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January 2005

Teaching Science at Liberal Arts Institutions

Pioneering in the Field of Psycho-Oncology

Investigating Infections from Multiple Perspectives

Increasing Knowledge About Disease Processes

Research at the Nexus of Clinical and Developmental Psychology

Opening Up the Box

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Bryn Mawr College
A newsletter on research, teaching, management, policy making and leadership in Science and Technology

Pioneering in the Field of Psycho-Oncology
By Dorothy Wright

Tekla Harms
Marguerite Stein Lederberg '57
Photo by: Leo Sorel

Twenty-six years ago, Marguerite Stein Lederberg '57 joined the new Psychiatry Service at Memorial Sloan-Kettering Cancer Center, New York City, as an attending psychiatrist. Established by Jimmie C. Holland, M.D., a seminal figure in psycho-oncology as a subspecialty within oncology, the service's mission was to delineate and treat the poorly known psychological problems of cancer patients and their families.

"When I interviewed with Dr. Holland for the position, something clicked," Lederberg recalls. "It was a formative moment because I thought, 'This is it. This extraordinary woman is doing exactly the things that need to be done.'"

Today Lederberg is an attending psychiatrist in Memorial Sloan-Kettering's Department of Psychiatry and Behavioral Sciences, which has become the country's largest training-and-research program in psycho-oncology. She also serves as a clinical professor of psychiatry at Weill Medical College of Cornell University and an adjunct associate professor of psychiatry at Mount Sinai School of Medicine, also in New York City .

Pain and Suffering

Lederberg earned her medical degree in 1961 at Y ale Medical School, New Haven, Conn. She completed a pediatrics residency in 1964 and an ambulatory pediatrics fellowship in 1968 at Stanford University Hospital , Palo Alto , Calif.

"One thing that had struck me during my pediatric residency was the difference between pain and suffering," Lederberg recalls. "I saw pain that could not be helped, but there was also a lot of suffering — confusion, anxiety and uncertainty — among patients and families, which was being ignored. I felt that, as doctors, we should be helping."

As someone with back problems, Lederberg also had personal experience with pain and suffering and the lack of psychological support for patients dealing with illness. "It had a lot to do with my eventually going into psychiatry with physically ill people because my lumbar disk problems periodically gave me enormous pain, put me flat on my back and sidelined me completely," she says. "I thought a lot about what it did to my sense of self, even though I was fortunate to have support and to get better."

Not long after finishing her pediatric training, another debilitating back episode prompted Lederberg to take a position as director of the Office of Women's Affairs at Stanford Medical School , where she found that she had an aptitude for counseling. She returned to Stanford, completing a residency in psychiatry in 1977.

Observer, Therapist, Teacher

As a psycho-oncologist, Lederberg has wide-ranging interests and expertise, including psychosocial stresses experienced by cancer patients, their families and medical caregivers, bioethics and end-of-life decisions.

In her influential articles and book chapters, Lederberg synthesizes her clinical observations with research data from the psychiatric literature, often bringing background issues to the forefront. For example, in her chapter, "The Family of the Cancer Patient," in Handbook of Psycho-oncology: Psychological Care of the Patient with Cancer (New York: Oxford University Press, 1989), Lederberg detailed the unique and powerful effects of a loved one's cancer on family members, persuasively arguing for recognition of the family as "second-order patients" and for family therapy. In another chapter, "Psychological Problems of Staff and Their Management," she documented the psychological stresses on medical caregivers and outlined interventions to help them remain sensitive to their patients. Her article, "Making a Situational Diagnosis: Psychiatrists at the Interface of Psychiatry and Ethics in the Consultation-Liaison Setting" (Psychosomatics, July-August 1997), delineating the fine line between exercising psychiatric expertise and facilitating ethical decision-making, was awarded the 1997 Dorfman Journal Article Prize of the Academy of Psychosomatic Medicine. She is working on a new article on the psychological and ethical burdens on families, patient surrogates and doctors dealing with end-of-life decisions such as "do-not-resuscitate" orders.

Among her teaching activities, Lederberg has conducted seminars and workshops on psychological issues for medical students, physicians, nurses, psychiatrists and staff who work with cancer patients. A lecturer and adviser on ethics issues, she is active on a number of committees, including the Tri-Institutional Ethics Program Planning Committee of Memorial Sloan-Kettering, Rockefeller University and Cornell University Medical Center .

With numerous memberships in professional societies, Lederberg is a founding member of the International Psycho-Oncology Society and a distinguished fellow of the American Psychiatric Association.

Overcoming Defeatism

Over the years, Lederberg has confronted challenges common to psychiatrists working with oncology-treatment teams, including professional defeatism associated with patients' depression. "It is as if to say, 'Well, of course he or she is depressed; if I had cancer I'd be depressed, too.' So the depression goes untreated," she says. "One of our biggest messages as psycho-oncologists is this: Whatever else is going on, if you can make an accurate diagnosis of depression, it's treatable.

"I have treated people within months of their death, improving their depression so that they woke up in the morning able to feel some interest and potential for enjoyment in the day," Lederberg continues. "The cancer had not changed; in fact, it had progressed. But their attitude toward it had changed."

Lederberg believes the field of psycho-oncology has made significant progress toward its goals. "Dr. Holland and her colleagues have gone a long way in creating both an awareness of the suffering, and a process to recognize, diagnose and treat it," she says. "We don't have perfect answers. But we try."

 

Dorothy Wright contributes news and feature articles on science, technology, engineering and general-interest topics to a variety of publications, including Civil Engineering and Engineering News Record.

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