[Anxiety, the heart patient and the organization of psychosomatic medicine]

Using a simplified biopsychosocial model, it is possible to outline several aspects of the partly real, partly unreal anxieties of the patient with heart disease, also in connection with defense strategies. Questions regarding the formal introduction of psychosomatic medicine are raised exemplary findings in the area of heart transplants, resuscitation and denial aspects are mentioned. The medical-care system and the patient complement each other in perception and strategic handling of anxiety, partly in stabilized, partly in destabilized ways. The development of a future organisation of psychosomatic medicine must differentiate between consultant services, liaison services, working groups and independent departments. As in the analytical-therapeutical situation, the understanding of the function of defense strategies is the prerequisite to overcome the symptom, which - experienced or not experienced, expressed or not expressed - means anxiety both for patient as well as for those who work in institutions.