Ebertswil, Switzerland

“If I start painting a picture, the first thing to me is, to try to find the unity of sky-earth-water”

These words of the famous French painter, Camille Pissarro, I would like to put at the beginning of my presentation and welcome you herewith. Thank you for giving me the chance to present you the pioneering Affoltern hospital model and on the other hand also give you a short summery of the dealing with illness, suffering and sorrow in such a model. I would also ask you to be forbearing with my English language-it’s not my mother tongue!

May I introduce you to the hospital Affoltern am Albis: It’s a subsidized area hospital , responsible for basic health care for about 40`000 inhabitants.

Departments contain: Internal medicine, surgery, gynaecology and obstetrics, including physical therapy. Additional to the acute care clinic are the home for chronically ill patients, the nursing home for less serious illnesses with a geriatric and psychiatric day clinic. There is also a GOPS-a protected surgery and aid station, intended for civil catastrophes.

Its about 10 years ago, in 1989 exactly, when an expansion risk on basic medical services was taken: The introduction of Expressive Arts Therapies, disposal at every patient, independent of illness, complementing basic medicine care in all sections of the hospital and the additional homes. This requires understanding and cooperation with existing structures, health authorities and their regulations, as well political engagement.

How come, that this hospital introduced Expressive Arts Therapies (short: Expressive Therapies) additional to the classical medicine?

It is symbolic for the long-standing culture of asking, looking for new ways and philosophically thinking at the Affoltern hospital and must be understood as an answer to a discomfortable feeling amongst the onesided, extremely specialized conventional medicine of today.

Questions like:

• On which guidelines of mankind should we base our work in the hospital?
• What is our understanding of health and illness?
• How do we manage with death?
• How fare goes our ability and where are our limits?

led to many discussions and finally 1992 to the visions of the Affoltern hospital.

“Our image of humanity, our understanding of sickness and suffering and our insight into the imperfection of our knowledge and actions are the basis of our guidelines. All our efforts for both the sick and the healthy are to be seen against this background.

We regard body, soul and spirit as a unity. They are indivisible, in sickness as in health.

Health and sickness are complementary and antithetical. Sickness and suffering are part of humanity. Even when, on occasion, they may be felt most strongly in one single element- body, soul or spirit- they invariably affect the whole being.

We are aware that mankind will never fully comprehend the secret of life, despite all our scientific, psychological and religious insights. We respect this secret, and seek to draw it into our work.“

These are clear guidelines to all hospital personnel– A medical doctor, who is only interested in techniques will not agree with the visions of this hospital and a patient who is demanding endless medical examinations, without questioning , will not find physicians in this hospital, who will comply with them.

Let me now explain the model of the interdisciplinary treatment at the Affoltern hospital.

The division into body-soul-spirit is a construct, which helps us to organize our enormous knowledge. We realize, that we can no longer be all-rounders, thus everybody has to choose their area, representing one aspect. Putting parts together again, to recall the indivisibility of mankind, can only be dealt with using interdisciplinary teamwork. The management of the Affoltern hospital dares to perceive, as well as the great achievements of specialization, also the suffering it has caused. With this pioneer work they are treading a new path.

The new term of universal psychosomatics is an essential point in the model. Everybody understands the term „psychosomatics“. Unfortunately psychosomatics often became degraded to a „ rubbish bin“ for whatever cannot be ascribed to a specialist area.

If we follow the guidelines of the Affoltern hospital visions, that the human being is in principle indivisible, regardless of whether the „ sign“ appears in form of a broken leg, depression, attempted suicide, an appendix, complicated delivery, etc., we accept, there are thus no individual psychosomatic illnesses but every illness (and all health) is basically somato-psychic-spiritual. The universal psychosomatics includes the spiritual level as an existential aspect of humanity in contrast to standard dualistic psychosomatics. A pastoral assistant is therefore part of the interdisciplinary team.

In 1997 a philosopher joined the existing team. He visits the hospital regularly and talks with patients, seeks for close proximity, solidarity and empathy. To transmit the art of living, also in illness, to accept his own limits, to take responsibility for his own life is the philosopher’s request. But he also takes care of the whole hospital personnel to help prevent the „ burn out syndrome“.

Very recently ethics are complementing the interdisciplinary teamwork, carried out in training sessions for all hospital personnel: Difficult situations work out together instead acting against each other. Its one of their main aims.

A future project is, to include the existing hospital extern care (known as Spitex) as a

part of outpatient care.

Let me come back to the expressive Arts Therapies, which has proved itself already more than ten years and became a very important part of the interdisciplinary teamwork. Human being accepted as a unity of body, soul and spirit agrees with Expressive Therapies very much, which allows to convert the principles of the model. It offers to the patient the possibility of encountering their illness in an active way, of challenging it, of giving it sense and meaning.

Different authors have given their thoughts to this subject.

Beuys says:

Illnesses are the gates to renewal

and Morgenstern expresses it as follows:

Every illness has it’s special sense, because every illness is a purification. One only has to find out, from what one is cleaned.

To describe in detail, how the Expressive Therapies works, would take too long. Maybe, the words of Laotse outlines Expressive Therapies in a very profound way.

We look it -
but we do not see it.
It is invisible.

The visible
is making the form
of a work.
The not visible
is making the value out of it

Laotse

All the same I would like to present in pictures a typical story of a women, which was successfully treated in the Interdisciplinary Therapeutic Method.

The woman in question is about 40 years old and had a extreme consummation of medicine. In her history we find:

• Halforphan
• Dominate mother
• Sexual abuse
• Anorexia nervosa
• Abuse of laxative with Hyperaldosteronisme
• Migrane resistant on therapy, etc.

The patient was treated by about ten different specialists and spent several periods in hospital.

As a polytoxicomanic patient with an enormous drug consummation she was given up by the doctors.

The patient was hospitalised in Affoltern in a serious state of crisis after a one year consummation of over 140 hours of doctors consultations.

Today after five years the patient is on her own resources, in no need of medicine, feels free and has regained confidence. Doctors’ consultation has been reduced to 2 to 3 hours per year.

This impressive case story proves also the consequences of economic problems above the endless suffering of the patient.

The following pictures show the art work of our patient. They were mainly painted in her hospital room or at home, but they are always part of the sessions.

The patient when painting alone takes herself from level to level, handling her themes creatively from step to step. – Clearly painted chapters are recognizable – New forms and new colours point towards new topics appearing in the foreground.

The conclusion of my presentation can be summarized as follows:

Every illness is basically somatic-psychic-spiritual and every human being is indivisible and can only be dealt with using interdisciplinary teamwork. This is to be achieved in the integrational pioneering model of the Affoltern hospital.

The expressive Therapies, based on the female principal, and conventional medicine, based on the male principal, supplement each other fruitfully. Extended by the practised philosophy and ethics the model described may have future prospects and cause radical changes in health service as well as in economical size of medical treatment.

Thank you for your attention!

My cordial thanks to:
Annina Hess-Calbalzar, M.A.
Dr. Christian Hess-Cabalzar

Literature

1. Master‘s Thesis on Expressive Arts Therapies by Annina Hess-Cabalzar 1996

2. „Das Affoltern Modell“, revised May 1999, Bezirkspital Affoltern

3. Psych. Störungen bei internistischen und chirurgischen Patienten (Psych. Uni. Klinik, Lübeck)1995

4. The Economic Results of Failed Treatments in Psychosomatic and Somatopsychic Diseases. (F. Lamprecht, Uni. Hannover) 1996

5. „Lebenskunst und Krankheit“ von PD Dr. W. Schmid, Philosoph, Berlin, 1998

6. „Von der Kunst des Berührens und des Berührtwerdens“ PD Dr. W. Schmid, Philosoph, 2000

7. „Einsicht statt Aufsicht“ von PD Dr. W. Schmid, Philosoph, Berlin, 1999