Mind, Body, and Medicine by Raphael N. Melmed

Mind, Body, and Medicine



Download Mind, Body, and Medicine




Mind, Body, and Medicine Raphael N. Melmed
Language: English
Page: 424
Format: pdf
ISBN: 0195131649, 9780195131642
Publisher: Oxford University Press, USA

From The New England Journal of Medicine

The belief of the Greek philosophers in the separateness of mind and body, although challenged from the beginning, has its counterpart in medicine. The importance of a holistic approach to a patient would seem to be self-evident, but the separation of psychiatric and somatic medicine occurred during the early 20th century and has been reinforced by the rapid development of biologic knowledge and ever-increasing specialization. The generalist movement, sustained by economic pressures, may be seen as medicine's challenge to the belief in the separateness of mind and body.

Mind, Body, and Medicine: An Integrative Text is a timely contribution to the reconciliation of body and mind in medicine. As Melmed points out, the title may be misleading because what he really attempts is ``an integrative text'' of mind and body in medicine. The first part of the book deals with somatization (why and how some patients express emotional stress through somatic symptoms), doctor-patient communication, the role of stress, the somatic expression of anxiety, and mechanisms of disease control. In the second part, Melmed deals with some specific clinical presentations, such as chronic pain syndromes, including visceral and thoracic pain, respiratory and cardiovascular expressions of anxiety, chronic fatigue, and depression. The last section discusses specific approaches for dealing with the psychosomatic aspects of disease: drugs, stress management, behavioral intervention, and relaxation.

The book is very well written and extremely well referenced. Melmed does not hesitate to use older references, which is welcome in these hectic times of progress and pseudoprogress in medicine. The chapters dealing with challenges in doctor-patient communication, hyperventilation, stress, and relaxation (and many others) are a pleasure to read.

It is evident that a textbook of 400 pages that attempts to integrate somatic and psychological presentations of disease will not satisfy everyone. Some readers will be disappointed by the absence of discussions of eating disorders, drug abuse, and sexual dysfunction. Others may be critical of Melmed's tendency to switch rapidly from very detailed and somewhat cumbersome biologic data to almost exclusively behavioral explanations and treatment proposals. A chapter about the newly rediscovered narrative medicine would have been welcome, and some reference to the old Freudian analytic approach would have been useful. The repetitions can be irritating, and some explanations in the text could have been summarized in figures (e.g., neurobiologic pathways) or tables (e.g., dosages and side effects of antidepressant drugs). This would have made the book more accessible to the hurried practitioner or resident.

It sometimes seems as if Melmed fears the final step -- approaching the patient from the beginning in a truly holistic manner. Why should doctors first exclude somatic disease and only then consider an emotional process? It is well known that, with such a unilateral approach, more anxiety may be produced by clinical tests with false positive results. For most doctors, a negative result is still less exciting than finding a rare disease. An integrative approach should consider emotional and somatic disease together, right from the first encounter with the patient. Furthermore, some reflection on what is truly somatic and what is psychological would have been interesting. Fatigue is considered a somatic symptom. But is it really? As the author points out, depression causes many somatic symptoms, and upper respiratory tract disease may be followed by depression. A truly integrative writer on the mind-body connection should challenge the often artificial classification of diseases as psychiatric or somatic entities.

Does Melmed reach his goal, which he states is ``to convince medical practitioners, whether primary care physicians or medical specialists, that the great majority of psycho-physiological processes may be relatively easily understood and effectively managed''? Maybe not; neurobiologic and psychobiologic pathways are as complicated as the patients who suffer from psychosomatic diseases. However, despite some deficiencies, the book can be recommended to physicians who want a wide view of psychosomatic diseases as seen through the eyes of an erudite internist and behaviorist and to residents who, during their training, may not have been introduced to these problems.
Hans Stalder, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

"Let me start by saying that I found the manuscript most interesting, well written, well-referenced and relevant to me as a practicing academic family physician. The parts definitely hold together well and the book as a whole is coherent. Dr. Melmed presents an impressive combination of thoughtful discussion about the conceptual basis for the mind-body connection as well as practical suggestions for incorporating the theory into clinical practice. The book is intellectually stimulating, east to read, and clinically relevant. Melmed brings together the distillation of a prodigious literature review with wonderful practical examples and applications."--Ronald Schneeweiss, M.D.

"The book is very well written and extremely well referenced. Melmed does not hesitate to use older references, which is welcome in these hectic times of progress and pseudoprogress in medicine. The chapters dealing with challenges in doctor-patient communication, hyperventilation, stress, and relaxation (and many others) are a pleasure to read."--New England Journal of Medicine

"The book can be recommended to physicians who want a wide view of psychosomatic diseases as seen through the eyes of an internist and behaviorist and to residents who, during their training, may not have been introduced to these problems."--New England Journal of Medicine

"...is a magnum opus by a psychologically minded, often brilliant internist who has read widely on the interface between psychiatry and the rest of medicine. The author covers the gamut of medical illnesses in which there are or may be psychological components. The book, which the author correctly terms a text, is exhaustively and meticulously referenced...in summary, this book offers an exhaustive, well researched, intellectual approach to the psychophysiology of diseases...It is recommended to and would be greatly appreciated by psychiatrists as well as to other physicians and all people interested in the connections between mind and body."--JAMAAugust 14, 2002

"The book isery well written and extremely well referenced...the book can be recommended to physicians who want a wide view of psychosomatic diseases as seen through the eyes of an erudite internist and behaviorist and to residents who, during their training, may not have been introduced to these problems."--The New England Journal of Medicine, Hans Stalder, M.D.

"This book, authored by Raphael N. Melmed, takes on the task of synthesizing these often highly complicated and controversial areas. He writes as a practising internist and one who has contributed extensively to the literature of the subject he expounds. He was well trained in the field and he writes with a clarity and authority that is rare, combined with balance."--John Bienenstock, MD, Clin Invest Med

"Dr. Melmed takes a holistic approach that is free of the usual cliches and hence is thought-provoking. I recommend this book to psychiatrists, nurses, and social workers who work with patients who have chronic medical conditions."--Psychiatric Services

Journal of Clinical Psychiatry, January 2003

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