever known measuring eleven by eleven feet.  The only source of natural light is a single skylight, and you have never met anyone your age.  In fact, you’ve never met anyone aside from your mother, who shares your restrictive existence.  This is the world of five-year-old Jack in Emma Donoghue’s masterfully written work, Room, winner of six literary awards worldwide, and shortlisted for seven others since its publication in August 2010.

Jack’s mother is a college student who, kidnapped seven years earlier, was kept in a soundproof shed by a man known to Jack simply as “Old Nick.”  Jack is born two years into her imprisonment, the product of one of Old Nick’s routine rapes.  Nevertheless, Jack’s relationship with his mother verges on normal.  Stressed from reading the same story for the umpteenth time, and arguments over eating green beans, Jack’s mother is determined to provide the best for her child in the small ways she can.  She argues with her captor for vitamins, enforces an exercise regimen, and says grace with Jack before every meal.

The situation is eerily true-to-life, acknowledging elements of human adaptability to even the harshest of circumstances.  Although he is pale with a compromised immune system from never having been outside, Jack is bright, inventive, and feisty.  Donoghue deemphasizes the role of Old Nick, focusing instead on the cohesiveness of the mother-son bond and the development of Jack’s character.

Around Jack’s fifth birthday, his mother begins explaining to him the concept of Outside.  “When I was a little kid I thought like a little kid…but now I’m five I know everything… it makes my head tired,” Jack states.  While he is not particularly keen on leaving the familiarity of Room, Jack’s mother becomes increasingly decided that Jack can and must have a normal childhood.  She devises a plan to break the two out of Room, now that her son is old enough, and they embark on an escape.

Donoghue does not end there, because in many ways, the battle for freedom and normalcy only begins with the getaway.  Jack now has to adjust to everything from riding in cars to the feeling of grass.

As far-fetched as we would like to imagine this novel is, Donoghue was not only inspired by true events, but also had to delve deep into many infamous cases of dysfunctional families, kidnappings, rapes, and infanticide.  “This is a hideous line of research,” Donoghue admitted in a National Post interview “I wish I could clean out my brain.”  A particularly grotesque story of pivotal influence to the author was the Fritzl Case of 2008 from Austria.

Joseph Fritzl was convicted of having kidnapped his own daughter, Elisabeth.  For 24 years he kept her in his basement, raping her and fathering seven children from the incestuous relationship.  Fritzl had convinced everyone, including his wife, Elisabeth’s mother, that their daughter had run away to join a cult.  He even forced Elisabeth to write letters to her parents intermittently to preserve the facade.  Eventually due to a health emergency, one of the children had to be rushed to the hospital.  Fritzl’s story began to splinter, the authorities were called, and Elisabeth and the captive children were rescued.

“Imagine realising that the world is not the locked-up room you thought it was,” Donoghue told Macleans, “this idea of a wide-eyed child seeing the world completely anew just gripped me.”  For those who criticized the author on her book’s morbid and macabre nature, it should be noted that the real life events from which this story was inspired, put bluntly, are a hell of a lot worse.

The youngest sibling in the Fritzl’s case is Felix, incidentally five years old at the time of rescue.  A detective on the case recalls how the boy pointed at the moon upon seeing it for the first time asking, “Is that God up there?”

Donoghue’s characters struggle with personal resilience and adaptability when confronted with the unthinkable.  At the end of the novel, Jack’s new, still wavering, state of freedom even inspires a certain measure of hope for cases like the Fritzls.

-Ruth Shach, Contributing Writer

Robert T Muller - Toronto Psychologist

Book Review: Pornland – How Porn Has Hijacked our Sexuality

00Book Reviews January, 18

Claiming that mainstream porn is in the business of “making hate,” sociology and women’s studies professor Gail Dines at Wheelock College, Boston, has been a voice in the anti-pornography movement for two decades.  In her latest book, Pornland: How Porn Has Hijacked our Sexuality, Dines challenges the idea that the porn industry is in the business of “making love.”

She opens the subject with “The awkward truth, according to one study, is that 90 percent of 8-to-16-year-olds have viewed pornography online.  That means there is an entire generation of young people who think sex ends with a money shot to the face.”  She points to the violence, rape and trauma embedded in mainstream pornography as cleverly wrapped in a sexual cloak, rendering it invisible.  Those who protest are deemed anti-sex instead of anti-violence.

Dines has been portrayed as an uptight, anti-sex, victim feminist.  But before judging, we should understand her arguments.




Argument #1:  Pornography is First and Foremost a Business

Informative and well researched, the first three chapters describe the emergence of the porn industry.  Dines walks readers from post World War II America to the present, describing the evolution of mass porn distribution as a key driver of new technological innovations.  The most recent of these innovations being streaming video on computers and cell phones, allowing users to buy porn in private without embarrassing trips to seedy shops.

A multi-billion dollar business, content has been shaped by the contours of sophisticated marketing, state of the art technology, and competition within the industry.  Dines says that underestimating the power of this well-oiled machine is the biggest mistake consumers of porn often make.

Argument #2: Porn is More Than Just Fantasy

The next few chapters are devoted to myth busting.  Dines considers porn to take place in “a parallel universe where love and intimacy are replaced by violence and the incessant abuse of women.”  The majority of scenes from fifty top rented pornographic movies contained physical and verbal abuse; in fact, 90 percent of scenes contained at least one aggressive act.

In her chapter Leaky Images:  How Porn Seeps into Men’s Lives, Dines examines the argument that porn is just entertainment citing that it is naive to think that fantasy can somehow remain separate from consumers’ actual sex lives. She looks at issues like the real-world effects of porn by drawing comparisons to the plastic surgery industry.  “Many women know that the image of the model in the ads is an airbrushed, technologically enhanced version of the real thing, but that doesn’t stop us from buying products in the hope that we can imitate an image of an unreal woman.”


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When the content source –big business– is considered, it becomes clearer how porn is not fantasy in the traditional sense of the word.  Rather than coming from imagination, longings and experiences, these “fantasies” are highly formulaic factory-line images.

Argument #3: Pornography Breeds Violence

In 2002, the case of Ashcroft v. Free Speech Coalition deemed the 1996 Child Porn Prevention Act unconstitutional because its definition of child pornography (any visual depiction that appears to be of a minor engaging in sexually explicit conduct) was too broad.  Dines explains that the law was narrowed to cover only those images of an actual person under the age of 18 (rather than one that simply appears to be).  Since then, Pseudo Child Pornography or PCP has exploded all over the internet.

In PCP, “childified” women are adorned with pigtails and shown playing with toys.  They are penetrated by any number of men masquerading as fathers, teachers, employers, coaches, and just plain old anonymous child molesters.  Dines gives examples of defloration sites and websites specializing in virginity-taking, where an intact hymen is displayed before penetration.  This disturbing issue serves as the climax of Dines’ book.

Unfortunately, Dines may lose a number of readers by drawing a link between viewing PCP and pedophilia.  Dines interviews sexual offenders in prison, questioning them about their child porn consumption prior to engaging in child abuse.  Almost without fail, offenders admitted to the use of porn before committing their crimes.  This kind of retrospective research cannot accurately show cause-effect and fails to consider a host of other potential factors influencing child abuse (e.g., prior history of sexual abuse from a caregiver).  In this way, she overstates her case.


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Still, Pornland provides a rich examination of the porn industry and what it means to grow up in a porn-saturated culture.  Despite a bent toward sensationalism, the book will help female and male readers question their beliefs about sex and also question where those beliefs come from.


-Anjani Kapoor, Contributing Writer

Robert T Muller - Toronto Psychologist

Book Review: Becoming Trauma Informed

00Book Reviews, Unclassified January, 18

Red, and your heart starts to race.  Red, and your palms sweat.  Red, and the sounds around you blur together.  Imagine becoming emotionally aroused or distressed at the sight of simple stimuli, like the colour red, without knowing why.

Because triggers like this can take the form of harmless, everyday stimuli, trauma survivors are often unaware of them and the distress they cause in their lives.  And clinicians who practice without the benefit of a trauma-informed lens are less able to help clients make the connection.

To address this and other concerns, researchers Nancy Poole and Lorraine Greaves in conjunction with the Centre for Addiction and Mental Health (CAMH) in Toronto recently published Becoming Trauma Informed, a book focused on the need for service providers working in the substance abuse and mental health fields to practice using a trauma informed lens.




Becoming Trauma Informed provides insight into the experiences, effects, and complexity of treating individuals who have a history of trauma.  Without a clear understanding of the effect traumatic experiences have on development, it is challenging for practitioners to make important connections in diagnosis and treatment.

The authors describe how someone who self-harms may be diagnosed with bipolar disorder, possibly insufficiently treated with only medication and behaviour management.  But using a trauma informed lens, the practitioner would more likely identify the self-harming patient as using a coping mechanism common to trauma survivors, giving rise to trauma informed care.

Such care involves helping survivors recognize their emotions as reactions to trauma.  And helping clients discover the connection between their traumatic experiences and their emotional reactions can reduce feelings of distress.

Throughout the text, the authors describe an array of treatment options, pointing to ways they can be put into practice; for example, motivational interviewing to provide guidance during sensitive conversations, cognitive behavioural therapy for trauma and psychosis, and body centred interventions to allow clients to make connections between the mind and body, an approach that has become increasingly popular in recent years.

Importantly, the authors emphasize that a single approach to trauma-informed care is unrealistic and insufficient.  While all treatments should include sensitivity, compassion, and a trusting relationship between therapist and client, specific groups require unique approaches.

The authors devote chapters to specific groups, including men, women, parents and children involved with child welfare, those with developmental disabilities, and refugees.  They outline different approaches necessary for trauma informed care in various contexts, such as when working in outpatient treatment settings, in the treatment of families, and when working with women on inpatient units, where treatment requires sensitivity to both the individual’s lived experiences and environment.




A unique and compelling feature of this book is the focus on reducing risk of re-traumatization, an often neglected topic.  Responding to the need for trauma survivors to feel safe, the authors outline how trauma informed care minimizes the use of restraints and seclusion (practices that can be re-traumatizing), and they offer ways to reduce the risk of re-traumatization by placing trauma survivors in less threatening situations, where they are less likely to feel dominated.  This may involve matching female clients to female therapists or support groups comprised of only females.

The numerous case studies help illustrate specific scenarios, challenges, and outcomes of trauma informed care and highlight the growing recognition of the link between substance abuse, mental illness and traumatic experiences.

While the text is theoretically grounded, the authors convey information in a way that is accessible to wider audiences.  It provides critical information for those working in the field by underscoring the relationship between past experiences and current functioning.

Becoming Trauma Informed delivers a deeply informative look into the field of trauma therapy.

-Janany Jayanthikumar, Contributing Writer

Robert T Muller - Toronto Psychologist

Book Review: The Antidote – Happiness for People Who Can’t Stand Positive Thinking

00Book Reviews January, 18

Since the rise of Positive Psychology in the late 1990s, the quest for happiness has become a quasi epidemic.  Motivational speakers ask that we eliminate the words ‘no’ and ‘impossible’ from our vocabulary, while various psychotherapies suggest we learn to take focus away from our anxieties and replace them with optimistic thoughts.

Some think that to achieve happiness, we must eliminate all negativity and anxiety from our minds; a task many would find challenging or even impossible.




In Oliver Burkeman’s new book The Antidote: Happiness for People Who Can’t Stand Positive Thinking, the ineffectiveness of modern strategies for happiness is only part of the problem.  For Burkeman, “there are reasons to believe that the whole notion of seeking happiness is flawed to begin with.  For one thing, who says happiness is a valid goal in the first place?”

Burkeman approaches “the cult of optimism” with skepticism.  Eliminating negative thought is not only impossible, but also unnatural.  Our efforts to suppress certain thoughts or behaviours are much more likely to evoke them.  If you were told to not think about a white bear for a minute, could you?

Research by Canadian psychologist, Joanne Wood, has shown that individuals who spend time reciting positive affirmations that do not resonate with their internal state become more distressed.

While Burkeman acknowledges that we like hearing positive messages about ourselves, he explains that it is more beneficial that we maintain a coherent and consistent sense of self.  The research shows that for people with low self-esteem, messages like mantras are unsettling, and usually are rejected as they conflict with one’s sense of self.

For Burkeman and many others he interviews, happiness is not about suppressing anxiety, but about observing and experiencing it as a natural, necessary, and transient sensation.

Tracing the practice of immersing oneself in thoughts of the anxious worst-case scenario back to the Stoic philosophers, Burkeman suggests not forcing positivity, but taking ‘the negative path’ instead.

While negative can refer to unpleasant experiences and emotions, the philosophies of happiness he discusses are best thought of as ‘negative’ since they involve practicing skills of ‘not doing.’  In this approach, you learn not to chase positive feelings so aggressively.  He argues that the negative path is “not so much a path at all, but a shift in perspective that urges you to detach from a strict set of ideals and thought patterns.”

Through conversations with various contemporaries, like new age thinker Eckhart Tolle,and experts in goal setting, he outlines how accepting uncertainty and failure as a natural part of life allows the individual to enjoy the journey rather than worry about reaching the desired happiness destination.

Burkeman is not one to shy away from experimentation.  He chronicles the process of his negative path and provides an intimate look into his own anxieties and discomfort.  He attends motivational seminars, sits in Vipassana silence for 10 days, travels to the slums of Nairobi, experiences Mexican death ceremonies and challenges his own views of self and identity.




What Burkeman offers, in part, is a lighthearted and valuable theory of balance.  His exploration not only highlights various understandings of happiness but also the roadblocks we encounter when we immerse ourselves too deeply in the oversimplified dichotomies of happiness and unhappiness.

While Burkeman’s writing can come across as overly cynical in tone, his book is a reminder that leaning too far towards one school of thought may be as detrimental as it may be rewarding.

His wit, combined with the thoroughness of his research, makes for an enlightening read, one that may shift the way you view yourself and others.

– Jana Vigor, Contributing Writer

Robert T Muller - Toronto Psychologist

Book Review: The Trauma of Everyday Life

00Book Reviews January, 18

Mark Epstein, a psychiatrist and Professor of Psychotherapy and Psychoanalysis at New York University, became involved with Buddhism when he was a Harvard undergraduate.  Over the past 20 years, he has written five books about Buddhism, eastern spirituality and psychotherapy.

It’s not surprising that Epstein’s sixth book turns to trauma.  The First Noble Truth of Buddhism, after all, is the principle of dukkha or suffering.  This dukka, as the author explains, manifests itself in a range of spiritual, psychological, and physical woes.  It is not necessarily acute and extraordinary, as we often think of the trauma that causes Posttraumatic Stress Disorder (PTSD).

Epstein points out that dukka is an inherent part of being human and warrants the everyday connotations implied by the title of his book, “The word, generally translated as ‘suffering’ but carrying the literal meaning of ‘hard to face,’ was the Buddha’s emphatic summary of the entire human predicament . . . . Indeed, just being a person in this world brings suffering because of how insignificant we feel and how impermanent we are.”


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In The Trauma of Everyday Life, Epstein explores how the “hard to face” permeates our lives and the relevant wisdom he sees coming from the tales or teachings of Siddhartha Gautama (the Buddha).  Often, the chapters use common psychological terms to frame the symptoms of trauma (e.g., “Dissociation”), as well as the tools available to combat them (e.g., The Way Out Is ThroughFeelings MatterA Relational Home).  If this were a conventional collection of essays on the topic, one would expect these sections to be penned by such diverse experts as prolonged exposure therapist Edna B. Foa or somatic theorist Bessel van der Kolk.

But neither Foa, van der Kolk, nor a score of other trauma experts make the cut.  Pediatrician and psychoanalyst Donald Winnicott, on the other hand, is frequently referred to, because of his work on developmental trauma, an attachment disorder Epstein views at the heart of much suffering.

Epstein, for the most part, seems uninterested in current scholars or therapists who do not easily integrate into his psychodynamic/Buddhist paradigm.  Instead, the author constructs his book as an exploration and integration of thematic aspects of the Buddha’s development and subsequent path to enlightenment.

If this all sounds more theological than psychological, it’s because it is. The Trauma of Everyday Life is a misleading title.  It is something like a publishing sin of omission not to disclose the bias in a book’s point-of-view.  The disclosure was there, for example, in Epstein’s most recent work, Psychotherapy Without the Self:A Buddhist Perspective.  By not declaring itself, The Trauma of Everyday Life markets to the reader as the practical guide to the subject (one penned by a doctor, no less).  Expecting practical psychology, the reader may be confused by the book’s theo-psychological single-mindedness.

The book sometimes falls prey to seemingly glib lines, such as: “The key, taught the Buddha, lies in not taking trauma personally.”  In other passages, Epstein’s passion for his subject manifests itself in a sermonizing tone.  Here, dogma overtakes objectivity, and the doctor asserts unverifiable statements, such as, “The Buddha was very smart about the mind.  Psychiatrists and brain scientists today are just catching up to him.”


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Still, there is a faith-based comfort and richness in The Trauma of Everyday Life. At its best, its style is less often preachy than plain spoken.  And when Epstein turns away from the Buddha, to relating (too short) vignettes about his clients and his family, the writer finds secular moments of being.  To me, these sections resonate nearly as much as the longer narratives about Siddhartha Gautama.

Throughout, Epstein stresses mindfulness and other means for finding an authentic way to relate to suffering and to transcend the loss, self-loathing, and isolation in our lives.  In doing so, he makes me think that Eastern spirituality may find intersections as much with existentialism (or Louis C.K. riffs on how smart phones prevent us from experiencing mundane melancholy) as with psychoanalysis.  But a greater expansion of how Epstein juggles his religion with his profession, an eclectic therapy, no doubt, would have been a welcome addition to this book.

-Stevenson Baker, Contributing Writer

Robert T Muller - Toronto Psychologist

Book Review: Drop the Worry Ball

00Book Reviews January, 18

Parents are inundated with conflicting advice on how to raise their children.  Pediatrician William Sears’ attachment parenting couldn’t be more different from the approach taken by “tiger mother” Amy Chua.  The range of “how-to” styles can leave parents scratching their heads about what’s best.

Research tends to support an authoritative parenting style, a balance of clear guidelines and expectations paired with warmth and attentiveness.  But in this age of perfected parenting, we are seeing an increase in anxiety and depression in children.  Some think that caregivers are overparenting, and that this over-attentiveness may be causing problems.

In his latest book Drop the Worry Ball (2012, Wiley),clinical psychologist Alex Russell says that children no longer grow up; nowadays we raise them, placing all responsibility on the parents.  This results in caretaking that is too protective, too involved.  At the extreme, this becomes helicopter parenting.  Parents “hover” nearby, hyper-aware of the risks and needs of their child before the child is able to evaluate a situation or make decisions on their own.


Russell’s observation of the two outcomes of over-parenting:  too little or too much anxiety in children, parallel research of Ellen Sandester, professor at Queen Maud University College of Early Childhood Education in Norway.  Sandester argues that it is through risk that children expose themselves to fearful situations, and the thrill experienced from coping with anxiety helps develop the child’s evaluation of their ability to cope with future challenges.  When children are prevented from engaging in these non-catastrophic risks, they become either hypo-anxious or hyper-anxious.  With the first, there is too little realistic perception of consequences, so the child seeks greater thrill or tries out more dangerous situations.  With hyper-anxiety, the lack of experience leads the child to become phobic of novel situations.

Similar, but not identical to Sandester, Russell argues that we are seeing two kinds of children develop as a result of over-parenting.  First, there are those who become disengaged or avoidant of stress and anxiety and don’t want to take on the adult world.  And second, there is the hyper-anxious child, the pleaser and perfectionist.  The imbalance of anxiety is created by anxious parents who hold the worry for their children –essentially shielding them from normal developmental experiences.  Similar to Sandester’s analysis, these children are deprived of the opportunity to cope with healthy, necessary levels of stress and anxiety.


That anxious parents could produce anxious children is not surprising, but that over-attentive parenting leads to hypo-anxious, disengaged children seems counterintuitive.  A lot of media attention has been given to the increasing numbers of children who are disengaged.  Russell argues however, that the same parenting style can create this avoidance of anxiety.  The parents make the adult world appear stressful and unmanageable, so why grow up?

Russell acknowledges that there is no quick fix, and that all parents make mistakes.  He recommends a mindful approach to parenting.  That is, a shift back to listening and reflecting on what the child says and does, instead of giving advice or actively taking over.

Parents need to appreciate that the child has the ability to cope with everyday risks, and need to give the child the space he or she needs to solve problems.

This book is a worthwhile read for parents.  Sometimes we need to remind ourselves that raising kids is about being “good-enough,” not perfect.

After all, children do grow up, and seem to do this best with a little space to explore and learn from mistakes.

-Heather Carter-Simmons, Contributing Writer


Book Review: The Body Keeps the Score

00Book Reviews January, 18

Bessel van der Kolk, a psychiatrist well known for his work on Posttraumatic Stress Disorder (PTSD), has written once again on the origins and consequences of trauma. Using research and examples from his own practice, van der Kolk’s The Body Keeps the Score sheds light on how these experiences affect the body.

Looking at physiological changes as a symptom and reflection of trauma, he describes how body posture, breathing, movement, and position during therapy should be viewed as a rich source of information for patients and clinicians.

One study he cites used Functional Magnetic Resonance Imaging (FMRI) to demonstrate that when trauma survivors are reminded of the painful event, they experience high activity in the  —a part of the brain associated with danger warning, activating the body’s stress responses—but low activity in  , the part of the brain in charge of language production. This finding explains why it may be difficult for trauma survivors to vocalize their thoughts and feelings, but why they so frequently experience a sense of danger and agitation.

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Although this information is valuable for clinicians looking to improve treatment and understanding of their clients, it is presented in a somewhat dense format that may be inaccessible to less experienced readers.

Yet van der Kolk does provide an array of statistics of interest to the general public, explaining for example that trauma survivors are far more likely to be admitted to hospital and diagnosed with high blood pressure, autoimmune disorders, and other conditions compared to people who have no experiences with trauma.

He also cites a seminal investigation conducted by researchers Robert Anda and Vincent Felitti at the U.S. Center for Disease Control, which studied 17,421 participants using comprehensive medical evaluations and the The results showed that two thirds of the participants had experienced a traumatic childhood event, such as physical or emotional abuse, and that as the ACE score increased, so did the incidence of chronic depression, suicide, obesity, poorer financial resources, and risky behaviors in later life.

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Van der Kolk points out that the ACE study, and others like it, illustrate the role of childhood trauma in the development of poor mental and physical health. In the author’s own words, the drug addiction that one sibling experiences and the rheumatoid arthritis that the other suffers from may stem from the same trauma experienced by both during childhood.

Much of the book is devoted to discussing treatment options. Yet once again, the material is dense and may be challenging for lay readers. And so the book may best serve researchers seeking a comprehensive guide to studies on the longitudinal effects of trauma, as well as clinicians who want to understand the underlying biological mechanisms that provoke certain responses to trauma.

For ambitious clients who want to understand more about their traumatic experiences or the treatments that would help them most, browsing the treatments section of the book may be most helpful. The section focuses on examples of clients van der Kolk has personally treated. His stories exemplify the positive regard and respect he routinely demonstrates during sessions and may help people discover what they are looking for in a trauma therapist.

-Genevieve Hayden, Contributing Writer

Feature: M Yashna on Flickr
First: Amazon 
Second: U.S. Army on Flickr