JORGE H. DARUNA Introduction to Psychoneuroimmunology Boston, MA: Elsevier Academic Press, 2004, 304 pages (ISBN 0-12-203456-2, US$69.95 Hardcover) Reviewed by LINDA E. CARLSON
Dr. Daruna tackles a large and daunting area of research in psychoneuroimmunology (PNI). PNI is not defined, except to say, "It seeks to shed light on how mental events and processes modulate the function of the immune system, and how, in turn, immunological activity is capable of altering the function of the mind" (p. 7). Throughout, the fundamental unity and interconnectedness of bodily systems is emphasized, a cornerstone of PNI first articulated by Robert Ader in 1980. The first two chapters discuss the aim and organization of the book and historical antecedents. Insight from ancient medical wisdom is summarized with the recognition that these philosophies had essentially understood the principal dynamics of balancing bodily systems centuries ago. In this context, PNI uses scientific method to show the long-recognized unity of the organism.
The book is well organized with each chapter suitably divided into sections and subsections; necessary as the text itself is physically small. The intended audience are students in medicine, nursing, psychology, public health or social work. However, those without a university-level biology education may find the chapters on the immune, endocrine, and nervous systems difficult, as the language assumes an understanding of cell biology, neurochemistry, and neuroanatomy. The glossary of terms is helpful but not inclusive and there are a very large number of abbreviations introduced in the first few chapters. Medical students and basic scientists will be most at home in these first chapters, which cover immune system basics (Chapter 3), endocrineimmune modulation (Chapter 4), and neuroimmune modulation (Chapter 5). Much more detail is given here than other sources aimed at students, perhaps too in-depth for some, but valuable for graduate researchers who require a better understanding of the complexities of these systems. A section in Chapter 3 on commonly used measures of immune function is most welcome.
The next section deals with stress, contextual change, and disease (Chapter 6), and psychosocial stress: neuroendocrine and immune effects (Chapter 7). The basic understanding of systemic functioning is applied to the stress paradigm with a repeated emphasis on the importance of context. Stress is viewed as contextual change, with context broken down into the social environment, other life forms, nonliving environment and within the individual organism. Change in any of these spheres constitutes stress. Disease is also framed as a contextual change and therefore, stress. The individual shapes the context in which the immune system operates through thoughts, feelings, and behaviour. This view of the organism existing in several different contexts simultaneously is fitting and recognizes the complexity of layered influences on health and illness.
Chapter 7 moves from theoretical to empirical, summarizing research on neuroendocrine and immune effects of psychosocial stress. As is the case throughout the book, the focus is on the human literature, and research is summarized without reference to studies or authors. Sources are listed at the end of each chapter but without reference in the text to specific findings. Most sources are review articles, books or book chapters, so determining original studies is difficult. This is appropriate for some textbooks but is frustrating to those who wish to investigate specific findings further. Psychosocial effects of stress are organized by the type of outcomes assessed: endocrine activity, autonomie and peripheral neural activity, central nervous system activity, immune system activity (further broken down into nonspecific, humoral, and cell-mediated immunity), and neuroendocrine-immune pathways. This specificity allows the reader easily to focus on areas of interest. …