By Norman B. Levy

Associate Professor of Psychiatry, Departments of Medicine and Psychiatry  |  Associate Director, Medical-Psychiatric Liaison Service  |   State University of New York  |  Downstate Medical Center  |  Brooklyn, New York

As its name indicates, “psychonephrology” explores the psychological impact of kidney disease and focuses particularly on patients receiving kidney transplants or dialysis treatment. The  Israeli psychiatrist Atara Kaplan DeNour and I were looking for a name for this new area in 1965, at the dawn of these life-saving treatments. The choice was between “nephropsychiatry” and “psychonephrology”. The latter was chosen because we believed it was more inclusive of different but related professions.

At the time, it was necessary to make systematic investigations into the area between psychology and kidney disease. As a junior psychiatrist in a large municipal hospital in Brooklyn my director, Franz Reichsman, and I was tasked with assisting members of the nephrology department with a difficult decision. The Director of Nephrology, Eli Friedman, and his selection committee had to choose which individuals should be accepted into a new nine-bed dialysis unit at the hospital. With limited resources and all of the patients suffering from end-stage kidney disease, such a decision in those days was choosing who would live and who would die. The decision of the committee, of which we were not members, was to exclude active drug addicts and all patients who were grossly psychotic. All others were accepted until the program was full. Unfortunately, those remaining were not considered because there was simply no space for them. This process offered us a golden opportunity to interview prospective candidates and follow their journeys. We were able to make systematic studies of their adaptation to — and struggles with — dialysis treatment. Throughout this arduous treatment, patients were placed in a unique position of abject dependency on a machine and were accompanied by a limited number of personnel.

After this experience, we wrote papers and published books about our findings. I continued to generate interest about psychonephrology by holding 12 international conferences on the subject.

Psychonephrology continues today as a vital aspect of caring for patients affected by kidney disease.

 

Norman B. Levy is the leading authority on the psychology of hemodialysis, and considered the father of psychonephrology. He is the author of over fifty articles, ten book chapters and several texts on various aspects of psychosomatic medicine.

Norman B. Levy’s publications on the topic of psychonephrology include:

Psychonephrology 1: Psychological Factors in Hemodialysis and Transplantation

Psychonephrology 2: Psychological Problems in Kidney Failure and Their Treatment

Living of Dying: Adaption to Hemodialysis