AJP nov97 Book Forum • Does Stress Cause Psychiatric Illness?

This small book reviews one of psychiatry's cardinal issues: whether stress causes and/or contributes to mental illness. This is a very old question, as the editor, Dr. Mazure, and Benjamin G. Druss point out in the first chapter, “A Historical Perspective on Stress and Psychiatric Illness.” They review the history of stress from Hippocrates to Selye and beyond, with a special emphasis on Kraepelin, Meyer, and the DSMs. In chapter 2, “Life Events and Other Possible Psychosocial Risk Factors for Episodes of Schizophrenia and Major Depression: A Case-Controlled Study,” Bruce P. Dohrenwend et al. present a study of life events whose findings suggest that major fateful events have a role in depression and that occupation with noisome characteristics has a role in episodes of nonaffective psychotic disorder. Alan Breier, in chapter 3, “Stress, Dopamine, and Schizophrenia: Evidence for a Stress-Diathesis Model,” summarizes evidence on the role of stressful life events and chronic interpersonal stress in the relapse of schizophrenia. He makes a strong point for the pathophysiological hypothesis of schizophrenia, which involves stress-induced dysregulation of subcortical dopamine activity.

Constance L. Hammen tackles the importance of stress in mood disorders in chapter 4, “Stress and the Course of Unipolar and Bipolar Disorders.” Studies revealed that stressors are associated with a greater risk for recurrence or relapse in bipolar disorder, even in medicated patients. Dr. Hammen emphasizes that the relationship between stressors and symptoms is influenced by a wide array of variables, both internal and external. She also argues that there are “psychological residues” contributing to the recurrence and chronicity in mood disorders. Chapter 5, “The Relationship of Stress to Panic Disorder: Cause or Effect?” by Sherry A. Falsetti et al., points out the similarities of panic disorder and posttraumatic stress disorder (PTSD) and their comorbidity. The authors also present data on the high rate of criminal victimization among patients with panic disorder. In chapter 6, “Etiological Factors in the Development of Posttraumatic Stress Disorder,” J. Douglas Bremner, Steven M. Southwick, and Dennis S. Charney provide a marvelous overview of stress and PTSD, including stress factors, prestressor factors, peritraumatic factors, and poststressor factors. Chapter 7, “Stress of Bereavement and Consequent Psychiatric Illness,” by Kathleen Kim and Selby Jacobs, deals with the most severe stressor. Bereavement is also an ideal model for examining the relationship among this significant stressor, mental health, and risk factors for psychiatric complications. David L. Snow and Marsha L. Kline discuss stress prevention in the final chapter, “Preventive Interventions in the Workplace to Reduce Negative Psychiatric Consequences of Work and Family Stress.” They focus on two significant protective factors: social support and coping strategies, and their relationship to psychiatric outcomes.

One might find this a wordy argument instead of a simple, “Yes,” to the question of whether stress causes and contributes to mental illness. However, the issues are complicated, and this book skillfully addresses them. The chapter on PTSD is outstanding and could be recommended for residents as well as anybody else interested in stress and PTSD. I missed the discussion of a few issues, such as the role of stress in dissociative and eating disorders, a detailed discussion of the role of personality, and a summary. A psychodynamically oriented reader may miss discussions of psychodynamic issues. Nevertheless, this book is an easy, yet highly educational and well-organized, read. I would recommend this book to anybody interested in the role of stress in mental illness.