Psychiatric News October 15, 2004
Volume 39 Number 20
© 2004 American Psychiatric Association
p. 18
Psychosomatic Medicine Brings Psychiatry Back to Its Roots
Eve Bender
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.
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.
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Jimmie Holland, M.D. (right), posing with APA President Michelle Riba,
M.D., says consultation-liaison psychiatry "is an important model for
the survival of psychiatry in 21st-century medicine."
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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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