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The Two Diagnoses as Proposed by Dr. Paul Tournier
Most everyone interested in bringing together medicine and pastoral care is familiar with Dr. Paul Tournier and his work. Dr. Tournier, a Swiss physician, emerged onto the world stage after World War II as he shared his professional and spiritual journey through a series of popular books. Trained in traditional medicine, he was committed to the day-to-day care of his patients as a family physician. But early in his medical career he realized that psychological and spiritual issues played a significant role in the physical illnesses and subsequent recovery of his patients. He was intrigued by the tight weaving together of the physical, the spiritual, and the psychological well-being of these patients. He came more and more to practice what he called "Medicine of the Person."
He first outlined his concepts in the popular book, Médecine de la Personne (originally published in 1940 and translated into English as The Healing of Persons, published in 1965) followed by Le personage et la personne (trans. The Meaning of Persons, published in English in 1957). A later book, A Doctor’s Casebook in the Light of the Bible, expanded on the concept that mind, body and spirit are indelibly tied together and influence each other in a variety of ways.
As defined by Tournier, Medicine of the Person is not just another branch of medicine. It is an all-inclusive approach to patient care that sees the patient as a “whole person” whose life and health are conditioned by family, community, body, and spirit. In Tournier’s view, care to the physical, the psychological, and the spiritual components of the person are integral to the restoration and maintenance of health.
We in the twenty-first century, surrounded by our technological marvels, can learn much from Tournier about how to effectively minister to hurting people. This excerpt from The Doctor’s Casebook in the Light of the Bible reminds us that Dr. Tournier’s insights continue to be relevant to the effective care of our contemporary patients:
Clearly, any kind of illness raises questions of two quite distinct orders: firstly, scientific—questions concerning the nature of the malady and its mechanism; secondly, spiritual questions concerning the deep meaning of the illness, i.e., its purpose. We may say, then, that every illness calls for two diagnoses: one scientific, nosological and causal, and the other spiritual, a diagnosis of its meaning and purpose.
The first diagnosis is objective. It is we doctors who make it on our patients. Of course we need his (the patient's) collaboration, but it might be termed a passive collaboration. (It is much more difficult to tend a brother doctor than any other patient, precisely because the former seeks to take part in the working out of the diagnosis.) All we require of our patient is that he furnish us with the data on which to base our judgments, to tell us what he feels and the diseases he or his forbearers had had previously.
The second diagnosis, on the other hand, is subjective. It is the patient himself, and never the doctor, who can make it through the impulse of his inmost conscience. We in our turn can help him to establish this diagnosis, but here again passively; that is to say, not by suggesting a diagnosis to him, but through the climate of spiritual fellowship that we offer him.
From the point of view of the patient's eternal destiny, the second diagnosis is much more important than the first. But from the strictly medical point of view they are of equal importance. (A Doctor's Casebook in the Light of the Bible, page 13)
The physician will use his experience and technology to make the first diagnosis. The second diagnosis is much harder for today’s physician to make—or even contemplate. In fact, at this point the pastoral counselor, the hospital chaplain, and the minister, are most likely to help the patient come to grips with this second diagnosis. Modern medicine with all of its technology is very adept at making this first diagnosis and treating its symptoms. In fact, we are so enraptured with our technological capability that we easily ignore the significance of the second diagnosis all together. The discipline of pastoral care as modeled by Dr. Wayne Oates can help the health professional put both diagnoses in perspective.
Dr. Tournier’s point that the second diagnosis (the meaning that any malady has for the patient) has equal importance in the patient’s treatment is seldom understood by health practitioners today. However, the reality of this observation continues to be relevant. We must admit that the faithfulness with which the patient submits to our diagnostic tools, or follows our prescriptions (written and otherwise), depends largely on his or her understanding of the illness and its meaning. So all of us—physicians, therapists, spiritual counselors—will be helpful to our patients to the degree that we acknowledge and respond to both diagnoses.
- Published: 24 August 2010