Book Review

AIDS, HIV, and Mental Health

N Engl J Med 1994; 331:1100-1101October 20, 1994

Article

AIDS, HIV, and Mental Health
(Psychiatry and Medicine.) By Michael B. King. 197 pp. New York, Cambridge University Press, 1994. $39.95. ISBN: 0-521-45294-5

Michael King, an academic clinician at the Royal Free Hospital in London, has written this book for the Psychiatry and Medicine series, which focuses on the interface between medicine and psychiatry. The series integrates aspects of the two disciplines, including important observations by consultation-liaison psychiatrists; discussion of clinical questions posed by internists, general practitioners, and psychiatrists; and a concise, relevant review of the literature. It best serves areas where psychiatric morbidity and organic pathology overlap; HIV and AIDS are important examples.

In this book, the author assumes the role of a personal guide leading us through the confusing and stigmatized world of HIV, AIDS, and mental health. I was put off initially by his personal approach, probably fearing that I would not learn enough. As I read on, however, not only were my fears alleviated, but I also became increasingly responsive. Dr. King successfully guides the reader through the clinical and political maze that has been, for better or worse, such a vital and volatile aspect of HIV and AIDS during the past decade. He tells an interesting story in one of the most readable styles I have encountered in a medical book, demonstrating both excellent writing skills and an outstanding ability to teach.

Like other valuable guides, Dr. King not only presents data from studies and clinical observation but also gives a careful critique, presenting a number of points of view. The result goes far beyond that suggested in the introduction, where he states his hope of providing an objective overview and clarifying ill-founded attitudes, premises, and opinions.

Clarifying ill-founded attitudes and opinions on this topic is no small task. The fields of psychiatry and HIV and AIDS have been plagued by misconceptions; the area of their interface suffers no less. Dr. King correctly assumes that the reader will have a number of mistaken ideas, and his informal but challenging style encourages readers to consider changing -- and in some cases, correcting -- them.

The 10 chapters address the relevant topics: fear of infection, psychological disorder, neuropsychiatric aspects, sexual behavior, drug use, and stress and immunity. Of particular relevance are the chapters on health care givers and family members. Dr. King's personal guidance is easily seen in the sections on psychological disorders associated with HIV and AIDS. For example, the overdiagnosis of psychiatric illnesses in HIV-infected people has been a serious problem, increasing fears and confusion. The author outlines and critiques the early reports of high rates of psychiatric illness among infected people that failed to differentiate between AIDS and HIV, using uncontrolled groups with high rates of drug abuse or a history of psychiatric disturbance. This careful review makes the reader aware that the sensationalism of those early studies has affected both the subsequent treatment of patients and the attitudes of care givers toward patients, leaving an impression with patients, health care professionals, and the public that has been difficult to dispel. One also realizes more clearly the real clinical risks of psychiatric illness and AIDS and HIV, such as the risk of suicide and when to be concerned about it, the higher rates of psychiatric disorder in the intravenous-drug-using population with HIV, and the progressive nature of neuropsychiatric illness. Relinquishing misconceptions results in clearer thinking, better science, and improved treatment -- goals that legitimately demand our attention in this field.

King does not overwhelm the reader. His clear style succeeds in instructing by clarifying the complexities of HIV and AIDS. This book will provide a valuable framework for psychiatrists, internists, and general practitioners; as the epidemic touches all health care workers, however, any of us could also read and appreciate it.

For me, one limitation of the book was its minimal discussion of HIV and AIDS in adolescents, although the book does discuss other subgroups. Nonetheless, the book is rich in clinical insight without being a clinical textbook on psychiatric management. The author's excellent overview leaves the reader not only satisfied, but also thoughtful and inspired.

Lynn E. Ponton, M.D.
University of California, San Francisco, San Francisco, CA 94143