Georg Ivanovas From Autism to Humanism - systems theory in medicine

6. Systemic Medicine

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6.14 The therapeutic attitude

The health of my patient will be my first consideration

Hippocratic oath

In order to improve the health of a patient, medicine has to deal with all aspects of the human. It is neither more scientific, nor more medical and probably not more effective to be concerned only with one aspect. Medicine is about healing, about organisation, about robustness, about evolvability, about the meaning of life. The physician has to provide the necessary requisite variety. It would be unscientific not to do so.

In order to deal with the ‘higher’ levels and layers concerning human and social values and interactions it is more important to read Dostojewski than the newest issue of the Lancet. Thus, the ‘narrative medicine movement’ (chap. 1) has a much a wider impact than only the improvement of the communicative skills. It represents a part of medical practice which can be defined as the attitude of the physician. This term comprises many aspects like affect, cognition, and behaviour (Zimbardo/Ebbesen: 7). It is strongly connected to all the value decisions a physician continuously makes (chap. 6.1), to the notion of power (chap. 4.6.a), to the interhuman relationship. Many examples for how the attitude influences our medical practice have been provided. Here a last one: Children with ADHD are often treated with drugs, when parenting would be as effective or even a better solution (Constantini 2006). The best proof is that children after divorce are more often treated with Ritalin (Strohschein 2007), although a good supporting structure would be more important (Ohio State University 2008). In fact, a whole range of educational problems is treated with antidepressants (Jureidini et al 2004) or antipsychotic drugs (Olfson et al 2006), often with doubtful results (Jureidini et al 2004). Such developments have far reaching consequences. First, they tend to decrease the robustness of the treated individual. Second, they teach the ‘social lesson’ that solutions can be achieved by drugs (US National Drug Control Policy 2008). Third, they prevent that other solutions, other states (chap. 4.11) can be found. Fourth, through social and epigenetical learning such imposed alterations might lead to a change of the human adaptation even for generations.

Hence, the central value decision in every treatment is: What kind of control is intended? A central or distributed control? Is drug treatment considered as front-ranging or adjuvant? This is an undecidable question (chap. 3.4) which translates in succession into a whole range of decidable questions. Just as it is impossible not to communicate (chap. 3.7) it is impossible that the physician’s attitude does not influence the therapy. Moreover, in the field of the autistic-undisciplined thinking two physicians might come to a totally different strategy to promote health, even in using the same date (Zuger 2008b).

In this aspect the “Advice to young doctors from members of the editorial board of the British Medical Journal” (appendix I) is not only an accumulation of unrelated recommendations but a reminder of the pivotal concerns of medicine. This requires an independent thinking, a ‘fearless speech’ (Papadimos/Murray 2008).

Some decades ago there was a humanistic movement in psychotherapy, a movement not related to one method but obliged to the basic principles of humanity. It saw itself as a third force in psychology between the one-sidedness of psychoanalysis and behaviouristic psychology. Its main values were (Revenstorf 1982):

  • individual experience and not theorizing and objectivity,
  • non-reductionism stressing the basic human abilities of creativity and self-actualisation,
  • meaningfulness, that is, that psychological concepts and research have to be based on the question whether the results make sense for human existence,
  • dignity, the aim to support those forces in humans that enable a dignified life.

Although this is a psychological manifest, the same values could serve as a foundation for all human therapy. They are as true in diabetes as in rheumatic arthritis or depression. Being aware of the basic human values and the fact that every therapy is first of all a value decision, a physician has a considerable variety of options.

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