There is no better teacher than experience. That premise has driven a proliferation of autobiographies about mental disorders or what Carol Joyce Oates characterized as “pathographies.” The market is flooded with compelling memoirs of people who faced and mostly overcame mental disorder or life challenges.
Autobiographies uniquely provide a patient’s inside look into pathological experiences and psychological treatments – a perspective from the other side of the couch. Memoirs complement research and case studies performed from the outside looking in (Sommer et al., 1998). Written in the person’s own words, an autobiography emphasizes themes and topics that the writer, as distinct from a psychotherapist or researcher, considers important. Anyone who has read an autobiographical account of psychoanalysis with Freud immediately appreciates the complementary perspective (Lynn & Vaillant, 1998).
There is little uniformity among the credentials of memoir authors and virtually no controlled research on their self-help effectiveness. While some authors are celebrities or politicians, others are ordinary people with a story to tell. Self-help resources lack formal regulation, and there is very little evidence to verify the accuracy or effectiveness of autobiographies (Rosen, 2004). Those who possess the most economic influence on self-help materials are rarely mental health experts; instead, marketing exerts considerable power in an unregulated marketplace with little research to guide consumers.
Over the past 20 years, we and our colleagues have complied lists of autobiographies for clinical and teaching purposes to guide both consumer selection and practitioner recommendations (Clifford, Norcross, & Sommer, 1999: Norcross et al., 2003). These lists were then rated by licensed psychologists for their value. Through these studies we hope to establish expert consensus on meritorious self-help autobiographies.
By way of review, in Fall 2011 Registrants rated self-help materials spanning 40 mental disorders and life challenges. Respondents rated only those autobiographies with which they were sufficiently familiar. We used a 5-point, Likert-type scale that ranged from +2 to -2 to rate autobiographies. A rating of +2 indicated an outstanding or highly recommended autobiography that is the best or among the best in that category. A +1 indicated a book that provides good advice and can be helpful. A rating of 0 indicated an average autobiography, while negative ratings designated those to be avoided.
Table 1 displays the percentage of Registrants reporting the effectiveness of six types of self-help recommended to their own patients. Self-help books and self-help groups were rated by psychologists as either “somewhat helpful” or “very helpful” for 85% and 86% of clients, respectively. Only 6 to 7% of clients were harmed by the recommended books or groups. In regard to autobiographies, Registrants reported an average of 57% of their patients were helped by them, 40% experienced no effect, and only 3% experienced any harmful effects. In fact, self-help materials, when recommended by psychologists, proved harmful on only rare occasions.
Note: The survey asked, “In general, what help do your patients/clients report from using the following self-help resources that you recommended?”
Table 2 presents the top 50 autobiographies in rank order as determined by expert consensus. The mean ratings and the number of raters were used to identify the highest rated resources. All of the autobiographies in the table were rated by at least 10 psychologists and secured a mean rating of 1.00 and higher.
The five most frequent categories of highly rated autobiographies were death and grieving, depression, schizophrenia, substance abuse, and eating disorders. The top five autobiographies were Letting Go (death & grieving), Breaking Free from Compulsive Eating (eating disorders), Tuesdays with Morrie (adult development), A Grief Observed (death & grieving), and Elegy for Iris (dementia/alzheimer’s).
The psychologists’ ratings can prove a useful guide for sorting through the unregulated world of self-help autobiographies which, to our mind, are vastly underutilized and clinically valuable resource from the other side of the couch.
Note From the Editor: We recently published three articles on self-help resources in mental health inThe Register Report. The articles were based on a series of surveys of psychologists, including Registrants, and listed respondents’ highest-rated self-help books, autobiographies, and films.
The surveys asked psychologists to rate hundreds of self-help resources. Neither the authors nor the National Register intended to imply endorsement of any of the self-help resources listed in the surveys. A number of Registrants, including one of the authors, expressed concern that one of the top-rated self-help books, The Courage to Heal, has been involved in lawsuits and implicated in false memories. Other Registrants have written to the authors and the National Register stating that a particular film or autobiography has not proven suitable for some clients.
The National Register does not endorse or recommend any self-help resource included in the series of articles. We encourage Registrants to independently evaluate any self-help book, autobiography, or film prior to recommending the resource to patients.
Kavita J. Shah is a senior psychology major at the University of Scranton, where she co-managed the research surveys on which this article is based. She is currently applying to doctoral programs in psychology.
Bob Sommer is Distinguished Professor Emeritus at the University of California where he chaired four departments (Psychology, Environmental Design, Rhetoric & Communication, and Art), although not all at the same time. He has been reading client autobiographies for more than 50 years.
John C. Norcross, PhD, ABPP, is Professor of Psychology and Distinguished University Fellow at the University of Scranton, editor of Journal of Clinical Psychology: In Session, and a clinical psychologist in part-time practice. Dr. Norcross was a member of the National Register Board of Directors from 2002-2009.
Clifford, J. S., Norcross, J. C., & Sommer, R. (1999). Autobiographies of mental health clients: Psychologists’ uses and recommendations. Professional Psychology: Research and Practice, 30, 56-59.
Lynn, D. J., & Vaillant, G. E. (1998). Anonymity, neutrality, and confidentiality in the actual methods of Sigmund Freud: A review of 43 cases, 1907-1939. American Journal of Psychiatry, 155, 163-171.
Norcross, J. C., Santrock, J. W. Campbell, L. M., Smith, T. P., Sommer, R., & Zuckerman, E. L. (2003). Authoritative guide to self-help resources in mental health (rev ed.). New York: Guildford.
Norcross, J. C., Campbell, L. M., Grohol, J. M., Selagea, F., & Sommer, R. (in press). Self-help that works (4th ed.). New York: Oxford University Press.
Rosen, G. M. (2004). Remembering the 1978 and 1990 task forces on self-help therapies. Journal of Clinical Psychology, 60, 111-113.
Sommer, B., Clifford, J. S., & Norcross, J. C. (1998). A bibliography of mental patients’ autobiographies: An update and classification system. American Journal of Psychiatry, 155, 1261–1264.