Environment and Psychopathology
Environment and Psychopathology
A.-M. Ghadirian and E.H. Lehmann
New York, NY: Springer Publishing Company, 188 pp, 1993
When I initially browsed through this book, I wondered how topics as diverse as seasonal affective disorder, taijin kyofu sho, the homeless, and terrorism could be tied together in a cohesive mental health theme. After completing it, I believe the editors deserve credit for doing just that. Drs. Ghadirian and Lehmann are well-known and respected clinician researchers from McGill who are eminently qualified to examine the interaction between our environment and the expression of mental illness. As they point out in the introduction, this interaction is complex and difficult to study, but is essential for understanding stress and coping. Their book is divided into three sections: physical factors and psychopathology; social and cultural forces; and catastrophic forces. The first section includes chapters on how light, noise, pollution, and nutrition may contribute to psychopathology. The second section looks at the relationship between mental illness and culture-bound syndromes (taijin kyofu sho is a form of Japanese social phobia), the “postwar generation”, homelessness, and substance abuse. The psychological effects of natural disasters, terrorism and torture, and concentration camps are addressed in the final section.
Overall, the writing and editing are good, the quality of the book is excellent, and the price is very reasonable. The usual problem with multi-authored books (that of overlap between chapters) is a non-issue because of the diversity of topics. My one criticism of the technical aspects is that the references in the text include all the authors’ names. While I very much prefer text references in this author/year style instead of numbers, I find it annoying to have to wade through five or six author names for a single reference, especially when several references are cited.
The chapters are succinct and well-written by authorities in each field. As expected in a book with this theme, the authors range from psychobiologists, to sociologists, to epidemiologists. Sometimes the chapters are a bit too sparse. Gerald Klerman has a chapter on the fascinating epidemiologic data showing increasing depression rates in younger age cohorts in the 20th century. He describes the methodology in detail, but does not elaborate on possible explanations for these findings. Unfortunately Dr. Klerman died last year, but his ideas and speculations on the matter would have been very interesting. Other topics such as environmental illness, or “20th century disease” seem conspicuous by their absence. Dr. Lehmann has not contributed a chapter, but Dr. Ghadirian penned the chapter on psychoactive substance abuse and psychopathology, a nice summary of the available literature. The chapter on homelessness and psychopathology by Wallace, Streuning and Susser offers a well-thought out treatise that limited effective social networks leading to spiralling feedback loops that result in homelessness. The final chapter by John Sigal on concentration camps points out that all of the literature on survivors of concentration camps is based on people from Western industrialized nations, and that we have very little understanding of the psychological effects of atrocities on Third World people. He pointedly suggests that this may be merciful, but I wonder about this restricted focus that we have in the “First World”.
One small omission from the book’s introduction is a clear statement of the target audience, i.e. who should read the book. This is important, because I think of books as meals. Choosing a meal depends on your appetite and interest. For example, reference books are like smorgasbords — there is lots of variety and everything is available in vast quantities. Researchers prefer gourmet fare, like nouvelle cuisine — small portions, but carefully and exquisitely prepared with only quality ingredients. Residents tend to favour health food — lean and spare, with all the vital nutrients but no frills. Medical students like easily digestible food that has been strained of birdseed. In this analogy, I would classify this book as an appetizer course — small, varied, tasty nibbles that whet your appetite for more. When thinking about environmental effects on mental illness, one tends to forget broader issues like culture or disasters, and ubiquitous factors like light or noise. I would therefore recommend this book to readers interested in brief essays on the way selected environmental factors can affect psychopathology and mental illness.