Medically unexplained illnesses are frequently encountered in primary care and specialty practice, as well as in psychiatric and behavioral health settings. These psychosomatic conditions are often viewed as ‘fashionable’ and carry the label of somatizing disorders (Ford, Reference Ford1997). Patients with these conditions tend to ‘doctor shop’ and frequently pass from one clinician to the next (Taylor et al. Reference Taylor, Klein, Lewis, Gruenewald, Gurung and Updegraff2000). Susan K. Johnson in her book, Medically Unexplained Illness has surveyed the recent literature on how psychological, social and physiological factors contribute to the clinical presentation and clinical course of selected ‘unexplained’ syndromes. Specifically, irritable bowel syndrome (IBS), fibromyalgia (FM), and chronic fatigue syndrome (CFS) are addressed with detailed descriptions of symptoms, diagnosis and bio-psycho-social treatment. Additionally, the more recent syndrome, multiple chemical sensitivity (MCS), is extensively reviewed and discussed with respect to treatment options and possible co-morbidities.
These four medical conditions usually occur in women, and are frequently associated with anxiety and depressive disorders. Medically unexplained illnesses are also associated with significant utilization of health-care resources. They may account for as much as 15% of a primary-care physician's practice time (Smith et al. Reference Smith, Monson and Ray1986).
The author, Dr Johnson, focuses much of her attention on unanswered questions pertaining to the four syndromes in order to explain how gender and bio-psycho-social factors contribute to the development of these ‘unexplained’ illnesses. Medically Unexplained Illness contains a fascinating discussion of etiological factors for IBS, FM, CFS, and MCS. Each of the four syndromes are discussed in the context of childhood and family development, interpersonal and psychosocial stressors, cultural and cognitive factors. These factors may serve to predispose a vulnerable individual to the development of a psychosomatic disorder, or psychosocial or physiological factors may serve to precipitate and/or perpetuate the condition. Moreover, the neurobiological underpinnings of these illnesses are briefly considered with regard to the current literature and recently promulgated hypotheses. The chapters that address CFS are especially noteworthy. The chapters devoted to FM are less impressive. However, the psychosocial and gender implications of each of the four illnesses are well conceived and effectively discussed. The treatment of each syndrome is well outlined, including the need to consider history of trauma and abuse, and any interpersonal or ‘cognitive’ issues.
What clearly falls short in this book is the explanation of the biology for each of the ‘unexplained disorders’ which may certainly be an indication as to why these illnesses are indeed ‘unexplained’. In most cases, pharmacotherapy, antidepressants or anxiolytics, are recommended in combination with psychotherapeutic, psychosocial or alternative treatment modalities. Co-morbid psychiatric disturbance is readily acknowledged in this text, but generally not addressed in any detail for the purposes of diagnosis or treatment. Obviously, the author recognizes that both must be treated in order to achieve an optimal outcome.
The author presents a superb synthesis of the treatment interventions that have been shown to be the most effective for each of the four conditions. The bio-psycho-social model ‘helps to illuminate a contextual perspective to account for the interaction of biological, psychological, and social, and cultural factors’. The author effectively informs the reader of the importance of all of these factors in the development of disease perception, symptom generation, and health-care seeking (Mayer, Reference Mayer1999).
Medically Unexplained Illness is certainly well written and superbly organized. As explicitly stated, the book is intended for health and clinical psychologists, gender researchers, and medical sociologists. The text would be useful to all clinicians who encounter patients with psychosomatic disorders or for those who work in settings where somatization is frequently encountered. Patients and family members of individuals diagnosed with IBS, FM, CFS, or MCS or other medically unexplained illnesses could also benefit from reading this text.
