[Overcoming disease and biography of lumbar disk surgery patients--a typology based on 30 case studies]

A random sample of 30 patients hospitalized for lumbar disc surgery was studied on four specific occasions: before surgery in a biographic interview; during post-operative treatment by behavioural observations; at discharge from hospital and 15 months on average after surgery in further interviews about their ability to cope with the illness and about their social adaptation. Data analysis was carried out according to the method of structural hermeneutics (Oevermann et al. 1979). By contrastive comparison of the cases, a typology of coping behaviour in patients during the out-patient, in-patient, and post-hospitalization phase was developed. 15 patients showed a consistent type of coping behaviour which we have termed "autonomistic". This finds expression at the behavioural level in a patient-doctor struggle who determines treatment. It is motivated by an ambivalence conflict between fear of and desire for dependence and care. Variants of autonomistic coping behaviour and their dependence on biographic influences are presented using 2 case histories. Against this background the problem of adaptivity is discussed.