The Growh of George Engel's Biopsychosocial Model. The Growth of George. Engel's Biopsychosocial Model. Corner Society Presentation – May 2. By Theodore M. Brown I’ve set myself a very difficult task.
I’ve only been in Rochester for the past 2. I got to know Dr. Engel pretty well – even “rounding” with him.
Dunwoody Holdings, Inc. In 1937, Joe Engel stood on a street corner in downtown Chattanooga offering shares of stock in the Chattanooga Lookouts for $5 a piece to. Yosl Bergner at the Engel Gallery.
I am an historian, not a physician, and most of. I have. tried to take what I have learned from Dr. Engel and his writings and placed. American medicine during the seven decades when he was active in.
Many of you doubtlessly heard from Dr. Engel – as I did – on.
George started out under the. Dr. Emanuel Libman (the L in. George L. Engel) to become a very biomedically- oriented investigator. Dr. Soma Weiss of Harvard in the early forties cajoled George into. John Romano. about the investigative work Romano and Engel began together at Harvard and.
Cincinatti a few years later; about the curricular. Dr. Engel’s Medical- Psychiatric “Liaison” fellowship training program. Rochester medical curriculum with what for a long time.
Monica”. studies beginning in the fifties and their continuation and elaboration over. Franz Reichsman, Bill.
Greene, Art Schmale and Sandy Meyerowitz who, with Dr. Engel, made Rochester.
Jakob Engel-Schmidt (f. United States (Dissent) Adkins v. Children's Hospital Barron v.
He- Ho”) as a “final. Program in Biopsychosocial Studies under the leadership of. Tim Quill, Tony Suchman and Rich Frankel in the nineties and the role it has. Dr. Engel’s encouragement and Dean Hundert’s support, in the.
Double Helix” curriculum. I hope to provide context and. I have already indicated, and in some cases I can provide depth. He majored in chemistry at. Dartmouth College, which he entered at age sixteen in 1. He was strongly. committed to the ideas of Jacques Loeb, the famous “apostle of mechanistic.
He obtained permission from the Dartmouth biology to. Loeb’s experiments on mechanistically- produced “tropisms.” In. George wrote his first. Thought. as a Product of Brain Metabolism.” In the summer between his junior and senior. Woods Hole Marine Biological Laboratory. Ralph Gerard, professor of physiology at the. University of Chicago and one of the pioneers of neurochemistry.
George’s. first major project, which led to his first publication (in 1. It was the obvious place to go for an aspiring. During his pre- clinical years, George was, in fact, a.
As a result of his continuing association with Ralph. Gerard, he was asked by the Rockefeller Foundation to spend two months during. Leningrad Institute of Experimental Medicine in the. Alexander Gurwitsch, a Russian physiologist working on “mitogenetic. Ivan Pavlov. Since, by coincidence, the XV.
International Physiological Congress took place that summer in Moscow and. Leningrad, Congress participants – including several Hopkins physiology. Institute labs by George serving as.
Russian was very good). Moreover, uncle Manny arranged for him to work. Boston City Hospital where he met Soma Weiss, soon. Harvard’s Hersey Professor of the Theory and Practice of Physic and. Peter Bent Brigham Hospital. The chief of medicine during Engel’s house officership, Dr.
Eli. Moschowitz, moved, however, in certain new, dramatically different directions. In fact, while George. In 1. 93. 9, in a major reorganizational move, the well- known. Lawrence Kubie moved from Columbia to Mount Sinai as Asssociate. Psychiatrist and as head of a new “psychosomatic” service.
Kubie described. the move a few years later as part of the “invasion. He dismissed most of what psychoanalytic psychiatrists had to say as “laughable”. He worked, for example, on “the signficance of the carotid.
Sinai psychiatrist, Sydney Margolin, he continued. Perhaps modelling his approach on Soma Weiss’ vitamin therapy in. And by 1. 94. 1. George eagerly prepared to leave Mount Sinai and its psychosomaticists behind.
Boston and work again with Soma Weiss. Although he still. Weiss had. also moved with the times and become interested in the emotional dimensions of. In 1. 94. 0 he published in the Journal.
American Medical Association an Alpha Omega Alpha address on “The. Medical Student Before and After Graduation” in which he pointedly told his. When George arrived at the Brigham in 1. Weiss had introduced some dramatic changes since.
He had invited a young psychiatrist, John Romano, to join. Department of Medicine and help teach the emotional and psychological. Fully integrated into Weiss’ medical service.
Romano conducted rounds at patients’ bedsides, where he would pull up a chair. To add to Engel’s shock, Weiss also strongly encouraged him to. Romano on a research project focused on delusional. Engel would study them with precise electroencephalographic techniques. Romano would investigate their mental states in psychological detail. Romano. had already accepted a position as Professor and Chair of the Department of. Psychiatry at the University of Cincinnati College of Medicine and promptly.
George the opportunity to join him in that department. George at first. refused but was persuaded to move by Eugene Ferris, one of Weiss’ former. Department of Medicine at. Cincinnati, where he also offered George a position. George thus came to. Cincinnati in 1. 94.
Medicine and Psychiatry and found. Ferris and. Arthur Mirsky were the standouts in Medicine, while Romano, Milton Rosenbaum. Maurice Levine made Psychiatry equally stimulating.
George found the. Cincinnati group “the most exciting I’d ever encountered, before or since.” For George, the single most important event.
Cincinnati was the abandonment of his resistance to psychological factors in. At first, he tried to ignore the psychosomatic buzz in the Cincinnati.
Gradually, however, he let down his guard. Ferris was. instrumental as he took a broadly clinical approach to the wide- ranging studies. Cincinnati group was. Instead of sticking to physiological observations, Ferris led. In. addition, Rosenbaum persuaded or perhaps manipulated George into doing. While. supervising him in that psychotherapy experience over the course of a year. Rosenbaum helped Engel overcome his.
Sigmund Freud. With Romano, for example, Engel returned to. No longer keeping Romano and his psychological. Engel enthusiastically studied psychogenic. EEG- measured brain metabolism. He had thus adopted. Franz Alexander had recently made.
He participated in psychosomatic conferences. Under the. inspiration of John Romano, he also conceived dramatically expanded and far more. It was Romano’s strong conviction that “psychiatry. Engel and Romano called for a “more comprehensive frame of reference or. He had been given the opportunity to shape. Rochester. With the. Rochester’s Chair of Medicine William S.
Mc. Cann. Romano now had the chance to develop the training program that had been stymied. Cincinnati. He offered Engel an assistant professorship in the Department of. Psychiatry with a specific invitation to play a major role in Rochester’s “psychosomatic”. Mc. Cann offered George an assistant professorship in Medicine. This. time, Engel did not hesitate to join Romano.
In 1. 94. 7 Engel added a required course. Psychopathology” for second- year medical students, in which he offered. This course also. In the early fifties arrangements were made for Engel and his. Unlike other liaison programs, an important feature of Rochester’s was. He began his personal.
Sandor Feldman in August, 1. Uncle Manny, the role of his mother (Manny’s. But George did not absorb Alexandrian. In 1. 95. 3 he received a major research grant from the United States. Public Health Service and another from the Foundations’ Fund for Research in.
Psychiatry. In 1. American Psychosomatic.
Society. The Liaison Group had grown large enough to allow the redistribution of. With. a burst of energy, George undertook an ambitious new program of investigation. Monica” studies. Let’s focus on the latter.
Monica had been. born with a congenital atresia of the esophagus, which required that two. Monica was discharged from. But when her home situation changed drastically, she failed to thrive. Strong at fifteen. After. she was nursed back to health and during a protracted hospitalization, Engel and. Reichsman undertook a series of studies on Monica. They believed that they had.
Monica’s. behavioral responses, “object relationships,” and gastric secretory. Their access to Monica’s detailed case history and multiple.
In the first instance, Monica quickly lapsed into extreme. During the depression- withdrawal state. Monica’s hydrochloric acid production was markedly reduced and. During pleasure, it was just as markedly elevated. The. processes concerned in establishing mental representations of objects and their.
Most generally, they saw in Monica’s behavior evidence that “two. Monica’s reaction of. Their two most. notable presentations were on successive days in May, 1. American. Psychosomatic Society and the American Psychoanalytic Association. At the latter. meeting, their work was the focus of an all- day symposium, with panel. America’s leading psychoanalysts. One stated. that the study opened a new field of psychoanalytic research “through which.
Another noted that the Engel- Reichsman investigation “brings. A third reported. Journal of the Psychoanalytic Association, concluding that “surely. Engel and Reichsman (with the infant Monica) is and will remain a.
Generalizing from his Monica studies and. Engel soon led his colleagues in the Liaison. Group to a distinctive “Rochester style” of psychosomatic research.
He first. inspired William Greene, who in the early fifties had begun general, somewhat. In 1. 95. 4- 1. 95. Engel “to consider the dynamics of. After that experience, Greene summarized his. The occurrence of various.
These included. the loss of a significant person such as the mother, father, husband, or child. Half of such separations or losses during the 4- year. The. majority of patients showed an affect of sadness or hopelessness for weeks or. In 1. 95. 5 he began “a survey of the psychobiological. He. reported that “3. Within the psychosomatic.
Engel developed new theories of hysterical conversion phenomena and the. Alexandrian) psychosomatic orthodoxies of the day.