Mind, Body, and Medicine: An Integrative Text

Books concerned with the ways in which the mind can hold sway over the workings of the body have become very popular in the last 10 years. Paul Martin’s The Sickening Mind(1) was a good example of its type, and Melmed’s book arrived in the same week that I was asked to review a volume called Stress and the Heart for the British Medical Journal(2).

This interest may reflect an increased awareness of mind-body interactions in medicine, although my attempts to acquire a copy of the journal Advances in Mind-Body Medicine have so far failed. In our hospital library (a large university teaching establishment), copies of Time and The Economist are easier to come by than Advances in Mind-Body Medicine.

In Mind, Body, and Medicine, Melmed describes the ways in which stressors challenge the physical and psychological health of the individual. There are additional chapters on chronic fatigue and chronic pain as well as visceral pain syndromes and panic disorder and pragmatic advice about management of these disorders.

The strengths of this book lie in Melmed’s accounts of mind-body interactions from a physiological viewpoint, and the most interesting chapters are those in which he describes the pathophysiological mechanisms involved in psychosomatic illnesses. Melmed is not only a practicing clinician but also the head of a unit for behavioral medicine, and so he is uniquely suited to write about mind-body interactions of this sort. He is also aware of the importance of the doctor-patient interaction and how this may affect the outcome of a variety of medical disorders. Of course he is right in emphasizing that the assessment can influence the ways in which an illness evolves: he cites Engel’s statement in 1986 that the lack of adequate knowledge of human behavior among physicians compromises their effectiveness as clinicians.

The book is well written and well referenced and includes useful chapters on behavioral management of diverse disorders, with practical accounts of relaxation procedures in stressed states; Melmed is well aware of (and endorses) the use of cognitive behavior therapy as a powerful therapeutic tool in the medical context. He is right to do this because recent reviews carried out in the United States and the United Kingdom have emphasized the importance of cognitive behavior therapy in such disorders as chronic fatigue syndrome and chronic widespread pain (fibromyalgia).

Melmed is also concerned with restoring to patients a sense of control in an attempt to help diminish the intensity and frequency of distressing symptoms. This is in keeping with the current articles on patient empowerment, although most U.K. clinicians prefer the term “self-management.” Melmed cites the growing popularity of alternative medicine in the West as an expression of the need for patients to exert some control over particular treatment options, even if these treatments are demonstrably ineffective (as is the case for many alternative treatments used in patients with cancer). The patients who use these treatments seem less bothered that these treatments lack an evidence base than those who prescribe them. This is a major challenge for modern “evidence-based” medicine.

Because psychosomatic problems in clinical practice fall squarely in the arena of general medicine and its subspecialties, this book should be read primarily by general physicians, but it will also be of interest to psychiatrists and primary care physicians. Melmed rightly bemoans the “stilted, uneasy, inhibited relationship that characterizes the interaction of psychiatry with the rest of the medical profession” but sensibly declines to explore the historical origins of this unfortunate development. Surely radical changes must take place in the training of our physicians (or lack of it) before we can become as adept at understanding and managing the psychological aspects of medical practice outlined by Melmed in this humane and stimulating book.