Handbook of Clinical Health Psychology, vol. 1: Medical Disorders and Behavioral Applications

“We eat, drink, worry and smoke too much, and we drive too fast” (Robert R. Whalen, quoted in reference 1). But there is more to say about health psychology, much more, to the extent of three thick volumes, of which the book reviewed here is the first. The American Psychological Association, the book’s sponsor and publisher, has reason to be well pleased with this encyclopedic treatise, for it signifies the maturity of health psychology. As of 2003, in its 25th year, the Division of Health Psychology of the American Psychological Association has grown to 2,800 members. Health psychology, which might be roughly defined as the sum of the activities of psychologists who work in the health care system, includes a remarkable diversity—behavior change programs for smoking, obesity, and stress; support groups for victims of chronic illness and their families; nonpharmaceutical treatment to help patients cope with chronic pain; cognitive and emotional retraining following stroke; assessment of candidates for sex reassignment surgery, back surgery, and sterilization; and much more.

The 17 chapters of this handbook correspond to the 17 main categories of ICD-9 (2): a chapter each on neoplasms, metabolic disorders, mental disorders, and so forth. This medicine-centered approach has drawbacks, as the editors acknowledge, but it has advantages as well. The book is comprehensive, covering every illness from infections (codes 100–139) to symptoms, signs, and ill-defined conditions (codes 780–799). A user looking into any medical problem should need no more than a minute to determine whether it is discussed, and, if so, where. The diagnosis-oriented arrangement also meshes well with the specialties of the 35 authors.

A major limitation of the ICD-9 scheme stems from the fact that most of the practice and most of the theory of health psychology cuts across organ systems and diseases. It is no secret that excessive stress contributes to susceptibility to most diseases, exacerbates almost all diseases, and frequently is a consequence of disease. Naturally, almost every chapter discusses research on stress and coping with stress. The result is a good deal of repetition and, at the same time, less depth than would be expected in a single, combined treatment of the subject. We may expect such in-depth topical chapters in the handbook’s forthcoming volumes 2 and 3.

Each of the handbook’s chapters describes the most common medical problems within its ICD-9 category and, often, the less common as well. One finds well-written summaries of incidence, etiology, symptoms, physiology, prognosis, prevention, and treatments—pharmaceutical, surgical, and psychological. The summaries emphasize, as they should, the topics of most interest to health psychology: prevention, long-term management, interventions to increase compliance with treatment, and the role of psychosocial factors in causation and cure.

The book is at its best as a guide to the vast field of health psychology research. It cites more than 4,000 authors, almost half of them for work published within the past decade. But the handbook reviewed here is not the only guide to the field, and it is not necessarily the best. A rival one-volume Handbook of Health Psychology(3), published only 1 year earlier, cites nearly 12,000 authors! Less than 7% of the author citations are common to both handbooks, so the user would be well advised to consult both. Until the second and third volumes of the Handbook of Clinical Health Psychology appear, most practitioners will find the one-volume Handbook of Health Psychology more useful because it covers the core of health psychology—practical applications and theory—while those topics are left mostly to the future volumes of the three-volume handbook reviewed here.

The Handbook of Clinical Health Psychology has some surprising omissions. Diagnosis of attention deficit hyperactivity disorder has mushroomed during the past quarter century, and with it an armamentarium of increasingly costly pharmaceutical treatments (4). One would expect health psychologists to be deeply involved in the controversies concerning the diagnosis, prevalence, and treatment of this condition, but volume 1 mentions none of this.

Depression is treated in detail, but schizophrenia, mania, bipolar disorder, and posttraumatic stress disorder are not mentioned. Stigma, a major psychosocial concern for many patients, is barely mentioned. Death and dying are not even indexed, although much of value has been published on these subjects (5, 6). Some chapters cite the research literature extensively, but the chapter on neurology is little more than a descriptive summary of neurological diseases and pathologies. One of the best chapters surveys cardiovascular disease. It marshals the impressive evidence that “lifestyle” treatments—promotion of healthier diet, healthier habits, healthier emotions, and moderate exercise—produce dramatic improvement in overall heath and life expectancy, effects much greater than are foreseeable from drugs or surgery.

The ICD-9 approach omits some important topics. Clinical health psychologists cannot help but be affected for better or worse by newly coined diagnoses, many of them heavily promoted by pharmaceutical manufacturers. “Recovered memory syndrome” soon may be swept into the dustbin of history, but other new diagnoses are on the way. “Social phobia,” formerly known as shyness, is a promising source of income for the pharmaceutical industry; so is “sexual dysfunction,” i.e., disappointment with one’s sex life (7–9). Some health psychologists will welcome medicalization, others will resist it, but all will be affected by it. Controversies over commercial influence on research, diagnosis, and treatment (10) inevitably will be with us for many years, especially in health psychology, where results are so often measured in subjective feelings and subjectively assessed behavior. I hope that volumes 2 and 3 of this handbook will give these controversial issues the attention they deserve.

Reprints are not available; however, Book Forum reviews can be downloaded at http://ajp.psychiatryonline.org.