George Libman Engel: On the Occasion of His
Retirement
ROBERT ADER, PHD AND ARTHUR H. SCHMALE, JR., MD
themselves. George was a major in
chemistry and undertook some extra efforts to synthesize some chemiluminescent compounds. In the summer of 1933,
he began work at the Marine Biological
Laboratory, Woods Hole, Massachusetts,
with Ralph Gerard, then Professor of
Physiology at the University of Chicago.
Two summers' work yielded his first two
publications, which appeared in the/ournal of Biological Chemistry (1, 2).
The Woods Hole experience was an
extraordinarily stimulating one because of
the presence of many of the notable figures of physiology and biology of the day
whose lectures and seminars George avidly attended. During the second summer,
Gerard was on sabbatical leave in Europe
so George had the experience and opportunity of working entirely by himself and
succeeding. He learned the discipline and
the satisfaction of painstakingly repeating
experiments and the importance of
searching the literature. He also learned
that his mentor, the leading American authority on nerve metabolism, could be
wrong. On one occasion his results contradicted Gerard's hypothesis. Gerard required him to repeat the study and, during
the second summer, he was able to replicate his own findings to Gerard's satisfaction.
About this same time
great
excitement—and no little skepticism—
had been generated by the claim of a
From the Department of Psychiatry, Strong Memo- Russian biologist, Alexander Gurwitsch,
rial Hospital, Rochester, New York.
that living tissues emitted rays in the
Address requests for reprints to: Dr. Robert Ader,
Department of Psychiatry, Strong Memorial Hospi- ultraviolet range (1900-2600A) that had
tal, Rochester, NY 14620.
the property of inducing mitosis, hence
The family environment strongly influenced George Engel and his two brothers
to aspire to research achievement. A selfeducated grandfather who placed a high
premium on literacy and scholarship introduced them to the classics and inculcated a curiosity about nature. His parents
highly valued intellectual achievement.
Most important, however, was an uncle,
Emanual Libman, a physician of worldwide renown, in whose house he lived.
Emanual Libman, an intimate of many of
the great medical figures of the day,
exemplified the scientific physician who
successfully combined clinical practice
and laboratory research. He had a profound impact on George and his brothers,
all of whom aspired to emulate the high
scientific and clinical standards he had
set.
George and his twin brother, Frank,
early constituted themselves a "research"
team. In 1932, while undergraduates at
Dartmouth College they got permission
from the biology department to set up a
small laboratory to study the behavior of
amoebae and paramecia. This was an effort to duplicate some of the work of
Jacques Loeb and H. S. Jennings, which
George had read during a psychology
course. Nothing significant emerged, but
they learned a great deal working by
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
Copyright © 1980 by the American Psychosomatic Society, Inc
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52 Vanderbilt Ave., New York, NY 10017
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ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
called mitogenetic rays. By the mid19308, Gurwitsch was claiming that these
rays accurately reflected exothermic
chemical processes in living tissues and
hence provided a new and highly sensitive tool for the study of cellular metabolism. Ralph Gerard was commissioned by
the Rockefeller Foundation to visit Gurwitsch's laboratory in Leningrad and
make a recommendation concerning support of research in this area in the United
States. Gerard recommended that "a
bright young scientist" spend a couple of
months in the Leningrad laboratory before
any serious investment be made in this
research. He recommended that George
undertake this task. George and Frank
were then first year medical students at
Johns Hopkins University. George's condition for making the trip was that his
twin brother Frank accompany him. This
was accepted, and the summer of 1935
was spent at the All-Union Institute of
Experimental Medicine in Leningrad. His
project was to investigate the mitogenic
radiation of nerve on proprioceptive
stimulation. George was captivated by the
excitement as well as the intrigue of that
period at the Institute, a sprawling cdmpound on the outskirts of the city that
included Pavlov's laboratories and his
famous silent tower. In addition to Pavlov,
the most renowned of prerevolutionary
Russian physiologists and medical scientists were active workers in the Institute,
including Orbeli, Bykov, London, and Antischkow.
The experience in the laboratory was
fascinating but not conclusive, at least as
far as resolving the question by the Rockefeller Foundation. The Engels' main
contribution was to translate one of Gurwitsch's books (189) from Russian into
English. This was a complex process that
involved Gurwitsch reading aloud each
80
sentence in Russian, his wife orally repeating it in German, and his daughter
writing it down in French, which they
then translated into English.
The summer of 1935 also was the occasion of the XV International Physiological
Congress, which was held in Leningrad
and Moscow over a 2-week period. Because of the tremendous interest and
curiosity about Gurwitsch's work and because they were the only people in the
laboratory fluent in English, it fell upon
George and Frank to show visiting dignitaries around the laboratory and discuss
methods and concepts. Pretty heavy stuff
for a couple of first year medical students,
especially when visitors numbered current and future Nobel laureates: A.V. Hill
of London, Herbert Gasser of the Rockefeller, Charles Best of Toronto, Albert Szent
Gyorgy of Budapest, and Severo Ochoa,
then of Madrid, not to mention several of
the physiology instructors from Hopkins.
By this time, Lewis, George's older
brother (1909-78), had been awarded his
PhD in biochemistry by Columbia University and was beginning postdoctoral
studies with the pioneer steroid chemists
of Zurich and London.* George and Frank
were dutifully keeping their uncle
Emanual Libman informed of what they
were doing although not a little aprehensive that he would disapprove of what
they had worked out on their own during
the past three summers. In any event, it
was Libman who arranged the next summer, 1936, for George and Frank to work
with Harrison Martland, the noted
pathologist and medical examiner, who
*Lewis did pioneer work himself on steroid
chemistry at Johns Hopkins and became professor
and chairman of the Department of Biological
Chemistry at the Harvard Medical School.
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
had gained fame by being the first to
demonstrate the delayed lethal consequences of ingestion of radioactive materials through his study of luminescent
watch dial painters who succumbed to
leukemia or bone sarcoma years later.
Martland, the medical examiner of Essex
County, New Jersey, was a detective at
heart and set the future standards for
forensic pathology. He was particularly
expert at detecting signs of foul play. He
insisted on considering each death a medical legal case and autopsied every
cadaver about which there was even the
slightest question of the causes of death.
He scorned the use of rubber gloves in the
autopsy room as depriving the pathologist
of information he could learn from his
finger tips. That summer George assisted
or performed himself one, sometimes two,
autopsies a day, the emphasis being on
the gross rather than the microscopic material. A significant number of subjects
were victims of homicide and accidental
death, and he had an incredible opportunity to compare, virtually side by side, the
gross findings in such victims with those
dying of disease. Sometimes as many as
four autopsies were being performed
simultaneously in one large room, so over
that summer George viewed more than
300 autopsies. The record number for a
day was 13 (the occasion being the recovery from the Passaic River of a concretebooted gangland figure, news of which
was promptly followed by retaliative
shootings). This experience fixed indelibly in George's mind gross anatomy and
pathology and provided a sound basis for
clinical reasoning that he has called upon
ever since. In addition to the "routine"
work of the summer, George also did a
literature survey to establish the validity
of the association between polycystic kidneys and berry aneurysms of the Circle of
Willis, which was stimulated by Martland
encountering several such cases at the
autopsy table. Evenings and many
weekends were spent at the magnificent
library of the New York Academy of
Medicine. Out of that experience came
George's habit of visiting the medical library daily to scan the contents of newly
arrived journals. He still does this via Current Contents, but can now turn over to a
secretary the chore of indexing and sending for reprints.
By the time George began working with
patients during the last 2 years of medical
school, he was thoroughly imbued with
the importance of the scientific method.
At that time he was much more interested
in disease processes than in the patient.
He regarded each patient as an experiment of nature and was determined to
apply the same rigor and thoroughness to
the study of the case that he had learned
in his research endeavors during the preceding years. Further, he tried to emulate
Libman who was famous for picking up
information or physical findings that
others had missed and that often led to the
correct diagnosis. Hence, George cultivated extraordinary sensitivity in eliciting
the history and in performing the physical
examination as well as in studying laboratory material that in those days was done
by students and not by a technician. This
combination of commitment to scientific
method and fierce rivalry with Libman
was ideally suited to engender intense
ambivalent feelings among classmates
and teachers alike. For George to "instruct" the Chairman of the Department of
Medicine in the significance of phagocytic macrophages in the blood smear taken
from the earlobe, but not from the finger,
for the diagnosis of subacute bacterial
endocarditis (SBE), must have been pretty
hard to take (Libman at that time was the
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
81
ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
world's leading authority on SBE). And
two Engels at that, for his twin Frank was
doing quite the same. At the Boston City
Hospital during the summer of 1937,
Frank astonished the staff by correctly
diagnosing malaria in a derelict who had
not been outside of Boston's skid row. He
must have been a drug addict, a "mainline
shooter," who picked up the infection
from a sailor, a phenomenon not yet recognized. And it was George, the same
summer, who identified trichinosis as the
explanation of the illness of three patients
admitted over the span of a couple of
days; they were the chef and two waitresses from a restaurant across the street from
the hospital where many of the staff and
students took their lunch!
The Boston City Hospital experience in
the summer after George's third year of
medical school was especially important
because it was there that he came under
the influence of Soma Weiss. Weiss was
the first physician he encountered who
was able to combine in his study of the
patient clinical data and physiological
measurements, most of which were obtained at the bedside rather than in a
laboratory. This impressed George as the
next step beyond the more traditional
clinical pathological correlations made in
the autopsy room, and he was determined
to follow in Weiss' footsteps and
eventually work with him. Beginning during his fourth year in medical school and
continuing through the two-and-a-half
years of rotating internship at Mt. Sinai
Hospital in New York, George discovered
for himself how many fascinating research problems could be identified and
studied at the bedside with little more
than one's diagnostic acumen and the
instruments carried in one's pocket. By
the time he had finished his internship, he
had already presented three papers to the
82
New York Neurological Society and had
six papers in press (3-5, 152-153).
In anticipation of getting back to Boston
to work with Soma Weiss, George began
to keep a list of research problems to
pursue once he got into a full-time research setting. In light of subsequent developments, this list now makes interesting reading:
1) Mechanisms of fainting
2) Characterization of forms of
polyserositis
3) Menstrual edema and sex hormones
4) Porphyrins in neuropathies spastic
and colicky conditions of the GI tract,
radiation sickness, and sulfanilamide
toxicity.
5) Effect of sodium chloride on blood
pressure in Cushing's syndrome
6) Effects of methylene blue on toxic
symptoms of sulfa drugs
7) Effects of desoxycorticosterone
(DOCA) on carotid sinus hypotension
8) Differential effect on pain hypoand hypersensitive individuals (by
Libman test) on injection of saline into
spinous ligaments
9) Unexplained fever following removal of adrenal tumors in Cushing's
syndrome
10) Effect of paredrinol on hypertension
11) Influence of blood sugar levels on
degree of movements in Syndenham's
chorea
12) Central nervous system involvement in Addison's disease
13) EEG abnormalities in medical conditions, especially with patients with
neuropsychiatric manifestations
14) Effect of blood glucose levels on the
EEG
15) Renal function and primary hyperparathyroidism
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
16) Carotid sinus reflex hypersensitivity of the vagal type as a diagnostic aid
in identifying acute myocarditis in
rheumatic fever
17) Vagal type carotid sinus hypersensitivity as an indicator of digitalis toxicity
18) Vagal carotid sinus hypersensitivity as an indicator of conduction defects
in acute myocardial infarction
19) Desoxycorticosterone edema as a
diagnostic aid in Addison's disease
20) Effects of renal insufficiency on
blood levels of sulfa drugs
21) Alterations in carbohydrate metabolism in relation to premenstrual carbohydrate appetite
22) Possible role of carotid sinus or
body in the pathogenesis of paroxysmal
dyspnoea
23) Clinical diagnosis of lupus
erythematosus disseminatus
24) The occurrence and significance of
lymph node involvement in lupus
erythematosus disseminatus
25) Effects of hyperventilation
These were the early events that influenced George's professional career. Patently, the philosophy and pattern of his
approach to clinical research, for example, was already well established by 1941.
The fellowship at the Peter Bent Brigham
Hospital (1941-1942) marked the beginning of his formal research career. It also
marked the beginning of his teaching
career. These began and continue as inseparable parts of George's professional
activities. Before describing George's
specific contributions, some reference
should be made to certain other professional experiences that were important in
shaping his interests.
George began teaching "Physical Diagnosis" to Harvard medical students when
he returned to the Brigham and he has
continued as a teacher of clinical methods
ever since. He had been particularly eager
to return to Boston because of the opportunity it would afford to work with Soma
Weiss. It was with some reluctance, then,
that George followed Weiss' suggestion to
work with John Romano, a psychiatrist.
Shortly thereafter, Romano was appointed
Professor of Psychiatry in Cincinnati. At
first, George declined a position in
psychiatry in Cincinnati. However, a
meeting with Eugene Ferris resulted in an
invitation to join the Department of
Medicine at Cincinnati, which George accepted. He also accepted John Romano's
invitation of an appointment in
Psychiatry and, by this circuitous route,
became, in his own words, an "illicit
psychiatrist." Besides serving as the medical consultant to the psychiatric service,
George periodically functioned as the
rounding man in neurology. For a time, he
was also responsible for the clinical
pathological conferences. This included
selecting the cases, preparing the protocols, reviewing the material with the
pathologist, and conducting the weekly
conferences—in the morning with fourth
year medical students and in the afternoon with faculty.
The years between 1942 and 1946 at
Cincinnati were among the most formative in George's career. He was associated
with an extraordinary group of teachers
and scientists including Arthur Mirsky
and Gene Ferris in Medicine; John
Romano, Milton Rosenbaum, and Maurice
Levine in Psychiatry; Charles Aring in
Neurology; Albert Sabin, Sam Rappaport,
Ashley Weech, and George Guest in Pediatrics. This small, intimate group worked
together in teaching and in research, and
it was in this setting that George's penchant for diversification was realized. It
was also in this setting that George gradu-
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ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
ally developed his awareness of psychological factors in medicine.
When, in 1946, John Romano came to
Rochester to establish the Department of
Psychiatry, George accompanied him as
Assistant Professor of Psychiatry and
Medicine. There were several factors that
entered into the decision to move to
Rochester, the most salient of which were
probably related to George's ideas about
teaching. He was, for example, influenced
by the nature of the psychosomatic conferences that were held in Cincinnati.
These conferences, aside from the impact
of their substantive content, seemed to
communicate to students that they were
being expected to do what it took an
internist and/or neurologist and/or psychiatrist to do. George was convinced that
the psychosomatic perspective could be
communicated and modeled by a single
individual and was eager to evolve more
effective teaching approaches. He had,
besides, become very attached to John
Romano as a person and as a dynamic and
exciting teacher who had the capacity to
interest and involve people. George had
these same qualities, which he applied to
undergraduate medical student teaching
and to his development of the postdoctoral Medical-Psychiatric Liaison training
program. These qualities were equally
evident to faculty and reflected in
George's leadership of the "SeparationDepression" conferences and the Department of Psychiatry Research Conferences,
which were settings for the broad exchange of knowledge as well as the development of new ideas and concepts.
Inevitably, George's commitment to teaching resulted in his serving on teaching
and curriculum committees of both the
Department of Psychiatry and of
Medicine, as well as of the medical
school.
84
Although George became interested in
psychoanalysis while still in Cincinnati, it
was not until he came to Rochester that he
undertook psychoanalytic training. He
began analysis with Sandor Feldman in
Rochester and later began traveling to
New York and then Chicago for his training. George did get through his Boards in
Psychiatry; according to George, he bluffed his way through. He did not indicate
that he had had a residency in psychiatry,
but did note that he had been an Instructor
and Assistant Professor of Psychiatry at
Cincinnati and then at Rochester. The lack
of residency training was apparently overlooked. George's new found interest in
psychiatry did not diminish his involvement with issues in clinical medicine. He
continued to attend with students and
house staff on the medical floors and
regularly attended the meetings of the
Society for Clinical Investigation and the
Association of American Physicians. Although he was a member of several professional groups, George was not generally an active participant—with the single
exception of the American Psychosomatic
Society of which he was President in
1954.
George Engel has been an extremely
productive researcher and a prolific author whose publications span an extraordinarily broad sampling of the medical
sciences. Only a brief description of some
of the subjects that occupied his attention
can be mentioned.
While John Romano had devoted several years to delineating the clinical features of delirium as a clinical syndrome,
George had been making observations on
abnormalities in the EEG among medically sick patients, ignorant of the fact that
many of these patients were in fact delirious. Working together they published a
series of papers (27-29, 36, 46, 53, 58, 66,
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
86) that demonstrated that the degree of
diffuse slowing of EEG correlated well
with the magnitude of the identifying
clinical expression of delirium, namely
reduction in the level of awareness and
impairment of cognitive performance.
They were able to show that with improvement, whether spontaneous or
brought about by specific therapeutic
means, there was a progressive normalization of EEG that corresponded with improvement in the mental status of their
patients. Experimenting with healthy
volunteers, identical EEG and mental status changes were induced with hypoxia,
hypoglycemia, and alcohol. After 35
years, this work continues to be quoted as
the definitive references on the subject of
delirium. However, as was true at the time
of the study, delirium continues to be a
stepchild in medicine, frequently remaining unrecognized or misdiagnosed.
As one who was, himself, extremely
susceptible to vasodepressor syncope in
his younger days, interest in studying the
subject was actively generated in the
summer of 1937 in the course of George's
contacts with Soma Weiss, at that time the
leading authority on the subject. Thereafter, carotid sinus stimulation and measurement of pulse and blood pressure in
the recumbent, sitting, and standing positions became part of George's routine
physical examination; he took meticulous
histories of all subjects who reported having had episodes of fainting in their lives.
In 1939, with Margolin and Strauss, an
EEG was for the first time performed during syncope (151), which, in this instance,
involved an asystole induced by carotid
sinus stimulation. Over the next 10 years
studies of fainting were carried out with
various colleagues, notably John Romano
and Eugene Ferris (6, 25, 37, 43, 60-63,
89). The paper on differentation between
vasodepressor and hysterical fainting (37)
was cited as one of fourteen classic papers
published during the first 25 years of
Psychosomatic Medicine. The work on
fainting was brought together in a monograph (190) published in 1950, with a
second edition in 1962, which continues
to be a standard reference.
Under contract with the Committee on
Aviation Medicine of the National Research Council, a research team headed by
Eugene Ferris in Cincinnati was one of
several groups during World War II
charged with developing means of preventing high altitude decompression
sickness, a problem anticipated among air
crews as planes succeeded in reaching altitudes of over 20,000 feet. Over a 2 year
period (1942—44), 18 classified reports
were submitted to the Committee on Aviation Medicine. The notable accomplishment of this research was the successful
application of clinical observation as a
sound method for laboratory research (54,
200). Eliciting the story of illness and
making careful clinical observations of
volunteers developing decompression
sickness in the high altitude chamber, the
Cincinnati group succeeded in delineating the clinical syndrome and in
demonstrating significant behavioral
factors influencing susceptibility to the
disorder. For example, putting joints
under strain, as with deep knee-bending,
virtually assured the development of
painful bends in the joint so treated. This
helped bring under control a number of
variables that heretofore had interfered
with successful testing of means of preventing decompression sickness. Once it
became possible to induce bends at will in
a joint of choice, more definitive studies
of mechanisms could be undertaken. Thus
it became possible to show that the pain of
bends was not produced by intravascular
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ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
bubbles or bubbles within the joint, but by pain centers by pain fibers and pain
bubbles located at the insertion of the tracts—the telephone model. The model
allowed for no way of conceptualizing
tendons.
The discovery of a syndrome charac- pain other than as arising from a periphterized by transient focal neurological eral site. The psychological components
signs followed by contralateral headache of pain were discussed in terms of "indiclincially indistinguishable from mi- vidual reactions to pain." The term "cengraine occurring after decompression tral pain" referred to pain thought to arise
sickness provided an opportunity to carry from thalamic lesions. George's approach
out physiological studies preceding and challenged the basic model as reducduring attacks (30, 39). This yielded the tionistic, pointing out that pain, a subjecfirst EEG demonstration of focal slowing tive experience, is already a psychological
during the neurological manifestations frame of reference that cannot be applied
and documented its dependence on al- to structures such as nerve endings or
tered blood flow. During the vasodilating pathways. This viewpoint made it possieffects of breathing carbon dioxide, the ble to understand the occurrence of pain
neurological manifestations receded in a syndromes not based on concurrent somamatter of a minute or two to be replaced tic pathological processes. A pain-prone
by the contralateral headache, only to re- population was identified and its psychoturn when breathing CO2. Subsequently, social characteristics delineated. Particuit was possible to extend observations to larly important was the demonstrated resubjects during spontaneous migraine at- lationship of pain as a symptom to unresolved problems of aggression, guilt,
tacks (70).
Charles Aring and George Engel re- atonement, the need to suffer, and psychic
ported the first detailed clinical and sadomasochism. The relatively common
pathological
study
of
familial occurrence of pain as a conversion
dysautonomia (Riley-Day syndrome) in a symptom in all varieties of patients and
17-year-old boy (44, 45). An old lesion the role of pain as a defense mechanism
involving the right dorsomedial nucleus against depression and suicide were
of the thalamus led them to invoke de- documented. These observations (65, 71,
rangement of higher control of 85, 88, 97, 216, 242) have been repeatedly
hypothalamic function as the explanation. confirmed and extended by others.
The importance of psychological facSubsequent cases have not revealed any
such lesions, suggesting that the finding tors in ulcerative colitis was brought vividly to George's attention as an intern
in this case was incidental.
Studies of patients with unexplained with Eli Moschowitz, the chief of the
pain began in 1944 with a group diag- medical service on which he served. Even
nosed by the neurologists and neurosur- though an active interest in psychosomageons as "atypical facial neuralgia." Sub- tic issues was not to develop for several
sequently, these observations were ex- more years, this was one group of patients
panded to involve a population without among whom George always made a point
regard to location of the pain. At that time, to inquire, at least superficially, about
the dominant theory of pain regarded pain emotional factors. When years later
as a peripheral sensation mediated by George reviewed his discharge summaries
pain receptors and transmitted to higher on ulcerative colitis patients from his Mt.
86
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: ON HIS RETIREMENT
Sinai days, he was surprised to discover
useful clinical data that he could incorporate in later writings. Franz Alexander's
specificity concept was the stimulus that
prompted him to select ulcerative colitis
as a "classical psychosomatic disorder"
for study, beginning in 1945. Over the
next 10 years or so, George undertook the
care and study of as many colitis patients
as he could handle. Some he cared for as a
primary internist; with others he undertook
psychotherapy
and/or
psychoanalysis, with another physician
assuming primary medical care; many
more were seen in consultation. George's
objective was to learn as much as he could
about the personality, psychological development, family relationships, and the
circumstances surrounding the onset, remission, and the exacerbations of the active disease (73-75). He was interested in
studying a relatively large number of patients briefly and a smaller number intesively over years. The research was an
integral part of his practice, the data consisting of the detailed handwritten notes
he made of every visit with each patient. It
depended upon no outside funding. Only
after 6 years of data collection did George
begin the systematic examination of the
material that had accumulated, looking
for trends or themes, some of which were
then further explored with new patients.
George speaks with nostalgia about being
able to pursue clinical research in this
fashion—without the constraints of Review Boards and "quick results" in order
to ensure continuation of funding. He was
spared the errors of premature conclusions and was able to follow the material
wherever it took him, sometimes with
unexpected results; for example, the discovery that the end of an acute attack of
ulcerative colitis may be heralded by the
onset of headaches (78). The results of
these studies (82, 84, 95, 133, 184, 227,
239) have stood the test of time. Contrary
to Alexander's formulation, George and
his colleagues were able to show that the
disease was not primarily a disorder of
elimination but, rather a process involving first the mucosa and submucosa with
clinical manifestations consequent to that,
bleeding in particular. The significance of
object loss for onset and exacerbations
was first delineated in this group of patients as was vulnerability to loss related
to distinctive features of the early
mother-child relationship. Practical recommendations for the psychological care
of these patients emerged from literally
hundreds of incidents and experiences
involving other physicians and nursing
staff as well as George himself.
Interest in conversion as a mechanism
of symptom formation began with
George's studies of fainting in the early
1940s (37). Later studies (65, 67, 88, 105,
112) addressed particularly the high incidence of pain as a conversion symptom in
clinical practice and the possible significance of the conversion mechanism for
determining the site and timing of organic
lesions, especially those involving skin
and joints. The chapter in the textbook of
McBryde and Blacklow (218) was the first
treatment in depth of the subject since
reference to conversion (hysteria)
dropped out of textbooks of medicine in
the early part of the century.
Efforts to develop a broader, more inclusive concept of disease than was provided by the prevailing dualistic, reductionistic biomedical model were initiated
with a presentation on the occasion of the
dedication of the Institute for
Psychosomatic and Psychiatric Research
and Training of the Michael Reese Hospital on June 1, 1951 (201). Successive revisions and elaborations of the model ap-
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
87
ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
peared from time to time thereafter (72,
93, 94, 108, 135, 140, 192, 206), culminating in the current formulations of the
biopsychosocial model (142, 147).
With Franz Reichsman, George undertook several studies of behavior and
gastric secretion (76, 80, 92). These
studies led to the classic longitudinal
study of the developmental consequences
of trauma in infancy (the studies of
Monica and Doris) (e.g., 79, 83, 106, 118,
149, 175, 275). An ongoing project since
1953, the study of Monica, a child with a
gastric fistula, has yielded a rich harvest
of developmental and psychological information about Monica and her family,
only a fraction of which has yet appeared
in print. Over the years there have been a
total of 196 invited presentations around
the world, including 13 name lectures, by
members of the research team.
The discovery of conservation-withdrawal as a phenomenon, and its formulation as a basic concept, was a direct outcome of observation of Monica's remarkable detached withdrawal and sleep response to a stranger and its striking contrast to the more familiar active alerting
fear response ("stranger anxiety") characteristic of the 1-2 year old (79, 98, 124,
207). At first designated "depression
withdrawal," this was changed to
conservation-withdrawal to eliminate the
confusion resulting from mixing frames of
reference. As a primary biological regulatory process for organismic homeostasis, conservation-withdrawal can be
considered from phylogenetic and ontogenetic perspectives and its expression
at progressively higher levels of biopsychosocial organization identified as
"giving up" (224, 232). The psychic derivatives of this regulatory process and
their importance for health and disease
88
have been elaborated by Arthur Schmale
and George.
There were still other research questions on psychological processes in somatic disease shared with
Sandy
Meyerowitz, Arthur Schmale, and Robert
Ader (e.g., 119, 123, 135): in sudden
death, an interest in common with his
colleague William Greene (120, 125, 148);
and in grief and mourning (102, 137, 228),
among others that drew George's attention. Also, over the years George has never
hesitated to report himself as the result of
scientific study. Thus he appears as one of
the cases of migraine studied with EEG
(30), cerebral carotid sinus syncope (89),
vasodepressor syncope (190), hyperventilation (61), and variations in the normal
EEG over 5 years (55). Particular interest
was generated by his 10 year self-analysis
of his reactions to the death of his twin
brother (137).* Besides these, George's
published contributions include an impressive number of statements on clinical
teaching (81, 109, 121, 128, 129, 138, 193,
197) and on issues of medical education
(117, 122, 126, 127, 130, 131, 134, 136,
140, 143, 146, 147, 243, 250).
From the very beginning George considered himself, first, a teacher. Through
the years he has worked with medical
students on every clinical service;
medicine, pediatrics, surgery, ob-gyn,
psychiatry, neurology, CCU, IC, burn unit,
rehabilitation, family medicine, and primary care. His main emphasis has been on
the development of clinical skills (interviewing and physical examination) (193,
197) and, in an effort to understand the
*Frank, who was Professor of Medicine and
Physiology at Duke University School of Medicine,
died in 1963.
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
patient as well as the illness, on clinical
problem solving, an area (rarely taught
nowadays) in which George excels. In
this, he has been remarkably successful.
George has received numerous honors
and awards including visiting professorships that attest to his eminence in the
variety of fields in which he has worked; a
Career Research Award from the USPHS
that began in 1962; Franz Alexander
Award in 1962, the Helen Ross Lectureship
in 1974, and the First Therese Benedek
Memorial Lectureship in 1978 from the
Chicago Psychoanalytic Society; the Paul
Beeson Visiting Professorship of
Medicine at Yale in 1967, the Jacobi
Medal for "Distinguished Contributions
to Medicine" from Mt. Sinai Hospital in
1972, the William Menninger Award of
the American College of Physicians in
1968, and the John S. Lawrence Visiting
Professorship of Medicine at UCLA in
1975 (internal medicine); the fourth
Samuel Novey Lectureship in Psychological Medicine at Johns Hopkins in 1976;
the First Annual Edward Weiss Lectureship at Temple in 1975 (psychosomatic
medicine); the Gold Medal Award of the
University of Rochester in 1972; and the
23rd Cartwright Lectureship and Medalist
at Columbia University in 1977 (medical
education); and, most recently, the Vestermark Award in 1979 from the American Psychiatric Association. The Alpha
Omega Alpha Honor Medical Society designated George a Leader of American
Medicine, and he received the Modern
Medicine Award for Distinguished
Achievement exactly 40 years after his
uncle Emanual Libman was similarly
honored. Of these, George takes most
pride in the dozen or so lectures and
Visiting Professorships sponsored by the
AOA and other student societies because
these are distinctions bestowed by students.
As a person, George has distingusihed
himself in many other ways. Among them
is his great ability to "shift gears" very
quickly, going from one endeavor to a
very different one; his propensity for
going to the very heart of a matter in many
areas; and, last, but not least, his great
sense of humor and his wittiness, which
not only make him a master of the quick,
humorous reparte but also a superb
storyteller.* Along with his very timeconsuming professional activities he has
been a fine pater familias: to his wife
Evelyn who is a medical illustrator,
painter, and teacher of painting and a
superb cook; and to his children Peter and
Betty, who are a physician and conservator of art objects, respectively.
Students who have had specific and
ongoing contact with George through a
preclinical year of weekly sessions on
psychological development in health and
disease, a weekly clinical round as third
year medical clerks, or elective summer
clinical clerkships or research fellowships
number in the thousands. His more advanced students have participated in the
postresidency
Medical-Psychiatric
Liaison Fellowship Program. This program, established in 1946 under the joint
sponsorship of William McCann, Chairman of the Department of Medicine, and
John Romano, Chairman of the Department of Psychiatry, with George as its
Director, has been devoted to the development of educational and research
*Also, George must hold the record for creating
the most "doodles" during conferences. These have
been carefully preserved and are presented to colleagues, friends, and students on special occasions.
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
89
ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
programs in the psychosocial aspects of
illness and patient care directed to physicians who have completed residency
training in medicine, obstetricsgynecology, pediatrics, or psychiatry. As
a complement to Consultation (or Liaison)
Psychiatry, which aims to qualify psychiatrists to provide consultation and collaboration around clinical, educational, and
research issues with nonpsychiatric colleagues, the Medical-Psychiatric Liaison
Program has concentrated on the qualification of nonpsychiatric physicians in the
psychosocial dimensions of their parent
disciplines. The involvement and size of
the Liaison faculty has mushroomed over
the years as the medical school, clinical
departments, clinical services, subspecialty groups, and community hospitals
and health centers have requested help in
exposing their trainees to the Group's
psychosocial teaching. The faculty has
numbered between 10 and 16 over the
past 10 years and exists as a Unit in
Medicine and as a Division in Psychiatry
and in Obstetrics and Gynecology.
In the past 33 years, 125 physicians
have completed training in the Medical
Psychiatric Liaison Fellowship Program.
About half this group has gone on to full
academic careers, while the other half has
combined teaching responsibilities with
practice. George's philosophy of learning
and investigation at the bedside continues
to be the mainstay of the Group's training
and role modeling. Teaching is done with
the patient and the patient's story of illness. The physician learns how much of
what he does is effective because he (his
personality) is the instrument for whatever change occurs.
As it happens, we have had the privilege of reading some of the letters that
former students sent to George on the
occasion of his retirement celebration. We
can do no better in describing George's
influence on his students than to paraphrase the common thread in all these
letters to the effect that "No one individual, no one teacher, no one segment of
the education curriculum had a greater
impact on my development as a physician
and as a person than George Engel and his
program at Rochester."
The students who have yet to come
under George's influence are to be envied,
and we know that he will continue to
expand his sphere of influence as his
career continues.
REFERENCES
6.
90
Engel GL, Chao I: The comparative distribution of organic phosphorus compounds in the cardiac and
striated muscles of limulus polyphemus. J Biol Chem 108:389-393, 1935
Engel GL, Gerard RW: The phosphorus metabolism of invertebrate nerve. J Biol Chem 112:379-392,
1935
Engel GL, Margolin SG: Neuropsychiatric disturbances in internal disease: Metabolic factors and
electroencephalographic correlations. Arch Intern Med 70:236-259, 1942
Engel GL, Engel FL: The significance of the cartoid sinus reflex in biliary tract disease. N Engl J Med
227:470-474, 1942
Engel FL, Mencher WH, Engel GL: "Epinephrine shock" as a manifestation of a pheochromocytoma of
the adrenal medulla. Am J Med Sci 204:649-661, 1942
Engel GL, Romano J, Webb JP, Ferris EB, Ryder HW, Blankenhorn MA: Syncopal reactions during
simulated exposure to high altitude in decompression chamber. War Med 4:475-489, 1943
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
7. Ryder HW, Engel GL, Stevens CD, Ferris EB: The effect of carbonmonoxide hemoglobinemia of approximately 20% on the cerebral blood flow, gas exchange and electroencephalogram in human
beings. National Research Council CMR Committee on Aviation Medicine Report #95, 1942
8. Ryder HW, Engel GL, Romano J, Webb JP, Blankenhorn MA, Ferris EB, Brown WE: An assay of
dextro-amphetamine for its protective value in decompression sickness. National Research Council
CMR Committee on Aviation Medicine Report #112, 1943
9. Ferris EB, Webb JP, Ryder HW, Engel GL, Romano J, Blankenhorn MA: The importance of straining
movements in electing the site of the bends. National Research Council CMR Committee on Aviation
Medicine Report #121, 1943
10. Ferris EB, Webb JP, Ryder HW, Engel GL, Romano J, Blankenhorn MA: The influence of physical
activity and physical relaxation on susceptibility to decompression sickness. National Research Council CMR Committee on Aviation Medicine Report #126, 1943
11. Ferris EB, Webb JP, Ryder HW, Engel GL, Romano J, Blankenhorn MA: The protective value of
preflight oxygen inhalation at rest against decompression sickness. National Research Council CMR
Committee on Aviation Medicine Report #132, 1943
12. Engel GL, Romano J, Webb JP, Ferris EB, Blankenhorn MA, Ryder HW: Scotomata, blurring of vision
and headache as complications of decompression sickness. National Research Council CMR Committee on Aviation Medicine Report #127, 1943
13. Romano J, Engel GL, Webb JP, Ferris EB, Ryder HW, Blankenhorn MA: Syncopal reactions during
simulated exposure to high altitude in decompression chamber. National Research Council CMR
Committee on Aviation Medicine Report #128, 1943
14. Webb JP, Ryder HW, Engel GL, Romano J, Blankenhorn MA, Ferris EB: The effect on susceptibility to
decompression sickness of preflight oxygen inhalation as compared to oxygen inhalation during
strenuous exercise. National Research Council CMR Committee on Aviation Medicine Report #134,
1943
15. Engel GL, Romano J, Webb JP, Ferris EB, Ryder HW, Blankenhorn MA: Electroencephalographic
observation at a simulated altitude of 35,000 feet without anoxia on subjects with and without decompression sickness. National Research Council CMR Committee on Aviation Medicine Report #203,
1943
16. Engel GL, Romano J, Webb JP, Ryder HW, Ferris EB, Blankenhorn MA: Electroencephalographic
observation of two cases of the scotomata-migraine-syndrome complicating decompression sickness.
National Research Council CMR Committee on Aviation Medicine Report #227, 1943
17. Stevens DC, Ryder HW, Ferris EB, Engel GL, Webb JP, Senior F, Friedlander J: The rate of nitrogen
elimination from the lungs: its relation to decompression sickness. National Research Council CMR
Committee on Aviation Medicine Report #237, 1943
18. Engel GL, Romano J, Webb JP, Ferris EB, Ryder HW, Blankenhorn MA: Absence of demonstrable injury
to the central nervous system after repeated experiencing of decompression sickness. National Research Council CMR Committee on Aviation Medicine Report #263, 1944
19. Webb JP, Ferris EB, Engel GL, Brown E: Preselection tests at 35,000 and 38,000 feet. National Research
Council CMR Committee on Aviation Medicine Report #288, 1944
20. Webb JP, Ferris EB, Engel GL, Romano J, Ryder HW, Stevens CD, Blankenhorn MA: Radiographic
studies of the knee during bends. National Research Council CMR Committee on Aviation Medicine
Report #305, 1944
21. Engel GL, Webb JP, Ferris EB: Quantitative electroencephalographic studies of anoxia in humans:
comparison with acute alcoholic intoxication and hypoglycemia. National Research Council CMR
Committee on Aviation Medicine Report #346, 1944
22. Ferris EB, Webb JP, Engel GL, Brown E: A comparative study of decompression sickness under varied
conditions of exercise. National Research Council CMR Committee on Aviation Medicine Report
#363, 1944
23. Engel GL, Romano J, Ferris EB: The effect of atabrine on the central nervous system. Clinical and
electroencephalographic data. National Research Council CMR Subcommittee on Cordination of Malarial Studies, 1944
24. Webb JP, Engel GL, Stevens CB, Ferris EB: The effect of pressure breathing on decompression sickness
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ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
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Engel GL, Romano J, McLin, T: Vasodepressor and carotid sinus syncope: electroencephalographic,
electrocardiographic, and clinical observations. Arch Intern Med 74:100-119, 1944
Engel GL, Romano J, Ferris EB, Webb JP, Stevens CD: A simple method of determining frequency
spectra in the electroencephalogram: Observations on physiological variations in glucose, oxygen,
posture and acid-base balance on the normal electroencephalogram. Arch Neur Psych 51:134—146,
1944
Romano J, Engel GL: Studies of delirium. I. Electroencephalographic data. Arch Neur Psych
51:356-377, 1944
Engel GL, Romano J: Studies of delirium. II. Reversibility of the electroencephalogram with experimental procedures. Arch Neur Psych 51:378-392, 1944
Romano J, Engel GL: Psychologic and physiologic considerations of delirium. Med Clin N Am
629:629-638, 1944
Engel GL, Webb JP, Ferris EB, Romano J, Ryder HW, Blankenhorn MA: A migraine-like syndrome
complicating decompression sickness: scintillating scotomas, focal neurological signs and headache:
clinical and electroencephalographic observations. War Med 5:304-314, 1944
Romano J, Engel GL, Ferris EB, Ryder HW, Webb JP, Blankenhorn MA: Problems of fatigue as illustrated by experiences in the decompression chamber. War Med 6:102 — 105, 1944
Engel GL, Romano J, Webb JP, Ferris EB, Ryder HW, Blankenhorn MA: A migraine syndrome complicating DCS. Air Surgeon's Bull 1:8-9, 1944
Engel GL, Aring C, Scheinker, IM: Hypothalamic attacks, neurological C.P.C. Dis Nerv Sys 5:1-8,
1944
Webb JP, Engel GL, Romano J, Ryder HW, Stevens CD, Blankenhorn MA, Ferris EB: The mechanism of
pain in aviators' bends. J Clin Invest 23:934, 1944
Engel GL, Aring CA, Scheinker IM: Toxic encephalopathy, neurological C.P.C. Dis Nerv Sys
5:372-377, 1944
Engel GL, Rosenbaum M: Delirium. III. Electroencephalographic changes associated with actual alcoholic intoxication. Arch Neurol Psychiatr 53:44-50, 1945
Romano J, Engel GL: Studies of syncope. III. Differentiation between vasodepressor and hysterical
fainting. Psychosom Med 7:3 — 15, 1945
Engel GL, Ferris EB, Romano J: Studies of syncope. Cinn J Med 26:93-119,1945
Engel GL, Ferris EB, Romano J: Focal electroencephalographic changes during the scotomas of migraine. Am J Med Sci 209:157-164, 1945
Engel GL: Adenocarcinoma of sigmoid, C.P.C. Cinn J Med 26:157-164, 1945
Engel GL, Aring C, Scheinker IM: Cerebellar hemorrhage, neurological C.P.C Dis Nerv Sys 6:190-196,
1945
Engel GL, Aring C, Scheinker IM: Tuberculoma of the pons, neurological C.P.C. Dis Nerv Syst 12:3-7,
1945
Engel GL: Mechanisms of fainting. J Mt Sinai Hosp 12:170-190, 1945
Engel GL, Aring CD: Hypothalamic attacks with thalamic lesion: I. Physiologic and psychologic
considerations. Arch Neurol Psychiatr 54:37—43, 1945
Aring CD, Engel GL: Hypothalmic attacks with thalamic lesion: II. Anatomic considerations. Arch
Neurol Psychiatr 54:44-50, 1945
Engel GL, Webb JP, Ferris EB: Quantitative electroencephalographic studies of anoxia in humans.
Comparison with acute alcoholic intoxication and hypoglycemia. J Clin Invest 24:691—697, 1945
Engel GL: The clinical application of electroencephalography. Cinn J Med 27:151-180, 1946
Rapoport S, Stevens CD, Engel GL, Ferris EB, Logan ME: The effect of voluntary overbreathing on the
electrolyte equilibrium of arterial blood in man. J Biol Chem 163:411-427, 1946
Ferris EB, Engel GL, Stevens CD, Logan ME: The validity of internal jugular venous blood in studies of
cerebral metabolism and blood flow in man. Am J Physiol 147:517-521, 1946
Stevens CD, Ferris EB, Webb JP, Engel GL, Logan ME: Voluntary breath-holding. I. Pulmonary gas
exchange during breath-holding. J Clin Invest 25:723-728, 1946
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
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time of breath-holding to the oxygen tension of the inspired air. J Clin Invest 25:729-733, 1946
Ferris EB, Engel GL, Stevens CD, Webb JP: Voluntary breath-holding. III. The relation of the maximum
time of breath-holding to the oxygen and carbon dioxide tensions of arterial blood with a note on its
clinical and physiological significance. J Clin Invest 25:734-743, 1946
Engel GL, Romano J, Goldman L: Delirium. IV. Quantitative electroencephalographic study of a case of
acute arsenical encephalography. Arch Neurol Psychiatr 56:659—664, 1946
Ferris EB, Engel GL, Stevens CD, Webb JP, Blankenhorn MA: Nature of decompression sickness. Mod
Med 14:126-133, 1946
Engel GL, Romano J, Ferris EB: Variation in the normal electroencephalogram during a five year
period. Science 105:600-601, 1947
Engel GL, Scheinker IM, Humphrey DC: Acute febrile anemia and thrombocytopenic purpura with
vasothromboses. Ann Intern Med 26:919-933, 1947
Logan ME, Ferris EB, Engel GL, Evans JP: Artherialization of internal jugular venous blood during
hyperventilation as an aid in the diagnosis of intracranial vascular tumors. Ann Intern Med
27:220-224, 1947
Engel GL, Romano J, Ferris EB: Effect of quinacrine (Atabrine) on the central nervous system: clinical
and electroencephalographic studies. Arch Neurol Psychiatr 58:337-350, 1947
Romano J, Engel GL: Teaching experiences in general hospitals. Am J Orthopsychiatry 17:602—604,
1947
Engel GL, Romano J: Studies of syncope: IV. Biologic interpretation of vasodepressor syncope.
Psychosom Med 29:288-294, 1947
Engel GL, Ferris EB, Logan M: Hyperventilation: analysis of clinical symptomatology. Ann Intern Med
27:683-704, 1947
Grinker RR, Bennett AE, Engel GL, Finesinger JE, French TM, Gildea EF, Gill NM, Hughes J, Kolb LC:
Research of prefrontal lobotomy. GAP Report #6 1-9, 1948
McCann WS, Bruce RA, Lovejoy FW, Yu PN, Pearson R, Emerson EB, Engel GL, Kelly JJ: Tussive
syncope: observations on the disease formerly called laryngeal epilepsy with report of two cases. Arch
Intern Med 84:845-856, 1949
Engel GL, Grinker RR, Kaufman MR: The psychiatrist's contribution to the consent of health and
disease. Univ Chicago Round Table No. 688, 1951
Engel GL: Primary atypical facial neuralgia. Psychomsom Med 13:375—396, 1951
Samson DC, Swisher SN, Christian RM, Engel GL: Cerebral metabolic disturbance and delirium in
pernicious anemia, clinical and electroencephalographic studies. Arch Intern Med 90:4 — 14, 1952
Barchilon J, Engel GL: Dermatitis: An hysterical conversion symptom in a young woman. Psychosom
Med 14:295-305, 1952
Engel GL: Psychologic aspects of the management of patients with ulcerative colitis, NY State J Med
52:2255-2261, 1952
Izzo JG, Schuster DB, Engel GL: The electroencephalogram of patients with diabetes mellitus. Diabetes
2:93-99, 1953
Engel GL, Hamburger WW, Reiser M, Plunkett J: Electroencephalographic and psychological studies
of a case of migraine with severe preheadache phenomena. Psychosom Med 15:337—n348, 1953
Engel GL: Mechanism of psychogenic pain. Bull Med Society, County of Erie 30:8-9,20, 1953
Engel GL: Selection of clinical material in psychosomatic medicine: The need for a new physiology
(special article). Psychosom Med 16:368-373, 1954
Engel GL: Studies of ulcerative colitis. I. Clinical data bearing on the nature of the somatic process.
Psychosom Med 16:496-501, 1954
Engel GL: Studies of ulcerative colitis. II. The nature of the somatic processes and the adequacy of
psychosomatic hypotheses. Am J Med 16:416-433, 1954
Engel GL: Studies of ulcerative colitis. III. The nature of the psychological processes. Am J Med
19:231-256, 1955
Engel GL, Reichsman F: Affects, object relations and gastric secretion, Panel American Psychoanalytic
Assoc. J Am Psychoanal Assoc 4:138 — 148, 1956
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ROBERT ADER A N D ARTHUR H. SCHMALE, JR.
77. Friedman SB, Engel GL: Effect of cortisone and adrenocorticotropin on the EEG of normal adults,
quantitative frequency analysis. J CHn Endocrinol Metab 16:839-847, 1956
78. Engel GL: Studies of ulcerative colitis. IV. The significance of headaches. Psychosom Med
18:334-346, 1956
79. Engel GL, Reichsman F: Spontaneous and experimentally induced depression in an infant with a
gastric fistula: a contribution to the problem of depression. J Am Psychoanal Assoc 4:428—452, 1956
80. Engel GL, Reichsman F, Segal HL: A study of an infant with gastric fistula. I. Behavior and the rate of
total hydrochloric acid secretion. Psychosom Med 18:374—398, 1956
81. Engel GL, Greene WA, Reichsman F, Schmale AH, Jr., Ashenburg N: A graduate and undergraduate
teaching program on the psychological aspects of medicine. J Med Educ 32:859—872, 1957
82. Engel GL: Studies of ulcerative colitis. V. Psychological aspects and their implications for treatment.
Amn J Dig Dis 3:315-337, 1958
83. Reichsman F, Engel GL, Harway V, Escalona S: Monica, an infant with gastric fistula and depression:
an interim report on her development to the age of four years. Psychiatric Research Reports #8, Am
Psychiatr Assoc pp.12-27, 1958
84. Crohn BB, Engel GL, Flood CA, Garlock JH: Management of ulcerative colitis. Panel meeting on
therapeutics. NY Acad Med 34:366-386, 1958
85. Engel GL: "Psychogenic" pain. Med Clin North Am, pp.1481-1496, 1958
86. Engel GL, Romano J: Delirium, a syndrome of cerebral insufficiency. J Chron Dis 9:260-277, 1959
87. Berman BA, Engel GL, Glaser J: The electroencephalogram in allergic children. Ann Allergy
17:188-193, 1959
88. Engel GL: Psychogenic pain and the pain-prone patient. Am J Med 26:899-918, 1959
89. Engel GL: On the existence of the cerebral type carotid sinus syncope. Neurology 9:565-568, 1959
90. Engel GL: On timemanship: techniques for outwitting the chairman. Psychosom Med 21:263—264,
1959
91. Engel GL: A unified concept of disease. IRE Trans Med Electron 7:48-57, 1959
92. Reichsman F, Cohen J, Col will J, Davis N, Kessler W, Shepardson C, Engel GL: Natural and histamineinduced gastric secretion during sleeping and waking states. Psychosom Med 22:14—23, 1960
93. Engel GL: A unified concept of health and disease. Perspect Biol Med 3:459-485, 1960
94. Engel GL: Is grief a disease? A challenge for medical research. Psychosom Med 23:18-22, 1961
95. Engel GL: Biologic and psychologic features of the ulcerative colitis patient. Gastroenterology
40:313-317, 1961
96. Engel GL: Psychogenic pain. ] Occup Med 3:249-257, 1961
97. Engel GL: Guilt, pain and success. Success facilitated by the pain of glomus tumor and peptic ulcer.
Psychosom Med 23:37-48, 1962
98. Engel GL: Anxiety and depression withdrawal: the primary affects of unpleasure. Int J Psychoanal
43:89-97, 1962
99. Engel GL: The nature of disease and the care of the patient: the challenge of humanism and science in
medicine. The 14th Annual Gerber Oration. RI Med J 45:245-251, 1962
100. Engel GL: A unified concept of health and disease. J Am Osteopath Assoc 62:539—662, 1963
101. SchmaJe AH, Jr, Greene WA, Reichsman F, Kehoe M, Engel GL: An established program of graduate
education in psychosomatic medicine. Adv Psychosom Med 4:4 — 13, 1964
102. Engel GL: Grief and grieving. Am J Nurs 64:93-98, 1964
103. Engel GL: Clinical observation. The neglected basic method of medicine. J Am Med Assoc
192:842-852, 1965
104. Engel GL: Training in psychosomatic research. Adv Psychosom Med 5:16-24, 1967
105. Engel GL, Schmale AH, Jr: Psychoanalytic theory of somatic disorder. Conversion, specificity, and the
disease onset situation. J Am Psychoanal Assoc 15:344-365, 1967
106. Engel GL: Ego development following severe trauma in infancy: A 14 year study of a girl with gastric
fistula and depression in infancy. Bull Assoc Psychoanal Med 6:57—61, 1967
107. Engel GL: A psychological setting of somatic disease: The giving up-given up complex. Proc R Soc
Med 60:553-555, 1967
108. Engel GL: The concept of psychosomatic disorder. J Psychosom Res 11:3-9, 1967
94
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Engel GL: Medical education and the psychosomatic approach. A report on the Rochester experience,
1946-1966. J. Psychosom Res 11:77-85, 1967
Schmale AH, Jr, Engel GL: The giving up-given up complex illustrated on film. Arch Gen Psychiatry
17:135-145, 1967
Engel GL: Some obstacles to the development of research in psychoanalysis. J Am Psychoanal Assoc
16:195-204, 1968
Engel GL: A reconsideration of the role of conversion in somatic disease. Compr Psychiat 9:316-326,
1968
Engel GL: A life setting conducive to illness. The giving up-given up complex. Ann Intern Med
69:293-300, 1968 (Bull Menninger Clin 32:355-365, 1968
Engel GL, Schmale AH: Teoria psicoanalitica de los trastornos somaticos. Conversion, especificidad y
la situacion de comienzo de la enfermedad. Revista de Psicoanalisis 25:93-117,1968 (Spanish translation of Psychoanalytic theory of somatic disorder. J Am Psychoanal Assoc 15:344-365, 1967)
Engel GL, Schamle AH:Theories psychoanalytique du trouble somatique: Conversion, specificite, et
circonstance d'invasion de la maladie. Rev Med Psychosom 10:197-215, 1968 (French translation of
Psychoanalytic theory of somatic disorder J Am Psychoanal Assoc 15:344-365, 1967)
Engel GL, Schmale AH: Eine psychoanalitische theorie der somatischen storung. Psyche 23:241 — 261,
1969 (German translation of psychoanalytic theory of somatic disorder. J Am Psychoanal Assoc
15:344-365, 1967
Engel GL: On the care and feeding of tHe faculty. A responsibility of students. N Engl J Med
281:351-355, 1969
Engel GL: Ego development following severe trauma. Bull Phil Assoc Psychoanal 19:234-236, 1969
Mei-Tal V, Meyerowitz S, Engel GL: The role of psychological process in a somatic disorder: multiple
sclerosis I. The emotional setting of illness onset and exacerbation. Psychosom Med 32:67-86,1970
Engel GL: Sudden death and the medical model in psychiatry. Can Psychiatr Assoc J 15:527 — 538,
1970
Engel GL: Some limitations of the case presentation method for clinical teaching. An alternative
approach. N Engl J Med 284:20-24, 1971
Engel GL: Care and feeding of the medical student. The foundation for professional competence. J Am
Med Assoc 215:1135-1141, 1971
Adler R, MacRitchie K, Engel GL: Psychologic processes and ischemic stroke (occulsive cerebrovascular disease) I. Observations on 32 men with 35 strokes. Psychosom Med 33:1-29, 1971
Engel GL: Attachment behaviour, object relations and the dynamic-economic points of view: critical
review of Bowlby's "Attachment and Loss." Int J Psychoanal 52:183 — 196, 1971
Engel GL: Sudden and rapid death during psychological stress. Folklore or folk wisdom? Ann Intern
Med 74:771-782, 1971
Engel GL: The implications of changes in medical education. Hosp Practice 6:109-116, 1971
Engel GL: Must we precipitate a crisis in medical education to solve the crisis in health care? Ann
Intern Med 76:487-490, 1972
Engel GL: The education of the physician for clinical observation. The role of the psychosomatic
(Liaison) teacher. J Nerv Ment Dis 154:159-164, 1972
Morgan WL, Engel GL, Luria MN: The general clerkship. A course designed to teach the clinical
approach to the patient. J Med Educ 47:556-563, 1972
Engel GL: Enduring attributes of medicine relevant to the education of the physician. Ann Intern Med
78:587-593, 1973
Engel GL: The best and the brightest. The missing dimension in medical education. Pharos
36:129-133, 1973
Engel GL: Today's medical student: more overloaded than educated. Prism 39-40,58, 1974
Adler R, Troup S, Engel GL: Psychische Faktoren bei einem colitis-ulcerosa-ahnlichen Krankheiitsbild
Kerry-Blue-und eines Skye-Terriers. ZF Gastroenterol 12:191-192, 1974
Engel GL: The prerequisites for graduate medical education. Bull NY Acad Med 50:1186-1193, 1974
Engel GL: The psychosomatic approach to individual susceptibility to disease. Gastroenterology
67:1985-2093, 1974
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147.
148.
149.
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Engel GL: The information explosion and the education of the medical student. An historial analysis.
Pharos 38:21-24, 1975
Engel GL: The death of a twin. Mourning and anniversary reactions. Fragments of 10 years of selfanalysis. Int J Psychoanal 56:23-40, 1975
Engel GL: Identification, inspiration and learning. Arch Intern Med 135:1381-1383, 1975
Engel GL: Reactions to the death of a twin. Rochester Rev 4-12, 1976
Engel GL: Too little science. The paradox of modern medicine's crisis. Pharos 39:127 — 131, 1976
Engel GL: Vivo y saludable a los ochenta. Cuadernos Psicoanalisis 9:9-20, 1976
Engel GL: The need for a new medical model: a challenge for biomedicine. Science 196:129-136,1977
Engel GL: The care of the patient: art or science? Johns Hopkins Med J 140:222-232, 1977
Engel GL: Emotional stress and sudden death. Psychology Today II 114, 118, 153-154, 1977
Engel GL: The biomedical model and medical malpractice. In Conference proceedings: Medical Education and Malpractice Litigation. (Report #10, Institute of Human Values in Medicine, edited by WJ
Wirislade and B Towers). Philadelphia, 1977, pp. 5-20
Engel GL: Biomedicine's failure to achieve Flexnerian standards of education. J Med Educ
53:387-396, 1978
Engel GL: The biopsychosocial model and the education of health professionals. Ann NY Acad Sci
310:169-181, 1978
Engel GL: Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med
89:403-412, 1978
Engel GL, Richsman F, Dowling AS, Harway V, Hess DW: Monica: a 25-year longitudinal study of the
consequences of trauma in infancy. J Am Psychoanal Assoc 27:107-126, 1979
Engel GL: The biopsychosocial model, resolving the conflict between medicine and psychiatry.
Resident Staff Physician 25:70-74, 1979
Abstracts
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Margolin SG, Strauss H, Engel GL: Electroencephalographic changes associated with hypersensitivity
of the carotid sinus. Arch Neurol Psychiatr 45:889-890, 1941
Engel GL, Margolin SG: Clinical correlation of the electroencephalogram with carbohydrate metabolism. Arch Neurol Psychiatr 45:890-891, 1941
Engel GL, Margolin SG: Neuropsychiatric disturbances in Addison's disease and the role of impaired
carbohydrate metabolism in the production of abnormal cerebellar function. Arch Neurol Psychiatr
45:881-884, 1941
Engel GL, Romano J: Experimental studies of vasodepressor syncope. Proc Ctr Soc Clin Res 16:84—85,
1943
Romano J, Ferris EB, Engel GL: Focal electroencephalgraphic changes in carotid sinus reflex hypersensitivity of the cerebellar type. Proc Ctr Soc Clin Res 16:86, 1943
Engel GL, Romano J, Webb JP, Ryder H, Ferris EB, Blankenhorn MA: A migraine-like syndrome
associated with exposure to high altitude. Proc Ctr Soc Clin Res 16:86—87, 1943
Engel GL, Ferris EB, Webb JB, Stevens CD: Studies on voluntary breath-holding. Proc Ctr Soc Clin Res,
17:61-62, 1944
Engel GL, Rosenbaum M: Studies of the electroencephalogram in acute alcoholic intoxication. Proc Ctr
Soc Clin Res 17:62-63, 1944
Engel GL, Ferris EB, Romano J: Focal electroencephalographic changes during the scotomas of migraine. Proc Ctr Soc Clin Res 17:63-64, 1944
Engel GL, Ferris EB, Stevens CD, Logan ME, Webb JP: The syndrome of hyperventilation. Proc Ctr Soc
Clin Res 18:21-22, 1945
Ferris EB, Engel GL, Stevens CD, Logan ME, Webb JP: Breath-holding. Proc Ctr Soc Clin Res 18:55-56,
1945
Engel GL, Ferris EB, Stevens CD, Logan ME, Webb JP: The syndrome of hyperventilation. J Lab Clin
Med 31:474-476, 1946
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GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
163.
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170.
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172.
173.
174.
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Engel GL: The clinical applications of electroencephalography. Arch Neurol Psychiatr 55:553-557,
1946
Samson DC. Swisher S, Christian RH, Engel GL: Some observations on the mechanism of delirium in
pernicious anemia. J Clin Invest 30:669, 1951
Engel GL: Surrogate ego role of the physician. Round Table: Psychotherapy in medical and surgical
hospitals. Bull Am Psychoanal Assoc 81:170-173,1952
Izzo JL, Schuster DB, Engel GL: The EEG of patients with diabetes mellitus. EEG J 4:380, 1952
Engel GL: A critical definition of the disorder, essential hypertension. Round Table: Problems of
hypertension. J Am Psychoanal Assoc 1:562-574, 1953
Reichsman F, Engel GL, Segal HL: Modification of the gastric secretory response to histamine during
varying behavioral states: observations on an infant with a gastric fistula. J Clin Invest 34:959, 1955
Reichsman F, Engel GL, Segal HL: Behavior and gastric secretion: the study of an infant with a gastric
fistula. Psychosom Med 17:481, 1955
Cohen J, Colwill J, Davis N, Kessler W. Shepardson R, Reichsman F, Engel GL: Effect of histamine on
nocturnal gastric secretion during sleeping and waking states. J Clin Invest 37:884, 1958
Reichsman F, Samuelson D, Engel GL: Behavior and gastric secretion. II. Study of a four year old with
gastric fistula. Psychosom Med 27:483, 1965
Adler R, MacRitchie K, Engel GL: Psychological factors in the setting of cerebrovascular accidents
(stroke) and the personality of the stroke patient. Psychosom Med 31:454, 1969
Frader M, Barry CJ, Schalch DS, Engel GL: Endocrine changes during experimentally induced sadness.
I. Serum growth hormone. Psychosom Med 33:471, 1971
Engel GL, Reichsman F, Anderson D: Behavior and gastric secretion. III. Cognitive development and
gastric secretion in children with gastric fistula. Psychosom Med 33:472, 1971
Engel GL, Reichsman F, Harway V, Hess DW: Follow-up study of an infant with gastric fistula and
depression. IV. Infant feeding and behavior as a mother 19 years later. Psychosom Med 36:459, 1974
Discussions
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18,4185.
186.
187.
Engel GL: Discussion of Fox HH and Gifford S: Psychological responses to ACTH and cortisone. A
preliminary theoretical formulation. Psychosom Med 15:614—627, 1953
Engel GL: Discussion of Bandler B: Historical review of the concepts of psychosomatic medicine and
Margolin S: Certain aspects of therapy. Am J Psychiatry 114:1-7, 1958
Engel GL: Discussion of Benedek T: The organization of the reproductive drive. Inst for
Psychoanalysis, Chicago, November 15, 1957, pp. 1 — 7
Engel GL: Discussion of Gitelson M: Psychosomatic phenomena: conversion or anxiety equivalents?
Theroretical and therapeutic implications. Chicago Psychoanal Assoc, September 23, 1958, pp. 1-5
Engel GL: Discussion of Mohr GI, Josselyn IM, Spurlock J, Barron SH: Studies in ulcerative colitis. Am
J Psychiatry 114:1067-1076, 1958
Engel GL: Discussion of Alexander F, Pollack G: Experimental study of psychophysiological correlations. Am Psychosom Soc, May 2, 1959, pp. 1 — 5
Engel GL: The behavioral sciences, remarks at the First Institute on Clinical Teaching. J Med Educ
34:149-150, 1959
Engel GL: Discussion of Gorney R: Of divers things: preliminary note on the dynamics of scuba diving.
Psychoanal Forum 1:226-276, 1966
Engel GL: Psychological factors in ulcerative colitis in man and gibbon. Gastroenterology 57:362-365,
1969
Engel GL: The psychosomatic approach as a preventive measure in the care of patients with peptic
ulcer. Adv Psychosom Med 6:186-189, 1971
Engel GL: In memorium: Maurice Levine, 1902-1971. Am J Psychiatry 128:652-655, 1971
Engel GL: Retrospective comment: Weiner H, Thaler M, Reiser MF, Mirsky IA: Etiology of duodenal
ulcer. I. Relation of specific psychologic characteristics to rate of gastric secretion (serum pepsinogen)
in Psychosomatic Classics, edited by A Shapiro. Basel, Karger, 1972, pp. 265-266
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188. Engel GL: Communication between clinician and experimentalist in Physiology, Emotion and
Psychosomatic Illness, edited by R Porter and J Knight. Ciba Foundation Symposium 8 (new series),
Amsterdam, Excerpta Medica, 1972, pp. 384-386
Books
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190.
191.
192.
193.
194.
195.
196.
197.
198.
199.
Engel GL, Engel FL: Translation of Mitogenetic Analysis of the Excitation of the Nervous System, by
AG Gurwitsch. Amsterdam, NV NoordHollandische Utgerver Maatschappj, 1937
Engel GL: Fainting: Physiologic and Psychologic Considerations. Springfield, 111, Charles Thomas,
1950
Engel GL: Fainting: Physiologic and Psychologic Considerations, 2d Ed. Springfield, 111, Charles
Thomas, 1962
Engel GL: Psychological Development in Health and Disease. Philadelphia, Saunders, 1962
Morgan WL, Engel GL: The Clinical Approach to the Patient. Philadelphia, Saunders, 1969
Engel GL: Psychisches Verhalten in Gesundheit und Krankheit. Bern, Huber, 1969. (German translation of Psychological Development in Health and Disease. Philadelphia, Saunders, 1962
Morgan WL, Engel GL: Propedeutica Medica, Interamerican (Printed in Mexico), 1971. (Spanish translation of the Clinical Approach to the Patient, Philadelphia, Saunders, 1969)
Morgan WL, Engel GL: L'Esame Clinico Del Malato II Pensiero, Roma, 1971. (Italian translation of The
Clinical Approach to the Patient. Philadelphia, Saunders, 1969)
Engel GL, Morgan WL: Interviewing the Patient. London, Saunders, 1973
Engel GL: Psychological Development in Health and Disease (Japanese translation), Tokyo, Iwasaki
Choten, 1975.
Engel GL: Psychisches Verhalten in Gesundheit und Krankheit. 2. Auflage, Taschenbuch, Bern, Huber,
1976.
Chapters in Books
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204.
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207.
208.
209.
210.
98
Ferris EB, Engel GL: The clinical nature of high altitude decompression sickness, in Decompression
Sickness.N.R.C. Philadelphia, Saunders, 1951, pp. 4-52
Engel GL: Homeostasis, behavioral adjustment, and the concept of health and disease, in Grinker R:
Mid-Century Psychiatry. Springfield, 111, Charles Thomas, 1953, pp. 33-59
Engel GL: Syncope, in A Textbook of Medicine, 2nd ed. edited by RL Cecil and RF Loeb. Philadelphia,
Saunders, 1955, pp. 1495-1497
Engel GL: Contributions to: Toward a Unified Theory of Human Behavior, edited by RR Grinker. New
York, Basic Books, 1956, pp. 12-13, 19, 112-113
Engel GL: Syncope, in A Textbook of Medicine, 10th ed. edited by R Cecil and RF Loeb. Philadelphia,
Saunders, 1959, pp. 1434-1437
Engel GL, Reichsman F, Segal H: A Study of an infant with a gastric fistula, in Psychopathology—A
Source Book, edited by CF Reed, I Alexander, and SS Tomkins. Cambridge, Mass. Harvard University
Press, 1958, pp. (Reprinted from Psychosomatic Medicine 18:374-398, 1956.)
Engel GL: Humanism and science in medicine, in Psychiatry in Medicine, edited by NQ Brill. Berkeley, University of California Press, 1962, pp. 42-63
Engel GL: Toward a classification of affects, in Expression of the Emotions in Man. edited by P Knapp.
New York, International Universities Press, 1963, pp. 266-294
Engel GL: A unified concept of health and disease, in Ingle D: Life and Disease. New York, Basic
Books, 1963, pp. 339-365
Engel GL: Grief and Grieving, in Mereness D: Psychiatric Nursing. Dubuque, WC Brown, 1966, pp.
8-13
Engel GL: Introduction to brain disorders, in Comprehensive Textbook of Psychiatry, edited by AM
Freedman and HI Kaplan. Baltimore, Williams and Wilkins, 1967, pp. 706-707
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
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Engel GL: Delirium, in Comprehensive Textbook of Psychiatry, edited by AM Freedman and HI
Kaplan. Baltimore, Williams and Wilkins, 1967, pp. 711-716
Engel GL: Intestinal disorders, in Comprehensive Textbook of Psychiatry, edited by AM Freedman and
HI Kaplan. Baltimore, Williams and Wilkins, 1967, pp. 1054-1059
Engel GL, Reichsman F, Segal H: A study of an infant with a gastric fistula, in Behavior in Infancy and
Early Childhood, edited by Y Brackhill and GG Thompson. New York, Free Press, 1967, p. 86
Engel GL: The psychoanalytic approach to psychosomatic medicine, in Modern Psychoanalysis. New
Directions and Perspectives, edited by J Marmor. New York, Basic Books, 1968, pp. 251-273
Engel GL: Psychologic processes and gastrointestinal disorders, in Gastroenterologic Medicine, edited
by M Paulson. Philadelphia, Lea and Febiger, 1969, pp. 1418-1457
Engel GL: Pain, in Signs and Symptoms: Applied Pathologic Physiology and Clinical Interpretation,
5th ed. edited by CM MacBryde and RS Blacklow. Philadelphia, Lippincott, 1970, pp. 41-61
Engel GL: Nervousness and fatigue, in Signs and Symptoms: Applied Pathologic Physiology and
Clinical Interpretation, 5th ed. edited by CM MacBryde and RS Blacklow. Philadelphia, Lippincott,
1970, pp. 650-668
Engel GL: Conversion symptoms, in Signs and Symptoms: Applied Pathologic Physiology and Clinical Interpretation, 5th ed. edited by CM MacBryde and RS Blacklow. Philadelphia, Lippincott, 1970,
pp. 650-668
Engel GL, Reichsman F, Segal H: A study of an infant with a gastric fistula, in Psychosomatic Classics,
edited by A Shapiro. Basel, Karger, 1972, pp. 1-24
Romano }, Engel GL: Studies of syncope III. Differentation between vasodepressor and hysterical
syncope, in Psychosomatic Classics, edited by A Shapiro. Basel, Karger, 1972, pp. 74—83
Engel GL: A life setting conducive to illness: The giving-up-given-up complex, in The
Psychodynamics of Patient, edited by LH Schwartz and JL Schwartz. Englewood Cliffs, NJ, PrenticeHall, 1972, pp. 266-274
Engel GL: Grief and grieving, in The Psychodynamics of Patient Care, edited by LH Schwartz and JL
Schwartz. Englewood Cliffs, NJ, Prentice-Hall, 1972, pp. 376-387
Engel GL: Biographical note: Maurice Levine, in Levine M: Psychiatry and Ethics. New York, Braziller,
1972, pp. 255-262
Engel GL, Schmale AH: Conservation-withdrawal: a primary regulatory process for organismic homeostasis, in Physiology, Emotion and Psychosomatic Illness Ciba Foundation Symposium 8 (new
series) Amsterdam, Elsevier-Excerpta Medica, 1972, pp. 57—85
Engel GL: Grief and grieving, in The Dying Patient: A Nursing Perspective, edited by MH Browning
and EP Lewis. New York, American Journal of Nursing Company, 1972, pp. 105-116
Engel GL: Grief and grieving, in The Challenge of Nursing, edited by M Auld and H Birum. St. Louis,
Mosby, 1973, p. 200
Engel GL: Ulcerative colitis, in Emotional Factors in Gastrointestinal Disease, edited by AE Lindner.
Amsterdam, Excerpta Medica, 1973, pp. 99—112
Engel GL: Signs of giving up, in The Patient, Death and the Family, edited by SB Troup and WA
Greene. New York, Scribner's, 1974, pp. 45 — 72
Engel GL: A unified concept of health and disease, in Medical Behavioral Science, edited by T Millon.
Philadelphia, Saunders, 1975, pp. 185-199
Engel GL: Psychophysiological gastrointestinal disorders. I. Peptic ulcer, in Comprehensive Textbook
of Psychiatry II, 2nd ed. edited by AM Kaplan and BJ Sadock. Baltimore, Williams and Wilkins, 1975,
pp. 1638-1643
Engel GL: Psychophysiological gastrointestinal disorders. II. Intestinal disorders, in Comprehensive
Textbook of Psychiatry II, 2nd ed. edited by AM Kaplan and BJ Sadock. Baltimore, Williams and
Wilkins, 1975, pp. 1643-1648
Schmale AH, Engel GL: The role of conservation-withdrawal in depressive reactions, in Depression
and Human Existence, edited by EJ Anthony and T Benedek. Boston, Little, Brown, 1975, pp. 199-223
Engel GL: Versuch einer zusammenschau von gesundheit and krankjeit, in Was 1st Krankheit? edited
by KR Rothschuh. Darmstadt, Wissenschaftliche Buchgesellschaft, 1975, pp. 306-342
Engel GL: Psychological aspects of gastrointestinal disorders, in American Handbook of Psychiatry,
2nd ed, vol 4. edited by M Reiser. New York, Basic Books, 1975, pp. 653-692
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
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236.
237.
238.
239.
240.
Engel GL: Sudden and rapid death during psychological stress, folklore or folk wisdom? in Rediscovery of the Body. A Psychosomatic View of Life and Death, edited by CA Garfield. New York, Dell, 1977,
pp. 297-328
Glaser J, Engel GL: Psychodynamics, psychophysiology, and gastrointestinal symptomatology, in The
Gastrointestinal Tract in Stress and Psychiatric Disorder, edited by TM Almy and JF Fielding.
Philadelphia, Saunders. Clinics in Gastroenterology 6:507-531, 1977
Engel GL: Grief and grieving, in Directions, edited by CH Dagitz. Dubuque, Iowa, Kendall/Hunt, 1978,
pp. 93-99
Engel GL: The need for a new medical model. A challenge for biomedicine, in Dimensions of Behavior.
The Psychiatric Foundations of Medicine, edited by GU Balis. London, Butterworth, 1978, pp. 3—22
Engel GL: Colitis ulcerosa, in Lehrbuch der Psychosomatischen Medisin. edited by T von Uexkull.
Munich, 1979, Urban and Schwartzenberg, pp. 649-657
Engel GL: An approach to teaching and learning about grief, in Mental Health Issues in Grief Counseling. SE Weinstein: DHEW Publ. No. (HSA) 79-5264, 1979, pp. 45-64
Editorials
241.
242.
243.
244.
245.
Engel GL: Research possibilities in the dementias. Am J Psychiatr 106:146-149, 1949
Engel GL: Pseudoangina. Am Heart J 59:325-328, 1960
Engel GL: Is psychiatry failing in its responsibility to medicine? Am J Psychiatry 128:1561:1564,1972
Engel GL, Salzman L: A double standard for psychosomatic papers? N Engl J Med 288:44-46, 1973
Engel GL: Personal theories of disease as determinants of doctor-patient relationships. Psychosom
Med 35:184-186, 1973
246. Engel GL: Who makes the decisions that mold medical education? Assoc Hosp Med Educ J 7:1—2,
1974
247. Engel GL: Revision of the National Board Examinations. The need for study and debate. J Am Med
Assoc 228:579-580, 1974
248. Engel GL: Psychoanalysis alive and well at 80. J Am Med Assoc 231:579-582, 1975
249. Engel GL: Psychological factors in instantaneous cardiac death. N Engl J Med 294:664-665, 1976
250. Engel GL: Are medical schools neglecting clinical skills? J Am Med Assoc 236:861-863, 1976
251. Engel GL: Vivo y V "Saludable a los Ochenta." Caudernos Psicoanalisis 9:9-20, 1976
252. Engel GL: The predictive value of psychological variables for disease and death. Ann Intern Med
85:673-674, 1976
Book Reviews
253.
254.
255.
256.
257.
258.
259.
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Engel GL: Review of CF Schmidt: The Cerebral Circulation in Health and Disease. Springfield, 111,
Charles Thomas, 1950, in Electroencephalogr Clin Neurophysiol 3:253, 1951
Engel GL: Review of H Abramson: Neuropharmacology. New York, Josiah Macy Foundation, 1955, in
Psychosom Med 18:102, 1956
Engel GL: Review of SS Gottlieb: Research in Psychosomatic Medicine: Psychiatric Research Report,
Am Psychiatr Assoc, 1956, p. 93, in Psychosom Med 18:520, 1956
Engel GL: Review of Psychoanalysis, Scientific Method and Philosophy, edited by S Hook. New York,
University Press, in Perspect Biol Med 3:157, 1959
Engel GL: Review of A Garma: Peptic Ulcer and Psychoanalysis. Baltimore, Williams and Wilkins, in
Am J Dig Dis 4:829-831, 1959
Engel GL: Review of L Salzman, JH Masserman: Modern Concepts of Psychoanalysis. New York,
Philosophical Library, 1962, in Ment Hyg 47:511, 1963
Engel GL: Mental Illness: Vital Balance or Myth? Review of K Menninger: The Vital Balance: The Life
Processes in Mental Health and Illness, New York, Viking, 1963. Bull Menninger Clin 28:145, 1964
Psychosomatic Medicine Vol. 42, No. 1:11 (Supplement 1980)
GEORGE LIBMAN ENGEL: O N HIS RETIREMENT
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271.
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Engel GL: Review of N Kleitman: Sleep and Wakefulness, 2nd ed. Chicago: University of Chicago
Press, in J Am Med Assoc 187:783, 1964
Engel GL: Review of F Deutsch: Body, Mind and Sensory Gateways. New York, Basic Books, 1962, in
Psychoanal Q 394:433-435, 1964
Engel GL: Review of PESifneos: Ascent from Choas. Cambridge, Mass, Harvard University Press, 1964,
in Psychosom Med 27:496, 1965
Engel GL: Review of CW Wahl: New Dimensions in Psychosomatic Medicine. Boston: Little, Brown,
1964, in Psychoanal Q 35:330, 1966
Engel GL: Review of JJ Groen: Psychosomatic Research. New York: Macmillan, 1964, in Psychoanal Q
35:611-615, 1966
Engel GL: Review of JO Wisdom, HH Wolff: The Role of Psychosomatic Disorders in Adult Life. New
York, Pergaman, 1965, in Psychoanal Q 35:616, .1966
Engel GL: Review of KP Browne, P Freeling: The Doctor-Patient Relationship. Baltimore, Williams and
Wilkins, 1967, in Arch Intern Med 121:297-298, 1968
Engel GL: Review of ED Palmer: Functional Gastrointestinal Disease. Baltimore, Williams and Wilkins, 1967, in Am J Med Sci 255:337-338, 1968
Engel GL: Review of Psychosomatic Specificity, Volume 1 Experimental Study and Results, edited by
F, Alexander, TM French and GH Pollock. Chicago, University Chicago Press, 1968, in Science
164:689-690, 1969
Engel GL: Review of E Levitt: The Psychology of Anxiety. New York, Bobbs-Merrill, 1967, in Psychoanal Q 38:667, 1969
Engel GL: Review of HG Wolff: Stress and Disease, edited by S Wolf and H Goodell, in Am J Med Sci
259:424-425, 1970
Engel GL: Review of GL Bibring, RJ Kahana: Lectures in Medical Psychology. New York, International
University Press, 1969, in Arch Intern Med 126:174, 1970
Engel GL: Review of Psychological Aspects of Physical Illness, edited by ZJ Lipowski. New York,
Karger, 1972. Adv Psychosom Med 8:729-730, 1972
Engel GL: Perspective on depression. Review of Masked Depression, edited by S Lesse. New York,
Aronson, 1974; The Psychology of Depression, edited by R Friedman and M Katz. New York, Wiley,
1974; Somatic Manifestations of Depressive Disorders. New York, Elsevier, 1974. in Science
190:434-435, 1975
Letters to the Editor
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277.
278.
279.
280.
281.
282.
283.
284.
285.
Engel GL, Hoagland, H: Methods of frequency analysis of the electroencephalogram. Arch Neur Psych
57:379-383, 1947
Engel GL, Reichsman F: On identification. Int J Psa 40:60-61, 1959.
Engel GL: Letter to the Editor regarding: Percival Bailey's views on psychoanalysis. Perspec Biol Med
4:386-389, 1961
Seidenberg, R.Engel GL: Correspondence: Is grief a disease? Psychosom Med 23:426-427, 1961
Engel GL: Letter to the Editor: A clinical study of ulcerative colitis. J Am Med Assoc 183:147-148,
1963
Engel GL: Letter to the Editor: Quinacrine effects on the central nervous system. J Am Med Assoc
197:235, 1966
Engel GL, Schmale AH: Sudden death. Psychoanal Forum 1:234-236, 1966
Engel GL, Reichsman F: Letter to the Editor regarding paper by K Gaarder. Int J Psychoanal 471254,
1966
Gengel GL: Psychological factors and ulcerative colitis. Letter to the Editor. Br Med J 4:56, 1967
Engel GL: Letter to the Editor, Disputes Carnegie Commission Report acceptance. J Med Educ
47:756-757, 1972
Engel GL: Letter to the Editor: Vasovagal psuedohemorrhage. J Am Med Assoc 238:304, 1977
Engel GL: Letter to the Editor, ROAP or SOAP? N Engl J Med 299:780, 1978
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