Balintarbeit als medizinische Gegenkultur

Zusammenfassung

Ein wichtiges, aber wenig anerkanntes Kernelement der Arbeit von Michael Balint betrifft die von ihm aufgeworfenen Fragen zur medizinischen Erkenntnistheorie. Als er 1957 „The Doctor, His Patient and the Illness“ veröffentlichte, wurde die Medizin von Spezialisten und dem Bewertung der technischen Biowissenschaften dominiert. Balints Arbeit zeigte, dass der materialistische Empirismus in der Allgemeinärztlichen Praxis unzureichend war. Er bot eine alternative Epistemologie an, die von aristotelischer Phronesis (anstelle von Techne), abduktiver Inferenz (anstelle von hypothetisch-deduktiver) und fallbasierter abwägender Entscheidungsfindung (anstelle von regelbasierter Ableitung aus Verallgemeinerungen) untermauert wurde. Balints Theorien, sowohl seine offene Einführung der psychodynamischen Theorie in die medizinische Versorgung als auch dieser eher verdeckte Hinweis auf eine alternative Epistemologie, waren in der Mitte des Jahrhunderts ein wichtiger Teil der Reaktion auf die Dominanz der technischen Biomedizin. Balintgruppen verdienen eine wichtige Rolle in der medizinischen Ausbildung, weil sie eine der wenigen Möglichkeiten sind sich sicher zu fühlen.

Abstract

An important, but little acknowledged core value of Michael Balintʼs work concerns the questions he raised about medical epistemology. In 1957, when he published The Doctor, His Patient and the Illness, medicine was dominated by specialists and the perceived value of technical bioscience. Balintʼs work demonstrated that materialist empiricism was insufficient in generalist practice. He offered an alternative epistemology underpinned by Aristotelian phronesis (instead of techne), abductive inference (instead of hypothetico-deductive) and particular case-based deliberative decision making (instead of rule-based deduction from generalizations). Balintʼs Theories, both his overt insertion of psychodynamic theory into medical care, as well as this more covert pointing toward an alternative epistemology, were a strong part of the mid-century response to the dominance of technical biomedicine. Balint groups deserve an important role in medical education because they are one of the few ways to safely practice the ways of knowing that are essential to primary care encounters.

Schlüsselworte

Medizinische Erkenntnistheorie - Allgemeinmedizin - Kasuistik - Balint-Gruppe - Falsifikation - Empirismus

Key words

Medical epistemology - general medicine - casuistry - Balint group - falsification - empiricism

Publication History

Article published online:
04 September 2023

• Literatur

• 1 Sowerby P. Balint reassessed: the doctor, his patient, and the illness: a reappraisal. J R Coll Gen Pract 1977; 27: 583-589
• 2 Barnett BR. Balint, the doctor and the fear of being unscientific. J R Coll Gen Pract 1979; 29: 520-524 528-9.
• 3 Cohen H. The evolution of the concept of disease: presidentsʼs addess. Proc R SOc Med 1955; 48: 155-160
• 4 Temkin O. The double face of Janus and other essays in the history of medicine. Baltimore: John Hopkins University Press; 1977
• 5 Cohen H. The evolution of the concept of disease: presidents address. Proc R Soc Med 1955; 48: 155-160
• 6 Kleinman A. Writing at the magin: discourse between anthropology and medicine. Berkeley: University of California Press; 1995
• 7 Balint M. The doctor, His Patient and the Illness. London: International Inuversities Press inc; 1957
• 8 Aristotle, Nichomachean Ethics. New York: the Bobbs-Merrill Comoany Inc; 1962
• 9 Platt JR. Strong inference: Certain systematic methods of scientific thinking may produce much more rapid progress than others. Science 1964; 146: 347353
• 10 Montgomery K. How doctors think: clinical judgment and the practice of medicine. Oxford: Oxford University Press; 2006
• 11 Jonsen AR, Toulmin S. The abuse of casuistry: a history of moral reasoning. Berkeley, CA: University of California Press; 1988
• 12 Hunter KM. Doctorsʼstories: the narrative structure of medical knowledge. Princeton, New Jersey: Princeton University Press; 1991
• 13 Edmonds D. The big idea: a future without doctors., (web streaming audio). London: BBC World Service; 2020. Available from: https://www.bbc.co.uk/programmes/w3csxfjr
• 14 Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 137: 535-544
• 15 Stewart M, Belle Brown J, Weston WW, McWhinney IR, McWiliam CL, Freeman TR. Patient-Centered Medicine; Transforming the Clinical Method, 1^st ed. Thousand Oaks, CA: Sage Publications, Inc; 1995
• 16 Stephens GG. Family Medicine as Counterculture. Fam Med 1989; 21: 103-109
• 17 Stephens GG. Reflections on a post-Flexnerian Physician, in: White Kl., The task of medicine: dialogue at Wickenburg, Menlo Park Calif.: Henry J. Kaiser Family Foundation. 1988