- Email: [email protected]
The psychosomatic approach: Contemporary practice of whole-person care
louma/ Pnnted
o,fPsycho.mmc I” Great Brltam
Research.
Vol.31.
No. 3. p. 421425,
1987
M)22-3999/87 $0 00 + 0.00 Pergamon Journals Ltd.
BOOK REVIEWS The Psychosomatic Approach: Contemporary Practice of Whole-person Care. Edited by MARGARET .I.CHRISTIF and PETER MILLET. John Wiley, Chichester, 1986. 456 pp. Price: f32.50. THIS REALLY is a very interesting book, and it is so for two reasons; firstly the magnitude of the task the editors have set themselves and the authors, and secondly because of the variety and variation within the contents. However, the very factors that made it interesting give rise to its weaknesses. This is the second of two complementary volumes which orginated from the London Conferences of the Society for Psychomatic Research. The first volume, Foundations of Psychosomatics, appeared in 1981 and focused on the psychobiological foundations of psychosomatics. This second volume is directed towards ‘whole person-care’. It is stated that this volume advocates an approach to medicine that incorporates psychosocial factors into the study. prevention, diagnosis and clinical management of all diseases. However, there are some problems with the success of this endeavour. The impression from reading this volume is that the psychosomatic approach is one in search of both a definition and a theoretical underpinning. Although this may not be a problem experienced by the editors, it has occurred because of their brief to the individual authors to use ‘their own interpretation of the psychosomatic approach in medical practice’. The individual authors are from many different disciplines and backgrounds, which although producing an interesting mix of subject matter and perspectives also results in a variability in balance and quality. Some chapters are well reasoned critical appraisals leading from theory through assessment to intervention, but others are permeated with anecdotes and unsubstantiated opinion. There is a lack of underlying cohesion running through the volume, so that it is not so much a book as a collection of chapters, some good and some not so good, which results in a ‘I wonder what’s coming next’ impression. However. there are some excellent contributions, which are both well written and informative. The 19 chapters are organised into eight different sections: Contemporary Psychosomatics, The Beginnings of Life, Eating Behaviours, Cardiovascular Disorder, Pain and Anxiety, Wellbeing in the Community Environments, Surgery and Oncology and Terminal Care. The initial two chapters, Building on Psychsomatic Foundations (Christie) and ‘Psychosomatic’ A Historical and Semantic Inquiry (Lipowski) lead us through a history and meaning of psychosomatics. It has had a long and somewhat chequered history, although it is now anchored in the ‘inseperability and interdependence’of psychosocial and biological factors. A laudible approach, but one that does not discriminate between different theoretical orientations within each domain, hence the broadness of the psychosomatic approach is its weakness and this is reflected in the differing quality of the contributions. It is not possible to describe all the chapters and the majority are of a high standard. but some are worthy of mention. Morris, Copstick and Taylor produce an excellent chapter on Contemporary Attitudes to Care in Labour. This is a subject where there is much controversy but too little empirical data. but they admirably review what is available and make pertinent suggestions for the future. In contrast the chapter on the Whole-person Approach to Surgery (Stotter and Dudley) does not include much of the research that has been carried out on psychological factors and surgery and is written in a cavalier style which is irritating. For example. the following statement is made: “Women in particular, most of whom need to feel lovely and lovable. are sensitive to the effects of scarring”. Chapters by Steptoe on Essential Hypertension and by Pearce on Chronic Pain are models of how good chapters should be written. Baker writes an important and provocative contribution on health policy and preventative medicine and many of the new health service managers would do well to read and digest it. Berkowitz and Leff conclude their review of psychosocial intervention in schizophrenia with a useful section on the problems of implementing such an intervention. The chapter by Mackay and Lucas on Occupational Aspects of Health is informative and emphasises the role of organisations and management in reducing stress and illness. Unfortunately it is apparent from both this chapter and that of Baker that the U.K. lags behind North America in health promotion. Other chapters are more disappointing, that of Lacey and Birtchell (Eating Disorders) would have been more at home in a medical text and Priest on Benzodiazepines: The Search for Tranquillity, includes only half a page on non-pharmaceutical alternatives. For all its faults this is not a bad book. Is it worth reading and is it worth buying? Parts of it, in fact the majority of it is worth reading, whether it is worth buying depends on what the reader would hope to gain from it. It is a courageous attempt at a difficult task. For the reader with catholic tastes the variety may just make it worthwhile. Prestwich 421
Hospital,
NICHOLASTARRIER Salford Health Authority
o,fPsycho.mmc I” Great Brltam
Research.
Vol.31.
No. 3. p. 421425,
1987
M)22-3999/87 $0 00 + 0.00 Pergamon Journals Ltd.
BOOK REVIEWS The Psychosomatic Approach: Contemporary Practice of Whole-person Care. Edited by MARGARET .I.CHRISTIF and PETER MILLET. John Wiley, Chichester, 1986. 456 pp. Price: f32.50. THIS REALLY is a very interesting book, and it is so for two reasons; firstly the magnitude of the task the editors have set themselves and the authors, and secondly because of the variety and variation within the contents. However, the very factors that made it interesting give rise to its weaknesses. This is the second of two complementary volumes which orginated from the London Conferences of the Society for Psychomatic Research. The first volume, Foundations of Psychosomatics, appeared in 1981 and focused on the psychobiological foundations of psychosomatics. This second volume is directed towards ‘whole person-care’. It is stated that this volume advocates an approach to medicine that incorporates psychosocial factors into the study. prevention, diagnosis and clinical management of all diseases. However, there are some problems with the success of this endeavour. The impression from reading this volume is that the psychosomatic approach is one in search of both a definition and a theoretical underpinning. Although this may not be a problem experienced by the editors, it has occurred because of their brief to the individual authors to use ‘their own interpretation of the psychosomatic approach in medical practice’. The individual authors are from many different disciplines and backgrounds, which although producing an interesting mix of subject matter and perspectives also results in a variability in balance and quality. Some chapters are well reasoned critical appraisals leading from theory through assessment to intervention, but others are permeated with anecdotes and unsubstantiated opinion. There is a lack of underlying cohesion running through the volume, so that it is not so much a book as a collection of chapters, some good and some not so good, which results in a ‘I wonder what’s coming next’ impression. However. there are some excellent contributions, which are both well written and informative. The 19 chapters are organised into eight different sections: Contemporary Psychosomatics, The Beginnings of Life, Eating Behaviours, Cardiovascular Disorder, Pain and Anxiety, Wellbeing in the Community Environments, Surgery and Oncology and Terminal Care. The initial two chapters, Building on Psychsomatic Foundations (Christie) and ‘Psychosomatic’ A Historical and Semantic Inquiry (Lipowski) lead us through a history and meaning of psychosomatics. It has had a long and somewhat chequered history, although it is now anchored in the ‘inseperability and interdependence’of psychosocial and biological factors. A laudible approach, but one that does not discriminate between different theoretical orientations within each domain, hence the broadness of the psychosomatic approach is its weakness and this is reflected in the differing quality of the contributions. It is not possible to describe all the chapters and the majority are of a high standard. but some are worthy of mention. Morris, Copstick and Taylor produce an excellent chapter on Contemporary Attitudes to Care in Labour. This is a subject where there is much controversy but too little empirical data. but they admirably review what is available and make pertinent suggestions for the future. In contrast the chapter on the Whole-person Approach to Surgery (Stotter and Dudley) does not include much of the research that has been carried out on psychological factors and surgery and is written in a cavalier style which is irritating. For example. the following statement is made: “Women in particular, most of whom need to feel lovely and lovable. are sensitive to the effects of scarring”. Chapters by Steptoe on Essential Hypertension and by Pearce on Chronic Pain are models of how good chapters should be written. Baker writes an important and provocative contribution on health policy and preventative medicine and many of the new health service managers would do well to read and digest it. Berkowitz and Leff conclude their review of psychosocial intervention in schizophrenia with a useful section on the problems of implementing such an intervention. The chapter by Mackay and Lucas on Occupational Aspects of Health is informative and emphasises the role of organisations and management in reducing stress and illness. Unfortunately it is apparent from both this chapter and that of Baker that the U.K. lags behind North America in health promotion. Other chapters are more disappointing, that of Lacey and Birtchell (Eating Disorders) would have been more at home in a medical text and Priest on Benzodiazepines: The Search for Tranquillity, includes only half a page on non-pharmaceutical alternatives. For all its faults this is not a bad book. Is it worth reading and is it worth buying? Parts of it, in fact the majority of it is worth reading, whether it is worth buying depends on what the reader would hope to gain from it. It is a courageous attempt at a difficult task. For the reader with catholic tastes the variety may just make it worthwhile. Prestwich 421
Hospital,
NICHOLASTARRIER Salford Health Authority