[The first interview: taking into consideration countertransference-phenomena and interpretation]. / Anamneseerhebung: Berücksichtigung von Gegenübertragungsphänomenen und Deutung.

During history-taking the patient induces feelings and fantasies in his physician. They may be related to unconscious conflicts of the patient, contributing to his illness. Their verbalization by the physician, who clarifies their possible connection with the unconscious motivations of the patient can reach his emotions and foster his insight, thereby relieving his suffering. Not all patients benefit from the confrontation, clarification and interpretation by their physician.

[The "diagnosis" in the light of Charles S. Peirce, Sherlock Holmes, Sigmund Freud and modern neurobiology]. / Die "Diagnose" im Lichte von Charles S. Peirce, Sherlock Holmes, Sigmund Freud und der modernen Neurobiologie.

A diagnostic hypothesis is a causa ficta. It is an assumption, suitable to explain phenomena, which are not yet proven to be the only and valid explanation of the observed. One of Wilhelm Hauff's faitales illustrates how a hypothesis is generated. It is based on the interpretation of signs. Signs are of an ikonic, an indexical or a symbolic nature. According to S. Peirce, a hypothesis is created by abduction, to Conan Doyle's Sherlock Holmes by immersion into thoughts, and to S. Freud by free floating attention. The three procedures are alike. Neurobiological structures and functions, which correspond to these processes, are described; especially the emotional-implicite memory. The technique of hypothesis-generation is meaningful to clinical medicine.

[The signifiance of alternative medicine at a university hospital]. / Bedeutung der Komplementärmedizin im Pflegebereich. Untersuchung am Pflegepersonal der Universitätskliniken des Inselspitals.

Three hundred randomly selected nurses employed at the university hospital of Berne were asked by means of a questionnaire as to the application of complementary methods (CM) in patients of this hospital. 75% of the questionnaires were completed. 95% of the nursing staff indicated that they had recommended or applied CM's. The most frequently used methods being compresses, aroma therapy and homoeopathy. The members of the nursing staff, who use CM are ecology-minded, have had higher education and are nutrition conscious. CM training was found in 21%. The application of CM is usually suggested by members of the nursing staff, less frequently by the patients and rarely by physicians. One quarter of the nursing staff consults a physician before applying CM. Motivations for the application of CM are often based on the experiences of others and experiences from one's own childhood. Homoeopathy is the most prevalent method. CM is regarded to be integral, supplementary and conducive for the integration of orthodox medicine and psyche. In arrangement with the nursing staff direction we do not critically discuss our observations in this paper.

[Emotional reasons for therapeutic failures]. / Emotionale Ursachen von Behandlungsfehlern.

Medicine's science is still bound to a mechanistic, 17th century world-view. To give it up would force the physician to give up to manipulate the patient and to feel omnipotent toward him. Emotional reasons block him from doing so. Treatment mistakes are the consequence. The neglect of feelings evoked by the patient in the physician helps him to avoid to be exposed to own feelings, i.e. anxiety, hopelessness, anger. Again treatment mistakes follow. Sticking to theory and practice of alternative medical methods without having proved their efficiency prevents the physician to give up the cherished autistic undisciplined, magical thinking. Treatment mistakes ensue.

[Interviewing the patient--an "impossible" task]. / Die Anamneseerhebung--ein "unmögliches" Unterfangen.

A patient with atypical facial pain (conversion symptom) is presented, who had to suffer for more than 10 years, because physicians were unable to conduct a biopsychosocial interview. The characteristics of hard and soft data are mentioned. The significance of empathy for the data collection is stressed. The relationship between empathy and countertransference feelings is briefly discussed.

A comparison of self-concept and personality disorders in women with pain accounted for by psychological factors, women with major depression, and healthy controls.

OBJECTIVE: Do patients with pain accounted for by psychological factors (P) differ in their self-concept and personality disorders from patients with major depression (D) and healthy controls (C)? METHOD: Thirty hospitalized P-patients (DSM-IV, 307.80) and 30 hospitalized D-Patients (DSM-III-R) were given the Beck Depression Inventory on admission (BDI-1) and at discharge (BDI-2). Together with BDI-2, patients filled out the Personality Disorder Questionnaire for DSM-III-R (PDQR) and the Frankfurt Self-Concept Scales (FSKN). Thirty-two healthy comparisons (C) completed the same questionnaires. RESULTS: BDI-2 showed no significant differences between groups P and D, a prerequisite for the comparison of psychological traits. PDQR differed in the three groups. D showed more dependent, obsessive-compulsive, and histrionic personality features than group P. The three groups differed in FSKN total score and all 10 subscales (C (healthiest self-concept) > P > D). Groups P and D were different (P > D) in total score and subscales: performance, problem coping, confidence in behavior and decision taking, and self-esteem. Ten P-patients with pathological BDI-2 (P(D)) had significantly more disturbed PDQR and FSKN scores than the non-depressed (P(ND)), and closely resembled the D-patients. CONCLUSIONS: Personality disorders and self-concept are not homogenous in female patients with P. Subgroup P(ND) differs from patients with depression (fewer personality disorders, better self-concept), whereas subgroup P(D) closely resembles them.

Childhood experiences and adult behavior in a group of women with pain accounted for by psychological factors and a group recovered from major depression.

OBJECTIVE: In this study twenty-four women with pain accounted for by psychological factors (DSM-IV, 307.80) and twenty-four with major depression diagnosed according to DSM-III-R were compared to study the relationship between pain and depression. METHOD: They were examined by a semi-structured, tape-recorded interview to study their childhood experiences and adult behavior. The interviews were rated by two independent and blind raters. Interrater correlation (Cohen-Kappa) varied between good and close agreement. RESULTS: Of childhood experiences, "brutality between parents," "brutality toward child," and "sexual abuse" were often found in both groups and were more strongly represented in these than in comparison groups of former studies. As adults, the pain group had experienced more serious illness (p = 0.037) and surgery (p = 0.014). The depression group more often had a history of depression (15/24 vs. 4/24; p = 0.001). The pain group spoke negatively of its physicians (p = 0.001), was more hostile during the interview (p = 0.041), was less convinced of the benefit of the hospital stay (p = 0.029), felt less self-responsible, and was more pessimistic (p = 0.013). The pain patients also provoked negative emotions in the raters, whereas the latter's reaction to the depression group was compassion and interest (p = 0.0005) (Pearson's chi2 and Fisher's exact tests). CONCLUSIONS: The results show that negative childhood experiences are prominent and similar in patients with pain accounted for by psychological factors and in patients after major depression. Adult behavior, however, is very different.

[Can psychosomatic concepts make a contribution in surgery?]. / Haben psychosomatische Konzepte der Chirurgie etwas zu bieten?

All medical reasoning and action is based on a medical theory. Johannes Müller, the renowned 19th century physiologist, stated: "What we experience with our senses is not a mirror of objects characteristics, but rather depends on the living organism's interpretation of sense-receptor stimulation." A mechanistic model of medicine which does not reflect on and include individual reality and the influence of personality and personal history subjects patients to the danger of surgery; psychosomatic concepts reduce this danger. If the surgeon integrates (not adds!) the psychological and social dimensions in his theory of medicine, then the question of what psychosomatic concepts can contribute to surgery is answered: A patient with atypical facial pain due to a conversion reaction will not be operated. Patients will be dismissed and return home earlier after hip-joint operations. Persons with a strong body fixation and pain masking their fantasies of invulnerability (narcissistic block) will not be subjected surgery. Women with abdominal pain connected with childhood sexual abuse will not be submitted to operations in the genital area etc.

[Missed somatic diagnoses--inexcusable, missed psychogenic somatic disorders--a gentleman's offense]. / Verpassen somatischer Diagnosen--unverzeihlich, verpassen psychogener Körperstörungen--ein Gentleman's Delikt.

Overlooking somatic diagnoses is judged a serious failing, overlooking psychogenic somatization a minor mistake. This situation derives from the medical theory on which the physician bases his opinions, decisions and treatments. In this case, the mechanistic model deriving from the introduction of physics and chemistry into medicine in the 18th century. A 19 minute verbatim first interview illustrates how the biopsychosocial interview method serves to pinpoint psychogenic somatization in a woman who had been unsuccessfully examined and treated for four years, bringing the underlying blocked process of grief to light and making it the focus of therapy. Savings in time, cost and suffering are obvious.