Current Trends in Consultation-Liaison Psychiatry

Abstract

Liaison psychiatry was launched in the United States in the early 1930s as part of the drive to bring psychiatry closer to general medicine after decades of their geographic and conceptual separation.¹ In the 1920s and 1930s, psychiatric units became established in a growing number of general hospitals so as to strengthen the links between psychiatry and medicine in matters of patient care, education, and clinical investigations. As a logical outgrowth of this development, efforts were made to provide psychiatric consultations to the nonpsychiatric physicians working in the various divisions of the hospital. In 1929, George W. Henry, a pupil of Adolf Meyer, the founder of psychobiology, published a pioneering paper in which he spelled out the advantages and difficulties of establishing regular professional contacts or liaison between a psychiatric consultant and his medical and surgical colleagues.² In the years to follow, a number of teaching hospitals began to feature such liaison in an organized manner. In a few cases, a hospital psychiatric unit was nothing but a liaison service, operating without beds set aside for psychiatric patients, whose function was to offer psychiatric consultations and teaching throughout the general hospital.^1,3 In addition to providing clinical service and education to other physicians, liaison psychiatrists engaged in research at the interface of medicine and psychiatry. The emergence of psychosomatic medicine as an organized movement in the early 1930s stimulated interest in such research. Three persons pioneered psychosomatic medicine in America from about 1932 on: Helen Flanders Dunbar, Franz Alexander, and Harold G. Wolff.¹ Dunbar initiated a study, in a general hospital setting, on psychosocial aspects of several physical illnesses and hence became one of the first liaison researchers.⁴ She advocated a holistic approach to medical practice, theory, and research, an approach which was the hallmark of both Meyer’s psychobiology and psychosomatic medicine. Liaison psychiatry evolved as an organized endeavor by psychiatrists to apply and teach this approach in their work in nonpsychiatric divisions of general hospitals. The term “liaison psychiatry” was probably first used by Billings in 1939,⁵ but was not widely used until recently.