segunda-feira, 11 de junho de 2007

Regresso aos métodos da medicina dos anos 50

David Corfield, inglês, foi professor de História e Filosofia na Universidades de Cambridge e Oxford. Hoje dedica-se a escrever livros de divulgação científica. É autor do livro “Why Do People Get Ill?”, juntamente com Darien Leader.

Nesta entrevista, realizada há poucas semanas por email, David Corfield defende que o futuro da medicina ocidental passa por um regresso aos métodos dos anos 50. "Idealmente, deveríamos ter serviços de saúde integrados, capazes de oferecer tratamento médico e psicológico em simultâneo", afirma.

Why did you and Darien Leader decide to write this book?
Darian had the idea for the book over 7 years ago. I believe it was a combination of observing changes in his patients' symptoms during analysis, and his knowledge of a rich tradition of psychoanalytically-inspired approaches to medicine which had largely been forgotten.

He brought me in as a co-author as someone with a background in psychoanalysis, philosophy and science. We became friends years earlier when we coincided in Paris for a while, at a time when I was considering becoming an analyst.

I was excited to join the project as I saw that while a huge amount of physiological research detailing interactions between nervous, endocrine and immune systems was emerging, the psychological theory being employed in the emerging 'psychoneuroimmunology' was very weak. It seemed very timely to return to the psychosomatic approach of the 50s and earlier, with its emphasis on case studies rather than large statistical samples.

What kind of reactions did you receive until now from the medical community?
I don't think there have been enough reactions to say more than that we can expect a wide range of reactions. We've had some supportive private comments, including one from na old president of the Royal College of General Practitioners.

Why is so comfortable for people and doctors to separate the mind from the body. You say it's a defence mechanism. I
n what terms?
First of all, even if a doctor wanted to practice in a better integrated way, we shouldn't underestimate the difficulty for them. The social structure of the medical services acts to keep things as they are.

But as you note, we suggest in the book that there's a parallel to this institutional separation of mind and body in the defense mechanisms of some individuals. Perhaps we all employ these mechanisms to some extent, pointing to some external event as the cause of our malaise, imagining societal problems to be caused by outsiders, etc. It's very similar to blaming an illness solely on a germ or a pollutant.

We were especially interested in an extreme form of this inability to introspect, namely, alexithymia. Several theorists had suggested that the inability to process emotions may increase the chance of physical ailment.

Since medicine is today "poorly suited to respond to human illness" (page 324) should people avoid going to a doctor, mainly an annalist, if the illness is not very important? How can people know if a psychiatrist is going to apply a "strengthening" strategy or just "analysis" (page 309)?
There's a problem in knowing when an illness is important. Even if at present it's an indication more of a sychological crisis than a physiological malfunction, it may later gain physiological significance.

Ideally, one would encounter an integrated health service, which could deliver not only medical or psychological treatment, but also both, say, both a heart bypass and some form of therapy for one's depression.

As for how the psychothera
pist is to act, they have na enormous responsibility. The patient-doctor relation is rather a different one in which ideally they jointly decide which medical intervention to employ. One doesn't go into a therapeutic relationship deciding whether or not to have one's defense mechanisms strengthened.

Will we ever have a kind of "total psychoanalyst", as you suggest on the last chapter, capable of helping people to heal the soul and he body at the same time? Is that possible?
There are interesting examples of doctors who have later trained as psychotherapists, e.g., Brian Broom, Nick Read. Many psychoanalysts in the early days had a medical training. Ideally, medical provision would involve people f
rom different clinical backgrounds to provide a fully psychosomatic approach. So, a surgeon might have little knowledge of psychotherapy and yet be open to contributions from therapist colleagues.

A step in the right direction would be to expose medical students to some of the material we discuss in our book. At present, they see next to nothing of it. Patients do the rounds of the specialists before being sent to psychotherapists as a last resort.

The central idea of the book is that is very important for medicine to rethink the place were people/patients are in. Is that place rethinkable?
The problem is not only in medicine, but in western society. It's clearly rethinkable by some people,
but whether that's enough to change anything is another matter. It's unlikely that there could be wholesale change. Perhaps the best way would be to try to set up a few hospitals which adopt a self-consciously psychosomatic approach, employing practitioners sympathetic to the concept. Then we could see how they fare by comparison to orthodox hospitals.

Blog oficial do livro Why Do People Get Ill? aqui.