THE BALINTIAN APPROACH OF PSYCHOSOMATIC DISORDERS. The medicine called “Doctor”. Csilla Moldovan , Albert Veress , Éva Veress. BALINT ASSOCIATION OF ROMANIA. Michael Balint in his work “The Doctor, his Patient and the Illness”
THE BALINTIAN APPROACH OF PSYCHOSOMATIC DISORDERS
The medicine called “Doctor”
Csilla Moldovan, Albert Veress, Éva Veress
BALINT ASSOCIATION OF ROMANIA
Michael Balint in his work
“The Doctor, his Patient and the Illness”
opened new perspectives in understanding psychosomatic disorders and launched the notion of
“The doctor as a medicine”
PRESENTING THE “MEDICINE”
„The doctor is an entity for the benefit of others”
The doctor is the MEDICINE
The active substance of this medicine is
THE DOCTOR’S PERSONALITY
BPS MODEL of ENGEL
The doctor-patient relationship
is a critical component of the BPS model
The Biological System
The biological factors condition
the biological functioning
of the doctor
of the patient
The Psychological System
The psychological factors
The personality of the doctors
The personality of the patient
the professional motivation
and his attitude
towards perceiving and
the motivation of the
patients attitude towards
THE SOCIAL SYSTEM
THE SOCIAL FACTORS
The appearance and
the treatment of the illness
Expresses and experiences the illness depending on the social, cultural, familial, ethnic customs
His personality is influenced by the way he perceives the role of the doctor
THE WAY THE MEDICINE IS PRESENTED
“Each doctor creates a unique atmosphere” M. Balint
The overactive doctor:
authoritarian in the doctor-patient
relationship, leads the treatment
The partner doctor:
equality in the doctor-patient relationship,
treatment goes on in collaboration with the patient
paternalistic, treatment is conducted
by the doctor with a teacher-student-like
subordination of the patient
The friend doctor:
in most cases such a relation does not work
The Balintian doctor:
the best ailment in treating
THE BALINTIAN DOCTOR
“ The doctor as medicine”
Reveals the pathogenetic effects of psychosomatic disorders
Focuses on PS illnesses as a consequence of poor communication, isolation, and problems of making a living
Satisfies the communicational needs of the patient
Makes a survey of all possible solutions
to the patient`s problems
Reveals new perspectives in solving these problems
CHARACTERISTCS AND EFFECTS
Confines to the saying: “NIL NOCERE”
are considered to be a consequence
and expression of
PROBLEMS OF EXISTENCE and
PROBLEMS OF COMMUNICATION
The best medicine will be the doctor who
satisfies the patient`s need of communication
“The way the doctor offers himself to the patient depends on his personality rather than the needs of the patient”
The doctor as BPS model conditions the doctor-patient relationship
The pharmacological action of the
The quality of Doctor-patient-illness relationship
HOW DOES THE “DOCTOR MEDICINE” ACT UPON BPS?
PS symptoms express vital situations of the patient
The patient can not or does not want to deal with these problems
The problems of existence becoming illness-generating problems
HOW DOES THE “DOCTOR MEDICINE” ACT UPON BPS ?
In a lucrative relationship, where communication is possible, the doctor can prompt the
by spontaneously sharing thoughts, free association and all this will certainly cast light upon the basic problems of the patient
“HERE AND NOW”
THE INDICATION OF THE MEDICINE
The psychosomatic symptoms, which are linked to a vital problem can be the etiopathogenic factors in the genesis of the psychosomatic disorders:
social isolation, lack of communication, job difficulties, lack of satisfaction in love, lack of feelings, collapsing of traditions, uncertain daily existence, no perspectives for the future, accepting and idealizing compromises, moral crisis
In this situation there is nobody to receive the cry for help...
BUT the body of the patient itself, which will turn the problems from outside into somatic inner ones,
and finally the patient will call the doctor.
DOSAGE OF THE
Is determined by the:
• Gravity of the PS disorders
• Tolerance towards the medicine
• The development and intensity of side effects
In case of overdosing, the antidote couldbe:
GIVING UP THE RELATIONSHIP!
LIMITS IN ADMINISTRATION
The “Doctor Medicine” acts upon the
Patient and his Environment
BPS factors can limit its action
The family is also a BPS system with specific dynamics.
The “Doctor Medicine” can balance this system:
It could be a ”shock absorber “in the system.
Only by being present, he absorbs the negative shocks, making it possible for the others to live along with the problems
The system keeps on going against expectations, even if the problems persist.
LIMITS IN ADMINISTRATION
The doctor may experience unpleasant emotions while playing his therapeutic role, thus limiting the efficacy of the „Medicine”
The “medicine” cannot replace the poor social protection the ethnic, cultural and religious beliefs, the financial and social situation of the patient.
He could change the thinking of the patient, his status in the family, and could help him get through the emotional experiences due to the PS disorders
SIDE EFFECTS OF THE
The countertransfer of the doctor is the result of the influence of the patient on the unconscious mind of the doctor, and this will lead to an improper attitude with the patient:
aggressiveness, anger, indifference, unmotivatedly keeping the patient inside the relation, iatrogenic effects.
The doctor may crave for power(Adler)
This is to hide his inferiority as a medicine, feeling incapable of making a relationship and communicating with the patient. His anxiety, the uncertain diagnosis will only add to it.
“The doctor may become a `little dictator` to the patient”(Lanchland)
SIDE EFFECTS OF THE “DOCTOR MEDICINE”
SPECIAL NOTICE ON USING THE “MEDICINE”
There are three sorts of treatment: prophylactic, therapeutic and maintaining. Use and efficacy of the medicine called “doctor” also depends on the duration of treatment.
The better a doctor is appreciated, the more patients he must deal with.
Consequently, he will have less time to communicate with the patients.
Thus, more patients will leave him for other, possibly less efficient doctors,
but who have more time at their disposal.