Specifity, Typicality - Last Update
Michael Lowden's review of our book (Lancet 1991) has been very helpful, he said he enjoyed the book but hesitated to recommend it because he knew so many doctors it would irritate. One reason being that it was no longer a popular concept. It is now necessary to examine reasons for this, one is that General Practitioners' and Specialist's expectations were initially too high and they became disillusioned after referring patients with Ulcerative Colitis, Asthma, Rheumatoid Arthritis etc. etc., to psychiatrists who were mainly ignorant of psychosomatics too dependent on psychotropic drugs which were next to useless in psychodynamic disorders. The only exception being people sent for cognitive psychotherapy where management of a few disorders is not too unlike our own. The formulations of the pioneers, Alerxarder/Dunbar, Wort, e.g. the giving-up response (Engel) and Groen and verbal insult in Colitis (have been neglected but not wrong), Same applies to Harold Wolff's work on Migraine, Stuart Wolf's work on Peptic Ulcer and the surgeon Eastcott's memorable insight into patients with Crohn's Disease as "peacemakers" and "pig-in-the-middle". Others, such as pathologically unresolved mourning in Rheumatoid Arthritis and the Autoimmune Diseases are described in this book. Until these features of Typicality (Specificity) are recognised by all doctors and therapists and employed in helping sufferers from Psychosomatic Disorders change their coping mechanism there will be little progress and needless disillusion will continue.
J.W. Paulley MD. FRCP 2005
In a time when most doctors practice medicine as a technical application of the natural sciences, the authors, both experienced clinicians, combine the use of modern techniques with human understanding and psychological management of their patients in the practice of internal medicine.
Many of these patients suffer from "psychosomatic disorders", i.e. diseases in which emotional stresses play a major role in the production of the symptoms and/or signs. But just because such a large proportion of all illnesses seen by physicians fall within this category (whether functional or organic), this book is not only a guide to the theory of psychosomatic medicine; it describes the way in which the authors deal with patients in their daily practice. Based on many years of clinical experience and a critical appraisal of the literature, they have developed and tested an approach to what they describe as "psychological management". This is partly based on psychological and psychiatric principles but differs from specialised "psychotherapy" and can be learned and practised by physicians in combination with their technical medical treatment. Extensive attention is paid to the stresses, ambivalences and incompatibilities which the patients encounter in their communication with the key figures in their family and at work, and to which they have unsuccesfully tried to adapt without having been able to solve the problems actively. The authors' method is a further development of the art of history taking, with more attention given to sympathetic and understanding questioning and listening and the non-verbal signs of communication than to precisely focused advice or prescription. Their knowledge, accumulated over the course of years, of the specific problems which seem to precede the onset of the different psychosomatic disorders is presented at length and illustrated by numerous case histories.
The style of the book is highly personal; the literature is critically confronted with the personal experience of the authors. It is therefore not a formal, scholastic text and does not present the reader with a consensus of generally accepted opinions. On the contrary, its contents are based on personal opinions derived from personal, practical experience. It stimulates, even challenges the reader to compare his or her own knowledge critically with that of the authors. It is not an elementary textbook for students but a guide for practising physicians who want to be (or become) better doctors and do not fear, but may even enjoy critical controversies.
The book covers, then, the whole field of internal medicine. It also offers valuable chapters on the general methodology of psychosomatic practice. The chapters on the psychosomatic aspects of dermatology, obstetrics and gynaecology have been written by experts in these fi elds. The collaboration of authors from Great Britain, The Netherlands and West Germany is a special feature.
J.J. Groen, MD, FRCP 1989