In the context of productive medicine, we have done very well in recent decades, partly because we have had the means to do so. Surgical techniques and diagnostics have advanced enormously. Unfortunately, we have not paid the same attention to narrative-based medicine, the desire to understand. Talking has faded into the background. When technology is used, when something is taken, there is a good feeling of having done something. While all kinds of medical branches have evolved, narrative-based medicine has lagged behind.
But we need to understand illnesses, and regardless of the necessary diagnostics, it's essential to talk to each other. In the case of a herniated disc, you obviously have to look at the condition of the disc. But that's not enough. I think we're investing resources and money in things we don't really understand. In the case of a herniated disc, that means understanding why a person wasn't able to take more care of themselves in time or didn't start exercise and physical therapy. In my opinion, that's vital, because if we ignore this form of medicine, we'll fall into a cost trap.
At the moment, we simply perform all the examinations and therapies that are possible and necessary – but we forget that surgery can never be the complete solution. We need a psychosomatic and psychodynamic understanding to understand the illness in such a way that we can change behavior. And not because the doctor, for example, says, "Stop smoking." That never works! But because the patient understands what's going on and then wants to change something.
That's the beauty of psychosomatics: I can work with patients who want to understand and change something. For the patients who remain passive and say, "Make me healthy," I can't really help much.
Unfortunately, psychosomatics takes time and therefore money. But compared to diagnostic and treatment methods based on instruments, it's actually not that expensive. We look at where the problems really lie beyond the physical. I consider it a great blessing to be able to work this way.
I became a doctor because I'm interested in people in general and in every patient's story specifically – so I'm open to everyone who comes to see me. And most people find a connection to the psychosomatic approach during the initial consultation. It's rare that we have to part ways because patients don't agree with the psychosomatic approach. And even if they don't want to follow our suggestions, they still gain something from the initial consultation.
Unfortunately, patients usually come to us too late because they are treated for a long time in organic medicine. Patients are only referred to us when the problem has been resolved organically through surgery or other means, but the pain persists. If the therapists can't do anything more, their colleagues often suspect a somatoform disorder. But that's not necessarily the case. There is indeed physical suffering that causes pain. But you can work to help the person accept their situation and find the best possible relief.
This also applies, for example, to chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis, where inflammation recurs despite treatment. One can assume that there are triggers the patient is unaware of that contribute to their inability to recover. These patients, too, often present very late, simply because psychosomatics is often underestimated.
My idea is to include psychosomatic support from the very beginning of illnesses – so that an initial understanding of the illness can be developed early on.
Sometimes our patients fear that they will be considered mentally ill. But psychosomatics simply means respecting that people are not just made of matter or spirit. It is wrong to view people only as bodies. Every intervention in the body also means a greater or lesser psychological change. And I'm in favor of considering this from the outset.
So, for example, before removing a lipoma from an arm, which creates a scar that will then be lasered away, you can talk to a psychodynamic therapist about why the lipoma is bothering you so much. This way, you can avoid a lot of suffering. It's not about talking the patient out of something with the lipoma, but about reflecting on it and perhaps finding a different attitude. And once she's come to terms with why it bothers her, she'll have fewer problems with the scar afterwards, simply because she'll have made a considered decision.
For gastric banding, a psychosomatic consultation is already mandatory prior to surgery. The same is true for liver transplants. So, in some areas, this has long been the case. And I don't believe it's too complex or time-consuming to conduct a psychodynamic assessment of the patient's structure in parallel with treatment or surgical preparation.
I think that as a society, we generally have too little room for reflection. It should become fashionable so that going to a psychosomaticist is cool. Just like going to yoga, Pilates, or cosmetic treatments—to do something good for yourself. But there's still a widespread unease about taking a closer look at things. It's easier to pop a pill for sleep problems than to get to the bottom of things step by step. That's tedious and uncomfortable. But it's helpful to maintain health in this way and not simply want to consume health. That’s why I say: Dare to be more psychosomatic!