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Self, Social Identity, and Physical Health: Interdisciplinary Explorations (Rutgers Series on Self and Social Identity Vol 2)
Book Reviews DILIP RAMCHANDANI, M.D. BOOK REVIEW EDITOR
Self, Social Identity, and Physical Health: Interdisciplinary Explorations (Rutgers Series on Self and Social Identity, Vol 2) Edited by Richard J. Contrada and Richard D. Ashmore New York Oxford University Press, 1999, 269 pages, $60.00 ISBN 0–19–512730–7 Reviewed by Kevin C. Riley, Ph.D.
I
n keeping with the postulated multidimensional structure of identity and the multifacted interactions of identity and health, this book is organized along a number of dimensions. First, it is arranged into four sections: Self, Social Identity, and Systems Affecting Health and Health Care; Self and Social Identity in Stress, Coping, and Physical Disease; Self-Related Personality Structures, Identity Development, and Disease-Related Behavior; and Influences of Illness on Self and Identity. Next, in recognition of the “bidirectional influences between social and psychological phenomona and matters of physical health and illness,” both self and social identity are examined as “causes of physical disease and factors shaped by the experience of illness and its treatment.” Finally, an emphasis is placed on psychological stress as a psychphysiological mechanism in health problems and the influence of health-related behaviors in mediating the physiologic effects of psychological and social forces on health. The interplay of these multiple perspectives
160
and opinions adds to the richness of the presentations. The first section begins with a consideration of Self, Sickness, Somatization, and Systems of Care. John Kihlstrom and Luck Canter Kihlstrom use clinical conditions to illuminate how the act of considering oneself as ill or damaged influences the utilization of health care resources. This is followed by Margaret Lock’s contribution, The Politics of Health, Identity, and Culture, which explores the influence of social institutions on how individuals relate to their bodies and the changes that occur to these bodies. The suicidality of an adolescent Cree boy in Northern Quebec, the “nerva” suffered by Greek immigrant women in Montral, and the differences in experience of menopause in women in North America and Japan are used to illustrate the multiple effects of distinct social, political, and health care institutions. The second section of the book, Self and Social Identity in Stress, Coping, and Physical Disease, begins with a statistically elegant chapter by David R. Williams, Michael S. Spenser, and James S. Jackson who focus on Race, Stress, and Physical Health: The Role of Group Identity. Using multiple regression, they examine the relative contributions of factors, such as discrimination, chronic role-related and financial stress, life events, racial/ethnic identity, and self esteem on self-reported health problems. The presentation of data allows the mathematically unsophisticated reader to readily understand the interrelationships among these variables and the statistically
savvy clinician to examine the data in detail. In the following counterbalanced chapter, James W. Pennebaker and Kelli A. Keough explore How Traumas Threaten people’s self-definition and how people use the act of disclosure and the most fundamental social tool, language, to try to rebuild the self. They review work from the laboratory indicating the association of the act of not talking about a historical trauma with increased episodes of illness and subjective distress. In contrast, confiding (by simply writing for 15–30 minutes a day for 3 days) is associated with decreased physician visits, increased immune system functioning, positive changes in the autonomic nervous system (systolic blood pressure and heart rate), long-term improvement in mood, and even gradepoint average. The third section, Self-Rated Personality Structures, Identity Development, and Disease-Related Behavior, is the least conceptually integrated portion of the text. Susan Ouelette’s, The Relationship Between Personality and Health: What Self and Identity Have To Do With It, initially focuses on the limitations of the “Five-Factor Model” of personality assessment in health and illness. Suggestions for alternative evaluation strategies, most of which are still being developed, are explored at the conclusion of the chapter. Jeanne Brooks-Gunn and Julia A. Graber’s following chapter, What’s Sex Got to With It?, examines essential (but infrequently explored) subject of adolescent sexuality in terms of behaviors, transitions, and identities and how social context, self-knowledge, and self-conPsychosomatics 42:2, March-April 2001
Book Reviews trol influence the developing sexual self. The impact of early adolescent decisions on giving meaning to sexual identity and actions, the contextual influences of social relationships and the feed-forward/feed-backward influence of emerging nonsexual identity and later sexual choices (especially in regards to “high risk” behaviors) is nicely elaborated. The final section of the book, Influences of Illness on Self and Identity, begins with Howard Leventhal, Ellen Idler, and Elaine Leventhal’s treatise, The Impact of Chronic Illness on the Self System. Using disease models, such as cardiovascular disorders and some cancers, the authors explore the impact of multiple mental representations of disease (determined by factors such as the cause type, consequences, controllability, and timeline of the disease) on the cognitive processes that determine how individuals construct (and reconstruct) themselves and their illnesses across time. The final chapter in this section is Kathy Charmaz’s From the Sick Role to the Stories of Self, which she compares and contrasts the possible multiple roles acutely and chronically, physically compromised individuals can assume across time and how these roles influence interactions with friends, family, and physicians. The emergence and transformation of these identities from interactions of individuals with their disease, the social environment (including other individuals with similar disease processes), the losses encountered across time and the sense of (or loss of) control are elucidated in how people tell the stories of themselves as (alternatively or simultaneously) “sick” or “well.” While clearly a book that will interest specialists in behavioral medicine, the text also has a broad appeal to those with more pragmatic and philospohical interests. In the concluding rePsychosomatics 42:2, March-April 2001
marks of the book, Ashmore and Contrada state “our primary hope is that this volume will serve as a starting point for increased systematic use of self and identity in the social and behavioral analysis of health and illness.” They have clearly achieved this goal. The parallel conceptualizations of health and identity from both the microscopic (laboratory) and macroscopic (social) viewpoints serves as an intellectual catalyst for the student, researcher, and clinician.
The Transplant Patient: Biological, Psychiatric, and Ethical Issues in Organic Transplantation Edited by Paula Trzepacz and Andrea Dimartini New York Cambridge University Press 2000, 311 pages ISBN 0–521–55354–7 Reviewed by Dilip Ramchandani, M.D.
T
his is an important book written by a range of professionals involved in caring for patients seeking organ transplant. It is divided into 12 chapters by a varied mix of prominent clinicians/researchers—consultationliaison (C-L) psychiatrists, surgeons, internists, psychologists, and educators—working in the field. The opening chapter by the pioneer of liver transplantation, Dr. Thomas Starzl, provides an engaging review of the evolution of organ transplantation and the conceptual, as well as technical, barriers that had to be overcome before it all became possible. From the basic definitions of terms such as rejection, tolerance, graft-versus-host disease to the elucidation of complicated issues of the immunologic barrier, this chapter
serves as the foundation for more practical aspects that follow. Although occasionally a bit dense for the average clinician, it does provide a comprehensive bibliography for those wishing to pursue a deeper understanding of the complex material. Drs. Levenson and Olbrisch describe the rationale for psychosocial screening and the unevenness of the methods employed to do so in a wellwritten second chapter that also addresses both the advantages and limitations of the various approaches. There is a thoughtful discussion of the potential legal impact of the Americans With Disabilities Act on screening decisions. Switzer et al.’s comprehensive review of postdonation physical and psychosocial issues in kidney, liver and bone marrow transplants is commendable in their chapter on living organ donation. Their subsequent detailed discussion of quality of life (QOL) issues in organ transplantation is thorough, but the 27-page long table that summarizes the QOL studies, although useful, may be bit of an overkill in a 300 page volume. The chapter on pharmacological issues in organ transplantation by the editors and Dr. Gupta is a clearly written exposition of relevant topics with respect to hepatic drug metabolism, immunosuppressants, corticosteroids, and anti-infectious agents. Also they do ample justice to the vexing issue of alcoholism in patients seeking liver transplants-in terms of selection, monitoring, and outcome. I particularly enjoyed the review of ethical aspects of transplantation. Dr Grant Gillett poses a set of relevant questions at the beginning of this chapter and follows up with a lively articulation of issues, such as justification for transplantation, brain death, philosophical ambiguities of the persistent vegetative state and anencephaly, liv161
Self, Social Identity, and Physical Health: Interdisciplinary Explorations (Rutgers Series on Self and Social Identity, Vol 2) Edited by Richard J. Contrada and Richard D. Ashmore New York Oxford University Press, 1999, 269 pages, $60.00 ISBN 0–19–512730–7 Reviewed by Kevin C. Riley, Ph.D.
I
n keeping with the postulated multidimensional structure of identity and the multifacted interactions of identity and health, this book is organized along a number of dimensions. First, it is arranged into four sections: Self, Social Identity, and Systems Affecting Health and Health Care; Self and Social Identity in Stress, Coping, and Physical Disease; Self-Related Personality Structures, Identity Development, and Disease-Related Behavior; and Influences of Illness on Self and Identity. Next, in recognition of the “bidirectional influences between social and psychological phenomona and matters of physical health and illness,” both self and social identity are examined as “causes of physical disease and factors shaped by the experience of illness and its treatment.” Finally, an emphasis is placed on psychological stress as a psychphysiological mechanism in health problems and the influence of health-related behaviors in mediating the physiologic effects of psychological and social forces on health. The interplay of these multiple perspectives
160
and opinions adds to the richness of the presentations. The first section begins with a consideration of Self, Sickness, Somatization, and Systems of Care. John Kihlstrom and Luck Canter Kihlstrom use clinical conditions to illuminate how the act of considering oneself as ill or damaged influences the utilization of health care resources. This is followed by Margaret Lock’s contribution, The Politics of Health, Identity, and Culture, which explores the influence of social institutions on how individuals relate to their bodies and the changes that occur to these bodies. The suicidality of an adolescent Cree boy in Northern Quebec, the “nerva” suffered by Greek immigrant women in Montral, and the differences in experience of menopause in women in North America and Japan are used to illustrate the multiple effects of distinct social, political, and health care institutions. The second section of the book, Self and Social Identity in Stress, Coping, and Physical Disease, begins with a statistically elegant chapter by David R. Williams, Michael S. Spenser, and James S. Jackson who focus on Race, Stress, and Physical Health: The Role of Group Identity. Using multiple regression, they examine the relative contributions of factors, such as discrimination, chronic role-related and financial stress, life events, racial/ethnic identity, and self esteem on self-reported health problems. The presentation of data allows the mathematically unsophisticated reader to readily understand the interrelationships among these variables and the statistically
savvy clinician to examine the data in detail. In the following counterbalanced chapter, James W. Pennebaker and Kelli A. Keough explore How Traumas Threaten people’s self-definition and how people use the act of disclosure and the most fundamental social tool, language, to try to rebuild the self. They review work from the laboratory indicating the association of the act of not talking about a historical trauma with increased episodes of illness and subjective distress. In contrast, confiding (by simply writing for 15–30 minutes a day for 3 days) is associated with decreased physician visits, increased immune system functioning, positive changes in the autonomic nervous system (systolic blood pressure and heart rate), long-term improvement in mood, and even gradepoint average. The third section, Self-Rated Personality Structures, Identity Development, and Disease-Related Behavior, is the least conceptually integrated portion of the text. Susan Ouelette’s, The Relationship Between Personality and Health: What Self and Identity Have To Do With It, initially focuses on the limitations of the “Five-Factor Model” of personality assessment in health and illness. Suggestions for alternative evaluation strategies, most of which are still being developed, are explored at the conclusion of the chapter. Jeanne Brooks-Gunn and Julia A. Graber’s following chapter, What’s Sex Got to With It?, examines essential (but infrequently explored) subject of adolescent sexuality in terms of behaviors, transitions, and identities and how social context, self-knowledge, and self-conPsychosomatics 42:2, March-April 2001
Book Reviews trol influence the developing sexual self. The impact of early adolescent decisions on giving meaning to sexual identity and actions, the contextual influences of social relationships and the feed-forward/feed-backward influence of emerging nonsexual identity and later sexual choices (especially in regards to “high risk” behaviors) is nicely elaborated. The final section of the book, Influences of Illness on Self and Identity, begins with Howard Leventhal, Ellen Idler, and Elaine Leventhal’s treatise, The Impact of Chronic Illness on the Self System. Using disease models, such as cardiovascular disorders and some cancers, the authors explore the impact of multiple mental representations of disease (determined by factors such as the cause type, consequences, controllability, and timeline of the disease) on the cognitive processes that determine how individuals construct (and reconstruct) themselves and their illnesses across time. The final chapter in this section is Kathy Charmaz’s From the Sick Role to the Stories of Self, which she compares and contrasts the possible multiple roles acutely and chronically, physically compromised individuals can assume across time and how these roles influence interactions with friends, family, and physicians. The emergence and transformation of these identities from interactions of individuals with their disease, the social environment (including other individuals with similar disease processes), the losses encountered across time and the sense of (or loss of) control are elucidated in how people tell the stories of themselves as (alternatively or simultaneously) “sick” or “well.” While clearly a book that will interest specialists in behavioral medicine, the text also has a broad appeal to those with more pragmatic and philospohical interests. In the concluding rePsychosomatics 42:2, March-April 2001
marks of the book, Ashmore and Contrada state “our primary hope is that this volume will serve as a starting point for increased systematic use of self and identity in the social and behavioral analysis of health and illness.” They have clearly achieved this goal. The parallel conceptualizations of health and identity from both the microscopic (laboratory) and macroscopic (social) viewpoints serves as an intellectual catalyst for the student, researcher, and clinician.
The Transplant Patient: Biological, Psychiatric, and Ethical Issues in Organic Transplantation Edited by Paula Trzepacz and Andrea Dimartini New York Cambridge University Press 2000, 311 pages ISBN 0–521–55354–7 Reviewed by Dilip Ramchandani, M.D.
T
his is an important book written by a range of professionals involved in caring for patients seeking organ transplant. It is divided into 12 chapters by a varied mix of prominent clinicians/researchers—consultationliaison (C-L) psychiatrists, surgeons, internists, psychologists, and educators—working in the field. The opening chapter by the pioneer of liver transplantation, Dr. Thomas Starzl, provides an engaging review of the evolution of organ transplantation and the conceptual, as well as technical, barriers that had to be overcome before it all became possible. From the basic definitions of terms such as rejection, tolerance, graft-versus-host disease to the elucidation of complicated issues of the immunologic barrier, this chapter
serves as the foundation for more practical aspects that follow. Although occasionally a bit dense for the average clinician, it does provide a comprehensive bibliography for those wishing to pursue a deeper understanding of the complex material. Drs. Levenson and Olbrisch describe the rationale for psychosocial screening and the unevenness of the methods employed to do so in a wellwritten second chapter that also addresses both the advantages and limitations of the various approaches. There is a thoughtful discussion of the potential legal impact of the Americans With Disabilities Act on screening decisions. Switzer et al.’s comprehensive review of postdonation physical and psychosocial issues in kidney, liver and bone marrow transplants is commendable in their chapter on living organ donation. Their subsequent detailed discussion of quality of life (QOL) issues in organ transplantation is thorough, but the 27-page long table that summarizes the QOL studies, although useful, may be bit of an overkill in a 300 page volume. The chapter on pharmacological issues in organ transplantation by the editors and Dr. Gupta is a clearly written exposition of relevant topics with respect to hepatic drug metabolism, immunosuppressants, corticosteroids, and anti-infectious agents. Also they do ample justice to the vexing issue of alcoholism in patients seeking liver transplants-in terms of selection, monitoring, and outcome. I particularly enjoyed the review of ethical aspects of transplantation. Dr Grant Gillett poses a set of relevant questions at the beginning of this chapter and follows up with a lively articulation of issues, such as justification for transplantation, brain death, philosophical ambiguities of the persistent vegetative state and anencephaly, liv161