PSYCHOTHERAPY WITH THE PHYSICALLY ILL

An effective treatment in internal medicine presupposes that the abnormal changes which are hidden in the body of the patient become visible. The traditional understanding of disease is based on pathological anatomy, that means on the cutting up of corpses. It is no doubt indispensable for medical treatment, but in the opinion of the author it is often not taken into consideration that there is another completely different concept of suffering. The idea is that the sick person opens himself by speaking. It is the duty of the doctor to listen to him and to give him the chance to give up his taciturnity. Psycho-analysis was the first step. Three cases studies illustrate the point: The first is a 24-year old man who was admittet to a clinic for internal medicine because of a subchronic glomerulonephrits. In the psychotherapeutic dialog with the author the psychodynamic of the intermittent disease could be clarified. In the second case it is shown that not only the so called alexithymia of the physically ill person limites how much a patient can speak about his feelings, but also the doctor's attitude. The female patient, who was a 35-years old teacher, was firstly treated for a heart attack in a clinic for internal medicine. There she wanted to deal with the background of her illness, but her doctor advised her against it with the words that many people had already died from psychosomatics. Her anxiety intensified so much that she took a long time before she consulted a psychotherapist. In the third case the author describes how much resistance to psychotherapy can be in the patient himself. The patient who was a 36-year old worker could overcome his own resistance by close cooperation of the general practioner and the psychotherapist. In a short follow-up of the further development of the patients it is manifested that the third case showed the best result. The author traces it back to the fact that in contrast to the other patients he was treated by two therapists who complemented each other.