Mind over matter | |
Abnormal illness behaviour. Issy Pilowsky. Chichester: John Wiley & Sons 1997 (xi + 265pp.). ISBN: 0 471 965731. |
With the long-overdue
emphasis on communication skills in medical education now being specifically addressed in the Graduate Medical Programs, the publication of this scholarly and eminently readable book on abnormal illness behaviour is opportune. It is to Pilowsky's credit that he makes both the clinician and educated layman question prior concepts and biases surrounding such nosology as hypochondriasis, hysteria, somatisation, and that dreaded term malingering. Pilowsky discusses the resistance to a psychological approach to abnormal illness behaviour seen in many patients, therapists and, indeed, many families interviewed in diverse clinical settings. He addresses the consultation-liaison issues particularly well in relation to chronic pain and chronic multisystem disease, emphasising the importance of the content and structure of the doctor-patient and doctor-relative interview. The occupational health and medicolegal implications of overuse syndrome, chronic fatigue syndrome and other "illness affirming" syndromes are also highlighted in this comprehensive book. I was impressed by the five topics emphasised as ingredients in the "explanatory therapy" used to help patients understand the relationship between their emotions and their physical symptoms. Judging by Pilowsky's critically argued theoretical and practical commentaries, including many useful case histories, this is an important theme. The five ingredients include provision of accurate information, helping a patient to understand his selective perception on anticipated events, unlearning the focusing on certain bodily sensations, clarification of misunderstandings in doctor-patient communications, and the need to repeat the transmission of information in digestible amounts. Unfortunately, while Pilowsky's "wish list" for the treatment of abnormal illness behaviour includes many attainable goals between doctor and patient, the development of such "explanatory therapy" treatment programs in mixed specialty units or abnormal illness behaviour units may be an unattainable goal in Australia given the current economic rationalism prevailing in our healthcare system. Roger W Bartrop |