For some decades the medical interview has been aimed not only at establishing a diagnosis, but also at determining the patient’s state of health and quality of life. In the field of geriatrics, conversation with the patient intends yet to assess the extent of physical fitness and mental performance impairment as well as to evaluate the risk factors which lead to a decrease in mental capacity and also the patient’s socalled psychological resilience, which determine the favorable course of aging. Researchers enumerate some kinds of factors determining mental resilience, e.g. pride in one’s personality, positive family relations, empowering relationships with professionals, the so-called ‘power of giving’, a balanced view on life and so on . There are, however, very few guidelines in geriatric literature on how to obtain this ‘balanced perception of one’s own life’. We do not find such tips either in the papers of authors who write about assessing the so-called ‘trajectory of life’.
We have presented recently an attempt to formulate a method of insight into the way we remember and even how we arrange the remembrance of own biography . As we emphasized, one should pay attention not only to biographical facts but also to important ‘psychological transformations’ concerning decisions on one’s own further anticipated actions and behavior.
An example would be the decision that, “it is not worth striving for good grades in school or even to get a formal education because prosperity in life depends on other conditions” or for example, “that monogamy is not an advantageous pattern of behavior”.
Moreover, in our view, so far geriatric researchers have not paid enough attention to the kinds of extremely important facts which determine the course of life, resulting from dramatic, often hidden biographical events such as exclusion from family, broken family ties, sexual abuse like rape, incest, the suicide of someone close, the death of the mother in childhood, war or disaster experiences. They cause so-called entanglements, and sometimes incline one to acts of revenge or plans to take vengeance . As we mentioned, various literary works contain thrilling descriptions of such key mental changes. The content of the novel “Fates and furies” by Lauren Groff can exemplify such descriptions.
The question arises why this set of data about patients is rarely considered by geriatricians. The development of a new approach for gathering information from patients in the form of so-called motivational interviewing techniques sheds new light on this issue . It occurs that gathering the data important for the change of adverse behaviors requires the application of special techniques necessary to ‘resist the righting reflex’ and ‘understand the patient’s motivations’.
In the case of gathering information which is most essential for understanding the patient’s trajectory of life, the patient’s biographical remembrance and his perceptions of the meaning of his own life , special techniques also seem necessary.
In this case, we need new approaches which would facilitate the discovery of past events that the patient does not want to disclose, because this could undermine his dignity, could cause remorse or could be, in his opinion, even dangerous. One of these methods is the technique of family constellations . This technique is, however, not recognized by most academic psychologists. Therefore, it seems to us that it is necessary to search for other ways of conversation with the patient which would enable the disclosure of such biographical data that is discussed by Lauren Groff in her novel.
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