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BOOK REVIEWS |
Psychoneuroimmunology
Robert Ader, David L. Felten, and Nicholas Cohen
reviewed by Charles L. Raison and Andrew H. Miller
Care of the Psyche: A History of Psychological Healing
Stanley W. Jackson
reviewed by David W. Hodo
Social Support Measurement and Intervention: A Guide for Health and Social Scientists
Edited by Sheldon Cohen, Lynn G. Underwood, and Benjamin Gottlieb
reviewed by Perry M. Nicassio
ROME II: The Functional Gastrointestinal Disorders
Edited by Douglas A. Drossman, Enrico Corazziari, Nicholas J. Talley, W. Grant Thompson, and William E. Whitehead
reviewed by Bruce D. Naliboff
Cognitive-Behavioral Treatment of Irritable Bowel Syndrome: The Brain-Gut Connection
Brenda B. Toner, Zindel V. Segal, Shelagh D. Emmott, and David Myran
reviewed by Bruce D. Naliboff
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Drive, Suite 4000, Atlanta, GA 30322
Robert Ader, David L. Felten, and Nicholas Cohen
Academic Press, San Diego, 2001, Vol. I 727 pages, Vol. II 856 pages, $299.95
Strengths:
comprehensive coverage of nearly all topics that relate in any way to neuroendocrine, behavioral, and immunological interactions, including important areas not covered in most review articles
Weaknesses:
the lack of any chapter reviewing the immune system requires that readers approach the text with a relatively sophisticated understanding of the immune system
Target reader:
basic and behavioral scientists working in the area of brain-immune system interactions or in related areas such as metabolism or sleep
Eponymous with the field it so impressively surveys, Psychoneuroimmunology, when first published in 1981, gave a name and an identity to a wide range of previously disparate enterprises aimed at understanding how bidirectional interactions between brain and immune system affect behavior and health. It is a graphic testimony to the explosive growth of the field that Psychoneuroimmunology has grown through three editions from 17 chapters to 67 chapters spread across two thick volumes. This text certainly represents the largest and most comprehensive review of psychoneuroimmunology to be found in any one publication, and as such it promises to serve as an indispensable reference guide for researchers looking for both isolated pieces of hard-to-find information (such as the effect of citrus aroma on immune functioning) and for hypothesis-driven model systems to account for stress–immune system interactions.
The text is divided into six parts, with parts I through III in volume 1 and parts IV through VI in volume 2. Part I examines nervous system effects on immunity, part II examines neuroendocrine effects on immunity, part III explores immune system effects on the nervous system, part IV examines behavioral effects on immunity, part V discusses various aspects of stress and immunity, and part VI covers psychoneuroimmunology and pathophysiology. The first four chapters of the book are especially impressive in providing a detailed and comprehensive review of the current state of the science, beginning with a refreshingly broad review of the phylogenetic history of neural, neuroendocrine, and immune interactions by Cohen and Kinney. This chapter goes far toward placing the field in an evolutionarily informed context, something that is all too frequently missing in reviews that focus exclusively on short-term functional and anatomic interactions. Cohen and Kinney’s chapter is complemented by articles elsewhere in the text that challenge an unspoken, but widespread, tendency to view immune/stress reactions to stress or illness as physiological mechanisms conducive to pathology. Especially effective in offering an alternate adaptive perspective on immune/stress system activity are chapters by Maier, Watkins, and Nance and by Barnard and Behnke. Following Cohen and Kinney’s chapter are three extensive chapters that serve as sophisticated tours de force in the areas of innervation of lymphoid organs, biological signaling mechanisms, and neurotransmitter receptors on lymphoid cells. Although each of these chapters is an excellent review of relevant basic science, it is a weakness in so inclusive a book that no discussion is given to the role that cytokines may play in inducing resistance to glucocorticoid inhibition of both stress and immune system activity.
In general the organizational pattern of the book is such that the most complicated basic science data are presented first, followed by chapters dealing at the level of physiology rather than molecular biology. Many of these chapters take a systems approach to describing how neuroendocrine and immune systems communicate. Of these chapters, the one by Hori and colleagues entitled "Central Cytokines: Effects on Peripheral Immunity, Inflammation, and Nociception" is especially notable for the clarity of its presentation of the oft-repeated axiom that communication between neuroendocrine and immune systems is bidirectional. They offer a remarkably succinct, and generally balanced, overview of how cytokines and the hypothalamic-pituitary-adrenal axis mutually interact. Other chapters discuss specialized physiologic functions affected by the immune system, such as sleep and fever. Rounding out the book are a number of chapters on what might be described as neuroimmunologic novelty acts: marijuana and immune modulation, hypnosis and immunity, and alternative medicine and the immune system, to mention a few. This breadth of discussion is admirable, yet most of these chapters are inconsequential, a reflection of the paucity of data available in these areas.
Psychoneuroimmunology will probably be most utilized as a resource for specific interest areas, rather than as a textbook to be read cover to cover, because substantial redundancy exists between chapters. The book would be a quarter shorter if the numerous chapters on all sorts of subjects that nonetheless review cytokine effects on corticotropin-releasing hormone were all condensed into one discussion of the topic. However, this redundancy may have a redeeming side. It allows the dedicated reader a chance to sit in on the multitudinous points of conflict that exist in psychoneuroimmunology on topics ranging from esoterica to very basic questions, such as "How do cytokines enter the brain?" and "Does stress activate the immune system in ways that lead to significant health sequelae?" Perusing the book entire is a little like reading the Japanese tale of Roshamon in which the same incident is told from the point of view of each of the characters with strikingly different results with each retelling. Perhaps the lesson is the same here: to gain the most knowledgeable understanding of what is going on in psychoneuroimmunology, we may benefit from being exposed to as many interpretations of the same data sets as possible.
University of Alabama, Huntsville, PO Box 1334, Selma, AL 36702-1334
Stanley W. Jackson
Yale University Press, New Haven and London, 2000, 392 pages
Strengths:
history of psychological healing from antiquity to present including religion, philosophy, and psychology, excellent prose, occasionally exceptional
Weaknesses:
greater eloquence and detail of antiquity than modern psychological movements
Target reader:
psychiatrists, psychologists, social workers, and general audience interested in intellectual history
Stanley Jackson has written a thoughtful history of psychological medicine. It is a worthy addition to an area of knowledge that remains elusive and controversial. He addresses this essential but contradictory area of medicine methodically and adroitly, balancing both clinical and historical aspects. His insight into the contributions of antiquity and the progression of psychological healing through philosophy and religion is particularly keen. He honors the originality of our forefathers and mothers in the pursuit of emotional balm, and attempts to interweave that experience into modernity.
The author excels as an historian. The chapter on "Animal Magnetism, Mesmerism, and Hypnosis" deals delicately but precisely with this much misunderstood evolution in medical practice. He deals factually and fairly with Franz Anton Mesmer, that most charismatic but maligned major figure, in the search for the meaning of the mind and how to sculpt it. The critique of the ambivalently held Mesmer is in balance with an equally fair picture of the hysteria often associated with his detractors. The public remains fascinated with hypnosis, and the debate continues almost 230 years later. Psychological healing has always been a subject of debate, no less today than in the past.
Jackson does a marvelous service in chronicling the duality of religion and science in psychological healing. This hot potato is usually ducked, particularly by those writing from a medical point of view. We are still jousting over who gets the credit and who is in charge. The debate over which discipline, psychiatry (psychology), religion (which religion), or philosophy that leads to true mental health remains contentious. The practitioners of these disciplines continue to hesitate to recognize the accomplishments of the others.
Dr. Jackson is likewise conversant with the science of psychological healing. His writings on "persuasion" are excellent. He discusses various approaches to psychotherapy and their merits. He acknowledges the place of their respective innovators and how each learned from others. His conclusion is compelling, and he brings together the various branches into a single tree. Still unanswered is the question of what constitutes normality. Is it pleasure, balance, neurochemical concordance, altruism, or Darwinian superiority? In a balanced fashion, the author explores these possibilities and details his own reasonable and flexible conclusions.
This book compares favorably with the writings of Ludwig Edelstein, Owsei Temkin, and Robert Jay Lifton. These writers have provided a structure of our current state of information with greater depth, equilibrium, and balance. They put more flesh on the bones.
Professor of Psychology, and Director, Clinical PhD and Health Psychology Programs, and Associate Adjunct Professor of Psychiatry,, California School of Professional Psychology-San Diego, 10455 Pomerado Road, San Diego, CA 92131, Email: pnicassio@mail.cspp.edu
Edited by Sheldon Cohen, Lynn G. Underwood, and Benjamin Gottlieb
Oxford University Press, New York, 2000, 368 pages, $45.00/$36.00
Strengths:
excellent theoretical treatment of the literature; provides helpful guidelines for the social support researcher; comprehensive
Weaknesses:
none significant
Target reader:
social support researchers and interventionists
The premise that social relationships and supports may play a significant role in physical health and psychological well-being has been the subject of considerable theoretical and research interest for several decades. In addition to demonstrating the import of social factors to adjustment, this area of scholarly inquiry has highlighted a major tenet of the biopsychosocial model: that individual health status and psychological functioning can only be understood by an appreciation of the social contexts in which they occur. This burgeoning area raises several important questions for the researcher and clinical scientist, many involving important distinctions between social support measures and constructs, and the implications of theory to the design and implementation of social support interventions.
This highly comprehensive and analytical treatise provides an excellent conceptual foundation and reference for the conduct of social support research. This coedited volume sets forth the following objectives: 1) to provide a broad conceptual framework for addressing the role of social relationships in mental and physical health, 2) to aid researchers in understanding the conceptual criteria underlying decisions for selecting measures and designing interventions, 3) to present diverse options for social support measurement, and 4) to present diverse options for social support interventions. Geared to the researcher but also helpful to the clinician, the volume does an excellent job of fulfilling its objectives and synthesizing related literature from the fields of sociology, social psychology, epidemiology, and behavioral medicine. The interdisciplinary nature of the field of social support constitutes a major focal point of the book and is illustrative of the paradigm necessary for conducting effective research.
Interestingly, the organization of the book mirrors the conceptual framework and developmental process for planning and implementing research. Part I constitutes a theoretical and historical overview of social relationships and health, drawing particular attention to the main-effects and stress-buffering models of support and highlighting some major themes and problems in social support measurement and intervention. The introductory chapter sets the stage for part II, which comprises four chapters on social support measurement. These chapters cover a range of important themes and research challenges, starting with an excellent overview of models for examining social support–health relationships and their implications for measurement selection. The next three chapters address the measurement of social integration and social networks, measurement of perceived and received support, and measurement of relationship properties and interactions. These chapters stress the importance of examining and assessing the various contextual factors that may give rise to social support. The authors present useful and extensive summaries of measures dealing with an array of social relationship and support constructs and alert the reader to their strengths and limitations. Part III addresses the processes of developing and implementing social support interventions. The first chapter of this section identifies the salient parameters for planning social support interventions, discussing the importance of such criteria as the nature of the support provider, characteristics of the recipient, mediating mechanisms, and intervention goals. The next chapter is an excellent review of the functions, pitfalls, and effectiveness of support groups. The final two chapters of this section address one-to-one support interventions and how to optimize support in the natural environment. The material in these chapters focuses on such areas as implementation of home visitation and mentoring programs and strategies to mobilize support for spouses and family members of persons with various health problems. Part IV of the book is a clearly and insightfully written integration of the major conceptual and methodological issues in the field of social support research, offering some useful guideposts for future researchers.
Despite the vast breadth of content reviewed by a collection of excellent social scientists, some common themes emerge throughout the book and, in essence, define the character and current status of the field. A major theme is that social scientists need to devote greater attention to the contextual factors giving rise to support. These include not only features of social relationships, such as trust, intimacy, and commitment, but also qualities of the broader social environment that differ in what the authors refer to as "social capital," or the resources that are generally available in the social environment. A major implication of the contextual view of support is that environments pose varying degrees of risk to health and well-being on the basis of their differential capacity to engender support. Intervention researchers must, therefore, assess the social climate and resources of targeted populations in designing social support interventions.
In addition to an emphasis on context, another theme that is introduced in Chapter 2 is the importance of considering the role of cognition in support. The construct of social support, according to the social constructionist perspective, reflects the perceptions of individuals about their social world. Differences in such perceptions account for a significant part of the variance in perceived support, independently of the actual support provided by network members. In turn, perceived support may enhance positive beliefs about the self, which in turn may have beneficial health consequences. The finding that highly socially integrated individuals tend to have better health outcomes may also depend, to some extent, on the benefits to identity that result from functioning in different roles or participating in a range of activities. This information-processing perspective of support is often ignored in intervention research when too often investigators establish intervention processes and goals without recognizing the role of the appraisals and schemas of recipients.
A third critical theme is an emphasis on understanding the mechanisms through which support operates to affect health outcomes. The first two chapters of the book offer several useful conceptual frameworks for examining how the main effects of social support may be explained by changes in cognition, mood, coping, health behaviors, and other potential mediators. The book draws careful distinctions between main-effect and stress-buffering models and their implications for measurement and intervention design. It also advocates for more intensive study of the mediational influences of social support interventions and for the adoption of appropriate measures to examine mediational effects. The study of mediation has largely been missing from intervention research, leaving unanswered important questions regarding the mechanisms of action of effective support interventions. Finally, the book emphasizes the ongoing need for social support interventions to be rationally constructed, with appropriate consideration given to theoretical models, assessment of the target population’s needs, intervention goals, and an evaluation of the type of support rendered and received.
In summary, this volume fills a unique void in the social support literature. It orients the reader to the major questions and challenges in the field and provides an outstanding historical and theoretical foundation for comprehending and conducting research. Tables present useful summary information that solidifies major points and suggestions from the narrative. Although the writing style is highly analytical, erudite, and in some instances a challenge to comprehend, the text is well organized and logically presented. The book is a "must" acquisition for a behavioral science audience, particularly social support researchers and interventionists.
Professor of Psychology, and Director, Clinical PhD and Health Psychology Programs, and Associate Adjunct Professor of Psychiatry,, California School of Professional Psychology-San Diego, 10455 Pomerado Road, San Diego, CA 92131, Email: pnicassio@mail.cspp.edu
Edited by Douglas A. Drossman, Enrico Corazziari, Nicholas J. Talley, W. Grant Thompson, and William E. Whitehead
Degnon Associates, McLean, VA, 2000, 764 pages, Hard cover $99.95
Strengths:
contains the revised consensus diagnostic criteria for functional gastrointestinal disorders plus up-to-date reviews of the field; well organized and includes sample questionnaires
Weaknesses:
only those inherent in a still-evolving symptom-based diagnostic system
Target reader:
a must-have volume for all clinicians and researchers with an interest in functional gastrointestinal disorders
UCLA/CURE Neuroenteric Disease Program, Psychophysiology Research, W-151 West LA VAMC, 11301 Wilshire Blvd., Los Angeles, CA 90073, Email: naliboff@ucla.edu
Brenda B. Toner, Zindel V Segal, Shelagh D. Emmott, and David Myran
Guilford Press, New York, 2000, 200 pages, $32.00
Strengths:
an excellent, practical, clinical text describing a cognitive therapy approach for irritable bowel syndrome (IBS); includes a wealth of specific examples and techniques
Weaknesses:
more of a manual for a specific therapy approach than a comprehensive text on the varieties of cognitive behavioral strategies used with this population
Target reader:
primarily psychologists, psychiatrists, or other therapists; may also be of significant interest to nontherapist clinicians interested in psychological issues in IBS
A variety of chronic gastrointestinal complaints have long been included among the core psychosomatic symptoms. However, it is only relatively recently that one could identify a maturing and integrated field of study specifically aimed at what are now labeled functional gastrointestinal disorders (FGDs). Two new volumes, ROME II: The Functional Gastrointestinal Disorders (second edition) and Cognitive Behavioral Treatment of Irritable Bowel Syndrome: The Brain-Gut Connection, each in its own way reflects the increasing maturity of this field and should provide impetus and foundation for further growth. For those of you unfamiliar with this field (and maybe about to skip over this review), I should also add that FGDs represent a tremendous opportunity for clinicians and scientists involved in brain-body interactions. I hope these volumes and others like them will help to spark a broader visibility for FGDs across psychiatry and psychology.
As defined in ROME II, FGDs include esophageal disorders (eg, heartburn), gastroduodenal disorders (eg, dyspepsia), bowel disorders (eg, IBS), functional abdominal pain, functional disorders of the biliary tract and pancreas, anorectal disorders (eg, fecal incontinence), and pediatric disorders (eg, infant rumination syndrome). Many of these disorders are extremely common; IBS, for example, affects 10% to 20% of the population. Although generally not life threatening, these disorders lead to significant suffering, disability, and healthcare costs. ROME II is the latest outgrowth of a long-term collaborative effort of more than 50 clinicians and scientists who participated in topic-based workgroups to provide diagnostic criteria for FGD and summarize the theoretical and scientific status of the field. A similar number served as reviewers of the manuscripts. The ROME process began in 1988 with ROME I criteria published in 1994. This is an ambitious but essential task and naturally one burdened by the empirical limitations, differences of opinion, and fluidity of an evolving field.
The core of the volume is the chapters giving the updated consensus diagnostic criteria for each of 25 disorders in five anatomical regions of the GI tract. As with the DSM process, the criteria are based on a combination of empirical data, clinical observations, practical considerations, and ultimately expert consensus. Although it is easy to focus criticism on the arbitrary nature of the some of the decisions, the lack of clearly validated causal pathophysiological models for these disorders, and the very thin crust of data on which some of the criteria rest, it would be unfair for two reasons. First, the volume generally represents a fair and comprehensive integration of the data at hand, and its faults are primarily those inherent in the extant literature. Second, and perhaps more important, the ROME II volume and process explicitly recognizes the multifaceted role of consensus and diagnosis in the field’s rapid evolution and the importance of this process as a system to both use and react against.
The organization of the book is excellent. One must applaud the ROME II leadership and especially the senior editor, Dr. Drossman (a former president of the Psychosomatic Society), for putting together an extremely readable text. The diagnostic criteria are easy to find, and the consistent format throughout as well as the summary of criteria in the appendix make the volume an excellent diagnostic reference. Two other appendices are also worthy of note. The volume contains example questionnaires using the ROME II diagnostic strategy, targeted for both clinical and epidemiological research. In addition to the diagnostic criteria chapters, the volume contains issue-based reviews on such topics as physiology of FGD, psychosocial aspects of FGD, and design of treatment trials. These are also committee products, but they are well edited, comprehensive, and concise. Reading through them, one can easily see both the tremendous progress made in the past decade and the "just scratched the surface" nature of FGD research. The emphasis in this volume on integrating peripheral GI and central nervous system (CNS) mechanisms in understanding these disorders will hopefully solidify a paradigm shift that has been brewing for some time and lead to more study (and resources) devoted to CNS-based mechanisms in the coming years. Like a well-done serialized adventure story, this volume ends with promise of ROME III. I look forward to it.
Cognitive-Behavioral Treatment of Irritable Bowel Syndrome is a very different but also important book for clinicians with an interest in FGD. It is primarily a clinical text that begins with a review of cognitive behavioral approaches to IBS. In both this introductory section and the clinical sections to follow, there is an emphasis on women’s issues as they pertain to the psychology of IBS and feminist perspectives on psychotherapy. IBS is found more frequently in women, especially among those seeking specialty care; however, significant numbers of men also suffer from this disorder, and the symptoms are often similar between the sexes. The second two-thirds of the book covers general clinical topics, such as assessment and appropriateness of patients for therapy, and provides an in-depth description of a specific cognitive-based group intervention.
Although the treatment section focuses on a specific intervention (used in a large treatment trial), the authors do a very good job of both connecting the specific interventions to general cognitive therapy principles and, more importantly, to a series of "themes" critical in IBS. The strong points of this volume are in the clinical section. The identification of IBS-specific themes, such as bowel performance anxiety, sense of control, social approval, perfectionism, anger, shame, self-nurturance, and especially the therapeutic strategies for addressing each one, are valuable contributions to the IBS literature. These sections make clear both the similarities and differences between patients struggling with IBS and those with other chronic medical conditions. The material will be of significant use to anyone who works with these patients (whether a psychotherapist or not). In addition, the clear clinical examples and manual-like sections describing the treatment techniques will also be quite useful for therapists.
A potential criticism of the volume may be its limitation in scope. The emphasis on female IBS sufferers is partially justified by the paucity of research on men, but it may also (unintentionally) promote a misleading notion that IBS is primarily a women’s disorder. The treatment section is also detailed but not comprehensive. For example, common behavioral therapy strategies of relaxation, physical exercise, or in vivo exposure techniques, or other psychotherapeutic modalities used by behavioral therapists, such as self-hypnosis, are not given much attention despite potential promise in this area. These criticisms aside, the volume is a clear and persuasive explanation of how to apply cognitive therapy to IBS. I believe (as do the authors) that psychological assessment and treatment for patients with health problems is greatly enhanced, and in fact may only be effective, when the clinician understands how to make his or her arsenal of techniques relevant in the context of a specific medical condition.
It is probably also true that the ignorance of most mental health clinicians about FGD has kept them from seeking access to this large group of patients who may benefit from their services. By providing for the first time a detailed manual of cognitive therapy for IBS, this volume will help to promote increased interest and comfort among clinicians in serving those with these disorders.
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