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.
Dr. Henry Grunebaum
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?