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Stressful life events: Their nature and effects
BOOK REVIEW
Stressful Life Events: Their Nature and Effects. Edited by Barbara SneN Dohren wend and Bruce P Dohrenwend, John Wiley & Sons, New York, 1974, 340 pgs, $42.95. The Dohrenwends need no introduction to the field of psychiatric epidemiology. For more than a generation they have been distinguished by a thoroughness and comprehensiveness in their work that has focused attention on the need for an epidemiologic methodology that can be applied and understood cross-culturally and across disciplines. The book contains 18chapters, divided into five parts. Contributors to each section form an impressive who’s who amongst clinicians, scientists and researchers in medicine, psychiatry, psychology, epidemiology, and sociology. Part I has four chapters authored by Hinkle, Holmes and Masuda, Rahe, and Mechanic. The investigation of the relationship between episodes of physical illness and stressful life events is the subject of Part I. Mechanic, in a discussion of the papers in this section, while recognizing that stressful life events may play a role in episodes of illness, characterizes this as a “vague generalization” at our present state of knowledge. He stresses the need to “refine our hypotheses and methods of investigation so that our efforts begin to cumulate and establish the utility of this viewpoint in the practice of medicine.” Part II, Clinical Research on Relations Between Stressful Life Events and Particular Types of Physical and Psychiatric Disorder, contains a chapter on Life Events and Myocardial Infarction by Tores Theorell. Theorell describes a number of studies in which M.I. patients reported retrospectively major life change events in the year preceding the MI. He suggests “a combination of both genetic and social circumstances may be operating.” Richard Hudgens discusses life event studies carried out with medically ill adolescents. He concludes that retrospective studies are so filled with pitfalls and problems methodologically as to render them useless. Paykel contributes a chapter which focuses on personal susceptibility and interactions of undesirable events, especially undesirable ones. Part 111 contains four chapters on community research exploring association between stressful life events and psychiatric symptomatology. Populations studied contained both children and adults, urban and rural areas. Both cross-sectional and longitudinal data are presented. Shepherd Kel376
lam critiques Part III. He characterizes research done in the area of stressful life events to date as simplified, stage one and makes a strong plea to move forward toward conceptual development and standardization of methodology. The last four chapters form Part IV which has an emphasis on methodology. Problems both conceptual and operational are critiqued here. The work of Holmes and Rahe (Schedule of Recent Experiences) is reviewed in some detail by George Brown. The Dohrenwends summarize the work of the 27 contributors in a single relevant question and one cogent answer. “What is the risk that illness or disability actually will follow stressful life events? Unfortunately, this question cannot be answered definitively from the evidence that is currently available.” This is not an easy book to read. Unfortunately, it suffers, as so often happens with a collection of presented papers, from a variety of writing styles and skills. The reader is left with a sense of unevenness and of repetition. This is not a book for a layman or even a general professional audience. It is of definite value for the researcher in the biological and behavioral sciences. It is a must for those who teach in the health care field. The Dohrenwends are to be commended for the compilation of a series of original papers destined to become a classic in the field. Julia Mayo, D.S. K New York, New York
Psychiatric Ethics. Edited by Sidney Bloch and Paul Chodoff; Oxford $32.50. In their introduction
Press,
1981,
365 pgs,
to their book Psychiatric
Ethics, the authors articulate on psychiatric ethics:
the need for a book
Psychiatrists, along with their medical colleagues, have, throughout the history of their profession, assumed implicitly that they could perform their task without ethical difficulties by by serving the best interests of their patients. Because of the complex times we live in, psychiatrists’ comfortable, traditional practices are being scrutinized in many arenas. One result, as the authors point out, is increasing emphasis on ethical
Comprehensive
Psychiatry, Vol. 25, No. 3, (May/June)
1984
Stressful Life Events: Their Nature and Effects. Edited by Barbara SneN Dohren wend and Bruce P Dohrenwend, John Wiley & Sons, New York, 1974, 340 pgs, $42.95. The Dohrenwends need no introduction to the field of psychiatric epidemiology. For more than a generation they have been distinguished by a thoroughness and comprehensiveness in their work that has focused attention on the need for an epidemiologic methodology that can be applied and understood cross-culturally and across disciplines. The book contains 18chapters, divided into five parts. Contributors to each section form an impressive who’s who amongst clinicians, scientists and researchers in medicine, psychiatry, psychology, epidemiology, and sociology. Part I has four chapters authored by Hinkle, Holmes and Masuda, Rahe, and Mechanic. The investigation of the relationship between episodes of physical illness and stressful life events is the subject of Part I. Mechanic, in a discussion of the papers in this section, while recognizing that stressful life events may play a role in episodes of illness, characterizes this as a “vague generalization” at our present state of knowledge. He stresses the need to “refine our hypotheses and methods of investigation so that our efforts begin to cumulate and establish the utility of this viewpoint in the practice of medicine.” Part II, Clinical Research on Relations Between Stressful Life Events and Particular Types of Physical and Psychiatric Disorder, contains a chapter on Life Events and Myocardial Infarction by Tores Theorell. Theorell describes a number of studies in which M.I. patients reported retrospectively major life change events in the year preceding the MI. He suggests “a combination of both genetic and social circumstances may be operating.” Richard Hudgens discusses life event studies carried out with medically ill adolescents. He concludes that retrospective studies are so filled with pitfalls and problems methodologically as to render them useless. Paykel contributes a chapter which focuses on personal susceptibility and interactions of undesirable events, especially undesirable ones. Part 111 contains four chapters on community research exploring association between stressful life events and psychiatric symptomatology. Populations studied contained both children and adults, urban and rural areas. Both cross-sectional and longitudinal data are presented. Shepherd Kel376
lam critiques Part III. He characterizes research done in the area of stressful life events to date as simplified, stage one and makes a strong plea to move forward toward conceptual development and standardization of methodology. The last four chapters form Part IV which has an emphasis on methodology. Problems both conceptual and operational are critiqued here. The work of Holmes and Rahe (Schedule of Recent Experiences) is reviewed in some detail by George Brown. The Dohrenwends summarize the work of the 27 contributors in a single relevant question and one cogent answer. “What is the risk that illness or disability actually will follow stressful life events? Unfortunately, this question cannot be answered definitively from the evidence that is currently available.” This is not an easy book to read. Unfortunately, it suffers, as so often happens with a collection of presented papers, from a variety of writing styles and skills. The reader is left with a sense of unevenness and of repetition. This is not a book for a layman or even a general professional audience. It is of definite value for the researcher in the biological and behavioral sciences. It is a must for those who teach in the health care field. The Dohrenwends are to be commended for the compilation of a series of original papers destined to become a classic in the field. Julia Mayo, D.S. K New York, New York
Psychiatric Ethics. Edited by Sidney Bloch and Paul Chodoff; Oxford $32.50. In their introduction
Press,
1981,
365 pgs,
to their book Psychiatric
Ethics, the authors articulate on psychiatric ethics:
the need for a book
Psychiatrists, along with their medical colleagues, have, throughout the history of their profession, assumed implicitly that they could perform their task without ethical difficulties by by serving the best interests of their patients. Because of the complex times we live in, psychiatrists’ comfortable, traditional practices are being scrutinized in many arenas. One result, as the authors point out, is increasing emphasis on ethical
Comprehensive
Psychiatry, Vol. 25, No. 3, (May/June)
1984