Handbook of Stress, Medicine and Health

Ed Cary L Cooper CRC Press, £69, pp 388 ISBN 0 849 32908 6

Medicine has yet to decide its role in understanding and treating stress related disorders. There is a huge and increasing public interest in the part played by stress in illness, and a firm general belief that this role is a considerable one. Medical science–preoccupied with such contemporary excitements as molecular biology, transplants, and imaging technology–seems reluctant to listen to the clamour at its door.

Only psychiatry has accepted–not always unanimously–that stress can be important in the genesis of illness, and that understanding more about stress could open new avenues of treatment. Some serious proselytising is needed to prevent medicine surrendering stress to those sociologists, psychologists, and others who are taking more interest in it as a social and pathological phenomenon. Or will the study of stress eventually become part of the medical canon, as earlier ages saw immunology and molecular biology transform from esoteric science to medical practice? One way to encourage this process is to produce a series of well written, informative, and relevant papers summarising current views on stress and its medical importance. This handbook is an attempt to do just that, and it is partly successful.

Its strength lies in the breadth of its approach. Just about every illness that has been related to stress (mental disorder, cardiovascular disease, AIDS, cancer, diabetes, etc) gets at least a mention, sometimes even a whole chapter. The emphasis is heavily clinical so there is little about the huge experimental literature on stress, though one chapter on endocrinology is an exception. The authors are drawn from a satisfyingly wide range of institutes, countries, and disciplines; there are few subjects better able to persuade those with entirely different backgrounds and traditions to try to talk to each other.

The book's weakness lies in the uneven quality of the contributions, and even their style–the editor needed more courage and a more active blue pencil. Some chapters are really papers that describe a single piece of work, while others are very general discussions (almost musings) on selected aspects of stress. But some give the reader what is really wanted–a critical overview of the field, an assessment of the undoubted technical and theoretical pitfalls, and an indication of where things are going.

Tellingly, there is rather little about the role of doctors. But there are some startling suggestions: read this book to find out whether stress can influence the onset or course of cancer, if heart disease is really associated with stress, what “social support” means, whether the course of AIDS is influenced by the patient's attitude, and so on. Most of all, however, read how workers in the subject are struggling with the concept of stress itself–one that has moved from a simple, almost mechanical, model to one that includes social and personal psychology as well as physiology and neuroscience. A reader wanting all this is not helped much by the arrangement of the chapters–to find out about current thoughts on, say, stress and cancer you will need to dodge from section to section.

A brave attempt, but not a landmark and not as good as the Handbook of Life Stress, Cognition and Health (edited by S Fisher and J Reason, Wiley, 1988).

Rating: **