- Email: [email protected]
Describing the psychological consequences of disease
DISSECTING ROOM
Describing the psychological consequences of disease Cambridge Handbook of Psychology, Health and Medicine Edited by Andrew Baum, Stanton Newman, John Weinman, Robert West, Chris McManus. Cambridge: Cambridge University Press. 1997. Pp 660. Paperback £45. ISBN 0-521-43686-9. Hardback £120. ISBN 0-521-43073-9. ith 14 Masters’ courses in the UK alone, the discipline of health psychology is growing fast. Much of the emphasis of health psychology is in understanding the normal process of illness behaviour, attitudes to disease, or adaption to illness. Hence its remit is broader than clinical psychology or liaison psychiatry, both of which cover similar areas from a predominantly clinical perspective. Despite the obvious importance of the topic to practitioners, and as a research-based
discipline in its own right, health psychology is still an emerging subject. For example, it is afforded only the humble status of a special interest group within the British Psychological Society. This handbook therefore comes as a landmark in the subject’s development. The aim of the text (to provide an “encyclopaedic handbook”) and its title are ambitious. This reflects the ambition of a discipline that seeks to cover a staggeringly broad terrain. At its most practical level, health psychology looks at important but relatively narrow issues such as the impact of receiving a falseEduardo Paolozzi positive screening test result. At a more general level, the discipline is interested in the psychological consequences of disease. However, whereas liaison psychiatry research would ask rather narrow questions (“what proportion of people with stroke develop depression”), health psychology would be equally interested in normal adaption after disease. Health psychology addresses more than the arena of normal clinical practice however; essential to the discipline is an understanding of risk behaviour. Such an understanding should allow those involved in health education and promotion to think of better strategies to reduce risk of disease. The five editors achieved the Herculean task of bringing together nearly 200 contributors writing on Commissioned by the Chelsea & Westminster almost 250 topics. These are Hospital, this bronze collecting box (1997) arranged in three sections: stands in the main entrance. It is one of 11 “psychological foundations”, new installations by young or established “psychology, health and artists loaned, purchased, or commissioned by illness”, and “medical the Chelsea & Westminster Hospital Arts topics”. The first section Project. The new works include William Pye’s provides a useful resumé Water Cube (1996) and David Gaggini’s Itai of basic psychology Doshin. Since the hospital opened in May, dealing with topics such as 1993, more than 700 paintings, drawings, memory, personality, and original prints, posters, photographs, and development. The second sculptures have been installed for a better section covers broad themes environment for staff, patients, and visitors. of health psychology: doctor-
W
Untitled [Collecting Box]
1594
patient communication, emotional expression and health, and so on. The final section deals with the psychology of specific medical illnesses and treatments. The contributions are concise, authoritative, and well referenced. With so many topics and contributors, the consistently high quality of these contributions is impressive. However, the range of contributors is also the book’s main weakness. The text at some points seems to be more a survey of the special interests of the contributors than to provide a coherent picture of psychology, health, and medicine. Despite its reasonable structure, it cries out for more grouping of related topics. Alcohol, benzodiazepine, and opiate dependence are covered in separate sections without any theoretical discussion of addiction behaviours in general. Similarly headache, back pain, pelvic pain, irritable bowel syndrome, and chronic fatigue are all treated as separate topics, but it would have been more useful to have had a section on medically unexplained symptoms and somatisation, to help make the links between disorders that probably share more similarities than differences. Another anomaly is the omission of psychiatric disorders. Despite sections on stigma and social-skills training there is no separate discussion of schizophrenia. Nor is there any space devoted to depression and adjustment disorders, which are collectively the commonest psychiatric reaction to physical illness. I was left wondering whether these omissions were motivated by diplomacy or the fear of treading on other professions’ toes, or whether they signalled the increasing alienation of psychiatry from the rest of medicine. Despite these flaws, the Cambridge Handbook of Psychology, Health and Medicine is welcome. It deals with a subject that affects all doctors, yet frequently has a low profile in undergraduate education. It will undoubtedly be a central text for health psychology students. It will also be a useful reference book to any clinician or researcher or medical educator seeking to understand the psychology of the illnesses they treat, the treatments they prescribe, and the behaviours they prohibit. Matthew Hotopf Department of Psychological Medicine, King’s College School of Medicine, 103 Denmark Hill, London SE5 8AZ, UK
THE LANCET • Vol 351 • May 23, 1998
Describing the psychological consequences of disease Cambridge Handbook of Psychology, Health and Medicine Edited by Andrew Baum, Stanton Newman, John Weinman, Robert West, Chris McManus. Cambridge: Cambridge University Press. 1997. Pp 660. Paperback £45. ISBN 0-521-43686-9. Hardback £120. ISBN 0-521-43073-9. ith 14 Masters’ courses in the UK alone, the discipline of health psychology is growing fast. Much of the emphasis of health psychology is in understanding the normal process of illness behaviour, attitudes to disease, or adaption to illness. Hence its remit is broader than clinical psychology or liaison psychiatry, both of which cover similar areas from a predominantly clinical perspective. Despite the obvious importance of the topic to practitioners, and as a research-based
discipline in its own right, health psychology is still an emerging subject. For example, it is afforded only the humble status of a special interest group within the British Psychological Society. This handbook therefore comes as a landmark in the subject’s development. The aim of the text (to provide an “encyclopaedic handbook”) and its title are ambitious. This reflects the ambition of a discipline that seeks to cover a staggeringly broad terrain. At its most practical level, health psychology looks at important but relatively narrow issues such as the impact of receiving a falseEduardo Paolozzi positive screening test result. At a more general level, the discipline is interested in the psychological consequences of disease. However, whereas liaison psychiatry research would ask rather narrow questions (“what proportion of people with stroke develop depression”), health psychology would be equally interested in normal adaption after disease. Health psychology addresses more than the arena of normal clinical practice however; essential to the discipline is an understanding of risk behaviour. Such an understanding should allow those involved in health education and promotion to think of better strategies to reduce risk of disease. The five editors achieved the Herculean task of bringing together nearly 200 contributors writing on Commissioned by the Chelsea & Westminster almost 250 topics. These are Hospital, this bronze collecting box (1997) arranged in three sections: stands in the main entrance. It is one of 11 “psychological foundations”, new installations by young or established “psychology, health and artists loaned, purchased, or commissioned by illness”, and “medical the Chelsea & Westminster Hospital Arts topics”. The first section Project. The new works include William Pye’s provides a useful resumé Water Cube (1996) and David Gaggini’s Itai of basic psychology Doshin. Since the hospital opened in May, dealing with topics such as 1993, more than 700 paintings, drawings, memory, personality, and original prints, posters, photographs, and development. The second sculptures have been installed for a better section covers broad themes environment for staff, patients, and visitors. of health psychology: doctor-
W
Untitled [Collecting Box]
1594
patient communication, emotional expression and health, and so on. The final section deals with the psychology of specific medical illnesses and treatments. The contributions are concise, authoritative, and well referenced. With so many topics and contributors, the consistently high quality of these contributions is impressive. However, the range of contributors is also the book’s main weakness. The text at some points seems to be more a survey of the special interests of the contributors than to provide a coherent picture of psychology, health, and medicine. Despite its reasonable structure, it cries out for more grouping of related topics. Alcohol, benzodiazepine, and opiate dependence are covered in separate sections without any theoretical discussion of addiction behaviours in general. Similarly headache, back pain, pelvic pain, irritable bowel syndrome, and chronic fatigue are all treated as separate topics, but it would have been more useful to have had a section on medically unexplained symptoms and somatisation, to help make the links between disorders that probably share more similarities than differences. Another anomaly is the omission of psychiatric disorders. Despite sections on stigma and social-skills training there is no separate discussion of schizophrenia. Nor is there any space devoted to depression and adjustment disorders, which are collectively the commonest psychiatric reaction to physical illness. I was left wondering whether these omissions were motivated by diplomacy or the fear of treading on other professions’ toes, or whether they signalled the increasing alienation of psychiatry from the rest of medicine. Despite these flaws, the Cambridge Handbook of Psychology, Health and Medicine is welcome. It deals with a subject that affects all doctors, yet frequently has a low profile in undergraduate education. It will undoubtedly be a central text for health psychology students. It will also be a useful reference book to any clinician or researcher or medical educator seeking to understand the psychology of the illnesses they treat, the treatments they prescribe, and the behaviours they prohibit. Matthew Hotopf Department of Psychological Medicine, King’s College School of Medicine, 103 Denmark Hill, London SE5 8AZ, UK
THE LANCET • Vol 351 • May 23, 1998