On August 1st, 2023 James Strain quietly died at his home in Riverdale New York. In February he became 90 years of age and decided to close his psychotherapeutic practice. His patients will miss him for his warmth, scholarship, and stimulating guidance. We will all miss him as one of the founding fathers of our field whose vision was crucial to its development. Don Lipsitt, founding editor of General Hospital Psychiatry called him ‘an ambassador for C-L psychiatry’. However, ambassadors are usually for a single country and Jim was everywhere – in fact he reported visiting all 251 countries in the world minus 3 or 4. Perhaps he is better described as the ‘foreign secretary’ of our field, with a unique capability to promote Consultation-Liaison Psychiatry (CLP).
Jim followed his father’s footsteps with a degree in Botany from the University of Michigan. He then attended Case Western Reserve School of Medicine, took his psychiatric residency at the University Hospitals of Cleveland and a fellowship in psychiatric research, developing a rat model for electroconvulsive therapy. After winning the Menninger Award for outstanding research accomplished by a resident in the United States, Jim moved to New York City to enter the NY Psychoanalytic Institute for analytic training. His analyst was Charles Brenner and his supervisors were Edith Jacobson and Charlie Fisher.
He pursued his psychiatric career by first joining Robert Michels at St. Luke’s, then Morton Reiser and Ed Sachar at Montefiore. It was with Marvin Stein at Mount Sinai where Jim became the head of the Division of CLP. Mount Sinai became his lifelong headquarters from where he trained over 120 fellows and where he developed a method of documenting the populations served by C-L psychiatrists. His first research article from this work was written with Zebulon Taintor. It was also in that period that he started his collaboration with the late Jeffrey Hammer, at Northwestern University in Chicago. Jim and Jeff, assisted by John Lyons the epidemiologist, became a ‘dynamic duo’ in the history of CLP. They developed a computerized database called (MICRO-CARES) that would become an important tool for providing data to negotiate for funding of services with hospitals boards or health care insurers. As this work began before widespread use of the internet, it also provided an early literature search program. This work was important in sparking population and service oriented research, such as the European Consultation Liaison Workgroup study (11 countries, 56 CLP services, 250 consultants and 14,717 patients) for which Jim and Jeff were the consultants. This study in turn informed the development of a European CLP/Psychosomatic-network that finally led to the formation of the European Association of Consultation-Liaison Psychiatry, Psychosomatic Medicine, and Integrated care (EAPM) which is now the European sister association of the Academy of Consultation – Liaison Psychiatry (ACLP) formerly the Academy of Psychosomatic Medicine.
Another of Jim’s achievements was the replication of the Kornfeld Levitan hip-fracture study in a clinical trial done in NYC and Chicago. Jim received three contracts from the NIMH to develop models of mental health training for primary care that led to the development of collaborative services, later found effective in clinical trials by Wayne Katon and his group. Jim’s research had a broad scope and also included topics such as the first National Cancer Institute grant to study the compliance of physicians in randomized controlled trials. His knowledge is reflected in his leading role in the section for ‘stress related disorders’ in the development of DSM-IV and DSM-5, in particular in adjustment disorder. Another notable achievement was his participation as the only psychiatrist on an Institute of Medicine panel developing a handbook on developing guidelines in medicine.
Towards the end of his career Jim focussed on the hypothesis that depression is a systemic, and not just a mental disorder, which resulted in another book. He was outstandingly productive, publishing 557 peer reviewed articles, 7 textbooks and giving 807 national and international lectures. In the 1980’s during the period of transition from the dominance of psychoanalytic thinking towards the more empirical model offered by the DSM-III, a conflict arose about how best to deliver CLP-services. Arguments arose between those who believed in doing more consultations and those who advocated more liaison. Jim argued for more liaison. Once a week Jim met with the chair of ENT and his staff who presented him a patient, whom Jim would interview and advise on the care of. All the staff who attended these meetings learned from his teaching. Jim believed that doing consults for referrals was not enough: He would say; ‘I always wonder why I was asked only to see this patient and not his neighbour.’ As the conflict between those advocating for more consultations and those advocating for more liaison increased, a resolution was needed. Harold Allen Pincus working at the NIMH organized a debate between Tom Hackett representing the consultation model and Jim representing the liaison model. The debate was vigorous. Its aftermath was however tragic as, only two weeks later, Tom Hackett suffered a fatal heart attack whilst riding his horse had. Hackett’s death was an enormous shock to CLP in the USA. Happily however, within a few years the New York-based Society for Liaison Psychiatry called for the creation of a national organization for CLP and the Academy for Psychosomatic Medicine (APM) transformed itself to become that. It was later renamed the Academy of Consultation-Liaison Psychiatry (ACLP), the very name of which symbolizes a resolution of the Hackett Strain conflict. Jim then became a leading member of ACLP and was recognized by the organization’s Eleanor and Thomas Hackett Award, its highest honour.
Jim was not only a highly dedicated CL psychiatrist, he also was a seasoned traveller who skied and scuba-dived all around the world. He dived at the Blue Hole in Belize, attended a sky burial in Tibet, found dinosaurs egg in the Gobi desert and, in a Stanley-Livingston like encounter, met Jeff Hammer in Africa. Jim’s travels always included the promotion of CLP and support for those who struggled in poor circumstances to establish services in their country, be it Zimbabwe, South Africa, or Mexico to name just a few. Gladys Witt Strain, his wife and life-long partner, shared most of these travels with him. She is Emeritus Associate Professor of Nutrition in Surgery at Weill Cornell School of Medicine and a warm, sharp, decisive individual who has an enormous energy as reflected in her research. Their three sons are all doctors. There are no better words than those of Gladys and their sons to remember Jim Strain by:
‘He was an amazing man who helped out so many, gave of himself tirelessly, and was of amazing energy. He worked until he was 90 years old and honestly we think he loved every day of it. He had the gift to see the best in everyone and support them in their endeavours. He will be incredibly missed….’
Jim’s foresight, vision, and ideals will live on in all our work. Our thoughts are with Gladys and his family.
