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Book Review   |    
Mind-Body Deceptions: The Psychosomatics of Everyday Life
Bernard Vaccaro, M.D.
Psychiatric Services 1999; doi:
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by Steven Dubovsky, M.D.; New York City, W. W. Norton & Company, 1997, 394 pages, $29.95

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Steven Dubovsky is professor of psychiatry and medicine at the University of Colorado School of Medicine in Denver. He has written this book for the educated layperson, but residents in psychiatry, allied health professionals, and even general practitioners would find it rewarding reading. The layperson would find the book an understandable introduction to the psychiatry of somatoform disorders.

Mind-Body Deceptions attempts to show how the mind and body both help and interfere with each other and to advance awareness among both patients and clinicians of mind-body interactions. The author essentially gives an overview of psychiatry as it relates to psychosomatic medicine. He arranges his text to consider four "deceptions," beginning with the deception that the study of the mind is fundamentally different from the study of the body.

Dr. Dubovsky does a masterful job reviewing, evaluating, and synthesizing a broad overview of the psychiatric and psychosomatic literature and presenting it in an easily readable form. Weaving together the threads of basic science, psychopharmacology, and psychological and psychoanalytic theory, he gives the reader a basic understanding of how the mind and body work.

The first of the book's four sections, on mind-body deceptions and modern science, reviews the history of psychiatry and the psychosomatic movement, the influences of psychoanalysis, the development of biological psychiatry, the role of genes and gene expression, and the role of experience in development of psychiatric and psychosomatic illness. It also discusses the development of liaison psychiatry and its impact on the psychiatric care of the medically ill. Part 2, called The Mind Deceives the Mind, defines and reviews somatization disorders and the role of temperament, "goodness of fit," and early childhood development in their formation.

Part 3, The Body Deceives the Mind, looks in depth at depression from the perspectives of both biological and psychological theory. It presents an accessible introduction to the basic neurobiology of depression and introduces the concepts of neurons, neurotransmitters, and receptor theory and their relationship to depression and its treatment. This section also reviews the theory of kindling and the impact of recurrent illness on the individual. It includes two excellent chapters that are consumers' guides to psychological and biological therapies for depression.

Part 4, The Mind Deceives the Body, discusses the impact of stress on physical health. Summarizing both animal studies and human data, it reviews the concepts of learned helplessness, the phenomenon of voodoo death, sudden death induced by grief and strong emotion, and the impact of stressful life events on health. It also reviews the ameliorating and protective effect of social support and attachment. The last chapters introduce psychoneuroimmunology and explore the role of stress, its impact on the immune system, and its relationship to cardiac illness and cancer survivorship.

Dr. Dubovsky's expertise as a scholar is clearly conveyed in this book. Mind-Body Deceptions is easily readable, and its bibliography is extensive. The book's strength is that it conveys in an understandable way an appreciation for the complexity of the brain and how it mediates behavior. Dr. Dubovsky also clearly states the limitations of the psychiatrist's art and science. I found particularly elucidating the chapter on "Somatization Deceptions" and the complex interaction of temperament and early experience on the development of these disorders.

Dr. Vaccaro is an instructor in psychiatry at Harvard Medical School and is attending psychiatrist on the consultation-liaison service and neuropsychiatrist on the behavioral neurology unit at Beth Israel Deaconess Medical Center in Boston.




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