Bibliotheca Medica: Physician for Tomorrow

In a short chapter on prognosis and therapy several useful signs indicative of hypochondria are presented: if the patient refers to his complaints rather interpretively; if he seems to present his complaint for discussion and for the sake of presentation only; and if the patient has visited a great many physicians with the same problems over many years with a net effect of an increase in his worry and distrust. The author goes on to corroborate the usual impression that therapy is rather unrewarding with severely hypochondriacal syndromes. Nonetheless, electroconvulsive therapy and the newer anti-depressant drugs seem to be quite effective in some patients, especially those who have an associated depression. On the whole, however, the fact that only 19 of this book's 452 pages concern prognosis and treatment, epitomizes my impression that Hypochondriacal Syndromes is primarily a tour de force of descriptive and nosological psychiatry, albeit an interesting phenomenologic case book. Although the author does avoid polemics, I feel he goes to inordinate lengths in discussing all the possible permutations and combinations of signs and symptoms. While this work does document the ubiquity of psychogenic somatization processes and the severe personality disorganization they may imply, it does not seem to be a major theoretical contribution, except perhaps as a summary of the extensive world literature. Finally, this study disappointingly does not present any therapeutic procedures, either psychological or pharmacological, which might be used by practicing physicians. It is apparent that such specific and practical treatment approaches are still to be developed, as psychiatry tries to find such means, as does the rest of medicine, at the bedside and in the laboratories.