Psychosomatic Medicine Brings Psychiatry Back to Its Roots
Much has changed since the 1800s, when psychiatrists were referred to as“ alienists” and their primary job was to remove people with mental illness from society. In those days, psychiatry was practiced outside the medical setting.
Since that time, not only have psychiatry and the rest of medicine become integrated, but also a subspecialty has sprung out of the need to deal with the psychiatric aspects of diseases such as cancer, cardiovascular disease, and other health problems, according to Jimmie Holland, M.D.
As the Wayne E. Chapman Chair in psychiatric oncology at Memorial Sloan-Kettering Cancer Center in New York, Holland has developed groundbreaking methods of diagnosing and treating psychiatric problems in people with cancer.
Holland spoke to attendees at the plenary session of APA's fall component meetings in Washington, D.C., last month about the history of consultation-liaison psychiatry or psychosomatic medicine, as the field is increasingly becoming known.
“This subspecialty is an important model for the survival of psychiatry in 21st-century medicine,” she said.
Holland noted that physician Benjamin Rush made one of the first efforts to unite psychiatry with the rest of medicine. While working at Pennsylvania Hospital in 1811, Rush said “Man is said to be a compound of soul and body...[They] are so intimately united that one cannot be moved without the other.”
Early in the 20th century, a historic educational initiative in psychiatry in North America took place at Johns Hopkins University School of Medicine in Baltimore, where Swiss-born psychiatrist Adolf Meyer, M.D., taught a course on psychobiology.
Meyer coined the term “psychobiology” to emphasize his belief that mind and body were integrated, and that each influences the other. He also directed the Henry Phipps Psychiatric Clinic at the university, which opened in 1913.
Through his teaching, Meyer “helped to break down the dualism of mind and body,” Holland said. He influenced the child-guidance movement of the 1920s and contributed to teachings on dynamic psychotherapy and psychoanalysis.
Holland said that George Henry, M.D., a senior physician at Bloomingdale Hospital at Cornell University Medical School, wrote the first paper about consultation-liaison psychiatry in a 1929 issue of the American Journal of Psychiatry.
In his paper, Henry described the stigma that pervaded the general medical setting when it came to patients with mental illness. “When psychiatry is first introduced into a general hospital,” he wrote, “there is likely to be indifference or even resistance on the part of the hospital staff... .In one hospital, the superintendent said, `insanity is hopeless, and there are no insane patients in my hospital.'”
From about 1930 to 1960, Holland said, the psychosomatic movement“ focused on finding a psychological basis for several major chronic diseases” such as peptic ulcer, asthma, hypertension, and cancer.
During that era, she noted, “Patients were studied to determine the events or emotions that purportedly caused their cancer.”
Proponents of the psychosomatic movement believed that childhood conflicts led to abnormal cell growth or that grief and stress could cause cancer, she added, and not only were these beliefs false, they may have “served to alienate the psychiatrist even further from his or her medical brethren,” Holland said, quoting Thomas Hackett, M.D., a leader in the field of psychosomatic medicine.
Groundbreaking advances in psychiatry and general medicine provided the backdrop for a number of positive events that occurred after the 1970s: consultation-liaison psychiatry achieving subspecialty status and the development of disease-specific areas in consultation-liaison psychiatry, such as oncology, nephrology, and cardiology.
Holland noted that consultation-liaison psychiatrists are seen by patients as “another white coat on the medical team who asks questions that are a little different,” and patients are less frightened in dealing with them because they don't have to walk down a hall to a psychiatry unit to get help for mental health problems. “The stigma is reduced,” she stated.
As consultation-liaison psychiatrists, Holland said, “we have the ability to bring psychiatry closer to the field of medicine, where it has roots.”
Holland is the recipient of APA's 2005 Adolf Meyer Award, which requires the presentation of a lecture at an APA meeting. APA established the award lecture in 1957 to advance psychiatric research by enabling psychiatrists to hear from leading scientists and to exchange new research information with outstanding colleagues.
The next Adolf Meyer award lecture is scheduled to be presented at the 2005 Institute on Psychiatric Services in San Diego. ▪
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Published online: 15 October 2004
Published in print: October 15, 2004
Notes
A pioneer in the field of consultation-liaison psychiatry looks back over the past two centuries to the days when people with mental illness— and those who treated them—were kept out of medical settings.
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