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  • Title: [Illness, anxiety and the physician. An example from neurology and neurorehabilitation].
    Author: Barolin GS.
    Journal: Wien Med Wochenschr; 1991; 141(22):512-25. PubMed ID: 1801454.
    Abstract:
    There are rationally treatable fears arising from the acute situation (especially in rehabilitation patients) as well as the irrational anxieties of the mainly endogenous depressive. In the condition which we have come to call "concomitant depression", especially in neuro-rehabilitation, we can find both types of fear and anxiety, often in the same patient with mutual overlapping. In dealing with the fears of the incurably ill patient it is essential to know the phase-related progression in order to give empathy and help in entering the further phases at the appropriate times. It is important to know the "typical anxieties of the elderly" and to take them into account in concomitant psychotherapy, whereby group therapy has proved to be especially useful. On the other hand, the anxieties of the doctors themselves have to be dealt with, which opens a wide field for psychodynamic supervision and the Balint-groups. Apart from psychodynamic components there should however be a distinctly defined teaching program for the health profession, as well. On the therapeutic sector, we have to mention the organismic therapies, which have a good anxiolytic quality (therapy by hypnoid states and/or relaxation). Anxiety is by no means the only known contra-productive psychodynamic factor, but it is a point of onset for a desirable integrative approach in medicine, as a counterbalance against present tendencies towards over-specialisation, which at time can be counter-productive and detrimental to the patient. To achieve this, psychotherapy has to leave its ivory tower in order to radiate into all medical disciplines. It is not our task to eradicate anxiety in its pathological overflow by therapy; but to recognize and acknowledge it as an existing human dimension, thereby preventing it from turning into counter-productive moxiousness. Essential in this process are self-reflexion, empathy, training and systematic application of therapeutic techniques in efficient combination.
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