Marie 2010

ReferateCongresul Internațional Balint 2009anxiety for the welfare of my aging father who lives in SouthAfrica and with whom I communicate regularly by phone.During the reflection session at the end of the meetingI informed all present of my intention to go and visit myparents more regularly than previously. The following dayI called my travel agent and booked a flight to Cape Townfrom where I now, some three years later, write this abstractduring my second “home-visit” this year.As an interesting footnote, my patient now rarely complainsabout his lack of bowel motions and comes and visitsme in my office. Over time I have discovered a highly intelligent,interesting and insightful man whose visits are indeeda pleasure and privilege for me.May he and Gerald my father be spared many more yearsof good health!Dear FriendsAt the last Balint congress in Lisbon two years ago, I hadthe pleasure of taking lunch with Michael Courtenay and hiswife. He had just given his plenary talk in which he recalledworking in a very early group led by Michael and EnidBalint and invited us to consider how we might have treatedMarcel Proust and his psychosomatic asthma. I mentionedthat this was my first congress and that attending had beena dream of mine for many years, my father also a familyphysician, having been to Oxford in 1982. At some point inthe conversation he asked me whether I had ever experienceda FLASH. He was of course referring to where in herbook, Six minutes for the Patient, Enid Balint dedicates achapter to “The Flash Technique” referring to when doctorsbecome aware of their feelings in the consultation and onoccasions interpret those feelings back in a way that can giveinsight into the presenting problems. The Webster on linedictionary has eight different meanings for the word “flash”including : to appear suddenly, to give off light suddenlyor in transient bursts, to have sudden insight and finally toexpose one’s breasts or genitals usually suddenly and brieflyin public(which I assume is not what Mike or Enid had8Buletinul Asociaţiei Balint, vol. xii., nr. 45, Martie 2010in mind). In my family, flash has connotations to the FlashFlood in which my father’s father was swept away from himwhen he was 11 years old, leaving him and his three youngersiblings to be raised by their grieving 30 year old mother.It is my pleasure to now present to you what I then sharedwith Michael and to add a small twist to my tale.It was March 2005 and Maccabi Tel Aviv had just reachedthe finals of the European Basketball competition to be heldin Moscow a month hence. I was very busing planning mytrip when I attended our local Balint Leader’s bi-annual retreatattended by some 30 members. The format as alwaysincluded 2 fishbowl sessions dedicated principally to refininggroup leader’s skills. I joined the inner circle as a groupmember. As was my may then, I had difficulty dealing withsilence at the start of a group and so immediately offered topresent the following case.My patient is an 82 year old retired physician who hadjoined my practice with his ailing wife some two years earlier.They had moved to a new apartment in my area to beclose to their daughter (who is not a patient of mine). Ashis wife was severely disabled, my meetings with them werealways at their home. Some of the early meetings were devotedentirely to her but he would often also ask to be examined.He had a fairly long list of medical problems whichincluded Hypertension, Diabetes Mellitus, and Benign ProstateHyperplasia and claimed to suffer from Peripheral neuropathyof his legs which caused pain and weakness eventhough I had found no evidence of such in his medical chart.Despite his age, he is, unlike the majority of my patients hisage, exceptionally sharp witted and intelligent. So manyconsultations became intellectual challenges for me as he isalways curious for scientific explanations for all my diagnoses.He often subtly reminded me that he was a doctor byspeaking medically like “Do you think the spasms are in mygastrocnemius? “ or “Do you think I may have Basedow’ssyndrome?”.After about six months his wife passed away unexpectedlyand as far as I recall the cause of death was undetermined.What I do recall is that on visiting him during the sevenday period of mourning traditional to our Jewish cultureand again on various occasions thereafter, he showed nosigns of sadness or remorse. He merely continued with hislife remaining fairly self involved. He employed a male caregiverto move in with him and they live together till this day.At this point I must add that he treats Lohn with the utmostrespect and gratitude, something I have always admired.It was at about the time of his wife’s death, that he startedto become obsessed with his bowel motions. He felt it essentialto have a daily motion and would go into elaborate detailsof all the techniques he used to procure such an event. Ofcourse he would also look for medical explanations for thisdreaded disease and convinced himself that he had developeda Diabetic Autonomic Neuropathy . So off he went to