Abstract
This book is the compilation of a series of review papers published in 1991-1992 in a journal, Psychotherapy and Psychosomatics, which is not widely known in consultation-liaison psychiatry circles in Australia. Thus, it is a multi-author work with contributors from a broad spectrum of backgrounds, both regarding country of origin and clinical orientation. Professor Issy Pilowsky is the Australian representative. Unfortunately, some of the chapters have the cumbersome quality of translations and lack the flow and readability of those by the English-speaking writers. The latter are also the only ones to use tables and figures to enhance the text.
The title is rather a misnomer. The Oxford Dictionary defines a handbook as: ‘a small book giving useful information’. This is not a small book. As well, a handbook should comprehensively cover its subject and that is not done. Major areas of psychosomatic medicine are omitted (e.g. pain, obstetrics, organ transplantation other than renal and primary care). Use of the term ‘psychosomatic’ reflects the editors’ continental European origins.
However, my most severe criticism is that this book, although published in 1998, is badly out of date. Most recent references are of 1991/1992, apart from two chapters by one of the editors, with some as new as 1995! Thus, DSM-III-R diagnostic categories are generally used.
After an historic introduction by Engel developing the biopsychosocial model, there are three sections: fundamental issues; clinical issues; and treatment.
Chapters in the first section are variable in quality and there is considerable overlap as different writers cover similar territory. Blackwell's chapter on ‘Sick Role Susceptibility’ gives a good model for this concept as does Mayou's paper on somatisation, although recent important US studies are missing. Wise's final chapter, ‘Teaching Psychosomatic Medicine’ is well focused and practical.
The second section covers important fields of gastroenterology, cardiology, endocrinology, oncology, gynaecology and end-stage renal failure. It was also pleasing to read chapters on seldom explored areas of dermatology, otorhino-laryngology and psychological reactions to medical procedures, the last well written by a nurse—a sign of the times. Although again patchy and far from all-encompassing, this section is clinically relevant and occasionally quite entertaining (e.g. Cassileth's description of ‘furor medicus’ as doing unneeded investigations or surgery out of uncertainty or just to ‘do something’).
The last section on treatment is the most useful and comprehensive, if still dated: for example, there is no reference to Moorey and Greer's work with cognitive-behavioural therapy in oncology or Wessely's in chronic fatigue, and SSRIs do not rate a mention! The final chapter on inpatient psychotherapy gave me fascinating new insights into the German healthcare system: ‘there are more beds in special units for inpatient psychosomatics and psychotherapy in Germany than in the whole of the world put together’, nearly all are psychodynamically orientated, situated in health spa towns, offering admissions lasting several months and supported by health insurance. Or is that a thing of the past?
The book concludes with an appendix rightly pointing out the inadequacies of DSM-III and ICD-10 regarding ‘psychosomatic syndromes’ and proposes a new 12-category classification which still lacks any unifying conceptual basis. Readers are invited to participate in a field trial, which has not, to my knowledge, reached mainstream literature.
I believe that this book should only be considered for inclusion in an already well-stocked library. It would perhaps be of use to senior psychiatry trainees preparing exam case histories or dissertations. Otherwise, the Massachusetts General Hospital Handbook of General Hospital Psychiatry is a much better investment.