Psychology and Psychiatry. Edited by J. Milgromand G.D. Burrows. Wiley, Chichester, 2001. £82.50.351pp. ISBN: 0471981087.

Medicine has acknowledged}and often embra-ced}the indivisibility of mind and body sinceHippocrates linked temperament to the balance ofbodily fluids. In the intervening millennia, despitethe proliferation of medical specialisations ondifferent aspects of bodily or mental function,holistic clinical approaches have continued toflourish within Medicine, shaped by the holisticdemands of patients who do not present theirdisease in convenient mental or physical cate-gories. Experimental Psychology, on the otherhand, with its roots in science, has tended toeschew holism. The individual has been subdividedinto personality, emotion, cognition and so on,and each of these has been further subdivided sothat Psychology has produced very detailedknowledge about relatively circumscribed areas.Therefore, Psychiatry and Clinical Psychologybegan with very different approaches and respon-sibilities in mental health care. Whereas Psychiatryhas had to provide some response to the range ofproblems that confront it, the scientific base has,arguably, often been lacking. Psychology, on theother hand, has been able to pick and choose,working only with those groups and problems forwhich it had an evidence-base.

The extension of each discipline into physicalhealth care therefore makes for a fascinating casestudy of the role of professional, scientific, politicaland clinical factors in shaping professions. More-over, there are challenges for both LiaisonPsychiatry and Clinical Health Psychology inapplying principles developed in mental health tothe very different conditions of physical health.For instance, in mental health care, anxiety anddepression are by definition problems to beremedied. In physical health, though, they mightsometimes be normal, and even necessary oradaptive reactions to impending or recent chal-lenges. Therefore, I looked to this book for sometimely and searching analysis of the presentpositions of Liaison Psychiatry and ClinicalHealth Psychology and of how these have beenreached, together with some thoughtful, evenprovocative, prescriptions or possibilities for thefuture. What I found was some historical back-ground, some overviews of the basis for psycho-logical and psychiatric work in several areas of

physical health care, and some helpful pointsabout how psychologists’ and psychiatrists’ prac-tice need to change to meet the rigours of medicalcare. However, this does not add up to what I hadhoped for.

The book begins with an historical account ofthe two disciplines in physical health, a reviewof psychosocial influences on health, overviewsof psychological and psychiatric assessment andintervention, and overviews of psychologicalproblems and their management in inpatients.Then chapters address specific topics: pain, oncol-ogy, chronic disease, addiction, heart disease andhealth promotion, before concluding chaptersdescribe professional training and the organisationof psychology and psychiatry services.

To achieve an integrated text is hard in editedbooks. Here it is doubly difficult because the booklooks in two directions}Psychiatry and Psycho-logy}and many chapters are jointly authored bypsychologists and psychiatrists. However, ratherthan integrate perspectives, the editors haverevealed the seams, with the respective psy-chiatrists’ and psychologists’ names heading therelevant parts of some chapters. Readers from thedifferent disciplines will therefore identify withdifferent parts of the book. As a psychologist, Ifound it hard to accept the dogmatic certainty ofthe statement that ‘the sick and hospitalisedpatient is vulnerable to eight categories of psycho-logical stress’, of which the first was ‘the basicthreat to narcissistic integrity’. From a psychiatricperspective, I anticipate}and share}scepticismfor the claim that a psychometric test such as theMMPI would commonly be useful in medicalsettings. Two case studies in the chapter aboutoncology illustrate the opportunity that has goneunexplored. Mrs S was depressed after breastcancer and was treated by antidepressants; Mr E,on the other hand, had incurable renal cancer andhe and his family were helped by a psychologist toreframe their hope for the future. The questionthat interested me, but that the book did notsatisfactorily address, was why Mrs S and Mr Ereceived}and whether they should have recei-ved}different models of care. Other chapters arewritten without explicit references to the contribu-tions of Psychiatry and Psychology, so a readerlooking for guidance about professional roleswould be disappointed in these too.

It is also hard to achieve international relevancein a book, such as this, which targets professionalorganisation and roles. Authors are drawn mainly

BOOK REVIEWS 631

Copyright # 2003 John Wiley & Sons, Ltd. Psycho-Oncology 12: 628–634 (2003)

from Australia and the USA and, to the extent thatthey address the roles of the two disciplines, theydepict situations very different from most UKsettings. In the UK, it is rare that Psychiatry andPsychology have the need or opportunity todemarcate their respective roles in physical healthcare. Each is underdeveloped, and the disciplinesare less concerned with drawing lines between themthan with sharing the need to have psychologicalissues of any kind addressed in a useful way.

I found it hard to engage with the book for thesereasons}and because it neglected three areas thatare important to me. In the UK, at least, primarycare is a major area in which Clinical HealthPsychology operates, and has the importantadvantage that care at this level does not embodythe dualism that divides mental and physicalhealth services in hospital care. The generalpractitioner is expected}and expects}toaddress patients’ physical and psychological needs.Secondly, in hospital care, many psychologicalproblems that I see are not intrinsic to patients’psychopathology or psychological processes;they are products of the way that clinics workand of the ways that clinicians communicate withpatients}or don’t. Generally, this book assumes

that the individual patient is the one in need ofexpert help, which risks burdening many patientswith problems that lie elsewhere. Finally,one of the largest group of patients for whichphysical health clinicians seek psychological helpare those with physical symptoms unexplained byphysical disease, but the book neglects this group,also.

So who is the audience for this book? It is not amanual or guide for clinical practice (case studiesare used only sparingly), so it will not directlyinform clinicians’ practice. For reviews of psycho-logical factors in specific clinical areas, readers willalso probably more naturally go elsewhere. There-fore, the main attraction of this book is likely to befor those readers who want to read the historicalaccounts of the extension of Psychology andPsychiatry to medical settings in Australia andNorth America. Unfortunately, that is perhapsquite a small audience, for a small proportion ofthe book.

Peter SalmonProfessor of Clinical Psychology

University of Liverpool, UKDOI: 10.1002/pon.713

Territorios da Psicologıa Oncologica. Edited byMaria do Rosario Dias and Estrella Dura. ManuaisUniversitarios, Climepsi Editores, Lisbon, 2001.ISBN: 9727960189.

This book is an interesting mix in various respects.First, it brings together knowledge from twonearby but different countries. The first half ofthe book is in Portuguese and the second half inSpanish. This makes it hard to read at times. Itcovers topics from health psychology and clinicalpsychology perspectives. Even though the topicscovered are varied, there is a special emphasis onprevention and breast cancer. Chapters coveringtumour locations other than the breast are missingwhile other topics (e.g. palliative care) are givenmore coverage.

In general, the Portuguese authors nicelyintegrate social, political, philosophical, and spiri-tual issues in their contributions and write from ahealth psychology perspective covering issues alsorelated to diseases other than cancer. Trinidad andTeixeira attempt to integrate health psychology

and psycho-oncology within the Portuguese na-tional health system, specifically within primarycare, describing areas for such an integration totake place. Health education and prevention,screening, psychological support, training ofhealth professionals and the provision of contin-ued psychological care to professionals areoutlined. Justo describes the different aims ofpsycho-therapeutic interventions in cancer: im-proving patient’s interpersonal relationships,increasing treatment adherence, controlling treat-ment-related side effects, as well as their impact onthe immune system, the disease itself, and cancersurvival rates. Pais Ribeiro provides a detailedreview of the definition and measurement ofquality of life in oncology and describes it indifferent contexts: paediatric cancer patients,primary caretakers, and diseases other thancancer. Matias provides a historical perspectiveof the organisation of cancer care in Portugaltaking into account social, political and culturalfactors and describing the development of thePortuguese National Cancer Institute and itsinternational recognition. Almeida and Melo use

BOOK REVIEWS632

Copyright # 2003 John Wiley & Sons, Ltd. Psycho-Oncology 12: 628–634 (2003)