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Oliver G. Cameron

reviewed by Michael E. Robinson

Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspectives

edited by Peter W. Halligan, Christopher Bass, and John C. Marshall

reviewed by Burton Hutto

Visceral Sensory Neuroscience: Interoception

University of Florida, Dept. of Clinical and Health Psychology, P.O. Box 100165, Gainesville, FL 32653, Email: merobin@ufl.edu

Oliver Oliver G. Cameron
Oxford University Press, New York, 2002, 359 pages, $49.95

Strengths: a review and synthesis of a broad range of scientific literature, a cogent argument for the integration of mind and body.

Weaknesses: to integrate such a broad range of topics, depth of coverage of some literature is compromised

Target reader: psychologists, physicians, neuroscientists, and students interested in mind-body relationships

At first glance, the title of this volume seems incongruous with the table of contents and indeed the content itself. One is expecting to engage in a thorough read of the intricacies of physiology, anatomy, and basic neuroscience of the viscera. Those topics are, of course, presented in the various chapters in part II "The Essential Recent Science." However, a perusal of the rest of the table of contents indicates that the reader is in for a much more diverse experience. Part I "Definitions, History, Background" is a good review of standard definitions, theories of emotion, motivation, attention and arousal, and conditioning. All of these topics are referenced within the context of the viscera. The third section, "Related Topics and Summary," covers topics such as pain, body image, state-dependent learning, psychiatric disorders relevant to visceral symptoms and perception, and finally, a review of consciousness and body awareness. The review of the table of contents leads the reader to wonder how the author will be able to integrate such diverse topics.

Once into the initial chapters it became apparent that it was a limited definition of "neuroscience" that flavored my expectations of the book title. Dr. Cameron uses the term in its broadest sense, to incorporate topics that have traditionally been arbitrarily categorized into psychological or physiological domains. The integration of this broad range of topics and a major resulting theme of this volume is really an integration of mind and body.

Which section of the volume serves as novel information or review largely depends on the reader’s discipline. For psychologists, the first section will be a nice review of theories of emotion, classical and operant conditioning, and motivation. This material is likely to be new to traditionally trained physicians and neuroscientists. The middle section of the book, which deals with the neurophysiology of visceral perception, is likely to be new material for psychologists, but review material for neuroscientists and physicians. The final section is again more familiar territory for psychologists and psychiatrists, but may be enlightening for those trained in neuroscience and physical sciences.

Although some of the material presented in the book will be review for readers, these sections seem essential to accomplish the integration of psychology, visceral neurophysiology, and philosophy that define the volume. This work will serve as an excellent resource for physician-researchers, psychologists, and neuroscientists who are interested in studying visceral perception, whether it is visceral pain, normal sensation, or disease-related symptoms. By providing the broader context of these sensations, it will stimulate readers from different disciplines to examine different perspectives on their own work and on their patients’ or subjects’ experiences of visceral sensations.

Overall, this is an excellent volume for students and researchers to "catch-up" quickly on the visceral perception topic area. I strongly recommend it for anyone doing research on human visceral perception and believe that it will also be an informative text for those individuals involved in the clinical care of patients with visceral complaints.

Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspective

Department of Psychiatry, UNC, CB 7160, Chapel Hill, NC 27599-7160, Email: bhutto@med.unc.edu

Peter W. Halligan, Christopher Bass, and John C. Marshall
Oxford University Press, New York, 2001, 354 pages, $125

Strengths: a scholarly and multidisciplinary evaluation of the concept of hysteria and its manifestations

Weaknesses: a murky topic in human health remains murky

Target reader: clinicians in psychiatry, neurology, and medicine as well as scholars of other disciplines with interest in hysteria and conversion disorder

First, what is hysteria? "The contributors to this volume, who have carefully reviewed the issues, remain in doubt as to what hysteria actually means. So what chance does the average doctor have?" (p. 70). Despite this grim perspective, this volume does lay out the involved complexity in a thought-provoking and comprehensive fashion. Contributions from a variety of fields including branches of medicine and psychology, law, philosophy, anthropology, and classics are woven together into a reasonably coherent exploration of this enigmatic topic.

The book reads like a symposium. With some minimal reference to the other chapters in the book, each author offers a concise summary of their contribution to understanding the central problem: patients with neurological or medical symptoms that are inconsistent with demonstrable pathology. The chapters are ordered in such a way that the puzzlement and questions tend to build, and no final synthesis is attempted.

This lack of an integrated summary might seem like a statement in itself, attesting to an inevitable futility of investigating this topic. However, the various perspectives demonstrate the vital importance of this area of human health. Patients with symptoms not explained by known pathology raise many clinical, theoretical, and ethical questions. All angles are discussed, and suggestions are made about establishing common language that would facilitate deeper examination of the problem. However, there is fundamental disagreement among the authors for instance about whether physical or neurological pathology has been missed or misunderstood, whether, or how, the patient "knows" what they are doing, or whether various classifications such as conversion disorder and somatization are basically identical. There is relative consensus that such patients are common and that the prognosis depends on acuity of onset and presence of other psychiatric pathology. Yet, despite modest therapeutic zeal on the part of some and skepticism in others, there is no consensus approach to treatment strategies. This book is not written for the pragmatist.

Many of the chapters would stand alone as excellent reviews of their area. Most of the authors present their view in a relatively convincing manner, adducing ample evidence. However, the force of the book can be felt only by reading the chapters sequentially. Few edited collections of papers on a topic are this well coordinated. The authors may disagree, but the controversy is highlighted and celebrated by the careful juxtaposition of so many perspectives. The problem studied in this book presents many paradoxes, and the book will appeal to those who enjoy debate.

One sphere that the book may underemphasize is the perspective of the healthcare administrators, policy makers, or even insurance companies. These patients are well recognized for their "million-dollar work-ups" and disproportionate usage of health care resources. The book addresses proper evaluation and suggests various treatment strategies, but the views of someone who could discuss the economics and challenges such patients pose to large-scale healthcare would have been an interesting addition given the generally broad range of authorities sampled in the book.

The book raises more questions than it answers, but the new questions are sharper and point out important directions for the study of such patients. One basic question at the very end of the last chapter was "Do [such patients] become consistently less dependent on support if managed pragmatically by a multidisciplinary team... when compared with patients who are managed by current services?" Such defined and researchable questions make this book almost essential reading for those wishing to investigate in this area.

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