Clinical research in psychosomatic medicine: A collection of papers

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  • Biological Psychology 19 (1984) 147-149




    J.J. GROEN, Clinical Research in Psychosomatic Medicine: A Collection of Papers. (Van Gorcum, Assen, 1982) pp. 370.

    This extensive collection of papers is thought-compelling in many ways. Emeritus Professor of Medicine and Psychobiological Research, J.J. Groen, of the University of Leiden, presents a collection of twenty-two papers of which seven have been co-authored with one or more of his colleagues. The diverse papers, starting with one published in 1964, cover an eighteen year period of work in psychosomatic medicine. The fifteen chapters written by Groen himself would have made a book of 240 pages on their own, covering his extensive experience as a clinician and researcher within the areas of peptic ulcer, coronary heart disease, asthma, chronic hyperventilation, obesity and anorexia nervosa, diabetes mellitus, intractable pain, ageing and the so-called syndrome shift. One chapter presents perspectives on the psychosomatic use of physiotherapy, followed by another which offers guidelines for the application of psychotherapy in psychosomatic disorders.

    By including the co-authored papers, he has incorporated illustrations of his theoretical, empirical and clinical contributions to the areas of stress and disease, essential hypertension, ulcerative colitis, multiple sclerosis, and the use of group therapy in diabetes mellitus as well as family therapy in anorexia nervosa.

    For a number of reasons, there is a danger that this book will be perceived as a hotchpotch of chapters, related to psychosomatics, broadly defined. References are totally absent in eight chapters; one on physiotherapy is little more than a summary of a nice chat with a conference audience. The paper on ageing makes only a superficial use of references to related literature, which makes one wonder why they were included at all. References notwithstanding, the paper on nutritional behaviour is an indirect illustration of the great progress made within the area of eating disorders since 1973. On the other hand, the review chapter on psychosomatic aspects of coronary heart disease (published in 1976) includes more than 250 references, and is an excellent introductory paper to the history of CHD for both undergraduate and graduate students. The same holds for another paper of that vintage entitled Present status of the psychosomatic approach to bronchial asthma, which incorporates

    0301-0511/84/$3.00 0 1984, Elsevier Science Publishers B.V. (North-Holland)

  • 148 Book review

    an interesting discussion of the neurogenic versus allergic theory of asthma and a list of some 130 references.

    One chapter is an illuminating presentation of the history of what is currently termed the hyperventilation syndrome. Taken together with the recent work by Grossman and others in the Netherlands, this literature ensures that students can now be taught more efficient therapeutic approaches to the related and puzzling symptoms which Lum in England has called the fat folder syndrome. Groens paper is also a nice illustration of the shortcomings of psychoanalytic approaches to these and other psychosomatic symptoms. A third type of hapter includes a few reports on experimental research with the use of animal models and hard data. A final set of chapters makes no reference to any kind of observations but merely summarizes the authors psychosomatic treatment philosophy based on his own clinical experience.

    The conception of this field as interdisciplinary and multi-methodological does not in itself legitimate such variation in style and level of precision among chapters. There are also several printing errors throughout the book, and some of them are not without entertainment value. The chapter entitled The psychotomatic aspect of diabetes mellitus was certainly not meant for the dietitian, whilst spelling of diarrhoea as diarhea, diarrhea, and diarhoea, in the chapter on ulcerative colitis, appeared to call for one! While the inclusion of a subject index would have offered further opportunity for such creative spelling, it could also have served several useful purposes.

    Some of the papers include retrospective case histories to give flesh to the specificity hypothesis, e.g. for the typical personality of the patient with ulcerative colitis, essential hypertension and multiple sclerosis, respectively. In all cases, hypotheses take the form of a psychosocial conflict with a key figure, causing inhibition or substitution of affective communication in the patient, and they are formulated by the introduction of complex relations among relatively nonspecific constructs. They are not psychoanalytic in content. Nevertheless, these constructs can work well as vicarious targets for the criticism which Lipowski (1977) attributed to Alexanders psychoanalytic theory of psychosomatic disorders. The explanation of highly specific physio- logical symptoms by the introduction of very abstract psychoanalytic concepts did not work, and this failure was admitted in the mid-50s by Alexander himself. For the courageous Groen, in the case of multiple sclerosis, a specific personality type is outlined, with no data included to support it. In all cases, he calls upon future research to uncover the mediating mechanisms involved, but Groen and his colleagues have made a scholarly contribution to a promising beginning.

    The introductory and concluding chapter elucidate Groens view, shared by an increasing number of contemporary colleagues, that psychosomatic disease development is a biopsychosocial, multicausal process. It calls upon interdisci- plinary research and treatment teams. It is especially in this mutual testing by

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    another methodology of each others hypotheses, that a research group achieves an interdisciplinary purpose (p. 8). On the other hand, he does not wish to deny a major theory the use of any particular methodology, technology, or experimental paradigm in the advancement of science. In this respect Groens work is a good model for many more pedantic and tunnel-vision contem- poraries in the health-related research professions. Another emeritus professor in the psychobiological field of individual differences, H.J. Eysenck, states in 1975, that . . . measurement that fails to pay attention to theory is little better than busy work. Groens book safely escapes this type of criticism.

    We who have had the privilege and pleasure to meet Professor Groen and to listen to his papers, have learned to regard him as an open-minded, interested, encouraging and friendly colleague. It is good to see that Van Gorcum has celebrated this Colossus of a humanist by publishing a second volume in the series which started with volume one, published by Pergamon, in 1964.

    Sven Svebak

    University of Bergen