FP Watch

Book Reviews

When the body says no. The cost of hidden stress

author: Gabor Maté
Alfred A. Knopf Canada, a division of Random House, 1 Toronto St, Suite 300, Toronto, ON M5C 2V6; telephone (416) 364-4449; fax (416) 364-0462; website www.randomhouse.ca
2003/306 pp/$36.95

OVERALL RATING Very good
STRENGTHS Encourages readers to reconsider link between stress and illness
WEAKNESSES Evidence-based scientists beware
AUDIENCE General audience; medical practitioners; therapists; and patients with multiple sclerosis, cancer, scleroderma, amyotrophic lateral sclerosis, and other diseases the author classifies as immune system diseases

Gabor Maté reminds us of what we already know: that mind and body are inextricably linked. His book describes cases derived from his experiences as a family physician, a palliative care specialist, and psychotherapist, which illustrate this link and what the author describes as psychoneuroimmunoendocrinology. This is the name of the discipline that studies the related functions of the organs and glands that govern our behaviour and physiologic balance.

We read quotes from Plato to William Osler to Hans Selye, and we are reminded of how our current Western medical training severs the historical roots that once understood this link between stress and poor health. Our current way of thinking tends to separate our physiology into individual systems seemingly independent of one another, Maté argues, and attributes illness to genes or to biology that is outside of our control. Maté informs us of the value of reconsidering this approach.

The idea that we, as patients, are charged with controlling our destiny and our stress can be empowering but also guilt-inducing. The point is not to assign blame for getting sick to a patient (further blaming the victim), but rather to give patients the power to change things. In addition, we are charged as physicians with the task of understanding the context of our patients’ lives and the roots of illness within this context, and thereby seeing beyond the physiology of their illnesses.

This is new science based on old beliefs. It makes intuitive sense, and its principles are neither new to me as a family physician nor surprising, because Maté is describing what I know from experience to be true about the cost of hidden life stress on our health. Our ability to validate this science, however, has not kept pace with this avant-garde thinking, and we will need to be patient while we gather the evidence needed to move forward on these theories.

I recommend this book to all who want to better understand how our bodies say no through illness when we experience stress. Its closure with the seven As of healing offers readers some insight into how we can solve this dilemma by taking control of our lives, step by step, to reduce stress and stay well.

—Janet Dollin, MD CM, CCFP, FCFP

Dr Dollin is an Assistant Professor in the Department of Family Medicine, and is Director of the Office of Gender and Equity Issues in the Faculty of Medicine at the University of Ottawa in Ontario.

Medical orthopedics. Conservative management of musculoskeletal impairments

author: Rene Cailliet

American Medical Association Press, 515 North State St, Chicago, IL 60610 USA; telephone (312) 464-4512; fax (312) 464-5837; website www.amapress.com
2004/207 pp/$69.95 (US)

OVERALL RATING Fair
STRENGTHS Comprehensive review of pathophysiology, anatomy, and neuroanatomy
WEAKNESS Review of treatments is incomplete
AUDIENCE Family physicians

Medical orthopedics is an important subject that is insufficiently taught in medical schools, so it is encouraging to see a book on this topic published by the American Medical Association Press. However, although the title includes “Conservative Management of Musculoskeletal Impairments,” the main thrust of the book is a description of normal gross anatomy and neuroanatomy, physiology, and pathophysiology of a variety of musculoskeletal conditions. The text is sometimes difficult to follow but is illustrated by numerous line diagrams. There are good chapters on reflex sympathetic dystrophy, somatic pain syndromes, and fibromyalgia. The section on the spine probably overemphasizes the role of disks in production of pain. The section on treatment, however (though short), is excellent, emphasizing early return to function. It is a pity the author does not mention chiropractic or comment on the lack of association between symptoms and results of imaging studies.

I do not recommend this book as a textbook of management because there are numerous weaknesses. For example, in the shoulder, the author does not distinguish between subacromial and glenohumeral inflammation either in pathology or treatment and does not mention injecting either site or tendons of the rotator cuff. For carpal tunnel syndrome, there is no mention of night splints or steroid injections. Boutonnière deformity is inaccurately described as the same as mallet finger. For the knee, there is no mention of osteochondritis dissecans or osteoarthritis; neither is the symptom of locking mentioned.

For osteoarthritis of the hip, intra-articular steroids are described as first-line treatment, but surgery is not mentioned. Although Perthes disease is described, slipped femoral epiphysis is not.

Family physicians, residents, or students looking for help in managing the many orthopedic medical problems seen in the office would unfortunately be better advised to spend their money elsewhere.

—David Howe, MB, FRCS, CCFP

Dr Howe practises rural family medicine in Advocate Harbour, NS, and has a lifelong interest in orthopedic medicine.