The authentic life of Henry Grunebaum

Henry Grunebaum wrote: "Dying need not be merely a matter of letting go, of disengaging from those most dear to us, but of giving meaning, hope and a vital part of oneself to those whose lives we have touched and have touched us" ("A Final Round of Therapy, Fulfilling the Needs of 2," New York Times, Oct. 5, 2009). The reciprocity of this remark is now apt for Henry: that in his dying, he gives us a vital part of his life.

Henry Grunebaum died at age 87 on Friday, April 11, 2014. He was a member of the Group for the Advancement of Psychiatry (GAP) Family Committee, which was meeting on that Friday. We missed him from his usual seat by the window. He had been a member of GAP for many decades.

Henry was one of the earliest family psychiatrists: Since the 1950s, he thought, wrote, and taught us about our responsibility in caring for families. This essay is a reflection on Henry’s place in the history of family psychiatry. By following Henry’s interests, we take a tour of many family concerns that remain unattended by psychiatrists today.

His earliest work and writings concerned the care of children when a parent has a mental illness (Am. J. Psychiatry 1963;119:927-33). He was an inspiration to many during family psychiatry’s formative years.

As part of an Association of Family Psychiatrists discussion group, family psychiatrist Lee Combrinck-Graham of Stamford, Conn., wrote in remembrance of Henry: "I was a first-year resident and we had a young woman with a very young baby who thought she was an apple. This apparently had something to do with the Garden of Eden and Original Sin, but it definitely distracted her from caring for her baby. So, we wrote to Henry and read his paper, and we invited her husband to bring in the baby, and they all stayed there, on 10 Gates at the Hospital of the University of Pennsylvania. She was certainly able to stay more involved with her baby in the setting where she was getting a lot of coaching and input and support from the nurses. It was difficult, because there were no provisions for babies in psychiatric units – and what Henry had done was to inspire us to do something that was right to do, and make it work, and we did."

Fast-forward to 2011, when the University of North Carolina at Chapel Hill inaugurated the first perinatal psychiatry inpatient unit in the United States. The most frequent admitting diagnosis is perinatal unipolar mood disorder (60.4%). The unit’s success is measured by the significant improvements in symptoms of depression, anxiety, and active suicidal ideation between admission and discharge (P less than 0.0001) (Arch. Womens Ment. Health 2014;17:107-13).

Henry reminded psychiatrists of his early family research when, in 2011, he wrote a letter to the editor of the American Journal of Psychiatry: "It may interest readers of the article by Wickramaratne et al. on the children of depressed mothers that a study of a similar population with similar goals was conducted four decades ago" (Am. J. Psychiatry 2011;168:1222-3).

We still have a long way to go in providing care for children who have parents with mental illness. A few individuals such as Dr. Michelle D. Sherman of Oklahoma City (http://www.ouhsc.edu/safeprogram/) and Dr. William Beardslee of Harvard University (http://fampod.org) have developed programs for these children that are accessible to all practitioners, but we still lag far behind places such as the United Kingdom and Australia, which provide state programs for children who have parents with mental illness.

Henry next became concerned about the therapeutic neglect of fathers (J. Child. Psychol. Psychiatry 1964;5:241-9). He enrolled fathers in group therapy and wrote empathically about their difficulties (Br. J. Med. Psychol. 1962,35:147-54). Psychiatry still lacks a focus on fathers, especially those with mental illness.

Next, Henry turned his attention to the topic of love. Psychiatrists rarely speak of love, except with caution and a lack of comprehension. What do we say to our patients who ask us about love? There is no psychiatric theory of love. Martin S. Bergmann, Ph.D., explained: "Freud approached the topic of love reluctantly, fearing to encroach on a territory of poets or philosophers like Plato and Schopenhauer endowed with poetic gifts. Not without irony he claimed that when psychoanalysis touches the subject of love, its touch must be clumsy by comparison with that of the poets" (J. Am. Psychoanal. Assoc.1988;36:653-72).

Psychiatrists have written for the public, explaining love through brain chemistry. "A General Theory of Love" (New York: Random House, 2000), written by psychiatrists Thomas Lewis, Fari Amini, and Richard Lannon, is immensely popular and has been translated into many languages. In "Can Love Last? The Fate of Romance Over Time" (New York: W.W. Norton & Co., 2003), Stephen A. Mitchell informed readers that "romance depends on mystery, but long-term relationships depend on understanding. Romance gets its fizz from sexuality, but partnership demands tenderness and caring, not lust. Romance is based on idealization of the other, and idealizing anyone is asking for trouble." Freud described his yearning patients neatly: "Where they love, they have no desire; where they desire, they cannot love." What hormones are important in love?

Oxytocin is a significant hormone involved in the neuroanatomy of intimacy. It has a role in many biological processes, such as the promotion of wound healing (Curr. Opinion Psychiatry;2012;25:135-40), and in human bonding. Researchers recently reported on the role of partners’ hormones at the initiation of romantic love (Soc. Neurosci. 2014;9:337-51). Test subjects were 40 singles and 120 new lovers (60 couples). Couples were assessed for empathy and hostility. Oxytocin showed direct partner effects: Individuals whose partners had higher oxytocin showed greater empathy. Low empathy, on the other hand, was associated with high cortisol, but only in the context of high partner’s cortisol. High cortisol in both partners is associated with relationship breakup. The mutual influences between hormones and behavior highlight the systemic nature of relationships.

Empathy also is important in the recovery from schizophrenia. Investigators have identified the importance of warmth in reducing relapse rates (J. Abnorm. Psychol. 2004;113:428-39). On the flip side, the role of criticism is a well-known key family factor linked to relapse in many illnesses, both psychiatric and medical. Putting those ideas into clinical practice, however, has proven to be difficult, and the gap between research and practice is still quite large.

Henry considered romantic problems from the perspective of a practicing clinician. He stated: "There are no easy solutions available to the clinician whose clients are experiencing problems with romantic/erotic love. There are no easy solutions, because love itself, in all of its manifestations and disguises, is complicated and perplexing. But why should we expect it to be less so than life? We desire to have another to love, for without one we will be lonely and there will be no one who truly knows us. We desire to become one with the other, to be selfless, and to lose ourselves in sexual intimacy. But we are also afraid of losing ourselves, for we know that the person we love is other, independent, and that we can never truly know him or her. This is the predicament of love" (J. Marital Fam. Ther. 1997;23:295-307).

A fairly recent study validated Henry’s focus on love. When couples are asked to describe the main themes that determine the quality and stability of their relationships, they answer decisively "love" (Fam. Process 2003;42:253-67).

Throughout his life, Henry continued to share his own experiences of therapy in an authentic way. When he wrote about his visits with a dying patient in the New York Times in 2009, Henry revealed his own personal reflections on illness and death. In that piece, he taught us to be always considering our responses to our patients. He also taught us that we are always learning.

His last published work is a reflection on the relationship between a patient and therapist when that relationship spans decades (Am. J. Psychiatry 2012;169:434). He asked whether this is therapy or companionship – and if this matters. Henry resisted biological reductionism in psychiatry with a gentle wisdom that pointed to the role of narrative and family throughout history and in our work. He still reminds us that love and compassion are needed to do our work well.

Henry’s legacy for family psychiatry is deep, and he had several lessons for those of us who attend to patients:

• Work to maintain the mother-child bond when maternal illness is present.

• Attend to fathers.

• Remember that romantic/erotic love is a topic of great importance to psychiatry and health.

• Keep in mind that relationships with patients hold truths that we may not yet fully understand.

• Believe that love and compassion make work into a life’s joy.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).

Henry Grunebaum wrote: "Dying need not be merely a matter of letting go, of disengaging from those most dear to us, but of giving meaning, hope and a vital part of oneself to those whose lives we have touched and have touched us" ("A Final Round of Therapy, Fulfilling the Needs of 2," New York Times, Oct. 5, 2009). The reciprocity of this remark is now apt for Henry: that in his dying, he gives us a vital part of his life.

Henry Grunebaum died at age 87 on Friday, April 11, 2014. He was a member of the Group for the Advancement of Psychiatry (GAP) Family Committee, which was meeting on that Friday. We missed him from his usual seat by the window. He had been a member of GAP for many decades.

Henry was one of the earliest family psychiatrists: Since the 1950s, he thought, wrote, and taught us about our responsibility in caring for families. This essay is a reflection on Henry’s place in the history of family psychiatry. By following Henry’s interests, we take a tour of many family concerns that remain unattended by psychiatrists today.

His earliest work and writings concerned the care of children when a parent has a mental illness (Am. J. Psychiatry 1963;119:927-33). He was an inspiration to many during family psychiatry’s formative years.

As part of an Association of Family Psychiatrists discussion group, family psychiatrist Lee Combrinck-Graham of Stamford, Conn., wrote in remembrance of Henry: "I was a first-year resident and we had a young woman with a very young baby who thought she was an apple. This apparently had something to do with the Garden of Eden and Original Sin, but it definitely distracted her from caring for her baby. So, we wrote to Henry and read his paper, and we invited her husband to bring in the baby, and they all stayed there, on 10 Gates at the Hospital of the University of Pennsylvania. She was certainly able to stay more involved with her baby in the setting where she was getting a lot of coaching and input and support from the nurses. It was difficult, because there were no provisions for babies in psychiatric units – and what Henry had done was to inspire us to do something that was right to do, and make it work, and we did."

Fast-forward to 2011, when the University of North Carolina at Chapel Hill inaugurated the first perinatal psychiatry inpatient unit in the United States. The most frequent admitting diagnosis is perinatal unipolar mood disorder (60.4%). The unit’s success is measured by the significant improvements in symptoms of depression, anxiety, and active suicidal ideation between admission and discharge (P less than 0.0001) (Arch. Womens Ment. Health 2014;17:107-13).

Henry reminded psychiatrists of his early family research when, in 2011, he wrote a letter to the editor of the American Journal of Psychiatry: "It may interest readers of the article by Wickramaratne et al. on the children of depressed mothers that a study of a similar population with similar goals was conducted four decades ago" (Am. J. Psychiatry 2011;168:1222-3).

We still have a long way to go in providing care for children who have parents with mental illness. A few individuals such as Dr. Michelle D. Sherman of Oklahoma City (http://www.ouhsc.edu/safeprogram/) and Dr. William Beardslee of Harvard University (http://fampod.org) have developed programs for these children that are accessible to all practitioners, but we still lag far behind places such as the United Kingdom and Australia, which provide state programs for children who have parents with mental illness.

Henry next became concerned about the therapeutic neglect of fathers (J. Child. Psychol. Psychiatry 1964;5:241-9). He enrolled fathers in group therapy and wrote empathically about their difficulties (Br. J. Med. Psychol. 1962,35:147-54). Psychiatry still lacks a focus on fathers, especially those with mental illness.

Next, Henry turned his attention to the topic of love. Psychiatrists rarely speak of love, except with caution and a lack of comprehension. What do we say to our patients who ask us about love? There is no psychiatric theory of love. Martin S. Bergmann, Ph.D., explained: "Freud approached the topic of love reluctantly, fearing to encroach on a territory of poets or philosophers like Plato and Schopenhauer endowed with poetic gifts. Not without irony he claimed that when psychoanalysis touches the subject of love, its touch must be clumsy by comparison with that of the poets" (J. Am. Psychoanal. Assoc.1988;36:653-72).

Psychiatrists have written for the public, explaining love through brain chemistry. "A General Theory of Love" (New York: Random House, 2000), written by psychiatrists Thomas Lewis, Fari Amini, and Richard Lannon, is immensely popular and has been translated into many languages. In "Can Love Last? The Fate of Romance Over Time" (New York: W.W. Norton & Co., 2003), Stephen A. Mitchell informed readers that "romance depends on mystery, but long-term relationships depend on understanding. Romance gets its fizz from sexuality, but partnership demands tenderness and caring, not lust. Romance is based on idealization of the other, and idealizing anyone is asking for trouble." Freud described his yearning patients neatly: "Where they love, they have no desire; where they desire, they cannot love." What hormones are important in love?

Oxytocin is a significant hormone involved in the neuroanatomy of intimacy. It has a role in many biological processes, such as the promotion of wound healing (Curr. Opinion Psychiatry;2012;25:135-40), and in human bonding. Researchers recently reported on the role of partners’ hormones at the initiation of romantic love (Soc. Neurosci. 2014;9:337-51). Test subjects were 40 singles and 120 new lovers (60 couples). Couples were assessed for empathy and hostility. Oxytocin showed direct partner effects: Individuals whose partners had higher oxytocin showed greater empathy. Low empathy, on the other hand, was associated with high cortisol, but only in the context of high partner’s cortisol. High cortisol in both partners is associated with relationship breakup. The mutual influences between hormones and behavior highlight the systemic nature of relationships.

Empathy also is important in the recovery from schizophrenia. Investigators have identified the importance of warmth in reducing relapse rates (J. Abnorm. Psychol. 2004;113:428-39). On the flip side, the role of criticism is a well-known key family factor linked to relapse in many illnesses, both psychiatric and medical. Putting those ideas into clinical practice, however, has proven to be difficult, and the gap between research and practice is still quite large.

Henry considered romantic problems from the perspective of a practicing clinician. He stated: "There are no easy solutions available to the clinician whose clients are experiencing problems with romantic/erotic love. There are no easy solutions, because love itself, in all of its manifestations and disguises, is complicated and perplexing. But why should we expect it to be less so than life? We desire to have another to love, for without one we will be lonely and there will be no one who truly knows us. We desire to become one with the other, to be selfless, and to lose ourselves in sexual intimacy. But we are also afraid of losing ourselves, for we know that the person we love is other, independent, and that we can never truly know him or her. This is the predicament of love" (J. Marital Fam. Ther. 1997;23:295-307).

A fairly recent study validated Henry’s focus on love. When couples are asked to describe the main themes that determine the quality and stability of their relationships, they answer decisively "love" (Fam. Process 2003;42:253-67).

Throughout his life, Henry continued to share his own experiences of therapy in an authentic way. When he wrote about his visits with a dying patient in the New York Times in 2009, Henry revealed his own personal reflections on illness and death. In that piece, he taught us to be always considering our responses to our patients. He also taught us that we are always learning.

His last published work is a reflection on the relationship between a patient and therapist when that relationship spans decades (Am. J. Psychiatry 2012;169:434). He asked whether this is therapy or companionship – and if this matters. Henry resisted biological reductionism in psychiatry with a gentle wisdom that pointed to the role of narrative and family throughout history and in our work. He still reminds us that love and compassion are needed to do our work well.

Henry’s legacy for family psychiatry is deep, and he had several lessons for those of us who attend to patients:

• Work to maintain the mother-child bond when maternal illness is present.

• Attend to fathers.

• Remember that romantic/erotic love is a topic of great importance to psychiatry and health.

• Keep in mind that relationships with patients hold truths that we may not yet fully understand.

• Believe that love and compassion make work into a life’s joy.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).

Henry Grunebaum wrote: "Dying need not be merely a matter of letting go, of disengaging from those most dear to us, but of giving meaning, hope and a vital part of oneself to those whose lives we have touched and have touched us" ("A Final Round of Therapy, Fulfilling the Needs of 2," New York Times, Oct. 5, 2009). The reciprocity of this remark is now apt for Henry: that in his dying, he gives us a vital part of his life.

Henry Grunebaum died at age 87 on Friday, April 11, 2014. He was a member of the Group for the Advancement of Psychiatry (GAP) Family Committee, which was meeting on that Friday. We missed him from his usual seat by the window. He had been a member of GAP for many decades.

Henry was one of the earliest family psychiatrists: Since the 1950s, he thought, wrote, and taught us about our responsibility in caring for families. This essay is a reflection on Henry’s place in the history of family psychiatry. By following Henry’s interests, we take a tour of many family concerns that remain unattended by psychiatrists today.

His earliest work and writings concerned the care of children when a parent has a mental illness (Am. J. Psychiatry 1963;119:927-33). He was an inspiration to many during family psychiatry’s formative years.

As part of an Association of Family Psychiatrists discussion group, family psychiatrist Lee Combrinck-Graham of Stamford, Conn., wrote in remembrance of Henry: "I was a first-year resident and we had a young woman with a very young baby who thought she was an apple. This apparently had something to do with the Garden of Eden and Original Sin, but it definitely distracted her from caring for her baby. So, we wrote to Henry and read his paper, and we invited her husband to bring in the baby, and they all stayed there, on 10 Gates at the Hospital of the University of Pennsylvania. She was certainly able to stay more involved with her baby in the setting where she was getting a lot of coaching and input and support from the nurses. It was difficult, because there were no provisions for babies in psychiatric units – and what Henry had done was to inspire us to do something that was right to do, and make it work, and we did."

Fast-forward to 2011, when the University of North Carolina at Chapel Hill inaugurated the first perinatal psychiatry inpatient unit in the United States. The most frequent admitting diagnosis is perinatal unipolar mood disorder (60.4%). The unit’s success is measured by the significant improvements in symptoms of depression, anxiety, and active suicidal ideation between admission and discharge (P less than 0.0001) (Arch. Womens Ment. Health 2014;17:107-13).

Henry reminded psychiatrists of his early family research when, in 2011, he wrote a letter to the editor of the American Journal of Psychiatry: "It may interest readers of the article by Wickramaratne et al. on the children of depressed mothers that a study of a similar population with similar goals was conducted four decades ago" (Am. J. Psychiatry 2011;168:1222-3).

We still have a long way to go in providing care for children who have parents with mental illness. A few individuals such as Dr. Michelle D. Sherman of Oklahoma City (http://www.ouhsc.edu/safeprogram/) and Dr. William Beardslee of Harvard University (http://fampod.org) have developed programs for these children that are accessible to all practitioners, but we still lag far behind places such as the United Kingdom and Australia, which provide state programs for children who have parents with mental illness.

Henry next became concerned about the therapeutic neglect of fathers (J. Child. Psychol. Psychiatry 1964;5:241-9). He enrolled fathers in group therapy and wrote empathically about their difficulties (Br. J. Med. Psychol. 1962,35:147-54). Psychiatry still lacks a focus on fathers, especially those with mental illness.

Next, Henry turned his attention to the topic of love. Psychiatrists rarely speak of love, except with caution and a lack of comprehension. What do we say to our patients who ask us about love? There is no psychiatric theory of love. Martin S. Bergmann, Ph.D., explained: "Freud approached the topic of love reluctantly, fearing to encroach on a territory of poets or philosophers like Plato and Schopenhauer endowed with poetic gifts. Not without irony he claimed that when psychoanalysis touches the subject of love, its touch must be clumsy by comparison with that of the poets" (J. Am. Psychoanal. Assoc.1988;36:653-72).

Psychiatrists have written for the public, explaining love through brain chemistry. "A General Theory of Love" (New York: Random House, 2000), written by psychiatrists Thomas Lewis, Fari Amini, and Richard Lannon, is immensely popular and has been translated into many languages. In "Can Love Last? The Fate of Romance Over Time" (New York: W.W. Norton & Co., 2003), Stephen A. Mitchell informed readers that "romance depends on mystery, but long-term relationships depend on understanding. Romance gets its fizz from sexuality, but partnership demands tenderness and caring, not lust. Romance is based on idealization of the other, and idealizing anyone is asking for trouble." Freud described his yearning patients neatly: "Where they love, they have no desire; where they desire, they cannot love." What hormones are important in love?

Oxytocin is a significant hormone involved in the neuroanatomy of intimacy. It has a role in many biological processes, such as the promotion of wound healing (Curr. Opinion Psychiatry;2012;25:135-40), and in human bonding. Researchers recently reported on the role of partners’ hormones at the initiation of romantic love (Soc. Neurosci. 2014;9:337-51). Test subjects were 40 singles and 120 new lovers (60 couples). Couples were assessed for empathy and hostility. Oxytocin showed direct partner effects: Individuals whose partners had higher oxytocin showed greater empathy. Low empathy, on the other hand, was associated with high cortisol, but only in the context of high partner’s cortisol. High cortisol in both partners is associated with relationship breakup. The mutual influences between hormones and behavior highlight the systemic nature of relationships.

Empathy also is important in the recovery from schizophrenia. Investigators have identified the importance of warmth in reducing relapse rates (J. Abnorm. Psychol. 2004;113:428-39). On the flip side, the role of criticism is a well-known key family factor linked to relapse in many illnesses, both psychiatric and medical. Putting those ideas into clinical practice, however, has proven to be difficult, and the gap between research and practice is still quite large.

Henry considered romantic problems from the perspective of a practicing clinician. He stated: "There are no easy solutions available to the clinician whose clients are experiencing problems with romantic/erotic love. There are no easy solutions, because love itself, in all of its manifestations and disguises, is complicated and perplexing. But why should we expect it to be less so than life? We desire to have another to love, for without one we will be lonely and there will be no one who truly knows us. We desire to become one with the other, to be selfless, and to lose ourselves in sexual intimacy. But we are also afraid of losing ourselves, for we know that the person we love is other, independent, and that we can never truly know him or her. This is the predicament of love" (J. Marital Fam. Ther. 1997;23:295-307).

A fairly recent study validated Henry’s focus on love. When couples are asked to describe the main themes that determine the quality and stability of their relationships, they answer decisively "love" (Fam. Process 2003;42:253-67).

Throughout his life, Henry continued to share his own experiences of therapy in an authentic way. When he wrote about his visits with a dying patient in the New York Times in 2009, Henry revealed his own personal reflections on illness and death. In that piece, he taught us to be always considering our responses to our patients. He also taught us that we are always learning.

His last published work is a reflection on the relationship between a patient and therapist when that relationship spans decades (Am. J. Psychiatry 2012;169:434). He asked whether this is therapy or companionship – and if this matters. Henry resisted biological reductionism in psychiatry with a gentle wisdom that pointed to the role of narrative and family throughout history and in our work. He still reminds us that love and compassion are needed to do our work well.

Henry’s legacy for family psychiatry is deep, and he had several lessons for those of us who attend to patients:

• Work to maintain the mother-child bond when maternal illness is present.

• Attend to fathers.

• Remember that romantic/erotic love is a topic of great importance to psychiatry and health.

• Keep in mind that relationships with patients hold truths that we may not yet fully understand.

• Believe that love and compassion make work into a life’s joy.

Dr. Heru is with the department of psychiatry at the University of Colorado at Denver, Aurora. She is editor of the recently published book, "Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals" (New York: Routledge, 2013).