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Book Review   |    
The Environment and Mental Health: A Guide for Clinicians
Timothy Lacy, M.D.
Psychiatric Services 1999; doi:
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edited by Ante Lundberg; Mahwah, New Jersey, Lawrence Erlbaum Associates, 1998, 233 pages, $59.95

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In his introduction to this text, editor Lundberg states that the book "is designed to introduce the new field of environmental psychiatry, to illustrate its importance for clinical practice, and to serve as a practical guide." This is an ambitious task, especially considering that the field of environmental psychiatry is currently undefined. The editor includes an interestingly broad range of topics such as behavioral neurotoxicity, psychological response to trauma and disaster, risk perception and coping, environmental illness, the effects of the environment on mental health, nature and mental health, pet therapy, and ecopsychology.

Such a range of subjects led me to wonder whether environmental psychiatry is, in fact, a new field with a unified body of knowledge, or merely a collection of varied topics that share a common link with the environment. It was with hope for clarification that I read this book.

Like many edited books, this one suffers from inconsistency in the quality and scope of its chapters. A "guide for clinicians" should be pithy and clinically useful. While much helpful clinical information is contained in the book, I had to dig for it rather than having it readily accessible. Unfortunately, only one chapter in the text contains clinically useful tables.

In spite of these structural weaknesses, the text is informative, innovative, and helpful. It is well referenced throughout and has a useful index. The appendix contains a list of informative Web sites and toll-free telephone numbers where one can find useful environmental data.

The Environment and Mental Health is at its best when exploring the controversial syndromes that often frustrate clinicians. The contributors offer a balanced approach and consider all relevant data that are both supportive and unsupportive of so-called environmental illnesses—even though the difference between environmental illness and neurotoxin exposure remains unclear throughout the text.

One consistent theme is a call for physicians to question their own medical prejudice. The contributors argue that conditions such as environmental illness, Gulf War syndrome, and chemical sensitivity are frequently ignored or maligned by the medical and psychiatric professions out of bias rather than careful scientific scrutiny. They also correctly note the relative ignorance of most psychiatrists about behavioral neurotoxicology, which, they say, is barely mentioned in most psychiatric texts. Finally, the book cautiously ventures into political territory with its discussions of global warming, environmental racism, and biodiversity.

Although I remain unconvinced that environmental psychiatry is a separate field, the topics discussed in this introductory text deserve greater recognition by the mainstream mental health and medical communities. Such recognition would stimulate and facilitate high-quality research and help disseminate the resulting knowledge. Despite the structural weaknesses of this text, I found it refreshing and enjoyable. I recommend the book for all mental health professionals wishing to develop a special interest in the interaction between the environment and mental health. Public health students specializing in mental health would also greatly benefit from it, as would mental health clinicians working in veterans', military, or forensic settings.

Interactions between the environment and mental health are complicated and are poorly understood by most mental health practitioners. Clinicians must carefully consider all pertinent data when evaluating patients who may have environmentally induced illnesses. They can do so only when they are informed about the relevant environmental science. This book will prove valuable for clinicians faced with such challenges.

Dr. Lacy is assistant professor of psychiatry at the Uniformed Services University for the Health Sciences in Bethesda, Maryland, and codirector of the National Capital Combined Residency Program in Family Practice and Psychiatry.

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