Dr. Elisabeth Herz, 59, is director of psychosomatic obstetrics and gynecology at George Washington University Medical Center, and associate professor of psychiatry and ob/gyn at the GW Medical School. She received her ob/gyn training in Austria, then spent some 20 years traveling with her husband, the late Martin Herz, an American foreign service officer.

Because foreign service wives were not permitted to hold jobs, Herz practiced medicine as a volunteer wherever her husband was posted. She could not practice medicine at all during the four years (1973-77) her husband was U.S. ambassador to Bulgaria. When the Herzes returned to the United States, Elisabeth Herz fulfilled her life-long ambition to make psychiatry her second specialty.

I had decided to become a doctor when I was 8 years old. It wasn't the easiest thing to do, what with the Nazi occupation and everything going on in Austria in those days. When I decided to specialize in gynecology and obstetrics, that wasn't easy either because the best known professor in Europe at the University of Vienna didn't like women doctors. I was one of two women on a staff of 34.

It was while I was working there . . . that yes, I knew I had learned very well how to do surgery and all the things one does as ob/gyn, but I realized I was not well enough equipped to also deal with the emotional needs of a patient.

Working at different hospitals and clinics for the indigent in different countries deepened my interest in the emotional -- or rather, the psychosocial -- aspects because I was exposed to so many different cultures and saw all the different reactions and influences of the environment and what it did to a woman when she was pregnant or had to have surgery.

When we got back to Washington, I decided I would combine my many years of ob/gyn experience around the world with training and real knowledge in psychiatry.

I also felt that it was the right time for this joint specialty because women had become more assertive and were beginning to demand more from their ob/gyns than just being treated as "this ovarian cyst" or "that infertility problem."

It has now become clear that the reproductive sexual organs are more emotionally charged and therefore anything that happens to them -- disease or loss or dysfunction -- has a considerable emotional impact on the woman. On the other hand, as we now know, the psyche also influences sexual reproductive functioning. It goes both ways.

Medicine has developed so fast since the end of the Second World War, becoming more and more subspecialized, and on the other hand, psychiatry has also developed, but in another direction. And somehow the person fell in between. This is something that also made me feel that this is the right time for medicine and psychiatry to understand that they need each other.

The field is becoming constantly wider because there are so many new developments -- in vitro fertilization, artificial insemination, surrogate mothers, decision-making after amniocentesis . . .

I think there is a much greater awareness now, for example about the effects of multiple miscarriages, the different ways a wife and a husband may grieve and, now, how we can do some preventive work.

Now we have a psychiatric/obstetrics-gynecology society that meets annually that includes the few of us with both specialties, but also obstetricians and gynecologists and psychiatrists as well as social workers, psychologists. I never dreamed the field would get established so quickly.