| الوصف: |
The topic I was invited to speak about is “What role plays liaison psychiatry with regard to existential issues which arise in the clinics of palliative care?” What has psychiatry to say about existential issues faced by the severely ill and dying patient? Let me start with an anecdote. In Switzerland we are used to work as liaison psychiatrist with oncologist and palliative care physicians. One of our tasks is to provide a three-day seminar, mandatory for oncologists and hematologists. The seminar is run by 3-4 liaison psychiatrists, with 8-12 physicians who participate. It is constituted of role plays, case analyses and feedback to video-taped discussions between participants and simulated patients concerning bad news. The seminar is completed by 4-6 individual supervisions, during which participants discuss own difficulties in the clinical encounter with patients or show the liaison psychiatrist filmed medical consultations with real patients. During one of these supervisions, a chief resident in oncology showed me a video: he encountered a family, the 55-year-old father who was the patient with advanced cancer, his wife, and the daughter, all looking sadly at the oncologist. The first person who started to speak was the wife, who sighted deeply and said: after 30 years …. Then she sobbed. The family looked at each other and then looked again at the oncologist. What followed was an almost 15 minutes monologue during which the oncologist first reminded the family of the past treatments, why they were chosen and then stopped, being ineffective, and then explained why different other treatment options had no chance to work. We stopped the video and discussed: the oncologist very quickly understood that he was talking “medicine” but that the issue at stake was the sad experience of impeding separation after 30 years of marriage. He also recognized that there was no need for medical information, on the contrary the medical information served her own needs for protection against painful feelings and fears to address the emotions which emerged at the beginning of the consultation. A kind word, stating that indeed it is hard after so many years of a life together to be confronted with this sever and evolutive illness, would have been more appropriate, and even time saving. The family faced an existential situation, for which medicine has neither a treatment nor a solution. In my presentation I will argue that (i) psychiatry, as medicine, has no answers to existential questions, but that liaison psychiatry can (ii) help patients to identify how the individual biography colors the way they - as we all – relate or react to existential issues, (iii) help clinicians to confront their own anxiety and discomfort, which emerges in the encounter with existentially distressed patients and to support them in “staying with the patient” in troubled times, and (iv) raise awareness of the links and influences existing between society, medicine and the individual patient. My presentation will cover the following topics: Definitions: liaison psychiatry, the spiritual, religion and the existential What characterizes humans: anthropological capacities and vulnerabilities Existential vulnerabilities and their psychological consequences Psychotherapy and existential questions/distress: a case vignette Medicine and the existential: a critical view on latest trends Liaison psychiatry’s support of clinicians who care for the existentially distressed |
