Primary Psychosomatic Care
The main task of psychosomatic medicine is to promote the understanding of psychosomatic and to ensure adequate proper care for patients. Psychosomatic medicine is entitled to be included in basic medical care, completing the mostly organically, functionally and technocratically oriented conventional medicine. With knowledge and awareness in psychosomatic terms, the doctor can also evaluate and interpret the psychosocial background of the disease and treat the patient adequately by offering him/her appropriate and effective treatment.
Since 2003, primary psychosomatic care has become a compulsory part of education in the medical specialties of general medicine, pathology, gynecology and obstetrics in Germany, and it is planned to spread to other countries and medical specialties.
Doctors of any specialty who wish to acquire knowledge in Primary Psychosomatic Care have the opportunity to take part in individual modules of a course on HELLENIC BALINT SOCIETY’s Primary Psychosomatic Care.
In these Seminars we combine:
1. theory with
2. exercises on the intervention technique; and
3. the classical Balint work with small groups.
In the sense of “Primary Psychosomatic Care”, the physician should be able to record the physical and emotional state of the patient and his or her relationships with himself and others (including the physician) in his diagnosis. In this last part Balint groups are of particular importance. In essence, the universal primary psychosomatic service consists of three basic elements:
- Basic diagnosis – Recognition and physical and psychological and psychosocial influences on disease
- Basic therapy -Basic psychosomatic treatment is only possible in a confidential doctor-patient relationship. Basic treatment is mainly based on the integration of mental and physical aspects through verbal intervention.
But Psychosomatic Care does not mean Psychotherapy, as it is often misunderstood. Psychosomatic Care is a necessary part of medical practice and is not necessarily replaced by psychotherapeutic treatment. To meet these requirements, the attending physician must know the bio-psychosocial influence of the disease well and place it in the medical history. Doctor-patient relationship also plays an important role: By sensitizing and developing the own emotional endoscopic capacity, the physician must recognize the problems that arise in dealing with the patient and expanding his healing abilities.
- Collaboration – with psychosocial care and psychotherapists, when psychotherapy is needed.
Primary psychosomatic care is conducted in:
Functional disorders – e.g. the somatoform disorders, where symptoms emerge without an organic finding.
Psychosomatic diseases – natural diseases whose pathogenesis is related to psychosocial factors.
Somatopsychic disorders – mental health problems arising from the treatment of serious illnesses (for example cancer)
Mental disorders – such as anxiety, depression, etc.
Psychosomatic Concept and Approach
The word “Psychosomatic” is formed by combining the Greek words “psyche” and “soma” which mean “body and soul” and manages to reflect the mutual influence between body and soul.
Inevitably, when we refer to the soul and the mind, we move from the purely scientific level and we address some philosophical questions. In dualism (for example Descartes or Leibniz), the levels of the body and the soul are considered as independent entities that can or cannot influence each other.
Monism sees the body and the soul as different phenomena of an event (for example Plato, Aristotle, Spinoza…).
First Freud and his disciples, among whom was Michael Balint, expressed the word “Psychosomatic” while developing the Psychoanalytic method to heal physical symptoms with a background of the mental conflict.
In 1929, Michel Balint published a paper on psychoanalysis and clinical medicine, which made him one of the pioneers of psychosomatic medicine.
He was the first one to recognize the importance of the relationship between the doctor and his patient and invented his method to train doctors in order to make them able to use their relationship with the patient for a more successful therapeutic effect
We can distinguish 2 kinds of psychosomatic approach:
- Organic diseases can have psychological causes (psychogenic approach); and
- Every illness has psychosocial aspects (holistic approach).
Initial linear-causal models evolved gradually from interactive and systematic models such as the so-called “bio-psycho-social model”, so called by George Engel in the 1970s – replaced the mechanistic model and helps us understand more about the origin, processing, and treatment of somatic illnesses.
In summary, this means that any process involved in the pathogenesis of a disease is neither purely biological nor purely psychological, but that each illness involves both.
Biological processes are also manifested at the psychological level, which is visible in the case of a serious organic disease with a consequent mental involvement, as well as mental processes are manifested physically. Here we distinguish direct influence through e.g. hormone stress and indirect influence through harmful behavior patterns.
As a basic assumption, there is a corresponding neurophysiological response for each mental event.
As for a doctor to see the big image of the pathogenetic factors at his patient, a holistic and less “technocratic” approach is needed.
Only by the relative recording of the patient’s history, including the patient’s social and family status etc., can we talk about “Primary Psychosomatic Care“. And only through a good relationship and communication between physician and patient, the patient will report life events and thereby to give to the physician a complete picture of the possible causes of his pathology.
Through learning-modules related to “Psychosomatic Primary Care” and experience in greek Balint groups of the Hellenic Balint Society, the perspective widens as we look at patients and pathologies, and the physician learns to apply a holistic approach.