By Kyla Dunn

Caring for the Whole Person

Thirty years ago, psychiatrist Jimmie Holland started a revolution around an idea: Health professionals need to treat the painful emotions associated with cancer, not just the disease

By Kyla Dunn

Psychiatrist Stewart Fleishman, who trained at Memorial Sloan-Kettering from 1984 to 1986, and is now the director of cancer supportive services at Continuum Cancer Centers of New York, in New York City, saw the impact of Holland’s message first-hand. “The family would be saying, ‘You’ve got to be tough. You’ve got to be happy. I’m going to make you happy even if it makes you miserable!’ ” Fleishman recalls. “She would come and say, ‘Just be.’ It gave patients a sense of relief that was amazing.” He and the other psychiatric fellows training at the hospital would joke that Holland seemed to wave a magic wand around the room, making everything wonderful. (Holland, in response, gave magic wands to the fellows when they graduated.)

Under Holland’s leadership, Memorial Sloan-Kettering’s psychiatry service grew into the country’s largest training and research program devoted to psycho-oncology. She meanwhile created institutions to carry the field forward, including the International Psycho-Oncology Society, in 1984, and the American Psychosocial Oncology Society, in 1986. She was also a co-founder of the field’s flagship journal, Psycho-Oncology, in 1992. “She’s someone who likes to build things and see them grow,” says Marguerite Lederberg, a psychiatrist at Memorial Sloan-Kettering and Holland’s friend and colleague for almost 30 years. “There certainly have been a few other pioneers, but she has been able to create organizations that will carry the work on into the future.” When it came time to give this new field a name, Lederberg recalls, Holland championed the term “psycho-oncology” (as opposed to, say, “onco-psychiatry”)—precisely because it was general enough to welcome other professionals: the psychologists, nurses, social workers and chaplains whose involvement in a patient’s care is so crucial.

Holland now believes the field’s next challenge will be applying knowledge to practice. “We know a lot about how people cope with illness now,” Holland explains, “but it’s not really brought to bear on patient care.” One major barrier is lack of funding. Another, she says, is the stigma attached to mental health problems, even in the context of medical illness. As a result, she says, “People are reluctant to say they need help.” Holland recently worked on a tool to change that. The “Distress Thermometer” is a cartoon thermometer, on which patients mark their level of distress as if it were the rising mercury. (The scale goes from zero to 10.) They then indicate, in a series of check-boxes, the issues with which they most need help. The deceptively simple tool, says Lederberg, is a product of Holland’s years of experience and reflection: “That’s one of the things I admire about her. Some intellectuals require the trappings of complexity. She doesn’t. If something strikes her as necessary, and it’s quite straightforward, she just goes right for it—and it usually turns out to be very fruitful.”

Recently, Holland was part of a committee that helped the prestigious Institute of Medicine, of which she is a member, set a new and important standard: Every cancer patient must be screened and treated for psychological and social needs. After 30 years, the idea is finally becoming mainstream. “We’re saying it must be done as a part of routine quality cancer care,” she explains. “You can’t just treat the tumor. You have to treat the whole person.”