January 19, 2001

History Notes

Pioneering Psychiatrist Made Connection Between Mind, Body

By Lucy Ozarin, M.D., M.P.H.

Consultation-liaison psychiatry is a psychiatric subspecialty dealing with the relationship of mind and body and the effects of mental, social, and environmental factors on physiologic function. Since the time of the ancient Greeks, physicians, philosophers, and theologians have disputed whether the mind and body are single or dual entities. The work of Cannon (flight or fight), Selye (general adaptation syndrome), and others in the 19th and 20th centuries began to provide scientific evidence of the relationship. A major proponent of this view was Helen Flanders Dunbar, M.D., who began to research what was termed psychosomatic medicine and provided a foundation for consultation-liaison psychiatry.

Dunbar, daughter of a physicist, earned her undergraduate degree at Bryn Mawr in 1923 and her medical degree at Yale Medical School in 1930. She later acquired the degrees B.D., Ph.D., and D.Med.Sci. After spending a year in Europe, she became affiliated with Columbia University and the Presbyterian Hospital, where she was appointed psychiatrist to the medical service. She was a member of the American Psychoanalytic Society and went on to write more than 80 books and articles.

Dunbar’s clinical work led to her research in "personality profiles," later termed "personality constellations" associated with certain disorders, usually of a chronic nature, such as peptic ulcer, ulcerative colitis, asthma, and migraine. At Presbyterian, she studied 600 patients with cardiovascular disease, diabetes, and fractures. In 1936 she reported that psychologic factors appeared to influence both etiology and course of illness. She coined the term "accident-prone personality."

During those same years, Franz Alexander, a psychoanalyst in Chicago, was also studying psychosomatic disorders and came up with a "specificity hypothesis," concluding that specific unresolved emotional conflicts led to chronic tensions that caused dysfunction through structural changes in target organs. Dunbar did not accept the "specificity hypothesis," believing instead that the disorders had a complex rather than a specific underpinning.

Dunbar was a prolific writer. She did not like the term psychosomatic but could not find a more suitable term. In 1936 she published her book Emotions and Bodily Changes: A Survey of Literature on Psychosomatic Interrelationships. (The APA Library has a third-edition copy, 1943, which she autographed.) In 1943 she published Psychosomatic Diagnosis. She thought that the research findings could lead to appropriate prevention techniques and treatment.

In 1939 Dunbar was a founder and the first editor of the Journal of Psychosomatic Medicine, a post she held for eight years. The journal is now published by the American Psychosomatic Society.

The research work in psychosomatic medicine led the Rockefeller Foundation to make grants to general hospitals in 1934 and 1935 to stimulate collaboration between psychiatrists and other physicians. The Mount Sinai Hospital in New York and Rochester Medical School pioneered in consultation-liaison services. In the mid-1970s, the National Institute of Mental Health provided grants to 130 consultation-liaison programs.

Helen Flanders Dunbar died in 1959.