Offentl Gesundheitswes. 1991 Dec; 53 Suppl 3(): 203-15.

[Continuity--adjustment--autonomy--physician--patient--an overview of medical cultural philosophy in former East Germany]

Belau D.

The author probes into the "culture" of medical thinking in the former GDR in respect of the interlinking of socialisation of the doctor, within the framework of socialism, with the fate of the patient; the fundamentals of the development of science and of the pattern of cultural life; and the development of moral consciousness and health policy under the influence of Marxist-Leninist teachings. (One should not neglect the difference made by the author between "official Marxism-Leninism as decreed by the state" and "Marxist theory" as well as "public level of consciousness".) Errors of judgment, illusions, so-called "noble" ideals of the medical profession such as ambitiousness, engagedness, and readiness to shoulder responsibilities, were interwoven with the trend to functionalism, to keep the party bureaucracy of the SED in power. One of the thematic points of emphasis was the "changing of paradigms in medicine", such as the hostility to psychology as a feature of GDR socialism, or the sociopolitically dictated condemnation of non-institutional or "alternative" medicine. The author sees a basic trend to technocracy in GDR medicine. He shows up trends to "moral remote control" of the doctor, to a deliberately practised illusionment, a systematically engineered demounting of decisions based on moral constraints--such demounting being promoted both in the doctor's mind and in actual practice--and to eliminating emotional obstacles officially construed as "interfering" with a strictly objectified doctor-patient relationship. Nothing in this context can be soft-pedalled and excused. The author points specifically to the officially promoted vision of a "successful repair and construction of a New Man". Within the context of socialist ideal views and actual socialisation of the doctor there are similarities between the balance-sheets of 1945 and 1989 in Germany without attempting to suggest that this amounts to a comparison on the same level with the genocide and war guilt of the National Socialist era. Guilt is a burden on the mind, but non-assessed guilt and lack of a possibility of redemption destroys humans. The article is a plea against an increasing tendency to criminalize the former GDR citizen and the doctors. "It will be necessary to honestly review the past history embodying my own errors, mistaken concepts and illusions." All this is only a first approximation to an important and complex subject. It is the author's aim to promote a better understanding between the former GDR citizens and those of West Germany.