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John D. Loeser, MD, Department Editor
Reviewed by John D. Loeser, MD
J.R. Hubbard & E.A. Workman, CRC Press, Boca Raton, FL, 1997, 423 pages, $99.95 (hardcover), ISBN 0-8493-2515-3
This book catalogs the effects of stress on selected organ systems of the body. It is basically a listing of published animal and human research studies on the effects of stress on the cardiovascular, respiratory, endocrine, gastrointestinal, reproductive, and immune systems. It omits discussion of the musculoskeletal, dermatological, hematological, and hepatic systems.
The authors espouse a biopsychosocial model of human behavior and illness. A brief introductory chapter covering general issues in research on stress is followed by special medical topics including stress and addiction, stress and malignancy, stress and HIV-1, stress and dental pathology, pain and stress, stress and anxiety disorders, measurement of stress, biochemical indicators of stress, stress in the workplace, and psychodynamics of stress. The two concluding chapters describe cognitive, behavioral, and pharmacologic treatments for stress. There is a useful index, and each chapter has many references to the original research papers that are reviewed.
Although each chapter concludes with a summary of the research reported and attempts to evaluate the role of stress in the genesis of disease, I was left with an overall feeling that stress is both everywhere and nowhere in the practice of medicine. Part of my dissatisfaction relates to the lack of a clear distinction in many of the chapters between disease and illness or between symptom and sign. This book does not lead us much beyond the recognition that some stress makes people achieve personal goals and contribute to society, while too much stress overwhelms the individual and leads to reduced productivity and to suffering. Outlining the hypothalamic-pituitary axis and the pituitary-adrenal axis shows us how the brain can communicate with other organs but does not give us insight into how stress can lead to a symptom, let alone a disease. After all, excessive ACTH leads to Cushing's disease due to overproduction of cortisol; this disease is neither caused by stress nor does it produce signs of stress.
This book is a good source of references on how some kinds and amounts of stress affect certain organs or diseases. I do not consider it a handbook, for it does not provide practical information on what to do about clinical problems that may have a relationship to stress. If one accepts the argument that environmental factors are always part of a patient's illness, stress is not a unique phenomenon. Like the word pain, stress has many meanings; it is a multidimensional conceptual term that does not signify a quantity of something within a person.
John D. Loeser is professor of neurological surgery and anesthesiology at the University of Washington in Seattle.
Reviewer content represents the opinion of the reviewer, not APS.
Please direct your suggestions for future Resource Reviews to John D. Loeser, MD, Department Editor, at jdloeser@u.washington.edu
