„Eine Medizin der menschlichen Beziehungen” revisited - Aktuelle neurobiologische und psychosomatische Entwicklungen

Zusammenfassung

In seiner 1989 in dieser Zeitschrift erschienenen programmatischen Arbeit vertrat Herbert Weiner die These, dass Psychosomatische Medizin zu einer Medizin der menschlichen Beziehung geworden sei. Ziel dieser Arbeit ist, anhand der neueren Literatur der Frage nachzugehen, ob sich diese programmatischen Aussagen bestätigen lassen und welche weiteren Forschungsansätze sich hieraus ergeben können. Anhand tierexperimenteller Studien wird aufgezeigt, dass Trennung und Vernachlässigung bei Säugetieren nicht nur das Bindungsverhalten, sondern auch Hirnentwicklung und Stressregulation durch ein Zusammenspiel von Umwelterfahrung und Genregulation dauerhaft beeinflussen. Überlappungen zwischen neuronalen Netzwerken, die die affektive Erlebensdimension des Schmerzes prozessieren, helfen, sozialen Schmerz frühzeitig und intensiv zu signalisieren. Auch wenn wir weit von einem neurobiologischen Verständnis der Arzt-Patienten-Beziehung entfernt sind, ergeben sich deutliche Hinweise darauf, dass eine ermutigende und optimistische Einstellung des Arztes das körpereigene Opiatsystem des Patienten aktiviert, die Compliance fördert und positive Auswirkungen auf Wohlbefinden und Heilungsverlauf hat. Die neurobiologischen Studien bestätigen die Thesen Weiners und eröffnen neue Forschungsansätze zur Regulation von Gesundheit und Krankheit in zwischenmenschlichen Beziehungen.

Abstract

In his programmatic paper published 1989 in this journal, Herbert Weiner held the view that psychosomatic medicine has become a medicine of human relations. The aim of this review is to reflect if current scientific evidence supports his view. Evidence from animal studies suggests that early infant-mother separation or neglect not only has a lasting influence on attachment behaviour, but also on brain development and the ability for stress regulation mediated by environmental as well as genetic factors. Neuronal networks processing affective components of physical pain play a role in signalling painful emotional experiences due to social isolation and separation. A consistent finding across different studies is that physicians who adopt a warm, friendly and reassuring manner help activate patients endogenous opioid system, foster their compliance and promote better therapeutic results. In summary, evidence from neurobiological studies not only supports Herbert Weiner's theses but also opens new venues for interdisciplinary research.

Key words

doctor-patient-relationship - neurobiology - stress regulation

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