Why Balint should meet Psychosomatics

C. Jannes

In Balint groups, patient oriented medicine is preferred to illness oriented medicine.

In Psychosomatics, medicine is person oriented.

Psychosomatics addresses to a person as a Total Organism in the total organisation of the Environment.

The person is mind and body,

has a history (from birth till present), a family,

a masterplan, a status,

living conditions (housing, climate, etc.),

work, life style,  

etc.

Psychosomatics is the sum of x-oriented medicine, in which each approach is important, but where choices must be made in regard of efficiency, comfort, long-term goals.  Person oriented medicine is patient oriented plus.

Which are the different approaches we see in medicine?

Some doctors practice most of the time a complaint oriented medicine.

In this kind of medicine the doctor only focuses on the complaint and tries to ease the patient. We can see this for sleep problems, fatigue, lack of concentration and many other problems.  If the patient stops complaining, the doctor stops the treatment.

In Illness oriented medicine we can distinct between symptom oriented and syndrome oriented medicine.

In symptom oriented medicine the doctor focuses on the signs that indicate illnesses. He or she tries to see relations between causal factors and the actual disease. He or she is mainly in the here and now thinking and curing. His or her goal is to remove the symptoms, such as  pain, temperature, rash, tumor.

In syndrome oriented medicine the doctor tries to understand the symptoms in the broader context of knowledge and circumstances. He or she tries to classify, to distinguish between epidemics or pure single cases, between genetics and environmental factors. He or she works with a vision on the present and the future of the patient, a vision on cure and prevention, on acute and chronic, on acute danger and long term undermining, as is the case in depression, diabetes, artrosis.

Some doctors specialise and practice system oriented medicine or technique oriented medicine.

In system oriented medicine complaints, symptoms, syndromes are reduced to valuable information within one system such as the cardiovascular system, the respiratory system, the gastro-intestinal system, the skin, the psyche, etc. Most specialists practice this kind of medicine, but also in general practice, doctors tend, after the first round-up,  to stick with one system, when a symptom or an illness seems to be located in that system. The complaint seems to be of major importance, or the symptom causes visible harm or destruction in that system. 

In technique oriented medicine the doctor specialises in one technique and reduces his medicine in regard of the possibilities of his or her personal technical ability or the possibilities of his or her specialisation. Chirurgical interventions, medical visualisation, drug treatment or psychotherapy are examples of technical medicine where a technique dominates a global approach of the illness/patient/person.

In Patient oriented medicine the doctor looks at the patient as a whole. However his history, life style, family patterns, etc. are seen in the context of the disease. The purpose of the scrutiny of all these domains is to find the causes, the influences, the circumstances of an illness, and the possible negative or positive factors for the cure.

In Psychosomatic Medicine its our opinion that each doctor, in general practice or as a specialist, should approach the person. The person with his or her personality, history, possibilities, restraints, his or her goals and fears. He or she should treat him or her, support and follow up, considering all of this.

Psychosomatics is also a scientific approach.

Its about changes . Changes in the total organisation of a person. Changes in the environment. How changes can influence, can affect the person. Changes that occur, regardless of the ideologies we have, the concepts we made, the theories we believe in.

It is also about balances. An example is "le milieu intérieur" or "the internal environment" of Claude Bernard. Organisms have systems that keep the organisation in balance. Medicine is the science that studies and cures the changes that profoundly and sometimes irremediably affect aspects of the total organisation or the whole of it.

The knowledge of Pathways is important. The pathways that lead to a condition, be it health or sickness. When looking at one specific disorder, such as Depression, genetics, stress, personality traits, trauma, chronic illness, etc. are pathways that can result in a major depression. Sometimes in the history of the patient with a depression we see foregoing signs of exhaustion, such as emotionality, irritability, doubt, sleep disturbances, or signs of disbalance, such as head aches, instable blood pressure and irritable bowel. The condition of the depression itself is a profound disbalance of mood,  hypothalamus-hypophyse-adrenal axis, neurotransmitter regulation, etc.

Some pathways can continue after the termination of the treatment and could cause relapses or other disbalances, if they are not taken into consideration for a better follow-up.

The Balint method aims to improve the personal approach and skills of the doctor by a continuing inter-colleague meeting under the leading of a psychiatrist/ psychotherapist over several years.

The Psychosomatic Medicine approach considers the doctor as an agent of Change. The doctor him or herself is an instrument. The doctor can improve his or her knowledge, skills and attitude. Knowledge is widened by continuous learning, skill by practice and modelling, attitude by the enrichment of ones personality.

The Psychosomatic Medicine approach is about the person of the patient and of the doctor.

This is why Balint should meet Psychosomatic Medicine

28 oktober 2008