THE BALINTIAN APPROACH OF
PSYCHOSOMATIC DISORDERS
The medicine called “Doctor”
Csilla Moldovan, Albert Veress, Éva Veress
BALINT ASSOCIATION OF ROMANIA
1
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”
2
PRESENTING THE “MEDICINE”
„The doctor is an entity for the benefit of others”
(Scripcaru)
The doctor is the MEDICINE
The active substance of this medicine is
THE DOCTOR’S PERSONALITY
conditioned by
biological-psychological-social factors
BPS MODEL of ENGEL
The doctor-patient relationship
is a critical component of the BPS model
3
The Biological System
The biological factors condition
the biological functioning
of the doctor
of the patient
4
The Psychological System
The psychological factors
shape
The personality of the patient
influences
the motivation of the
patients attitude towards
their illness
The personality of the doctors
influences
the professional motivation
and his attitude
towards perceiving and
experiencing suffering
5
THE SOCIAL SYSTEM
THE SOCIAL FACTORS
Influence
The appearance and
the treatment of the illness
THE PATIENT
Expresses and experiences
the illness depending on the
social, cultural, familial,
ethnic customs
THE DOCTOR
His personality is
influenced by the way he
perceives the role of the
doctor
6
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
7
All-knowing doctor:
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
psychosomatic disorders.
8
THE BALINTIAN DOCTOR
“ The doctor as medicine”
M. Balint
ADVANTAGES
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
9
CHARACTERISTCS AND EFFECTS
Confines to the saying: “NIL NOCERE”
PSYCHOSOMATIC DISORDERS
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
10
CHARACTERISTICS OF THE
“DOCTOR MEDICINE”
AND HIS EFFICIENCY
• Capability of empathy: putting himself into the
patient`s situation. The patient expects understanding
• Capability of listening: by keeping silence and
listening, the doctor will eventually break the patient`s
resistance, the first step towards communication
• Capability of listening without judging: will help
assess the objective situation of the patient
• Tolerance, flexibility and sensitivity with the
patient a communicating doctor-patient relationship will
be settled
11
CHARACTERISTICS OF THE
“DOCTOR MEDICINE”
AND HIS EFFICIENCY
• Capability of changing his emotions towards the patient:
will produce a change in the situation of the patient, the
possibility of accepting a terminal situation
• Capability of intuition and realization of the awareness of
the transfer and countertransfer in the doctor-patient
relationship : will help the doctor control his emotions
towards the patient
• Capability of accepting that recovery means autonomy:
this liberates the patient from the relationship
12
PHARMACOKYNETICS
“The way the doctor offers himself to the patient depends on his
personality rather than the needs of the patient”
M.Balint
The doctor as BPS model conditions the doctorpatient relationship
The pharmacological action of the
“Doctor Medicine”
conditions
The quality of Doctor-patient-illness relationship
13
THE PHARMACOLOGICAL ACTION
OF THE “MEDICINE”
• Assessing the doctor patient relationship
• Assessing the tensions in the life of the patient
• A good understanding of the complex
interpersonal factors such as transfer and
countertransfer
• The correct assessment of the dynamics of the
doctor-patient relationship
14
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
15
HOW DOES THE “DOCTOR
MEDICINE” ACT UPON BPS ?
In a lucrative relationship, where communication is
possible, the doctor can prompt the
“BALINTIAN FLASH”
by spontaneously sharing thoughts, free association
and all this will certainly cast light upon the basic
problems of the patient
“HERE AND NOW”
16
THE PLACEBO EFFECT
• Depends on the efficiency of the “medicine”
• trust in the curing doctor
• the effect can be correlated with the apostolic function of
the doctor, who converts the patient to his own ideas
• The pharmacokinetics of the medicine called “doctor”
is also influenced by the way the medicine is
administrated
• This “magic ritual” of administration medicine can have
a considerable effect on the patient, increasing the
therapeutic efficiency of the medicine
17
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.
18
DOSAGE OF THE
“DOCTOR MEDICINE”
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 could be:
GIVING UP THE RELATIONSHIP!
19
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.
20
LIMITS IN ADMINISTRATION
The doctor may experience unpleasant emotions while playing his
therapeutic role, thus limiting the efficacy of the „Medicine”
NEGATIVE EFFECTS:
The “medicine” cannot replace the poor social protection the ethnic,
cultural and religious beliefs, the financial and social situation of the
patient.
POSITIVE EFFECTS:
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
21
SIDE EFFECTS OF THE
“DOCTOR MEDICINE”
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)
22
SIDE EFFECTS OF THE
“DOCTOR MEDICINE”
Doctor`s self defense is an adverse reaction as a defense
against professional frustration.
The behavioral stereotypes are:
-refusing the patient, the doctor will suggest that the patient is
in fact not ill at all.
-endless referrals to other specialists and paraclinical
investigations
Exaggerating the apostolic function:
the doctor tries to convert the patient to his conception about
the illness; he feels omnipotent as if he knew all, the doctor is
vulnerable to criticism from the patient, and feels hurt if
patient leaves him.
23
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.
24
The End
Sfârşit
Vége
Konec
25
TENC IU
VERI
MACI!!!
26