- Email: [email protected]
Review article
Journal of Psychosomatic Research, Vol. 46, No. 4, pp. 403–404, 1999 Copyright 1999 Elsevier Science Inc. All rights reserved. 0022-3999/99 $–see front matter
BOOK REVIEWS Psychosomatic Medicine. Edited by R. H. Adler, J. M. Herrmann, K. Kohle, et al. Munich: Urban & Schwarzenberg, 1997. 910 pp. The preface clearly describes this book’s aim as unifying the biological, psychological, and social aspects of illness within the German romantic tradition. This is followed by impressive contents pages promising a complete overview of what might be described as consultation–liaison psychiatry. Unfortunately, as with so many attempts at unification, one “side” comes out on top. In this book it is outdated psychoanalytic concepts of disease that emerge as all powerful. While few practicing clinicians would dismiss the importance of psychodynamics, other equally important perspectives, although discussed, seemed to be dismissed if they do not fit into the picture. Thus, in describing research on the etiology of schizophrenia, the results of neuroimaging studies describing enlarged ventricular/brain ratios are described as “quite unclear what these findings mean” and a note of warning is sounded that “neurologizing about patients is a hazard to them”; by contrast, the role of childhood experience is emphasized. I moved to the chapter on bronchial asthma, a condition of which I have some experience as a patient. I learned that, in receiving treatment for asthma, I need my ambivalence, type and extent of fear, and in particular my relationship with my mother to be determined. This relational pathology is seen as being “predominant” and “dictating” the functional and organic pathologies. I look forward to taking this up with my general practitioner when I return for a repeat prescription of inhaled corticosteroid; they were previously curative. I am obviously a clear case of repression! In summary, this book is something of a metaphor for the German tradition of psychosomatic medicine. At first sight, it promises so much, but closer inspection leads to disappointment. I have no doubt that believers will see it as a classic volume, but I fear that it will impress few others. A book for enthusiasts and the seriously curious only. Alan Carson Department of Psychiatry University of Edinburgh Kennedy Tower Morningside Park Edinburgh EH10 5HF, UK S0022-3999(98)00095-6
Chronic Fatigue and Its Syndromes. S. Wessely, M. Hotopf, M. Sharpe. Oxford: Oxford University Press, 1998. 416 pp. Price £65 (HB), £25 (PB). Imagine the Chief Medical Officer (CMO) of England and Wales announcing at a press conference that irritable bowel syndrome was a “real entity,” and his statement making headlines in the national newspapers. This is exactly what happened with chronic fatigue syndrome (CFS) this year [1]. Why is there such a brouhaha over chronic unexplained fatigue? Why do both doctors and patients think “ME” is either physical or mental? Why do some doctors dislike sufferers so much? Does “ME” really exist? How on earth do you treat it? The answers to these questions and many of the other mysteries surrounding CFS can be found in this excellent book. This is the seventh recently published book reviewing chronic fatigue syndromes to join my bookshelves. It is the best for several reasons. The book reviews fatigue as a complaint beyond the syndromes. The review is comprehensive and scholarly, taking the reader convincingly from history to hysteria and from physiology to politics. The book avoids the problem of the previously published accounts by having only three authors, thus giving the book the valuable attributes of consistency and clarity. Above all, the book is readable. Wessely, Hotopf, and Sharpe are three liaison psychiatrists who have been studying and treating patients with chronic unexplained fatigue for the last 10 years. They are best known for their epidemiological and treatment studies of chronic fatigue. In this book, the authors have set themselves the daunting
403
404
Book Reviews
task of tackling the very nature of fatigue, its medical and social history, as well as the etiology and management of chronic fatigue syndrome (CFS). The chapter on the nature of fatigue is often missing from other accounts because of the inherent difficulty of defining such a subjective complaint. The review of physical mechanisms includes a good account of fatigue secondary to other conditions, and contains the clinically useful advice that “. . . when a patient with a physical illness complains of fatigue the most likely factors to be responsible are mood disorders and deconditioning.” The middle section of 180 pages reviews all aspects of CFS and related syndromes. The authors depart from the CMO’s view of nosology by favoring a dimensional approach to CFS, suggesting that “. . . fatigue syndromes are often arbitrarily created syndromes that lie at the extreme end of the spectrum of polysymptomatic distress.” Neither neuromuscular nor immune etiological explanations are favored, but “there can be little doubt that fatigue syndrome is a reality after certain infections.” I was pleased to read their view that “so-called ‘organic’ factors may be equally important in those who do fulfil psychiatric criteria, and ‘psychological’ factors can still be important in those who do not.” Their conclusion is that a cognitive behavioral model best fits the current evidence of those factors that maintain CFS, with the syndrome being “a multifactorial process, rather than a collection of discrete disorders yet to be identified.” “CFS: A social history of twentieth-century illness” is the most novel and interesting chapter, suggesting the brouhaha is caused by avoiding stigmatizing psychiatric labels, the public’s increasing disenchantment with the medical model, and increasing fears of a polluted world. The authors demonstrate the importance of these social beliefs in CFS and remind us of the lessons CFS can teach us about other idiopathic illnesses. Regarding treatments they conclude that “CBT with exercise appears to be the most promising treatment of CFS.” Researchers, clinicians, and therapists of almost all persuasions will find this book readable and authoritative. Trainees and students will learn the delicate balance of negotiating therapeutic alliances with sufferers of uncertain disorders, while remembering that we need our patients to sometimes challenge our own set theories. Peter D. White Department of Psychological Medicine St. Bartholomew’s and the Royal London Medical and Dental School London EC1A 7BE, UK S0022-3999(98)00104-4
REFERENCE 1. Wilson E. ME is a real illness. Daily Mail 1998; July 17:17.
BOOK REVIEWS Psychosomatic Medicine. Edited by R. H. Adler, J. M. Herrmann, K. Kohle, et al. Munich: Urban & Schwarzenberg, 1997. 910 pp. The preface clearly describes this book’s aim as unifying the biological, psychological, and social aspects of illness within the German romantic tradition. This is followed by impressive contents pages promising a complete overview of what might be described as consultation–liaison psychiatry. Unfortunately, as with so many attempts at unification, one “side” comes out on top. In this book it is outdated psychoanalytic concepts of disease that emerge as all powerful. While few practicing clinicians would dismiss the importance of psychodynamics, other equally important perspectives, although discussed, seemed to be dismissed if they do not fit into the picture. Thus, in describing research on the etiology of schizophrenia, the results of neuroimaging studies describing enlarged ventricular/brain ratios are described as “quite unclear what these findings mean” and a note of warning is sounded that “neurologizing about patients is a hazard to them”; by contrast, the role of childhood experience is emphasized. I moved to the chapter on bronchial asthma, a condition of which I have some experience as a patient. I learned that, in receiving treatment for asthma, I need my ambivalence, type and extent of fear, and in particular my relationship with my mother to be determined. This relational pathology is seen as being “predominant” and “dictating” the functional and organic pathologies. I look forward to taking this up with my general practitioner when I return for a repeat prescription of inhaled corticosteroid; they were previously curative. I am obviously a clear case of repression! In summary, this book is something of a metaphor for the German tradition of psychosomatic medicine. At first sight, it promises so much, but closer inspection leads to disappointment. I have no doubt that believers will see it as a classic volume, but I fear that it will impress few others. A book for enthusiasts and the seriously curious only. Alan Carson Department of Psychiatry University of Edinburgh Kennedy Tower Morningside Park Edinburgh EH10 5HF, UK S0022-3999(98)00095-6
Chronic Fatigue and Its Syndromes. S. Wessely, M. Hotopf, M. Sharpe. Oxford: Oxford University Press, 1998. 416 pp. Price £65 (HB), £25 (PB). Imagine the Chief Medical Officer (CMO) of England and Wales announcing at a press conference that irritable bowel syndrome was a “real entity,” and his statement making headlines in the national newspapers. This is exactly what happened with chronic fatigue syndrome (CFS) this year [1]. Why is there such a brouhaha over chronic unexplained fatigue? Why do both doctors and patients think “ME” is either physical or mental? Why do some doctors dislike sufferers so much? Does “ME” really exist? How on earth do you treat it? The answers to these questions and many of the other mysteries surrounding CFS can be found in this excellent book. This is the seventh recently published book reviewing chronic fatigue syndromes to join my bookshelves. It is the best for several reasons. The book reviews fatigue as a complaint beyond the syndromes. The review is comprehensive and scholarly, taking the reader convincingly from history to hysteria and from physiology to politics. The book avoids the problem of the previously published accounts by having only three authors, thus giving the book the valuable attributes of consistency and clarity. Above all, the book is readable. Wessely, Hotopf, and Sharpe are three liaison psychiatrists who have been studying and treating patients with chronic unexplained fatigue for the last 10 years. They are best known for their epidemiological and treatment studies of chronic fatigue. In this book, the authors have set themselves the daunting
403
404
Book Reviews
task of tackling the very nature of fatigue, its medical and social history, as well as the etiology and management of chronic fatigue syndrome (CFS). The chapter on the nature of fatigue is often missing from other accounts because of the inherent difficulty of defining such a subjective complaint. The review of physical mechanisms includes a good account of fatigue secondary to other conditions, and contains the clinically useful advice that “. . . when a patient with a physical illness complains of fatigue the most likely factors to be responsible are mood disorders and deconditioning.” The middle section of 180 pages reviews all aspects of CFS and related syndromes. The authors depart from the CMO’s view of nosology by favoring a dimensional approach to CFS, suggesting that “. . . fatigue syndromes are often arbitrarily created syndromes that lie at the extreme end of the spectrum of polysymptomatic distress.” Neither neuromuscular nor immune etiological explanations are favored, but “there can be little doubt that fatigue syndrome is a reality after certain infections.” I was pleased to read their view that “so-called ‘organic’ factors may be equally important in those who do fulfil psychiatric criteria, and ‘psychological’ factors can still be important in those who do not.” Their conclusion is that a cognitive behavioral model best fits the current evidence of those factors that maintain CFS, with the syndrome being “a multifactorial process, rather than a collection of discrete disorders yet to be identified.” “CFS: A social history of twentieth-century illness” is the most novel and interesting chapter, suggesting the brouhaha is caused by avoiding stigmatizing psychiatric labels, the public’s increasing disenchantment with the medical model, and increasing fears of a polluted world. The authors demonstrate the importance of these social beliefs in CFS and remind us of the lessons CFS can teach us about other idiopathic illnesses. Regarding treatments they conclude that “CBT with exercise appears to be the most promising treatment of CFS.” Researchers, clinicians, and therapists of almost all persuasions will find this book readable and authoritative. Trainees and students will learn the delicate balance of negotiating therapeutic alliances with sufferers of uncertain disorders, while remembering that we need our patients to sometimes challenge our own set theories. Peter D. White Department of Psychological Medicine St. Bartholomew’s and the Royal London Medical and Dental School London EC1A 7BE, UK S0022-3999(98)00104-4
REFERENCE 1. Wilson E. ME is a real illness. Daily Mail 1998; July 17:17.