The authentic life of Henry Grunebaum
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).
