Book Review

Psychosomatic Medicine

N Engl J Med 2007; 356:1689April 19, 2007

Article

Psychosomatic Medicine
Edited by Michael Blumenfield and James J. Strain. 949 pp. Philadelphia, Lippincott Williams & Wilkins, 2006. $199. ISBN: 978-0-7817-6046-1

Lord Chesterfield (1694–1773) wrote, “I find, by experience, that the mind and the body are more than married, for they are most intimately united; and when one suffers, the other sympathizes.” The dilemma of the body–mind connection has perplexed scientists for centuries. Evidence of interest can be found in the earliest writings on the history of medicine. Psychosomatic medicine emerged as the field that focuses on coexisting medical and psychiatric conditions and serves as the interface between the two fields. In June 2005, the first subspecialty examination in psychosomatic medicine was administered by the American Board of Psychiatry and Neurology. The publication of Psychosomatic Medicine, edited by Michael Blumenfield and James J. Strain — two distinguished psychiatrists and icons in the field of psychosomatic medicine — closely followed this landmark event.

The book focuses on the challenges of diagnosis and treatment in psychosomatic medicine. Most methods currently used in the field were originally designed for use in pure psychiatric populations, not for patients with coexisting medical conditions. Ignoring the effects of coexisting conditions can result in inaccurate diagnoses and inappropriate treatment. There are numerous examples of disorders that were classified as “psychiatric” by default because their underlying mechanisms were not yet understood; later, scientific discoveries identified physiological mechanisms, and more specific microdiagnoses were assigned. The not-too-distant case of Helicobacter pylori is an obvious example. Other intriguing examples that are discussed in this book and that may be reassessed in the future are fibromyalgia, chronic fatigue syndrome, and hyperacusis.

The interaction between psychosocial disorders and cardiovascular disease is another interesting topic. The chapter in Psychosomatic Medicine that covers cardiovascular disease begins with the fascinating story of President Dwight D. Eisenhower, who had a myocardial infarction in 1955. His only obvious risk factors then were his type A personality and the overwhelming stress he was under as president. The chapter goes on to discuss the recognition, implications, and treatment of psychosocial risk factors in cardiovascular disease. In addition, it discusses the effects of depression on platelet, endothelial, autonomic, and hormonal functions, as well as other mechanisms that may further complicate cardiovascular disease.

This 51-chapter book is divided into 5 sections: “Evolution of Psychosomatic Medicine,” “Physical Conditions,” “Psychiatric Conditions,” “Special Topics,” and “Future Perspectives.” The first section starts with a chapter on the history of psychosomatic medicine, tracing the specialty from its roots in the early writings of Johann Christian Heinroth in the 19th century to its establishment as a psychiatric subspecialty in 2005. The book contains a wealth of updated information and covers a wide spectrum of frequently encountered clinical problems. It also provides detailed discussions of ethics, forensic applications, pregnancy, sexuality, alcoholism, death and dying, and pain and palliative care. Overall, the chapters are well organized and include sections on diagnosis and treatment. At the end of each chapter, the authors discuss case-based examples of common problems. The book also comes with a DVD that contains the full text and searchable references and that provides users with PowerPoint lectures on selected topics and significant questions and answers that can be used for teaching purposes.

David S. Sheps, M.D., M.S.P.H.
Mustafa Hassan, M.D.
Kaki M. York, Ph.D.
University of Florida, Gainesville, FL 32608
mustafa.hassan@medicine.ufl.edu