Michael Blumenfield, MD, and James J. Strain, MD (eds); Philadelphia: Lippincott Williams & Wilkins, 2006 949 pages • $199.00 (hardcover)
Reviewed by Mark A. Turner, MRCP, MRCPsych, PhDThe publication of a major new textbook is an important event in any discipline, but the arrival of Psychosomatic Medicine is a particularly exciting development for clinicians working in the interface between psychiatry and medicine. Blumenfield and Strain have done a masterly job of synthesizing the contributions of numerous leading authorities to provide structure for an emerging subspecialty that reconciles the competing demands of utility and comprehensiveness; they have still managed to include a substantial first section on the conceptual issues that make psychiatry uniquely interesting.
In keeping with this approach, Berrios and Marková’s analysis of symptoms and McHugh and Clark’s description of their “perspectival” approach to psychiatric classification set the tone for what is to come. These chapters are fascinating condensations of years of original work, which are accessible to the trainee yet detailed enough to serve as a point of departure for further research.
If psychosomatic medicine is to prosper, at a theoretical level it needs a framework not borrowed from general psychiatry. At a practical level, clinicians need a thorough understanding of all aspects of the psychiatric-physical medicine interface.
In order to address what are ultimately 2 sides of the same coin, section 2 takes a physical systemic approach and consists of a series of state-of-the-art reviews of the psychiatric aspects of cardiovascular, renal, and other diseases. Here, the chapters on inconspicuous topics such as pulmonary disease and burn injuries by Thompson and Sullivan, and Stoddard and colleagues, respectively, are especially welcome. The end product—which will again prove indispensable to all grades of clinicians—constitutes a determined step toward the realization of the editors’ vision that “as the 21st century unfolds, there will be more of an amalgamation of medicine and psychiatry.”
Depression and the somatoform disorders are the bread and butter of psychosomatic medicine, and it is therefore entirely fitting that these should be dealt with in the traditional way: as subjects in their own right. In keeping with this, the editors accord depression a special status and include an excellent review by Cowles and Nemeroff in the first theoretical section.
Other psychiatric conditions are introduced in section 3. Here again, the right balance is achieved and the contributions are uniformly useful and informative. It is perhaps worth drawing specific attention to Phillips’ authoritative summary of the perennially fascinating body dysmorphic disorder and to Boettger and colleagues’ discussion of delirium that places a refreshing emphasis on assessment.
By the end of these sections, the book has done most of its job. However, it would not be complete without discussions on treatment modalities, ethical considerations, and scientific advances such as genomic testing and brain imaging. These are covered in sections 4 and 5, which focus on “Special Topics” and “Future Perspectives,” respectively. Although several of the special topics might arguably have been better placed in sections 1 and 2, the final 2 sections as a whole reinforce what is obvious from the start: this is a marvelous book that deserves a place on the desk of every consultation- liaison psychiatrist. If we add to this that Psychosomatic Medicine comes with a CD-ROM of the entire text and useful trial software for patient care and medical student tracking, Blumenfield and Strain will surely play a central part in the training of psychiatrists in psychosomatic medicine for many years to come.
Dr Turner is a consultant psychiatrist at The Bamburgh Clinic, St Nicholas Hospital, in Newcastle upon Tyne, United Kingdom.
