Georg Ivanovas From Autism to Humanism - systems theory in medicine

5.4 Balneology

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b) beauty and dignity – the ‘placebo’ of human values

There are many ‘unspecific’ factors in balneology. One of the them is architecture.

Whoever visited one of the old spas and wandered around the parks, went into the spacey marbled receptions, had treatment in old bathrooms or just sat in a well organized garden made the experience how relaxing this kind of architecture is. Beauty and aesthetics characterized the spas from Ancient times. They were a major and cheap therapeutic factor (Kovarik 1985). Just as good manners are (Kahn 2008). Beauty is helpful in pain reduction (Tomasso et al 2008) and could also be beneficial in the hospital treatment (Major 2008).

But today, in contrast, physiotherapy has to be absolved as a scientific program in a functional atmosphere. In therapies the patients lie for half an hour or more in an often ugly room, looking at cold neon lamps, behind chequered metals which, although clean, always give the impression of something worn out. Today’s architecture often neglects the basic needs of humans for aesthetics. Although the measurement of the body functions are precise, a lot of good by such a knowledge is countered by an unattractive environment. It would be a misunderstanding of human nature to see such effects as irrelevant.

Granichstaedten (142- 145) describes two patients, one receiving the traditional therapy for syphilis at his time (first half of 19th century), the other one had hydrotherapy in a spa:


The patient with the traditional therapy vegetates in closed rooms, has a rigid diet developing a disgust for all meals, spending the days with a feeling of unease and depression. The nights are sleepless. Through the therapy his teeth become loose and the taste in his mouth is foetid. This is the state how he is released


The patient with hydrotherapy lives in fresh air with an increasing appetite. Although he is (mis)treated with cold water during the days, he will develop trust into the therapy. His good and deep sleep is disturbed in the morning with treatments leading him to sweat, but afterwards he will climb in the mountains, drinking fresh spring water. He will suffer crises, but he will get better. At the end of the therapy he will have eruptions all over the body, but he will be strong and on the way to health. This is how he is released.


Although this is pure propaganda, many of the points (fresh air, food, exercise, side effects of the therapy and general attitude) are still true today. To some extend hospital therapy has not changed too much. But balneology made some steps towards hospitalisation.

The most important difference between the two examples is – according to Granichstaedten – the ‘moral feeling’ (Granichstaedten: 148), the attitude of the therapist and the atmosphere of the whole environment. Today’s attitude is to solve all problems by drugs and therapeutical interventions. Therefore, it is no surprise that physicians and patients prefer passive therapies (Osthus/Jacobi 2002), which are – as seen before – less effective.

Balneology is one of the few branches in medicine having a different attitude than the mainstream medicine. Hardening and active exercise are most important features. But balneology also aims at changing the life style. This has been called Ordnungstherapie (therapy by order), a term introduced by Bircher-Benner.

Therapy by order’ helps to reinstall inner rhythms by a proper conduct of life. It might include such simple procedures like eating in family style of nursing home residents (Njis et al 2006). But it also includes the spiritual aspects of a therapy. Such issues are not only neglected in current medicine (Hammer 1990: 45). My be they are even as suppressed as sexual problems at the time of Freud. That is, a therapist using techniques of ‘therapy of order’ has to face questions of life for himself. It requires a stance on issues like suffering, death, happiness and so on (Brüggemann 1980). It requires an attitude (chap 6.14). What other sense has a therapy than to live ones own life (Hammer: 59)? Therefore, one of the most important qualities in the ‘therapy of order’ is dignity, dignity of the patient, dignity of the team and dignity of the individual doctor.

One of the main shortcomings of the reductionist approach is that it defines basic human values like beauty, respect and dignity as placebos. They have been abandoned by science despite their importance for life and therapy (Marmot 2003), despite their importance for medical practice (Leibold et al 2003).


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