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The social and psychological origins of the climacteric syndrome
187
Marurtras. 7 (1985) 187-188 Elsevier
Book reviews The social and psychological origins of the climacteric syndrome. John G. Greene. Gower Publishing Company Ltd., Aldershot, U.K. and Brookfield, VT, 1984, 247 pp., $ 29.50. When I first became involved in research on the psychosocial aspects of the climacteric - in 1969 - I had only few studies to refer to. Only the study by Neugarten and coworkers (1963) and the study of Laszlo Jaszmann (1967) into the epidemiology of climacteric complaints, a study in which I had been indirectly involved, gave me some clues about the importance of social factors for symptom formation in the years around the menopause. Uninhibited therefore by too much knowledge, and largely ignorant about sociological techniques, I leapt into my first research project: a comparative study of attitudes towards the menopause in five European countries. When the results appeared I had progressed in my thinking, and guided by Jean Kellerhals, a sociologist who joined forces with me, we continued our expeditions into that unknown area: the climacteric as a psychosocial and cultural phenomenon. Now, fifteen years later, climacteric research has come of age. I am grateful to John Greene for having compiled this status quo report of work done in the past. The first chapters of this book, on terminology, on climacteric symptoms and oestrogen therapy are primarily intended, I think, to explain to the social scientist what the climacteric means in medical terms. Still, they are a useful introduction even for the medical researchers in this field. I was surprised to see how few good placebo-controlled, double-blind studies have been done into the effects of oestrogens on climacteric complaints. The author has reviewed these critically. With regard to effects of oestrogens on the psyche, the author concluded: “any psychotropic effect of oestrogen remains undemonstrated”. I tend to agree with that statement. Controlled studies have provided insufficient evidence for any such effect. Yet every clinician who has treated climacteric patients has been struck by the consistency in the effect of oestrogen therapy on psychic well-being of his patient. Obviously it is difficult to quantify such an effect, but I am sure that, in time, the evidence will be brought forward. Not only are well-controlled, double-blind clinical studies on the effect of therapy few in number, but also studies of the social, cultural and psychological factors influencing symptom formation at the climacteric are scarce. The advantage however, is that here the research done by different workers is often complementary, each study adding a piece - or several pieces - to the jigsaw puzzle. This book shows the jigsaw puzzle as it is today. The author has incorporated new ideas and findings concerning the effects of life events - such as death in the natal family - into the concept that has grown over the years. He comes to a synthesis and presents a model of vulnerability which is very attractive and allows us to identify which women are heading for a difficult climactaric and which are not. The 0378-5122/85/$03.30
0 1985 Elsevier Science Publishers
B.V.
188
author concludes by stating that the vulnerability model appears to emphasise the negative side of the climacteric, but that this is not necessarily the case. “The opposite of vulnerability factors is not merely their absence. Their opposite is the presence of positive factors (....) all of which lead to high self-esteem”. This book is highly recommended to all involved in the study of psychosocial aspects of the climacteric and ageing. It is also compulsory reading for those involved in running menopause clinics and those treating many climacteric patients. Only by understanding why a patient suffers, can adequate help be supplied. Pieter A. van Keep Oss, The Netherlands
OSTEOPOROSIS I and 2. Editors: C. Christiansen, C.D. Arnaud, B.E.C. Nordin, A.M. Parfitt, W.A. Peck and B.L. Riggs. Glostrup Hospital, Copenhagen, 1984, 842 PP. These two books on osteoporosis are the proceedings of the Copenhagen International Symposium on Osteoporosis, June 3-8,1984. This symposium was one of the best organized, best attended and most comprehensive symposia ever organized on the subject of osteoporosis. Four months after the symposium, all the extended abstracts, references and discussions have been published, and thus the most recent information is available to interested doctors who were unable to attend the meeting. The following topics were introduced and discussed by the most competent clinicians and researchers: which measurements are relevant to pathogenesis, diagnosis and evaluation of treatment in osteoporosis? How can the patients at risk for developing osteoporosis be identified and what is the significance of osteoporosis from a cost-benefit point of view? How can the cellular and regulatory mechanism that underlies osteoporosis in its many forms be elucidated? What is the optimal prophylactic and maintenance therapy for osteoporosis? What is the role of vitamin D (and its metabolites) in the pathogenesis and treatment of osteoporosis? Each contribution is concise and well-presented, with one or two tables or figures. Most contributors include a reference list which will enable those who want to know ‘more to look it up in a more detailed article. These two volumes should become, and will remain, part of the library of all those involved with osteoporosis. J. Dequeker Louvain, Belgium
Marurtras. 7 (1985) 187-188 Elsevier
Book reviews The social and psychological origins of the climacteric syndrome. John G. Greene. Gower Publishing Company Ltd., Aldershot, U.K. and Brookfield, VT, 1984, 247 pp., $ 29.50. When I first became involved in research on the psychosocial aspects of the climacteric - in 1969 - I had only few studies to refer to. Only the study by Neugarten and coworkers (1963) and the study of Laszlo Jaszmann (1967) into the epidemiology of climacteric complaints, a study in which I had been indirectly involved, gave me some clues about the importance of social factors for symptom formation in the years around the menopause. Uninhibited therefore by too much knowledge, and largely ignorant about sociological techniques, I leapt into my first research project: a comparative study of attitudes towards the menopause in five European countries. When the results appeared I had progressed in my thinking, and guided by Jean Kellerhals, a sociologist who joined forces with me, we continued our expeditions into that unknown area: the climacteric as a psychosocial and cultural phenomenon. Now, fifteen years later, climacteric research has come of age. I am grateful to John Greene for having compiled this status quo report of work done in the past. The first chapters of this book, on terminology, on climacteric symptoms and oestrogen therapy are primarily intended, I think, to explain to the social scientist what the climacteric means in medical terms. Still, they are a useful introduction even for the medical researchers in this field. I was surprised to see how few good placebo-controlled, double-blind studies have been done into the effects of oestrogens on climacteric complaints. The author has reviewed these critically. With regard to effects of oestrogens on the psyche, the author concluded: “any psychotropic effect of oestrogen remains undemonstrated”. I tend to agree with that statement. Controlled studies have provided insufficient evidence for any such effect. Yet every clinician who has treated climacteric patients has been struck by the consistency in the effect of oestrogen therapy on psychic well-being of his patient. Obviously it is difficult to quantify such an effect, but I am sure that, in time, the evidence will be brought forward. Not only are well-controlled, double-blind clinical studies on the effect of therapy few in number, but also studies of the social, cultural and psychological factors influencing symptom formation at the climacteric are scarce. The advantage however, is that here the research done by different workers is often complementary, each study adding a piece - or several pieces - to the jigsaw puzzle. This book shows the jigsaw puzzle as it is today. The author has incorporated new ideas and findings concerning the effects of life events - such as death in the natal family - into the concept that has grown over the years. He comes to a synthesis and presents a model of vulnerability which is very attractive and allows us to identify which women are heading for a difficult climactaric and which are not. The 0378-5122/85/$03.30
0 1985 Elsevier Science Publishers
B.V.
188
author concludes by stating that the vulnerability model appears to emphasise the negative side of the climacteric, but that this is not necessarily the case. “The opposite of vulnerability factors is not merely their absence. Their opposite is the presence of positive factors (....) all of which lead to high self-esteem”. This book is highly recommended to all involved in the study of psychosocial aspects of the climacteric and ageing. It is also compulsory reading for those involved in running menopause clinics and those treating many climacteric patients. Only by understanding why a patient suffers, can adequate help be supplied. Pieter A. van Keep Oss, The Netherlands
OSTEOPOROSIS I and 2. Editors: C. Christiansen, C.D. Arnaud, B.E.C. Nordin, A.M. Parfitt, W.A. Peck and B.L. Riggs. Glostrup Hospital, Copenhagen, 1984, 842 PP. These two books on osteoporosis are the proceedings of the Copenhagen International Symposium on Osteoporosis, June 3-8,1984. This symposium was one of the best organized, best attended and most comprehensive symposia ever organized on the subject of osteoporosis. Four months after the symposium, all the extended abstracts, references and discussions have been published, and thus the most recent information is available to interested doctors who were unable to attend the meeting. The following topics were introduced and discussed by the most competent clinicians and researchers: which measurements are relevant to pathogenesis, diagnosis and evaluation of treatment in osteoporosis? How can the patients at risk for developing osteoporosis be identified and what is the significance of osteoporosis from a cost-benefit point of view? How can the cellular and regulatory mechanism that underlies osteoporosis in its many forms be elucidated? What is the optimal prophylactic and maintenance therapy for osteoporosis? What is the role of vitamin D (and its metabolites) in the pathogenesis and treatment of osteoporosis? Each contribution is concise and well-presented, with one or two tables or figures. Most contributors include a reference list which will enable those who want to know ‘more to look it up in a more detailed article. These two volumes should become, and will remain, part of the library of all those involved with osteoporosis. J. Dequeker Louvain, Belgium