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BOOK REVIEWS |
A Self-Diagnostic Approach to Understanding Organizational and Personal Stressors
Edited by Bernadette H. Schell
reviewed by Edgardo L. Pérez
Psychosomatic Medicine
Edited by Thure von Uexkull
reviewed by Erwin K. Koranyi
Chief Executive Officer, Chief of Staff and, Co-Director of the Center for Organizational Health, Homewood Health Center, 150 Delhi Street, Guelph, Ontario N1E 6K9, Canada and, Professor or Psychiatry and Health Administration, University of Toronto
Bernadette H. Schell
Quorum, Westport, CT, 1997, 305 pages
Strengths: practical approach to stress moderation
Weaknesses: the typesetting
Target reader: occupational psychiatrists, physician managers, human resources managers, organizational behavior experts
This book by Dr. Schell provides a practical approach to help individuals develop awareness of their stress-coping potential. It is a survival guide for organizational members. The emphasis of the book is that stress moderation is effective stress coping. The author utilizes psychological inventories to assist the reader’s own discovery of his/her stress-coping potential. It is an easy book to read and is filled with stress-related case studies from government documents, newspapers, and the author’s organizational clinical files. At the end of each chapter, practical stress-coping summary points are provided.
The content reflects the book thesis well. Part I is an introductory section that presents the international organizational stress-reduction challenge and the terminology related to the stress-coping process. The remaining four parts evolve from the four-step process management model entitled "C-O-P-E." The author’s model was developed for use by individuals in so-called high-stress industries. "C-O-P-E" stands for four types of self and organizational analysis that Dr. Schell proposes as essential elements for developing organizational members’ stress-coping potential.
The C-O-P-E approach is easy to use as a self-diagnosis and self-prescription tool. Individuals utilizing this approach should be able to diagnose their capacity to manage personal and organizational stresses and to implement changes in their home and work life.
The basic premise of the C-O-P-E strategy is that organizational members are accountable for their stress-coping activity. In essence, this model creates stress awareness and provides behavioral modification. Organizational members utilizing the C-O-P-E strategy feel more in control and managers of these companies report reduced absenteeism and accident rates with improved morale and productivity.
From the perspective of a psychiatrist and an executive, I find this book valuable in providing a practical approach to addressing stress issues in organizations. The author’s C-O-P-E model could facilitate the development of successful programs to help members in organizations cope more effectively with stresses. I recommend this book to occupational psychiatrists, physician leaders and managers, industrial psychologists, human resource managers, and others interested in organizational behavior. In summary, this book is a good addition to the field and is "a good value for the money."
Royal Ottawa Hospital, Department of Psychiatry, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
J. Robert Swenson Editor
Thure von Uexkull (Editorial board: Rolf H. Adler, Jorg Michael Herrmann, Karl Kohle, Othmar W. Schonecke, Thure von Uexkull, Wolfgang Weisiack)
Urban & Schwarzenberg, Munich, 1997, 1050 pages.
Strengths: Heinmann’s chapter on the neurobiology of emotions and a section on neurology by Kutemeyer and Schultz-Venrath
Weaknesses: overemphasis on the importance of psychoanalytic theory to psychosomatic medicine; lack of author and subject index; references of most chapters were not updated
Target reader: psychiatrists, psychologists, mental health professionals
With five previous German-language editions since 1979, this multiauthor work is advertised as a textbook of psychosomatic medicine. Part 1 consists of four chapters dealing with the theoretical underpinning of psychosomatics. The first of the 65, and probably a tone-setting chapter, is Georg (sic) L. Engel’s 8-page dissertation. The author laments the influence of an outdated 17th Century philosophy, which he states still prevails over the current art of psychosomatics. Engel’s work brought to mind a book on psychosomatic medicine from the 1950s, the outstanding author of which starts his chapter by quoting Lewis Carroll’s Alice in Wonderland: "The time has come" the walrus said "To talk of many things, Of shoes—and ships—and sealing-wax" And cabbages and kings... . Engel also talks of many things: his childhood; his uncle Emanuel Liebman; the brownstone house where he grew up; his brothers, Lewis and Frank. He provides us with Ch. Odegard and D.W. Zimmermann’s definitions of science, followed by an epistemological outline on the meaning of paradigm, comparing outdated and contemporary observation modes, emphasizing the need for dialogue between patient and physician. Of course, no one would question this, but then Engel climbs out on a limb by asserting that a skilled interview happens to be a "scientific investigation method." A rather ill-fitting case report follows ("Liqueur Lung") with the intention to demonstrate the detrimental outcome of an inappropriately applied technology over intelligent history taking. Another interview is quoted, this one having been performed by the author himself, which skillfully demonstrates the psychosocial background of a patient having had a myocardial infarction. Unfortunately, the incident leaves the reader with the false impression that this particular emotional background-machinery happens to be the proximate cause, rather than just one of the many contributing factors, of this incident. Correctly reemphasizing the need for a positive doctor-patient relationship, the author concludes that "being human" renders him to be "scientific," an eyebrow-lifting assertion. Although Engel voices displeasure of the "17th Century philosophy" that allegedly underlies contemporary psychiatry, no where in his chapter did I encounter a word on neurotransmitters, receptors, or genetic mapping. Nor was the logical empiricism, or Karl Popper, Ludwig Wittgenstein’s science philosophy, or Stephen Toulmin’s medical reasoning style or the cyberworld technology considered, all of which are vital influences in modern psychiatry, far removed from the 17th Century Descartes, Spinosa, Leibniz, Locke, or Berkeley.
The second chapter is by the main author, Thure von Uexkull, and Wolfgang Wesiack on the Bio-Psycho-Social model. In fact, there is little, if any, material that can be found on the "bio" facet and a bare minimum on the "social" strata, although the scale is heavily tipped in favor of the "psycho" feature, and that has a particular slant. The apology of the authors for writing a theoretical introduction to a medical textbook does not last long before they leave a 32-page prolegomenon, quoting morsels of philosophy, a soupçon of quantum mechanics, an iota of servomechanistic cybernetics, and Weiner’s communication system. Bertalanffy concepts, Heisenberg, Newton, and Medawar (not a great friend of psychoanalysis) are quoted. None of these scientists are discussed in detail; they are mentioned only in passing. So why mention them? It seems it is the authors’ wish to expropriate the entire terrain of psychosomatics as the exclusive domain of the psychoanalytic theory. Uexkull and Wesiack’s contribution seems to imply that whoever accepts the authenticity of psychosomatics, must ipso facto also accept the validity of the psychoanalytic theory and metapsychology. This chapter tries to embrace too much, and it is populated with complicated diagrams that do not clarify matters for the reader. The text, beset with linguistic thorns, is often abstruse and the terminology is further complicated by unnecessary German loan-words, like "Umwelt" (easily translates to environment), "Umwelt integument" (term coined by Uexkull’s father in 1920), "meaning utilization," "situational circle," "historicyl" (not in the dictionary), "functional circle," etc. One wonders whether the text could be simplified? Some of the explanations are based on single case reports.
Jasper Hoffmayer’s writing on molecular biology and heredity is a fine chapter except for the confusing terminology, such as "vertical and horizontal systems." H. Pauli’s dissertation on psychosomatic and sociosomatic origin of health and disease enumerates varieties of stressors that "disrupt the social net," but falls short of mentioning a few paltry items,—World War I, World War II, the Cold War—events that should have some meaning in Europe, in particular.
I was looking forward to Uwe Heinmann’s chapter on the "Neurobiology of Emotions" and his portrayal of the limbic system. Regretfully, the chapter had to be condensed to a mere 12 pages without any major illustrations. I can only sympathize with the author’s dilemma, what way to stow this Noah’s Ark? Personally, I believe that in place of the four—undoubtedly expensive—color pages depicting drawings by patients having ulcerative colitis or Crohn’s disease elsewhere in the book and by another author, some updated illustrations of the limbic structures and neurotransmitter pathways would have been more useful. However, Heinmann did an outstanding job. But there are a few points of misgivings as well, and I feel impelled to write a few marginalia. Unfortunately, I could not find "the other half" of the biological clock (the pineal and interpedunculate connections) in the description, nor was there any mention of the vital enzyme system (N-acetyltransferase, converting serotonin to melatonin). The fascinating work on cell transplantation experiments from the suprachiasmatic nucleus (Drucker-Colin, Ralph and Lehman’s work) and the retained circadian cycles in suprachiasmatic cell cultures (Bos and Mirmiran) had to be left out of the author’s review. Maybe too much was written about the hypothalamus and not quite enough on the amygdala, and nil about the new concept of "extended amygdala" (G. Alheid, L. Heimer) or on the nucleus accumbens (Jose de Olmos). It would have been useful to elaborate on the behaviorally significant apathetico-akinetic-abulic (Luria) and orbitofrontal (Kleist) prefrontal syndromes, particularly because of their modern psychiatric implications (Weinberger). In addition, the author goes into details about different subsets of memories, but the calcium-calmodulin, and N-methylaspertate-dependent long-term potentiation (LTP) was not mentioned. The author’s references need updating. The review, as a refresher, may be useful for those who already are quite familiar with neuroanatomy and neurophysiology.
It is not possible to discuss each chapter in detail in this review, but I do have a few more remarks. Othmar Schonecke and Michael Herrmann’s chapter on psychophysiology follows the reliable basic design of the topic, well known from major publications in the 1970s. Accordingly, most of their references: Cannon, Selye, Mason, Frankenheuser, Lazarus, Holmes, and Rahe are from late 1960s or early 1970s; only rarely can one find a reference from the 1980s.
An other section on neurology, by Mechthilde Kutemeyer and Ulrich Schultz-Venrath, is thorough, competent, and fairly up-to-date, and it is certainly worthwhile reading. The same cannot be said for the discourse dealing with headache by Clauss Bishoff, Helmut Zenz, and Harold Trave. Although writing on migraine, sumatriptan is not even mentioned, yet the second generation of these drugs is old news. I found writing on renal transplants by Ekkehard Gaus, Karl Kohle, Uwe Koch et al., to be a captivating chapter as well and dealt with the subject thoroughly.
All and all, this is not a book that is on my recommended list. It was difficult to review: despite five previous editions, the book has neither an author index nor a subject index. Inconveniently, all references appear lumped together alphabetically at the end of the book, except for nine chapters, which exclude the references from the common reference list and list them separately. It seems that since the last German edition the references have not been updated.
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