Georg Ivanovas From Autism to Humanism - systems theory in medicine

4.6. Second-order cybernetics in medicine

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a) the therapeutic relationship

It is difficult to describe the psychotherapeutic relationship, even if it is as standardized as the psychoanalytic setting. For example, it might be investigated from the point of view of power. Many authors analysed the power aspect of the therapeutical communication (Milgram 1975, Krippendorff 1995). Some see herein even the main source of the therapeutic interaction (Haley 1963). “Power is a powerful idea”(Cecchin et al 2005). Conclusively, it is a legitimate and interesting task to analyse, how therapists use their power. One investigation taped the first session of therapies and showed how therapists imply their system onto the clients, how they bind them. That is, what kind of communicative power they have to define the relationship (Bartesaghi 2002).

Such results are not only true for the psychotherapeutic relationship but also for every contact between a doctor and a patient. Power games may influence medical practice more than scientific results. Here comes the ‘Sissi syndrome’ into the play again. It might become a tool in the struggle between the doctor and the patient. The doctor might use it to get a patient ill, even if s/he does not feel so. The patient might use it, even if the doctor finds no special disturbance. (“Haven’t you read of the newly discovered Sissi syndrome?”).

But does power describe the whole truth? Or even a truth?

Feminism, e. g., investigated the intersexual relations mainly in terms of power. The results were often surprising, impressing or even shocking. But most people felt that this description is not the reality they live in.

Research produces only the results foreseen by the used instrument. Investigations of power provide power structures of a situation. Measurements with a thermometer only provide a result in temperature probably in oC, oF or oK. This does not change, even if the measurements are made with greater precision.

This is, indeed, true for every angle of observation. But there are angles that are socially accepted and others are not. It is accepted to describe every disease by its physiology whereas it is not so accepted to describe it by its social context (Simon 1995: 104-110), by power structure, financial interest (what is changing lately) or even by its religious meaning. Even the simple systemic approach to see a symptom or a disease as a means to stabilize a situation is beyond the current understanding. All these aspects cannot be ‘seen’ with a (standardized) physiological description. But “it is an important trend of the development of science that new aspects, previously unnoticed, are ‘seen’, i.e., come under the focus of attention and appreciation; and conversely, an important obstacle that the goggles of a certain theoretical conception do not allow to realize phenomena which, in themselves, are perfectly obvious. History of science is rich in examples of such kind” (Bertalanffy 1968: 237).