Psychosomatic Medicine and Primary Care in Germany

Article excerpt

Friedhelm Lamprecht, MD,1 Wolfram Schueffel, MD,2 and Benyamin Maoz, MD, PhD3

Abstract: The development and training in psychosomatic medicine in Germany are presented. This branch of medicine emphasizes the biopsychosocial understanding of disorders, and psychological, particularly psychoanalytic, methods are used. The outcome of treatment studies are awaited to clarify their role in the medical services of Germany.

Introduction

The purpose of this paper is to describe the development of services and training in psychosomatic medicine in Germany. We think that this material might interest groups of psychiatrists and mental health professionals in Israel, particularly those who are actively engaged in educational programs of psychiatry and behavior sciences in primary (mainly family) medicine, and also function as psychiatric consultants in primary care, and those who participate in the planning and reconstruction of mental health services in Israel, in a period of continuous instability, lack of clarity, change and transition, in which many institutions, functions and jobs are re-defined.

An example is the job description of a "personal physician," which every health insured person in Israel should have by the year 2000, as proposed by the National Council of Health in the Community. The main task of this proposed personal physician is the coordination of all medical treatments (including psychiatry and mental health) which an individual has to undergo.

A personal physician therefore has to be trained in communication skills and should be able to integrate and incorporate psychosocial, personal and cultural dimensions into the overall picture of ones health state.

It might be interesting to get acquainted with the prerequisites in the field of "basic psychosomatic care" which are required in Germany (by law) from every physician (in every medical profession) who wants to practice in direct contact with patients, in a hospital, out-patient or ambulatory setting.

The term "psychosomatic" may seem strange for the Israeli reader, as no psychosomatic departments exist in Israel; and as psychosomatic medicine is often still perceived as a somewhat old fashioned psychoanalytical theory, dealing with the "psycho-genesis" of certain somatic diseases. There is no difference between modern psychosomatic medicine, as it is termed in Germany, and whole patient (and family) centered medicine, including and integrating behavioral (psychosocial) aspects, in the evaluation of every medical condition and health problem, as it might be termed in Israel.

History

The development of psychosomatic medicine in Germany is quite different from its development in English-speaking countries; therefore some historical remarks are necessary for better understanding.

The psychosomatic movement, which flourished in the late 1920s and early 1930s, was mainly dominated by new psychoanalytic ideas. Under the Nazi regime it was destroyed by expelling, killing or pushing the representatives, who were mostly of Jewish origin, underground. Fortunately most of them emigrated in time and survived, e.g., Franz Alexander, Siegfried Bernfeld, Erich Fromm, Frieda Fromm-Reichmann, Karen Horney, Max Eitingon, Melanie Klein and Ernst Siemel.

After World War II the first psychosomatic department within a university was sponsored by the Rockfeller Foundation at the University of Heidelberg. Psychodynamic thinking could not gain a foothold within psychiatry at that time, because psychiatry was very conservative and mainly clinically-descriptive oriented. German psychiatry still had to work through its own frequently fatal role during its cooperation with the Nazi regime and its racial ideology, a subject which was after the end of World War II mainly denied or repressed. Only in later years did psychiatrists start to work through this painful material. Therefore psychosomatic medicine, when reestablished after the war, developed outside of psychiatry either in internal medicine departments of university hospitals or in private institutions outside of the universities. …