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Chronic Fatigue Syndromes: The Limbic Hypothesis
Book Reviews
brief, psychodynamically informed therapy for medically ill patients by Levenson and Hales; the second reviews medical hypnosis. Dr. Greenberg is associate psychiatrist at Massachusclls General Hospital. and assistant professor of psychiatry. Harvard Medical School. Boston. MA.
Chronic Fatigue Syndromes: The Limbic Hypothesis By Jay A. Goldstein Binghamton, NY, Haworth Press, 1993, 259 pages ISBN 1-56024--433-X, $89.95
Reviewed by George B. Murra.\; M.D.
I
n this book the author discusses or touches on such entities as the Papez circuit, nitric oxide. the amydgala, hippocampus, dopamine receptors, protein kinase C, SPECT scans, cytokines, Purkinje cells, fibromyositis, neuropeptide Y, dynorphins. GABA, MK80l, posttraumatic stress disorder, thyroid-releasing hormone. Epstein Barr virus, brain electrical activity mapping, and much, much more. Goldstein. director of the Chronic Fatigue Syndrome (CFS) Institute, accepts the idea that CFS is a psychoneuroimmunologic disease. He writes as a clinician who diagnoses and treats CFS and not as a scientist narrowly limiting his field of interest. He interprets previous research in new ways and roves over many interesting hypotheses. The basic kernel of this book is his belief that CFS is best understood as being a limbic encephalopathy in a dysregulated psychoneuroimmunologic network. I would agree with the author that the vicissitudes of the limbic system may be involved at the mind-body interface, which is not adequately appreciated by researchers and has not filtered down to the level of the practicing physician. He feels that many with CFS have borderline personality disorders. He offers five types of pathophysiology underlying CFS, with possibly all five interacting in one patient. They are I) VOLUME 35 • NUMBER 6' NOVEMBER - DECEMBER 1994
CFS is a viral or postviral syndrome: 2) CFS is an immune dysfunction; 3) CFS is a neurologic disease; 4) CFS is a psychiatric disorder; and 5) CFS is a metabolic/nutritional/toxic/hypersensitivity disorder. The limbic system. he postulates. is the final common pathway for numerous noxious insults. Two sides exist concerning psychoimmunology data, the liberal and the conservative views. J Goldstein's book leans to the liberal side. Reference I. Stein M. Miller AH. Trestman RL: Depression. the immune system. and health and illness: findings in search of meaning. Arch Gen Psychiatry 1991: 48: 171-177
Dr. Murray is chief. the Avery D. Weisman. M.D.. Consultation Service. Massachusells General Hospital. and associate professor of psychiatry. Harvard Medical School. Boston. MA.
Therapists on the Front Line: Psychotherapy With Gay Men in the Age of AIDS Edited by Steven A. Cadwell, Robert A. Burnham, Jr., and Marshall Forstein Washington, DC, American Psychiatric Press, 1994, 608 pages ISBN 0-88048-588-2, $55
Reviewed by Mark Halman, M.D.. FR.C.PC.
A
IDS. the leading cause of death amongst gay men in the United States, has been the dominant force in the gay community since the early 1980s. Both HIV-seropositive and HIV-seronegative gay men face a host of challenges, ranging from staying seronegative in the age of AIDS, to dealing with the many losses caused by AIDS, be it from multiple bereavements. neurocognitive dysfunction. pauperization. or physical deterioration. Much of the psychotherapeutic work has been done in a setting of isolation, medicine's relative lack of ability to greatly affect the course of disease progression, the diffi5X3
brief, psychodynamically informed therapy for medically ill patients by Levenson and Hales; the second reviews medical hypnosis. Dr. Greenberg is associate psychiatrist at Massachusclls General Hospital. and assistant professor of psychiatry. Harvard Medical School. Boston. MA.
Chronic Fatigue Syndromes: The Limbic Hypothesis By Jay A. Goldstein Binghamton, NY, Haworth Press, 1993, 259 pages ISBN 1-56024--433-X, $89.95
Reviewed by George B. Murra.\; M.D.
I
n this book the author discusses or touches on such entities as the Papez circuit, nitric oxide. the amydgala, hippocampus, dopamine receptors, protein kinase C, SPECT scans, cytokines, Purkinje cells, fibromyositis, neuropeptide Y, dynorphins. GABA, MK80l, posttraumatic stress disorder, thyroid-releasing hormone. Epstein Barr virus, brain electrical activity mapping, and much, much more. Goldstein. director of the Chronic Fatigue Syndrome (CFS) Institute, accepts the idea that CFS is a psychoneuroimmunologic disease. He writes as a clinician who diagnoses and treats CFS and not as a scientist narrowly limiting his field of interest. He interprets previous research in new ways and roves over many interesting hypotheses. The basic kernel of this book is his belief that CFS is best understood as being a limbic encephalopathy in a dysregulated psychoneuroimmunologic network. I would agree with the author that the vicissitudes of the limbic system may be involved at the mind-body interface, which is not adequately appreciated by researchers and has not filtered down to the level of the practicing physician. He feels that many with CFS have borderline personality disorders. He offers five types of pathophysiology underlying CFS, with possibly all five interacting in one patient. They are I) VOLUME 35 • NUMBER 6' NOVEMBER - DECEMBER 1994
CFS is a viral or postviral syndrome: 2) CFS is an immune dysfunction; 3) CFS is a neurologic disease; 4) CFS is a psychiatric disorder; and 5) CFS is a metabolic/nutritional/toxic/hypersensitivity disorder. The limbic system. he postulates. is the final common pathway for numerous noxious insults. Two sides exist concerning psychoimmunology data, the liberal and the conservative views. J Goldstein's book leans to the liberal side. Reference I. Stein M. Miller AH. Trestman RL: Depression. the immune system. and health and illness: findings in search of meaning. Arch Gen Psychiatry 1991: 48: 171-177
Dr. Murray is chief. the Avery D. Weisman. M.D.. Consultation Service. Massachusells General Hospital. and associate professor of psychiatry. Harvard Medical School. Boston. MA.
Therapists on the Front Line: Psychotherapy With Gay Men in the Age of AIDS Edited by Steven A. Cadwell, Robert A. Burnham, Jr., and Marshall Forstein Washington, DC, American Psychiatric Press, 1994, 608 pages ISBN 0-88048-588-2, $55
Reviewed by Mark Halman, M.D.. FR.C.PC.
A
IDS. the leading cause of death amongst gay men in the United States, has been the dominant force in the gay community since the early 1980s. Both HIV-seropositive and HIV-seronegative gay men face a host of challenges, ranging from staying seronegative in the age of AIDS, to dealing with the many losses caused by AIDS, be it from multiple bereavements. neurocognitive dysfunction. pauperization. or physical deterioration. Much of the psychotherapeutic work has been done in a setting of isolation, medicine's relative lack of ability to greatly affect the course of disease progression, the diffi5X3